While the results of the practice performance survey suggest “best practice” and outline some of the activities that might improve performance, they are just a first step, albeit a crucial one. Physicians can be as effective as any small business owners in managing or at least overseeing the economic aspects of a practice. But many other issues should be addressed in such surveys. For example, Nurse Practitioners and Physician Assistants are mentioned, but productivity increases and the expectations of these providers are not included. The questions are how much work should be expected from the mid-level provider and has the use of physician extenders proven to be more financially beneficial than, for example, expanding the practice by hiring an additional physician? Furthermore, many other potential best practices should be explored, including having the medical practice employ outside billing companies compared to the practice managing the billing or the economic benefit (or burden) of electronic medical records. Finally, and perhaps unfortunately, physician productivity must be assessed and data on the generation of work relative value units as a tool to assess physician productivity should be included in future surveys.