Opinion | Independent Surgeons Are Disappearing. Here’s Why That Matters.

With today’s medical advancements and technologies, innovation in the surgical field is creating possibilities for patients that did not exist a few years ago. I utilize these new techniques to care for my patients with fewer side effects, faster recovery times, and better health outcomes.

Though the demand for surgery remains, trusted surgeons — particularly those in independent practices — may soon be in short supply. According to the Association of American Medical Colleges, our country will be short 15,800 to 30,200 surgeons by 2034. One contributing factor is the high cost of medical education, which discourages students from entering the surgical profession and creates substantial debt for those who do.

Of the few that go on to work in the surgical field, even fewer are entering private practice. That’s because ongoing reimbursement cuts for physicians are pushing newly trained surgeons into hospital-based jobs. In speaking with private-practice surgeons across the country, I consistently hear how this trend is threatening our ability to continue to provide high-quality care in the communities we serve, especially to patients in underserved areas who must travel farther for care. Congress must act quickly to address these trends and uphold the cornerstones of independent medicine.

In community-based oncology practices like mine, surgical oncologists work closely with patients to create a personalized care plan that limits disruption of their quality of life and day-to-day routine. These centers also provide access to integrated, state-of-the-art medical and radiation oncology services. This is vital for patients, particularly those who do not live within an easy drive of a hospital.

But reimbursement from CMS for surgical professional services, and evaluation and management services, has declined drastically relative to inflation. As reimbursement shrinks, private practices are finding it harder, financially, to survive, let alone to attract and retain top-tier talent, who are increasingly lured to hospital settings that can offer more competitive compensation.

On the other hand, many hospitals have responded to declining reimbursement by charging facility fees to offset financial losses. These unfair and unexpected charges create significant financial stress for patients, as they can cost up to hundreds of dollars per patient and often aren’t covered by insurance. Hospitals often claim that these fees cover overhead costs for the use of hospital space, equipment, and resources. Yet, the way these funds are used by hospitals is opaque — perhaps the increased revenue gives hospitals a leg up in offering more attractive salaries to surgeons.

The result? Hospitals are tipping the scales, removing surgeons from the community setting and shifting care into the hospital system. A survey of surgeons from the American College of Surgeons showed that the share of respondents in private practice had declined by 4% (from 21% to 17%) between 2017 and 2020, with 25% reporting that they did not believe they would finish their careers in private practice.

Surgeons in private practice have greater autonomy to curate the patient experience and more time to build close relationships with their patients rather than navigate a hospital or large health system bureaucracy. It’s no wonder then, that 80% of surveyed surgeons stated that it was moderately important to essential to preserve surgical private practices.

Two things are clear. First, cutting reimbursement for surgeons isn’t bringing healthcare costs down. Rather, it’s emboldening health systems to jack up fees, raise out-of-pocket costs, and limit competition from community-based providers. Second, and more importantly, the shift toward hospital-based care doesn’t necessarily improve patient outcomes. In a survey of physicians that moved from independent practices to corporate-owned practices (often affiliated with hospitals or health systems), 59% reported that patient care quality declined. However, studies offer variable findings depending on the type of surgery and level of care required.

To avoid consequences for patients and providers alike, we must protect private surgical practices. In the community setting, patients benefit from lower overall costs, new technology and medical advancements, and a preserved patient-physician relationship. I know this much is true for my patients.

It is time for lawmakers to take note of how these issues are impacting their constituents. While I strongly urge policymakers to ensure that reimbursement rates reflect the value of surgeons’ work, we must shine a light on how hospitals are using facility fees. One promising first step is the legislative framework introduced by senators Bill Cassidy, MD (R-La.) and Maggie Hassan (D-N.H.), which specifically targets facility fees and helps level the playing field between hospitals and independent clinics.

I urge federal lawmakers to protect independent medicine, maintain a healthy balance of competition, and help drive down the cost of healthcare overall. By addressing this growing concern, we can safeguard the future of healthcare for our communities and create a system that nurtures both providers and patients alike.

Amy McNally, MD, is a gynecologic surgical oncologist and currently serves as Chief Surgical Officer of The US Oncology Network.