The market forces fueling the integration race between physicians and other healthcare providers may directly influence why and when physicians join medical group practices.
That's the essence of a first-time study released earlier this month by the American Medical Association, which found that 33.4% of the nation's physicians now are involved in medical group practices, compared with 18% in the late 1960s.
AMA executives said physicians in solo practice who are considering entering a medical group should weigh all the options, but should think about whether they would be more productivity in a group setting. Physicians in groups that have a practice manager may spend less time doing administrative work, leaving more time for patient care.
The study, "Physicians in Medical Groups: A Comparative Analysis-1993," found that physicians in group practices, defined as having three or more physicians, have fewer restrictions on their autonomy, are more likely to contract with managed-care plans and tend to have somewhat higher incomes than physicians in solo practices.
The study is the AMA's first comprehensive examination of group practices that examined individual practice characteristics inside a group. According to the AMA, the study is intended to benefit those seeking detailed statistics and analysis of physician practice arrangements.
Using census, demographic and statistical information compiled from various AMA data bases, the study examines and compares the practice patterns, autonomy and managed-care relationships of physicians in medical groups with those of their counterparts in two-person or solo practices.
A prepared statement by James S. Todd, M.D., the AMA's executive vice president, said the survey's findings will help address the data needs of those in the healthcare industry that want to woo physicians in today's complex and competitive medical marketplace.
Profiles of medical group and independent practitioners were derived from statistical data on demographic characteristics such as gender and age, and practice-style characteristics such as hours worked, expenses, income, managed-care arrangements and perceived clinic autonomy.
The study found that physicians "seem to be increasingly involved" in multiple practice arrangements.
For example, physicians in some faculty medical schools can be found in revenue- and income-generating practices in the form of faculty practice plans.
The study also found other characteristics that distinguish medical group practice physicians from solo practitioners:
Young female physicians are somewhat more likely to join a medical group practice arrangement than are older male physicians who work in a solo or two-physician practice.
Among specialty physicians, radiologists and anesthesiologists are the most likely to practice in a group setting. Psychiatrists are the least likely to practice in groups.
The nation's North Central region has relatively more primary-care physicians practicing in groups than any other region.
Non-metropolitan counties with fewer than 25,000 residents and metropolitan areas with populations of more than 1 million have the smallest proportion of primary-care physicians in group practices.
Physicians in rural states are more likely than physicians in urban areas to be in solo or two-physician practices.
Although group practice physicians make up almost half of primary-care physicians in the West North Central region-an area from Idaho to Iowa and north of Kansas and Missouri-they account for about a fourth of those in the Mid-Atlantic states.
Solo or two-physician practice physicians are most heavily concentrated in the West South Central region.
On average, both group physicians and solo practitioners worked 58.9 hours each week in 1992.
The fee for an established-patient office visit was slightly higher among group practice physicians than physicians in solo practices.
On average, physicians earned $170,600 in 1991. Group practice physicians earned about $30,000 more than independent physicians and $67,000 more than physicians in other practice arrangements.
Among specialty physicians, group physicians earned more than solo physicians.
Group physicians are much more likely than independent physicians to treat Medicaid patients and contract with PPOs.
The size and specialty characteristics of the physician group affect group physicians' managed-care relationships. Physicians in larger groups are much more likely than physicians in smaller groups to be involved with HMOs, and their average percentage of annual group revenues from HMOs also tends to be greater. Also, physicians in multispecialty groups are more likely than physicians in single-specialty or general/family practice groups to be involved with HMOs and PPOs. Multispecialty group physicians derive a much smaller average percentage of annual group revenues from PPOs than from HMOs.