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  • Charlotte Radiology taking PE?

    Posted by Unknown Member on January 22, 2018 at 12:32 pm

    Rumors flying all over that Charlotte Rad took private equity money and is aggressively trying to convince their SR partners to join them.  I suppose if this is true, Strategic Radiology is done.  While RP and others have been doing this for sometime, I’m curious if this changes anything.  Riverside did the same over a year ago and has gone quite.  I think 2018/19 is going to be interesting to say the least.  

    Sandman_42 replied 3 years, 8 months ago 18 Members · 79 Replies
  • 79 Replies
  • Count Contrastula

    Member
    January 22, 2018 at 2:29 pm

    At the end of the day this could turn in our favor. When, not if, it all goes to crap and these private equity scum cant change vet their contracts, good deals will be offered by whoever the cleanup is assigned to. Good deals.. and in desirable areas (except Colombus lol)

    Guy o know who works in Philly for big group. Last two contracts they were offered were from an Envision practice purchase . Guess how long ago?? 5 years. When everybody vested finally leaves. Before that it was painful dwindle

  • mariacardei7_785

    Member
    January 22, 2018 at 6:27 pm

    Quote from Rad-ical

    Rumors flying all over that Charlotte Rad took private equity money and is aggressively trying to convince their SR partners to join them.     

    I thought they made very good+ money; how much more needed? So WHY?

  • Unknown Member

    Deleted User
    January 22, 2018 at 9:02 pm

    When you say taking private equity money, are you saying they sold to RP? I’ve heard Charlotte radiology is selling, but how/who did they sell to?

    • Unknown Member

      Deleted User
      January 23, 2018 at 4:23 am

      Heard they sold out to RP. 

    • Unknown Member

      Deleted User
      January 23, 2018 at 7:33 am

      No.  I am hearing they partnered with another PE firm in an effort to compete with RP and others in the market.  Will be interesting to watch from the sidelines.

      • nicolasvg.1003

        Member
        January 23, 2018 at 9:55 am

        Good for them, to push back against RP. Hopefully they still control the majority of their practice. 

        • Unknown Member

          Deleted User
          January 23, 2018 at 10:09 am

          how is selling to another (or any) PE firm good. Charlotte radiology probably shopped around and sold to the highest bidder. This is the trend of the future.

          • nicolasvg.1003

            Member
            January 23, 2018 at 11:33 am

            If they sold out, yes it is bad. If they took some investment money to build up the practice to fight off the other corporates, without fully selling out, it might not be as bad and may signal a new approach. 

            • Unknown Member

              Deleted User
              January 23, 2018 at 11:51 am

              Took some investment money? How does that work? Like borrowing money from the bank, but instead from private equity firm?

              • venkysakthi97

                Member
                January 23, 2018 at 6:27 pm

                LOL. Borrowing money from an investment firm means they are going to demand equity ownership-it’s just a matter of how much. Taking money from banks is “stupid” money (banks are stupid) cuz they just want the money back. Taking money from investors is taking “smart” money (i.e. the lenders are the smart ones) because they are going to ultimately control the shots. LOL

                • Unknown Member

                  Deleted User
                  January 24, 2018 at 12:51 pm

                  It was suggested that Charlotte radiology “took some investment money to build up the practice to fight off the other corporate, without fully selling out.” Is there any truth to this? Can we all get some money from private equity firm without fully selling out?

                  • Unknown Member

                    Deleted User
                    January 24, 2018 at 4:00 pm

                    I’ve read the content of their website.  It appears they take majority control when they invest.  I don’t know much about this world, but I doubt many quality firms would invest and let radiologists manage their investment.  I can barely balance my checkbook…oops, just dated myself.

                    • Unknown Member

                      Deleted User
                      January 25, 2018 at 6:29 am

                      Quality firms can absolutely simply invest and let the rads manage, for sure. They are only looking for an exit. It’s called a roll-up. [link=https://www.investopedia.com/terms/r/rollup.asp-0 ]https://www.investopedia….s/r/rollup.asp-0 [/link]
                       
                      The PE firm may have some “nuclear options” if the group starts to implode or lose money — they are often allowed to step in and right the ship if it is listing. But as long as you are making the money they expected, they don’t give a sh$$ how you staff your hospitals or service the contracts. They just want the ability to buy other firms like you, ideally get you all on the same health care, malpractice insurance, and billing, and then sell the new mega group to another entity. 
                       

                    • Count Contrastula

                      Member
                      January 25, 2018 at 8:39 am

                      Compete with rad partners. Another shark in the water. Great.

                    • Unknown Member

                      Deleted User
                      January 25, 2018 at 1:26 pm

                      So in your opinion, is it better to sell to a PE firm or to RP? Who would pay more to buy, I guess I’m asking? We went with RP and so far have been really happy with our partnership, but a buddy of mine is in the process of selling his group; they have talked to all 3: RP, MedNax and Envision. They have a pretty decent size stable group but they have not entertained the private equity firm route. Maybe there is more cash and they might be willing to pay and that would explain why Charlotte radiology and Riverside did it this way.

                    • afazio.uk_887

                      Member
                      January 25, 2018 at 4:48 pm

                      Can I ask what about RP has made you “really happy”?  Not passing any judgement, but what is so great about them that you are happy with a 30% pay skim for eternity, besides the short term benefit of the lump sum payment?  What added value do they really bring that justifies such a large skim job? Just curious.  Feel free to PM if you prefer. 

                    • nelson33.jn

                      Member
                      January 26, 2018 at 7:48 am

                      Charlotte radiology? Aren’t they one of the premier huge groups in NC? This doesn’t bode well for radiology.
                       
                      And while we are one the topic, are there any other good groups in NC offering partnership and not looking to sell out to these vultures? I’m interested in the area – Just for my own edification…

                    • Unknown Member

                      Deleted User
                      January 26, 2018 at 2:27 pm

                      Clinically, we have added contracts to our practice under RP and improved our service (well, actual improvement is debatable but it is perceived as an improved by our hospitals). Our relationship with hospitals we serve is better than ever; in general, hospitals trust the RP brand. They also offer a lot of resources which weren’t available before we joined.  Financially, we did take a small salary cut but it was not 30%. At our salary level currently and with the stock market return in recent years we are set up to come out ahead over the period of next 10-20 years in comparison to salary level before we joined. Of course our stocks in RP have more than doubled.
                      Reimbursement in my opinion, and I’ve been doing this for a while now, is going down, not up. Sure you can always read more, work more and say your salary is going up but dollar per study is only heading one direction. This is definitely the right decision for our group (a stable midsize practice). Partners are smiling a little more and generally more fun to work with as many technologists have noticed.
                      Strong stable groups, like ours, are sign on. I have personally bought a lot more RP stocks, so that tell you that I am a believer.
                       
                      Hope that helps.

                    • afazio.uk_887

                      Member
                      January 26, 2018 at 2:48 pm

                      If your salary went down only a little, that means your lump sum payments was small.   The model they use is pretty simple after all, pay you a lump sum up front which is how much they skim yearly multiplied by a multiple.  
                       
                       
                       

                    • Unknown Member

                      Deleted User
                      January 26, 2018 at 3:52 pm

                      Quote from StringSign

                      Clinically, [b]we have added contracts to our practice under RP[/b] and improved our service (well, actual improvement is debatable but it is perceived as an improved by our hospitals). Our relationship with hospitals we serve is better than ever; [b]in general, hospitals trust the RP brand.[/b] They also offer a lot of resources which weren’t available before we joined.  [b]Financially, we did take a small salary cut [/b]but it was not 30%. At our salary level currently and with the stock market return in recent years we are set up to come out ahead over the period of next 10-20 years in comparison to salary level before we joined. Of course our stocks in RP have more than doubled.
                      Reimbursement in my opinion, and I’ve been doing this for a while now, is going down, not up. Sure you can always read more, work more and say your salary is going up but dollar per study is only heading one direction. This is definitely the right decision for our group (a stable midsize practice). Partners are smiling a little more and generally more fun to work with as many technologists have noticed.
                      Strong stable groups, like ours, are sign on. I have personally bought a lot more RP stocks, so that tell you that I am a believer.

                      Hope that helps.

                       
                      So you gave up control, got busier, and got paid less. The RP brand? Come on now, that’s DaVita. What’s to be trusted? 

                    • nelson33.jn

                      Member
                      January 27, 2018 at 7:34 am

                      Nibbler, much thanks and appreciation for the info.

                    • reuven

                      Member
                      January 27, 2018 at 11:16 am

                      Quote from StringSign

                      Of course our stocks in RP have more than doubled.

                      You won’t know what your stock is worth until you are able to sell it. But I’m sure that its speculative value makes you feel better about your decision

                    • Unknown Member

                      Deleted User
                      January 27, 2018 at 2:35 pm

                      Yes, I understand that and certainly considered it before writing a big check to purchase more stocks. I love the idea of planting my flag right next to the venture capitalists’ either when IPO or sell for multiples. They make money and I make money, everyone wins. It’s capitalism, which is the foundation of this country. And we finally have a president in Trump who understands that. Expect greatness in the stock market, 15-20% gain next 10 years!

                    • afazio.uk_887

                      Member
                      January 27, 2018 at 3:16 pm

                      I guess I simply don’t understand the math.  They skim money off the top of your salary forever, but pay you a lump sum of cash/stock up front.  The break even point is perhaps between 5-10 years based on what multiple you get.  After that, they are making money off your back, skimming off the top of your professional fee income.  Unless they figure out a way to increase your salary over time, I don’t see how you are better off in the long-term.  A very big risk would be they sell before 10 years to MEDNAX or someone else, the executives and VC cash out and the rads face salary CUTS, not improvement under the new owners.
                       
                      I guess I don’t see what they are bringing to the table that benefits the rads unless your group is facing possible displacement or contract loss.

                    • Unknown Member

                      Deleted User
                      January 28, 2018 at 5:52 am

                      15-20% gain in the next 10 years? You mean total or average annual? It is unwise to rely on predictions of stock returns over a 10 year period.

                    • Unknown Member

                      Deleted User
                      January 28, 2018 at 5:54 am

                      15-20% gain in the next 10 years? You mean total or average annual? It is unwise to rely on predictions of stock returns for a 10 year period.

                    • antoni.bielazik_633

                      Member
                      January 28, 2018 at 6:31 am

                      Quote from vonbraun

                      15-20% gain in the next 10 years? You mean total or average annual? It is unwise to rely on predictions of stock returns for a 10 year period.

                       
                      If those are your expectations, you will be very disappointed.  Based on current valuations and dividend rates, expect 4% annual gains over the next 10 years for US equity.

                    • Unknown Member

                      Deleted User
                      January 28, 2018 at 8:58 am

                      I think StringSign drank the kool-aid.

                    • afazio.uk_887

                      Member
                      January 28, 2018 at 10:16 am

                      For some reason, just based on the way he writes, I am not convinced he is a practicing radiologist.  Perhaps some RP employee who’s in charge of propaganda.

                    • Unknown Member

                      Deleted User
                      January 29, 2018 at 5:03 am

                      yes, highly efficient radiologist here. Cranked out 250 studies yesterday on call.
                       
                      propaganda? This is auntminnie board here, not North Korea. Really.
                       
                      If you know the numbers, take 2 partners, one going with RP, the other doesn’t. Who comes out ahead money wise in 10 years? Do the calculations.

                    • g.giancaspro_108

                      Member
                      January 29, 2018 at 6:35 am

                      Our group did those calculations under multiple market scenarios and the private radiologist came out way ahead every time. It was not even close. We were utterly baffled why anyone would sell. There is an enormous cost to selling. As noted above CEO Holden and his expensive executive crew’s money has to be skimmed from somewhere. Perhaps we were wrong, would you be willing to share more details supporting your beliefs?

                    • nicolasvg.1003

                      Member
                      January 29, 2018 at 10:57 am

                      Come on people, let’s get real here.  These corporate-VC groups have an obvious and simple plan.  Purchase large groups for fairly cheap, establish local/regional dominance, then displace/steal contracts from small and medium sized groups.  These wall street/business types have no ethics.  There are a million examples of corporate greed and unethical behavior leading to people dying or going bankrupt and nobody cares, forget some rad group losing a contract. Rads are snakes but they are nothing compared to these guys. 
                       
                      Rads like stringsign above are simply useful (greedy) idiots on this path for them.  Frankly, I think the main rads who allowed these guys to gain a foothold in the field should lose their board certification for the disservice they have done to the field.  Of course, that’ll never happen since the ABR is corrupt and only interested in MOC fees. 

                    • nicolasvg.1003

                      Member
                      January 29, 2018 at 11:16 am

                      As hospitals consolidate, it makes it even easier for them. They will simply take those contracts and offer the on-site rads salaried employee positions…. no buy-out, no stock options, nada.  Thus as they grow they won’t need as much capital / debt to fuel growth.  This is obvious to me and plain as day.   These guys are going to eat our lunch and laugh all the way to the bank.   Amazing how dumb and myopic doctors are.  I can’t believe anyone would think these corporate types are benevolent or give 2 sheets about radiology.  
                       
                       

                    • Unknown Member

                      Deleted User
                      January 29, 2018 at 11:58 am

                      And I thought I was cynical.  Thank you [link=http://www.auntminnie.com/forum/showprofile.aspx?memid=49141]General_Rad2016[/link] for proving me wrong.  You take the cake. It’s almost as if being a physician excuses us from being capitalistic.  Let’s admit it, most of us are greedy.  It’s ok to admit that we want to make money.  The difference is many on our peers feel entitled simply because we went to medical school.  

                    • nicolasvg.1003

                      Member
                      January 29, 2018 at 12:26 pm

                      Health care is not a free market.  It is highly regulated, or it should be.  People’s lives are at stake.  Are you ok with Valeant pharma and pharma boy jacking up critical drug prices 3000% and ok with people dying because of it?  After all, they are just being “capitalistic”. Who is going to lose from the corporate take over of radiology??? Def not the VC and suits.  The rads will lose, but the patients will lose the most as we all become slave RVU monkeys and quality drops significantly.  
                       
                      I am not being cynical either — just look at what the VC corporate entities are buying.  They aren’t buying small or medium sized groups for a reason….. it is plainly obvious to anyone with half a brain what their business model is and going to evolve into.  
                       
                      DaVita paid out over a billion dollars in fines for fraud, you think these are “good guys” who are planning to “play nice” down the road???  
                       
                      Seriously, get real folks. 
                      Anyway, not like it matter, nothing is going to change and this trend is never going to reverse.  I will just save my breath I suppose. 
                       
                       
                       
                       
                       
                       
                       
                       
                       

                    • Unknown Member

                      Deleted User
                      January 29, 2018 at 12:52 pm

                      Guess I’m just optimistic that someone will do it the right way.  Focusing on patient care first.  

                    • antoni.bielazik_633

                      Member
                      January 29, 2018 at 12:53 pm

                      With these intrusions into our profession, it is ever more important for us to reach financial independence early and say F it when work becomes intolerable.

                    • antoni.bielazik_633

                      Member
                      January 29, 2018 at 12:55 pm

                      These parasitic groups will go bankrupt instantly when there is no peon willing to working for them.

                    • nicolasvg.1003

                      Member
                      January 29, 2018 at 1:05 pm

                      Quote from Rad-ical

                      Guess I’m just optimistic that someone will do it the right way.  Focusing on patient care first.  

                      Oh man, please tell me you aren’t serious?   
                       
                      In any event, it is sort of a pointless discussion at this time as this trend is just gaining strength. No sense getting worked up over things out of ones control.  The future of radiology is dystopian, however, I guarantee it. 
                       
                      Life goes on, however……
                       

                       

                    • Unknown Member

                      Deleted User
                      January 29, 2018 at 4:27 pm

                      Stop with the negativity. I am a radiologist like you guys, and clearly our skill sets are the assets here. Maybe the groups that sold, Charlotte Radiology, included, are outsmarting the Venture Capitalists? Did that ever occur to you that we might be smarter than them? We take the money and if it goes bust we get our practices back. We win and then win some more. For once we are biting back at VC.

                    • afazio.uk_887

                      Member
                      January 29, 2018 at 5:05 pm

                      The radiology mega-corps are held together by very restrictive non-compete agreement.  They are the glue that keep them together and subjugate the rads.  If you want to take down these corps and restore radiologist stature, attack the non-compete agreements not the business itself.  Many people feel these agreements are not legal and there is a very active push to have them outlawed.  If rads came together to influence policy (ACR, where are you?)and make these type of agreements non-enforceable, these corps would either crumble or have to treat rads with utmost respect.

                    • Unknown Member

                      Deleted User
                      January 30, 2018 at 5:57 am

                       
                      Restrictive covenant non compete agreements have been held constitutional in my state by the state supreme court, as long as they are not unreasonably restrictive.
                       
                       

                    • cieminsjohn

                      Member
                      January 30, 2018 at 1:46 pm

                      Quote from vonbraun

                       
                      Restrictive covenant non compete agreements have been held constitutional in my state by the state supreme court, as long as they are not unreasonably restrictive.

                       
                      Enforced locally as well.   Its kept a friend of mine who works for a megacorp/corp job from trying to create his own way.   He tried to go with a screw it attitude until lawyers came knocking on his door from friendly megacorp (prior to corp purchase). 
                       
                      Can’t have competition if the megacorp has a monopoly.  

                    • Count Contrastula

                      Member
                      January 31, 2018 at 6:44 am

                      Enforceable or not doesnt really matter. How much money do you have available to fight it? The mega groups and companies often have long established relationships with a legal firm, or better yet, even the medium sized companies have in house legal. I remember Optimal which was small had in house. Cost for them to litigate is minimal. If they go for injunctions etc, you could spend 100-200k in 6 months fighting it

                    • reuven

                      Member
                      February 1, 2018 at 6:54 pm

                      Quote from StringSign

                      Stop with the negativity. I am a radiologist like you guys, and clearly our skill sets are the assets here. Maybe the groups that sold, Charlotte Radiology, included, are outsmarting the Venture Capitalists? Did that ever occur to you that we might be smarter than them? We take the money and if it goes bust we get our practices back. We win and then win some more. For once we are biting back at VC.

                      If you are a radiologist then you are radiologist second and a professional salesman first

                    • Unknown Member

                      Deleted User
                      February 1, 2018 at 8:00 pm

                      Incorrect, I am a money making radiologist first, just like most of you private practice radiologists out there. I’m not shy to admit it (this is an anonymous forum so I can be brutally honest), money is what matters to all of us. If joining does not help a partner’s bottom line and you’ve crunched the number, then don’t. But if it helps, then you should, simple as that. I speak positively about RP because our experience has been great thus far. The message here is not necessarily to promote RP as it has more to do with encouraging private practice radiologists go out there and make that money however you can. If you think differently then you don’t belong in private practice, go to the VA or academic department. Can we all at least agree that money is the priority in private practice? Once we all agree, then rest is just easy simple math.

                    • stan.janus_621

                      Member
                      February 1, 2018 at 10:00 pm

                      StringSign,
                      I find your arrogance and lack of human decency appalling. You claim to be a private practice radiologist but by selling your practice you’re just another corporate employee cog in the wheel. Good luck finding people to work for you and support your lazy short sided selfish motives. I wish you the WORST of luck.

                    • bek071358_440

                      Member
                      February 2, 2018 at 4:21 am

                      Ditto…..long term lurker here, finally came across something I felt obligated to respond to. For all you new grads looking for a job, imagine what life will be like working alongside (or is it for) StringSign and his corporate masters. You owe them nothing- Wow. Unless he started his practice from scratch thats remarkably ignorant, perhaps thats what he has to tell himself to sleep at night. Our group ran across these snake oil salesmen as well, and while those of us with 5 years or less would certainly have made out financially, it was on the backs of those behind us. You cant buy a soul, find a group with one. We are still out here and will clean up the pieces when this Ponzi scheme collapses.

                    • Unknown Member

                      Deleted User
                      October 6, 2020 at 4:38 am

                      Quote from StringSign

                       I’m not shy to admit it (this is an anonymous forum so I can be brutally honest), money is what matters to all of us. ….
                       
                      The message here is not necessarily to promote RP as it has more to do with encouraging private practice radiologists go out there and make that money however you can. If you think differently then you don’t belong in private practice, go to the VA or academic department. Can we all at least agree that money is the priority in private practice? Once we all agree, then rest is just easy simple math.

                       
                      Negative.. we cannot agree. This is one of the most cynical posts I have ever seen.  

                      I was PP until our practice sold to PE. 
                      MY priorities were #1) high quality state of the art work #2) personal satisfaction #3) money will follow, and will be very adequate. This formula worked for many many years. Then PE decided to tap our money stream

                      I left academics because I was tired of other people (chairman, etc) running my life. Time to graduate to full adulthood. 

                      For me – PP means – 1) running your own show the way you want. Clinically. You can make choices to make your care better and sacrifice some $. 2) YOU and no one else gets the benefit of your efforts. And that means, more $. So – you can do #1, sacrifice some dollars to make your care better, and you are still WAY ahead. 3) Because you run your own practice, you can set the pace of the practice to maximize the Radiologist satisfaction. That means a proper pace of work. Unlike so many sweatshops right now that are experiencing relentlessly increasing requirements for RVU’s and hours, with no possibility of controlling your work environment. This is a recipe for burnout and for physician suicide.

                      As I heard one person involved in converting a practice into a PE practice “I have no interest in physician satisfaction” 

                    • Unknown Member

                      Deleted User
                      October 6, 2020 at 7:01 am

                      Quote from Dr.Sardonicus

                      Quote from StringSign

                      I’m not shy to admit it (this is an anonymous forum so I can be brutally honest), money is what matters to all of us. ….

                      The message here is not necessarily to promote RP as it has more to do with encouraging private practice radiologists go out there and make that money however you can. If you think differently then you don’t belong in private practice, go to the VA or academic department. Can we all at least agree that money is the priority in private practice? Once we all agree, then rest is just easy simple math.

                      Negative.. we cannot agree. This is one of the most cynical posts I have ever seen.  

                      I was PP until our practice sold to PE. 
                      MY priorities were #1) high quality state of the art work #2) personal satisfaction #3) money will follow, and will be very adequate. This formula worked for many many years. Then PE decided to tap our money stream

                      I left academics because I was tired of other people (chairman, etc) running my life. Time to graduate to full adulthood. 

                      For me – PP means – 1) running your own show the way you want. Clinically. You can make choices to make your care better and sacrifice some $. 2) YOU and no one else gets the benefit of your efforts. And that means, more $. So – you can do #1, sacrifice some dollars to make your care better, and you are still WAY ahead. 3) Because you run your own practice, you can set the pace of the practice to maximize the Radiologist satisfaction. That means a proper pace of work. Unlike so many sweatshops right now that are experiencing relentlessly increasing requirements for RVU’s and hours, with no possibility of controlling your work environment. This is a recipe for burnout and for physician suicide.

                      As I heard one person involved in converting a practice into a PE practice “I have no interest in physician satisfaction” 

                      ^^^^ Absolutely. It’s about running the practice the way you want. Money could be #1, but rarely is; as it usually follows, as stated above. 

                    • Unknown Member

                      Deleted User
                      October 6, 2020 at 4:30 am

                      Quote from StringSign

                      Stop with the negativity. I am a radiologist like you guys, and clearly our skill sets are the assets here. Maybe the groups that sold, Charlotte Radiology, included, are outsmarting the Venture Capitalists? Did that ever occur to you that we might be smarter than them? We take the money and if it goes bust we get our practices back. We win and then win some more. For once we are biting back at VC.

                       
                      Well, that is a nice hypothesis. 
                      But that is not what we are seeing. We are seeing one practice after another go PE, and turned into sweatshops with the docs getting a pittance, and the business types making big dollars for essentially being brokers. No Value Added.

                      An early example of this was Toledo Mercy – PP thrown out, a PE outfit that was captained by some docs from Mass General, called at that time Imaging Advantage. After 2 years of a 3 year contract, IA was tossed out, and the hospital did what… did they get  back a PP group. No – they hired their own radiologists, and now they have employed radiologists. Now the hospital gets all the pro fees and pays as little as possible to the Radiologists.

                      THAT is how it is working.

                      ANY examples (hopefully multiple) of new PPs taking over from formerly PE operations? I don’t know of any
                       

                    • Sandman_42

                      Member
                      October 6, 2020 at 3:29 pm

                      Quote from Dr.Sardonicus

                      Quote from StringSign

                      Stop with the negativity. I am a radiologist like you guys, and clearly our skill sets are the assets here. Maybe the groups that sold, Charlotte Radiology, included, are outsmarting the Venture Capitalists? Did that ever occur to you that we might be smarter than them? We take the money and if it goes bust we get our practices back. We win and then win some more. For once we are biting back at VC.

                      Well, that is a nice hypothesis. 
                      But that is not what we are seeing. We are seeing one practice after another go PE, and turned into sweatshops with the docs getting a pittance, and the business types making big dollars for essentially being brokers. No Value Added.

                      An early example of this was Toledo Mercy – PP thrown out, a PE outfit that was captained by some docs from Mass General, called at that time Imaging Advantage. After 2 years of a 3 year contract, IA was tossed out, and the hospital did what… did they get  back a PP group. No – they hired their own radiologists, and now they have employed radiologists. Now the hospital gets all the pro fees and pays as little as possible to the Radiologists.

                      THAT is how it is working.

                      ANY examples (hopefully multiple) of new PPs taking over from formerly PE operations? I don’t know of any

                      Actually Mercy now uses,
                       
                      wait for it . . . .
                       
                      RadPartners

                    • Unknown Member

                      Deleted User
                      January 31, 2018 at 12:21 pm

                      Sandeep, every group is different. If partners in your group is making a lot of money, like $1 million a year, then you obviously would not benefit from joining. But if you calculate upfront cash which will double in 7 years in this market then you calculate that against any income loss minus 39.6% tax going forward. An example would be a $80k decrease in salary which translate to $48k after tax money. You put that in the market going forward against money you receive and see which comes out ahead. Again if you make a ton of money in private practice and would take a $500k pay cut a year then it would not make since. But which ever number comes out ahead will help drive that decision. It’s a decision based on money. That is why Charlotte Radiology sold, putting a smile on Charlotte radiology rads. Very strong group, look them up.

                    • afazio.uk_887

                      Member
                      January 31, 2018 at 12:54 pm

                      You seem to ignore the very real risk that Rad Partner will reduce your salary after your initial 4 year contract is up, or sell out to an entity that does.  The deal is only a good one if your salary is never cut for the rest of your working career with them, which could be 20 yrs plus for a rad in their 40s.
                      If they don’t pull such shenanigans and actually use scale to improve your income over time, then it has the potential to be good for the groups that join…. however, there is absolutely no guarantee that they will take that approach, and frankly, wall street guys probably don’t deserve a whole lot of trust imo.
                       

                    • Unknown Member

                      Deleted User
                      January 31, 2018 at 1:23 pm

                      You guys can second guess all you want. The bottom line is, Charlotte, Miami Vascular, Baylor, Tennesse group, Synergy are all large, strong thriving groups that sold. Its naive to think these guys didnt crunch the numbers and decide what is best. Everyone has to look and see if it works for them.

                    • afazio.uk_887

                      Member
                      January 31, 2018 at 3:21 pm

                      Short-term, absolutely I am sure the guys at the top of these practices all got nice checks. Medium to long -term I don’t think there is any guarantee that it will turn out to be a good move for these groups.  It certainly could be, if the corporate entities deliver on what they claim they will, but it is far for certain.  Here is a simple question — if it comes down to increasing the bottom line for stock holders and the executives in change vs. reducing income to the radiologists, what do you think will happen??
                       
                       
                       
                       

                    • Unknown Member

                      Deleted User
                      February 1, 2018 at 5:02 am

                      It will depend on the radiology job market. If there is a shortage, they would have no choice but to increase pay. When job market was saturated a few years back, we forget that independent radiology groups lowered pay, increased partnership track years, and decrease number of vacations (5-6 weeks off) for a lot of job posting; these are dirty plays made by partner radiologists to profit more. Radiologists are driven by same greed as executives and there is nothing wrong with that. If numbers work out for in your favor then it’s stupid not to sell. Who are you preserving the practice for, future millennials?
                       
                      Anyways, arguing about this is stupid because thousands of radiologists in radiology groups are negotiating to join as we speak. It’s not just a trend, its the future. When everyone sold, new grads will have no choice and there is nothing wrong with that. Yes there are new grads, residents and fellows not happy with it. But to all the partners out there, you owe them nothing.
                      [b] [/b][i] [/i][u][/u][strike][/strike]
                       

                    • Patrick

                      Member
                      February 1, 2018 at 5:57 am

                      “But to all the partners out there, you owe them nothing. ”  – String Sign
                       
                      As a partner, I owe new grads and new hires fairness and a dignified work environment.  I am a steward.  I am proud to be part of a practice that offers a fair and consistent shake to new comers.  We are not perfect, but we don’t manage ourselves to get rich off the next the generation.  We manage ourselves to the benefit of all our radiologists and take the cultivation of the next generation seriously.  We thrive or suffer with the market. 
                       
                      StringSign, I am ok with dissent and certainly not anti-corporate, just healthily skeptical, but don’t dismiss the next generation and their desires so easily.  They can break the business model you appear to defend.  Consolidation can occur on terms managed for the radiologist provided the proper culture and management are in place.  We don’t have to be part of a cycle of ever larger transactions.  I am not convinced a corporate future is a forgone conclusion.
                       
                      Recent grads, lurking, beware the group you join–corporate or independent.
                       

                    • nicolasvg.1003

                      Member
                      February 1, 2018 at 9:51 am

                      Wow, radiology as a field is fascinating and interesting, but radiologists can be some of the worst and most pathetic people out there.  Pathetic passive aggressive eunuchs running the show. 

                    • afazio.uk_887

                      Member
                      February 1, 2018 at 4:28 pm

                      Quote from StringSign

                      When job market was saturated a few years back, we forget that independent radiology groups lowered pay, increased partnership track years, and decrease number of vacations (5-6 weeks off) for a lot of job posting; these are dirty plays made by partner radiologists to profit more.

                      This is a fair point. There was wide-spread low balling of new grads, excessive length of partnership tracks and churn-and-burn going around.  Perhaps PP radiology simply cannot ethically self-govern and deserves corporate enslavement.

                    • Unknown Member

                      Deleted User
                      February 1, 2018 at 4:45 am

                      Quote from fushibob

                      You guys can second guess all you want. The bottom line is, Charlotte, Miami Vascular, Baylor, Tennesse group, Synergy are all large, strong thriving groups that sold. Its naive to think these guys didnt crunch the numbers and decide what is best. Everyone has to look and see if it works for them.

                       
                      I don’t doubt they crunched the numbers and made an informed decision. I guess deciding what is ‘best’ depends on perspective. What’s best for senior partners close to retirement might not be what’s best for newly hired rads. I think that angle is often overlooked by groups that sell. If you’re a new grad,  why would you join one of these groups? You probably wouldn’t, unless you didn’t have many other options.
                       
                      If the job market stays on track, I suspect PE-owned groups will struggle to recruit/retain new hires. Don’t take my word for it though, have a look at the ACR job board. Lots of jobs available at some of these thriving, strong groups that have been re-posted every 3 months or so. 
                       

                    • reuven

                      Member
                      February 1, 2018 at 6:57 pm

                      Quote from StringSign

                      Sandeep, every group is different. If partners in your group is making a lot of money, like $1 million a year, then you obviously would not benefit from joining. But if you calculate upfront cash which will double in 7 years in this market then you calculate that against any income loss minus 39.6% tax going forward. An example would be a $80k decrease in salary which translate to $48k after tax money. You put that in the market going forward against money you receive and see which comes out ahead. Again if you make a ton of money in private practice and would take a $500k pay cut a year then it would not make since. But which ever number comes out ahead will help drive that decision. It’s a decision based on money. That is why Charlotte Radiology sold, putting a smile on Charlotte radiology rads. Very strong group, look them up.

                      Market returns are unpredictable.  PP paychecks are far more predictable.  Your comparing apples to oranges

                    • Unknown Member

                      Deleted User
                      February 2, 2018 at 9:07 am

                      Are you serious?  Wow, couldn’t be more wrong.  Pretty sure the market will be up in 10 years!  Historically 7%, perhaps lower.  PP salary?  Lets see, declining reimbursement, loss of hospital contracts, ACO, physician extenders, AI.  Yeah, sounds like a sure thing to me!

                    • antoni.bielazik_633

                      Member
                      February 2, 2018 at 9:32 am

                      The market will be up in 10 years but don’t expect 7% annual returns.  With current dividend yield and dividend growth, expect 4% nominal returns.  Factoring in inflation, that’s 2% a year.
                       
                      [link=http://beta.morningstar.com/videos/830763/Bogles-Reasonable-Expectations-for-Market-Returns.html]http://beta.morningstar.c…or-Market-Returns.html[/link]

                    • Unknown Member

                      Deleted User
                      February 2, 2018 at 9:51 am

                      radi2012:
                      Nobody can predict the market return in the next decade. Everybody makes spiculations. But there is a high likelihood that market will be up and the salaries will be plateaued or down.
                      If you factor in inflation, you should also factor in inflation when you talk about radiologists’ salaries.

                    • Unknown Member

                      Deleted User
                      February 2, 2018 at 9:52 am

                      Bogle is a smart guy but everybody including him agree that every prediction of especially numbers are incorrect.

                    • antoni.bielazik_633

                      Member
                      February 2, 2018 at 10:44 am

                      Quote from Hospital-Rad

                      Bogle is a smart guy but everybody including him agree that every prediction of especially numbers are incorrect.

                       
                      You are correct.  But I think his point is that we should expect depressed returns over the next 10 years given current valuations.

                    • afazio.uk_887

                      Member
                      February 2, 2018 at 10:50 am

                      Just to play devil’s advocate here – but one of the benefits of being a part of a large national group like RP is that it does reduce your downside risk.  It essentially eliminates risk of contract loss for smaller and medium size groups.  You now have a large multi-million dollar corporate entity that has a vested interest in your practice keeping all its contract and the practice growing.  I think this can be a substantial benefit to smaller sized groups, which are the most vulnerable with the changes happening currently with hospitals/radiology groups.  
                       
                       
                       

                    • Unknown Member

                      Deleted User
                      February 2, 2018 at 11:31 am

                      That’s true but for a smaller group with good salary, it makes sense to keep the status quo and once the ship sinks, the radiologist can find a corporate job. RP us not going to pay anything significant to buy a small group.

                    • afazio.uk_887

                      Member
                      February 2, 2018 at 3:15 pm

                      Yes, that is a valid strategy for sure.  Who knows, the ship may never sink if it is a tough to recruit to locale.

                    • Unknown Member

                      Deleted User
                      February 3, 2018 at 11:14 am

                      Corporates dont just buy your work.

                      They often buy your outpatient centers and ancillary businesses. Perhaps at an attractive multiple of EBITDA. That can change the numbers and motivations significantly.

                    • rmettille

                      Member
                      February 4, 2018 at 12:14 pm

                      See this article about what happens when private equity bought out retailers in the recent past. Extrapolate to medicine. Disaster for the practices but eventually new opportunities will present themselves. [link=https://wolfstreet.com/2018/01/22/the-private-equity-firms-at-the-core-of-brick-mortar-retail-bankruptcies/]https://wolfstreet.com/20…r-retail-bankruptcies/[/link]

                    • reuven

                      Member
                      February 2, 2018 at 10:34 am

                      Quote from fushibob

                      Are you serious?  Wow, couldn’t be more wrong.  Pretty sure the market will be up in 10 years!  Historically 7%, perhaps lower.  PP salary?  Lets see, declining reimbursement, loss of hospital contracts, ACO, physician extenders, AI.  Yeah, sounds like a sure thing to me!

                       
                      Actually you are wrong because you are comparing apples to oranges.  In your example you are selling your human capital which has bond like returns and taking that capital and placing it in the stock market which has unpredictable and volatile returns.  You are significantly increasing your risk profile by doing this.  Furthermore you also are ignoring the high probability that your future corporate master will decrease your salary as much as possible after your initial 4 year contract disproportionate to the potential declining reimbursement as well as treat you as a replaceable part in their mega radiology machine which will reduce your career satisfaction.    The cherry picked argument for selling to PE ignores these significant risks so I’ll pass on jumping off the cliff despite watching many of my colleagues do so.

                    • poymd25

                      Member
                      January 30, 2018 at 6:38 am

                      That growth is very poor. 
                       

                    • jmedina2

                      Member
                      October 5, 2020 at 10:14 am

                      .

                    • jmedina2

                      Member
                      October 5, 2020 at 10:17 am

                      String sign. Any updates on how the practice is faring? Are things still going as planned? Is there anything you think of that you could have done better when making the decision to sign with them?
                       
                       

                      Quote from StringSign

                      Clinically, we have added contracts to our practice under RP and improved our service (well, actual improvement is debatable but it is perceived as an improved by our hospitals). Our relationship with hospitals we serve is better than ever; in general, hospitals trust the RP brand. They also offer a lot of resources which weren’t available before we joined.  Financially, we did take a small salary cut but it was not 30%. At our salary level currently and with the stock market return in recent years we are set up to come out ahead over the period of next 10-20 years in comparison to salary level before we joined. Of course our stocks in RP have more than doubled.
                      Reimbursement in my opinion, and I’ve been doing this for a while now, is going down, not up. Sure you can always read more, work more and say your salary is going up but dollar per study is only heading one direction. This is definitely the right decision for our group (a stable midsize practice). Partners are smiling a little more and generally more fun to work with as many technologists have noticed.
                      Strong stable groups, like ours, are sign on. I have personally bought a lot more RP stocks, so that tell you that I am a believer.

                      Hope that helps.
                       
                       
                      [link=https://www.auntminnie.com/Forum/showprofile.aspx?memid=3407]Waduh Dong[/link] 
                      Can I ask what about RP has made you “really happy”?  Not passing any judgement, but what is so great about them that you are happy with a 30% pay skim for eternity, besides the short term benefit of the lump sum payment?  What added value do they really bring that justifies such a large skim job? Just curious.  Feel free to PM if you prefer. 

  • Unknown Member

    Deleted User
    January 26, 2018 at 10:43 am

    ARA and STRIC were going to merge night services at one time weren’t they … become more competitive with RP Envision et c etc
     
    What will groups like this do?  Aren’t they the Charlotte Radiology of Texas?

  • Unknown Member

    Deleted User
    January 28, 2018 at 10:29 am

    RadPartners private stock – who knows the value?   Can make any claim about it
     
    Envision    
               Nov   2015       85
               Nov     2017     25   (during ‘Trump’ market; 36 now)
     
    Mednax   Sep  2015  81
                  Sep 2017   42       (during ‘Trump’ market; 55 now)
     
    If you decrease $/RVU over 700 rads can maintain CEO $21 milloon paycheck!!
     
     
    (As President and Chief Executive Officer at ENVISION HEALTHCARE CORP, Christopher A. Holden made $21,726,391 in total compensation. Of this total $1,040,000 was received as a salary, $1,560,000 was received as a bonus, $0 was received in stock options, $19,000,000 was awarded as stock and $126,391 came from other types of compensation. This information is according to proxy statements filed for the 2016 fiscal year.)