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Private equity is taking over derm

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  • Private equity is taking over derm

    https://www.axios.com/private-equity-dermatology-practices-takeover-84f62d15-fe9c-4f98-a7d3-f697a1c63dd4.html

  • #2
    And rads. And ophtho. And EM. And Anesthesia. And vet medicine. And...

    Comment


    • #3
      There are very reasonable concerns with Medicare-for-all etc, but I can't say I find working for PE preferable in any way....

      Comment


      • #4
        no DMs yet from PE for peds.....internet must still be down....

        Comment


        • #5




          And rads. And ophtho. And EM. And Anesthesia. And vet medicine. And…
          Click to expand...


          Don't forget hospital medicine and internal medicine. I work for a hospital that is staffed by Teamhealth.  They are owned by one of the largest private equity firms in the world (Blackstone Group).  1 out of every 5 EM grads go to work for Teamhealth.  They are absolutely massive and continuously expanding.

           

          Comment


          • #6
            Yup.  Been going on for a long time.  They and the insurance industry have killed private practice EM.

            Comment


            • #7
              Yup. Seems like the future of medicine is PE or government work. If this is so, I'd pick the latter, and strongly advise against medical school.

              Comment


              • #8




                And rads. And ophtho. And EM. And Anesthesia. And vet medicine. And…
                Click to expand...


                And GI..!

                Comment


                • #9


                  Vagabond MD wrote: And rads. And ophtho. And EM. And Anesthesia. And vet medicine. And… And GI..!
                  Click to expand...


                  And path!

                  Comment


                  • #10




                    And rads. And ophtho. And EM. And Anesthesia. And vet medicine. And…
                    Click to expand...


                    And dentistry!

                    Comment


                    • #11




                      Yup. Seems like the future of medicine is PE or government work. If this is so, I’d pick the latter, and strongly advise against medical school.
                      Click to expand...


                      Yup, it has been this way awhile now. I do advise any pre-meds, nurses, etc who ask or shadow against MD/DO training if their primary concerns are financial reasons or work that's mostly self-directed. Medicine's a great job quality and challenge, but too expensive and tremendous time opportunity cost for such a limited top end $ and muted autonomy yet full liability.

                      Socialized medicine is happening incrementally, and the PE and hospital systems are essentially the govt contractors for the talent and equipment now, not unlike the insurances are govt contractors for the policies. I'm not fully against socialized medicine, but anywhere else that has it also has free/cheap med school and very limited liability. That's the problematic part for MDs in USA: serious downsides with increasingly limited upside.

                      The 1986 tax reforms were crushing to small med/dent biz net incomes (and recent 2018 changes are what makes them attractive to VC/PE takeovers now). The rise of student loans to crush credit/debt ratio of the young docs and the GFC lending tighten-up means only Richie Rich type MDs can start from scratch or buy in/out as majority partner of an office.... PE and employment more common than any meaningful biz ownership is even becoming the case for dent, pod, chiro, etc.

                      ...the vast majority will work for PE (hospital directly or large group leasing labor to hospitals) or for the govt, as you said. There is nothing wrong with that since the salaries are far from average, but there are fewer choices. No alpha male (or female) loves to call someone else their boss and basically punch a clock and shake their head frequently at skeleton staffing or other non-medically trained admin "improvements." It is a fairly bleak outlook with all of the grads coming out willing to undercut one another for jobs (not even mentioning midlevel issue). It is fairly amazing to me the level of interest we get whenever we have a hospital position open. It is almost sad the dozens of grads who will basically sign the contract without reading it... for fear their even more gleeful peers with bigger student loans will sign it.

                      If you get frustrated, just look at current pharmacy job outlook, though. They have poor job quality and poor pay/choices. We have it fairly good. It is not all doom and gloom when you get to have challenge, job doesn't break down your body too much, take home solid coin, and help people with problems they could never solve themselves. I still currently recommend RN as the best financial play (income for time/cost, lack of liability and pressure) among the medical stuff, though. Good topic

                      Comment


                      • #12







                        And rads. And ophtho. And EM. And Anesthesia. And vet medicine. And…
                        Click to expand…


                        And dentistry!
                        Click to expand...


                        And Peds! Oh wait, nevermind...

                        Comment


                        • #13
                          Yes, it continues. In my experience it’s the older dermatologist who is looking for an exit strategy. First dermatologist in my town that sold out was in his mid sixties and retired just around three years later. Next was late fifties and she tired of the beancounter administrators telling her to see more patients per hour. Within a few years she had quit and gotten a government job. Both of those practices were shut down (I’m assuming at a loss for the PE firm). Recently three more practices have sold including a couple of ex-military derms who I think don’t want to practice too much longer. They may be in for a rude awakening as their new masters demand increased profits. None of these three practices has very high volume so I’m wondering how it’ll work out.

                           

                          Private equity may be doing well by acquiring dermatology practices but it doesn’t seem to be that way in my city.

                          Comment


                          • #14







                            Yup. Seems like the future of medicine is PE or government work. If this is so, I’d pick the latter, and strongly advise against medical school.
                            Click to expand…


                            Yup, it has been this way awhile now. I do advise any pre-meds, nurses, etc who ask or shadow against MD/DO training if their primary concerns are financial reasons or work that’s mostly self-directed. Medicine’s a great job quality and challenge, but too expensive and tremendous time opportunity cost for such a limited top end $ and muted autonomy yet full liability.

                            Socialized medicine is happening incrementally, and the PE and hospital systems are essentially the govt contractors for the talent and equipment now, not unlike the insurances are govt contractors for the policies. I’m not fully against socialized medicine, but anywhere else that has it also has free/cheap med school and very limited liability. That’s the problematic part for MDs in USA: serious downsides with increasingly limited upside.

                            The 1986 tax reforms were crushing to small med/dent biz net incomes (and recent 2018 changes are what makes them attractive to VC/PE takeovers now). The rise of student loans to crush credit/debt ratio of the young docs and the GFC lending tighten-up means only Richie Rich type MDs can start from scratch or buy in/out as majority partner of an office…. PE and employment more common than any meaningful biz ownership is even becoming the case for dent, pod, chiro, etc.

                            …the vast majority will work for PE (hospital directly or large group leasing labor to hospitals) or for the govt, as you said. There is nothing wrong with that since the salaries are far from average, but there are fewer choices. No alpha male (or female) loves to call someone else their boss and basically punch a clock and shake their head frequently at skeleton staffing or other non-medically trained admin “improvements.” It is a fairly bleak outlook with all of the grads coming out willing to undercut one another for jobs (not even mentioning midlevel issue). It is fairly amazing to me the level of interest we get whenever we have a hospital position open. It is almost sad the dozens of grads who will basically sign the contract without reading it… for fear their even more gleeful peers with bigger student loans will sign it.

                            If you get frustrated, just look at current pharmacy job outlook, though. They have poor job quality and poor pay/choices. We have it fairly good. It is not all doom and gloom when you get to have challenge, job doesn’t break down your body too much, take home solid coin, and help people with problems they could never solve themselves. I still currently recommend RN as the best financial play (income for time/cost, lack of liability and pressure) among the medical stuff, though. Good topic
                            Click to expand...


                            You must be joking

                            Comment


                            • #15







                              Yup. Seems like the future of medicine is PE or government work. If this is so, I’d pick the latter, and strongly advise against medical school.
                              Click to expand…


                              Yup, it has been this way awhile now. I do advise any pre-meds, nurses, etc who ask or shadow against MD/DO training if their primary concerns are financial reasons or work that’s mostly self-directed. Medicine’s a great job quality and challenge, but too expensive and tremendous time opportunity cost for such a limited top end $ and muted autonomy yet full liability.

                              Socialized medicine is happening incrementally, and the PE and hospital systems are essentially the govt contractors for the talent and equipment now, not unlike the insurances are govt contractors for the policies. I’m not fully against socialized medicine, but anywhere else that has it also has free/cheap med school and very limited liability. That’s the problematic part for MDs in USA: serious downsides with increasingly limited upside.

                              The 1986 tax reforms were crushing to small med/dent biz net incomes (and recent 2018 changes are what makes them attractive to VC/PE takeovers now). The rise of student loans to crush credit/debt ratio of the young docs and the GFC lending tighten-up means only Richie Rich type MDs can start from scratch or buy in/out as majority partner of an office…. PE and employment more common than any meaningful biz ownership is even becoming the case for dent, pod, chiro, etc.

                              …the vast majority will work for PE (hospital directly or large group leasing labor to hospitals) or for the govt, as you said. There is nothing wrong with that since the salaries are far from average, but there are fewer choices. No alpha male (or female) loves to call someone else their boss and basically punch a clock and shake their head frequently at skeleton staffing or other non-medically trained admin “improvements.” It is a fairly bleak outlook with all of the grads coming out willing to undercut one another for jobs (not even mentioning midlevel issue). It is fairly amazing to me the level of interest we get whenever we have a hospital position open. It is almost sad the dozens of grads who will basically sign the contract without reading it… for fear their even more gleeful peers with bigger student loans will sign it.

                              If you get frustrated, just look at current pharmacy job outlook, though. They have poor job quality and poor pay/choices. We have it fairly good. It is not all doom and gloom when you get to have challenge, job doesn’t break down your body too much, take home solid coin, and help people with problems they could never solve themselves. I still currently recommend RN as the best financial play (income for time/cost, lack of liability and pressure) among the medical stuff, though. Good topic
                              Click to expand...


                              Agreed 100%. You can graduate at 20 and earn 100k in certain parts of the country with excellent opportunities for advancement and many nonclinical avenues if you burn out. Not only that, patients and society LOVE nurses and they advocate really well for themselves. Our salaries go down, but theirs only go up. No one ever complains about the high cost of American nursing salaries even though they dwarf those in any other country.

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