PracticeUpdate Conference Series World Congress of Dermatology 2019

" Private equity firms and venture capitalists are interested in one thing: making money. Those of us in medicine have many other goals, and many of us make decisions for our patients where we actually lose money because patient care comes first. I don’t see how these values can overlap. "

“They offer a young dermatologist a pretty good salary to start, and then they ‘normalize’ those sal- aries and lower them,” she continued. “They make them sign a noncompete [agreement]. … You owe your soul to them because the noncompetes can be very wide and very unreasonable. And although you could fight them if you go to court, that's very expensive to do it. Most young people don't have the funding to do that.” There are wider consequences. Private equity firms are starting their own residencies and then hiring their own residents. “Residents are paid an unlivable wage and are [therefore] required to bor- row from the private equity practice. When they graduate, they immediately have to pay it back or work for the private equity firm,” said Dr. Grant-Kels. “It’s a form of indentured servitude.” Specialists are hired away from academic medical centers, mak- ing it more difficult to train new dermatologists in academic settings. Private equity firms purchase an “anchor” practice and then buy up other practices in the area, cre- ating “mega-groups.” With the focus set on profits, practices in disadvantaged communities or those that largely serve more complex cases or Medicaid patients will close. “Ultimately, there will be bank- ruptcies, lack of dermatology jobs, lack of access

to care for patients, and loss of diversity in practice,” predicted Dr. Grant-Kels. “I think private equity is not the model that we should aspire to,” she concluded. “You lose control. Patients are not notified that the practice has been sold to private equity. I do not believe that the phy- sician extender model, to the extent that they are using it, is a good one. I think the consequences of private equity dermatology are huge, particularly as it relates to education. It’s going to have a huge impact on residencies. It’s going to have an impact on access, … and I think it's going to impact the work/life satisfaction of dermatologists who are used to controlling their own environment.”

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WCD 2019 • PRACTICEUPDATE CONFERENCE SERIES 11