US Generalist Physicians and Groups That Focused Practice in a Single Care Setting: 2014-2017

Area of Science:

• Health Services Research
• Primary Care Medicine
• Geriatric Medicine

Background:

• Generalist physicians, trained for primary care, are increasingly practicing in facility-based settings like hospitals and nursing homes.
• It remains unclear if this trend correlates with an increase in generalists focusing on office-based care.

Purpose of the Study:

• To examine trends in the prevalence of generalist physicians and physician groups practicing in a single care setting.
• To understand practice setting specialization among generalist physicians.

Main Methods:

• Retrospective cross-sectional study utilizing 2014-2017 Medicare fee-for-service billing data.
• Analysis focused on generalist physicians trained in family medicine, internal medicine, or geriatrics.
• Measured the proportion of patient visits by physicians across office, outpatient hospital, inpatient hospital, and other settings.

Main Results:

• The proportion of generalist physicians specializing in a single setting increased from 62.80% to 67.00% between 2014 and 2017 (6.69% increase).
• A statistically significant trend (p < 0.001) indicated increasing practice focus on single settings.
• In 2017, only 4.63% of physician groups comprised physicians from multiple setting types.

Conclusions:

• Generalist physicians, particularly those caring for older adults, are narrowing their practice focus to single health care settings.
• This specialization trend was not mirrored by an increase in multi-setting physician groups.
• Further research is needed to assess the impact of these trends on primary care fragmentation and patient outcomes.