Urologists Make the Shift

May 1, 2013 – In The News
Urology Times

As waves of change in medicine erode urologists’ ability to go into and stay in traditional solo and private practices, many new urologists are opting for hospital employment. This is as established practitioners wonder whether solo—even small-group practice—survival is possible.

Todd A. Rodriguez, said urology solo and private practices are particularly vulnerable to change given the specialty’s dependence on insurance covered services, which include office visits and ancillary services.

“The problem is that in order to have those ancillary services and make them profitable, there has to be a certain amount of volume that goes through the practice. Solo practitioners in urology generally can’t support radiation therapy service, for example, without being part of larger group practices,” Rodriguez said.

There are good reasons to be in a larger, integrated group practice according to Rodriguez.

“Certainly, there are opportunities to improve the delivery and quality of care because you have a larger patient population,” he said, “and you can share information among doctors in the group practice. You can analyze patient statistics and see what kinds of treatment modalities work better than others. And you can do all that in an integrated basis. That’s one of the big pushes for health care reform: to integrate the delivery system.”

From cost and administrative standpoints, being in a larger practice allows urologists to share financial risks and practice burdens, and offers economies of scale.

“So if you have to buy a $500,000 electronic medical record system and you spread that over 20 doctors, it’s certainly a lot more tolerable than bearing that cost yourself or sharing it with two or three doctors,” Rodriguez said. “You can generally hire more expensive advisers. Smaller practices can’t afford a compliance officer, for example.”

Whether it’s better to go with a single-specialty or multispecialty group is a matter of preference.

“The common thinking with multispecialty is that you have a built-in referral base,” Rodriguez said. “On the other hand, all the other primary care doctors in the community may not want to refer to you because they are afraid of losing their patients to your partners who are in primary care.”

According to Rodriguez, multispecialty practices often struggle with income division issues because some specialties are more labor intensive and may not generate as much revenue as other specialties.

“I have seen situations where there can be some contention over how different specialties in a group practice should share in practice profits,” Rodriguez said.