Many private practices—for example, doctors, dentists, lawyers, and veterinarians--are merging into larger entities.

That’s not all bad for the consumer. The professional has on-site colleagues with whom to discuss your situation. And cost savings may accrue from shared equipment and facilities.

But larger practices have downsides. The consumer must usually pay more because, in addition to paying the practitioner, the fee includes profit for the firm. For example, I have had many clients who are lawyers working for a sizeable law firm. Most of them are under strong pressure to maximize billable hours at a rate much higher than what they would charge as a solo practitioner.

Also, as businesses, large practices shift much work from the professional to a paraprofessional. In theory, that should save the client money but I wonder whether the saving is always worth it: consulting a nurse practitioner instead of your physician, a paralegal instead of your lawyer, a dental hygienist instead of your dentist.

Apart from the difference in expertise, the professional delegating much the work to one or more paraprofessionals creates the need for accurate communication and recordkeeping. That takes time and increases cost, and an even occasional error in communication can cause an outsized problem.

Finally, when only one person is responsible for a case, that person may be more psychologically invested than if s/he parcels out pieces, for example, to a co-counsel, paralegal, or legal secretary. I believe my physician, John T. Jones, cares more about me (and I about him) because he’s seen me himself for 30 years now. Same with my dentist, Thomas Smithers, who chooses to clean my teeth rather than have a hygienist do it, even though he could make more money doing dentist-level work on another patient. I co-counsel with solo-practicing psychologist Michael Edelstein. My doggie Einstein’s vet, Gerry Dzendzel, is a solo practitioner as is the lawyer who created my estate plan, Mark Wahrhaftig. I just had to hire another lawyer, Brian Heitner, and he works in a very small firm. I sense that they all care more about providing fine service than about profit maximization.

Of course, there are good and bad choices within a firm of any size. Here are a few thoughts on choosing a professional:

  • Yes, get referrals from friends and from a professional association (for example, a local medical or legal society) but ask them questions to help ascertain whether that professional would be well-suited to you. For example, “I’m going to be seeing a doctor to (insert your primary objective.) Do you get the sense s/he’d be good at that? Also, describe the kind of personality you work well with, for example: fast-paced versus relaxed, brilliant but cocky versus average but humble.
  • Yes, consider online reviews but take them with grains of salt. Trust bad reviews more than good ones—friends of the professional often post the paeans. But bad reviews can sometimes come from competitors posing as clients or simply are clients who have “issues” and blame the professional unfairly. Rule of thumb: If  the professional has a large number of reviews, most of which are laudatory, that’s a worthy data point in their favor. Beyond the numeric rating, look at why the professional got good and bad reviews. That can help you decide how much weight to give them.
  • If possible, before making a paid appointment with the professional, speak briefly with him or her. Get in touch with how you’re feeling as you’re interacting. Do you feel confident this person can help you? That you’d get along with him or her? That you’d trust this person?

In a complex situation, a team may be needed but I’m wondering whether, as consumers, we might generally be wise to give preference to solo practitioners and to very small group practices.  

Marty Nemko's bio is in Wikipedia.

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