Interesting read

[doctalaughs]

Why Private Equity Is Furious Over a Paper in a Dermatology Journal

Interesting read. Anyone know the leadership at aad and their perspective? Looks pretty bad on their part.

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[asmallchild]

Why Private Equity Is Furious Over a Paper in a Dermatology Journal

Interesting read. Anyone know the leadership at aad and their perspective? Looks pretty bad on their part.

I agree, a bad look for the AAD and for dermatology. As it does everywhere else, money talks.

 

[MOHS_01]

The real question here is.... does anyone here have a copy of that paper from before they took it down? Apparently it was shared on a derm Facebook group page. It has to be something good for a university to roll over for a corporate lawyer’s legal threats....

 

[reno911]

The real question here is.... does anyone here have a copy of that paper from before they took it down? Apparently it was shared on a derm Facebook group page. It has to be something good for a university to roll over for a corporate lawyer’s legal threats....

I'd like to see the original as well. If anyone has it please PM me.

Also based on the NYT article it's not clear that the university "rolled over". The AAD leadership pulled the article and while it says that some changes were submitted, it sounds like the changes are the ones the AAD wanted and not the ones Advanced's lawyers approached UF about. But from the way the article is written, it is not entirely clear.

 

[smartparts]

How do I know if mine is the "before" copy ?

 

[MOHS_01]

How do I know if mine is the "before" copy ?

Has a revised copy been released? If not, and you have a copy, it is the “before” version 1.0


I’ll be having a convo with a couple of industry guys soon, will report back. This should be fun. I mean enlightening.

 

[MOHS_01]

Has a revised copy been released? If not, and you have a copy, it is the “before” version 1.0


I’ll be having a convo with a couple of industry guys soon, will report back. This should be fun. I mean enlightening.

As expected, they're a little touchy about it. Makes me want to dig a little deeper into this, looking at putting someone on payroll as we speak to crunch MC referral data and practice patterns for providers and see if any trends pop.

 

[MullerCell]

https://lookaside.fbsbx.com/file/ko...ZYfFK7Zc5rQlv25oArHhbYd4zSojjkhCJFTxvd9pAkNvA

 

[doctalaughs]

Interesting read (the original article).

I wonder what Dirk claims is “factually incorrect” in this article. I also wonder if this comes to legal battles if Suzanne (the aad president) can show there really is no e-mail trail that the AAD leadership influenced him as the NYT articles claim.

Either way, you have to be either blind or corrupt (ie financially benefitting) to not see these PE firms are horrible for our specialty and for patient care. To say there are “two sides” to the argument is ridiculous. All you have to do is look at anesthesia or EM to see where this road leads....

 

[TMP-SMX]

AAD has said they want to get their name out there to the public. I think they've succeeded.

 

[Fpg1245]

I may not post in this forum often but it obvious PE has infiltrated a large part of medicine and it hasn’t been very good. Plenty of specialties have gone down this road Anesthesia, EM, Oncology, even Radiology and it’s a disaster for doctors and patients. PE eats through the health care value chain like termites. It appears Derm has fared better in keeping themselves private unlike a lot of other specialties. When it comes to PE they sneak up on you and before you know it they’re the only employer in town. I am anxious to see if derms will have the courage and tenacity to stand up when so many others fell silent because of greed or fear.

 

[russwheeler]

Interesting read (the original article).

I wonder what Dirk claims is “factually incorrect” in this article. I also wonder if this comes to legal battles if Suzanne (the aad president) can show there really is no e-mail trail that the AAD leadership influenced him as the NYT articles claim.

Either way, you have to be either blind or corrupt (ie financially benefitting) to not see these PE firms are horrible for our specialty and for patient care. To say there are “two sides” to the argument is ridiculous. All you have to do is look at anesthesia or EM to see where this road leads....

ABD can't score an exam.

AAD can't review an article.

We say we want to police ourselves.

FWIW: I think Dirk Elston is a good guy and cares about the specialty. He probably should not have pulled the article but I don't think he has bad intentions. Maybe leave it up and say we are investigating potential inaccuracies that have come to our attention following the initial acceptance...and state what these are.

 

[JDMD243.0]

ABD can't score an exam.

AAD can't review an article.

We say we want to police ourselves.

FWIW: I think Dirk Elston is a good guy and cares about the specialty. He probably should not have pulled the article but I don't think he has bad intentions. Maybe leave it up and say we are investigating potential inaccuracies that have come to our attention following the initial acceptance...and state what these are.

Dirk is also an ABD director who sells review books for ABD exams and replaced Bruce Thiers as JAAD editor as well as MUSC Derm Chair.

 

[Skindoc83]

According to the Facebook page one of the disagreements dirk had was with the assertion the that PE groups are deliberately going recruiting thought leaders in the derm field. Interestingly enough, zitelli and brodland just signed with qualderm....

I’ve also read on the same Facebook group that PE groups are having trouble hiring new dermatologists. It seems the newly graduating residents realize that the offers are not very good.

 

[asmallchild]

According to the Facebook page one of the disagreements dirk had was with the assertion the that PE groups are deliberately going recruiting thought leaders in the derm field. Interestingly enough, zitelli and brodland just signed with qualderm....

I’ve also read on the same Facebook group that PE groups are having trouble hiring new dermatologists. It seems the newly graduating residents realize that the offers are not very good.

Not good for them personally, not good for the specialty.

I have noticed I no longer get the advertisements for sky high salaries from these PE groups anymore. Maybe they too realize that kind of salary isn't sustainable and people get annoyed when they get switched from guaranteed salary in Year 1 to productivity in Year 2 and see their income plummet...

The PE group in my region has difficulty hiring midlevels and has been hemorrhaging support staff over the last 12 months to competing practices in town.

 

[doctalaughs]

I may not post in this forum often but it obvious PE has infiltrated a large part of medicine and it hasn’t been very good. Plenty of specialties have gone down this road Anesthesia, EM, Oncology, even Radiology and it’s a disaster for doctors and patients. PE eats through the health care value chain like termites. It appears Derm has fared better in keeping themselves private unlike a lot of other specialties. When it comes to PE they sneak up on you and before you know it they’re the only employer in town. I am anxious to see if derms will have the courage and tenacity to stand up when so many others fell silent because of greed or fear.

I pray that we do.

The problem is that PE is smart. Those that have all the power and control (ie practice owners nearing the end of their career) stand to benefit tremendously from selling their practices. Most easily get a 1-2m dollar buyout, much more if they are controlling partners in a large group or take a leadership position to help PE gobble up more practices.

That's how a small # of greedy dermatologists sell out the specialty even when a large majority of younger dermatologists are wholly speaking out against it. Our advantage is the lower barrier to entry and lack of exclusive hospital contracts makes this a harder specialty to completely dominate compared to ones like EM and anesthesiology.

I don't know Dirk but I do know Suzanne. She seemed like she cared about the specialty in the past but you know what they say... power corrupts. Also, when all your "leadership" friends are also in bed with the PE firms reaping a ton of money, it's hard not to be influenced by their viewpoints.

 

[doctalaughs]

If you read the paper carefully a few of these dermatologists (or midlevels) working for the PE firms are insane.

11 biopsies (on AVERAGE) per medicare patient? That person should be in jail!!

 

[Dusn]

The original article should be attached to this post, in case there is any trouble with the link above.

 

[Skindoc83]

The rise of PE in derm is just another reason why the baby boomers are the greediest generation in American history. Our national infrastructure is abysmal because they didn’t want to pay taxes to maintain it. Our environmen is declining because they want cheap energy now. The United States has abdicated its role in the world because they couldn’t tolerate the idea of a woman being president. Now, they want to retire and sell their practice while thinking that they’re entitled to a million dollar buy out. The days of buying a practice and inheriting all of those patients is over, a practice is worth little more than it’s hard assets. So rather than accept this they are destroying our field because: “screw you, I want mine.”

 

[bronx43]

Rheumatologist here. I feel like rheum is a bit similar to derm in that we are both small specialties and the private practice model is still reasonable. PE hasn't gone into our specialty because it's not nearly as profitable, though many rheum practices can generate 7 figures for the partners.
My question is if a dermatologist can just up and leave a practice and start up shop in the next town, what power do PE firms really have over dermatology as a whole? Like many people mentioned, a practice isn't worth much more than the brick and mortar... so if PE is overpaying for a derm practice, who is losing out?

The real threat always comes from within a specialty - namely the people controlling the SUPPLY of physicians. Once we become commoditized and our supply increases, that's the when the floor falls out from under us.

 

[doctalaughs]

It’s true that dermatologists can just leave and setup solo shops which made it more resistant to PE compared to other specialties where the ship sailed decades ago (anesthesiology, EM etc).

However, as the govt and insurance continues to setup more and more burdens on practice (billing, coding, emr, meaningful use, mips, etc) its harder and harder to cut a decent salary going solo.

In addition PE firms negotiate higher rates from insurance so these large dermatology mills can bill sometimes 175% for the same work a solo guy does who has no negotiating power.

Finally PE has enough capital to setup capture all the ancillary streams of revenue from self referral (ie in house path lab and pathologist, in house mohs, cosmeceuticals, estheticians, full battery of cosmetic lasers etc). So they end up paying a dermatologist probably more than they can get solo (unless the market is completly empty or the solo guy is working twice as hard) while still taking a lot for themselves. Of course this extra money is coming right out of patient pockets for similar if not inferior medical care.

No wonder this country is going bankrupt from healthcare expenditures....

 

[JDMD243.0]

It’s true that dermatologists can just leave and setup solo shops which made it more resistant to PE compared to other specialties where the ship sailed decades ago (anesthesiology, EM etc).

However, as the govt and insurance continues to setup more and more burdens on practice (billing, coding, emr, meaningful use, mips, etc) its harder and harder to cut a decent salary going solo.

In addition PE firms negotiate higher rates from insurance so these large dermatology mills can bill sometimes 175% for the same work a solo guy does who has no negotiating power.

Finally PE has enough capital to setup capture all the ancillary streams of revenue from self referral (ie in house path lab and pathologist, in house mohs, cosmeceuticals, estheticians, full battery of cosmetic lasers etc). So they end up paying a dermatologist probably more than they can get solo (unless the market is completly empty or the solo guy is working twice as hard) while still taking a lot for themselves. Of course this extra money is coming right out of patient pockets for similar if not inferior medical care.

No wonder this country is going bankrupt from healthcare expenditures....

My guess is that amazon J.P. Morgan walmart et al are going to be the next big fish in the pool and we will soon be wearing flare and paper hats asking if customers would like extra clobetasol with their cryo.

 

[MOHS_01]

It’s true that dermatologists can just leave and setup solo shops which made it more resistant to PE compared to other specialties where the ship sailed decades ago (anesthesiology, EM etc).

However, as the govt and insurance continues to setup more and more burdens on practice (billing, coding, emr, meaningful use, mips, etc) its harder and harder to cut a decent salary going solo.

In addition PE firms negotiate higher rates from insurance so these large dermatology mills can bill sometimes 175% for the same work a solo guy does who has no negotiating power.

Finally PE has enough capital to setup capture all the ancillary streams of revenue from self referral (ie in house path lab and pathologist, in house mohs, cosmeceuticals, estheticians, full battery of cosmetic lasers etc). So they end up paying a dermatologist probably more than they can get solo (unless the market is completly empty or the solo guy is working twice as hard) while still taking a lot for themselves. Of course this extra money is coming right out of patient pockets for similar if not inferior medical care.

No wonder this country is going bankrupt from healthcare expenditures....

That is about to change; we just had to change our tactics to reflect the times.

Find the right lever and make the politician understand that it is in their best interest to pull on it for us. There is not enough “efficiency” to be found in the system for the PE backer to realize 7-12% returns plu pay the provider what they should be earning. I actually look forward to watching the titans fall.