Over Half of Dermatologist Practices Separated from 2014 to 2020

Thomas Cwalina, MBA

New data from a cross-sectional study found that a 51.3% of dermatologist positions were separated from 2014 to 2020, with practice separation occurring more frequently in medium- and large-sized practice groups and among early- and late-career dermatologists.

Practice separation was also more common in certain geographic areas such as the Northeast and West regions.

Investigators noted that medical practice separation, which included “job hopping,” has increased operational costs to health care systems and affected patient experiences owing to discontinuity of care and access gaps.

An investigative team led by Thomas Cwalina, MBA of the Department of Dermatology at the University Hospitals Cleveland Medical Center, sought to determine the frequency in which dermatologists separate from their practices and identify physicians and practice characteristics associated with practice separation.

The Methods

The study collected data from archived versions of the Centers for Medicare & Medicaid Services Physician Compare Database (2014-2020) for physicians reporting their primary specialty as dermatology.

Dermatologists were likely to be training in a solo practice within 5 years of medical school practice. Practicing outside of the US and District of Colombia, and with fewer than 1000 relative value units billed in the separate Medicare Provider Utilization and Payment Data file were excluded.

Practice separation was defined as dermatologists belonging to medical position who were removed from the data set in the subsequent year.

The team determined the rate of practice separation for each year and cumulatively as the total proportion of 2014 practices separated by 2020 by both physicians and practice characteristics.

Finally, a multivariable logistic regression model was conducted to determine physician and practice characteristics that were associated with cumulative separation by 2020, and all calculations were conducted from August to December 2021.

The Findings

Cwalina and colleagues identified 12,320 dermatologists and 4283 medical practices during the study period, with a total of 19,541 unique dermatologist or practice positions.

Investigators observed that an average annual proportion of 15.4% (12.4% in 2019 to 18.1% in 2018) of dermatologists separated from their positions each year. Overall, a total of 51.3% of positions in 2014 were separated by 2020.

The District of Columbia (73.8%), Rhode Island (67.3%), and Missouri (61.3%) had the highest cumulative practice separation, while Vermont (30.8%) and Maine (32.1%) had the lowest.

The multivariable logistic regression model revealed that practices located in the Northeast (adjusted odds ratio [aOR], 1.19; 95% CI, 1.06-1.33) or West (aOR, 1.14; 95% CI, 1.02-1.28), those with medium (10-99; aOR, 1.17; 95% CI, 1.05-1.32) or large group size (≥100; aOR, 1.13; 95% CI, 1.02-1.27), while those in academic settings (aOR, 1.23; 95% CI, 1.07-1.40) had increased odds of practice separation.

Additionally, dermatologists at the beginning (1-9 years since training; aOR, 1.91; 95% CI, 1.67-2.20) and later in their careers (≥25 years since training; aOR, 1.38; 95% CI, 1.26-1.51) had increased odds of practice separation.

The team noted that prior research into potential reasons for voluntary separation included higher pay, improved administrative support, burnout, and poor work relationships.

“While increased practice separation among early-career dermatologists may be inherent for all new dermatologists, monitoring is warranted because a younger generation of dermatologists, comprising more of the overall workforce, may increase dermatologist workforce mobility in the future,” the team wrote.

The study, "Dermatologist Workforce Mobility:
Recent Trends and Characteristics," was published online in JAMA Dermatology.