Group practice impacts on patients, physicians and healthcare systems: a scoping review

Abstract

ObjectiveTo identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems.Study designA scoping review was performed based on the methodology proposed by Arksey and O’Malley, and refined by Levac et al. Titles and abstracts were screened by two reviewers. A quantitative analysis was performed to assess the type, year and region of publication, as well as the population studied. A qualitative descriptive analysis was performed to identify common themes.Study settingMEDLINE, EMBASE and Cochrane databases were searched from database inception to October 2018 for papers which assessed outcomes relevant to the research question.ResultsOur search strategy returned 2408 papers and 98 were included in the final analysis. Most papers were from the USA, were surveys and assessed physician outcomes. Advantages of group practices for patients included improved satisfaction and quality of care. Studies of physicians reported improved quality of life and income, while disadvantages included increased stress due to poor interpersonal relationships. Studies of healthcare systems reported improved efficiency and better utilisation of resources.ConclusionsGroup practices have many benefits for patients and physicians. However, further work needs to be done assessing patient outcomes and establishing the elements that make a group practice successful.

Building organisations, setting minds: exploring how boards of Dutch medical specialist companies address physicians’ professional performance

“…2 Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. 3 Research Department of Medical Education, University College London, London, UK. 4 Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, University of Amsterdam, Amsterdam, Netherlands.…”

“…Governments in high-income countries are reforming healthcare systems to achieve high quality and safe care while maintaining costs [ 1 , 2 ]. To meet reconfigurations demands, self-employed physicians reorganise themselves into new and often larger organisations, impacting their work environment and practice [ 3 – 7 ]. Self-employed physicians may find that by reorganising, they gain control over their work, allocate resources more efficiently [ 5 ], or create a strong collective that may offer more power to negotiate with hospitals [ 8 , 9 ].…”

“…Therefore, it is problematic that we have limited insight into how novel physician-led organisations like MSCs achieve high quality and safe care [ 3 , 5 , 19 ]. More particularly, knowledge about effective strategies to address physicians’ professional performance is lacking [ 4 , 11 , 20 ].…”

Identifying desired qualifications, tasks, and organizational characteristics of practice managers—a cross-sectional survey among group practice physicians in Germany

“…This can be interpreted as a sign of a PM’s positive effect on the personal time and efficiency gains for physicians. Nevertheless, it also emphasizes the need for interpersonal relationship management and managerial tasks in larger practices [ 10 , 13 , 25 , 26 ].…”

“…An international scoping review found that while group practices improve physicians’ quality of life, the higher stress caused by the more complex interpersonal/staff relationships is a disadvantage [ 25 ]. In a German context, it was confirmed that burnout in joint practices was higher than in solo practices [ 30 ].…”