Small family physician practices are often thought of as a dying breed in the field of medicine. How can they possibly compete against large hospital systems with more staff members, more physicians and more resources? In this David and Goliath scenario, smaller practices have a few tricks up their sleeves.

Over the summer, Health Affairs released a study highlighting how small primary care practices have low rates of preventable hospital admissions (ambulatory care–sensitive admissions). Researchers conducted a national survey of 1,045 primary care practices with 19 or fewer physicians from July 2007 to March 2009. Using data from the National Study of Small and Medium-Sized Physician Practices and 2008 Medicare claims, the study found that practices with one to two physicians had 33% fewer preventable hospital admissions when compared to practices with 10 to 19 physicians. The study also found that physician practices with three to nine physicians had 27% fewer hospital admissions. In addition, physician-owned practices had fewer preventable admissions than hospital-owned practices. The authors of the study noted that 40% of admissions may have been preventable.

Bigger isn’t always better

While it is often assumed that larger practices can provide better patient care, there is little evidence to support this notion. In fact, the majority of U.S. office-based physicians work in practices with fewer than seven doctors. The study sought to determine the relationship between practice size and quality of care. So what exactly do these small practices have that bigger physician practices don’t?

The study suggests that smaller practices have the ability to foster better patient relationships since they have greater access to their physicians over the phone. Patients of smaller practices also have an easier time scheduling appointments when they need them the most. In smaller practices, it is possible for patients to develop closer ties to physicians and staff members, which may ultimately lead to better health outcomes.

These are just a few key characteristics to consider when examining different physician environments and how they may affect hospital admission rates. Other factors may include ownership, incentives, processes (patient-centered medical homes) and relationships with insurance companies.

Challenges for small practices

Small physician practices may be thriving and improving patient care, but there are challenges that remain. These groups often practice under the threat of hospitals stealing patients through decreased referrals as well as poaching physicians and attracting high quality staff away from practices that need these resources.

These practices are also at a disadvantage when it comes to technology. Larger practices will most likely have increased access to health information technology (HIT) to help them better manage large volumes of patient data.

To give these smaller practices a fighting chance to sustain their current business models while providing quality care, medical groups and hospital leaders looking to acquire small practices should find a means of collaboration. Small practices would benefit from policies that would allow them to share resources with larger practices to improve patient care overall.

In today’s changing healthcare environment, practices big and small should increase their efforts in keeping patients out of hospitals. Through better coordinated care and shared resources, physician practices and hospitals can work together to dramatically decrease admission rates and create a healthier patient population.


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