Damn the Reality of Small Practices - Full Speed Ahead

The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small practices. Studies concede that small practices and hospitals have problems with the rapid changes and redesigns

Can small practices recover after the last 4 years of "Damn the Torpedoes" reorganization and rapid change?

Government, insurance, and foundation designers of health care have facilitated rapid change without consideration of the landscape of health access. Health access workforce where needed:
  • Is about half primary care and half non-primary care clinician
  • Is more likely to involve smaller practices as clinician need increases
  • Is more likely to involve family physicians due to the enhanced distribution of FM
  • Is more likely to involve older physicians nearer to retirement - more vulnerable to the rapid change
Damn the reality, full speed ahead for more specialties added outside of primary care with more added to each specialty for MD, DO, NP, and higher specialization means further concentration into locations that already have top concentration.

There remains the ignorance of the importance of permanent broadest generalist clinicians, most primary care experience, long term continuity of primary care clinicians, insufficient revenue for primary care, consequences of innovative payment designs, consequences of being forced to spend even more while generating less revenue

And all more important in small practices and those most needed for most Americans falling further behind.

Small hospitals and small practices are fragile. Once they are gone, their patients will have no where to go and no way to spend local dollars locally, where care and economic impact are most needed.

Graham Center Small Practices


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Blogs indicate that primary care can be recovered and should be recovered.

Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.

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