Group practice in Urology: A cross-sectional analysis over 8 years (2014-2021)

Purpose: Physician and medical practices have undergone significant consolidation over the last decade. This has been in response to federal and financial changes to health care delivery within the United States. As per the 2021 AUA annual census, the percentage of employed practicing urologists (not in solo or partnership practice) increased from 51.3% to 64.4% between 2015 and 2020 (AUA Census 2021). Our objective was to further examine the changing trends among provider groups within Urology between 2014 and 2021. Methods: Publicly available information from within Medicare Physician Compare, published by the US Centres for Medicare and Medicaid Services (CMS) was used. Practice size data were pulled from I month each year between 2014 and 2021 and filtered by physicians listing 'Urology' as their primary specialty. Practices were divided into categories based on size. Statistical calculations were conducted using R (version 4.0.2). Results: Solo or partnership practice declined by 15.9% compared to larger practice groups which increased by an average of 5.1 %. Providers within the Northeast US illustrated the largest migration to larger practices with 101 %, 162% and 232% growth among practices with 25-99, 100-499 and over 500 providers, respectively. Conclusion: Urologists have been moving increasingly towards larger group practice since 2014. An emphasis on value-based healthcare, integration of electronic records and an increase in administrative workload are only some of the influencing factors likely responsible for this trend. Further studies are needed to examine the effect practice consolidation has on patient outcomes and cost of care.