Is the Size of Your Practice a Good Fit?
Factors to Consider Before You Decide

By Abigail Green
Abigail Green is a writer for Physicians Practice

Are physicians who practice in a large group setting better off than those who choose solo or small practices? Ask a dozen physicians and you’ll get as many different answers. Since studies have found no association between practice size and quality of care, determining the choice that’s right for you comes down to a variety of personal and professional factors.

Going solo
For allergist Robyn Levy, M.D., of the Family Allergy & Asthma Center in Atlanta, the benefits of solo practice can be summed up in one word: autonomy. Levy, who practiced in a two-person group for several years before going solo, likes that “you know all your patients, you know their families, you have a very close pulse on your practice.” She also likes that decisions are up to her alone as the sole physician. “Like today, I sat down with my secretary and went over all the days I would be out of the office in the next year,” said Levy. “I don’t have to worry that that’s not going to work for somebody else.”

Levy believes that more specialists in particular are choosing solo practice these days because of the freedom and flexibility it offers. “As a specialist, you can really make a decision that if I am not here right now, my patients can get at least their basic needs met by their primary provider,” she said. However, she noted that this might not be an option for certain specialists, like oncologists or family physicians.

Given the changing health care environment when he finished residency, ophthalmologist Steven Montgomery, M.D., didn’t consider solo practice an option. He liked the idea of a bigger, more stable practice that offered the camaraderie he experienced in residency. “I enjoyed the ability to discuss patients and share ideas and kind of work together as a team,” he said. Montgomery found what he was looking for at Shepherd Eye Center, a seven-physician practice in Las Vegas.

Group advantages
Anuj Gupta, M.D., of Peachtree Orthopedic Clinic in Atlanta agrees with Montgomery about the benefits of a larger practice: “There’s a much more collegial atmosphere — if you have a question or a problem with a particular patient, there are numerous other physicians in the office off whom you can bounce ideas, and I think that equates to good medicine.”

Before joining his current 24-physician practice, Gupta was part of a two-person group and briefly practiced solo. While the physician conceded that a small practice has the benefit of making decisions more easily since there are fewer people involved, “I would have to say that it’s a very, very small advantage,” he said.

In contrast, a large practice offers some major business advantages, said Gupta. “First, you get to pool your resources in order to hire professional management, so that it takes some of the burden of managing a practice off of the shoulders of the doctors,” allowing the physicians to concentrate on seeing patients. “Second,” he continued, “it allows you to pool your resources and collectively put together ancillary income, such as surgical centers or MRI centers or physical therapy.”

Another advantage of being in a large practice is the collective bargaining power it allows its physicians. For instance, said Gupta, “If you have a group of doctors who are bringing a hospital a lot of business and the hospital is not providing you with the services that you need to take care of your patients, then you have much more of an ability to negotiate with the hospital to provide those services.”

Christina Kennelley, administrator of the Shepherd Eye Center, adds that the economies of scale are a major advantage of larger group practices. “If you have a one-physician practice, you have to have one person who’s an expert in billing, one person who’s an expert at the front desk and one who’s an expert at coding and possibly a surgery scheduler. If you’re in a multiple group practice, you don’t have to continue to hire one of those people for each physician — you can recognize efficiencies.” Having multiple specialists under one roof means offering patients more services within the practice.

The bottom line
While the general belief seems to be that solo physicians have less income since they aren’t generating revenue when they’re not in the office, allergist Levy has discovered that isn’t exactly true. “The reality is that you can be a little bit busier before you leave town and when you return, so that it almost evens out what you might do in a month,” she said. Levy, who employs a physician assistant (PA), a practice manager, six nurses, three front-desk employees and an administrative assistant, now takes off a week during each of the slow summer months. “For the other 15 days that I am here in the office, it will be packed to the gills,” she said. “And it feels great because I still make the same income that I would have in an August or June when I was in town and here everyday.”

Physicians in group practices, however, believe that they are coming out ahead financially. “After a year and a half in my current practice, which is a large practice, compared to two years in my previous practice, financially, I’m doing at least twice if not two and a half times as well as I was doing in that practice,” said Gupta. “I probably spend fewer hours working in this practice than I did in my previous practice, and I’m still making substantially more money.”

Work/life balance
Many physicians base their choice of small versus large practice on which one allows them to better balance work and family life. “The reason I went into ophthalmology is because I did plan to have a family, I wanted to have time to spend with the kids and have some after-hours and weekends available,” said Montgomery, a father of four. Even now as a practice owner, “most evenings I’m home with my family,” he said. “I imagine that if I were in solo practice, I’d be going over all the billing after-hours and all that. For me, I’m glad I chose this direction.”

Specialists like Levy may rely on PAs or primary care doctors to cover for them when they are away from the office, but for the most part, larger groups have the advantage when it comes to taking call. “I spend less time on call; I don’t spend as many evenings and weekends in the hospital, but I’m always very comfortable that my patients are being well cared for by my partners when I need it,” said Gupta.

Levy admits that it takes a commitment to their personal life for solo practitioners to achieve balance, but her advice holds true for solo and group practice physicians alike: “The secret is to never think of yourself as indispensable because you know what? Then you will be. And no one pays that price more than you.”