Trends in Neurosurgical Practice Size: Increased Consolidation 2014–2019

Background: Practice consolidation in healthcare has widespread consequences for providers and patients. Although many studies describe this phenomenon in various medical specialties, no such analysis has been performed in neurosurgery specifically. The goal of this study was to assess the trends in the size of U.S. neurosurgery practices over a 5-year period. Methods: Neurosurgery practice characteristics were obtained from the Medicare Physician Compare database from March 2014 through October 2019 on the Centers for Medicare & Medicaid Services Website. Neurosurgeons were separated on the basis of their practice size. Group practice sizes ranged from solo practitioner practice to large multispecialty groups and health organizations. Eight groups were identified (1 or 2, 3–9, 10–24, 25–49, 50–99, 100–499, 500–999, and ≥1000 members). Additionally, neurosurgery practices were analyzed across the 4 U.S. geographical regions to understand changes in practice size and distribution. Results: The percentage of neurosurgeons in smaller practices of 1 or 2 members decreased, from 20.09% to 13.05%; 3–9 members, from 17.79% to 9.41%; and 10–24 members, from 10.53% to 8.0%. The largest increase was seen in health organizations of 1000 members or more, with an increase from 9.85% to 22.84%. Conclusions: This study shows that over the past 5 years, a substantial trend toward increasing practice sizes has evolved. The effect of the differences in practice size should be examined to determine the large-scale impacts on patient care, payment models, and healthcare access, in addition to neurosurgeon compensation, and satisfaction.