You have to be kidding me. I can hardly believe this is even serious. Never setting foot in the state of Texas again, let alone spending a dollar there. I’ll take my higher taxes and Rust Belt life and live in peace.
Can anyone in the group in Texas enlighten us? Anyone want to relocate? Almost all the pediatricians in our area are at or near retirement age.
Three of us own an independent pediatrics practice in the far exurbs of a major metropolitan area. Its roots go back to the 1980s, and we are the second generation to run it rather than the one who built it. We plan to retire at the same time roughly four years from now, so we have started thinking about succession. Lately it’s getting more serious.
We were fortunate in our timing and in our payer mix, and the practice performs better than most people expect from peds. Each of us works 2.5 clinical days a week, supported by three part-time APPs, which comes to about 3.2 FTE. The work is 100% outpatient, and each of us clears north of $400,000. It’s not surgeon money, but it pays the bills, and we made more when we were working four days a week.
As best we can tell, the economics work because of a reasonable commercial payer mix, high volume, disciplined vaccine purchasing, and overhead we have held as flat as we can for years. Our founder taught us good business practices and we’ve managed to keep it going.
For a long time we assumed one of our kids would take the practice over. Some are pediatricians. But they have all built their lives elsewhere, which is what adult children do.
We haven’t figured out a structure. We expect the usual two-year partnership track so everyone can confirm the fit. Our own buy-ins were financed out of productivity bonuses over five years, and we never felt them, and we would do the same for whoever comes next. We are also thinking seller financing, priced so that a successor can actually carry it as we are set financially and mostly want the practice to remain independent. It also needn’t be a single person. Two or three physicians splitting it the way we have would work well, which lowers the per person profit, but also spreads the risk.
Nobody would need to relocate. Most physicians in the area live in the suburbs of the metro and commute here. That said, we live here and think it’s a strategic advantage because people see us.
The honest drawbacks are that it is a high-volume practice, that vaccine cost runs to about a quarter of collections and therefore requires attention to margins, and that the operational burden falls on whoever takes it on. We run the practice largely by text message with an occasional video call, and once every year or two a trusted advisor organizes a retreat for us to set strategic direction. That arrangement works only because the three of us get along extremely well.
What I would like to know:
**1.** What makes you skeptical? I would rather hear the objections now than watch candidates quietly fail to respond.
**2.** What would you need to see before you believed the numbers? Certainly when partnership time comes, we would open the books.
**3.** If you considered ownership and chose employment instead, what decided it for you?
**4.** Where do pediatricians who genuinely want to own a practice look?
The three of us have become close friends over the years, and each of us has left significant money on the table more than once rather than kill the goose. We would like whoever comes next to be as content doing this as we have been. I am not recruiting here; we are just to get this right before we begin.
Three of us own an independent pediatrics practice in the far exurbs of a major metropolitan area. Its roots go back to the 1980s, and we are the second generation to run it rather than the one who built it. We plan to retire at the same time roughly four years from now, so we have started thinking about succession.
We were fortunate in our timing and in our payer mix, and the practice performs better than most people expect from pediatrics. Each of us works 2.5 clinical days a week, supported by three part-time APPs, which comes to about 3.2 FTE. The work is entirely outpatient, with no call and no nursery, and each of us clears still north of $400,000. (Yes, I am aware of how that sounds.)
As best we can tell, the economics work because of a reasonable commercial payer mix, high volume, disciplined vaccine purchasing, and overhead we have held as flat as we can for years. Our founder taught us good business practices and we’ve managed to keep it going.
For a long time we assumed one of our kids would take the practice over. Several of them are pediatricians. But they have all built their lives elsewhere, which is what adult children do.
We have not settled on a structure. We expect a two-year partnership track, so that everyone can confirm the fit. There would be no capital at risk and no bank loan. Our own buy-ins were financed out of productivity bonuses over five years, and we never felt them, and we would do the same for whoever comes next. Seller financing, priced so that a successor can actually carry it, because we are set financially and mostly want the practice to remain independent. It also need not be a single person. Two or three physicians splitting it the way we do would work well.
Nobody would need to relocate. Most physicians in the area live in the suburbs of the metro and commute here. That said, we live here and think it’s a strategic advantage because people see us.
The honest drawbacks are that it is a high-volume practice, that vaccine cost runs to about a quarter of collections and therefore requires attention to margins, and that the operational burden falls on whoever takes it on. We run the practice largely by text message with an occasional video call, and once a year or two a trusted advisor organizes a retreat for us to set strategic direction. That arrangement works only because the three of us get along extremely well.
What I would like to know:
**1.** What would make you skeptical? I would rather hear the objections now than watch candidates quietly decline to respond.
**2.** What would you need to see before you believed the numbers? Certainly when partnership time comes, we would open the books.
**3.** If you considered ownership and chose employment instead, what decided it for you?
**4.** Where do pediatricians who genuinely want to own a practice look?
The three of us have become close friends over the years, and each of us has left significant money on the table more than once rather than kill the goose. We would like whoever comes next to be as content doing this as we have been. I am not recruiting here; we are just to get this right before we begin.
My wife and I are experienced travelers but planning our very first cruise: likely Greece, Croatia, Montenegro, Venice, and Athens. We are considering Regent, Seabourn, Silversea, and Explora. (Others?)
We both have pain and limited stamina, and we are concerned about keeping up with group excursions on hills, stairs, cobblestones, and archaeological sites. We value comfort and good value more than the lowest price.
Which cruise line and itinerary would you recommend for first-time cruisers who want more sights but fewer steps? Are Regent’s included excursions workable, or would another line be better for arranging and buying easier private tours rather than paying for excursions we may not be able to do?