5 ms·

> A doctor knows what his practice is worth and wants every cent he can get out of it - but the next generation of doctor is not going to be able to compete wit

by vault_ 3y ago

> A doctor knows what his practice is worth and wants every cent he can get out of it - but the next generation of doctor is not going to be able to compete with debt financing what a PE cash-buyer can get. In my opinion, the physician in this example is a monster. Profit maximization is a choice, not some kind of moral imperative. Am I supposed to have any respect for somebody selling out their employees and patients to vampires so they can retire to a beach or whatever? The solution I'd want to see for situations like this is to find a way to sell to the people who have a continuing interest in how the business is run: employees and customers. The "exit" that does right by all interested parties would be something like having a newly formed employee coop gradually buy out the founder's ownership stake. To make a tech analogy, you don't have to sell your 0-day to foreign government just because they pay more than the bug bounty program! You don't have to sell out your community to vampires because they're the highest bidders! This is a choice that somebody is making.

legitster 3y ago
Well, keep in mind that from the perspective of the rest of the healthcare industry, private practices are kind of dinosaurs at this point. They don't play well in our modern system, and the last 50 years of healthcare legislation has done everything short of outright banning them. New doctors are not trained or expected to run businesses. Getting money from medicare or insurance is a nightmare. Patients want access to more services than ever before. The entire idea of a private practice is anathema to modern ideas of healthcare oversight and access equity. Even getting private malpractice insurance is almost impossible now. There is a reason almost nobody is starting private practices anymore. So to give the doctors a bit of credit this is a chance to slip quietly into the night.
- JohnFen 3y ago
  This explains quite a lot about why health care has been noticeably getting worse over the last several years -- for everybody. In my part of the US, you can't even find a doctor that is taking new patients at all, private practice or otherwise. Talking with some doctors, it's clear that being a doctor these days is a very undesirable job. I know I wouldn't want to do it.
JumpCrisscross 3y ago
> Am I supposed to have any respect for somebody selling out their employees and patients to vampires so they can retire to a beach Nobody else will buy it. The alternatives are shutting down the practice or forcing oneself to keep working. Particularly in medicine, the latter is dangerous. > solution I'd want to see for situations like this is to find a way to sell to the people who have a continuing interest in how the business is run Sounds like a buy-out strategy! Seriously. Berkshire Hathaway could negotiate good deal terms by making this promise.
- pitaj 3y ago
  > Nobody else will buy it. The alternatives are shutting down the practice or forcing oneself to keep working. Particularly in medicine, the latter is dangerous. Can't you just hire a "CEO" who will take over all management responsibilities?
  - JumpCrisscross 3y ago
    > Can't you just hire a "CEO" who will take over all management responsibilities You, the retiring doctor, hire a manager whose job it is to hire another doctor? Do you not see why this works at scale but for one practice?
BeetleB 3y ago
> In my opinion, the physician in this example is a monster. Profit maximization is a choice, not some kind of moral imperative. They've had a career of treating patients. I think they've satisfied the moral imperative already. And selling to PE doesn't necessarily equate to "profit maximization". It could just mean "decent sale". As the OP said, often there simply isn't anyone available to buy it out at the timeline it needs to be bought out. > The solution I'd want to see for situations like this is to find a way to sell to the people who have a continuing interest in how the business is run: employees and customers. The "exit" that does right by all interested parties would be something like having a newly formed employee coop gradually buy out the founder's ownership stake. I don't doubt that this can work (it has for other businesses!). However, a given doctor wants to retire soon. Can you point him to a concrete plan to set this up? As in a firm that will have said plan ready, does all the legal work, and manages the terms with the existing employees/customers? The doctor already has his hands full treating patients and running the business. If you cannot point him to such a resource, then do you see why he'd just sell to PE?
- derbOac 3y ago
  > They've had a career of treating patients. I think they've satisfied the moral imperative already. No offense (really), but speaking from professional experience, I think this is naive and contributing to a lot of reasons why healthcare costs have started to spiral out of control. There are moral doctors, and immoral ones, and everything in between. I'm not really sure why healthcare provision as an economic transaction is necessarily more moral than any other economic transaction that brings net benefit to the receiver of the service. If there was such a cost to the physician overall, in terms of altruistic cost-benefit balances, they'd have trouble finding people wanting to go to medical school. I think the labor markets (in terms of medical school supply and demand) speak to the nature of that balance. I don't want to demonize doctors (my family and myself fall into these categories) but I think it's dangerous to idolize them at the same time.
  - P_I_Staker 3y ago
    I want to demonize doctors.
tomaskafka 3y ago
The system and incentives the US voters have set up says "we want you to sell to the vampires, and will give you a huge financial bonus if you do". Maybe if voters didn't want such system, they might vote different people into power, or vote to change the system. POSIWID. https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_wha...

by vault_ 3y ago

legitster 3y ago

Well, keep in mind that from the perspective of the rest of the healthcare industry, private practices are kind of dinosaurs at this point. They don't play well in our modern system, and the last 50 years of healthcare legislation has done everything short of outright banning them. New doctors are not trained or expected to run businesses. Getting money from medicare or insurance is a nightmare. Patients want access to more services than ever before. The entire idea of a private practice is anathema to modern ideas of healthcare oversight and access equity. Even getting private malpractice insurance is almost impossible now. There is a reason almost nobody is starting private practices anymore. So to give the doctors a bit of credit this is a chance to slip quietly into the night.

JohnFen 3y ago
This explains quite a lot about why health care has been noticeably getting worse over the last several years -- for everybody. In my part of the US, you can't even find a doctor that is taking new patients at all, private practice or otherwise. Talking with some doctors, it's clear that being a doctor these days is a very undesirable job. I know I wouldn't want to do it.

JumpCrisscross 3y ago

> Am I supposed to have any respect for somebody selling out their employees and patients to vampires so they can retire to a beach Nobody else will buy it. The alternatives are shutting down the practice or forcing oneself to keep working. Particularly in medicine, the latter is dangerous. > solution I'd want to see for situations like this is to find a way to sell to the people who have a continuing interest in how the business is run Sounds like a buy-out strategy! Seriously. Berkshire Hathaway could negotiate good deal terms by making this promise.

pitaj 3y ago
> Nobody else will buy it. The alternatives are shutting down the practice or forcing oneself to keep working. Particularly in medicine, the latter is dangerous. Can't you just hire a "CEO" who will take over all management responsibilities?
- JumpCrisscross 3y ago
  > Can't you just hire a "CEO" who will take over all management responsibilities You, the retiring doctor, hire a manager whose job it is to hire another doctor? Do you not see why this works at scale but for one practice?

BeetleB 3y ago

> In my opinion, the physician in this example is a monster. Profit maximization is a choice, not some kind of moral imperative. They've had a career of treating patients. I think they've satisfied the moral imperative already. And selling to PE doesn't necessarily equate to "profit maximization". It could just mean "decent sale". As the OP said, often there simply isn't anyone available to buy it out at the timeline it needs to be bought out. > The solution I'd want to see for situations like this is to find a way to sell to the people who have a continuing interest in how the business is run: employees and customers. The "exit" that does right by all interested parties would be something like having a newly formed employee coop gradually buy out the founder's ownership stake. I don't doubt that this can work (it has for other businesses!). However, a given doctor wants to retire soon. Can you point him to a concrete plan to set this up? As in a firm that will have said plan ready, does all the legal work, and manages the terms with the existing employees/customers? The doctor already has his hands full treating patients and running the business. If you cannot point him to such a resource, then do you see why he'd just sell to PE?

derbOac 3y ago
> They've had a career of treating patients. I think they've satisfied the moral imperative already. No offense (really), but speaking from professional experience, I think this is naive and contributing to a lot of reasons why healthcare costs have started to spiral out of control. There are moral doctors, and immoral ones, and everything in between. I'm not really sure why healthcare provision as an economic transaction is necessarily more moral than any other economic transaction that brings net benefit to the receiver of the service. If there was such a cost to the physician overall, in terms of altruistic cost-benefit balances, they'd have trouble finding people wanting to go to medical school. I think the labor markets (in terms of medical school supply and demand) speak to the nature of that balance. I don't want to demonize doctors (my family and myself fall into these categories) but I think it's dangerous to idolize them at the same time.
- P_I_Staker 3y ago
  I want to demonize doctors.

tomaskafka 3y ago

The system and incentives the US voters have set up says "we want you to sell to the vampires, and will give you a huge financial bonus if you do". Maybe if voters didn't want such system, they might vote different people into power, or vote to change the system. POSIWID. https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does https://en.wikipedia.org/wiki/The_purpose_of_a_system_is_wha...