RE: Formula for Value of a Practice
From: David Helfman, DPM
After reading all the articles on valuations of a practice, I would like to try to summarize the topic to ensure we are all comparing apples to apples. The reality is that everyone has given good input but I would like to offer a simple and concise summary of valuation methodologies that will be easy to understand based on real life experience.
There really are no rules of thumb anymore, and selling a practice is like selling any other service business, so it’s important to understand who is buying your practice and then you can come up with a logical formula and rationale for valuing your practice. I think the easiest way to
start this process is to put your practice in one of three buyer buckets.
1. Buyer: Current associate or new podiatrist wanting to buy...
Editor's Note: Dr. Helfman's extended-length letter can be read here.
From: Bryan C. Markinson, DPM
Dr. Borreggine's concern is legitimate but not from the perspective of the elimination of podiatry, but that the DPM degree does not allow us full scope. The step up of ancillary providers such as NPs and PAs is a natural extension of the changing environment in medicine that enables patients to get seen and still be economically solvent. There is no turning back from this.
The best approach for DPMs by far is to let every full scope nurse practitioner in your community know your availability and what you can do. Even lecture to them at their meetings. From my own personal experience, the one NP who decides to do foot care is completely outnumbered by the rest that will not. Nurse practitioners are a steady consistent source of patients in my practice.
All we have to do is show up at the dance! Attend the hospital meetings of dermatology, endocrine, vascular, etc. They will flood your office.
Bryan C. Markinson, DPM, NY, NY
RE: Dealing with an Incompetent Attending
We often look at the lack of residency programs, but what about the quality of the ones that do exist? As a resident, I have a lot to learn. I know this. But, what do I do when I have an attending affiliated with my residency program that is horrible in the OR? By horrible, I mean very poor in technique, illogical in selection of procedure as well as execution. He amputates things that don’t need to be amputated, fuses joints on people that don’t need to be fused. The hospital I work in has a very large population of low-income minority patients. I know this attending only wants to help, but I’m beginning to feel that they have NO regard for these people, but rather just view them as guinea pigs.
I’m witnessing these events and it is so frustrating. I feel so lost, and I don’t know what to do. I have not learned a single thing from this attending; only what not to do. This attending is a wonderful, easy going, friendly attending, but in my eyes: an incompetent surgeon. Without being too specific, I witnessed a procedure where I believe more harm was done than help. Despite my protest, there was nothing I could do but stand there and watch it happen. I’m writing to vent - but also to seek advice.
