Small Independent Primary Care Practices Serving Socially Vulnerable Urban Populations

Area of Science:

• Primary Care Medicine
• Health Services Research
• Social Determinants of Health

Background:

• Independent primary care practices are crucial for serving socially vulnerable populations in urban settings.
• Understanding the operational realities and challenges faced by these practices is essential for policy development.

Purpose of the Study:

• To quantify the extent of family physicians serving socially vulnerable patients in urban independent practices.
• To explore the practices, challenges, and support needs of physicians in these settings.

Main Methods:

• Quantitative analysis of national physician recertification data (2017-2020).
• Qualitative in-depth interviews with 22 physicians owning small, independent urban practices serving a majority of socially vulnerable patients.

Main Results:

• The proportion of urban family physicians in small independent practices (1-5 clinicians) decreased from 22.6% (2017) to 19.3% (2020).
• Nearly half of these physicians reported over 10% of their patients were socially vulnerable.
• Physicians identified significant time on social determinants of health, minimal external support, financial strain, future concerns, and strong personal commitment.

Conclusions:

• Small independent practices serving vulnerable patients rely heavily on physician personal sacrifice.
• Health equity policies are recommended to alleviate physician burden and sustain these vital practices for vulnerable patient access.