The Shrinking Number of Primary Care Physicians Is Reaching a Tipping Point

Impact Of Non-Certified Surgeons On Medicare Patient Care

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The following is a summary of "Characteristics and Practice Patterns of Non-Certified Surgeons Treating Medicare Patients," published in the January 2025 issue of Surgery by Moreci et al. 

This study aims to examine the patient demographics and practice patterns of non-certified surgeons who provide care to Medicare patients across the United States.

Although the majority of surgeons in the U.S. Are board-certified, non-certified surgeons are still permitted to practice in many regions. Concurrently, shortages in the surgical workforce pose significant threats to patient access to necessary surgical care. Non-certified surgeons may play a critical role in addressing these access issues. However, limited information is available about the practice behaviors and patient populations served by non-certified surgeons.

Using a comprehensive dataset of Medicare claims from 2014 to 2019, this study identified practicing general surgeons, categorizing them as either board-certified or non-certified in general surgery, based on data from the American Board of Surgery. An analysis of surgeon practice patterns and patient characteristics was then conducted. 

The study included data from 2,097,206 patient cases treated by 16,076 surgeons, of which 6% were non-certified. Compared to their certified counterparts, non-certified surgeons were less frequently fellowship-trained (20.5% vs. 24.2%, P=0.008) and more often foreign medical graduates (14.5% vs. 9.2%, P<0.001). Non-certified surgeons were more likely to practice in for-profit hospitals (21.2% vs. 14.2%, P<0.001) and critical access hospitals (2.2% vs. 1.3%, P<0.001) and were less commonly found in teaching hospitals (63.2% vs. 72.4%, P<0.001). Non-certified surgeons also treated a higher proportion of non-White patients (19.6% vs. 14%, P<0.001) and a greater percentage of patients from the two lowest socioeconomic status quintiles (36.2% vs. 29.2%, P<0.001). Emergency admissions were more prevalent in operations performed by non-certified surgeons (68.8% vs. 55.7%, P<0.001). There were no significant differences in the sex or age of patients treated by certified and non-certified surgeons.

Among Medicare patients, non-certified surgeons predominantly cared for more non-White patients, individuals of lower socioeconomic status, and those in rural or critical-access hospitals. These findings suggest that non-certified surgeons may be essential in providing care to underserved populations, potentially helping to mitigate disparities in access to surgical services.

Source: journals.Lww.Com/annalsofsurgery/abstract/2025/01000/characteristics_and_practice_patterns_of.23.Aspx

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Female Physicians Are Underrepresented In High-Compensation Specialties

Among residents entering high-compensation vs non-high-compensation specialties, female physicians were underrepresented, according to a research letter published in JAMA.

Researchers sourced National Graduate Medical Education Census and Electronic Residency Application Service data to analyze patterns in the proportion of female applicants and matriculants to Accreditation Council for Graduate Medical Education-accredited residency programs for high-compensation surgical and nonsurgical specialties between 2008 and 2022. A total of 26 specialties had matriculant data for all years, of which 14 (surgical, n=9; nonsurgical, n=5) were identified as high-compensation. To evaluate trends in the proportion of female residents matriculating to high-compensation vs non-high-compensation specialties, Prais-Winsten regression with Crochrane-Orcutt transformation was used.

Sex data was available for 490,188 (99.9%; women, 47.4%) of 490,437 residents who matriculated to pipeline specialties. A total of 124,982 (25.5%; women, 34.6%) entered high-compensation specialties (surgical, 57.6%; nonsurgical, 42.4%).

The proportion of female matriculants entering high-compensation specialties significantly increased from 2008 (32.7%) to 2022 (40.8%; P =.003), but remained lower than the proportion entering non-high-compensation specialties (from 53.0% to 53.3% in 2022; P =.44).

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Future studies should identify which strategies were successful in attracting women to these specialties and whether they could be implemented by high-compensation nonsurgical specialties.

A significant interaction was identified between specialty category and time (P <.001) for high-compensation specialties, with an increase in the proportion of female matriculants to surgical specialties from 28.8% in 2008 to 42.4% in 2022 (P <.001). No significant change was observed among nonsurgical specialties (from 37.6% in 2008 to 38.7% in 2022; P =.55).

From 2009 to 2022, the proportion of female applicants to high-compensation nonsurgical specialties decreased from 36.8% to 34.3% (P =.001). In contrast, the proportion of female applicants to high-compensation surgical specialties increased from 28.1% to 37.6% (P <.001) during the same time frame.

A modest increase was observed in the sex ratio of matriculants to applicants across both surgical (2009: 1.0 [95% CI, 1.0-1.1]; 2022: 1.2 [95% CI, 1.2-1.3]; P =.005) and nonsurgical (2009: 1.0 [95% CI, 0.9-1.0]; 2022: 1.2 [95% CI, 1.1-1.3]; P =.003) specialties.

Study limitations include the lack of individual-level demographic data and exclusion of 4 specialties from applicant-related analyses.

"Future studies should identify which strategies were successful in attracting women to these specialties and whether they could be implemented by high-compensation nonsurgical specialties," the study authors concluded.

This article originally appeared on Neurology Advisor

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