SELLING or SELLING OUT?
PARTNERING WITH PRIVATE-EQUITY
Selling or selling out?
There has been quite a bit of unsolicited advice directed at the owners of private dermatology practices recently. The advice comes from critics of private equity in dermatology, and its thrust is fairly simple: private practice owners should not sell their practice to a private equity-backed group. Doing so, these critics imply, is not just selling your practice. It’s selling out.
This is an assumption I whole-heartedly reject.
The decision my partners and I made to combine our successful, multi-site private practice with the private-equity backed group Forefront Dermatology has proven enormously beneficial for us, our patients, and the rest of our team. As an illustration, I’m now a third more productive than I was before we joined Forefront, and I haven’t added a single hour to my workweek.
For me, selling was never an exit strategy; it was a way to offload stress, secure the future of a practice I had spent my career building, and rebalancing how my professional time was spent. Still, I never anticipated how fully this decision would transform how I practice medicine. After three years in this new partnership I can confidently say I have become a far better physician than I was before—and what’s more, I genuinely enjoy my work again. Having reliable and sophisticated administrative support has unburdened me and my partners, and the result is greater satisfaction for us, superior care and service for our patients, and a wider network of expert physicians to teach and to learn from.
“I’m now a third more productive than I was before we joined Forefront, and I haven’t added a single hour to my workweek.”
Forefront Physician Perspectives 2021: Together we are greater than the sum of our parts.
An Interview with Thomas Bender III, MD, FAAD, ABD Dr. Thomas Bender joined Forefront Dermatology in 2018 after establishing Advanced Dermatology’s first location in Mobile, Alabama nine years prior. Coming from a military background (USAF), he believes that a cohesive group is greater than the sum of its parts—a philosophy that guided the founding, staffing, and expansion of his own successful private practice, and one he has sustained as a Forefront Dermatology physician owner and board member.
Deciding to Join Forefront
My decision was part chemistry, part practicality. Both were important.
First, our cultures had to match. In dermatology if you take excellent care of your patients and put them first— and you also take excellent care of your staff—you’ll do very well financially. But you have to have your priorities in that order. When folks get those goals mixed up, they just don’t do as well in the long run.
I learned pretty quickly that the dermatologists who started Forefront put patients first, and the ones who’ve joined it have absolutely sustained those same values.
My second reason for joining Forefront had to do with the terms and nature of the partnership. In the course of evaluating different groups, I ran into several that wanted to squeeze us into their already existing structure; we would essentially be an extension of their platform. Forefront was different—in large part, I think, because they are truly led by physicians. In addition to ensuring complete clinical autonomy, they genuinely valued the operational expertise we’d developed in our region.
Forefront Physician Voices:
My advice to residents
Margaret “Molly” Moye, MD, is a Board-certified Dermatologist and Fellowship-trained Mohs Micrographic Skin Cancer Surgeon. She joined Forefront Dermatology’s Louisville, Kentucky office in 2016.
My job search as a resident/fellow
I graduated from fellowship in 2016, so my job search began in 2015. After having moved across the country multiple times for training, my husband and I wanted to find a place to call our own, so location was a huge factor for me. At that time, a Forefront office in Louisville, KY was hiring a Mohs surgeon, so I explored that opportunity just as I explored academic and smaller private practice opportunities. My mentors were supportive of my exploring all available options and encouraged me to find a group of Dermatologists I trusted in a practice where I would be treated fairly and have the necessary resources to thrive.
Even though I only graduated from fellowship a few years ago, it feels like quite a different time in our specialty. Back then, Dermatologists as a whole seemed to get along better without advocating for or against specific practice models.
I joined Forefront Dermatology, a physician-led, PE-backed dermatology group practice, in 2016. I practice Mohs surgery and general dermatology. As someone coming out of fellowship, I felt it was a strength that I would have other Dermatologists and Mohs surgeons from across the country to lean on for advice on setting up a Mohs lab, managing complex patients, and growing my practice.
I am not a shareholder in Forefront, although I have the opportunity to become one in the future. By sharing my hiring story, I simply hope to give others coming out of residency training a better understanding of what working for this particular practice is like.
“I simply hope to give others coming out of residency training a better understanding of what working for this particular practice is like.”
Forefront Physician Voices:
My path and advice to residents
Todd Rickett, MD, PhD, specializes in medical dermatology and contact allergy at Forefront Dermatology’s Louisville, Kentucky office. He joined Forefront in 2017 after completing his residency at Rush University Medical Center in Chicago. He earned his MD from Indiana University School of Medicine and a PhD from Purdue University.
“Forefront’s physician leaders and services have been extremely supportive in helping me learn the business of medicine and that support has helped me make a smooth transition from residency to practice.”
—Todd Rickett, MD, Board-Certified Dermatologist, Forefront Dermatology
A change of plan
Coming out of residency, I was looking to join a large group practice or university-based practice. I eventually opted to join the Louisville, KY office of Forefront Dermatology, a physician-led, private equity-backed group practice.
This decision might sound odd to residents who’ve been told again and again that private equity (PE) threatens physician autonomy and patient care. Now that I’ve actually worked in this setting, though, I’ve come to believe that those critiques are narrowing residents’ understanding of their career options. I’m adding my specific experience to the conversation so that residents get a more complete and even-handed view of where they may wish to practice.
Making the decision
In looking for the right place to practice, I had a few criteria in mind. I wanted a large, established group with excellent physician support as I had minimal experience with the non-clinical aspects of practicing medicine (billing, compliance, credentialing, MIPS, etc.). I also wanted to practice in my home state, so location was a paramount consideration.
I already knew the Forefront office in Louisville to be an established and respected part of the local medical community. Their compensation model and benefits package was competitive with or superior to my other offers. And the interview process, contract review, and negotiation were all very straightforward and forthright. But I still had to overcome some doubts before I made the decision to join.