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Research ArticleOriginal Research

Physician Multisite Practicing: Impact on Access to Care

Imam M. Xierali
The Journal of the American Board of Family Medicine March 2018, 31 (2) 260-269; DOI: https://doi.org/10.3122/jabfm.2018.02.170287
Imam M. Xierali
From Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine, Georgetown University Medical Center, Washington, DC; and Department of Geography and Anthropology, Louisiana State University, Baton Rouge.
PhD
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    An example of 10 practice locations of a urologist who also subspecializes in female urology/pelvic medicine and reconstructive surgery in the Atlanta metropolitan area. Data are based on the Georgia Medicaid Management Information System. The 10 practice sites include 2 cancer treatment centers, 2 hospitals, 3 medical imaging centers, and 3 urologic treatment centers in 10 different locations across 5 counties. HPSA, primary care health professional shortage area (snapshot as of February 8, 2014).

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    Figure 2.

    Map of change in local spatial accessibility after adjusting for the multiple practice sites.

Tables

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    Table 1.

    Number of Practice Sites per Physician Based on Registered Physician Provider Data from Georgia Medicaid Management Information System

    Number of PhysiciansMeanMedianPercentiles
    75th90th95th
    All20,1163.32479
    Age (years)
        <404,6513.62479
        40–496,1403.52479
        50–594,5143.22469
        ≥604,1552.72367
        Unknown6563.12368
    Sex
        Male13,3323.42479
        Female6,13632468
        Unknown6483.12468
    IMG status
        IMG4,3973.22479
        Non-IMG15,0803.32479
        Unknown6393.12468
    Present employment setting
        Self-employed solo practice2,1702. 11246
        Two-physician practice5722.42356
        Group practice8,6943.52479
        Medical school3553.42468
        State/local2,4083.32468
        Federal1133.22479
        Other5,8043.42479
    Primary specialty
        Non-primary care12,9823.624710
        Primary care6,4952.62367
            Family medicine2,2022.82368
            General practice9521245
            Internal medicine2,6432.62357
            Pediatrics1,5552.62367
        Unknown6393.12468
        Other select specialties
            Anesthesiology8943.524710
            Cardiovascular diseases5824.546910
            Diagnostic radiology7168.7492541
            Endocrinology, diabetes and metabolism1211.91234
            Emergency medicine1,0932.92456
            Gastroenterology3933.32578
            General surgery6142.72457
            Nephrology3416481420
            Neurology3092.72457
            Neuroradiology10411.76143444
            Obstetrics and gynecology1,0772.72457
            Orthopedic surgery5243.22478
            Otolaryngology278435713
            Psychiatry5081.81234
            Plastic surgery13721247
            Urology2493.32589
            Vascular and interventional radiology1097.9591830
    • IMG, international medical graduate.

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    Table 2.

    Negative Binomial Regression Predicting the Number of Practice Sites per Physician

    EstimateSE95% LCLM95% UCLMP Value
    Intercept1.18330.01591.15211.2144<.0001
    Age (years)
        <400.28840.02050.24820.3287<.0001
        40–490.27040.01810.2350.3058<.0001
        50–590.15910.01890.1220.1962<.0001
        ≥60Reference
    Sex
        MaleReference
        Female−0.15440.0139−0.1816−0.1273<.0001
    IMG status
        IMG0.02680.015−0.00260.0562.0735
        Non-IMGReference
    Present employment setting
        Self-employed solo practice−0.41380.0225−0.4579−0.3696<.0001
        Two-physician practice−0.320.0394−0.3973−0.2427<.0001
        Group practiceReference
        Medical school−0.06030.0457−0.14990.0293.1873
        State/local−0.07490.0196−0.1132−0.0366.0001
        Federal−0.12330.081−0.28190.0354.1279
        Others−0.06620.0162−0.0979−0.0345<.0001
    Primary Specialty
        Non–primary careReference
        Primary care−0.27810.0138−0.3052−0.2511<.0001
    Dispersion0.4090.00660.39630.4221
    • A total of 19,451 cases were used; 665 cases were excluded because of missing values.

    • IMG, international medical graduate; LCLM, Lower Confidence Limit; SE, standard error; UCLM, Upper Confidence Limit.

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The Journal of the American Board of Family     Medicine: 31 (2)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 2
March-April 2018
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Physician Multisite Practicing: Impact on Access to Care
Imam M. Xierali
The Journal of the American Board of Family Medicine Mar 2018, 31 (2) 260-269; DOI: 10.3122/jabfm.2018.02.170287

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Physician Multisite Practicing: Impact on Access to Care
Imam M. Xierali
The Journal of the American Board of Family Medicine Mar 2018, 31 (2) 260-269; DOI: 10.3122/jabfm.2018.02.170287
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