By Dr. Brendan Hallissey, Guest WriterAs I started to write my thoughts on this subject, I was wearing my 1-month-old son in a Babybjörn. He was intermittently falling asleep on my chest and fussing a little to remind me that I should continue to bounce up and down to keep him happy. After our journey of opening a practice, nearly reaching burnout, and then selling to private equity, I felt as happy as I had ever been. It was a long trip to get to this point, but it all seemed to happen at the right time.
I grew up in a small town in Maine, and, like many people from the sticks, I felt some kind of yearning to escape and “make it.” I didn't know exactly what that was. But my mother had always spoken to me like an adult, so I realized that to “make it,” I would have to make money. Like a lot of people, I viewed being a doctor as a good choice and went through different iterations of what type of doctor I would become. Being an analytical person, I explored many avenues as I advanced through school, but I realized the path that fit my personality best was dentistry. I liked that it was a respected field in which I could help people, but it would not require me to be called into the hospital at any time of day or night and have to carry the stress of life-or-death situations on a regular basis. Despite the urban legends, the dentists I knew all seemed happy with their careers, and I definitely wanted to find happiness.
My family life was tumultuous as a child, due in part to my parents fighting and worrying about money. I thought that having the kind of money a dentist can make would make me happy. I thought that buying a practice was the solution to our problems. But I learned there was a different path.
Buying My Practice (and All the Stress and Debt That Came with It)
Ten years after graduating from dental school, my wife (also a dentist) and I were the owners of two practices and too many headaches. I learned from seeing the financial stresses of debt on my family that it can very negatively affect your happiness, and, up until this point, I had done a pretty good job of managing it. As the employment market in our area tightened after the 2008 financial crash, my options were to commute over an hour to work, sit home while my wife worked, continue to work in a group practice that I was getting squeezed out of by new ownership, or purchase a practice. I opted for the last option, and, in doing so, I took on over $1 million in debt. We muddled along and saw the opportunity to take on an additional practice that would change my wife's half-hour car commute to one in which we could walk or bike together each day.
Mr. Money Mustache—with his lessons on frugality and, quite frankly, avoiding driving—had some definite influence there. While we were saving on commuting, we added several hundred thousand more dollars to our debt load when we bought the additional practice. We also doubled the headaches.
Much stress came about from several other dentists' tales of embezzlement. Given my risk-averse nature, I was doing all of the banking and books for both businesses. In addition to working at her own practice, my wife was continuing to work 30 hours a week as an associate at another office in New Hampshire, and I was working part-time at that New Hampshire office to try to earn more to pay off our massive debt—in particular, she was concerned about her school debt from a private dental school.
As we were thinking about starting a family, the debt seemed like an insurmountable obstacle. Could we really raise a child, giving him the attention we wanted to give with the amount of work we were doing both in and out of the practices? The stress was coming to a head in 2016, and it became apparent that we needed to find an option that could improve our work/life balance. I now know that we were heading toward burnout, but I had never even heard the term at this point (except as a reference to stoners).
Sometimes, though, your salvation just falls from the sky—or at least gets delivered into your mailbox.
More information here:
A Dental Career Reimagined — I Thought I’d Be Rich But I Found Wealth in Another Way
The DSO Down-Low: How Private Equity Has Infiltrated Dentistry
Private Equity Comes Calling
I received a mailing from a company I had never heard of called Heartland Dental. I was skeptical of the offer to affiliate my dental practice, because what I knew—or thought I knew—about “corporate dentistry” was all negative. It was the big bad Boogeyman that was going to take over and crush us poor little independent practitioners. It was all about profit, and the quality of care was substandard.
We were desperate for a change in our lives, so I figured it couldn't hurt to check it out. What I found is that Heartland Dental has pretty specific criteria for considering an affiliation and that we didn't quite fit it. Armed with the knowledge of what would make us a better fit, I worked on improving the business side of our practices with the aim of having the option to affiliate our practice. Over the next year, I worked on the areas I needed to affiliate (cutting down on our overhead and travel expenses so we could improve our profitability on paper), and I was soon in a position where earnest negotiations could begin.
As a practitioner in my prime with two profitable businesses, I was definitely going against the grain of the traditional model of “buy a practice, work until you are 60 or 70, sell to a young hungry dentist, and use the money to pad retirement.” The problem here is that the financials of our industry are unpredictable 30 years in the future.
At the time I was researching my options, it was 2016 and I came up with the following: according to the Centers for Medicare and Medicaid Services (CMS), healthcare expenditures accounted for 17.8% of the US’s total GDP in 2015, and they were expected to rise to almost 20% by 2025. While 2023 was 17.6%, the projections still hold true that healthcare will continue to grow as a portion of GDP.
I can see healthcare as a commodity, yet there are significant headwinds mentally for many people seeing healthcare this way caused by our society's political leanings or feelings about healthcare. At the time, Medicare For All was a popular talking point, and I had no idea how this might affect dentistry. I like to think of healthcare as a business in the same way that Ronnie Coleman, an eight-time Mr. Olympia, thought about bodybuilding: “Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-ass weights.” In this case, everybody wants healthcare, but nobody wants to pay for it.
It would be wonderful if we could treat all of healthcare as a free and basic right, but the aforementioned debts my wife and I held required us to get paid for our services—not just to cover our own debt payments, but also for our living expenses, retirement planning, and a premium for the fact that we have skills that not everyone has. There has to be some incentive for people to go through the rigorous schooling and training required to attain these skills. The counterargument sounds something like, “Are you just going to leave sick people dying in the streets?” Of course, nobody wants to do that. But the public discourse playing out at the time seemed like a very deep risk to our long-term financial success.
I personally believe having only catastrophic insurance would help reduce the cost of healthcare by helping commoditize it. If people are directly paying their fees for checkups, medications, and minor or routine procedures, there would be competition. Fees would come down and become more uniform. Currently, though, insurance seems so opaque to most people that price discovery and value for cost are difficult to assess. Price pressure primarily comes from government and insurance companies. The government decides what amounts it will pay. This is presumably not enough to economically sustain many institutions, and so it charges an individual a rate that is higher than a market-driven rate to make up the difference. Insurance companies then pay somewhere in between, and based on the efficiencies of the institution, they may choose to participate or not with the plan based on whether it makes economic sense.
I'm glad to see that there are some medical facilities that are stepping out of this model and going straight fee-for-service and charging fees that are much more reasonable. I do not, however, see this taking over anytime soon, because the current system is so entrenched. How this process will play out in my life is another very deep risk.
At least for the foreseeable future, we will have a system that is highly unpredictable. Will the emotional element win out with a groundswell of political force that changes the entire system to a single payer one? Will the power of insurance companies to dictate fees and care increase? Will another economic crash drastically change the available dollars for healthcare expenditures? Will Medicare and Medicaid go defunct and cause some other kind of drastic restructuring? No one can know for sure. The only thing I knew for sure was that I would have years of debt service with deep risk of an entire industry upheaval. That thought caused me to lose a lot of sleep.
More information here:
Why More and More Dentists Are Going ‘Out of Network’ — And Why That’s Actually Good News
Is Dentistry Worth It? Comparing It to Being a Pediatrician, a Planner, and a Plumber
Thinking About Selling to a DSO
In the smaller space of dentistry, which in 2014 accounted for 3.4% of total medical expenditures according to the CMS, the times they were a changing. For a long time, dentistry had a nice little niche from a practitioner's standpoint. Insurance was a minor part of the payer base, if at all, and market forces set fees at a point that allowed some of the older generations of dentists to make financially and personally rewarding livings in an industry with relatively low overhead and regulation.
Technological changes, increased government regulation, and a growth of insurance company rules and participation had shrunk the profit margin achievable for the small independent practitioner. This was concerning to doctors with more career ahead of them than behind them. As I looked ahead, I felt as though the future would involve increased supply and compliance costs, decreased insurance company payments, and uncertain economics which would affect year-to-year the available money people were willing or able to pay to take care of their dental needs. Staring at this uncertainty vs. the certainty of our debt service, transitioning into the realm of a Dental Service Organization (DSO) became more appealing.
What Is a DSO?
Before we go any further, let’s talk about how a DSO works (at least in my case).
There are different types and structures. I know Heartland’s best, but there are differences with other DSOs.
For Heartland, the DSO is contracted with a local state corporation that employs the doctors of that state. The doctors practice according to their license in their state and have complete clinical autonomy. The Heartland DSO takes care of many back-end services that a dental practice needs—like supplies ordering, negotiating with labs and suppliers, ensuring compliance with state and national regulations, payroll, mentoring and education offers for affiliated doctors, marketing, and HR.
I have not worked for another DSO, but I hear from colleagues that some others are much more restrictive on issues, like which supplies or labs you use, and that some try to influence your clinical decisions in ways that make doctors feel uncomfortable.
DSOs can be owned by one or a few doctors; sometimes, they're majority private equity with as little as one doctor, if required by state law.
Our DSO has many doctors and employee stockholders. KKR purchased a majority stake in Heartland in the last few years. There are still many doctor-owners, and it has been woven into the fabric of the company by Dr. Rick Workman, the founder of Heartland, that doctors continue to have the ability to purchase an ownership stake.
In many ways, I view this as a mutual fund of dental practices. In a sense, you are buying a share of all of the affiliated offices instead of having all of your risk concentrated in your own single office.
The Benefits of a DSO
Here's what a DSO could provide for me as the owner of a dental practice:
- No more concerns about payroll, unexpected expenses, or embezzlement: Having a large company to be a part of mitigates risk. If a snowstorm shuts down my office for a week or blows down some trees and closes us for a month, our staff will still get paid—thanks to the other practices that are part of the company. If a hurricane closes an office in Florida, my productivity can help it out while they clean up and rebuild. The shutdowns during the early months of COVID proved this; I slept like a baby knowing I was part of a team of incredibly bright doctors that would band together to figure out the best path forward.
- Eliminate the debt load and access equity now: My wife and I had been aggressively paying down our debt, but there was no guarantee that our economic situation would remain unchanged and that we could even pay it in the future. There was also no guarantee that the practice would be an asset that I could sell in 30 years. As the DSO space grows, including starting new offices, I believe that the economics will dictate that practice values decline because it will be cheaper to start a new practice than to purchase an existing one. Combine this with the increasing debt load of recent graduates of dental school, and the pool of available buyers will also decrease. A student with $500,000 in debt and a skill set that is not as advanced as a dentist with years of experience under their belt will not be able to finance or sustain a thriving practice. Working for a DSO that can provide guaranteed income and mentorship will be a bigger and bigger percentage of first-career choices for new graduates.
- Eliminate much of the headache of managing the business of dentistry: The DSO has already accumulated many “best practices” through years of experience and the brain trust that is created by so many doctors sharing the ideas and practices that have worked for them.
- Lower cost of healthcare for my family and employees: While I believe a market-based healthcare system would be better and less expensive, being a part of a larger group means that we can negotiate better rates within the current system. I couldn't afford to pay for employee healthcare as a solo practitioner, but all of our team members became eligible for a nice health insurance plan when we were affiliated.
- Maintain profitability better than on my own: As part of a large group, we can negotiate better prices on all of our expenses that were not available to me as a solo practitioner. In short, there is power in numbers.
Making the Jump to a DSO
I started to research what it was like to work with Heartland. In all, I talked to more than a dozen different doctors who had been working for the company for different amounts of time. I got some great perspectives and what I believe were candid responses to my questions. One thing I heard in the process was, “I know I sound like I'm drinking the Kool-Aid, but I like the taste of the Kool-Aid.” Ultimately, we worked out a deal that eliminated our business debts, merged our practices, paid off my wife's remaining educational debt, and left us with just our home mortgage as a debt.
Could we have sold for more in the future? Maybe. Could we have done a lot worse? Definitely.
I had the opportunity to purchase Heartland stock as part of our sale. We opted instead to pay off the nearly $400,000 in other debt that we had. A portion of the sale price was paid out over the following five years. This money was at risk if I had chosen to leave employment before the end of the term. As an affiliated doctor, I worked in my original practice for four years. My wife's practice was merged with mine, and she began working part-time.
All Heartland-affiliated doctors are paid in the same way. We have a base salary and then have a profitability bonus. Just like the spread of intraspecialty pay in medicine can be quite broad, doctors who offer more services or are more productive can be compensated well for this.
No employees were laid off with our merger. Actually, we grew and hired more employees. Our hard work in growing our practices and improving our profitability while aggressively paying down our debts allowed us to accumulate a significant amount of illiquid equity. The sale allowed us to access this equity at a time when it served our family better by improving our quality of life. A few years later when our dental practices were shuttered by the COVID pandemic for more than two months, I thought back to how glad I was that I had pulled those chips off the table instead of continuing to let it ride into my 60s.
I spoke to other doctors who found themselves in tough financial situations made worse by the economic shock of the pandemic as they tried to evaluate if an affiliation with Heartland could help them as well. Perhaps I would have mathematically done better by grinding out a couple more years, but I prefer to be early than late, and I have no regrets about the timing of my sale.
Once the deal was all lined up, we began trying to start a family. Nine months later, we were blessed with a little boy, and my wife took off three months to spend with him while not worrying about business or educational debt. Our practice grew, thanks in part to the support and the best practices education that all of us have received. I traded feeling tired and being up late doing books for late-night diaper changes and feedings. I couldn't have been any happier with the decision. I get home from work earlier, and aside from the odd emergency call, I do not have any work-related responsibility outside of normal office hours.
More information here:
Selling Your Practice to a Private Equity Firm
Why I Still Sleep Well
I had one nagging thought in the back of my mind. I felt like at some point I may be asked to compromise my ethics and I would have to find a new job. Eight years later, how’s it all going? I’m still working for the same company, and I’ve never been asked to compromise my ethics. I realize how foolish that thought was. A company cannot grow and sustain growth by shady dealing. I’m a better doctor. I am more engaged with my patients (QuickBooks no longer calls me to the back office to worry about the overhead). I have moved to a different state, saying goodbye to the snowy Maine winters that no longer feel as good on my aging joints. I have taken on a role as a mentor to other doctors where I get to help them grow clinically and share the financial wisdom that The White Coat Investor freely shares. I am even more convinced I made the right choice.
The growth of DSOs has continued, and while current valuations are still good for selling a practice, my concerns that the values will diminish by the time I’m 65 seem more valid. Technology is rapidly growing in dentistry. Lasers, artificial intelligence, 3D printing, and robotics are normal parts of our conversations, and they aren’t free. Regulation has continued to increase, and payers have continued to clamp down on reimbursements.
I continue to sleep well having chosen to be early instead of late selling my practice.
I imagine I’ll get some hate mail about being part of a big bad corporation. Before you hit send or submit, realize that you have the right to choose a different path. There will likely still be at least a niche of private fee-for-service practices. Maybe we will see a complete return to the old days. I doubt it, but maybe. The tide is coming in, and I believe DSOs are the future of dentistry.
If this article makes you consider transitioning your practice, I urge you to do your due diligence. Not everyone is a fit for the DSO life. If you really like having control over every aspect of your practice, you’re probably not going to like being part of a group. If you find yourself wishing you had more helpful colleagues to guide you and encourage you, you may love it. It’s your practice; do what you want with it. All I know is that in 2015 and 2016, I was getting so burned out I was focused on FIRE and leaving clinical practice altogether.
After the relief of stress I found working as a Heartland-affiliated doctor, I took the approach of cutting out the parts of the work I enjoyed the least while growing in the work I enjoyed the most. As part of a large network, I now have the opportunity to work with many other doctors through our educational offerings as a teacher, mentor, and coach. I could spend my time being more financially productive, but the time I spend working with younger doctors, helping them achieve their goals, is something I believe will fill my cup for years to come.
Today, my version of “making it” is working on perfecting a life from which I do not want to retire. I can care for my patients, volunteer at a local indigent clinic, mentor and teach colleagues, and be a more involved husband and father. Our practice sale was a blessing for my family, and I hope that the insight shared here can help other docs with one of the most important decisions of their professional lives.
[FOUNDER'S NOTE BY DR. JIM DAHLE: The title of this piece is slightly misleading, but bear in mind that titles are mostly designed to draw you in to read the article. Being accused of writing clickbaity titles is one of the greatest compliments that can be directed at our content director. Dr. Hallissey certainly sold his practice, but as he explained well in the article, that may or may not be right for you. As a general rule, I'm a big fan of ownership, whether it's owning your own home, owning your practice, or owning stocks and real estate as investments. Owners get control and, when things go well, the lion's share of the benefits. There's a lot of value in that. But as Dr. Hallissey explained well, there's usually plenty of hassle and risk to go along with that value. Sometimes, it makes sense to reduce the risk and the hassle, even if it means giving up some or even all of the benefits of ownership. But you better go in with your eyes open to selling a practice, just as much as when you go into buying or starting a practice. Who the new owner is really makes a difference, and not every new owner/company/DSO/private equity is the same. “Private equity” (which is an incredibly vague term, of course) has a terrible reputation for harming doctors and decreasing the quality of care. Just as I warn employers, “If you treat doctors like labor, they'll start acting like labor,” I also warn doctors, “When you give up ownership, don't be surprised when you're no longer treated like an owner.” Hope you enjoyed the post.]
What do you think? Are you considering selling your practice? Would you ever sell to PE? Would you ever want to work for a PE-affiliated office?
This post seems disingenuous. In all of my decades of dental care, not one dentist I have gone to took insurance- rather, they charge up front and submit your bill, so you get reimburse for whatever your insurer chooses to pay. And these are some of the happiest medical professionals I’ve ever met, who never retire early. Offices are well run, no one is there late. There is lots of money to be made in this specialty. This is quite different from my surgical specialty where private or not, you are much more dependent on the myriad of office support required to get someone to the OR or even to radiology for imaging.
To be bought by private equity suggests an unsuccessful practice. What is the salary differential?
Let’s be very clear, this DSO is not a benevolent organization. There would be no practice purchasing if it was profitable. Since insurance reimburses dental care so poorly, they are clearly making money somewhere. There are too many holes in this guest post to follow it. It reads like an ad.
Chris, my first practice I owned ran just this way. I was not in network with any plans and straight fee for service. We would submit for patients just as your describe. Bob Dylan is still singing the truth today and the times still are a changing.
The National Association of Dental Plans reports that 88% of patients have a dental plan now. The majority of patient will no longer accept a practice that is out of network. They have options and they exercise them. I’m sure I could have continued on for years in the same pattern. I’m not the very best doctor in the world, but I care about the quality of my work and give my best to those that trust me. I’m sure I could have maintained a loyal following of people willing to do it my way.
One of my main points is that there are DEEP RISKS that can not be clearly calculated and planned for but that can have a catastrophic effect on your finances. I was looking to derisk and diversify my financial situation
More and more people, right or wrong, are being drive by the financial incentive to see in network providers. I didn’t want to try to fight the tide I saw coming in.
As far as being unsuccessful that’s just untrue. I would never have been able to sell an unsuccessful practice and achieve my financial goals hocking a worthless enterprise.
I’ve been a Heartland-supported doc for almost 10 years. I worked for another DSO my first year out of school but the comparison is night and day. I plan to spend the rest of my career with Heartland.
I wanted to share some pieces of my story that I hope will at least be thought-provoking. My dad and grandpa sold their multi-office dental practice that has been in business since the late 1920s to a non-Heartland DSO when I was 10 years old. I vividly remember my mom and dad (pre-sale) burning the midnight oil every two weeks to run the company payroll on a dot matrix printer in the home den after they thought we had all gone to bed. They were tired and, I’m sure, on the road to mid-30s burnout.
I also distinctly remember massive changes for the better in my dad after affiliating- less stress, better health, and frankly, better and more present parenting. It made all the difference in the word for me and my siblings and, I’m sure, extended the healthy years he will get to enjoy in his life.
For me, Heartland is a perfect fit. I am glad that I can take care of my patients and lead my team during the week, come home on Thursday afternoon, and give myself fully to my wife and kids until Monday morning. I am glad I have 2500+ doctors to email questions to at the drop of a hat – and, practically universally, responses are gracious and helpful. I also am given access to world-class CE that has vastly improved my clinical and leadership skills.
Like Dr. Hallissey, I am afforded the chance to mentor new docs and help them fill in the gaps left in them by their dental school training in regards to their skillset and confidence. Whether or not they stay with Heartland, my hope is that all Heartland-supported docs are better for their time spent here.
Of course, DSOs and Heartland are not for everyone and there is a place at the table for all sorts of models of practice. But, due to myriad factors, the genie is out of the bottle in dentistry in regards to DSOs. I’m glad I am where I am.
One last point: I believe any dentist who walks into my Heartland-supported practice would come away with the impression that I do appropriate, high quality work, that our team matters to me, and that, when push comes to shove, that we do the right thing for the right reason.
Heartland-supported or Heartland-owned?
No, I absolutely will not sell to private equity.
I thought this was a great article. I am not a dentist, but just a plain ol ObGyn.
I worked for 1 large private practice that did not treat me well. Poor pay and horrible hours. When my mother landed in the ICU in another state, no one would relieve me so that I could be with her. I had to work a 36 hour shift. I told them I was going to see my mom and they would have to deal with the schedule. I drove to see my mom and, I called to let them know what was going on. No one picked up. My first day back, I told them that I no longer worked there. I read my contract and it was poorly done. It said a “reasonable time” for notification of resignation. So I gave them 2 weeks. They balked, and I gave them 8 hours. They took the 14 days.
I then went and worked for another smaller boutique practice. 2 providers with 14-15 days of call. It was poorly paid, and poorly managed. Covid hit and in 6 weeks we folded.
I then went to work for a hospital based practice, and I am happy. They are transparent with finances. I am paid very well. They are fair. My hours are appropriate and if I work overtime, I am paid for extra shifts. They appreciate my views on the practice and my recommendations to make it better. They don’t always use them, but they never ever say “stop it” or totally ignore me.
I find that I am valued, and my contributions make the practice better. I don’t know your practice patterns, but I’m willing to bet they make you feel the way I do with my practice.
Good for you two, you found your happy place. I am looking forward to hearing more from you.
Thank you for the support. I worked full time for 3 different practices and part time or lcums for 3 others before buying. If you’ve seen one practice you’ve seen one practice. I think fairness is the key thing that makes a position worth while. It’s not all about pay. As you point out the way our team treats us and supports one another makes a huge impact on quality of life. Both Alexis and I have covered practices because of maternity, honeymoons, illness etc. As a private owner I felt like it was incredibly hard to go away because I didn’t have that kind of support. If we took a family vacation the practice shut down. I’m very happy to have a bigger team. I’m glad to hear you found a great fit for yourself….I hope that your team continues to excel and outpace the negative folks.
Dr. Dahle, While not generally a fan of DSO-model, I was appreciative to read this piece. My wife is an employee of a large regional hospital chain, so it’s hard for me really argue against someone being an employee. In my wife’s case and the Hallissey’s, it seems that both didn’t want to be a business owner due to a variety of issues. It’s a good thing that there are still ways for physicians/dentists to be in the practice without having to be an owner in my opinion. I’m not really sure what the alternative would be for those physicians. I never got the sense this was an advertisement by the way. I’ve got emails going back with WCI from September 2012 (I still haven’t bought that plane), so I’ve been here a long time and know how upfront with your disclosure policies.
I believe the article is very helpful for a lot of young couples in the same predicament, the transparency of the author is admirable it’s not easy to share personal experience. We all are professionals and have taken different paths after graduation. Not all DSOs are cut from the same cloth, after graduation I dove into private practice my one friend joined DSO I admit I was skeptical with his decision but respected it.. I continued with my practice we were profitable but I was burnt out 12 years into it. I wanted to do more mission trips I wanted to serve my community I wanted to travel I wanted it all but I did not have the time and energy. So I sold my practice pivot to locum jobs so I can have more time to spend to go on mission trips . During those locum assignments I have learned what DSOs are, the good the bad and the ugly, my travel had brought me in 6 different states and learned a lot.. one important thing is I don’t want to own my practice and for some that is perfectly ok and there’s a lot of people like me.. I like my freedom ,and I like to take care of my patients. How can I combine those 2 ?. So. I called my friend and asked if he was still in the same DSO and he said he is, so I joined Heartland in 2018.
I work 3 sometimes 4 days I can take vacation anytime I want
I get compensated well, I have the freedom to help anyone who walks in our office.. we never send anyone home that is in pain or has an abscess even if they cannot pay us.. We serve our community and we serve them well.. We are not robots we lead our team. Heartland is doctor led, this article is not advertisement. I would caution any consumer out there that not all private practice cares for your well being either … just do your due diligence nobody is perfect ask for second opinion if something does not feel right.. I always encouraged my patients to seek second. For those who like private practice that’s great! It’s not for everyone , then write an article why it’s so wonderful and add how many hours you work .. we average 32 clinical hours a week mine is slightly less. It’s a great alternative. This gives great work/life balance.. NO one forces me to work 6 days like other DSOs do.
Great point! As an owner and younger worker I didn’t mind the longer hours. I am happy with around 30 clinical hours as well now. I don’t think I would have been able to work those hours as an owner without hiring additional associates thus taking on more work and headache than I ultimately want.
Kudos to you for writing an article knowing that it would generate discussion (and controversy.)
That being said, you will notice some vitriol from physicians. Studies have shown poor patient outcomes with PE. In my speciality (EM) two of our major organizations are pushing back on the corporate practice of medicine. You will find very few practicing physicians who would publicly state that private equity in medicine is a good thing.
Also, as a MBA I noted that you made a comment ” I’m still working for the same company, and I’ve never been asked to compromise my ethics. I realize how foolish that thought was. A company cannot grow and sustain growth by shady dealing. ” In my two years in b-school, I never recalled having a lecture on ethics. Maximizing profit…yes. But never ethics. I used to work for a PE-backed CMG at a for-profit hospital chain (that made record profits last year) and I saw first hand the effects on patient care in the pursuit of profit.
I’m glad you found a job situation that works for you Unfortunately that has not been the case with many.
I have no argument with you. I’ve heard many of the same things about PE in Medicine. I. Sure however that there are docs that are happy and perhaps unwilling to publicize it due to the target for negativity that would be placed on them.
I think we can all agree that our Healthcare system is suboptimal. We are evolving and I don’t know what we will look like when we emerge from the chrysalis. For Dentists I believe we will be better off in many ways by working together as part of the right DSO and pushing those that are not serving doctors and patients well out. I bet that the same coyod be said of medicine but do not have enough inside information to hold that belief very strongly. I would be interested to read about what doctors are doing to improve the outcomes for patients while minimizing burnout and improving the lives of providers at a reasonable and fair cost to patients while paying docs fairly for their expertise. Seems like the golden question I do t have an answer ro but I hope some really intelligent minds are working on this.
What is missing here in the article is the non-disparaging clause you certainly signed and are held to that is holding you back from discussing the true negatives
I shared in the comments that I have 3 things that I would like differently from my current situation:
1. I wish our 401k allowed us to do the mega backdoor Roth conversion.
2. I miss some of the combined business and leisure travel I did when I owned my practice
3. I miss the credit card points I accumulated buying supplies for my office.
That’s it. I’m sure others have other complaints about their employment situations, but I’m content with my choices. If I was gifted a private practice I would affiliate it with Heartland all over again. It was a wonderful and rewarding inflection point for Me. Not everyone will be a good fit for every situation. It’s clear that there is plenty of hate out there. I wanted to share that at least in my case and the case of many of my friends and colleagues it is misplaced because we are happy with our employment and our ability to have harmony between our work and personal lives.
Hey guys, you made your point long ago and received an appropriate response. Please stop badgering the guest posters or I’ll have to start editing comments.
I feel like if I made 5 million dollars from selling my practice and still got to keep my job along with a minority ownership I would be THRILLED no matter what the circumstance.
This article is a joke. The only people that benefit from this sale are Heartland and you. Your patients, your staff, and future dentists don’t.
Which part is the joke? This is my honest well thought out take. At least for me I can say I am a better doctor when I am not also concerned about owning my practice. My attention is more focused on my patients and I was able to avoid burning out thus keeping me available to care for patients instead of leaving the profession all together and taking the FIRE path.
Now as part of a larger team I serve as a mentor to younger docs and help them achieve their goals. They get to learn from my years of trials and tribulations.
For this n of 1 I can’t see how it is worse for any patients or doctors aside from those patients that would like me to move back to the northeast and be their doc again.
The OP likely disagrees with you about the patients at least.
And at any rate, given those are the two parties to the transaction, maybe it’s just fine that those are the two who are happy with it.
I have heard stories that would support the argument about potentially being better for the patient. I have also seen things from solo owners that I felt lacked integrity or were not the best for the patient.
I know I’m better when not wearing the owner hat as well.
We can’t make blanket statements that one way is always best.
I want to see a world with less interference between docs and patients and better long term outcomes where docs are paid fairly and patients get great care. I don’t know if I’ll see it in my lifetime but this move refreshed me and helped me to be better and last longer.
I suspect most of the time doctors owning the practice leads to a happier, less burned out doctor and better care, but there certainly must be plenty of exceptions. I’ve met plenty of docs that WERE NOT happier running their own, often terribly unprofitable, practices.
I think it may be better as an owner with multiple partners. Dentistry most often has one or maybe 2 doctors. All of the work of the owner falls to one person who is also doing the clinical work. It seems like more medical groups are multi partner. Do you think that makes less burden and improves ownership?
Obvious upsides and downsides to both, but yes, in general, there are more economies of scale and help/expertise available with more owners.