The results of the “Grade Your Payers” survey are reported in this issue. The survey, which Family Practice Management conducted in concert with the AAFP, was designed to collect family physicians' opinions of the health plans they deal with. And the opinions collected are about as negative as you'd expect.

It's important to realize that the survey instrument was published in FPM and posted online for completion by any AAFP member who wished to respond. Clearly, that means that the results cannot be taken as representative of the entire AAFP membership. At the same time, though, the methodology means that the survey instrument was a widely distributed, extraordinarily open invitation to all AAFP members to say what was on their mind. Published as it was in FPM, available online, covered in AAFP News Now and mentioned in various FPM and AAFP e-mail notices to members, it must have been brought to the attention of a large proportion of AAFP members.

What, then, are we to make of the fact that only 307 members completed the survey? The last survey FPM conducted using a similar methodology collected more than 400 responses, despite being a longer, more involved survey on what one would think was a niche topic: electronic health records (see “Electronic Health Records: A User-Satisfaction Survey,” February 2005). And what do we make of the fact that 50 percent of respondents to the payer survey are in solo practice while the percentage of solo docs in the Academy's membership at large is only 18 percent?

While we can only speculate, I would bet that both of these phenomena have the same explanation: The smaller their practices, the more likely physicians are to be exposed to the raw reality of dealing with third-party payers. Physicians in larger groups, insulated by a layer or two of administrative personnel, will be less likely to feel the pain or have opinions they want to express. If this is true, it makes the results of the “Grade Your Payers” survey that much more important for them. Large groups and solo physicians practice in the same health care system; they breathe the same air. If there's something noxious in the air, the soloist may be overcome first, but the big groups need to know they're just as much at risk.