[the_d3f4ult]

I'm an ophthalmologist. This phenomenon is endemic to all outpatient and procedure-based medical specialties. Especially eyes and teeth but also including emergency medicine, radiology, gi etc. It absolutely does lead to poorer quality patient care as practices are purchased with a second-liquidity event in mind and thus must show an increase in margins via increased "efficiency." In reality this means less technicians and less doctors seeing more and more patients. Remember that the doctors absorb the liability for poor patient care.

Another commenter mentioned that "most physicians are just bad at business" as a factor driving these acquisitions, there may be some truth to this, but the stereotype of the gullible, bumbling physician businessperson is bullshit. All of the practices being acquired were created and run successfully by physicians and many physicians are quite good at it. What is a huge problem is the predatory behaviors of senior partners looking for an exit strategy via equity buyout. I was searching for a job recently and it is almost impossible to find a position that is "partnership track" - something that used to be the norm. Even worse, practices will bring on junior partners with the promise of equity in the practice, force them to sign a non-compete as a term of their employment and then churn them after 2-3 years or worse - sell the practice to an equity firm.

There are a lot of things that need to change to create a healthy, diverse healthcare ecosystem, but an easy change that would be to ban physician non-competes. They do nothing but entrench equity firms and regional conglomerates making it impossible for competition to arise. Getting rid of the "certificate of need" regulations and generally decreasing the regulatory burden and thus cost to enter the market for a new competitor would also be a big step. The whole thing is gross. Most physicians want autonomy but don't know where to start. I wish there was a startup that could streamline the process - automate or outsource the front and back end work and sell or lease "starter practices" or something.

[bruckie]

I think this cuts both ways. I have a friend who's a recently-retired partner in an ophthalmology practice, and it was very difficult for him to find someone who wanted to buy into the partnership to take his spot. He said that many docs these days just want to go to work, do their job, and go home, without dealing with all of the additional burdens that come with owning a business. He thinks that's a big contributing factor to the corporatization of medical practice.

[the_d3f4ult]

What'd he end up doing? I don't know the specifics of your friend's situation, but I hear this a lot from older guys who want absurd buy-ins based largely on good-will.

[bruckie]

He eventually found someone, but ended up working a couple of extra years before he could find a buyer. I don't know enough to judge whether the valuation he was looking (or eventually got) for was reasonable or not.