In this episode of Group Practice, host Neal Goldstein discusses why private equity (PE) firms are often able to operate more strategically than independent physician groups—and how those groups can adopt similar approaches without selling. Drawing on his experience, Neal explains that PE firms benefit from centralized decision-making, clear performance metrics like EBITDA, and shorter investment horizons that drive disciplined execution.

Neal highlights four areas where he sees PE firms create value: physician staffing (particularly succession planning and strategic hiring), expense management (focusing on eliminating inefficiencies such as excess real estate), deployment of capital (retaining earnings to fund growth), and corporate infrastructure (including strong leadership roles like COO, CFO, and CDO).

The core takeaway is that while PE has advantages, physician groups can improve performance by adopting even a few of these strategic disciplines—particularly around capital reinvestment, operational efficiency, and leadership structure.

In this follow-up episode of Group Practice, host Neal Goldstein addresses listener feedback about non-competes in physician practices. He tackles three key questions: Are non-competes ever appropriate? What’s the point of enforcing them if they’re often struck down? And what alternatives exist?

Neal argues non-competes remain appropriate in several contexts: competing against hospital systems, PE-backed practice sales, groups with exclusive hospital contracts, and specialties with high capital costs. He emphasizes that despite headlines suggesting otherwise, non-competes are still being enforced and represent valuable contractual rights worth protecting.

For practices seeking alternatives, Neal offers practical strategies: conditioning tail coverage on non-competition, structuring severance with clawback provisions, strengthening non-solicitation clauses, and negotiating robust no-hire provisions in hospital contracts.

In this episode of Group Practice, host Neal Goldstein interviews Dr. Lowell Weil, Executive Chairman of Balance Health and formerly the CEO of Weil Foot & Ankle Institute a 53-physician podiatry group founded by his father Dr. Lowell Weil Sr. Dr. Weil discusses the five practice settings for podiatrists: solo/small practices, orthopedic groups, hospital systems, large independent groups, and platform-backed groups like Balance Health.

Dr. Weil highlights the mounting challenges facing small practices – stagnant Medicare reimbursement, rising costs, and physician burnout – and explains how Balance Health addresses these issues by providing operational support, compliance infrastructure, and professional camaraderie while preserving clinical autonomy.

What sets Balance Health apart is its physician-majority ownership structure, with over 150 podiatrist-owners, physician leadership at all levels, and a commitment to hiring and developing young doctors. Dr. Weil emphasizes that patient care, not profit, drives the organization’s mission.