Long but good read: “The pharma industry from Paul Janssen to today: why drugs got harder to develop and what we can do about it” by Alex Telford.
The American College of Radiology runs a large and presumably quite profitable job forum. (I believe they outsource its management to a third-party company, but it’s on their website, and their branding is all over it.)
And I’m sure the ACR doesn’t want to police the content of that job forum, if nothing else because nitpicking job listings may discourage people from paying for said listings. Outside of the logistics and hassle, there is an obvious financial incentive to look the other way to potentially misleading content.
However.
I don’t see how one can justify allowing Radiology Partners to disingenuously call itself an “independent private practice” on its job postings (other than by just acknowledging the financial conflict that RP is probably the job forum’s largest customer by a wide margin).
I’m not even saying these are bad jobs. Quality is irrelevant here. You are what you are, and pretending you’re not a nationwide private equity conglomerative corporate practice in a job listing for a teleradiology position is only something you do because you don’t want to get filtered out of people’s search queries.
Here are the options for “work setting” they could have picked:
- Academic institution
- Independent private practice
- National radiology practice
- Health system or hospital
- Hospital-affiliated group practice
- Non-hospital group practice
- Multi-specialty entity
- Outpatient clinic
- Military Treatment Facility
- U.S. Public Health Service
- Department of Veterans Affairs facility
- Teleradiology
- Locum Tenens/Independent Contractor
- Other (Please specify)
If you believe in your model and are proud of your practice, then why pretend that you are independent when you’re not? Why not just pick “teleradiology” for a tele job? The straightforward explanation is that they know what job applicants want/are searching for, and their ads will perform better if that’s how they’re listed.
All the RP listings I’ve seen—and not just for the direct RP corporate offerings like this but also for their individual groups—describe the work setting as independent private practice.
This seems, at best, duplicitous and disingenuous. The generally accepted meaning of an independent practice is a business owned and operated entirely by its physicians (and not a hospital, health system, or other business/corporate entity). Physicians are the minority owners of Radiology Partners.
It doesn’t matter if one believes that independence or some variety of corporate structure is better (or even if they’re on the whole equal). There are multiple different options, and RP is cynically picking the wrong one.
§
Meanwhile, a quick update about that non-independent parent corporate entity, as reported in Radiology Business this week:
S&P said it is placing all Rad Partners’ ratings on CreditWatch with negative implications. This reflects “heightened downside risk,” analysts noted, given the potential that RP might default on its loans or engage in a distressed exchange in 2024.
From “How to Do Great Work” by Paul Graham:
Schools also give you a misleading impression of what work is like. In school they tell you what the problems are, and they’re almost always soluble using no more than you’ve been taught so far. In real life you have to figure out what the problems are, and you often don’t know if they’re soluble at all.
Schools sometimes also give students the misleading impression that learning is not fun for its own sake and that writing should be boring.
From “The Bitter Lesson” by Rich Sutton:
In speech recognition, there was an early competition, sponsored by DARPA, in the 1970s. Entrants included a host of special methods that took advantage of human knowledge—knowledge of words, of phonemes, of the human vocal tract, etc. On the other side were newer methods that were more statistical in nature and did much more computation, based on hidden Markov models (HMMs). Again, the statistical methods won out over the human-knowledge-based methods. This led to a major change in all of natural language processing, gradually over decades, where statistics and computation came to dominate the field. The recent rise of deep learning in speech recognition is the most recent step in this consistent direction. Deep learning methods rely even less on human knowledge, and use even more computation, together with learning on huge training sets, to produce dramatically better speech recognition systems. As in the games, researchers always tried to make systems that worked the way the researchers thought their own minds worked—they tried to put that knowledge in their systems—but it proved ultimately counterproductive, and a colossal waste of researcher’s time, when, through Moore’s law, massive computation became available and a means was found to put it to good use.
[…]
We want AI agents that can discover like we can, not which contain what we have discovered. Building in our discoveries only makes it harder to see how the discovering process can be done.
In addition to being New Year’s, this site turned 15 years old (!) today. It contains hundreds of posts, over a half million words, and oodles of my time.
Thanks for reading!
2023 is the tenth year of sharing my reading list. (The blog is also turning 15(!). I am…aging.
Here are the prior years: 2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015, and 2014.
My crystal ball is as cloudy as ever.
Earlier this month I wrote about Radiology Partners loaning a group money to help shore up radiologist compensation. That happened, but I was also wrong in my estimation of the likelihood of repayment: it turns out RP may be getting some of that money back after all.
The ultimate outcome is still up in the air, but I’ve addended my previous post with an update.
From “Serious Medical Errors Rose After Private Equity Firms Bought Hospitals,” reported by the NYT:
The study, published in JAMA on Tuesday, found that, in the three years after a private equity fund bought a hospital, adverse events including surgical infections and bed sores rose by 25 percent among Medicare patients when compared with similar hospitals that were not bought by such investors. The researchers reported a nearly 38 percent increase in central line infections, a dangerous kind of infection that medical authorities say should never happen, and a 27 percent increase in falls by patients while staying in the hospital.
“We were not surprised there was a signal,” said Dr. Sneha Kannan, a health care researcher and physician at the division of pulmonary and critical care at Massachusetts General Hospital, who was the paper’s lead author. “I will say we were surprised at how strong it was.”
In honor of the late great Charlie Munger, Stripe Press has his popular book (mental models, decision-making, stuff like this) available for free online in both a well-formatted browser-based ebook and audiobook formats: Poor Charlie’s Almanack: The Essential Wit and Wisdom of Charles T. Munger
Update 1/11/2024:
The specific practice loan that I referenced as giving rise to this post began earlier in 2023, and this post was months in finalizing. I’d originally intended to publish it in the summer. Since publishing, I’ve since learned that RP’s extra support has briefly paused.
That’s right, at least for a month or two, the group’s compensation reached the threshold that turned off the “advance” from RP. Hospital subsidies saved the day. Note that the loan term itself isn’t over, and after briefly not needing it, the group has since required more gravy.
Ultimately, this suggests that RP may have chosen the loan method for supporting this practice because they had specific reasons to (correctly?) believe that the loan period would be time-limited: It’s obviously better to give some money temporarily in a non-binding fashion to save a group in crisis than to permanently change the contract if you don’t have to.
The real question for the future will be: will the group consistently earn enough in the end to pay back several million dollars of borrowed money, and if so, how long does that take? And/or, does the group fight it? It sounds like what seemed like free money at the time may ultimately be an actual loan, and paying back that advance will therefore constrain compensation going forward unless long-term profits stay below the mark due to increased contractor use, the need to sweeten up internal moonlighting rates, or understaffing requires dropping volumes. Any or all of those things may happen. They are things happening at groups of all stripes across the country.
The future remains uncertain as always—and RP may still never recoup this loan—but this also means that I was wrong in how easily I dismissed the likelihood of RP seeing some of this money back.
This month credit agency Moody’s downgraded Radiology Partners again (surprising exactly no one): the first (and smallest) of its large debt obligations is due in 2024, they currently owe 10x their earnings, and they can only service these debt obligations through refinancing, which is challenging in the current market even before you consider the potentially tenous state of RP’s acquired practices when they reach their 5-year vesting window. It was inevitable.
If you ask RP, they will tell you that all third parties—whether Moody’s or just a random internet troll like myself—don’t understand their business and aren’t privy to the magic happening behind the scenes.
They consistently maintain that they will be able to refinance, though they never publically acknowledge that the most likely refinancing they will achieve is some form of distressed exchange like a debt-to-equity swap that would likely dilute current shareholders (and is considered a bankruptcy equivalent).
Here’s a slide from their big meeting earlier this year:
I know some people in the radiology community think that when the debts come due that RP will go bankrupt and disappear, but that’s simply not going to happen. Depending on how broadly one defines “success,” there’s an excellent chance they’ll be successful. (To wit, Envision emerged from bankruptcy in the hands of its creditors, but it didn’t go anywhere.)
But here is something you haven’t seen in the news but is nonetheless interesting:
Radiology Partners—already dealing with recurrent credit downgrades, cashflow problems, and investor fears—has been offering no-interest loans to some of its practices to shore up compensation.
Note: I’ve heard a similar story independently from several RP radiologists, but I do not know how common the offer has been (I suspect not very). For what it’s worth, I did reach out to RP and Melinda Collins (AVP of Marketing and Communications) on Twitter/X last week without a response. If you’re at RP and want to weigh in on this purported practice, please reach out. If I’m wrong or misleading in any way, I really, really want to know.
To my knowledge, nobody has pressed RP on this issue yet, and it has not been discussed in any public forum other than a brief mention on this site earlier this year in a quotation from a former RP radiologist. Since that time, I heard from multiple sources that at least one practice has taken the offer, hence this post.
So how does this look in practice? Let’s discuss.