For the first time ever, the U.S. has more physicians who work as employees of a hospital system or a practice owned by other physicians (47.4%) than those who run their own practice (45.9%), according to new survey data from the American Medical Association.

The big picture: Doctors have gradually shifted away from owning a practice — 75.8% were independent in 1983, and that number has been falling ever since.

Between the lines: This shift has a big effect on costs. Health insurers pay significantly more for routine patient visits when they are in a hospital-owned practice instead of an independent clinic — even though the services are the same.

Go deeper: States look to cap hospital rates by tying employee health plans to Medicare

Editor’s note: An earlier version of this story misstated the percentage of doctors who are employed by hospital systems. 47.4% of physicians work as employees of either a hospital system or a practice owned by other physicians.

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