The day of solo practitioners is coming to an end. In its place will be gaggles of gastroenterologists and flocks of physicians. Mega practices are becoming the norm in American medical care.

Here’s a few pictures of this trend, somewhat dated (they only go through 2015) but still quite revealing.

The figure below illustrates the distribution of primary care physicians in the U.S., from June 2013 to December 2015. It reveals that over just 18 months, there was a big decline in the percent of physicians in solo or two-physician practices. There was a commensurate rise in the percent of physicians in groups of five hundred or more docs:

The rate of change is slower for some specialists. But the trend is the same – fewer small group practices and more mega practices:

There are lots of factors promoting these changes. Providers are adapting to new reimbursement models that reward physicians who can better coordinate care, which is easier to do in a larger group.

Physicians are being pushed to adopt electronic medical records, which require large investments that are often beyond the reach of small practices.

A lot of physicians want to have a better work-life balance. Practice with one other doctor, and you’re facing call every other night. Not exactly conducive to coaching your kids in soccer.

And of course, there is price negotiation. When insurers demand lower prices from providers, large group practices have the leverage to say no.

I don’t have strong feelings about whether this consolidation trend is good or bad, overall, for the quality of medical care or the lives or practicing physicians. Whatever the balance of pros and cons might be, I expect the movement to consolidate physician practices isn’t about to reverse course.

Welcome to the new normal.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

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