[BeetleB]

> 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]

> 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.

[stubybubs]

Also from experience, I think it's Baumol's cost disease really starting to show. Wages/practice costs for doctors have increased because everything around them is more expensive.

A family doctor in my hometown used to be able to afford a house in the nicest neighbourhood on their earnings. They didn't have to talk about money, and when they sold their practice they were happy to make sure it went into the right hands and sold it for a reasonable amount of money.

These days a family doctor can get a 2 bed condo or a townhouse near their practice, or they can have a long commute with something larger. After paying for office expenses, childcare (which also suffers from Baumol's cost disease) and their more expensive education, there's far less for retirement. You really have to maximize what you get out of your practice when you sell it.

I know there's a long history of it being "a calling" and expecting sacrifice. That's still expected, and yet the same rewards aren't there as in the past. Nobody in the past looked like a greedy asshole because they didn't have to ask for more money or really worry about anything. It was set up your practice and live your life on autopilot.

[P_I_Staker]

I want to demonize doctors.