Robert Graham Center Research

Small Family Practices Continue to Thrive, Survey Reveals

January 15, 2016 04:24 pm Michael Laff Washington, D.C. –

Small and solo family physician practices continue to thrive despite growing pressures to consolidate, researchers found in a recent study.

[Doctor listenting to young girl's heart with mom next to her]

Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care analyzed data from a 2013 survey of family physicians and discovered that just over half of respondents worked in solo or small practices. The research findings,(www.annfammed.org) published in the January/February issue of the Annals of Family Medicine, indicate that such practices remain a staple of primary care even as large health centers attempt to gain market dominance by purchasing or employing them.

The largest proportion of family physicians, 35.9 percent, were found in small practices consisting of two to five physicians. Solo practices accounted for 15.4 percent, medium practices of 6 to 20 physicians made up 31 percent and larger practices made up 17.7 percent.

The results, based on a survey of 10,888 family physicians seeking certification through the American Board of Family Medicine, were a small surprise to researchers, who expected the number of solo and small practices to be lower.

Story Highlights
  • Research published in the January/February issue of the Annals of Family Medicine shows that solo and small practices are a staple of primary care.
  • Physicians in solo practices were more likely to have been in practice for more than 30 years, and to be male, and African American, Asian or Hispanic.
  • The findings are based on a survey of 10,888 family physicians who sought certification through the American Board of Family Medicine in 2013.

"We assume that everyone is consolidating, but that is not actually true," said Winston Liaw, M.D., M.P.H., medical director for the Graham Center and one of the study's authors.

Physician age is a major determinant of the size of a physician practice, outstripping race and gender. Physicians in solo practices were more likely to have been in practice for more than 30 years, and to be male, and African American, Asian or Hispanic.

"Recent graduates are gravitating toward larger practices," Liaw said. "Younger physicians are looking for greater balance between work and family. They are putting a priority on shared responsibility in a collaborative team environment."

In contrast with previous research, the current survey showed physicians in solo practice were not more likely to be practicing in counties with high poverty rates.

Physicians in small and medium practices were found to offer the broadest scope of care, while those in solo and large practices were the most likely to have admitting privileges and provide hospital care.

Researchers found rural areas to have a greater concentration of solo and small practices, which are slower to participate in practice transformation.

"Although physicians working in solo and small practices are vital to primary care, particularly in rural areas, they are missing out on practice transformation," the authors wrote. "Extension programs and community health teams have the potential to facilitate this transformation."

One disadvantage that solo and small practices face is having fewer resources to hire care coordinators or allied health professionals. Only 22 percent of solo practices and 35 percent of small practices have a care coordinator, compared with 63 percent of large practices.

Liaw said it is important for solo and small practices -- and insurers -- to find ways to support shared resources either by forming independent practice associations or other networks that enable practices to remain small if they desire to be. Otherwise, the authors wrote, they "may be missing out on new payment models that are dependent on patient-centered medical home certification."

"There are informal ways to combine practices together so they can collaborate and hire a care coordinator, a dietician or a social worker, but those systems aren't in place," Liaw said.

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Research Compares Hospital Admission Rates for Small Versus Large Practices

(8/20/2014)

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