Perhaps more monetary value is created in the short term, but as a patient, would you choose to get your care from the leveraged corporate entity that must make its margins, or the diligent local doc who youโve grown to trust and runs his practice to support his local community?
Incentives matter.
Buying practices with leverage and a 5-7 year time horizon for an exit changes administrative incentive from high quality patient outcomes to network growth and profit margin.
In your 2nd or 3rd iteration of this cycle, what happens to the patient outcomes? These forces counteract each other. Management ends up making tradeoffs.
This is not true.
First, most doctors / dentists may be really good medical providers but don't know how to run a business. Often bringing in some basic business practices can create really nice growth.
Second, individual medical offices dependent on one or a handful of doctors aren't worth very much. Way too much key man risk. But a network of these offices are great businesses. Recurring revenue. A cyclical. Limited capital required. The multiple arbitrage is great.
So if you can keep buying and getting both the growth from professionalization and the multiple arbitrage these are great growth businesses.
Now you can overpay for either the platform or the add-ons. You can botch the integrate. Lots of things can go wrong in these deals. But they are also really great opportunities that lots of firms that know how to execute have made great returns on.
Before the agents became reliably autonomous, we chatted with them in a terminal.
Their context could only fit a million tokens (max). They were slow. They had โhallucinationsโ. We inspected their every thought. We watched their every output.
The mid-20s were weird for us all.
Somehow it was learning how many people are fulltime employed to maintain the Golden Gate Bridge that flipped something inside of me in my understanding of the entropic force civilization has to constantly fight against. Before that moment I thought โ I had not applied real conscious thought โ you simply build a building or anything really and then you just โฆ have it. After that I understood everything is constantly at the brink of being lost.