Objective

To describe how much of the recent increase in hospital-cardiologist integration has come from acquisitions of physician practices compared to individual employment decisions. While the role of physician practice acquisitions has received considerable attention in the news, integration may also be driven by individual physicians accepting employment at hospital-based practices.

Data sources

American Medical Association Physician Masterfile and Medicare data.

Study design

Analysis of changes in hospital-cardiologist integration from 2011–2018. We measured increases in integration and changes in the number of independent and hospital-owned practices.

Data collection/extraction methods

N/A

Principal findings

18 percent of cardiologists were integrated in 2011, rising to 25 percent in 2016. Of this rise, 48 percent occurred with no acquisitions. Physicians who had completed residencies in the past five years (early-career physicians) had higher rates of integration which also increased over time: the percentage of early-career physicians joining hospital systems rose from 25 to 32 percent, indicating rapid growth in the number of physicians who began their careers working in hospital-based sites.

Conclusions

A large and growing portion of hospital-cardiologist integration came from hospital employment at the individual physician level. Future policies focused on preserving competition and affordability may benefit from better understanding this form of consolidation.