To the Editor:

The article about the collapse of medical management groups was excellent [“Disintegration: How Employed Doctors Are Landing on Their Feet,” November/December 1999]. But it didn't mention one of the major problems our practice met in dissolution with MedPartners.

MedPartners' management framework left our five-physician, one-nurse-practitioner practice with a MedPartners manager (who left when the company did), a general office manager and five supervisors. After the MedPartners affiliation ended, with no financial history to work from, we needed months of observation and financial monitoring to determine that we were extremely top-heavy in management. We increased the number of physicians to seven and were still able to pare our management staff down to a general manager, one accounts-payable manager, one nursing supervisor and one staff supervisor. The change in management saved our practice nearly 10 percent of our operating costs.

My advice to any physician resuming management of his or her own practice is this: Analyze your management needs early on and adjust them quickly to avoid unnecessary expenses.