Characteristics and Practice Patterns of Non-Certified Surgeons Treating Medicare Patients

The objective of this study is to explore the patient characteristics and practice patterns of non-certified surgeons who treat Medicare patients in the United States.

Although most surgeons in the United States are board-certified, non-certified surgeons are permitted to practice in many locations. At the same time, surgical workforce shortages threaten access to surgical care for many patients. It is possible that noncertified surgeons may be able to help fill these access gaps. However, little is known about the practice patterns of non-certified surgeons.

A 100% sample of Medicare claims data from 2014 to 2019 was used to identify practicing general surgeons. Surgeons were categorized as certified or non-certified in general surgery​​ based on data from the American Board of Surgery. Surgeon practice patterns and patient characteristics were analyzed.

A total of 2,097,206 patient cases were included in the study. These patients were treated by 16,076 surgeons, of which 6% were identified as non-certified surgeons. Compared with certified surgeons, non-certified surgeons were less frequently fellowship-trained (20.5% vs 24.2%, P =0.008) and more likely to be foreign medical graduates (14.5% vs 9.2%, P <0.001). Non-certified surgeons were more frequently practicing 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 likely to practice in a teaching hospital (63.2% vs 72.4%, P <0.001). Compared with certified surgeons, non-certified surgeons treated more non-White patients (19.6% vs 14%, P <0.001) as well as a higher percentage of patients in the 2 lowest SES quintiles (36.2% vs 29.2%, P <0.001). Operations related to emergency admissions were more common amongst non-certified surgeons (68.8% vs 55.7%, P <0.001). There were no differences in sex or age of the patients treated by certified and non-certified surgeons.

For Medicare patients, non-certified surgeons treated more patients who are non-White, of lower socioeconomic status, and in more rural, critical-access hospitals.