Evidence map›Paper›PMID 42509168›Full record

ArticleAnnals of family medicine2026

Physician Experiences in Health System-Owned Practices and Independent Practices: Insights From Interviews With Primary Care Physicians.

Sara G McCleskey, Maria DeYoreo, Shiyuan Zhang, Kelsey O'Hollaren, Justin W Timbie

Abstract read
In one paragraph

Article in Annals of family medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Sara G McCleskeyRAND, Santa Monica, California.
Maria DeYoreoRAND, Santa Monica, California.
Shiyuan ZhangRAND, Arlington, Virginia.
Kelsey O'HollarenRAND, Santa Monica, California.
Justin W TimbieRAND, Arlington, Virginia jtimbie@rand.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeHealth system ownership of physician practices has grown rapidly, yet little is known about how health system structures and processes affect primary care physicians' day-to-day experiences while delivering care. We aimed to examine how practice ownership influences physician experiences with autonomy, care coordination, infrastructure, and patient relationships in health system-owned versus independent primary care practices.

methodsQualitative study using semistructured interviews were conducted from March through May 2024 with 30 primary care physicians: 15 employed by health systems and 15 practicing independently. Using qualitative content analysis, we compared perspectives on practice infrastructure and operations across settings.

resultsWe identified 5 major themes: (1) health system physicians reported less autonomy in scheduling and operations, but greater financial and legal protections; (2) health systems offered embedded clinical support teams and easier access to specialists, while independent physicians managed needs with limited staff; (3) shared electronic health records and integrated networks in health systems facilitated care coordination and specialty care access while independent physicians relied on manual outreach and professional relationships; (4) health system physicians worked within cultures emphasizing productivity and performance metrics, whereas independent physicians prioritized time and continuity with patients; (5) centralized communication structures hindered patient access in health systems, while independent physicians valued responsiveness.

conclusionsPrimary care physicians in each model face distinct trade-offs influencing care delivery and satisfaction. Health systems provided resources that support integrated care but often constrained physician autonomy and patient accessibility. Independent practices fostered operational flexibility and stronger relationships yet lacked multidisciplinary support.

Indexed as

Attitude of Health PersonnelDelivery of Health CarePhysicians, Primary CarePrimary Health CareAccess to Primary CareAdultElectronic Health RecordsFemaleHumansInterviews as TopicMaleMiddle AgedPhysician EngagementProfessional AutonomyQualitative Researchdelivery of health care, integratedorganizational culturephysicians, primary careprimary health careprofessional autonomy

Identifiers

PMID42509168
PMCPMC13405895

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.