Racial/Ethnic Minority Identifying Family Physicians Are More Likely to Work in Solo Practices

• Ethnic and Racial Minorities
• Family Physicians
• Health Services Accessibility
• Solo Practice

A declining proportion of family physicians (FPs) are working in solo and small practices.¹ Given that FPs working in these settings are more likely to be practicing in rural and underserved areas, the reduction in this workforce has significant implications for access to primary care in these communities.¹ Prior research from 2013 to 2015 demonstrated that a higher proportion of non-White FPs (including Black, Hispanic/Latino, and Asian) are practicing in solo and small practices than their White counterparts.² Thirty-nine percent of non-White patients see racially concordant physicians, and those seeing physicians of the same race/ethnicity have better health outcomes and reduced costs.^3,4 A reduction in the proportion of FPs practicing in solo and small practices may disproportionately affect the health of racial/ethnic minorities and further exacerbate health disparities.

Using a cross-sectional study design, we characterized the proportions of racial/ethnic-minority-identifying FPs in the United States practicing in solo or small practices using responses to the 2014 to 2021 American Board of Family Medicine Certification Examination Practice Demographic Registration Questionnaire, which is a required component of registration for board-certified FPs to continue certification. Race and ethnicity were identified by self-report. Details about the questionnaire can be found elsewhere.⁵ This use of these data were approved by the American Academy of Family Physicians Institutional Review Board.

Of 53,225 FPs, 6,448 (12%) were in solo practice (Table 1). Examining race/ethnicity, 17% of Black FPs, 16% of Hispanic/Latino FPs, and 14% of Asian FPs are in solo practice compared with 11% of White FPs (P ≤ .01). Meanwhile, in larger practices with >20 providers, there were no substantial differences by race/ethnicity of FPs.

We found that a significantly higher proportion of racial/ethnic-minority-identifying FPs, especially those who identify as Black, Hispanic/Latino, and Asian, are practicing in solo practices than their White counterparts. With the proportion of FPs in solo practices declining from 14% to 11% between 2014 and 2021, access for these racial/ethnic minority groups may be at risk because a majority of patients see racially concordant FPs.^3,6 Among various factors, this decline in solo practice has been driven by greater costs related to measurement reporting, electronic health records, and population health management.² With some evidence that solo practices have better outcomes compared with many larger practices,^7⇓–9 racial/ethnic disparities in health outcomes may be further exacerbated by the continuing decline of FPs in solo practice. Future studies are needed to explore how the decline in FPs in solo practices is impacting access to primary care for racial/ethnic minorities and to understand how FPs in solo practices can best be supported in continuing to provide access for patients who identify as racial and ethnic minorities.

• Received for publication September 23, 2022.
• Revision received December 8, 2022.
• Accepted for publication December 13, 2022.