Physicians Drawn to Mid-sized, Single-Specialty Practices

A report released last month by the Center for Studying Health System Change, or HSC, says that fewer American physicians are working in solo and two-physician practices and that the number of physicians moving to mid-sized, single-specialty practices is increasing.

Furthermore, the report says that the trend toward mid-sized, single-specialty practices is not the organizational model that best supports what policy makers see as the most efficient practice model of the future -- a model that could offer

Indeed, says the report, many policy makers, particularly leaders in the quality improvement arena, would prefer that physicians move to large multispecialty practices because of the enhanced financial and administrative resources available in such practices.

HSC is a nonpartisan policy research organization based in Washington. Paul Ginsburg, HSC president says in a news release that physician practice setting preferences during the past decade likely reflect changes in physician financial incentives. "Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care," he says.

The report cites additional HSC research that suggests the upsizing practice trend may affect the most vulnerable patients -- those least able to afford care. "Physicians in smaller practices with an ownership stake are substantially more likely to provide charity care than physicians in larger practices or non-owners," says the report.

The report also shows that between 1996-97 and 2004-05

Report authors point out that although the number of solo and two-physician practices is shrinking, medical practices of that size continue to be predominant among America's physician practices. Physicians age 51 and older posted the biggest decrease in solo and two-physician practices throughout the decade.

The report represents findings from four HSC community tracking physician surveys conducted by telephone between 1996 and 2001. The first three surveys contained information on about 12,000 physicians; the last survey included responses from about 6,000 physicians. Physician response rates ranged from 51 percent to 65 percent.