Table 1.

Primary Care Practice Characteristics, by Medical Assistant to Primary Care Clinician Staffing Ratios

All Practices2 or More Medical Assistants per PCCFewer Than 2 Medical Assistants per PCCP Valuea
No., (%)1,252142 (11.3)1,110 (88.7)
Practice ownership (%)P <0.01
    Independent19.734.017.8
    Medical group  6.4  7.8  6.2
    Hospital14.518.414.0
    Health system38.917.641.6
    Federally Qualified Health Center19.721.519.4
    Other  1.0  0.8  1.0
    Independent practice association affiliation (%)15.814.915.9
Practice sizeP <0.01
    Solo physician  0.5  1.8  0.4
    Small (2-9 physicians)76.982.676.2
    Medium (10-19 physicians)13.211.413.5
    Large (20+ physicians)  9.3  4.310.0
Primary care physicians (mean, SD)         6.5 (6.9)          4.9 (3.2)          6.7 (7.2)P <0.01
Advanced practice clinicians (mean, SD)         3.7 (5.7)          3.9 (6.0)          3.7 (5.7)
Specialty mix
    No specialists58.961.358.6
    Low specialists (1-29%)20.917.521.3
    High specialists (30% + )20.321.120.1
Rural-urban continuum code (%)
    Metropolitan82.380.682.5
    Micropolitan10.410.710.3
    Small town  4.9  7.6  4.5
    Rural  2.5  1.1  2.7
Area deprivation index of practice zip code          96.5 (19.7)          99.6 (16.1)          96.1 (20.0)P <0.05
Weekend care (% yes)31.743.030.2P <0.05
After-hours weekday care (% yes)57.268.255.8P <0.05
Professional language services (% always/often)71.466.871.8
Behavioral health integration (% yes)50.749.950.9
Reduced staff hours/layoffs (% yes)38.530.039.5
Staffing shortages impacting patient care (%)P <0.05
    Not at all  9.112.0  8.8
    A little17.228.315.8
    Some35.629.736.4
    Quite a lot38.130.139.0
    Complex care management processes (range: 0-3; mean [SD])          1.7 (0.8)          1.8 (1.0)          1.7 (0.7)
    Practice innovation culture (range: 0-3; mean [SD])          1.5 (0.7)          1.7 (0.6)          1.5 (0.7)P <0.01
    Health information technology functions (range: 0-1; mean [SD])          0.7 (0.3)          0.6 (0.3)          0.7 (0.3)P <0.05
  • PCC = primary care clinician.

  • a Values without P values are not statistically significant (P >0.05).

  • Note: Specialty mix was calculated as specialists divided by total physicians and advanced practice clinician count included include nurse practitioners, physician’s assistants, and clinical nurse specialists. Health information technology functions included questions assessing patient access to their electronic medical records, patient input into medical records, secure messaging, prescription refill notifications, advanced analytics. Complex care management processes included measures of non-physician involvement with patient care coordination, adherence to care plans, supporting risk modification and medication adherence. The Area Deprivation Index of the practice’s zip code from the Neighborhood Atlas was sourced from the Neighborhood Atlas and includes the domains of income, education, employment, and housing quality, where areas with greater socioeconomic disadvantage are ranked higher. The rural-urban continuum code of the practice’s zip code was included. Staffing shortages were assessed using responses to a question that asked, “How much are staff shortages within your practice impacting patient care (do not include shortages related to being ill with COVID)?,” which included the response options of “Not at all,” “A little,” Some,” and “Quite a lot.”