Small urology practice model may pay big dividends

May 1, 2012

There is certainly a perception that urologists are consolidating into larger and larger organizations, as well as an implication that the small practice model is no longer economically viable. Yet urologist John E. Bertini, Jr, MD, has been able to start, grow, and maintain a small, successful independent practice in downtown Houston for 25 years.

Key Points

Opening his solo general urology practice at St. Joseph Hospital in 1987, Dr. Bertini took his first partner several years later, and this year will add a third physician. The practice has sought to manage growth and expenses by seeing patients not only in a central office, but also in the offices of two large primary care organizations and a rehabilitation facility/clinic.

Dr. Bertini's practice is productive, efficient, and full service. New patient and total patient volume are in the top 50th percentile nationally, and the practice employs four full-time equivalent staff members per physician-which is below the median FTE/physician of 5.24 for "better performers," according to the Medical Group Management Association. Cystoscopy, prostate biopsy, and other procedures are typically done in the office, not a separate ambulatory facility. Each physician blocks two half-surgery days to maximize time and efficiency in the clinic. With the addition of a new physician, this practice will offer full-service adult urology inclusive of robotics.

The business and compensation model is straightforward. Each physician draws a salary, and the practice sets aside a bonus pool. Participation in the bonus pool is based upon a simple production formula. Like many academic models, and in contrast to the large practice model, Dr. Bertini notes his small business cannot take advantage of some business opportunities such as ancillary imaging, radiology, and radiation centers.

"We neither benefit from ancillary revenue, nor are we heavily dependent upon passive income. We are also fortunate to have many high-quality facilities available to our patients," Dr. Bertini said.

Finally, running a small practice may offer less complicated decision making and politics than a large practice. "We don't have so many personalities" to consider in running the business, Dr. Bertini said.

Bottom line: I asked Dr. Bertini to summarize the principles of his success.

"Patients and referring doctors still respond to compassionate care and clear communications," Dr. Bertini said. "Treat every patient such that they feel you are competent and concerned about them. Be on time, be personable, be conversant, and don't overbook. Treat employees with respect. Get involved in medical staff leadership. Be active in your community. Be honest in your business dealings. Choose your partners wisely. Reserve time for your faith, your family, and yourself." Amen.

Dr. Dowling is an independent consultant and the former medical director of a large metropolitan urology practice. He resides in Fort Worth, TX.