Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
    • Annals Forum (Archive)
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
    • Annals Forum (Archive)
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

Solo and Small Practices: A Vital, Diverse Part of Primary Care

Winston R. Liaw, Anuradha Jetty, Stephen M. Petterson, Lars E. Peterson and Andrew W. Bazemore
The Annals of Family Medicine January 2016, 14 (1) 8-15; DOI: https://doi.org/10.1370/afm.1839
Winston R. Liaw
1Virginia Commonwealth University, Richmond, Virginia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: winstonrliaw@gmail.com
Anuradha Jetty
2Robert Graham Center, Washington, DC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephen M. Petterson
2Robert Graham Center, Washington, DC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lars E. Peterson
3American Board of Family Medicine, Lexington, Kentucky
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew W. Bazemore
2Robert Graham Center, Washington, DC
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Tables

  • Additional Files
    • View popup
    Table 1

    Characteristics of Physicians and Their Practices, by Practice Size

    CharacteristicSoloSmall (2–5 Providers)Medium (6–20 Providers)Large (>20 Providers)P Value
    Family physicians, No. (%)a1,677 (15.4)3,913 (35.9)3,371 (31.0)1,927 (17.7)–
    Sex, No. (%)b
     Male1,130 (67.4)2,459 (62.8)2,086 (62.9)1,216 (63.1)
     Female547 (32.6)1,454 (37.2)1,285 (38.1)711 (36.9).002
    Race, No. (%)b
     White1,258 (75.0)3,208 (82.0)2,763 (82.0)1,514 (78.6)<.001
     Black or African American134 (8.0)237 (6.1)186 (5.5)99 (5.1).001
     Asian257 (15.3)404 (10.3)366 (10.9)272 (14.1)<.001
     Others28 (1.7)64 (1.6)56 (1.7)42 (2.2).46
    Ethnicity, No. (%)b
     Non-Hispanic1,544 (92.1)3,700 (94.6)3,212 (95.3)1,801 (93.5)<.001
     Hispanic133 (7.9)213 (5.4)159 (4.7)126 (6.5)<.001
    Years in practice, No. (%)b
     0–10316 (18.8)1,137 (29.1)1,000 (29.7)542 (28.1)<.001
     11–20592 (35.3)1,291 (33.0)985 (29.2)583 (30.3)<.001
     21–30510 (30.4)1,099 (28.1)1,046 (31.0)613 (31.8)<.009
     ≥31259 (15.4)385 (9.8)340 (10.1)189 (9.8)<.001
    Percent of county earning <100% of FPL14.914.514.714.7<.000
    Rurality of county, No. (%)b
     Urban1,402 (83.6)3,117 (79.7)2,799 (83.0)1,755 (91.1)<.001
     Rural: 20,000–50,000 people113 (6.7)271 (6.9)255 (7.6)101 (5.2).01
     Rural: 2,500–19,999 people149 (8.9)428 (10.9)280 (8.3)69 (3.6)<.001
     Rural: <2,500 people13 (0.8)97 (2.5)37 (1.1)2 (0.1)<.001
     Combined rural275 (16.4)796 (20.3)572 (17.0)172 (8.9)<.001
    Region of country, No. (%)
     North262 (15.6)629 (16.1)488 (14.5)202 (10.5)<.001
     South704 (41.1)1,387 (35.4)966 (28.7)517 (26.8)<.001
     West328 (19.6)748 (19.1)910 (27.0)671 (34.8)<.001
     Midwest355 (21.2)1,096 (28.0)961 (28.5)525 (27.2)<.001
    • FPL = federal poverty level.

    • ↵a Percentage across groups.

    • ↵b Percentage within groups.

    • View popup
    Table 2

    Practice Organization Characteristics, by Practice Size

    CharacteristicSoloSmall (2–5 Providers)Medium (6–20 Providers)Large (>20 Providers)P Value
    Practice organization, No. (%)a
     Solo1,487 (88.7)000
     Group02,243 (57.3)1,427 (42.3)721 (37.4)<.001
     Safety net26 (1.6)386 (9.9)432 (12.8)156 (8.1)<.001
     Other164 (9.8)1,284 (32.8)1,512 (44.9)1,050 (54.9)<.001
    Care coordinator, No. (%)a
     Yes370 (22.1)1,356 (34.7)1,623 (48.2)1,210 (62.8)<.001
     No1,307 (77.9)2,557 (65.4)1,748 (51.9)717 (37.2)
    PCMH certification, No. (%)a
     Yes110 (6.6)737 (18.8)1,046 (31.0)681 (35.3)<.001
     No1,567 (93.4)3,176 (94.2)2,325 (69.0)1,246 (64.7)
    • PCMH = patient-centered medical home.

    • ↵a Percentage within groups.

    • View popup
    Table 3

    Services Provided, by Practice Size

    ServiceaSoloSmall (2–5 Providers)Medium (6–20 Providers)Large (>20 Providers)P Value
    Patient care in a language besides English, No. (%)
     Spanish404 (24.1)747 (19.1)787 (23.4)462 (24.0)
     Other218 (13.0)292 (7.5)207 (6.1)170 (8.8)
     No1,055 (62.9)2,874 (73.4)2,377 (70.5)1,295 (67.2)<.001
    Newborn care, No. (%)
     Yes741 (44.2)2,326 (59.4)2,064 (61.2)1,043 (54.1)<.001
     No936 (55.8)1,587 (40.6)1,307 (38.8)884 (45.9)
    Prenatal care, No. (%)
     Yes140 (8.4)436 (11.1)607 (18.0)394 (20.5)<.001
     No1,537 (91.7)3,477 (88.9)2,764 (82.0)1,533 (79.6)
    Obstetric deliveries per year, No. (%)
     01,627 (97.0)3,666 (93.7)2,964 (87.9)1,689 (87.7)<.001
     1–2527 (1.6)114 (2.9)244 (7.2)135 (7.0)
     26–5010 (0.6)72 (1.8)106 (3.1)71 (3.7)
     ≥5113 (0.8)61 (1.5)57 (1.7)32 (1.7)
    Other specialists at primary practice site, No. (%)
     Multispecialty0642 (16.4)1,466 (43.5)1,414 (73.4)<.001
     Single specialty1,677 (100.0)3,271 (83.6)1,905 (56.5)513 (26.6)
    Provides inpatient care, No. (%)
     Yes635 (37.9)1,225 (31.3)1,164 (34.5)724 (37.6)<.001
     No1,042 (62.1)2,688 (68.7)2,207 (65.5)1,203 (62.4)
    Has admitting privileges, No. (%)
     Yes1,136 (67.7)2,424 (62.0)2,117 (62.8)1,240 (64.4)<.001
     No541 (32.3)1,489 (38.1)1,254 (37.2)687 (35.7)
    Scope, I-SOP score, mean (SD)b14.1 (3.4)14.8 (3.4)15.0 (3.7)14.5 (3.6)<.001
    • I-SOP = Individual Scope of Practice.

    • ↵a Percentage within groups.

    • ↵b Possible scores range from 0 to 30, with higher scores indicating greater scope.

    • View popup
    Table 4

    Characteristics Associated With Practicing in Solo or Small Practices, and in Solo Practices

    CharacteristicModel 1: Solo or Small vs Medium or LargeModel 2: Solo vs Small
    OR (95% CI)P ValueOR (95% CI)P Value
    Sex
     Male (ref)1.001.00
     Female0.95 (0.87–1.03).220.87 (0.76–0.99).03
    Race
     White (ref)1.001.00
     Black or African American1.22 (1.03–1.44).021.57 (1.25–1.99)<.001
     Asian1.13 (1.00–1.27).0581.97 (1.65–2.36)<.001
     Others0.96 (0.72–1.29).801.27 (0.81–2.01).30
    Ethnicity
     Non-Hispanic (ref)1.001.00
     Hispanic1.33 (1.13–1.58)<.0011.62 (1.28–2.05)<.001
    Years in practice
     0–10 (ref)1.001.00
     11–201.27 (1.15–1.40)<.0011.70 (1.45–2.00)<.001
     21–301.02 (0.92–1.14).681.91 (1.61–2.27)<.001
     ≥311.31 (1.13–1.51)<.0012.74 (2.22–3.40)<.001
    Percent of county earning <100% of FPL0.99 (0.98–0.99).0011.01 (1.00–1.02).24
    Rurality of county
     Urban (ref)1.001.00
     Rural: 20,000–50,000 people1.17 (1.00–1.37).0460.97 (0.76–1.23).79
     Rural: 2,500–19,999 people1.76 (1.52–2.03)<.0010.83 (0.67–1.01).07
     Rural: <2,500 people3.16 (2.18–4.58)<.0010.33 (0.18–0.59)<.001
    Region of country
     South (ref)1.001.00
     Northeast0.90 (0.79–1.02).090.82 (0.69–0.98).03
     West0.47 (0.43–0.53)<.0010.86 (0.73–1.02).08
     Midwest0.66 (0.59–0.73)<.0010.67 (0.57–0.78)<.001
    Constant3.59<.0010.29<.001
    • FPL = federal poverty level; OR = odds ratio; ref = reference group.

Additional Files

  • Tables
  • Supplemental Appendixes 1-2

    Supplemental data: Appendixes 1-2

    Files in this Data Supplement:

    • Supplemental data: Appendixes - PDF file
  • The Article in Brief

    Solo and Small Practices: A Vital, Diverse Part of Primary Care

    Winston R. Liaw , and colleagues

    Background Solo and small practices are facing growing pressure to consolidate. This study sets out to determine the percentage of family physicians in solo and small practices and the characteristics of and services provided by these practices.

    What This Study Found More than half of family physicians work in small and solo practices. Thirty-six percent of study respondents work in small practices and 15 percent work in solo practices. Small practices are the most likely to be located in a rural setting (20 percent). Small and solo practices are more common among African American, Hispanic and experienced physicians who have been in practice more than 30 years.

    Implications

    • Family physicians working in solo and small practices still outnumber those working in medium and large practices.
    • These findings, the authors conclude, raise concerns about the types of physicians and communities that are being disproportionately affected by practice consolidation.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 14 (1)
The Annals of Family Medicine: 14 (1)
Vol. 14, Issue 1
January/February 2016
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Solo and Small Practices: A Vital, Diverse Part of Primary Care
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
1 + 13 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Solo and Small Practices: A Vital, Diverse Part of Primary Care
Winston R. Liaw, Anuradha Jetty, Stephen M. Petterson, Lars E. Peterson, Andrew W. Bazemore
The Annals of Family Medicine Jan 2016, 14 (1) 8-15; DOI: 10.1370/afm.1839

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Solo and Small Practices: A Vital, Diverse Part of Primary Care
Winston R. Liaw, Anuradha Jetty, Stephen M. Petterson, Lars E. Peterson, Andrew W. Bazemore
The Annals of Family Medicine Jan 2016, 14 (1) 8-15; DOI: 10.1370/afm.1839
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Place Matters: Closing the Gap on Rural Primary Care Quality Improvement Capacity--the Healthy Hearts Northwest Study
  • Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context
  • A Cross-Sectional Study of Factors Associated With Pediatric Scope of Care in Family Medicine
  • Identifying Practice Facilitation Delays and Barriers in Primary Care Quality Improvement
  • The Ability of Practices to Report Clinical Quality Measures: More Evidence of the Size Paradox?
  • Rebuilding after COVID: Planning Systems of Care for the Future
  • A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care
  • Does Ownership Make a Difference in Primary Care Practice?
  • Correlates of Burnout in Small Independent Primary Care Practices in an Urban Setting
  • Quality of Cardiovascular Disease Care in Small Urban Practices
  • Technical Assistance for Primary Care Practice Transformation: Free Help to Perform Unpaid Labor?
  • Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?
  • Holding On and Letting Go: A Perspective from the Keystone IV Conference
  • The Impact of Debt on Young Family Physicians: Unanswered Questions with Critical Implications
  • The Paradox of Size: How Small, Independent Practices Can Thrive in Value-Based Care
  • In This Issue: Size Matters
  • Achieving PCMH Status May Not Be Meaningful for Small Practices
  • Google Scholar

More in this TOC Section

  • Patient Satisfaction With Medical Care for Chronic Low Back Pain: A Pain Research Registry Study
  • Disparities in Shared Decision-Making Research and Practice: The Case for Black American Patients
  • Health TAPESTRY Ontario: A Multi-Site Randomized Controlled Trial Testing Implementation and Reproducibility
Show more Original Research

Similar Articles

Subjects

  • Person groups:
    • Vulnerable populations
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health policy
    • Health services
    • Professional practice

Keywords

  • physician’s practice patterns
  • primary care
  • practice-based research
  • private practice
  • rural health services
  • solo practice

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine