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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
MD, MPH
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  • For correspondence: winstonrliaw@gmail.com
Anuradha Jetty
2Robert Graham Center, Washington, DC
MPH
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Stephen M. Petterson
2Robert Graham Center, Washington, DC
PhD
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Lars E. Peterson
3American Board of Family Medicine, Lexington, Kentucky
MD, PhD
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Andrew W. Bazemore
2Robert Graham Center, Washington, DC
MD, MPH
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Article Figures & Data

Tables

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    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.

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    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.
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The Annals of Family Medicine: 14 (1)
The Annals of Family Medicine: 14 (1)
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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

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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
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