Podiatry Supergroups

[PointyNippers]

What are people's thoughts on these private practices being bought out by podiatry supergroups (foot and ankle specialists of mid-atlantic, etc.)?

They have been expanding pretty aggressively recently, some practice owners I thought would NEVER sell have been bought out.
Are they really offering that much?
Do the benefits really outweigh the cons by that much?

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[pod squad]

I don't blame owners who sell to them one bit. Take that golden parachute, it's the closest thing you'll get to a retirement/exit plan in PP.

 

[Feli]

I would not say they are good or bad. They just are.

I work for the largest pod group in my state, which has a few offices in other states... I was also offered a job for FASMA at a couple of their NC locations before I took this one.

(+) The (base) pay is higher than small PP.
[-] The partnership or owner opportunity is non-existent.
(+) There is no worry on the marketing or staffing or reimbursement things that can be a headache if you're a small PP owner.
[-] The staffing or marketing or billing/collections might suck, depending on your management.
(+) You can have fair autonomy depending on how you set it up.
[-] There is the annoying undertone to push nail samplings, OTC stuff, DME, certain refers, etc to bonus.
(+) There are a lot of docs in the group to share coverage and mastermind with on coding, etc.
[-] There is always the chance that you'll be replaced with someone cheaper (just like hospital FTE jobs) if you don't play their game.

A few of the supergroups have failed in epic fashion. I'm sitting in an office right now that is was used for a bit by a supergroup from Colorado that bankrupted themselves.... owner was smart enough, DMC trained. It is not impossible to fail when you are borrowing at high VC interest rates to expand quickly, though.

A couple of my buddies and my residency attendings run the big/huge groups. Their doc retention is high, higher than small/medium PPs for sure... near 100% retention for the multi-state big group my residency attendings run. So yeah, some of them run pretty darn smooth.

For better or worse, the big groups are here to stay.
Podiatry always laments the lack of hospital/MSG jobs, so these big groups are essentially to DPMs what Concentra is to ER docs and NPs? As to why "some practice owners I thought would NEVER sell" do sell... welp, everything is for sale at the right price.

 

[heybrother]

I would not say they are good or bad. They just are.

I work for the largest pod group in my state, which has a few offices in other states... I was also offered a job for FASMA at a couple of their NC locations before I took this one.

The (base) pay is higher than small PP.
The partnership or owner opportunity is non-existent.
There is no worry on the marketing or staffing or reimbursement things that can be a headache if you're a small PP owner.
The staffing might suck, depending on your management.
You can have fair autonomy depending on how you set it up.
There is the annoying undertone to push nail samplings, OTC stuff, etc to bonus.
There are a lot of docs in the group to share coverage and mastermind with on coding, etc.
There is always the change that you'll be replaced with someone cheaper (just like hospital FTE jobs) if you don't play their game.

A few of the supergroups have failed in epic fashion. I'm sitting in an office right now that is was used for a bit by a supergroup from Colorado that bankrupted themselves.... owner was smart enough, DMC trained. It is not impossible to fail when you are borrowing at high VC interest rates to expand quickly, though.

A couple of my buddies and my residency attendings run the big/huge groups. Their doc retention is high, higher than small/medium PPs for sure... near 100% retention for the multi-state big group my residency attendings run. So yeah, some of them run pretty darn smooth.

For better or worse, the big groups are here to stay.
Podiatry always laments the lack of hospital/MSG jobs, so these big groups are essentially to DPMs what Concentra is to ER docs and NPs? As to why "some practice owners I thought would NEVER sell" do sell... welp, everything is for sale at the right price.

This brings up a recent discussion on the anesthesia forum. They point out some ortho groups have begun to sell. I would have told you ortho would never sell because its so profitable. Well they do - they just want enormous money ie. $10 million.

My big thing on some of these things is - people will never know just how much wealth they missed out on

To me the trifecta of private is:
(a) own/partner your practice
(b) own your building
(c) own shares in a surgery center

We never talk about real estate on here but consider - my partner owns our building. He owns it because its been occupied by his family for like 30-40 years. The practice pays "market rent" but he owns it outright and it has no mortgage. If you own a building outright with no mortgage then you essentially will just pay taxes (yeah yeah, he also has upkeep and what not). Texas is somewhat notorious for taxes (albeit no state income tax), but its still a big win. He puts most of the rent money in his pocket.

Owning your own physical real estate may not be possible in certain parts of the country, but its a wealth builder when it exists.

 

[Feli]

...

To me the trifecta of private is:
(a) own/partner your practice
(b) own your building
(c) own shares in a surgery center

...

Yeah, if you are talking about making $ on non-pt stuff. ^^

For making money just from the clinic/pts:
1) Good payers
2) Little competition in area
3) Source of associates you can underpay (ie local residency program)

3 is optional, but sure helps PP bottom lines
2 might be the biggest thing... I know plenty of very mediocre-skilled docs who have retired early and well by being the only DPM for 50+ miles.

 

[heybrother]

Yeah, if you are talking about making $ on non-pt stuff. ^^

For making money just from the clinic/pts:
1) Good payers
2) Little competition in area
3) Source of associates you can underpay (ie local residency program)

3 is optional, but sure helps PP bottom lines
2 might be the biggest thing... I know plenty of very mediocre-skilled docs who have retired early and well by being the only DPM for 50+ miles.

#2 is the easiest path to #1. United wants to pay sub-Medicare? Who cares if you have a waitlist of BCBS bunions, ingrowns, and plantar fasciitis.

#3 though is the path to misery. My opinion, a major problem for a lot of podiatrists is no partner. 2 people paying the rent. Manager/biller/authorizing people, fancy or not, spread across the collections of two people. Even with a surgery day and an afternoon off the clinic is still probably going to have coverage except maybe on Friday afternoon.

I briefly had this fantasy that when my partner quit I'd drop everything that's trash ie. Humana (already gone), United (will be gone) and Aetna. But having realized that I'm probably never going to squeeze any additional money out of the payors the trick is going to be having someone solid down the hallway seeing 20-25.

I don't need someone else's money. I just want to keep as much of my own as possible.

 

[619]

Yeah, if you are talking about making $ on non-pt stuff. ^^

For making money just from the clinic/pts:
1) Good payers
2) Little competition in area
3) Source of associates you can underpay (ie local residency program)

3 is optional, but sure helps PP bottom lines
2 might be the biggest thing... I know plenty of very mediocre-skilled docs who have retired early and well by being the only DPM for 50+ miles.

#2 and #3 are contradictory haha. No place in this country you have a local residency program with little competition. Someone tell me a place like that and I can move their tomorrow jk jk. I am happy with my office location even though there is a residency program less than 30 miles from me and I have about 4 pods less than a mile radius from me. Reason is my office is next to a level 2 trauma hospital so naturally it's saturated buy every specialist not just podiatry. I can throw stone and it will surely land on a cardiologist, Infectious disease, IM etc before a podiatrist.

Out of the 3 options, I will pick #1 first then #2. In a growing city or county, there will be enough patients to go around once you do good work. For #3 If you are in a desirable state and county, new grads will find you looking for jobs especially with 2 new schools opening.