The smallest physician practices still make up the largest percentage of medical practices as a whole, but their share of the pie is shrinking, according to a recent study.
The percentage of doctors in solo or two-physician practices has fallen to 32.5% from 40.7%, according to results of surveys taken by the Washington-based Center for Studying Health System Change in 2004-05 and 1996-97. The trend is driven by doctors leaving the world of self-employment to take jobs with single-specialty group practices.
The report also concludes that the movement may ultimately drive up costs because physicians in larger groups will have more power to demand higher payments from health plans.
The shifts in physician work settings indicate that policymakers advocating quality-measure reporting and pay-for-performance programs are achieving one of their goalslarger practicesand are getting nowhere in anotherpromoting multispecialty practices, says Joy Grossman, a senior researcher for the center and a study co-author. There is a strong belief that, if you provide these incentives (in the form of pay-for-performance), it will ultimately drive aggregation into larger practices, she says. Some in the policy arena see large multispecialty practices as the ideal.
Although there is no conclusive evidence that this approach results in better care, Grossman explains that the theory at work is that larger practices have the staff to devote to quality improvement and the resources to invest in electronic health records that can facilitate quality measurement. She adds that, under this theory, there is better coordination of care because a physician can refer a patient to a specialist within his or her own practice.
The survey also found that the percentage of doctors in practices of six to 50 physicians has risen to 17.6% from 13.1% during the same period. Additionally, the latest survey showed the percentage of physicians who own or have an ownership stake in their practice falling to 54.4% from 61.6%.
American Academy of Family Physicians Chairman Rick Kellerman, M.D., says that geography may explain some of the findings. We have a lot of members in rural areas that just are not able to aggregate into larger groups, he says. But, what were hearing from our members in urban areas is that its becoming tougher and tougher to maintain a solo or small-group practice.
Solo practices in urban settings are finding it harder to deal with insurers that keep getting larger as companies consolidate, said Kellerman, who chairs the department of family and community medicine at the University of Kansas School of Medicine, Wichita, and is part of a five-physician family medicine practice.
The latest report, based on responses from more than 6,600 physicians, is the fourth in a series of surveys on the subject. The previous three surveys, drawing responses from about 12,000 physicians, were conducted in 1996-97, 1998-99 and 2001-02.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.