Are family medicine clinics being increasingly bought and run by non-MDs?

[Centurion35]

I've recently talked to some of my old high school friends and one of them mentioned that their sister bought a walk-in clinic but she isn't a MD. Apparently, this is becoming more common especially in the GTA. A few FM residents I met stated PAs and NPs are buying walk-in clinics and working at the clinics they own. One of my friends dad is planning on retiring and had a big interest from a PA to buy and staff with MDs. Is this part of the new scope creep happening? I always thought that owning a family medicine clinic was restricted to MDs but turns out this is not the case. 

[JohnGrisham]

36 minutes ago, Centurion35 said:

I've recently talked to some of my old high school friends and one of them mentioned that their sister bought a walk-in clinic but she isn't a MD. Apparently, this is becoming more common especially in the GTA. A few FM residents I met stated PAs and NPs are buying walk-in clinics and working at the clinics they own. One of my friends dad is planning on retiring and had a big interest from a PA to buy and staff with MDs. Is this part of the new scope creep happening? I always thought that owning a family medicine clinic was restricted to MDs but turns out this is not the case. 

Very common and not new. Its a shame that non-MDs can own family medicine clinics.

[Pakoon]

Would they simply be collecting rent or charging overhead? Id hope they can't take from the physicians OHIP billings, as them taking a % of billings seems like a great model to incentivize slow docs. If they are charging a fixed salary the. I'd assume the docs involved wouldn't be busting their own backs to meet demands?

[shikimate]

Isn't it usually the model to take a % of billings like 60/40, 70/30 kinda deal?

[bearded frog]

On 3/2/2022 at 7:54 PM, JohnGrisham said:

Its a shame that non-MDs can own family medicine clinics.

Why? Some would absolutely prefer to just pay an overhead and not have to worry about maintenance, ordering, HR, bills, etc.

[JohnGrisham]

2 hours ago, bearded frog said:

Why? Some would absolutely prefer to just pay an overhead and not have to worry about maintenance, ordering, HR, bills, etc.

Yes, but my preference is an MD should own the clinic  - as they at least would have a better understanding of what their associate colleageus go through, and don't see it purely from the financial perspective and rip off said MDS.

 

[JohnGrisham]

On 3/3/2022 at 7:53 AM, shikimate said:

Isn't it usually the model to take a % of billings like 60/40, 70/30 kinda deal?

yes, in the majority of places its % split.  Very few places in the westcoast at least charge fixed flat fee overhead. For the average to above average billers, you have to negotiate step wise splits to make it fair. i.e. once you bill 200k, your % split drops to make it more fair.  Otherwise you are paying more disproportionately overhead compared to lower billers.

[JohnGrisham]

On 3/2/2022 at 9:06 PM, Pakoon said:

Would they simply be collecting rent or charging overhead? Id hope they can't take from the physicians OHIP billings, as them taking a % of billings seems like a great model to incentivize slow docs. If they are charging a fixed salary the. I'd assume the docs involved wouldn't be busting their own backs to meet demands?

This is how its done in most urban FFS centres on the west coast. And from what ive seen in ON - % split of your billings.  If you go slow and bill less, you also make less - so not sure how it functionally works to slow down docs. What it does do, is incentivize docs to find additional income streams with lower overhead. I.e. why work 5 days of clinic at 30% overhead when you can do 2-3 days clinic and do 2-3 days hospital based work or LTC with 0% overhead.

[bearded frog]

On 3/4/2022 at 11:50 AM, JohnGrisham said:

Yes, but my preference is an MD should own the clinic  - as they at least would have a better understanding of what their associate colleageus go through, and don't see it purely from the financial perspective and rip off said MDS.

 

Perhaps, but the Venn Diagram of good MD and good business manager don't always overlap.

[1D7]

7 hours ago, bearded frog said:

Perhaps, but the Venn Diagram of good MD and good business manager don't always overlap.

On a small-medium scale, sure it often makes sense to have higher level administrative help.

I'm with JohnGrisham in that I don't like the idea of non-MDs or corporate entity owning a chain of clinics. I realize you were probably talking about a smaller scale, but it's a real a slippery slope. In the U.S. large corporate groups has compromised care in many areas, turning dermatology clinics into biopsy mills, incentivizing shoddy radiology reports, inappropriate utilization of nonphysicians because of lower upfront costs, etc.

When physicians give up control over their practices, it creates a systemic problem for both physicians and patients.

 

[1D7]

By the way there's a major difference between "Wow there's a ton of paperwork, we better hire someone to manage all of it" kind of admin providing support, and "Hey here's $XXXXXX for ownership of your practice, you answer to me from now on" where the docs sell their practice and autonomy for cash.

This has already happened to pharmacy with corporate acquisition of the majority of retail pharmacy. This has led to significant drops in autonomy and pay for pharmacists, and prioritizing $$$ over patient care.

Quote

https://www.cbc.ca/news/business/pharmacists-say-corporate-pressure-can-lead-to-prescription-mistakes-1.2928309

"Some Canadian pharmacists are saying they are under intense pressure to meet business quotas, which causes an assembly-line mentality that increases the likelihood of making mistakes."

"Some pharmacists say the pressure to meet profit targets can compromise the quality of the care and attention they’re able to dispense."

"“You keep hearing, ‘Doing more with less, doing more with less.’ ... “It's every pharmacist’s worst nightmare.”"

[JohnGrisham]

9 hours ago, bearded frog said:

Perhaps, but the Venn Diagram of good MD and good business manager don't always overlap.

Sure, but theres still more than enough who want to do both, and even more that are capable of doing so, when they realize what the alternatives are.

People are also programmed from day 1 due to being told "you need to get x y z business people to help you do a b c", when you're told repeatedly you cant do Z because you "need" all these different business people to do it for you, it leads to programmed helplessness as well. Its the reason why theres always an "MD rate" that is inflated, why there is a lot of inappropriate investing, insurance, finance, and accounting "advice" given to MDs. Many are taught that "there is no way you can do medicine AND learn the basics of business! Its too much! Just pay me $$$ to handle it for you". Then when you actually do it, and realize its not that hard - you look back and grimmace at how taken advantage alot of those in medicine were.

[bearded frog]

4 hours ago, JohnGrisham said:

Sure, but theres still more than enough who want to do both, and even more that are capable of doing so, when they realize what the alternatives are.

People are also programmed from day 1 due to being told "you need to get x y z business people to help you do a b c", when you're told repeatedly you cant do Z because you "need" all these different business people to do it for you, it leads to programmed helplessness as well. Its the reason why theres always an "MD rate" that is inflated, why there is a lot of inappropriate investing, insurance, finance, and accounting "advice" given to MDs. Many are taught that "there is no way you can do medicine AND learn the basics of business! Its too much! Just pay me $$$ to handle it for you". Then when you actually do it, and realize its not that hard - you look back and grimmace at how taken advantage alot of those in medicine were.

I am not talking in the abstract, a close family friend is a GP and owned his clinic in a partnership with the other GPs in the clinic. They had been doing it that way for decades, but according to him the worst part of his job by far is the admin stuff. Hiring and firing secretaries, clinic maintenance, dealing with infrastructure stuff. Eventually they sold the building and moved the practice into a place that was owned by a corporation and they just paid an overhead and didn't have to worry about the infrastructure stuff and he preferred it much more.

What I'm saying is, different strokes for different folks.

[innocentius]

If one wanted to do this, where would one get started? Are there any companies//people you could hire who could walk you through the process? What would be the return on investment on a walk in clinic business in the GTA from a purely business perspective?

[JohnGrisham]

9 hours ago, bearded frog said:

What I'm saying is, different strokes for different folks.

Definitely and I know many on the converse who love being owners(especially in areas where real-estate has booned in the last decade), and get a good manager to do alot of the stuff that you describe. The problem is with larger corporations in the game, it makes it harder for smaller outfits to get in because the larger ones scoop out real-estate etc, esp in bigger centres. They have economies of scale and can take losses in some parts while a small outfit cant.  

 

[Nachoolibre]

Does anyone know if FHO clinics can be bought by non-MDs?

[Rationalistlens]

the system wants docs, particularly family docs, to see patients fast (finish consults under 10 mins on average) in order to survive while increasing their misdiagnosis rate as a result and to take the fall for that if complaints go to regulatory colleges. That part though I cannot exert control over or change.
 

What I can control is my business expenses and maximize my earnings. hence i own my clinic location and keep tight control over billing and expenses.