Hey, check out frequent Chip's Blog poster Brandon Bettancourt making a splash on the AMA WWW site in a piece about chosing a PM system during this age of EHR purchasing. I have to say that I can't argue with the list of questions everyone should ask any potential PM vendor.
Meanwhile, back with some data. One assumption made by many is that larger practices make more money per provider - not necessarily true, as I have pointed out before. In fact, I think that practices who merge (vs. grow organically) make less money.
Although the graph below doesn't address the cost side of the balance sheet, it provides interesting detail about the earning potential of pediatric practices. To summarize: there is a slight negative correlation between the size of a practice and the expected income per physician. In other words, our smaller clients earn more $$. More about that in a second.
I deliberately left off the values on the axes so that an extra-curious reader can't figure out information about some of our clients. And, I removed from the image a few outliers who would have been easy to identify (namely, the larger practices). But as you climb the Y axis, you are looking at larger practices. As you extend on the X axis, you are looking at physicians generating more revenue.
The implication here is that larger practices don't generate more income per pediatrician. And, as a rule, they don't. To test my theory, I ran a similar analysis comparing practice size and patient volume - it looks nearly identical. Smaller practices are also busier. What a surprise.
So unless there is some magic on the accounts payable side of the equation for larger practices (which there is...sometimes good, sometimes bad), smaller practices generate just as much revenue as larger practices on a per-provider basis.
What do you say about that?
Large group productivity
Hey Chip, I admit to being remiss about reading your blog, but, as I sure you know, I could not help but comment on your productivity posts. There is no question that a tightly run, low overhead solo practice can earn more money than a poorly run large practice. The key is in how the practice is run. A badly managed large group, of which I know many, will clearly do worse than a better managed large group and a better managed small practice. Also I think the earnings per physician is not the value to look at. The earnings per equity partner would be a better value. If a practice is structured where everyone is a partner, then I would tend to agree with you (God Forbid). MGMA data clearly shows that earning per physician is best among medium size groups (11-20 or so) and goes down when the group gets bigger. If you are small, in a market where you can negotiate effectively, know how to negotiate effectively, see patients efficiently, and manage your expenses, I have no doubt that your earnings for yourself will be higher than a group. Those are a lot of ifs, however, and depend on the small practices being business savvy, which is is the exception rather than the rule. I think your sample is not representative of pediatric practice where gaining size allows your to buy expertise and business skills (other than consulting one of us, of course). As we all know the key is management, not size, although I think the combination of moderate size, good business structure with employed physicians rather than partners, and good management will yield the best results. Herschel Lessin MD
> Hey Chip, I admit to being
That's OK, I've been remiss at writing them :-)
Exactly. The problem - a problem, anyway - is that many large practices sell themselves purely on their size and non-existent superior services.
Yes, that would be nice but a) I don't have that data and b) there should be a strong correlation, don't you think?
Here's the question, though: why does the earnings-per-physician go down as the practices get larger? Physicians working a little less?
Chip Hart - Pediatric Solutions
chip @ pcc.com
800-722-7708
http://pedsource.com/blog
Hey Chip
I think earnings per physician go down depending on the practice structure. If everyone is a partner, then all are earning the same, hopefully high income. I think senior docs may try to slow down and will therefore be supported by younger docs in most practices. Also, there comes a point, where incremental physicians and size does not give much of a return, although this will depend on market share potential. Also, everyone may work less. In data I have seen from Modern Physician, earnings per physician are highest in the 11-25 size group and decline thereafter. If you are hiring employed physicians or mid levels then the per partner earnings can be better maintained.