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Practice in Focus: Large, single-specialty practice offers freedom to endocrinologists
Northeast Florida Endocrine & Diabetes Associates, originally started by two physicians, now claims to be one of the largest private endocrinology practices in the nation, David R. Sutton, MD, an endocrinologist who helped found the single-specialty group in 1992, told Endocrine Today.
The practice, also known as NEFEDA, employs 13 endocrinologists, six nurse practitioners/physician assistants, a podiatrist, and four diabetes educators who provide an ADA certified diabetes education program. According to its founders, this unique large, single-specialty group serves to provide the best treatment options for patients, and the structure makes for a balanced — albeit busy — workload.
It takes a village
With the help of nurse practitioners and physician assistants, NEFEDA doctors see patients at four office locations, ranging from 2,000 to 17,000 square feet in size, and eight hospitals throughout the Jacksonville, Fla., area. A typical full day consists of 25 to 35 patients in the office, in addition to hospital rounds/consults of approximately 15 to 20 patients per physician.
“By having a group of our size, we have been able to maintain a busy and lucrative outpatient practice,” Sutton said, “but also manage to hold onto a busy inpatient practice.”
David Sutton
Endocrinologists at the practice strike a work–life balance by working well together, Sutton said. They generally work 50 to 65 hours each week, depending on the individual. On weekends, doctors may end up conducting rounds in four to five hospitals via weekend-call rotation and cross-coverage.
“Everyone in the area has a very congenial nature in practicing medicine,” Sutton said; the Jacksonville native noted the entire geographic area has a very “laid-back” attitude. “We’re all really easygoing, noncompetitive and nonthreatening.”
Each individual is treated as a separate cost center inside the practice, which allows room for preference and flexibility, Sutton said.
“Everyone is free to see as many or as few patients as they want, and to work at the load they are comfortable with,” Sutton said. “Some choose a heavier workload which could result in more income but of course more hours worked, it’s a trade-off for them.”
With so many doctors under one roof, Sutton said it is important to recognize and appreciate the variances in how each of them practices medicine, based on their unique experience.
“Everybody keeps their egos in check. There are a lot of ways to treat individual patients. One way is not the only way; 95% of medicine will be identical. It’s the other 5% that you shouldn’t be argumentative or judgmental about.”
From the beginning, Sutton said, the group has adhered to the concept that no doctor be pigeon-holed in any single area. Each of the endocrinologists has his or her respective backgrounds and interests, but every one of them will treat any and all patients.
Doing good business
The practice is essentially a “three-legged stool,” the way Sutton described it, supported by hospital and inpatient work, outpatient services to patients and ancillary services.
“Those three together afford patients total endocrine care and services, in one convenient location, along with the ability to provide a substantial amount of financial stability and income for our group,” he said.
Each of the offices has capabilities to perform ultrasonography, laboratory services and other diagnostic tests. With a full laboratory and nuclear center, NEFEDA can provide patients with a range of ancillary services. Thyroid uptake scans and other nuclear scans, cardiology nuclear stress tests, nerve conduction studies, bone density scans and thyroid ultrasounds are all conducted within the practice. NEFEDA strives to position itself to provide the most common endocrine diagnostics that patients typically require.
The group has a strong contracting presence with the insurance providers in the area, Sutton said, which translates to receiving more appropriate compensation for the work they do, simply leveraging the size of the group and the number of patients treated at NEFEDA.
“A smaller group would be disadvantaged” by insurance policies, Sutton said. “The size of our group allows for contracting advantages, similar to hospital-owned or multi-specialty groups.”
NEFEDA does all its medical billing in-house. Being such a large group allows the 13 providers to amortize billing costs, reducing per person expenditure and enabling them to have the latest computer software packages and full-time onsite information technology employees and services.
This team of physicians, which includes David R. Sutton, MD, treats the whole of endocrine disorders at their Florida practice. Note: Robert Miller, MD, is not included in the photo.
Photo courtesy of NEFEDA.
Another advantage of being a big group is having a full-time CEO and chief financial officer, Sutton said, so the endocrinologists “don’t have to do a lot of nitty-gritty day-to-day management that sometimes can overwhelm a doctor managing a business, too.”
Sutton recalled an earlier period, when the partners would meet with corporate lawyers and corporate accountants and handle accounts receivable and payable. Now, they brought in experts in those areas, which Sutton said allows them more time to focus on treating patients.
On the edge, in the community
Although it is a small part of the business compared with daily practice, the clinical research at NEFEDA is quite vast, with 10 to 20 studies going on at any given time, primarily in the fields of diabetes, lipids and osteoporosis, according to Sutton. “We pursue research opportunities solely in the field of endocrinology, as it’s our specialty.”
The group has always conducted research studies, he said, but a recent relationship formed with the local clinical research organization, East Coast Institute for Research (ECIR), has boosted the caliber of research and saves NEFEDA time and money.
“[ECIR] moved into our offices, and they manage their own staff, secure the studies, and we become the principal investigators,” Sutton said. Once NEFEDA decides to participate in a study, ECIR secures it and negotiates the financial aspects, then pays the group a percentage.
Solo practitioners, Sutton said, would never have the patient volume to demand this breadth of studies, on everything from disease states, such as type 1 and type 2 diabetes to insulins, orals, glucagon-like peptide-1 and implantables.
“It’s a great win for our practice because it keeps us on the cutting edge and excited about new frontiers in medicine. It’s also a great win for patients because they get the newest therapies available, and it’s usually at no expense to them.”
NEFEDA also boasts a diabetic wellness center and program. Its published findings of improved health and cost benefits associated with the program were presented at the American Association of Clinical Endocrinologists 2013 annual meeting. The group also secured a contract with Florida State Community College to enroll their employees with diabetes into the wellness program.
Looking into the future, Sutton said NEFEDA is “leaning and working toward” the idea of expanding the practice to other geographic locations, where they would find synergy and unite with other groups.
“When people realize they could make more money, have more stability, minimize economic pressures and allow them to concentrate on providing comprehensive quality care as a large group than they would be able to on their own, then there’s an incentive,” Sutton said. “When everybody’s maximizing their income potential while providing quality care, everybody’s happy.” – by Allegra Tiver
- David R. Sutton, MD, can be reached at Northeast Florida Endocrine & Diabetes Association, 915 W. Monroe St., Suite 200, Jacksonville, FL 32204-1177; phone: 904-384-2240; website: www.nefeda.com.