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Fewer than half of U.S. physicians worked in private practice during 2020, continuing a trend that has accelerated in recent years, according to a survey by the American Medical Association (AMA).

Data collected from 3,500 U.S. physicians showed that 49.1% worked in physician-owned practices, a relative 9% decrease from the previous survey in 2018, when 54% of respondents said they worked primarily in private practice. The decline is the largest 2-year change since AMA started the biennial survey in 2012.

The shift away from private-practice settings has been in evidence for several years, but the magnitude of decline from 2018 to 2020 suggested the shift toward larger, nonphysician-owned practices has increased. The newest survey showed that 17.2% of physicians worked in practices with 50 or more physicians, as compared with 14.7% in 2018.

"There are several contributing factors to the ongoing shifts in practice size and ownership that include mergers and acquisitions, practice closures, physician job changes, and the different practice settings chosen by younger physicians compared to those of retiring physicians," said AMA President Susan R. Bailey, MD, in a .

"To what extent the COVID-19 pandemic was a contributing factor in the larger-than-usual changes between 2018 and 2020 is not clear. Physician practices were hit hard by the economic impact of the early pandemic as patient volume and revenues shrank while medical supply expenses spiked. The impact of these economic forces on physician practice arrangements is ongoing and may not be fully realized for some time," she added.

Despite the historically large shift away from private practice, the survey continued to reflect diversity in practice types, sizes, and ownership arrangements for medical practices. As a result, no single practice style or characteristic should be considered a "typical physician practice," according to the AMA.

Other key categorized findings from the survey included:

• Employed physicians: 50.2% of all patient care physicians in 2020, as compared with 47.4% in 2018 and 41.8% in 2012
• Self-employed physicians: 44% of all patient care physicans in 2020 versus 45.9% in 2018 and 53.2% in 2012
• Ownership: About 40% of patient care physicians worked directly for hospitals or in practices at least partly owned by hospitals
• Practice size: 53.7% work in practices of 10 or fewer physicians, as compared with 61.4% in 2012
• Private-practice business structure: limited liability company (27.8%), S corporation (24.7%), C corporation (15%), partnership (~10%), and sole proprietorship (~10%)

The survey is part of the AMA Policy Research Perspective series examining long-term trends in medical practice arrangements and payment methods. It is available on the .

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