Why Multi-Location Practices Are Rethinking Best-of-Breed in 2026

For much of the last fifteen years, the standard advice to a growing practice was "best-of-breed": choose the strongest tool for each job, whether scheduling, reminders, intake, billing follow-up, reviews, or payroll, and connect them. The logic was sound. A specialist tool is usually better at its one job than an all-in-one suite's version of it.

What that advice underestimated was what happens as a practice adds locations. Best-of-breed optimizes each tool. A multi-location operation depends on how the tools work together, and that's a different problem.

Practices are getting bigger and more spread out

The shift in practice size is well documented. The AMA's 2024 Physician Practice Benchmark Survey found that 47.4% of physicians worked in practices with 10 or fewer physicians, down from 61.4% in 2012, while the share working in practices of 50 or more rose to 18.3%. Physician-owned private practice fell to 42.2% of physicians.

Larger practices mean more locations, more staff, and more handoffs between people who never sit in the same room. A tool stack one office manager could hold in her head at a single site becomes a coordination problem at three or five.

The connection count grows faster than the tool count

Here's the arithmetic best-of-breed tends to hide. Every pair of tools that needs to share information is a connection someone must build, maintain, or bridge by hand. Four tools make six possible pairs. Seven tools make twenty-one.

Not every pair needs to talk, but more do than most practices expect. Scheduling needs to know about intake. Intake needs to reach the EHR. Billing follow-up needs appointment and eligibility data. Reporting needs a bit of everything.

Each connection ends up as one of three things: an integration someone actively maintains, a vendor-built link that works until one side changes, or a person copying data. Most practices have a mix, and the third category is usually larger than anyone realizes.

More locations multiply the problem quietly. Each site tends to configure its tools a little differently, with its own appointment types, intake questions, and naming habits. The integration that worked at the first location needs adjusting at the fourth.

Consider a hypothetical three-location practice and follow one new patient through it. She books online through a scheduling tool. Her intake form arrives in a separate forms tool, and someone at the front desk re-enters her insurance details into the EHR. Eligibility is checked through a payer portal, and the result is noted in the chart by hand. Her reminder texts come from a third system that pulls from the schedule overnight. When she reschedules by phone at a different location, the change is made in the EHR, but the reminder tool still sends the old time. None of these tools is bad at its job. The gaps are between them, and at each gap a person either does the work or the patient notices.

Now repeat that journey a few hundred times a week across three front desks, each with slightly different habits. That is where the time goes, and it rarely shows up on any single vendor's invoice.

Where the cost actually lands

License fees are the visible part. The larger costs land on staff.

Switching and reorienting. A study published in Harvard Business Review followed 137 workers at three Fortune 500 companies and found they toggled between apps and websites nearly 1,200 times a day, losing just under four hours a week to reorienting after switches.

Training in high-turnover roles. Practice leaders in a May 2025 MGMA Stat poll named medical assistants and front-office staff as the most frequent turnover hotspots. Those are the roles that touch the most tools, so every tool in the stack adds onboarding time for each new hire.

Manual transactions. The 2024 CAQH Index estimated that a manual claim status inquiry costs a provider about $13.80 in staff time, against $3.64 when handled electronically, and that inquiries by phone averaged 25 minutes. When systems don't share data, staff fill the gap with phone calls, portals, and re-keying.

The honest case for keeping some specialists

Consolidation has real trade-offs, and it's worth being plain about them.

Depth. An all-in-one system may not match a specialist on every feature. Some teams will lose something they valued, and that loss should be named before the decision, not discovered after.

Concentration risk. Relying on one system raises the stakes of an outage. The February 2024 cyberattack on Change Healthcare, a widely used claims and payments hub, showed how far a single failure can reach: in an American Hospital Association survey of nearly 1,000 hospitals, 94% reported a financial impact. Any consolidation plan should include a written procedure for running scheduling, check-in, and payments when the core system is down.

The EHR is a special case. Clinical documentation carries regulatory, specialty, and data-migration weight that operational tools don't. Many groups sensibly keep the EHR decision separate from everything else.

A better question than "best-of-breed or all-in-one"

For a multi-location practice, the more useful question is: where should our data live, and how many times should a person have to type it?

A workable approach:

1. Keep specialists where clinical depth matters. Typically the EHR and specialty-specific clinical tools.
2. Unify the operational layer. Cross-location scheduling visibility, intake, patient communications, staff management, and reporting. This is where handoffs pile up and where a single system tends to pay back fastest.
3. Connect the two through a small number of maintained integrations, rather than a web of point-to-point links nobody owns.
4. Standardize processes across locations first, so the software reflects one way of working instead of five.

That operational layer is what our custom software subscription is designed to cover: one system built around how your locations actually run, connected to the clinical tools you keep. Whether you build it, buy it, or subscribe to it, the principle is the same.

What to do this week

List your tools and draw a line between every pair that shares information. Label each line "automatic," "vendor link," or "manual." Count the manual lines and estimate the weekly minutes each one takes, then multiply by the number of locations doing it. A hypothetical practice with five manual lines at ten minutes a day each, across three locations, is spending two and a half staff hours every day on work none of its software is doing.

If you haven't built the tool list yet, the 30-minute software audit is a good starting point, and why dermatology groups hit the consolidation question first shows how this plays out in a specialty that grew by acquisition early.

Once the manual lines are counted, the conversation with partners becomes concrete rather than theoretical. If it would help to talk through your own map, the page on software for multi-location medical practices is a good place to start.

If you're weighing what a fix would cost, our guide to how much custom software costs breaks down build, maintenance and three-year totals, and the software stack cost calculator adds up what your current tools cost today.