Examines the effect of community size on how physicians view their practices as reported by respondents to two waves (1996-97 and 1998-1999) of a national sample survey conducted as part of the Community Tracking Study (CTS). Results suggest that bigger is not necessarily better when it comes to physicians' perceptions of their practice. A key challenge is whether larger urban-based practices can be decomposed into smaller clinical microsystems that can benefit from the strengths of physician practices in small city or rural settings yet retain the presumed benefits of larger scale organizations.