Article Figures & Data
Tables
Characteristic Solo Small (2–5 Providers) Medium (6–20 Providers) Large (>20 Providers) P Value Family physicians, No. (%)a 1,677 (15.4) 3,913 (35.9) 3,371 (31.0) 1,927 (17.7) – Sex, No. (%)b Male 1,130 (67.4) 2,459 (62.8) 2,086 (62.9) 1,216 (63.1) Female 547 (32.6) 1,454 (37.2) 1,285 (38.1) 711 (36.9) .002 Race, No. (%)b White 1,258 (75.0) 3,208 (82.0) 2,763 (82.0) 1,514 (78.6) <.001 Black or African American 134 (8.0) 237 (6.1) 186 (5.5) 99 (5.1) .001 Asian 257 (15.3) 404 (10.3) 366 (10.9) 272 (14.1) <.001 Others 28 (1.7) 64 (1.6) 56 (1.7) 42 (2.2) .46 Ethnicity, No. (%)b Non-Hispanic 1,544 (92.1) 3,700 (94.6) 3,212 (95.3) 1,801 (93.5) <.001 Hispanic 133 (7.9) 213 (5.4) 159 (4.7) 126 (6.5) <.001 Years in practice, No. (%)b 0–10 316 (18.8) 1,137 (29.1) 1,000 (29.7) 542 (28.1) <.001 11–20 592 (35.3) 1,291 (33.0) 985 (29.2) 583 (30.3) <.001 21–30 510 (30.4) 1,099 (28.1) 1,046 (31.0) 613 (31.8) <.009 ≥31 259 (15.4) 385 (9.8) 340 (10.1) 189 (9.8) <.001 Percent of county earning <100% of FPL 14.9 14.5 14.7 14.7 <.000 Rurality of county, No. (%)b Urban 1,402 (83.6) 3,117 (79.7) 2,799 (83.0) 1,755 (91.1) <.001 Rural: 20,000–50,000 people 113 (6.7) 271 (6.9) 255 (7.6) 101 (5.2) .01 Rural: 2,500–19,999 people 149 (8.9) 428 (10.9) 280 (8.3) 69 (3.6) <.001 Rural: <2,500 people 13 (0.8) 97 (2.5) 37 (1.1) 2 (0.1) <.001 Combined rural 275 (16.4) 796 (20.3) 572 (17.0) 172 (8.9) <.001 Region of country, No. (%) North 262 (15.6) 629 (16.1) 488 (14.5) 202 (10.5) <.001 South 704 (41.1) 1,387 (35.4) 966 (28.7) 517 (26.8) <.001 West 328 (19.6) 748 (19.1) 910 (27.0) 671 (34.8) <.001 Midwest 355 (21.2) 1,096 (28.0) 961 (28.5) 525 (27.2) <.001 Characteristic Solo Small (2–5 Providers) Medium (6–20 Providers) Large (>20 Providers) P Value Practice organization, No. (%)a Solo 1,487 (88.7) 0 0 0 Group 0 2,243 (57.3) 1,427 (42.3) 721 (37.4) <.001 Safety net 26 (1.6) 386 (9.9) 432 (12.8) 156 (8.1) <.001 Other 164 (9.8) 1,284 (32.8) 1,512 (44.9) 1,050 (54.9) <.001 Care coordinator, No. (%)a Yes 370 (22.1) 1,356 (34.7) 1,623 (48.2) 1,210 (62.8) <.001 No 1,307 (77.9) 2,557 (65.4) 1,748 (51.9) 717 (37.2) PCMH certification, No. (%)a Yes 110 (6.6) 737 (18.8) 1,046 (31.0) 681 (35.3) <.001 No 1,567 (93.4) 3,176 (94.2) 2,325 (69.0) 1,246 (64.7) PCMH = patient-centered medical home.
↵a Percentage within groups.
Servicea Solo Small (2–5 Providers) Medium (6–20 Providers) Large (>20 Providers) P Value Patient care in a language besides English, No. (%) Spanish 404 (24.1) 747 (19.1) 787 (23.4) 462 (24.0) Other 218 (13.0) 292 (7.5) 207 (6.1) 170 (8.8) No 1,055 (62.9) 2,874 (73.4) 2,377 (70.5) 1,295 (67.2) <.001 Newborn care, No. (%) Yes 741 (44.2) 2,326 (59.4) 2,064 (61.2) 1,043 (54.1) <.001 No 936 (55.8) 1,587 (40.6) 1,307 (38.8) 884 (45.9) Prenatal care, No. (%) Yes 140 (8.4) 436 (11.1) 607 (18.0) 394 (20.5) <.001 No 1,537 (91.7) 3,477 (88.9) 2,764 (82.0) 1,533 (79.6) Obstetric deliveries per year, No. (%) 0 1,627 (97.0) 3,666 (93.7) 2,964 (87.9) 1,689 (87.7) <.001 1–25 27 (1.6) 114 (2.9) 244 (7.2) 135 (7.0) 26–50 10 (0.6) 72 (1.8) 106 (3.1) 71 (3.7) ≥51 13 (0.8) 61 (1.5) 57 (1.7) 32 (1.7) Other specialists at primary practice site, No. (%) Multispecialty 0 642 (16.4) 1,466 (43.5) 1,414 (73.4) <.001 Single specialty 1,677 (100.0) 3,271 (83.6) 1,905 (56.5) 513 (26.6) Provides inpatient care, No. (%) Yes 635 (37.9) 1,225 (31.3) 1,164 (34.5) 724 (37.6) <.001 No 1,042 (62.1) 2,688 (68.7) 2,207 (65.5) 1,203 (62.4) Has admitting privileges, No. (%) Yes 1,136 (67.7) 2,424 (62.0) 2,117 (62.8) 1,240 (64.4) <.001 No 541 (32.3) 1,489 (38.1) 1,254 (37.2) 687 (35.7) Scope, I-SOP score, mean (SD)b 14.1 (3.4) 14.8 (3.4) 15.0 (3.7) 14.5 (3.6) <.001 - Table 4
Characteristics Associated With Practicing in Solo or Small Practices, and in Solo Practices
Characteristic Model 1: Solo or Small vs Medium or Large Model 2: Solo vs Small OR (95% CI) P Value OR (95% CI) P Value Sex Male (ref) 1.00 1.00 Female 0.95 (0.87–1.03) .22 0.87 (0.76–0.99) .03 Race White (ref) 1.00 1.00 Black or African American 1.22 (1.03–1.44) .02 1.57 (1.25–1.99) <.001 Asian 1.13 (1.00–1.27) .058 1.97 (1.65–2.36) <.001 Others 0.96 (0.72–1.29) .80 1.27 (0.81–2.01) .30 Ethnicity Non-Hispanic (ref) 1.00 1.00 Hispanic 1.33 (1.13–1.58) <.001 1.62 (1.28–2.05) <.001 Years in practice 0–10 (ref) 1.00 1.00 11–20 1.27 (1.15–1.40) <.001 1.70 (1.45–2.00) <.001 21–30 1.02 (0.92–1.14) .68 1.91 (1.61–2.27) <.001 ≥31 1.31 (1.13–1.51) <.001 2.74 (2.22–3.40) <.001 Percent of county earning <100% of FPL 0.99 (0.98–0.99) .001 1.01 (1.00–1.02) .24 Rurality of county Urban (ref) 1.00 1.00 Rural: 20,000–50,000 people 1.17 (1.00–1.37) .046 0.97 (0.76–1.23) .79 Rural: 2,500–19,999 people 1.76 (1.52–2.03) <.001 0.83 (0.67–1.01) .07 Rural: <2,500 people 3.16 (2.18–4.58) <.001 0.33 (0.18–0.59) <.001 Region of country South (ref) 1.00 1.00 Northeast 0.90 (0.79–1.02) .09 0.82 (0.69–0.98) .03 West 0.47 (0.43–0.53) <.001 0.86 (0.73–1.02) .08 Midwest 0.66 (0.59–0.73) <.001 0.67 (0.57–0.78) <.001 Constant 3.59 <.001 0.29 <.001 FPL = federal poverty level; OR = odds ratio; ref = reference group.
Additional Files
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.
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