In this episode, host David Mandell welcomes Bob Goettling, a seasoned investment banker and legal expert with over 30 years of experience in healthcare transactions, to discuss the emerging relevance of ESOPs (Employee Stock Ownership Plans) for physician practices. Goettling shares his professional journey, from early M&A work to helping physician groups explore monetization options, including ESOPs as a potentially powerful but underutilized tool.

Bob breaks down the core structure and history of ESOPs, describing them as trust-based leveraged buyouts that allow physicians and employees to own their practice while benefiting from significant tax advantages. He explains how the Bloom Organization itself became an ESOP nearly a decade ago, and how his team has since developed a tailored hybrid ESOP model for medical practices, especially as interest in private equity has cooled due to rising interest rates and negative post-deal experiences.

While ESOPs offer clear advantages—like retaining control and optimizing tax outcomes—they also come with complexity. Goettling stresses the importance of choosing the right advisors and ensuring a strong internal management structure. Not every practice is a good fit; size, structure, and strategic alignment are critical factors. The episode offers high-level insight into how ESOPs work, who they benefit, and what red flags to watch for in considering this alternative to traditional M&A routes.

KEY INSIGHTS

1. ESOP stands for Employee Stock Ownership Plan and enables employees to become beneficial owners through a trust structure.
   
   
2. Originally introduced in the 1950s, ESOPs gained traction in the 1970s due to government incentives.
   
   
3. Goettling and his team at Bloom implemented an ESOP for their own firm nearly 10 years ago and now advise physician groups on doing the same.
   
   
4. Tax benefits are significant: ESOP sellers can defer or eliminate capital gains, and the entity itself becomes tax-exempt.
   
   
5. ESOPs allow physicians to monetize their practice without surrendering control, unlike private equity deals.
   
   
6. The model is ideal for larger practices (15–20+ physicians) with existing governance (boards, CEOs, CFOs).
   
   
7. Complexity is a key barrier—ESOPs involve oversight from both the IRS and Department of Labor.
   
   
8. Hybrid ESOP models can account for partners, junior doctors, staff, and even future hires.
   
   
9. Mistakes often stem from poor advisory choices; experience with ESOPs is essential to avoid pitfalls.
   
   
10. ESOPs can be a game-changer for practices looking to stay independent while scaling strategically.

Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com.

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In this episode of the Wealth Planning for the Modern Physician podcast, host David Mandell sits down with two highly respected medical leaders—Dr. Mark Figgie, Chief Emeritus of the Surgical Arthritis Service at the Hospital for Special Surgery (HSS), and Dr. Joel Press, Physiatrist-in-Chief at HSS—to explore their personal and professional journeys in medicine. Dr. Press shares how his diverse early experiences led him to physiatry, while Dr. Figgie recounts his balance between science, business, and a lifelong pursuit of education, including earning an MBA during his fellowship.

The conversation shifts into a discussion of mentorship at the Hospital for Special Surgery, where both physicians have played key roles in developing a cross-disciplinary mentorship model to support younger doctors. Their focus extends beyond clinical guidance to include career development, personal financial planning, and wellness—areas often overlooked in traditional medical training. This approach fosters institutional collaboration and a stronger culture at HSS.

Finally, the episode dives into physicians' relationships with industry. Dr. Figgie offers candid advice on contracts, intellectual property rights, and ethical considerations when working with device manufacturers. He emphasizes the importance of legal review and staying true to what benefits patients. Dr. Press adds insight into personal financial trust, suggesting that doctors build a "board of directors" for trusted guidance. The episode closes with a preview of future initiatives aimed at supporting physicians earlier in their careers through financial education and mentorship.

Key Insights:

• Dr. Press discovered physiatry through a unique summer program, showing the value of early exposure to diverse specialties.
  
  
• Dr. Figgie pursued an MBA during fellowship, believing in the power of financial literacy for physicians.
  
  
• Mentorship at HSS now includes financial, administrative, and personal development components—not just clinical.
  
  
• A cross-specialty mentorship program allows different departments (e.g., orthopedics and radiology) to learn from one another.
  
  
• Many young physicians lack basic financial planning tools, leading to under-preparedness later in their careers.
  
  
• HSS has created a repository of recorded educational sessions covering mortgages, insurance, investing, and more.
  
  
• Dr. Figgie cautions against blindly signing industry contracts without legal review, especially when IP is involved.
  
  
• Relationships with medical device companies often include consulting, design input, or teaching—but require transparency.
  
  
• Dr. Press emphasizes the importance of building a trusted "personal board of directors" to help with life and career decisions.
  
  
• Future initiatives at HSS may include subsidized financial checkups for new physicians to kickstart long-term planning.
  

Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!

In this second episode of a two-episode interview, host David Mandell continues his conversation with Corey Kleinschmidt, an industry veteran in the locum tenens space.

The episode kicks off with a recap of Part 1 and a reintroduction to Cory’s extensive background in the industry, including his work with Jackson Healthcare and his current role at Locumpedia. The focus then shifts to actionable steps for physicians considering locum—starting with educating themselves through resources like Locumpedia’s No BS Guide and connecting with other providers who’ve already taken the plunge.

Cory outlines the importance of understanding the business side of locums, emphasizing that physicians are essentially independent contractors. This means getting smart about taxes, possibly forming an LLC, and making strategic choices about which agencies to partner with. He explains how working with staffing firms can simplify everything from job placement to credentialing and malpractice coverage, while also highlighting the variability in agency models—some being high-touch and others more transactional.

Licensing and credentialing are also critical topics covered in this episode. Cory discusses the value of multi-state licensing and the Interstate Medical Licensure Compact (IMLC), as well as how staffing firms often assist in navigating these hurdles. The conversation wraps up with a look at contracts, pay structures, and what to expect in terms of housing, travel reimbursement, and malpractice coverage. David and Cory underscore the importance of doing your homework to ensure a successful and rewarding locum tenens experience.

KEY INSIGHTS:

1. The No BS Guide on Locumpedia is a comprehensive starting point for understanding locum tenens.
   
   
2. Locumpedia’s “Locum CME” news roundup keeps physicians up to date on trends, including how AI is shaping the field.
   
   
3. Talking to other physicians with locum experience can offer real-world insight into the pros and cons.
   
   
4. Most physicians working locums are classified as independent contractors and should understand how this affects taxes and benefits.
   
   
5. Many physicians form LLCs to optimize tax deductions and liability protection.
   
   
6. Staffing firms play a central role in matching physicians to opportunities and handling all non-clinical logistics.
   
   
7. There are over 200 locum tenens agencies, so it’s important to research and vet potential partners through reviews and referrals.
   
   
8. The Interstate Medical Licensure Compact (IMLC) can simplify multi-state licensing for qualified physicians.
   
   
9. Staffing firms often provide malpractice insurance, travel and housing—details that should be reviewed in the contract.
   
   
10. Contracts typically include compensation terms, responsibilities, reimbursement policies, and clauses like noncompetes and cancellation terms.

Learn more, including additional show notes, links, and detailed key takeaways, by visiting physicianswealthpodcast.com.

Click here to get your FREE copy of our latest book, Wealth Strategies for Today's Physician!