A few weeks ago, I opened up a survey with a very specific intent: to find out what, if any, demographic and resource-demand patterns exist among independent practices opening up over the last few years. As Susanne Madden and I have noted at the NCE, we feel like we are seeing an interesting change in the "face of the AAP." But feeling a change is not the same as actually measuring a change, so off we go.
In this first of a three-part report, I'll fulfill my promise and share the results from the survey. Part One will focus on the demographics of pediatricians and their practices. Let's begin by looking at the makeup of the respondents themselves.
- 114 total respondents. Statistically significant? Perhaps not. Significant for discussion? No question.
- 62% are female, 38% male.
- 61% are 46 years old or older - 39% are 45 or younger. 16% are 40 or younger!
- When you cross reference these variables, you quickly see what many of us have known for some time: younger pediatricians are more likely to be female - almost 50% of the women who responded are 45 or younger, 20% are 40 or younger. In contrast, only 9% of the men are <=40 and 25% <=45.
The AAP must know this information from membership data already, but what's important here is that it's reflected in independent pediatric practices. More on that in a bit. What else did we learn? Ethnicity distribution is also no surprise:
- 23% of respondents effectively reported as "non-white."
- 70% of non-white respondents are women.
- Furthermore, the majority of non-white respondents are also under 46 years old.
If we conclude that the survey is even remotely representational of independent pediatric practices, it's clear that the younger a pediatrician is, the more likely it is that she's female and non-white. The alternative to this supposition is, I suppose, that young, non-white female pediatricians might enjoy taking on-line surveys more than their older, white, male counterparts. I am not convinced.
Let's keep going and look at the practice demographics and tie those together with the individuals.
- 23% of the practices represented are solo. 22% have 2-3 clinicians, 33% have 4-8, 17% have 9-20, and 5% have 21+. This very much aligns with what PCC sees in the wild with perhaps less emphasis on the middle of the pack.
- Where do people practice? 14% report being urban practices, 69% report suburban, and 17% report being rural. Again, concurrent with our subjective view.
- Medicaid coverage has a distribution that syncs with PCC's benchmarking data: 25% report <5% Medicaid, 12% report 5-10%, 11% report 11-20%, 11% report 21-30%, 21% report 31-50%, 7% report 51-70%, and 11% report >70%.
- 92% of the practices represented are independent groups. 3% are in "super groups" (still independent) and the remaining 5% are owned by a hospital/health system.
- 92% of the respondents report being owners/partners in their practice. Aligns clearly with the above. However, only 53% report being a founder of their practices.
- Finally, the average practice has been open for 26 years, but the stddev is 21 years! Almost 20% of the respondents have opened their practices some time since 2010.
Now, looking at the above, are there any correlations with the other demographics?
- Women are much more likely to be in smaller practices - 36% more likely to be solo, for example. Women are more likely to be in younger practices, too.
- Women are much more likely to be in rural practices and a little less likely to be in suburban practices.
- Women are much more likely to be in high-Medicaid practices. This also means they are less likely to be in low-Medicaid practices.
- Women are more likely to have started their own practices. [Here, your alarms should be going off.]
Because of the high correlation among gender, age, and ethnicity - i.e., younger, non-white women - most of these correlations above track across all three variables. For example, doctors under the age of 46 have a much higher concentration of Medicaid than their counterparts (it's findings like this that really raise my eyebrows - are you listening, AAP?). However, a few distinctions jump out:
- non-white physicians are much more likely to be urban and, to a lesser extent, rural. In other words, these physicians are not setting up shop in the places where 80% of the pediatricians are presently serving patients. Are we surprised at this natural progression of the market? Pediatricians have been feasting on the less-Medicaid-heavy suburban populations for years, so new pediatricians have to push into tighter markets. Not only does this look like a clear evolution in the market, it may also indicate where these physicians come from. Remember this.
- younger physicians are also more likely to be in urban and rural (vs. suburban) settings.
In the next installment of the examination of this data, we're going to look at where pediatricians get their practice management advice. The third installment will focus on who is creating new independent practices - I think the results might startle anyone who hasn't been paying attention.