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Is RP still buying practices
Haven’t seen news in a while. Is PE still buying large practices anywhere?
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39 Replies
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RP has one leg in the grave and both hands in Radiologists pockets. Well see which way it ends up.
If they can weather the bondholders (who by reports have already lawyered up), mass radiologist exodus upon vesting, new radiologist skepticism, refinancing a crapload of debt and if AI comes to fruition in the next 5-10 years then the future is bright for them.
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Right now RP is trying to find the greater fool to refinance their debt. I doubt there are any new practices being acquired. However they may be picking up new local contracts at existing groups still.
“The nations largest imaging group is reportedly seeking new investors to help repay more than $2 billion in debts, according to a report published Wednesday.
Radiology Partners has hired Barclays Plc, hoping to raise preferred equity with a portion of its debts coming due in the next two years. Bloomberg Law reported the move on June 28, citing sources with knowledge of the plan, who asked to remain anonymous because the matter is private.”
[link=https://radiologybusiness.com/topics/healthcare-management/healthcare-economics/radiology-partners-seeking-new-investors-help-repay-more-2b-debt-report#:~:text=The%20nation’s%20largest%20imaging%20group,in%20the%20next%20two%20years.]https://radiologybusiness…%20next%20two%20years.[/link]-
Preferred equity will dilute existing shareholder, many of which are Rads.-
Quote from STOIC
Preferred equity will dilute existing shareholder, many of which are Rads.
I wonder how they will spin this to the radiology rank and file.-
They dont need to spin it. Rads that work for them placed location above common sense and their own economic interests. Most of those leaving, ironically, are the money hungry sellouts who dont care to put up with peanuts for salary when theyve tasted PP money. Eventually though, the drop in staffing causes low morale even among the morons who put location above all else, causing them to actually grow a pair and leave.
Pretty sure RP leadership should be going to church. Because they need to pray for a miracle- lower interest rates, boomers wanting to hangon til 80 and higher reimbursement rates by CMS. None of which have a high likelihood of happening.
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Why do you downgrade the importance of location tho? To me, it is one of the most important factors. Life is too short to not live in a place that you like. I would take a 400k RP gig if it were in Manhattan or some other sweet locale.
If they were smart business people, they would only buy out the practices in the best locations, as many people prioritize location. But they just bought everything they could including difficult to staff places like Iowa and Kentucky. What do I know tho.
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Exactly; location is a significant factor, to say otherwise is to turn a bling eye and push for personal issues down the road. At the end its a job; if you can leech off these PP gigs and manage your money well, I see no problem with it. PP sucks, but so do most bosses in most jobs. Dont see them leaving anytime soon.
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I mean a lot of people have self respect and refuse to give away 30% of their rvu generation to their overlords. I cant speak to the people that will do anything just to be in a certain location. Only thing I will say is that you can do tele and make as much or more than some of these PE gigs. Also if you want location might as well do academics. At least then you are readig half the volume. And still PP jobs or good employed gigs in most major cities. If you have trouble getting one of those jobs in this market, its probably that you just arent a good rad. PE rads tend to be lower quality rads, bottom of the barrel so to speak
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You seem very judgmental.-
If you think city desirability will be the saving grace of RP groups take a look at how many openings they have in places like Nashville and Austin. They’re literally recruiting for every position. And you know that each position has multiple openings.
Now imagine what things are going to look like when RP dilutes everyone’s equity and the buyout rads jump ship. -
With respect to PE in radiology in general, all the stuff mentioned here as things that MAY HAPPEN has in fact happening all over:
“buyout rads jump ship” — look at Las Vegas
“However they may be picking up new local contracts” — Huh??? Please see Chicago
“preferred equity will dilute existing shareholder, many of which are rads” — that has already been happening the last 4 to 6 years, only issue now it will accelerate rapidly, likely to the point where whatever shares were apportioned for Rads are worthless or at most pennies on the dollar.
“new radiologist skepticism” — add hospital administrator skepticism and increasingly hostile work environment (longer hours, more RVUs required, lower pay, on and on) with zero true ownership stake in the business
“city desirability” “location is a significant factor” — this concept is essentially obsolete with many full time jobs (some with 100% of the benefits of onsite work and some with partnership track), therefore it will not help PE
“prayer for lower interest rates” — LOL!!!
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I agree with PirateRad, but also, this is sort of the obvious end point isn’t it?
What did people think was going to happen when radiologists relinquished control and money to a group of private equity investors? Did they honestly think things were going to improve? I don’t believe anyone is dumb enough to believe this. This was driven by greed on both ends and this is what it gets you.
I interviewed for new jobs about 2.5 years ago, and I interviewed at two PE practices. They both made a point of telling me, almost verbatim, “It was the right move for us.” Translation: “We wanted money.” I would have had more respect for the person if they just told me they wanted to cash in rather than try to out lipstick on a pig. -
I think the rads thought they were going to get filthy rich
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Quote from dergon
I think the rads thought they were going to get filthy rich
I know the type. Fancy themselves business minded and think a radiology practice can be monetized the way a regular company can. In come PE to show them how and they lose their shorts. But nice and slowly so they don’t even notice. -
Totally.
We are doctors, not business men.
It was nauseating to watch the board members at my last practice try to act like some super businessmen. They would throw around the jargon. They would keep people uninformed so only they knew what was happening so as to keep power. They would use language people could not understand so people felt like they were dumb and the “business men” were smart. And they still got worked. Total fools.
I don’t understand why people behave this way. I was in a practice of 30 people, few of which were actual business owners in their past careers and all of which were either very bright or at least not stupid. Did we make decisions as a group and get input from people that were smart and had experience? No. The little board huddled at dumb restaurants and tried to play business man.
These practices are totally outgunned by PE.
My lame joke when describing the qualifications of the board members at my previous practice was: Have some respect, they’ve seen ll 3 of the Godfather movies. -
Right outgunned in a negotiation but PE does not know our business better than we do. We can grow a great business with tremendous cash flow on our own. However, it will never be a company that will have some form of liquidity event. We can become rich. We cannot become super rich because of this fact. Have to stop that fantasy.
What we have to recognize is our business is supporting radiologists, not others that skim off of our work. Therefore, the only answer to even considering talking to PE is no. -
Having tried to find good gigs with private groups, the reason RP survives and will likely thrive is flexibility, one of the biggest things new rads are looking for. It was crazy how rigid private groups are when hiring and how poorly they approach things like tele and IR. When RP can create the exact or nearly exact work environment you want and aloe you to live where you want and even come close on salary as most groups, its no wonder new rads keep going there. Several of my colleagues have shifted to RP jobs knowing full well the PE issue but wanted to leave small PP groups that cant adapt to changing priorities.
As an example, I was looking at groups in Chicago – all of them wanted weekends reading 250+ cases, weekday calls, some has nightfloats required, and still partner salaries were around 600 max. RP offered daytime with some tele work, no nights, no weekends at their Chicago location for 550, similar volume expectations.
Thankfully went the way off locums, and Id be the first to crap on RP as not aligned with the interests of the field but private groups need to be competitive as well. Eventually people overlook the whole PE overlord things when they need a job that works for them. -
Quote from Sam679
Having tried to find good gigs with private groups, the reason RP survives and will likely thrive is flexibility, one of the biggest things new rads are looking for. It was crazy how rigid private groups are when hiring and how poorly they approach things like tele and IR. When RP can create the exact or nearly exact work environment you want and aloe you to live where you want and even come close on salary as most groups, its no wonder new rads keep going there. Several of my colleagues have shifted to RP jobs knowing full well the PE issue but wanted to leave small PP groups that cant adapt to changing priorities.
As an example, I was looking at groups in Chicago – all of them wanted weekends reading 250+ cases, weekday calls, some has nightfloats required, and still partner salaries were around 600 max. RP offered daytime with some tele work, no nights, no weekends at their Chicago location for 550, similar volume expectations.
Thankfully went the way off locums, and Id be the first to crap on RP as not aligned with the interests of the field but private groups need to be competitive as well. Eventually people overlook the whole PE overlord things when they need a job that works for them.
Ya agree with this. As a resident I remember the ARA group in Austin had ridiculous starting salaries (sub 200) with non existent or 5+ year partnership track if you were IR or mammo trained. With RP the salaries are higher in the same group although partnership doesnt mean much with PE. Interestingly ARA never really had to advertise for openings. Seemed like there was always some chum willing to take em up to live in Austin lol.
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A lot of private practices are still run by the old paradigm of 30-40 years ago. The way things are structures in many of these groups belong to the pre-internet era.
For example, a lot of private groups is the distribution of salaries. I know in certain groups, IR does 7-8 paras and thoras and FNAs a day and make full partner salaries while DRs are killing themselves to clean the list. While the whole group makes 45-50/RVU, once you redistribute the production to cover the cost of IR and also pay for nighthawk and pay for IR call and consider the hospital committees and etc that you have to attend, the DR guys don’t make more than 30-35/RVU that is offered by many telerad outfits.
If the private practice wants to survive, it has to ask more from the hospitals. The hospitals should pay call money. They should pay some subsidy for IR services. They should pay for nighthawk. The rads should get paid for going to tumor boards, doing admin work, etc. The hospital should pay some extra money for things like UGI, BEs, reviewing outside studies, answering phone calls and etc
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The decade of 2010s was the lost decade for radiology. While the economy was booming and many businesses were thriving, the radiology private practice was going south. Now it is time to take advantage of the opportunity that came up. The pendulum has turned the other way and now the radiology groups have upper hands to negotiate new contracts. Hospital admins and PEs screwed us all in the last decade and now it is our time.
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Quote from OnsiteRad
A lot of private practices are still run by the old paradigm of 30-40 years ago. The way things are structures in many of these groups belong to the pre-internet era.
For example, a lot of private groups is the distribution of salaries. I know in certain groups, IR does 7-8 paras and thoras and FNAs a day and make full partner salaries while DRs are killing themselves to clean the list. While the whole group makes 45-50/RVU, once you redistribute the production to cover the cost of IR and also pay for nighthawk and pay for IR call and consider the hospital committees and etc that you have to attend, the DR guys don’t make more than 30-35/RVU that is offered by many telerad outfits.
If the private practice wants to survive, it has to ask more from the hospitals. The hospitals should pay call money. They should pay some subsidy for IR services. They should pay for nighthawk. The rads should get paid for going to tumor boards, doing admin work, etc. The hospital should pay some extra money for things like UGI, BEs, reviewing outside studies, answering phone calls and etc
You make some solid points but with respect to IR, the type of stuff you mention could be covered by a general rad (or trained mid-level). Also PP IR tend to also participate in substantial diagnostics. In my group, they also do higher level procedures such as embolization for GIB, TACE etc. Plus they take overnight IR call. So while they have slightly lower total wRVU, it sorta balances out. Pure breast imagers also have significantly higher wRVU than other diagnostic rads. Its all a trade-off and one has to buy into the team concept
Also there is some resistance from some partners to adapt to the new paradigm (shorter partnership tracts, higher starting pay, more flexibility with scheduling etc) but they are slowly seeing the light as there is no alternative. However a new rad can’t expect full partnership while working fully remote when all the other partners are actually working on site. The trade-off is wRVU in the $60s rather than $30s offered by PE
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Quote from jd4540
You make some solid points but with respect to IR, the type of stuff you mention could be covered by a general rad (or trained mid-level). Also PP IR tend to also participate in substantial diagnostics. In my group, they also do higher level procedures such as embolization for GIB, TACE etc. Plus they take overnight IR call. So while they have slightly lower total wRVU, it sorta balances out. Pure breast imagers also have significantly higher wRVU than other diagnostic rads. Its all a trade-off and one has to buy into the team concept
Also there is some resistance from some partners to adapt to the new paradigm (shorter partnership tracts, higher starting pay, more flexibility with scheduling etc) but they are slowly seeing the light as there is no alternative. However a new rad can’t expect full partnership while working fully remote when all the other partners are actually working on site. The trade-off is wRVU in the $60s rather than $30s offered by PE
I exactly know what you mean by your last paragraph.
The only thing that I disagree with you is the last paragraph. In most private practices, due to costs of practice and redistribution of money the DRs are get paid something around 40/RVU.Most IRs do TACE and GIB but the bulk of their work is low paying procedures. My goal is not to bash IR at all. But you have to take into account that when you want to hire someone, although you get paid 50-55/RVU, due to redistribution of money the ultimate pay is nothing close to that number.
As much as I hate telerad outfits, I don’t think their business model is doomed to fail. The package they offer is not as good as many private practices, but is not also very off. It is within a range that still can attract a good number of rads. For example, some rads may hate going to the hospital and are willing to pay some premium for it. I Know a rad who is divorced and prefer to work exclusively from home.
My point is that if private practice wants to survive, it has to be more flexible. It can not continue what it used to do and still expect to be successful.
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Yeah Chicago RP offered competitive salaries right up to implosion. Its funny when people mention RP offering competitive salaries. Do you think they are doing it out of the goodness of their hearts? Or do you think it is because the market shortage demands reasonable salaries? I think we know the answer. And followup question- do you think they will continue to pay reasonable salaries if they somehow corner the market or if the rad shortage abates? I think you know the answer to that too. Any way you slice it, RP or PE in general is not a good longterm play. If you want to settle down and grow roots somewhere then Joining PE is a dicey move
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Quote from sartoriusBIG
Yeah Chicago RP offered competitive salaries right up to implosion. Its funny when people mention RP offering competitive salaries. Do you think they are doing it out of the goodness of their hearts? Or do you think it is because the market shortage demands reasonable salaries? I think we know the answer. And followup question- do you think they will continue to pay reasonable salaries if they somehow corner the market or if the rad shortage abates? I think you know the answer to that too. Any way you slice it, RP or PE in general is not a good longterm play. If you want to settle down and grow roots somewhere then Joining PE is a dicey move
I agree with you with some reservations.
When the market is bad what you are saying is correct only and if only one is a partner of a group. But for a new fellow, a lot of times private practices offer a worse deal compared to PE.
When the market is good, for a new fellow a lot of times private practices still offer a worse deal compared to PE.Private practice is the best place to be if you are a partner. For a new fellow, the math may not add up. It is more like a speculation. Not long time ago, many private practices didn’t offer partnership or offered 5-7 years of partnership. Even now, I have heard of a group in NYC that offers 4 years of partnership.
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Well, those practices are outliers and can be ignored. I have serious doubts that the average private practice position is not better than the average PE position. Unless there is some serious mismanagement the math just doesn’t math.
Quote from OnsiteRad
But for a new fellow, a lot of times private practices offer a worse deal compared to PE.
When the market is good, for a new fellow a lot of times private practices still offer a worse deal compared to PE.Not long time ago, many private practices didn’t offer partnership or offered 5-7 years of partnership. Even now, I have heard of a group in NYC that offers 4 years of partnership.
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OnsiteRad, do a 5-10 year NPV calculation… Chances are that even with a partnership track up to 3 years, you’ll end up ahead in PP compared to PE, even with their higher starting salaries. Also, run the numbers to compare to the $/wRVU–it’s not that hard to do with some basic assumptions based on information provided at interviews. Indeed, you could do as well if not better than PE directly employed by many health systems.
4-5 yr partnership tracks are outliers… In fact, true PP in NYC is an OUTLIER too, lol. -
A few problems. New grads, for better or worse, are looking to get a big pay day right away. They dont want to grind right out of fellowship for 400 and 2-3 years to partner. They pick the job for 450 with 30k signing bonus. Shortsighted? Indeed. But thats how these PE get their hooks into you. Fellows at a program all talk – how much you starting at etc etc? Its wrongheaded but thats what I hear. Its all about the starting number as if it were somehow the end all be all. Of course, anyone with an ounce of sense knows that it is not.
As far as predatory PP anecdotal cases go same thing with any anecdotes. If someone told me to wash my bald head with pig urine because Joe Schmoe got results from it no thanks. Id rather be bald than risk it. Plenty of predatory bait and switch PE examples out there that would give a predatory PP a run for their money. Im not saying they dont exist. Of course they do. But dying breeds they are.
At the end of the day, its just the easy option for most grads. PE headhunters and their radiologist peons pursue you like a used car salesman. Before they know it, theyve bought the rusted jalopy, the extended warranty, the first aid kit and a steering wheel cover. One day they wake up and say, what did I do? Smart ones leave. Dumb ones are fraid to leave or know they couldnt cut it volume wise in PP
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Quote from sartoriusBIG
A few problems. New grads, for better or worse, are looking to get a big pay day right away. They dont want to grind right out of fellowship for 400 and 2-3 years to partner. They pick the job for 450 with 30k signing bonus. Shortsighted? Indeed. But thats how these PE get their hooks into you. Fellows at a program all talk – how much you starting at etc etc? Its wrongheaded but thats what I hear. Its all about the starting number as if it were somehow the end all be all. Of course, anyone with an ounce of sense knows that it is not.
As far as predatory PP anecdotal cases go same thing with any anecdotes. If someone told me to wash my bald head with pig urine because Joe Schmoe got results from it no thanks. Id rather be bald than risk it. Plenty of predatory bait and switch PE examples out there that would give a predatory PP a run for their money. Im not saying they dont exist. Of course they do. But dying breeds they are.
At the end of the day, its just the easy option for most grads. PE headhunters and their radiologist peons pursue you like a used car salesman. Before they know it, theyve bought the rusted jalopy, the extended warranty, the first aid kit and a steering wheel cover. One day they wake up and say, what did I do? Smart ones leave. Dumb ones are fraid to leave or know they couldnt cut it volume wise in PP
Aren’t most private practices signing fellows with bonuses for 400 with a decent bonus anyways? Heck, easy employed gigs will give you 400’s to start out of fellowship right now.
I signed for 300k and no bonus a few years ago, midst of covid. After some experience can’t believe how much advantage the private group took of me that first year – although they did make it up later. I left before the ‘buy in’ period started luckily. -
How many of you actually have worked for RP groups in major metro areas? Starting salaries are NOT higher than private groups. That’s a load of crap. I started at an RP group at 300k with no bonus and 8 weeks off. My current private group started me at 600k with a 50k sign on bonus and 12 weeks off. You PE shills can go shove it. Private groups don’t have to pay a 30-40% tax to Rich Whitney and the other RP parasites. They have the power in the 2023 job market to offer higher salaries. They also can offer higher starting vacation than RP groups because they can actually recruit and aren’t as massively short staffed.
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Quote from NYC
OnsiteRad, do a 5-10 year NPV calculation… Chances are that even with a partnership track up to 3 years, you’ll end up ahead in PP compared to PE, even with their higher starting salaries. Also, run the numbers to compare to the $/wRVU–it’s not that hard to do with some basic assumptions based on information provided at interviews. Indeed, you could do as well if not better than PE directly employed by many health systems.
4-5 yr partnership tracks are outliers… In fact, true PP in NYC is an OUTLIER too, lol.
I don’t disagree that pp is a lot better.
But as mentioned above, sometimes new fellows buy the BS that PE sells them.
A lot of new fellows are terrible at math. Offer them health insurance and sign on bonus and they jump into the job even with a lot less future prospects.
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Quote from OnsiteRad
A lot of private practices are still run by the old paradigm of 30-40 years ago. The way things are structures in many of these groups belong to the pre-internet era.
For example, a lot of private groups is the distribution of salaries. I know in certain groups, IR does 7-8 paras and thoras and FNAs a day and make full partner salaries while DRs are killing themselves to clean the list. While the whole group makes 45-50/RVU, once you redistribute the production to cover the cost of IR and also pay for nighthawk and pay for IR call and consider the hospital committees and etc that you have to attend, the DR guys don’t make more than 30-35/RVU that is offered by many telerad outfits.
If the private practice wants to survive, it has to ask more from the hospitals. The hospitals should pay call money. They should pay some subsidy for IR services. They should pay for nighthawk. The rads should get paid for going to tumor boards, doing admin work, etc. The hospital should pay some extra money for things like UGI, BEs, reviewing outside studies, answering phone calls and etc
Firsthand experienced this in a prior practice with prior ir colleagues. Caused a lot of resentment between the senior guys.
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Well said and your math is correct. Why deal with what you said when you can make 25 – 35$/wRVU from the comfort of your own home in your pajamas without dealing with the politics and demoralization of PP? No brainer.
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That’s assuming the US allows you to make money here and live over there in perpetuity. And, that no major conflicts break out around you. And that our system of debt-fueled, fiat currency based, economic growth persists into your retirement age.
And, based on what you’ve written, that real estate holds it’s value into the future with low(ish) interest rates.
All of these things may hold up, but something tells me that they also might not. You are taking a big risk on these assumptions is all that I’m saying, just like the rest of us are on our bets too.
When push comes to shove, sadly, the person who has the biggest gun and is willing to use it, usually wins.
Evolutionary software is always running in the background of our collective psyches after all. Hope your plan works, though, seriously.
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Yes but some on here seem to think that if you want to be in a certain location, and onsite work is only PE, then youre stuck. I agree that nobody is stuck in this market. You can easily do tele and live wherever you want, whether its manhattan NYC or mountainside in Denver or Park City. So if you choose PE and it later results that they slash your salary to 250k in a down market well you only have yourself to blame at that point. And they will slash salaries the first chance they get. If AI creates even a 20% efficiency gain, the market will go to crap again. I think that is worst case scenario- 20% efficiency gains 10 years from now. But even that would shift the market to a sellers market. Im just playing devils advocate as I dont think AI will do much if at all in my career but you cant just dismiss it entirely. Ill be out in 20 years tops. Ideally will be out in 15. If AI destroys our specialty in ten years time, Ill be out in 10. That is why I am focused on making money right now. I could go lifestyle oriented now, but I dont see that as smart with a lot of income downside in the future. Also 2025 is when income tax reverts to prior tax brackets. If dems at some point in the near future control congress and presidency, your tax burden may double on top of that. If you are making less than 450k and 12 weeks vacation in todays market, then you are not taking advantage of whats available and may regret it later.
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And the argument that PP will take advantage of you in a down market is even more reason to go PP now. If a down market hits and you are already partner, then you are largely sheltered from the storm, assuming your group doesnt depend on hospital subsidies which would also likely be on the chopping block in a down market. Sure the hospital could always take your contract from you, but youre at least have a chance of being immune to market forces which will most certainly reduce PE salaries and also hospital employed salaries to a lesser degree
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Completely fair. Agree 100%.
I just find it interesting that those people who are libertarian minded (myself included) still have to rely on some form of a system (usually involving the government too) to live and be ‘successful’ in our society, especially in this day and age.
I mean, let’s face it, very few people are truly self sufficient unless you are doing organic farming on your own plot of land (one of the most successful hedge fund managers of Universa investments actually does this too – Mark S. Maybe we should take heed). We all rely on the ‘system’ for something, for better or worse. Maybe, in the future, we will figure out a way to be truly more independent without ‘Big Brother.’ One can hope.
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Quote from Sam679
Having tried to find good gigs with private groups, the reason RP survives and will likely thrive is flexibility, one of the biggest things new rads are looking for. It was crazy how rigid private groups are when hiring and how poorly they approach things like tele and IR. When RP can create the exact or nearly exact work environment you want and aloe you to live where you want and even come close on salary as most groups, its no wonder new rads keep going there. Several of my colleagues have shifted to RP jobs knowing full well the PE issue but wanted to leave small PP groups that cant adapt to changing priorities.
As an example, I was looking at groups in Chicago – all of them wanted weekends reading 250+ cases, weekday calls, some has nightfloats required, and still partner salaries were around 600 max. RP offered daytime with some tele work, no nights, no weekends at their Chicago location for 550, similar volume expectations.
Thankfully went the way off locums, and Id be the first to crap on RP as not aligned with the interests of the field but private groups need to be competitive as well. Eventually people overlook the whole PE overlord things when they need a job that works for them.FYI many RP groups are just like the private group you described. Your Chicago example is a unicorn or super out of date with the current RP reality. Most RP groups are massively understaffed, huge call volumes, ton of weekend and evening call shifts, infinitely building outpatient lists, fake vacation that you can’t use because the schedule is understaffed, and overall demoralized radiologists. There’s a reason why RP Chicago is imploding/losing contracts and it’s not because they were too lifestyle focused… get real. In order to make 550k in a RP group you’re producing the equivalent private practice salary of 900k because RP is taking a 40% skim.
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100%.
I would take the part time 250k telerad gig living Bali or Tuscany over a 600k full time PP gig in the US. Which by the way goes MUCH further than 600k in the US, and since you’d be working part time from the above locales, you actually have ample time to enjoy it. And that is exactly what I am doing. I’m honestly surprised more wouldn’t. Is it comparison to others? consumerism? deflated self and professional worth if you don’t grit it out for 30-40 years?
People hurting their metabolic health, posture, eyesight, adding stress, giving themselves little time to enjoy their waking hours, and for what, digits on a screen? Once you figure out how money works, you no longer need to labor for pieces of paper and digits on a screen.
I guess folks would rather grind it out and pay 40-50% in tax. I don’t get it. I am talking both about full time telerads for large PE companies and most heavy call private practices.
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Quote from Sir Read Alot
Haven’t seen news in a while. Is PE still buying large practices anywhere?
What’s the Vegas situation? Wasn’t there an exodus?
