title: The employed surgeon: a changing professional paradigm.
abstract: OBJECTIVE
  To identify trends and characteristics of surgeon employment in the United States. Surgeons are increasingly choosing hospital or large group employment as their practice environment. DESIGN American Medical Association Physician Masterfile data were analyzed for the years 2001 to 2009.
  
  
  METHODS
  Surgeons identified within the American Medical Association Masterfile.
  
  
  METHODS
  Surgeons were defined using definitions from the American Medical Association specialty data and the American Board of Medical Specialties certification data and included active, nonfederal, and nonresident physicians younger than 80 years of age.
  
  
  METHODS
  Employment status and trends.
  
  
  RESULTS
  The number of surgeons who reported having their own self-employed practice decreased from 48% to 33% between 2001 and 2009, and this decrease corresponded with an increase in the number of employed surgeons. Sixty-eight percent of surgeons in the United States now self-identify their practice environment as employed. Between 2006 and 2011, there was a 32% increase in the number of surgeon in a full-time hospital employment arrangement. Younger surgeons and female surgeons increasingly favor employment in large group practices. Employment trends were similar for both urban and rural practices.
  
  
  CONCLUSIONS
  General surgeons and surgical subspecialists are choosing hospital employment instead of independent practice. The trend is especially notable among younger surgeons and among female surgeons. The trend denotes a professional paradigm shift of major importance.
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, 4008 Burnett, Womack Bldg, CB 7228, Chapel Hill, NC 27599, USA. anthchar@med.unc.edu
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
authors.forename: Shiara
authors.initials: S
authors.lastname: Ortiz-Pujols
authors.forename: Thomas
authors.initials: T
authors.lastname: Ricketts
authors.forename: Erin
authors.initials: E
authors.lastname: Fraher
authors.forename: Simon
authors.initials: S
authors.lastname: Neuwahl
authors.forename: Bruce
authors.initials: B
authors.lastname: Cairns
authors.forename: George F
authors.initials: GF
authors.lastname: Sheldon
mesh_terms: D000367:Age Factors; D004651:Employment / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians / Q000639:trends*; D011364:Professional Practice / Q000639:trends*; D012737:Sex Factors; D013038:Specialization / Q000639:trends*; D013043:Specialties, Surgical / Q000639:trends*; D014481:United States; D000078329:Workforce