(HealthDay)—From 2009 to 2016, more physicians entering the Medicare program worked at large group or hospital-owned practices than small group or independent practices, according to a research letter published online Jan. 14 in the Annals of Internal Medicine.

Referencing data from 2008 to 2017, Hannah T. Neprash, Ph.D., from the School of Public Health at the University of Minnesota in Minneapolis, and colleagues quantified how practice size and hospital ownership differ between physicians who entered versus exited the Medicare program.

The researchers found that from 2009 to 2016, there was an increase in the proportion of physicians in the largest practices (>50 physicians), from 32.1 to 48.8 percent. An increase was also seen in the proportion of physicians in hospital-owned practices, from 18.8 to 25.8 percent. Overall, 19.0 and 12.4 percent of physicians in the sample billed Medicare for the first time (entering physicians) and the last time (exiting physicians), respectively, during the study period. Entering physicians were more likely than exiting physicians to practice in large versus small group practices (58.4 versus 34.6 percent) and in hospital-owned versus independent practices (38.3 versus 20.9 percent). Entering physicians replaced exiting physicians at a ratio of 0.33:1 in the smallest practices; the ratios were 2.58:1 and 2.80:1 in the largest and hospital-owned practices, respectively. There was variation noted in replacement patterns within physician specialty.

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