3. How Are Family Practices Organized?

Commentary

Family physicians practice in a variety of organizational settings, with the largest share working in hospital- or health system–owned practices, with a sizable proportion still working in independently-owned practices.

Commentary

Nearly 40% of family physicians providing outpatient continuity care work at additional clinical sites beyond their primary site. Here is a snapshot of the variety of places they serve. 

Connections and Context

A growing number of family physicians are integrated into larger health systems, but many still work in independent, academic and publicly-financed practices crucial to serving vulnerable populations (Rittenhouse et al, 2021, Rittenhouse et al, 2024). Many family physicians work across more than one clinical site as part of their routine practice, reflecting the flexibility of the specialty and helping extend access to care across communities and care settings. With broad training as specialized generalists, family physicians are known for adaptation of their practices, regardless of location, to the demands and needs of their communities (Price et al, 2022).

Commentary

Family physicians practice in settings that span inpatient, outpatient, emergency, and community environments. Because of this breadth, collaboration with a wide range of healthcare professionals is central to how family medicine is delivered. These collaborations often include clinical support staff such as medical assistants (MAs), certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs), who contribute essential functions in patient care, care coordination, population health, and patient counseling. Family physicians also frequently work alongside nurse practitioners (NPs) and physician assistants (PAs), with supervisory or collaborative arrangements that vary by state legislation and organizational structure. Additional team members may include ancillary professionals, such as pharmacists for medication optimization, psychologists and social workers for behavioral health support, psychiatrists for complex mental health conditions, and care coordinators who help address social needs and transitions across care settings. Community health workers are also a growing addition to an effective primary care team.

Connections and Context

Team-based care is foundational to effective primary care. Family physicians, with their whole-person, relationship-centered training, are uniquely positioned to lead and thrive within these interprofessional care teams and report work with a wide range of healthcare professionals. (Jabbarpour et al, 2020). These team-based models enable more coordinated, patient-centered, and sustainable primary care delivery (Bitton, Fink, 2024). As these practice collaborations grow more popular, evidence is being generated on how to best integrate teams for better patient care (Solberg et al, 2025; Nguyen et al, 2025). When care is shared among skilled professionals, patients experience more coordinated and equitable care, clinicians are better supported in practicing at the top of their training, and health systems benefit from improved efficiency and outcomes. 

Commentary

Family physicians care for patients from birth well into adulthood, often extending that care to their patients’ children and other family members. This is a unique facet of family medicine as a specialty within U.S. primary care.

Connections and Context

Family physicians are said to care for patients of all backgrounds and ages, from ‘cradle to grave.’ This range of competency explains not only their adaptive value to whole communities and populations, but is a trait that may be worth preserving for the sake of family physician wellbeing, if variety is indeed the ‘spice of life’ (Weidner et al, 2018; Schrager, 2019). Individual family physicians’ panels of patients have historically varied widely in age range, depending on the urban/rural mix, presence of specialist groups, and other structural factors. 

Commentary

Nearly 65% of family physicians report that over 10% of their patients come from historically marginalized communities, with this share rising as rurality increases. Family physicians continue to lead in the primary care space by serving medically underserved patients where they live and work, highlighting the importance of care in place.

Connections and Context

Compared to other primary care physicians, family physicians care for a greater proportion of historically underserved patient groups. These populations include individuals and communities historically marginalized due to factors such as race and ethnicity, low income, rural residence, disability, language barriers, and limited access to care, underscoring the importance of care in place. Approximately one in five family physicians reported that over half of their patients were a part of such a group.

Commentary

Commentary: Fee-for-service payments continue to dominate primary care reimbursement models, including in family medicine; however, value‑driven and quality‑focused payment models are rapidly gaining ground. These alternative models drive a systems level and a public health focused shift in primary care delivery, with family physicians leading the way.

Connections and Context

Despite the rise in value-based purchasing programs, the majority of family physician payments remain fee-for-service value‑based reimbursement, bundled payments, and membership‑based/direct primary care, being assessed with increasing frequency (Park et al, 2018). Overall spending on primary care remains low at 5-7% of total spending on healthcare (Martin et al, 2020), despite public perceptions of much higher investment in this vital function (Ma et al, 2025).