7 ms·

I worked with people who did (human) clinic roll ups. Part of the issue at hand is that doctors and physicians are notoriously bad businesspeople. So once they

• banannaise 4y ago
  The inevitable march of capitalism: experts in every field are gradually relieved of their decision-making power by experts in finance, until finance guys control everything.
  • lordnacho 4y ago
    But you can have capitalism without financialization.
    • Ericson2314 4y ago
      "financialization" is more a boogieman than a solid concept. More competition (the best interpretation of "de-financialization" I can imagine) is not very solid solution for something like healthcare (or yes pet care) where the demand being inelastic makes "ransoming" easy.
      • shkkmo 4y ago
        Markets can work fine with inelastic demand if there is adequate information, freedom of choice and proper regulations.
        • WaxProlix 4y ago
          More like, could than can as far as I can see. Markets kick ass under certain circumstances, but in some areas it's almost impossibly hard to achieve those circumstances.
          • shkkmo 4y ago
            My point is that I don't think the inelasticity of demand is why the healthcare markets work so poorly.
        • adgjlsfhk1 4y ago
          the problem is that some markets inherently can't have adequate information because the customers by nature of being customers don't have time to shop around.
        • ryan93 4y ago
          Unfortunately government restricted the supply of doctors below population growth.
      • gwd 4y ago
        > best interpretation of "de-financialization" I can imagine "Financialization" means the insistence on seeing "business" as a machine which is to be optimized to maximize return on money. It's in contrast to people doing good work for a fair price. Compare these two veterinary practices. One has an owner who is a vet, who got into the practice because they love animals. They hire staff who love animals. They charge enough money to live reasonably comfortable lives and pay off their vet school bills. They could charge more but they don't. They don't try to push unnecessary services to raise more money. The second is owned by private equity, who got into the field because it has inelastic demand. Prices are carefully calibrated to extract the maximum amount of cash possible. They hire staff who focus on getting the most bang for the buck: they focus and push for expensive operations and do them in the shortest amount of time; operations which aren't cost-effective are passed over or simply not done. At every step of the road, "upselling" is a thing, to maximize money taken from pockets. The first is what I consider the best kind of "business": Doing good fork for a fair price. Those kinds of businesses make the world a better place to live in. The second is what I would call "financialization", and I consider the worst kind of business: Extracting as much money as possible for the least effort. Those kinds of businesses make the world a terrible place to live in. The first kind of business is the kind of capitalism I want, not the second.
        • HWR_14 4y ago
          > The first kind of business is the kind of capitalism I want, not the second. The problem is there's no rule you can apply that distinguished between those two, in a court of law or elsewhere. Unless you just look at if a bigger firm owns the vet office. But that doesn't help with the upselling vet or the large national organization who wants to help animals.
          • Ericson2314 4y ago
            Yup exactly. And say the owner-Vet who is doing it from a place of love takes a lone and needs to make some interest payments....what then! Indebtedness and greed are hard to distinguish when black boxes. Always remember that.
        • 4y ago
    • beowulfey 4y ago
      Doubtful. The point of capitalism is to optimize for maximum capital production. Ergo, the optimum solution always seems to end up being financialization, since it is so effective at producing capital.
  • BurningFrog 4y ago
    We've had capitalism for 250 years, and are still far from this alleged inevitable end state.
  • IG_Semmelweiss 4y ago
    A veterinarian cannot open a practice without doing a bunch of licensing and spending hundreds of thousands of dollars in education. Meanwhile, the PA next to him has what it takes from years of training but she will never open a vet clinic of his/her own. Thats not capitalism.
    • shkkmo 4y ago
      The solution to that is reforming the educational and licensing system, not putting finance people in charge.
    • Avicebron 4y ago
      what do you mean? That's exactly capitalism, it favors inequality heavily. The Vet made it to the top of the heap, and is now utilizing the PA as an exploitable workforce. Tech example, BigCo A gets first mover advantage, equally good BiggishCo B is a bit behind (for whatever reason), BigCo A leverages their position to prevent B from being able to compete long term - usually by acquisition, they work for us now.
      • pclmulqdq 4y ago
        It's not capitalism because a licensing cartel artificially keeps the supply of vets low by keeping out qualified PAs and nurses who could handle easy cases.
        • deleted 4y ago
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        • WaxProlix 4y ago
          It's exactly capitalism because concentrations of capital form and end up with a critical mass that controls various aspects of society - in this case licensing. It's also something that's literally happening under capitalism, right now, in very capitalist America.
          • 4y ago
  • refurb 4y ago
    If the finance guy is driving down costs and some of that makes it way to me, the consumer, I’m all for it. We didn’t get dirt cheap electronic because some engineer squeeze costs down and competed on price.
• conductr 4y ago
  I’ve hands on done these roll ups in mass (a ton of tiny M&A deals) and I would not characterize the physicians that way at all. They are generally fairly savvy small business owners and they always saw their practice as a retirement/nest egg. They also tend to burn out on all the insane regulations/insurance/employer/etc hoops they have to jump through and as a small business they tend not to have negotiating power or the scale to leverage shared services. These are the primary benefits of the roll up along with jacking up prices as much as possible obviously. Like many physicians these days, they see benefits of just being a W2 employee. It’s also a demographic wave, there’s a lot of near retirement folks that are winding down and these PE firms are providing liquidity for their practice. For the consumer though, it’s probably not a good thing at all
  • trhway 4y ago
    As result of the acquisition you may notice appearance of a business practice manager - a non-vet guy lurking behind the nurses and doctors at whom they all look trying to understand whether he approves or disapproves each and every action they do/say.
  • deleted 4y ago
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  • ShrigmaMale 4y ago
    Similar experience in PE a while back, know a lot of people who still do it, and yeah a lot of small business owners are cashing out right now as boomers retire. Between that and all the dry powder PE has on hand after recent massive raises there will be a lot of buying businesses going on, lots more than even a decade back. Especially now that inflation is stressing retirement savings and costs of everything are rising so fast while people will be looking more to private markets to up returns in bad economic conditions.
• cyanydeez 4y ago
  It's happening to engineering firms too? The great duopoly America is coming swiftly.