Solo and small group (fewer than 10) physician practices are an important piece in California’s healthcare landscape. They serve as access points for consumers to receive healthcare services, emphasize relationship-based continuity of care and serve the geographically and socio-economically underserved. More specifically, solo and small group physicians commonly serve ethnically diverse communities, presenting patients with culturally sensitive and competent care. In terms of access to care, nearly 70% of all ambulatory visits are to medical practices with five or fewer physicians and nearly one-third of U.S. physicians practice in solo and two-physician practices. These statistics indicate the high volume of individuals that utilize solo and small group physician practices for their healthcare needs. Also, the type of care provided by private physician practices is built on patient-provider relationships that develop as a result of ongoing care provided by a single physician. The physician may be more informed of a patient’s family life and general living environment. Recent studies have illustrated that solo and small group practitioners have lower re-hospitalization rates than larger practices; the point being that this aspect of care provided by private physicians may lead to better patient outcomes. Finally, solo and small group practices serve a large portion of underserved Californians. For example, 60% of Medi-Cal consumers receive care from solo and small group practices and between 49% and 85% of primary care physicians participate in Medi-Cal (depending on the region). Additionally, approximately 15% of rural Medi-Cal patients seek care from private physicians or physician groups. The availability of solo and small group physicians to Medi-Cal recipients has a large impact and must not be overlooked. It is these characteristics, as well as access, continuity of care, and a commitment to the underserved that make solo and small group practices a vital part of California’s healthcare mosaic.
However, it has become increasingly difficult for solo and small group physicians to practice medicine due to financial barriers, administrative demands and lack of adequate resources. The difficulties associated with opening and maintaining a practice has led to the downward trend of solo and small group private physician practices. Responses from graduating medical students show only 1.1% of graduates are interested in solo practice medicine. Also, only 1% of physician job searches were for solo practice placements. This data demonstrates the waning interest in solo physician practice over the years. This trend will have broad implications for access to care for many individuals.
As the health system continues to evolve, so does the private practice model. Physicians are joining larger medical practices, closing their practice to specific insurance types (e.g. Medi-Cal), experimenting with new payment models, and retiring. The issues that solo and small group physicians face must be addressed in order for these practices to not only remain a feasible option in California’s healthcare system, but also a source of care that is accessible and affordable for the most vulnerable individuals. This report will consist of three parts that identify and discuss challenges for solo and small group practices that limit their ability to be seen as viable practice models in the current health care landscape. Part I will provide an overview of California’s physician practice landscape. In part II, findings from stakeholder interviews will be covered, revealing the challenges of solo and small group physician practices. Part III will present ITUP’s recommendations for multilevel approaches to support the continual existence of the solo and small group practice model
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