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Derms aren't forsaking smaller practices


A new study suggests that while the proportion of physicians in solo and two-physician practices decreased significantly in 2004-05 for all specialties combined, dermatologists have remained largely committed to solo or two-practitioner practices.

Key Points

The telephone survey by the Center for Studying Health System Change in Washington polled 6,611 doctors, including 100 dermatologists. The research reveals that doctors, in general, are giving up their ownership stakes and moving away from the smallest practices toward more mid-sized, single-specialty groups.

The center, a nonpartisan policy research organization, conducted three similar prior surveys in 1996-97, 1998-99 and 2000-01. The survey results break down practice size by specialty, comparing 1996-97 results with those of the latest survey in 2004-05.

"Dermatologists do stand out. In terms of subspecialties that we looked at, dermatologists had the highest level of physicians remaining in solo and two-physician practices," Dr. Grossman says.

Other practitioners

The specialty with the closest high proportion of solo and two-physician practices is otolaryngology, with 49.3 percent of doctors in solo or two-physician practices in 2004-05. But, unlike dermatologists, otolaryngologists saw a significant dip in the proportion practicing in the smallest practices, which in 1996-97 was 57 percent.

The proportion of primary care physicians in solo or two-physician practices remained stable, at about 36 percent between 1996-97 and 2004-05.

Other dermatology-related study findings include:

"Trends in physician practice setting and ownership likely reflect changes in physician financial incentives over the past decade," said Paul B. Ginsburg, Center for Studying Health System Change president, in a press release.

"Physicians appear to be organizing in larger, single-specialty practices that present enhanced opportunities to offer more profitable ancillary services rather than organizing in ways that support coordination of care," he says.

Those incentives do not seem to be driving dermatology, Dr. Grossman says.

"Historically, we have always been in solo practice because we have less demanding call schedules," says Patricia K. Farris, M.D., a dermatologist practicing solo in Metairie, La.

Dr. Farris says she can call on a network of dermatologist colleagues to cover for her when she is away from the office, and a physician assistant helps to offset the workload.

While Dr. Farris says she likes the camaraderie associated with physician partnerships and thinks it would be nice to share the costs of running a practice, she says those incentives don't make her feel compelled to add dermatologists, who she says are in short supply.

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