"How Private Equity Is Ruining American Health Care."

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Splenda88

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Better think hard if you are a premed before 'wasting' your youth and $$$ on a medical degree...

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Better think hard if you are a premed before 'wasting' your youth and $$$ on a medical degree...

Going into medicine in 2021 is the biggest career mistake you'll make in your life.
 
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Thanks so much for posting this article. I think it's really relevant to a lot of the discussions we're having. Couple thoughts.

1. "During the videoconference, Morganroth argued that offering Botox in a pandemic wasn’t so different from a grocery store allowing customers to buy candy alongside staples."

This here encompasses the essence of this. Yes, it's effectively no different to the customer. Medicine, though, is by definition focused primarily on the health of patients foremost and that is grounded in our licensing/training. We must retain the elements of free-market (transparency of costs), but maintain our ethical standards.

2. "Today, when an investment firm buys a doctor’s office, what it’s actually buying are the office’s “nonclinical” assets. In theory, physicians control all medical decisions and agree to pay a management fee to a newly created company, which handles administrative tasks such as billing and marketing.In practice, though, investors expect some influence over medical decision-making, which, after all, is connected to profits."

This is a great point. PE knows there's a bloat in medicine and thinks by bringing in technology/automation, they can cut costs, but really they end up creating incentives for doctors that don't align with patient care (billing). They turn a profit, but don't help patients.
 
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Going into medicine in 2021 is the biggest career mistake you'll make in your life.
Tell that to the people grinding 60 hour weeks in meaningless corporate America making 60k to have the chance to make 6 figures one day, everything is relative
 
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Thanks so much for posting this article. I think it's really relevant to a lot of the discussions we're having. Couple thoughts.

1. "During the videoconference, Morganroth argued that offering Botox in a pandemic wasn’t so different from a grocery store allowing customers to buy candy alongside staples."

This here encompasses the essence of this. Yes, it's effectively no different to the customer. Medicine, though, is by definition focused primarily on the health of patients foremost and that is grounded in our licensing/training. We must retain the elements of free-market (transparency of costs), but maintain our ethical standards.

2. "Today, when an investment firm buys a doctor’s office, what it’s actually buying are the office’s “nonclinical” assets. In theory, physicians control all medical decisions and agree to pay a management fee to a newly created company, which handles administrative tasks such as billing and marketing.In practice, though, investors expect some influence over medical decision-making, which, after all, is connected to profits."

This is a great point. PE knows there's a bloat in medicine and thinks by bringing in technology/automation, they can cut costs, but really they end up creating incentives for doctors that don't align with patient care (billing). They turn a profit, but don't help patients.
The bloat is the admin
 
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The bloat is the admin
Not entirely. Going to a hospital is like going to a movie theater. Everything's overpriced. PE sees this and are licking their chops at how instead of charging $30 for a pair of gloves, they can charge $25.
 
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My favorite trust fund babies coming out to bash medicine in 2021 like it makes you a beggar when you finish.

Can you guys just quit already and have mommy come pay off your student loans and go back to yachting, or whatever tf it is you guys do that makes 300k salaries somehow seem completely insignificant? Why do you even hang around these forums?
 
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Going into medicine in 2021 is the biggest career mistake you'll make in your life.

Idk, half the boomers I know bet against Tesla. I think there are plenty of much worse decisions.

Medicine is as close to a guaranteed 6-digit job as anybody with a worthless Biology degree can get.
 
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If you want to see an end to private equity in medicine, a good place to start is lobbying your state legislature to outlaw "covenants not to compete" in healthcare. Such legislation should apply to nurses, physicians, x-ray techs, advanced practice nurses, dentists etc. Without enforceable covenants not to compete, private equity would have little to gain by buying a practice.

One of the great ironies about covenants not to compete is that lawyers draft them, sell them and enforce them. However, those covenants can't be applied to the practice of law!

Write your legislator and state senator now!
 
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One of the great ironies about covenants not to compete is that lawyers draft them, sell them and enforce them. However, those covenants can't be applied to the practice of law!

Write your legislator and state senator now!
and most legislators are lawyers so tough sell :)
 
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My favorite trust fund babies coming out to bash medicine in 2021 like it makes you a beggar when you finish.

Can you guys just quit already and have mommy come pay off your student loans and go back to yachting, or whatever tf it is you guys do that makes 300k salaries somehow seem completely insignificant? Why do you even hang around these forums?
I think a lot of it is grass-is-greener taken to a pathological level. I have a buddy who is ambitious to a fault, he gets offended at the idea of being "just" an attending physician. He talks a lot about nebulous "consulting and business" opportunities he is sure will present themselves by virtue of him aiming high and working hard. Like he really thinks an EM doc that keeps an eye open will get into some kind of successful venture that gives more influence and money than a doctor could ever obtain.

Never has any specifics of course, and wasn't even aware of the ACEP report about the job market of his own field. But a friend of a friend makes $1MM on wall street and isn't that smart so surely it's just a matter of time...

I don't think many of my friends understand that doctors are the biggest portion of the 1% and most get there by smart investing on their 300k.
 
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I think a lot of it is grass-is-greener taken to a pathological level. I have a buddy who is ambitious to a fault, he gets offended at the idea of being "just" an attending physician. He talks a lot about nebulous "consulting and business" opportunities he is sure will present themselves by virtue of him aiming high and working hard. Like he really thinks an EM doc that keeps an eye open will get into some kind of successful venture that gives more influence and money than a doctor could ever obtain.

Never has any specifics of course, and wasn't even aware of the ACEP report about the job market of his own field. But a friend of a friend makes $1MM on wall street and isn't that smart so surely it's just a matter of time...

I don't think many of my friends understand that doctors are the biggest portion of the 1% and most get there by smart investing on their 300k.
I think this year a lot of people have gotten into stock market with the pandemic. This wave’s yet to see a correction. I think normally a 10-15% return is pretty good! This year everyone has ditched their indexes for crypto or growth stocks or frankly anything and made a lot more though, until May.
 
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I think a lot of it is grass-is-greener taken to a pathological level. I have a buddy who is ambitious to a fault, he gets offended at the idea of being "just" an attending physician. He talks a lot about nebulous "consulting and business" opportunities he is sure will present themselves by virtue of him aiming high and working hard. Like he really thinks an EM doc that keeps an eye open will get into some kind of successful venture that gives more influence and money than a doctor could ever obtain.

Never has any specifics of course, and wasn't even aware of the ACEP report about the job market of his own field. But a friend of a friend makes $1MM on wall street and isn't that smart so surely it's just a matter of time...

I don't think many of my friends understand that doctors are the biggest portion of the 1% and most get there by smart investing on their 300k.
I still have no idea why anyone will ditch medicine to work in consulting but maybe i just really hate the environment of corporate finance
 
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I think this year a lot of people have gotten into stock market with the pandemic. This wave’s yet to see a correction. I think normally a 10-15% return is pretty good! This year everyone has ditched their indexes for crypto or growth stocks or frankly anything and made a lot more though, until May.
10-15% return, normally, is exceptional as in not the norm.
 
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I think a lot of it is grass-is-greener taken to a pathological level. I have a buddy who is ambitious to a fault, he gets offended at the idea of being "just" an attending physician. He talks a lot about nebulous "consulting and business" opportunities he is sure will present themselves by virtue of him aiming high and working hard. Like he really thinks an EM doc that keeps an eye open will get into some kind of successful venture that gives more influence and money than a doctor could ever obtain.

Never has any specifics of course, and wasn't even aware of the ACEP report about the job market of his own field. But a friend of a friend makes $1MM on wall street and isn't that smart so surely it's just a matter of time...

I don't think many of my friends understand that doctors are the biggest portion of the 1% and most get there by smart investing on their 300k.
This, if you can become financially intelligent, which isn't hard, working as a physician will have you in the top 1% of net worth by your late 30s. No other profession can guarantee that
 
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Tell that to the people grinding 60 hour weeks in meaningless corporate America making 60k to have the chance to make 6 figures one day, everything is relative
They also didn't spend 8 years on med school and residency with the opportunity cost of not working as well as the high level of loans from med school. Their level of responsibility is much less too.
 
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I also think there's a massive discrepancy between SDN fearmongering and reality. The collapse of EM and radonc was completely self inflicted by specialty leaders, but honestly, Twitter is far more realistic than SDN on these matters as much as i rail against Twitter
 
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They also didn't spend 8 years on med school and residency with the opportunity cost of not working as well as the high level of loans from med school. Their level of responsibility is much less too.
I dont think it has to do with # of years. We are just lucky right now this what the market would bear. One of my friend at one tine was making over 100k/yr with an AS degree in nursing working ~48 hrs/wk.

The moment the market is flooded with docs, no one would care the number of years we spend in school. Hence, salary between rural and working docs vs. NY docs.
 
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It really isn't. Working in corporate finance including as an analyst in PE is awful. It's residency levels of stress with little to no job security. Corporate medicine is far far better
I agree. I was actually trying to say the grass isn't that green on the other side of the fence.
 
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I dont think it has to do with # of years. We are just lucky right now this what the market would bear. One of my friend at one tine was making over 100k/yr with an AS degree in nursing working ~48 hrs/wk
I know someone in their 20s with an art degree making >250k in a very low stress job in silicon valley. Doesn't mean art school is a good alternative to medicine. Everyone likes to point at outliers in other fields and compare to the average among physicians. But watch how insane that looks when you flip it around:

I went to an Ivy League undergrad, spent a few years slaving away in Big 4 consulting, and attended Wharton for my MBA. I was only offered 180k, similar to my classmates, for my management position offers after all of that hard work. My uncle is a private practice radiologist outside of Chicago and he makes 750k working 8-5 with vacations every other month! Why was I such an idiot, the grass is so much greener in medicine.

Repeat for law school, compsci and engineering from target universities, finance, whatever. Its always like that, works in both directions. The truth is that medicine has much better security, a much higher floor, and a ceiling that goes nearly as high until you get into the obscene 0.01% firms.
 
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Tell that to the people grinding 60 hour weeks in meaningless corporate America making 60k to have the chance to make 6 figures one day, everything is relative
That is a perspective I fear most won't appreciate here. I believe its 100% correct though. "Non traditional" applicants or students are abundant but often means they did a masters program or some academic/research position before matriculating. My school lacks people that actually worked for a paycheck to pay a mortgage etc. I can only account for my school though. Most people that make complaints never worked any jobs besides medicine. Prior to starting medical school I was working 50-60 hours a week as a paramedic on an 911 ambulance, burnt out and stressed for less than 50k a year. I do admit that things aren't as rosy as before, but to call it "the biggest career mistake you'll ever make" is just ignorant. It compares it to what it used to be or some idea of what you thought it would be.

edit for typo
 
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I know someone in their 20s with an art degree making >250k in a very low stress job in silicon valley. Doesn't mean art school is a good alternative to medicine. Everyone likes to point at outliers in other fields and compare to the average among physicians. But watch how insane that looks when you flip it around:

I went to an Ivy League undergrad, spent a few years slaving away in Big 4 consulting, and attended Wharton for my MBA. I was only offered 180k, similar to my classmates, for my management position offers after all of that hard work. My uncle is a private practice radiologist outside of Chicago and he makes 750k working 8-5 with vacations every other month! Why was I such an idiot, the grass is so much greener in medicine.

Repeat for law school, compsci and engineering from target universities, finance, whatever. Its always like that, works in both directions. The truth is that medicine has much better security, a much higher floor, and a ceiling that goes nearly as high until you get into the obscene 0.01% firms.
You are preaching to the choir man. Medicine is no easy, so are most other jobs out there.

Radiology is an outlier in medicine. The salary and the fringe benefits these people got are insane IMO.
 
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10-15% return, normally, is exceptional as in not the norm.
Depends on how you look at the numbers, but the rule of thumb is over a 10 year period on average the market(S&P500) is around 12%. Year to year and decade to decade may be different but over the long haul it's about 12%.


This shows a little lower, around high 10%. 12% is just what I was taught in undergrad finance classes.
 
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That is a perspective I fear most won't appreciate here. I believe its 100% correct though. "Non traditional" applicants or students are abundant but often means they did a masters program or some academic/research position before matriculating. My school lacks people that actually worked for a paycheck to pay a mortgage etc. I can oblige account for my school though. Most people that make complaints never worked any jobs besides medicine. Prior to starting medical school I was working 50-60 hours a week as a paramedic on an 911 ambulance, burnt out and stressed for less than 50k a year. I do admit that things aren't as rosy as before, but to call it "the biggest career mistake you'll ever make" is just ignorant. It compares it to what it used to be or some idea of what you thought it would be.
SDN threads can look pretty elitist sometimes
 
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I dont think it has to do with # of years. We are just lucky right now this what the market would bear. One of my friend at one tine was making over 100k/yr with an AS degree in nursing working ~48 hrs/wk.

The moment the market is flooded with docs, no one would care the number of years we spend in school. Hence, salary between rural and working docs vs. NY docs.
It's getting flooded with mid-levels and patients don't care about the difference. Think about kids in med school now, it will be worse for them. I'm already feeling it.
Np have started private practicing too so they are directly competing for patients
 
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SDN threads can look pretty elitist sometimes
I get the "I can't do primary care like I wanted because I have 500K in loans that are compounding, so I'm doing anesthesiology" statement, but ones like these really make me wonder. I guess it's all about perspective. I've noticed how achievement oriented many of my classmates are. I get it, it's how you get selected to medical school when others don't, but that mindset needs to end at some point. I feel like income is just the next achievement. The idea that the wealthiest person is the one that makes the most money is simple, but wrong. You don't build wealth by working, you do it by saving and investing.
 
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It's getting flooded with mid-levels and patients don't care about the difference. Think about kids in med school now, it will be worse for them. I'm already feeling it.
Np have started private practicing too so they are directly competing for patients
Would not advise any premed to go into medicine now given how quick things are moving, but for someone like you who is already an attending, medicine is good (not great).
 
That is a perspective I fear most won't appreciate here. I believe its 100% correct though. "Non traditional" applicants or students are abundant but often means they did a masters program or some academic/research position before matriculating. My school lacks people that actually worked for a paycheck to pay a mortgage etc. I can oblige account for my school though. Most people that make complaints never worked any jobs besides medicine. Prior to starting medical school I was working 50-60 hours a week as a paramedic on an 911 ambulance, burnt out and stressed for less than 50k a year. I do admit that things aren't as rosy as before, but to call it "the biggest career mistake you'll ever make" is just ignorant. It compares it to what it used to be or some idea of what you thought it would be.
Not everyone wants or needs as much money as medicine makes. They put their 20 years in at some government job that they post on Facebook in, get their pension after 20 years. Less stress, less responsibility.
 
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Not everyone wants or needs as much money as medicine makes. They put their 20 years in at some government job that they post on Facebook in, get their pension after 20 years. Less stress, less responsibility.
That would be an outlier in my opinion. Most likely not all jobs are as stressful as the majority of jobs in medicine, or my previous job, however, that is not an accurate representation of a typical job.

There is also incredible stress associated to average paying jobs where many Americans live pay check to pay check.
 
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That would be an outlier in my opinion. Most likely not all jobs are as stressful as the majority of jobs in medicine, or my previous job, however, that is not an accurate representation of a typical job.

There is also incredible stress associated to average paying jobs where many Americans live pay check to pay check.
There are alot of government jobs. Alot. I have friends who work for them and it's cake.
 
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Federal government is the largest employer in the country. Non military payroll is 2 mill. Then state and local government. Union jobs, teachers, electricians....
 
As a counterpoint, for any students out there reading this, there is still a lot of validation in medicine. Yes there's a lot of regulation and 2020 really showed me that medicine is governed by costs and physicians are sometimes just gears of the machine. However, there is a unique gratification for being able to help someone in a singular way in the most dire of straits. That to me is still the biggest draw. Also, as a child of immigrants, a guaranteed six figure income can be a stepping stone to prosperity. This article should give you pause but shouldn't stop you from going into medicine if your heart is in it for the right reasons.
 
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Better think hard if you are a premed before 'wasting' your youth and $$$ on a medical degree...
Step 1: Start office
Step 2: Expand
Step 3: Sell to private equity
Step 4: Profit
 
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As bad as it may sound to a lot of people here, I pivoted away from clinical and chose to pursue an advanced degree (MD, PharmD, PhD) for the sole purpose of going into the biopharma finance space. Hopefully we see more MDs, etc., make a similar pivot because the comp is much more lucrative. Medicine is changing quick, don’t get caught on the wrong side hating yourself and your life for choosing the wrong pursuit. Leverage your advanced degree!
Spending 12+ years in grad school to get good compensation 🤔
 
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Yes, much better to spend 5-7 years getting a PhD in the sciences and then work another 3-5 years as a postdoc at 54K. And then, if you're really, really good, you may then get a tenure track position or govt reserch position and reach 250K after about 10 years.
 
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Yes, much better to spend 5-7 years getting a PhD in the sciences and then work another 3-5 years as a postdoc at 54K. And then, if you're really, really good, you may then get a tenure track position or govt reserch position and reach 250K after about 10 years.
Oh I wouldnt get a PhD if my goal was $$ either

ROAD to happiness is also the ROAD to fatFIRE

4 years as a student, 4-6 years making an average wage in a tolerable residency, then hop right into the 1% for as long as you want to work. Hard to beat
 
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Federal government is the largest employer in the country. Non military payroll is 2 mill. Then state and local government. Union jobs, teachers, electricians....
Sure it is cake, but it is also competitive to get into. Plenty of people who are non-military have to do something to stand out which typically requires 1-4 years of basically living on the fringe of poverty (Americorps VISTA for example) just to be able to apply to a decent government job.

I make just over 6 figures now, but I started out with 90k in debt for my electrical engineering degree and a 55k/yr salary. Our field guys work their backsides to the bone in adverse conditions, and most only make $15-25/hr outside of the union, supers make around $35/hr. How long do you want to be bending 4" rigid pipe in sub-zero or sweltering conditions for? The idea that medicine is a bad profession to get into now just seems absolutely insane to me. I feel like most of the doctors I see are driving expensive vehicles and probably do not manage their money properly. That being said, I don't think anyone is arguing that family docs/NPs/PAs are being pushed to extreme levels of patient turnover. That being said, I don't have an MBA, nor do I own/run a business, and I do not want to, so how can anyone not expect a tradeoff for getting to focus strictly on patient care versus having to do that and run a practce?
 
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But capitalism is the best and no one can question it! :cryi:
 
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Mostly all of this seems to miss a few intended points. I don’t think Pay/Salary is the gripe of most people making such warnings. The loss of control, oversight over their own patient safety parameters, dual standards within sub-specialties and attendant loss of professional camaraderie and respect, caused by non-clinicians (politicians, private equity, lawyers etc etc etc) have robbed some of satisfaction. Anyone who suggests that Physicians are underpaid have little idea of poverty. To suggest that Physicians are treated differently (even pay) is a more veritable argument. To minimize the “value” of what Physicians do, thereby ultimately affecting the quality of care and training for generations to come, that’s the greater problem of Medicine- which has turned it into a for-profit venture like never before.

Private Equity does not add value to Clinical care. While those types are out on team-building exercises listening to TED talks, they are stealing from Physicians (and Patients) engaged in the trenches grunting away.

The question to ask really is why take a almost half a million dollar loan for education while the lenders make money off you on the front end, and try to rip you off on the tail end too by saying you add little “value” as a Physician. Private equity, excessive Admin, Pharma, Health Insurance add to the costs and steal from everyone. Physicians though while we make a decent income are simply constantly targeted. The risk is just an erosion in quality of education, training and standards as we race to a lower level.. in the name of corporate profit and what’s become a total hypocrisy- the foundations of society. Problem is way beyond Medicine.. the Sociopaths are ruling. And we’re asking them to change. By logic, they won’t and the trajectory won’t- so choose carefully and if Medical School- choose your specialty based on these factors and your likes and dislikes. Make a balanced and informed decision.. which may include not going into Medicine.

That’s the undercurrent of the situation.. NOT “I wouldn’t go into Medicine in 2021”...
 
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If you care about compensation, computer science is really a great field right now. Most of my friends in college and grad school went directly to big tech companies and make 200k plus options/stocks right after graduation.
 
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