A Deep Dive into Medical Practice M&A With Clint Bundy and Matt Ebbel (Part 2)

Insights from A Surgeon, Team Physician & Entrepreneur with Dr. Brian Cole

Listen in as host David Mandell speaks with orthopedic surgeon Dr. Brian Cole. David and Brian begin the discussion with an overview of Brian’s career journey, his decision to earn an M.B.A. and his thoughts on the importance of business acumen in the medical field.

David asks Brian about the unique structure of his practice and academic work and then his experience working as team physician for a number of Chicago’s professional sports teams – both the pros and the cons.

Brian and David then chat about Brian’s involvement in healthcare-related businesses and why he focuses on business activity that relates to what he is doing medically.  They also discuss Brian’s leadership roles in professional societies, including what his advice is for the young physicians he trains or speaks to on career, financial, and business matters.

Finally, Brian tells David and the audience about his own podcast, Sports Medicine Weekly.

Learn more, incluing key takeaways and insights, as well as being able to listen to this and past episodes by visiting www.physicianswealthpodcast.com.

In the second part of the podcast, host David Mandell continues his conversation with investment banker Clint Bundy and private equity principal Matt Ebbel, focusing on the factors that contribute to successful mergers and acquisitions (M&A) in the healthcare sector, including medical, dental, and veterinary practices. They delve into what makes a practice an attractive acquisition target, the importance of cultural and strategic alignment, and future trends in healthcare M&A.

Matt Ebbel emphasizes the importance of considering the "day after" a sale, where physicians might find themselves with new responsibilities and a change in their work dynamics. He stresses the need for ownership alignment, candid dialogues about success, and the importance of evaluating the financials, doctor and staff retention, and the culture of a practice. Red flags include a lack of alignment, high turnover, and compliance issues. Ebbel also touches on the importance of setting realistic expectations regarding income adjustments post-acquisition to ensure a fair and sustainable deal and the value of physicians working with a financial advisor to see how a deal impacts their personal financial goals.

Clint Bundy outlines the "three legs of the stool" approach to evaluating practices: stability, profitability, and growth, with scale as a possible fourth factor. He emphasizes that while scale is beneficial, it's not a must-have for a practice to be considered strong. Bundy also highlights the necessity of running a competitive process to ensure the best offers for a practice, stressing the importance of certainty to close alongside the financial offer.

Both guests agree on the critical role of cultural fit and strategic alignment between the acquiring and acquired entities. They advise practices to conduct thorough due diligence on potential partners, considering factors like the platform's resources, commitment to medical quality, and the investment partner's track record and vision for leveraging technology.

Looking ahead, both Bundy and Ebbel express optimism for the M&A market in healthcare, despite recent macroeconomic challenges. They anticipate continued interest from private equity and possibly an increase in activity as market conditions stabilize. Ebbel specifically mentions potential public offerings by major players as a future benchmark that could spur more interest in the sector.

In summary, the podcast provides valuable insights into the complexities of healthcare M&A, offering practical advice for practices considering a sale or partnership. The discussion underscores the need for strategic planning, thorough due diligence, and alignment of values and goals to ensure successful transactions in the ever-evolving healthcare landscape.

Learn more, incluing key takeaways and insights, as well as being able to listen to this and past episodes by visiting www.physicianswealthpodcast.com.

Listen or watch as host David Mandell takes a deep dive into healthcare mergers and acquisitions (M&A), with investment banker Clint Bundy and private equity firm principal Matt Ebbel.  They discuss the advisory and strategic roles they play, aiming to maximize value and find the best partnerships for business or practice owners looking to sell or raise capital.

Bundy shares insights into the process of advising healthcare practices, emphasizing building trust, understanding client objectives, and assessing the market for potential transactions. He provides case studies to illustrate the varied scale and scope of deals he has worked on, ranging from solo practices to multi-location consortiums.

Ebbel offers a private equity perspective, highlighting the importance of selecting the right partners and platforms for growth or sale, especially in a changing economic landscape influenced by interest rates and market consolidation. He stresses the significance of operational excellence and strategic planning in achieving successful outcomes in healthcare M&A.

The discussion also touches on the challenges and opportunities within the healthcare sector, including regulatory hurdles, the impact of economic factors on transaction viability, and the strategic importance of aligning with partners who can add value beyond capital.

Learn more, incluing key takeaways and insights, as well as being able to listen to this and past episodes by visiting www.physicianswealthpodcast.com.

Listen in as host David Mandell speaks to returning guest plastic surgeon Dr. Jonathan Kaplan about adding a weight loss program to a medical practice – both for the patient’s health and happiness and the practice’s economics.

Jonathan begins the discussion with an overview of the current popular weight loss medications Ozempic/Wegovy (semaglutide) and Mounjaro/Zepbound (tirzepatide) and how they work. He then explains how his practice began consideration of a weight loss program for patients – because of both BMI limitations of patients who wanted surgery and due to suggestions from practice staff.

David and Jonathan then delve into the various elements a physician must consider when evaluating and then implementing a weight loss program for this/her patients., including how to scale it as a subscription business model.

The podcast concludes with a discussion of how the same business process of evaluating and implementing a weight loss program could be applied by a physician to other modalities, including hormone replacement, IV therapy, cosmetic therapies and more.

Learn more, incluing key takeaways and insights, as well as being able to listen to this and past episodes by visiting www.physicianswealthpodcast.com.

Listen in as host David Mandell chats with Certified Financial Planners Bob Peelman, Adam Braunscheidel, and Andrew Taylor from the OJM Group on three wealth planning topics that are relevant for 2024.

David begins by discussing with Bob Peelman the basics of 529 plans, including the two types of plans, tax benefits, planning flexibility factors and more.  Bob also delves into the new rules coming into effect in 2024 regarding the Roth IRA transfer provisions for unused 529 plan balances.

David then turns to Adam Braunscheidel to discuss HSAs.  He explains the importance of having a High Deductible Health Plan (HDHP) to qualify for an HSA and the potential of HSAs as a retirement savings vehicle, taking advantage of their unique triple tax benefit. Adam discusses the tactic of using HSAs for long-term savings by paying current medical expenses out-of-pocket and reimbursing oneself later from the HSA through tax-free distributions.

Finally, David chats with Andy Taylor about the question of whether to invest in bonds or hold cash, particularly in the context of recent interest rate fluctuations and inflation rates. Andy explains the inverse relationship between interest rates and bond prices, and how this impacts investment decisions and how the environment as they record the podcast (4^th Quarter 2023) is much different than it was 6, 12, or 18 months ago.

Learn more, incluing key takeaways and insights, as well as being able to listen to this and past episodes by visiting www.physicianswealthpodcast.com.

Listen in as host David Mandell interviews Dr. Madan Kandula, ENT surgeon, entrepreneur, and CEO of Advent, which he has grown to over 250 team members across 18 locations, serving over 1500 new patients monthly.

Dr. Kandula shares his background, including a brief description of his family's immigrant story from India, emphasizing the struggles his parents overcame and how this impacted his life and career. 

The conversation shifts to Dr. Kandula's career journey, starting with his first job out of training, where he initially joined a solo practice in Milwaukee which went terribly, eventually motivating him to start his own practice, Advent. He highlights the importance of providing outstanding patient care and building a strong referral network, and how these principles contributed to the growth of his practice.

Dr. Kandula then delves into the decision to partner with a private equity firm in 2020, a move aimed at expanding and professionalizing the organization. He emphasizes the importance of coming into such partnerships from a position of strength and how his unique approach to healthcare made Advent a successful venture.

The podcast concludes with Dr. Kandula stressing the significance of mindset in both personal and professional growth. He encourages physicians to recognize their power and potential, and to develop a strong, positive mindset through daily practice and habits.

Listen in as David chats with Carey Ransom, a serial entrepreneur, venture capitalist and angel investor. Carey begins by explaining how growing up around a family business fostered his entrepreneurial streak.

Carey then discusses what initially captures his interest in an entrepreneurial venture and why he often is skeptical of founders who are in love with their solutions. He and David also spend time delving into the total addressable market (TAM) for a business and why Carey thinks it is imperative to cut that down realistically.

Next Carey tackles the topic of boards for startup companies, as he has served on many of them. He shares that, as a board member or investor, the #1 thing he looks for from the management team is how they learn and adjust.

David and Carey then discuss Bonus, one of the ventures Carey is involved with today.

Carey concludes with his big-picture advice to physicians who may be considering a jump into full-time or part-time entrepreneurial ventures.

Learn more and listen to this and past episodes by visiting www.physicianswealthpodcast.com.

In this episode, David welcomes back two guests from earlier seasons – orthopaedic surgeons Dr. Sanjeev Bhatia and Dr. Matthew Provencher.  Sanjeev and Matt join David to discuss a new venture they’ve founded, along with David, called The Doctors Agents (TDA). 

Sanjeev and Matt begin with how they identified a need in the marketplace for physicians to know more and achieve better results when evaluating and negotiating jobs.  They discuss their personal stories and those they have seen from colleagues and fellows they train and delve into the reasons many physicians tend to evaluate jobs on their own, without the benefit of data, tools or professionals. 

Sanjeev introduces TDA and describes how it helps physicians seeking their first job out of training or changing jobs. David explains a bit about two on-demand tools that TDA provides 24/7/365 – a financial model for evaluating one or more jobs financially and an AI-based contract review.

Matt comments on the importance of TDA’s work to vet experts in medical contract law and financial planning as part of their offering for physicians.

David and Sanjeev then discuss how the financial model and AI contract review tools could be valuable even for physicians who are not changing jobs – from helping them map out their financial plan and dealing with changes at the practice or hospital to taking advantage of entrepreneurial opportunities as they arise. 

David wraps up with a review of the basic pricing for TDA’s various offerings in their Beta phase.

Learn more and listent to this and past episodes by visiting www.physicianswealthpodcast.com.

Host David Mandell chats with Dr. Jordan Romano in Episode 4.4 of the podcast. Jordan talks about his career, how he became involved in working as a medical expert witness, grew the work into a business, and now advises other physicians who are interested in this potential “side hustle.”

Jordan begins with the story of how he ended up in medicine and at Harvard and Mass General, as well as the non-traditional steps he took along the way. He relates why business was in his blood, given his family background in banking and finance.

Jordan covers how and why he first jumped into the field of medical expert witnessing, what he liked about it initially and what it took to turn it into a real business. He also shares what he sees as the most significant challenges to growing the business.

Jordan then discusses his current work in advising and coaching physicians looking to get into this space, what doctors typically can earn in the field, and common mistakes he sees physicians make when starting out.

Jordan wraps up the episode with his big picture advice for physicians considering this type of work.

Listen in as David chats with healthcare real estate expert Colin Carr.  Colin begins with his background in real estate in a variety of settings. He then tells the story of how, after seeing physicians do so poorly in deals, he decided to launch a firm dedicated to helping doctors.

Next, Colin explains the top mistakes he sees physicians and practices make when it comes to their real estate -- including do-it-oneself, not performing adequate due diligence and more – and what that will cost them in the long run.

Colin delves into the choice between leasing and purchasing for a medical practice and relates the importance of having a multi-factor decision process as the key to fostering long-term peace of mind.

He then discusses the significance of timing, in terms of when to make the ‘rent vs. own’ decision, when to contact a landlord on a possible lease renewal, and even when to reach out to potential real estate agents.

Colin wraps up by sharing how physicians can find an ethical, competent real estate agent they can trust.

Learn more and listent to this and past episodes by visiting www.physicianswealthpodcast.com.