Impact of the organization of practice on quality of care and physician productivity.

The association between group practice, on the one hand, and productivity and quality, on the other, is reviewed using data from a universal health insurance system. Although different patterns of practice were observed, only members of very small groups had higher patient volume than did solo practitioners. Diseconomies of scale in large groups are found. Patients were shown to visit group practitioners for somewhat more serious problems. Finally, group and solo physicians were compared both according to their standards of patient selection for tonsil/adenoid surgery and according to the outcomes of this surgery. No differences in these measures of quality of care were found.