Large Independent Primary Care Medical Groups

The Article in Brief

Large Independent Primary Care Medical Groups

Lawrence P. Casalino , and colleagues

Background In the turbulent U.S. health care environment, physicians are increasingly, choosing to become employed by large organizations, such as large multispecialty or single specialty medical groups. This opportunity is often not available, however, and many physicians are becoming employed by hospitals. For primary care physicians (PCPs), there is another option: the large physician-owned primary care medical group. Few physicians and policy experts are aware of these groups. In this article, the authors describe five large PCP groups and their advantages, disadvantages, and challenges.

What This Study Found Large independent physician-owned primary care groups offer physicians an attractive employment alternative to hospital or large multispecialty medical groups and can also benefit patients and society. The scale of the groups makes it possible for them to develop laboratory and imaging services, health information technology, and quality improvement infrastructure, while their multiple practice sites offer patients easy geographic access and the small practice environment that many patients and physicians prefer. The five groups studied had an average size of 148 physicians of whom 87 percent were primary care physicians. Unlike hospital-employed and multi-specialty groups, these independent groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Some, however, are under pressure to sell to organizations that could provide capital for additional infrastructure to engage in value-based contracting and provide substantial income to physicians from the sale.The groups' physicians reported only moderate satisfaction with their clinical workload and work-life balance, suggesting that the groups have not fully resolved the difficulties of practicing primary care medicine.

Implications

• The authors conclude that large independent primary care physician groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.