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Most Family Physicians Remain in Solo, Small Practices

October 13th, 2016

RICHMOND, VA – Most family physicians are resisting consolidation pressures and remaining in solo and small practices, according to a recent report noting that the trend might not be altogether positive.

A study appearing recently in the Annals of Family Medicine notes that more than half of the 10,888 family physicians who sought board certification in 2013 and completed a demographic survey worked in small and solo practices – 36% in small practices and 15% in solo practices.

Furthermore, according to the Virginia Commonwealth University-led study, small practices were the most likely to be located in a rural setting at 20%. In addition, the study found that small and solo practices were more common among African-American and Hispanic doctors as well as physicians overall who have been in practice more than 30 years.

Results also indicate that physicians were more likely to be working in small practices -- as opposed to solo practices -- if they worked in highly rural areas.

For the survey, practices were split into categories by size:

  • solo,
  • small (2-5 providers),
  • medium (6-20 providers), and
  • large (more than 20 providers).

Study authors raised concerns about the types of physicians and communities that are disproportionately affected by practice consolidation, noting that the likelihood of having a care coordinator and medical home certification increased with practice size. They question whether smaller practices are missing out on new payment models that are dependent on medical home certification.

“Large groups benefit from economies of scale, distributing the costs of practice transformation across clinicians. On the revenue side, larger practices have more negotiating power in some markets,” according to the researchers. “Practicing in a larger group may have other benefits, including increased control over work hours, shared resources, access to capital, and greater ability to manage risk. These market forces are fueling a race to get larger, absent any discussion of the consequences or acknowledgment that transformation for a large practice differs radically from that for a small practice.”

The articles called for policies to help small practices profit from economies of scale without sacrificing the benefits of being small.

“Family physicians in solo and small practices comprised the majority among all family physicians seeking board certification and were more likely to work in rural geographies,” study authors concluded. “Extension programs and community health teams have the potential to support transformation within these practices.”