Single Provider Practices

Today I read an op-ed article from a provider lamenting the eminent demise of the single provider practice. His feeling was that the single provider would need to be replaced over time by a multi-specialty practice due to economic realities. As I read the article, I understand why he thinks so, but believe his basic premise is ill-gotten.He based his whole argument on rising costs of the single provider and alleged that a multi-physician practice would cut his cost and ultimately reduce the cost of medicine. The reason I say this is because he asserts the opposite, that the single provider is what is driving up the cost of medicine.My observations do not bear these out. Many single provider practices get along quite well and charge less than most multi-provider practices we take on as clients. Actually, I have to encourage most of the single providers to increase their rates while the multi-providers jump on the band wagon from the get go.Part of the reason he feels the multi-providers reduce costs is a mistaken belief in cost sharing among those providers. For example, he feels that only one receptionist, and only one medical billing clerk would be handling the work. The reality I see is just the opposite. In the multi office, the labor force intensifies; more front office, more medical billing clerks, more clerical staff until it becomes buried in bureaucracy. The single office is not that way; it is more focused on the bottom line. I find that for every physician in the office, the number of personnel can easily be 50% to 100% more per physician than in the single physician office.We recently took on a practice with two physicians. They had four people just doing the medical billing, four nursing staff, one PA, three front office, an office manager and an office manager assistant. They count superbills, they count EOBs, they hand them off to someone else to count them, the add them, they stack them in a pile to be handled later until the pile becomes unbearable and meanwhile, they have sufficient time to socialize among themselves in the office and with their associates via the phone outside the office. The accountability factor drops to nil. My staff is much more efficient-don’t get me wrong, they have plenty of time to socialize but one medical billing position can easily handle six providers and in many cases handles up to ten. The larger the practice, the more inefficient they are. In this case alone, we would reduce the personnel by three and there is plenty more fat that could be cut out. Yes, the practice is making money, but it could be thriving rather than just making money.The authors basic premise was that the multi practice would have more money at the end of the year and that is likely correct, but it has less money per physician at the end of the year. As each provider comes on board he has his own desires and needs and from that comes duplication of services and increase in inefficiency!