Mastering Private Practice in a Post-Pandemic World: Insights & Strategies from Coastal Vascular and Vein Center's CEO Craig Kilgore Part 2

What happens when you mix the expertise of Coastal Vascular and Vein Center's CEO Craig Kilgore with the turbulence of the post-pandemic private practice landscape? You get a dynamic and insightful exploration of the challenges and opportunities facing private practices in this transformative era. From the consolidation of payer landscapes to the evolution of volume levels, and the constant struggle with staffing, Craig offers his perspective, grounded in his extensive experience across IT, finance, and executive administration. 

Craig goes beyond just identifying the problems: he offers tangible strategies for fostering growth, harnessing innovation, and engaging physicians and staff within a practice. Drawing from his own experience, he outlines the merits of owning property and diversifying business strategies to build a resilient and successful private practice. But it's not all rosy – Craig also shares his concerns about the declining interest among physicians in private practice and the ongoing struggle with staff retention. This episode is more than a conversation; it's a masterclass in navigating the choppy waters of private practice in a post-pandemic world. So, ready to get some invaluable insights? Of course, you are! Let the conversation begin.

Craig M. Kilgore, CEO - Coastal Vascular & Vein Center
(e) craig.kilgore@coastalvvc.com
(p) 843-577-4551

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Transcript

Aaron Higgins: 0:49

Welcome back to Beyond the Stethoscope Vital Conversations with SHP. I'm Aaron Higgins. On today's episode, Jason Crosby and I finish our interview with Craig Kilgore about the challenges facing private practices in a post-pandemic world. As he pulls out his crystal bald appear into the future of what he expects for the private practice scene. If you recall, Craig is the CEO of Coastal Vascular and Vein Center in Charleston, south Carolina. Craig has served in IT, finance and in administrative executive roles. Are you ready for this vital conversation? Let's get started.

Jason Crosby: 1:27

Kind of picking back previous points, because you've hit on this, the point of you've got payer consolidation, you've got consolidation in the private practice market in terms of going the employed route, in particular because of COVID in these last few years, and then volume slowly trickling back to some levels that are, you know, back to where they were. And then you've got staffing, still a concern. So you've got these variables out there that still present this challenge to the group. As you mentioned, you've transitioned recently from an ENT to a vascular group, but still a specialty private practice setting that all each experienced those same variables and challenges. What sort of staffing initiatives, way that you've engaged your staff members or the physicians to kind of keep them around the culture, you know, in a positive, moving fashion, whether it's a, you know, benefits thing or a team function or even a strategic initiative that, guys, we need to keep this practice moving forward, and here's a kind of a strategic objective we're going to work collectively to attain.

Craig Kilgore: 2:36

Well, it's kind of my opinion is that you know people like to be part of an organization that is moving forward. Yeah, they don't like to be stuck in a stagnant organization. So I think you know, by demonstrating that the, you know the physicians, are interested in growing, interested in innovation, you know, like innovation, whether it's an slurries, you know growth, so you know that's a big part of any practice success. Private practice success is is making sure that you have, you know, the appropriate ancillaries and that you are, you know, supported them legally. You know, not the illegal, but appropriately, and that's always the first thing. But then you know, actually looking at diversifying a little bit. So do they own their property, do they own their real estate? That's a business strategy and so that was a very successful one. So, you know, got to the point where you know they now own all their locations and even some, you know commercial, you know property, so they went beyond you know just the practice of real estate but into commercial. So that's a success story in itself. The vascular surgery group is looking to do similar things, maybe not so much in the commercial area but in the practice. You know, owned properties and so they just recently completed, before I joined, a new office with the name of a Tories surgery center in Summerville.

Craig Kilgore: 4:27

It's called development, called next, and so I see those kind of things as, as you know, people like to be part of something that has purpose or just something that's growing. And you know, a lot of times I get it. The risk associated with growth to some physicians, depending on their career, their stage in their career, you know, are they, you know, within 10 years of retirement or they, you know, 40 and going to work for another 20 plus years. I mean, a lot of that impacts their interest in growth and expansion. But that's what I like to do. You know I don't like to have to sit behind a desk and count nickels. You know I like to, you know, be active and growing and it and it's been pretty successful, I think, you know over the over my career. But if I think, if you look at other successful independent groups, you know they've done the same thing.

Jason Crosby: 5:29

Yeah, that's some great points. What I gathered there in your response was the practice itself is one thing, but you don't have to get timid with growth because of the practice you still and in your case you've got an ASC potential to grow via that path. You've got real estate as a potential opportunity to help. So looking at the total financial overall picture is more than the simply visits in your practice.

Craig Kilgore: 5:59

Right.

Jason Crosby: 5:59

Are you seeing that a lot more? You're really active in the administrator type networks, as you mentioned, and your experience, what you're seeing in South Carolina in particular Are you seeing that quite a bit.

Craig Kilgore: 6:10

It's kind of a mixed, a mixed back. You know it's kind of. Again, I think a lot of it has to do with the career cycle. You know where physician owners are. Yeah, the big things are you have to have a core group that's going to support a growth plan. But I would say yes, and I think it's actually going to expand because of the CON laws. That changes South Carolina and so, you know, we can now go and open an ambulatory surgery center without having to go through the regulatory CON process. Now you still have the financial constraints. You better, you know, give those serious concerns, but you have to be able to, you know, demonstrate that you can meet your debts. But I think that most groups are finding that they can, and so, yeah, I think that's you're going to see more of that in South Carolina just because of the elimination of the CON laws.

Aaron Higgins: 7:22

That sounds like a really positive change for South Carolina. And here in Georgia we still have CON laws. There's a lot of discussion around how should those change or evolve or go away? So it'll be interesting to see with our neighbor to the north how successful that's been for you all, because I think our markets are fairly similar in a lot of our key cities. So it'll be fascinating to watch and obviously that's a, I think, a positive thing. So let's go negative. Nellie, here for a second. From your perspective, where you're sitting as CEO, what do you feel like your challenges are going to be for the next I don't know three, five, 10 years?

Craig Kilgore: 8:06

Yeah, well, we've already touched on staff, so that's obviously going to be the number, probably the highest or the greatest concern.

Craig Kilgore: 8:17

The other issue. You know that we're seeing again a touched on a little bit, but you know, the number of physicians actually coming out wanting to go into private practice, and so you know we're already seeing trends that you know fewer and fewer want to be part of a private practice, more and more want to be in a Employed setting. So it's going to really, you know, limit the number of physicians for the specialists more so, I think. I think it's very much a factor you know, for specialists, more so than a primary care. I just know in my recent experience there's, I think, don't hold me to this number, but I think there's 350, you know, fellows that come out annually and a third of those you are looking to do a subspecialty fellowship, a third of those are looking to do Go to work for somebody and like a hospital system, and so you basically have 120 ent docs coming out that are potentially looking at private practice for the entire country. So it's real challenge.

Craig Kilgore: 9:33

I'm not sure this vascular numbers yet, but I don't think they're that much different, maybe even fewer. You know, because a lot of the the vascular surgery training programs that are, you know, the more technology, advanced and innovative ones are probably fairly limited to. So, yeah, it's going to be, you know, staff and staff retention and training, and then it's going to be providers physicians we have plenty, I think we have enough. You know, pa is coming out, nurse practitioners and certainly, you know, with their expansion of their scope of practice, you know, I think that's going to meet the needs for a lot of the primary care Practices and communities. But you know this specialist are going to be really in High demand and there's not enough slack about.

Aaron Higgins: 10:25

Yeah, and and I think you're right it coming from my own background and private practice and in the specialties I Was in I was in vascular and in cardiology it we couldn't replace our retiring providers fast enough. We would get someone fresh out of medical school with, you know, half a million dollars in In school debt. Yeah, we couldn't. We can replace them fast enough because that the difficulty was is they had so much debt they couldn't go hang a shingle on the on their own. So it's certainly a challenge everywhere. So, in a happier ending sort of question, looking back and even looking forward here, where would you define success? Where would, as a CEO and even as a private practice, what does success look like for you?

Craig Kilgore: 11:17

It's always been my goal in working with physicians to see their success, for them to thrive in practice growth, for them to at least maintain a good income and benefits, but also for them to have a good quality of life practice, a good balance. It's things like that that make me happy the other day. It's not easy to obtain, but I think that gives me the greatest success. I wish I could get more young folks interested in private practice because I think it's been such a great career. It is demanding and I'll say that I mean. Unfortunately there's way too many night meetings and stuff like that because physicians are working during the day, so it's not attractive to a lot of people. But it is a very rewarding career and I think it's been. I've enjoyed it. I like what I do and I want to keep doing some of it. I don't want to know that I want to do the day-to-day grind for 10 more years, but I certainly enjoy the development and the growth aspects. That's what I really enjoy.

Jason Crosby: 12:42

Great feedback, craig. Maybe to wrap this loop back to our original question and to Aaron's last one to you. We're both located in areas that have a university and health systems, universities that have health administration-type programs. Speak to those that might be listening that you came in through a different route, the IT and finance path. A lot of these folks are getting the MHSAs or maybe the MBAs. Speak to them, if you will, about okay, you're starting out. You're in this new, challenging environment. Here's a couple of little nuggets from someone that's been there, done that, as to how to have a smooth entry into the city.

Craig Kilgore: 13:21

Yeah, that's great. That's great because we at ENT they actually do have an internship program within USC. They'll take two, three of the students for a semester to come and work. I'm not as close to that, obviously I'm not there now, but still very familiar with what they were doing. But the biggest thing is you have to get your hands dirty. You have to learn it.

Craig Kilgore: 13:52

It's not like there isn't a textbook for practice management. I say that, but really you got to get your hands dirty. You got to sit at the front desk, you got to schedule a patient, you have to do demographics, you have to watch the revenue cycle, you have to understand the regulatory side. I know a lot of their training rightfully so is more geared to hospital administration than it is private practice. But I'm actually on a committee, advisory committee, with the USC to help give some exposure to the private practice world. So it's not for everybody again, but that is that are ambitious and are willing to put the effort, the time and the commitment in it can be extremely beneficial, rewarding to them personally and from a career standpoint.

Jason Crosby: 15:04

Great recommendation. I wish I could have asked you that a couple of decades ago myself.

Craig Kilgore: 15:10

You still got time, jason, come on.

Jason Crosby: 15:12

That's great feedback, craig, and with your background, I think folks will definitely appreciate it. So we've asked a lot of questions, we've gotten some great input and I do want to make folks aware that you may not be able to see this, but Craig, as he put it, strategically placed a UT hat right over your shoulder. So for those like myself in Georgia country, sec country, that's the first thing you see.

Craig Kilgore: 15:43

It's all in good fun. I love SEC football, so love SEC football, but kind of have a passion for Tennessee Falls.

Jason Crosby: 15:55

Hey, it's nothing better than the fall, nothing better than a good fall Saturday in the south for football. So, yes, most certainly agree with that. Well, craig, I'm half Aaron and I SHP. Really appreciate your time. This is great insight. We'll be sure to include all the information we can in our show notes and we thank you again.

Craig Kilgore: 16:14

Sure, something was beneficial to someone out there, so I appreciate the opportunity.

Aaron Higgins: 16:20

Yeah, thank you for coming Craig.

Jason Crosby: 16:25

You've been listening to Beyond the Stethes cope, Vital Conversations with SHP. This has been a production of strategic health care partners.

Aaron Higgins: 16:33

Your hosts are Jason Crosby and me, Aaron C Higgins. This episode was produced and edited by Nyla Wiebe. Our social media content producer is Jeremy Miller.

Jason Crosby: 16:44

The transcribers are myself, and our executive producers are Mike Scribner and John Crew.

Aaron Higgins: 16:49

For more information about SHP, the services we offer, including the back library of episodes, also transcripts, links to resources that we discussed and much more, please visit our website at shpllc. com slash podcast. Thank you for listening.