When It’s Time To Join A Private-Equity Backed Supergroup

Recently, I merged my practice, Hoosier Foot and Ankle (HFA), with Upperline Health. I spent the last 16 years pouring my heart and soul into developing Hoosier Foot and Ankle into something special. I did my due diligence in meeting with multiple national supergroups supported by private equity (PE) funding to determine the best fit. The decision proved difficult because many supergroups have experienced, knowledgeable leadership and colleague partners I know well and respect. 

I have experience working in every type of practice setting except for an orthopedic group. Each practice type has its pluses and minuses. Ultimately, I started my group and grew it to nine podiatric physicians and 11 offices. However, the daily burdens of being the sole owner of my practice began to take a toll on me. 

Around the same time that my practice's administrative responsibilities became onerous, private equity entered the podiatric profession. Private equity’s interest in health care spread across several specialties before emerging in podiatry. I view this as a black swan opportunity (defined as “unexpected events of large magnitude and consequence and their dominant role in history. Such events, considered extreme outliers, collectively play vastly larger roles than regular occurrences.”) with a limited window.¹ The podiatric market fragmentation due to the high number of solo practices and small groups makes the profession an active investment sector for private equity.

Consolidation within the health care market to contain costs, streamline processes and procedures, and improve patient outcomes based on data-driven treatment algorithms occurs at all levels within the field. This consolidation is an exit strategy opportunity for physician owners, for both those looking to retire and those of us looking to focus on patient care instead of operational/management tasks.

The benefits of joining Upperline Health were numerous. The immediate and potential financial prospects made sense for me. While they were a starting point in the decision-making process, other important factors were the company's structure, vision and personnel. Michael King, DPM, serves as Upperline's Medical Director. Dr. King is a Past President of the American Podiatric Medical Association and a national coding/billing expert. More importantly, he is a trusted friend. David Thorpe, the CEO of Upperline Health, is experienced and well-known in the private equity health care sector. 

Upperline Medical’s strategic plan and vision resonated with me. Data-driven patient-centric care backed by a financially strong organization with industry-leading systems and processes to execute the strategic plan is a recipe for success. Upperline Medical’s ever-growing team of podiatric physicians is impressive and includes several professional leaders such as Jeffrey DeSantis, DPM, and Christopher Reeves, DPM, FACFAS. Dr. DeSantis is a close friend and went through the merger process before me. His experience with the company sealed the deal for me. 

One of the concerns I hear from colleagues considering joining a national supergroup is a loss of autonomy. I understand those concerns as my professional career consists of numerous facets requiring a substantial time and effort commitment. My unique situation demonstrates autonomy is possible in the supergroup setting. Large national supergroups can provide resources that solo practices or small groups cannot. I believe in strength in numbers. The challenges brought on by the COVID-19 pandemic also demonstrated to me the advantages of practicing under a larger umbrella. 

Our profession is undergoing a paradigm shift in the type of practice for podiatric physicians. The influx of private equity into the development of national supergroups is a unique opportunity that was not an option for the podiatric physician until recently. This model's numerous advantages allow physician owners to remove their management/operational burdens while allowing those owners to focus on what they do best: care for patients. 

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, and a Fellow of the American College of Foot and Ankle Pediatrics. Dr DeHeer is also a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery.

Reference

1. Black swan theory. Available at: https://en.wikipedia.org/wiki/Black_swan_theory . Edited November 8, 2020. Accessed November 11, 2020.