Bigger practice, better quality? Practice size not the complete answer

New research suggests that larger physician groups deliver better care, but some doctors say there are ways solo practices can compete on quality benchmarks.

By Kevin B. O'Reilly, AMNews staff. Nov. 26, 2007.

Large physician groups have long had a head start on solo and small practices in the medical marketplace because they can negotiate better health plan contracts. Now, a rising tide of evidence indicates that size also confers a quality advantage.

Researchers admit that the medical literature emerging on the relationship between group size and quality is far from a slam dunk. They argue, however, that bigger physician groups can pool capital to pay for electronic medical records systems and other quality initiatives that help them more reliably deliver guideline-based care.

On the opposite end of the spectrum, a small but growing movement of doctors is experimenting with a leaner model of medicine that they say improves the financial viability of solo and small-group practice and, most importantly, improves patient care.

While medical skill may vary among individual physicians, an overriding question is the extent to which the system in which doctors practice can improve the odds that their patients will receive the right care at the right time. Is a system of giant, integrated medical groups the right path for medicine's future, or can the traditional small practice be redesigned for the era of quality measurement?

Trying to understand the connection between the practice structure and patient outcomes is "the Holy Grail of studies of physicians and quality," according to a December 2006 Annals of Internal Medicine editorial authored by Lawrence P. Casalino, MD, PhD.