Merger mania: a sign of the times or typical market maturation?

Historically, the self-suffi ciency of orthopedic surgeons has stretched beyond the limits of their profession and is a way of life. Autonomy in the choice of specialization, methodology, and practice setting has greatly infl uenced health care supply in the United States. However, at some point the interaction between businesspeople and health care providers transformed the focus of physicians to include more than just patient care. Orthopedic surgeons have predominately thrived independently in freestanding groups and solo practices. In 2008, according to the American Academy of Orthopedic Surgeons, 23,956 orthopedic surgeons were practicing in the United States.1 Of those, 63% (or 15,000 orthopedic surgeons) were practicing in private orthopedic groups or solo practices.2 As early as 2007, the American Medical Association showed that approximately 19% of all salary-based physicians and surgeons were employed by hospitals and medical centers.3 Compare that with the 8% (1916) of orthopedic surgeons employed by hospitals and medical centers, and it becomes apparent that orthopedics is rather divergent from the physician employment trend toward primary care and cardiovascular services.1 The gap between costs and reimbursements is increasing; thus, the smaller and less diverse practices are in real danger. Although orthopedic surgeons are steadfast and resistant to jumping onboard the wave of mass hospital employment, looming health care reform and a national push for accountable care will fashion greater barriers for independent physicians. Employment, as a result, has become a rather alluring perspective. Regulatory bodies in health care have advanced payment reform throughout the past half-century and are consequently restructuring the face of physician practice management, especially over the past 24 months. Bundled payments and cost-savings models are consistently being fl aunted as the do-or-die mentality for future practitioners. Economically, the risks involved with owning and managing small group practices have begun to outweigh the value of providing care autonomously. The health care climate has become unsteady and is primed for remarkable transition as the physician employment trend appears to be gaining momentum, specifi cally into orthopedics.