Yes it can be true, but it could also be true of a good running SMALL practice as well. You can have a large practice, fully staffed or with a management company that does NOT need to outsource nor would it be beneficial, however you will also have some good SMALL solo practices with a good staff and/or one biller doing a fine job that doesn't need to outsource. It's a numbers game, just like any other business. I can tell you that for every practice that does NOT need help there are 5 more that do. When you are marketing it's best to stay away from the negative and remain positive and confident. Yes you will probably hear more No's than yes's until you get your feet wet, but perseverance is key!