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Comment by geodel | Hacker News Reader

Not that I disagree. Its same pattern: half of the universities, most of liberal art colleges, 60% of IT companies, 70% of private Doctor practices and so on are too weak to survive next shock. The only sad part I see is nasty businesses like McKinsey is not fitting in any pattern of failure.

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I don't agree on the private doctor practice. Source, married a dr

Worst, worst case, the ~15k/yr in rent, ins, and software put a dent in profits, but if each visit is min 75$, you can figure out how hard it is to break even. Upper revenue is 200k+/yr

Reimbursement compression along with EHR/EMR requirements has seen a lot of practices acquired by large health systems.

Not to get too bogged down with details, but this winter she is looking to change EMR systems. The current one is the most expensive/established EMR for her field.

Rent is 12,000 dollars of expenses. EMR is almost trivial.

Vast majority of private practices are closing or being purchased by larger hospital systems.

Sure, same is true for software startups. Trade long hours and slightly above market pay for a lump sum payment and predictable patient load? The increasing complexity of interacting with health insurance providers and diagnostic labs has something to do with it, also. Why wouldn't a lot of them do that?

In Canada, the governments have been actively discouraging the solo practitioner practices for GPs.

Turns out that telling your patients to go to ER or a walk-in clinic every weekend/evening/holiday/illness/leave isn’t the best care.

And continuity of care if you retire/fall ill is rarely done well.

Multi-practitioner clinics can share an on-call schedule or evening/weekend hours, get bonuses for doing so and save money.

Also allows for flexible schedules. Want to work 3 days a week? Sure! Had a child and want to still work the occasional weekend only for a bit? Ok!

So is the housing market, so are people who've take up ungodly debt

I think we'd be better off with a bunch of small private colleges going under. The weaker yet still expensive and shrinking enrollment private colleges are dying slowly. They are just soaking up resources that could go other places.

One example is Cottey College, a small college in Missouri that is trying to get one of my relatives to go there. Down to below 300 students and shrinking fast.

Private Doctor practices? How can they be vulnerable?

Not an expert but the processing cost of insurance is supposedly very high. Question: how high compared is the cost of processing insurance on some meaningful basis?

Why are you calling McKinsey "nasty"?

True. You might as well call a sphere “round”. Redundant tautologies.

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