Earlier quoted context omitted.
Yes, they are called "Insecure overachievers". They are the bread and butter of investment banks, management consulting firms, big law firms, etc. They are also the reason that partnerships still thrive. A couple of years ago I was talking with this (big law) partner at a dinner, and we came in on the topic around partnership - and he just said it straight: The competition / rat race towards partnership is 100% skewe…
> Prestige is a powerful motivator. I know this to be true because I've seen so many people given BS titles instead of raises and be happy about it as if they got something of real value. But I don't understand it at all. Apparently, I lack the "prestige" gene.
Private equity is buying everything from vet offices to tech conglomerates
251–260 of 362 posts
Re: Private equity is buying everything from vet offices to tech conglomerates
#252Don't forget the amazing track record of BCG leading companies into bankruptcy. Yes BCG consulted for Toy's R Us. Maybe there is more too it... There is a conspiracy theory BCG is tied to SHF to lead companies into bankruptcy with help of negative news narratives and help from MM to internalize buy orders and place sell orders on lit markets driving stock prices down. No concrete evidence yet but who knows when all t…
Isn't there significant sample bias here though? I imagine companies in dire circumstances would be more likely to bring on consultants to help "right the ship"
Re: Private equity is buying everything from vet offices to tech conglomerates
#253Not much has changed.
Re: Private equity is buying everything from vet offices to tech conglomerates
#254Despite the directions the interviewer tried steering this conversation into, this is a really interesting interview. But when it comes to the private equity roll-ups, I think everyone is missing the forest for the trees. If you are a doctor looking to retire and sell your business there is no one else right now who would buy it . The same goes for every category of "mom and pop" business in the US. Even if you could…
But even outside of that, if you ignore that part of it, there's monopolization costs coming from other directions. Many physicians are getting squeezed by decreases in their options, as hospitals and clinics merge, which creates efficiencies that make it hard for small clinics to compete with, which in turn leads to fewer administrative options should a physician choose to try somsething else. My sense is it's even worse than that, because even if you still have a few large hospital systems to choose from, the administrators are being incentivized in the same ways across the chains, so it's one flavor of hyperprofitized healthcare corporation versus another flavor of hyperprofitized healthcare corporation. Basically, it's hard for small clinics to compete even if someone wants to, because healthcare has become a cuthroat profit-driven market, with lots of big money and plenty of opportunities for those in power to take advantage of advantages.
I guess what I'm saying is it's not just the debt for the young physician: it's a very risky thing to do, period, being a small clinic versus an oligopoly of large chains. "A doctor knows what his practice is worth and wants every cent he can get out of it" is one possibility, but another is that that seller is in a position of survivorship bias, and can't find buyers because they don't see it as a rational decision even outside of the debt question.
The reason why you don't see this with landscapers or plumbers or whatever is because those markets have far more competition, and they're not overregulated (at least to the same extent). Healthcare as a market is characterized by obstacles to competition everywhere: if you ignore the rationale for those obstacles, and just look at it for what it is, you're left with an infrastructure that's constituted largely of barriers and costs to entry and participation. Basically, the market has become too expensive even for practitioners to participate fully in, so the only thing left are financial heavyweights.
Re: Private equity is buying everything from vet offices to tech conglomerates
#255Earlier quoted context omitted.
My wife worked in aged care. There are plenty of nasty or racist old people in aged care that make their job awful
My dad spent his last 3 years in a nursing home. When he passed, the nurses cried. I was surprised, I thought they were just doing a job and didn't actually care. I was wrong, and was very grateful to them.
Re: Private equity is buying everything from vet offices to tech conglomerates
#256Earlier quoted context omitted.
> A doctor knows what his practice is worth and wants every cent he can get out of it - but the next generation of doctor is not going to be able to compete with debt financing what a PE cash-buyer can get. In my opinion, the physician in this example is a monster. Profit maximization is a choice, not some kind of moral imperative. Am I supposed to have any respect for somebody selling out their employees and patient…
> In my opinion, the physician in this example is a monster. Profit maximization is a choice, not some kind of moral imperative. They've had a career of treating patients. I think they've satisfied the moral imperative already. And selling to PE doesn't necessarily equate to "profit maximization". It could just mean "decent sale". As the OP said, often there simply isn't anyone available to buy it out at the timeline…
No offense (really), but speaking from professional experience, I think this is naive and contributing to a lot of reasons why healthcare costs have started to spiral out of control. There are moral doctors, and immoral ones, and everything in between.
I'm not really sure why healthcare provision as an economic transaction is necessarily more moral than any other economic transaction that brings net benefit to the receiver of the service.
If there was such a cost to the physician overall, in terms of altruistic cost-benefit balances, they'd have trouble finding people wanting to go to medical school. I think the labor markets (in terms of medical school supply and demand) speak to the nature of that balance.
I don't want to demonize doctors (my family and myself fall into these categories) but I think it's dangerous to idolize them at the same time.
Re: Private equity is buying everything from vet offices to tech conglomerates
#257Earlier quoted context omitted.
Maybe because now that the retail vet is destroyed and rich people need vets who are not pathologically inconvenient and terrible, there is a brisk market for retained private vets. This is a trend I’ve noticed that goes along with “enshittification” wherein the normal thing (let’s take grocery stores as an example) become either so downmarket-oriented (e.g., Dollar General) or aggravating (e.g., self-checkout lanes,…
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Re: Private equity is buying everything from vet offices to tech conglomerates
#258Earlier quoted context omitted.
My wife is a vet for a corporate owned hospital and our circle of friends are naturally very vet centric. They run the gamut from PE vets, corp vets, and private owners. We know GPS, specialists, dogs and cats only, large animal, exotics. What you are describing is not PE specific. Staffing issues, primarily technicians, have hit everyone across the board. It’s a combination of wages, training, quality of life. Moreo…
I dated a vet tech several years before COVID and it sounded like a horrendous job. $20/hr was considered good pay, you're constantly bending over, pickup up things (sometimes things that definitively do not to get picked up), and you're literally dealing with some of the shittiest parts of animal care.
Veterinary care up and down, including for veterinarians, is a field that is really not as lucrative as other fields that require a similar level of education.
Re: Private equity is buying everything from vet offices to tech conglomerates
#259Earlier quoted context omitted.
The idea that PE comes in and sets eight figures of their own money on fire and ruins a business, shooting themselves in the foot makes no sense, yet every other story online is about them doing exactly that. Of course there are LBO scams going on (more historically rather than currently) but these billion dollar firms don't come in and lose a ton of their own money along with money of their outside investors on a re…
> The idea that PE comes in and sets eight figures of their own money on fire and ruins a business, shooting themselves in the foot makes no sense, yet every other story online is about them doing exactly that. On How I Built This, they frequently talk to companies that were bought out by PE. Some had negative experiences, but the majority were positive.
Re: Private equity is buying everything from vet offices to tech conglomerates
#260Earlier quoted context omitted.
Better than doing the same work with heavier patients in nursing homes for $12/hr.
The level of mental trauma endured by vets I doubt is matched by elderly care nurses.