In our previous two posts, we looked at the overall decline in primary care physician productivity from 2002 to 2016, and the sharp uptick in capacity for medical sub-specialists during that same time period. For our final installment of this three-part series on the trends in physician productivity, our attention turns to surgical sub-specialties.
We analyzed the trends in ambulatory encounter productivity across 20 surgical sub-specialties for the same time period, 2002 to 2016. The results are a bit of a mixed bag, with slight increases for most specialties across the 15-year horizon and some sizeable growth for others. Transplant Surgery saw the largest increase with median productivity increasing from 648 in 2005 (data unavailable from 2002 – 2004) to 1,393 in 2016, for an overall increase of 115%, followed by Vascular Surgery with an increase of 107% and Oncology Surgery with a 70% increase.
Conversely, Ophthalmology and Thoracic Surgery had the largest decreases at 20% and 11% respectively, although neither would be considered a significant decline. 10 of the remaining 15 surgical sub-specialties we analyzed have remained relatively flat over the past 15 years, with either an increase or decrease in productivity of less than 10%.
What will be most interesting to watch for is, if and to what degree these trends continue, as most of the increase has actually happened over the past five years. From 2012 to 2016 alone, productivity increased by more than 50% in eight surgical specialties, including:
- Thoracic Surgery – 162%
- Transplant Surgery – 123%
- Cardiac Surgery – 107%
- Colon & Rectal Surgery – 89%
- Maternal Fetal Medicine – 89%
- Vascular Surgery – 85%
- Oncology Surgery – 54%
- Neurosurgery – 51%
Aside from those eight with tremendous growth in capacity, nine other surgical specialties have increased by between 15% and 50% over the same five years. In fact, the only two surgical specialties with a decrease in productivity since 2012 are Gynecology Oncology (22% decline) and Ophthalmology (2% decline).
Now for the million-dollar question, why the, sometimes significant, changes in physician productivity over the past 15 years? We chalk it up to a number of market forces that gained traction in our industry over that same timeframe, including: increased use of hospitalists (both primary care and specialist hospitalists), older physicians becoming more proficient with the use of EHR/EMR systems and younger doctors entering the work force with technological skills already in place, non-physician providers working more top-of-license, financial incentives to increase capacity, and improved technology driving down the use of complex, interventional, time-consuming procedures.
Given the current and looming shortage of physicians across the country, increasing the patient panel size for primary care will be a must. Plus, with more and more disruptive technology entering the healthcare marketplace, it will be interesting to see if productivity overall continues to increase, and at what pace.
If you have any questions or comments, please contact Shane Foreman at firstname.lastname@example.org or Ron Flower at email@example.com.