JK: I have a little bit of a bias here. I majored in social studies in college, and so I studied economics, history, and government. I personally would rather have health care dollars stay in the hands of those in health care. My personal preference, if I had a choice, would be to have an acquisition happen with organizations that have funds available and don’t have to go to a venture capital partner to get the funds. I think when you do that, you run the risk of losing control. In my experience, it’s much better to merge than it is to be acquired. Let me be clear that acquisitions can either be voluntary or involuntary. You can be told you must join that group, or you can do it on your own. I think if you can do it voluntarily, you’re in a much better position to negotiate and to get more than if you’re told you can’t continue the way you are and you have to be acquired by that group.

I think if you can do it voluntarily, you’re in a much better position to negotiate and to get more than if you’re told you can’t continue the way you are and you have to be acquired by that group. —Jay Kaplan, MD, FACEP

RI: I want to clarify for some folks that I think the situation Jay’s talking about is who’s telling you, “You have to be acquired.” It may be your hospital system, which will come to you and say, “Listen, we can’t do this with 23 different groups.”

SB: To follow up on what Jay had said, I think that all groups are at risk of being acquired. Whether your group is a single, independent practice or a large publicly held entity, you’re all at risk for being acquired by someone under some unforeseen circumstance. There are certain differences in how funding occurs. I know that most democratic groups are not looking at going to private equity markets to fund acquisitions. In fact, for the majority of my constituents and especially for my organization, we look at acquisitions as a needless activity, to some extent. Why would we invest $100–$200 million to acquire a group when we can do so organically and with same-store growth? Our philosophical approach has been that we don’t necessarily have to purchase the market to obtain a piece of that market. That’s a very different view of our growth strategy.