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Benefits of and Barriers to Large Medical Group Practice in the United States

Sept. 8 2003
Archives of Internal Medicine, Vol. 163, No. 16: 1958-1064
Lawrence P. Casalino, Kelly Devers, Timothy K. Lake, Marie C. Reed, Jeffrey Stoddard

For decades, reformers argued that medical groups can efficiently provide high-quality care and a collegial professional environment. The growth of managed care and the movement to improve quality provide additional reasons for physicians to practice in groups, especially large groups. However, information is lacking on recent trends in group size and the benefits of and barriers to group practice.

Gaining negotiating leverage with health insurance plans was the most frequently cited benefit; it was cited eight times more often than improving quality. Lack of physician cooperation, investment, and leadership were the most frequently cited barriers. Survey data indicate that 47% of private physicians work in practices of one or two physicians and 82% in practices of nine or fewer, and that the percentage of physicians in groups of 20 or more did not increase between 1996 and 2001.

Current payment methods reward gaining size to obtain negotiating leverage more than they reward quality. However, barriers to creating large medical groups are substantial, and most private physicians continue to practice in small groups, although the size of these groups is slowly increasing.

For a full copy of this article please visit Archives of Internal Medicine.

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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.