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Private equity is taking over derm

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  • Avatar Ghetto 
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    Status: Physician
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    Joined: 08/13/2017
    Earnest refinancing bonus

    The certain parts of the country that pay nurses $100k tend to have outrageous costs of living to offset that paycheck. Lots of nurses I know are burned out from overwork and an increasing patient to nurse ratio. There is a severe lack of autonomy. The only really happy ones I’m acquainted with work very part time in a cushy setting like an ASC. Hospital nurses in my experience are all looking for a way out.

     

    Sure you can go into administration but if you’re gonna do that why not just go get a business degree and be in middle management somewhere?

    #236950 Reply
    Liked by CordMcNally
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2806
    Joined: 01/03/2017
    The certain parts of the country that pay nurses $100k tend to have outrageous costs of living to offset that paycheck. Lots of nurses I know are burned out from overwork and an increasing patient to nurse ratio. There is a severe lack of autonomy. The only really happy ones I’m acquainted with work very part time in a cushy setting like an ASC. Hospital nurses in my experience are all looking for a way out.

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    I think that about 25-30% of the nurses I work with are currently working on getting their DNP. I feel like most hospital nurses switch floors/departments a decent amount but then end up not enjoying the new scenery.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #236952 Reply
    Avatar Eye3md 
    Participant
    Status: Physician
    Posts: 69
    Joined: 12/01/2017

    Everyone worries about a doctor shortage but the RN shortage/burnout problem is HUGE!!!  With the “overnight” expansion of NP programs, a lot of hospital RNs are taking advantage of these so they can obtain more autonomy, make more $$$, and/or get away from the grind/pressure of working the hospital floors. I believe hospital RNs already had a difficult life but EHR has surely tripled that difficulty (and helping to push more out the door)

    #237232 Reply
    Liked by q-school, Anne
    WorkingToFish WorkingToFish 
    Participant
    Status: Resident
    Posts: 68
    Joined: 08/28/2018

    Is there anybody on here that DOES work for private equity in the field of dermatology?

    Furthermore, is there anybody on here that has maintained the private practice model in dermatology with continued financial success?

    I have never been lost, but I will admit to being confused for several weeks. - Daniel Boone

    My sweat and my wages they don't seem to weight out
    I'm gettin' more aches than I'm gainin' in gold

    #237246 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    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.

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    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

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    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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    is it a fact that physician ‘salaries’ have gone down?  over what time period are we talking?   totally agree with other comments.

     

    #237249 Reply
    Avatar Ghetto 
    Participant
    Status: Physician
    Posts: 126
    Joined: 08/13/2017

    Private practice derm here. Doing fine as a solo physician with one physician assistant who is terrific.

    I know some derms who are employed by private equity after selling out. Most are not particularly happy due to having to give up their autonomy. As I posted before, the ones who sell out are either late career looking for a payout before retirement or ex-military who are already somewhat institutionalized and are looking for a way to cut down on the administrative aspects of running a practice. I find that most military docs get a real eye opener when they leave the rather cushy lifestyle and realize how much more work it takes to survive in the real world.

    #237305 Reply
    Liked by snowcanyon

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