Letter: Comply with the cash on Arizona election audit

Bill Windsor, Sun City West

Hopefully readers of the Daily Independent took the time to read and review two recent articles in the July 30th issue. The first was “Trump supporters raise US $ 5.6 million for election exams”.

What’s interesting here is that Senate President Karen Fann first got the ball rolling by hiring Cyber ​​Ninjas, an unknown company with no experience or credentials and at the helm of an outspoken Trump supporter named Logan.

The price of $ 150,000 … what a bargain. In reality, you can’t buy rye ham without a drink for $ 150,000 in these circles. But Logan knew what he was doing. The ticket is now $ 5.6 million and growing. Not to say he (Logan) will get it all, but he will likely need help getting to the bank.

Well, in fairness, Karen Fann has invested many extra hours (beyond her duty as a Senator) in promoting this exam fraud, and it is only reasonable that she should receive a portion of the $ 5.6 million as a “finder’s reward.” “For recommending Cyber ​​Ninjas, a company recommended to her by someone whose name she” cannot remember. “

Apparently, the names of entities (or people) who donated to this fiasco are sacred and do not need to be disclosed for the purposes of the First Amendment.

If a topic is so important to me personally that I would make a donation, I would like to see my name in lights.

The point I want to get across here is to follow the money. I am sure the Daily Independent will keep us updated.

The second article reads, “The DOJ is issuing the strongest warning on election scrutiny yet.” This article discusses the efforts Fann and Attorney General Mark Brnovich (among others) are making to undermine the credibility of President Joe Biden’s election. The two (Karen and Mark) want to intimidate minority voters, then and now. So comes the 2022 election time, which will give your party an advantage.

Voting is a right, not a privilege.

This couple know their efforts are in vain, but they will persist in this farce to keep their names until the next election. Their intent is to rally the Trumpers (with Trump’s help) and keep their support through thick or thin. This couple are so evident in their pursuit of political power that, for lack of a better word, they are disgusting (yet entertaining nonetheless).

For these two, power is money and money is power.

To Counter Authoritarianism and Corruption in Central America, Observe the Cash

Während ihres jüngsten Besuchs in Guatemala warnte US-Vizepräsidentin Kamala Harris Migranten, „komm nicht“ – eine Botschaft, die vergeblich sein sollte. Viele Migrationstreiber sind nicht in der Hand der USA: Klimawandel, Ernährungsunsicherheit, Kriminalität und Korruption. Und obwohl Harris und US-Präsident Joe Biden angekündigt haben, dass sie ihre Bemühungen auf diese Ursachen angehen, frühere Bemühungen – insbesondere gegen Korruption – wurden von Regierungen in der Region vereitelt, die solche Bemühungen als existenzielle Bedrohung ansehen.

Während desselben Besuchs kündigte Harris auch eine neue Antikorruptions-Task Force des US-Justizministeriums (DOJ) für das Nördliche Dreieck an, das aus El Salvador, Guatemala und Honduras besteht. Aber in den letzten Jahren waren ihre Führer sehr beschäftigt Abbau jeglicher Institutionen die für Transparenz oder Kontrolle der Macht des Präsidenten sorgen können, einschließlich der Antikorruptionskommissionen aller drei Länder: der Internationalen Kommission gegen Straflosigkeit in Guatemala (CICIG), der Mission zur Unterstützung des Kampfes gegen Korruption und Straflosigkeit in Honduras und Anfang dieses Monats der Internationalen Kommission gegen Straflosigkeit in El Salvador (CICIES). Am Tag nach Harris’ Ankündigung kündigte der salvadorianische Präsident Nayib Bukele an, Bitcoin zu einem gesetzliches Zahlungsmittel, die Warnungen der Vereinigten Staaten und des Internationalen Währungsfonds (IWF) über eine mögliche Förderung von Geldwäsche und Steuerhinterziehung auslöst.

Während ihres jüngsten Besuchs in Guatemala warnte US-Vizepräsidentin Kamala Harris Migranten, „komm nicht“ – eine Botschaft, die vergeblich sein sollte. Viele Migrationstreiber sind nicht in der Hand der USA: Klimawandel, Ernährungsunsicherheit, Kriminalität und Korruption. Und obwohl Harris und US-Präsident Joe Biden angekündigt haben, dass sie ihre Bemühungen auf diese Ursachen angehen, frühere Bemühungen – insbesondere gegen Korruption – wurden von Regierungen in der Region vereitelt, die solche Bemühungen als existenzielle Bedrohung ansehen.

Während desselben Besuchs kündigte Harris auch eine neue Antikorruptions-Task Force des US-Justizministeriums (DOJ) für das Nördliche Dreieck an, das aus El Salvador, Guatemala und Honduras besteht. Aber in den letzten Jahren waren ihre Führer sehr beschäftigt Abbau jeglicher Institutionen die für Transparenz oder Kontrolle der Macht des Präsidenten sorgen können, einschließlich der Antikorruptionskommissionen aller drei Länder: der Internationalen Kommission gegen Straflosigkeit in Guatemala (CICIG), der Mission zur Unterstützung des Kampfes gegen Korruption und Straflosigkeit in Honduras und Anfang dieses Monats der Internationalen Kommission gegen Straflosigkeit in El Salvador (CICIES). Am Tag nach Harris’ Ankündigung kündigte der salvadorianische Präsident Nayib Bukele an, Bitcoin zu einem gesetzliches Zahlungsmittel, die Warnungen der Vereinigten Staaten und des Internationalen Währungsfonds (IWF) über eine mögliche Förderung von Geldwäsche und Steuerhinterziehung auslöst.

Jeder erfolgreiche Ansatz zum Nördlichen Dreieck muss zwei konvergierende Phänomene berücksichtigen: Die Vereinigten Staaten sind weniger hegemonial als früher, und die Region wird zunehmend autokratisch. Präsidenten konsolidieren ihre Macht in Partnerschaft mit kriminellen Elitenetzwerken, um sich von der öffentlichen Rechenschaftspflicht und dem Druck von außen abzuschotten.

Doch während diese Regierungen repressiver und korrupter werden, bleibt ihre Achillesferse – die Abhängigkeit vom globalen Geld – von ausländischen Regierungen, internationalen Finanzinstituten, Banken, Investoren und ihren eigenen im Ausland lebenden Bürgern. Und da Korruption weitgehend finanzieller Natur ist, erfordert ihre Bekämpfung die Einbeziehung dieser Akteure; Washington kann es nicht alleine schaffen, und Bidens Ansatz muss sowohl mutig als auch realistisch sein, was den Einfluss und die Grenzen der Vereinigten Staaten in der Region angeht. Zu diesem Zweck sollte er sich auf vier Bereiche konzentrieren: strafrechtliche Ermittlungen, gezielte Sanktionen, Kreditaufsicht und Rechenschaftspflicht in Handelsabkommen.

Staatsanwälte in den Vereinigten Staaten haben bereits strafrechtliche Ermittlungen gegen verschiedene staatliche und regierungsnahe Persönlichkeiten in der Region eingeleitet. Im Jahr 2019 wurde der honduranische Präsident Juan Orlando Hernández als a . bezeichnet Mitverschwörer in einem Fall von Drogenhandel durch die US-Staatsanwaltschaft für den südlichen Bezirk von New York. Dieses Jahr ein Gericht im Südbezirk verurteilt sein Bruder Tony Hernández, ein ehemaliger Kongressabgeordneter, dessen Initialen auf von ihm geschmuggelten Kokainpaketen gestempelt waren. Ihm wurde vorgeworfen, Einnahmen aus dem Drogenhandel verwendet zu haben, um den Präsidentschaftswahlkampf seines Bruders zu finanzieren.

An anderer Stelle haben sich ähnliche Muster herausgebildet. Bukele ist von zahlreichen Beamten und Personen mit angeblichen Verbindungen zu umgeben Alba Petroleos, eine Partnerschaft, die effektiv dazu dient, Gelder für PDVSA, Venezuelas staatliche Ölgesellschaft, die unter internationalen Sanktionen steht, zu waschen, und die Texis-Poster, ein weiterer Geldwäschering. In Guatemala wurden mehrere Beamte wegen Zollbetrugs und Verschwörungen genannt, darunter der ehemalige guatemaltekische Präsident Otto Pérez Molina. Regierungsbeamte in diesen Ländern, die versuchten, diese Verbindungen zu untersuchen, darunter der ehemalige Generalstaatsanwalt von Salvador, wurden entlassen und durch sympathischere Personen ersetzt. Journalisten, die nach Transparenz strebten, wurden eingeschüchtert und schikaniert. In diesem Jahr weigerte sich Guatemalas Kongress, einen bekannten Anti-Transplantations-Richter in das Verfassungsgericht zu setzen. Diese Razzien werden oft von US-Beamten öffentlich gerügt, aber sonst nicht viel.

Aber Geldwäsche und andere Finanzkriminalität gehen über die Grenzen hinaus, und Staatsanwälte in den Vereinigten Staaten und anderen Ländern sind nicht dem gleichen Druck ausgesetzt wie Diplomaten. Wie der Fall des DOJ gegen Hernandez zeigt, können strafrechtliche Ermittlungen solche Beamten zur Rechenschaft ziehen. Migranten nennen oft ihre eigenen Regierungen als Motive für die Ausreise; Der Nachweis, dass niemand über dem Gesetz steht, schreckt zukünftiges Fehlverhalten ab und schafft letztendlich das Vertrauen der Öffentlichkeit in die Institutionen.

Auch hier können multilaterale Gremien eine Schlüsselrolle spielen. Die Organisation Amerikanischer Staaten, die mit El Salvador zusammengearbeitet hatte, um CICIES zu gründen, bevor sie geschlossen wurde, könnte Informationen aus den von der Regierung unterdrückten Korruptionsuntersuchungen veröffentlichen, die Menschenrechtsgruppen namens dafür zu tun. Internationale und nichtstaatliche Organisationen können von Regierungen blockierte Ermittlungen fortsetzen und den Menschen direkt Transparenz bieten.

Auch die Biden-Administration kann mit gezielten Sanktionen eine klare abschreckende Botschaft aussenden. Die Regierung hat bereits Schritte unternommen, um Beamte mit bekannten kriminellen Verbindungen zu benennen. Eine Liste des US-Außenministeriums nennt unter anderem Bukeles Kabinettschef und ehemaliger Stabschef des guatemaltekischen Präsidenten Gustavo Adolfo Alejos. Diese Strategie des Namens und der Schande erfordert jedoch Beamte, denen Scham am Herzen liegt. Es muss auch direkte Konsequenzen haben. Weitreichende Sanktionen sind ein stumpfes Instrument, das für normale Bürger oft schädlich und gegen Regierungsbeamte wirkungslos ist, wie die Politik der Trump-Administration gegenüber Venezuela und dem Iran gezeigt hat. Es gibt jedoch gezieltere Sanktionen, die gegen Regierungsbeamte gerichtet werden können, insbesondere die Sanktionen des Global Magnitsky Act des US-Finanzministeriums, die ihre Konten einfrieren und Unternehmen davon abhalten, Geschäfte mit ihnen zu tätigen. Diese wurden auf saudische Beamte angewendet, die mit der brutalen Ermordung des Journalisten Jamal Khashoggi in Verbindung stehen. Infolge der Anwendung des Magnitsky Act kann das Financial Crimes Enforcement Network des Finanzministeriums auch Geldwäsche durch US-Banken untersuchen und Vermögenswerte beschlagnahmen, die in den Vereinigten Staaten von korrupten Beamten gehalten werden. Die Vereinigten Staaten können auch korrupten Beamten den Erhalt von Visa verbieten. Visa-Sanktionen scheinen keine harte Strafe zu sein, aber solche Instrumente werden effektiver, wenn sie mit den Beamten anderer Länder koordiniert werden, die sie möglicherweise besuchen müssen.

Wie andere Länder wissen, haben die Vereinigten Staaten einen beträchtlichen Einfluss auf internationale Kreditinstitute wie den IWF, die Weltbank und die Interamerikanische Entwicklungsbank. Diese Institutionen können weiterhin durchsetzbare Standards für finanzielle Transparenz und strenge Prüfungen als Bedingungen für Kredite an Länder in der Region in Zusammenarbeit mit den Vereinigten Staaten und anderen Kreditgebern verlangen.

Insbesondere die Bitcoin-Ankündigung von Bukele unterstreicht den Wunsch einiger Regierungen, sich vor der Kontrolle dieser Organisationen zu schützen. Doch El Salvadors Bezeichnung von Bitcoin als Währung gefährdet seinen Zugang zu Krediten, eine gefährliche Aussicht für ein Land, dessen Auslandsverschuldung sich 100 Prozent seines BIP nähert. Kryptowährung kann Geldwäsche und Umgehung von Sanktionen erleichtern, da Peer-to-Peer-Überweisungen nicht von Swift, dem globalen Nachrichtensystem für Banken, überwacht werden – eine Sorge, die bereits von US-Finanzministerin Janet Yellen geäußert wurde. Die ins Stocken geratenen Verhandlungen mit dem IWF über ein Darlehen in Höhe von 1 Milliarde US-Dollar spiegeln wahrscheinlich Bedenken des Fonds über die zukünftige Fähigkeit El Salvadors zur Bekämpfung von Steuerhinterziehung und die Möglichkeit von Zahlungsbilanzproblemen im Rahmen eines Bitcoin-Doppelwährungssystems wider. Um Geldwäsche zu verhindern, sollten die Vereinigten Staaten und internationale Finanzinstitute davon absehen, Gelder aus Bitcoin-Transaktionen als Zahlung für internationale Verpflichtungen der salvadorianischen Regierung anzunehmen und das Ausfallrisiko jeder Regierung berücksichtigen, die ihre Einnahmen auf den zukünftigen Wert der Kryptowährung setzt.

Beschaffungsbetrug ist eine weitere häufige Form der Korruption. Auch hier können Kreditinstitute eine Rolle spielen, um die Transplantation zu stoppen. Vor seiner Schließung hatte die Antikorruptionsbehörde von El Salvador den Missbrauch von Mitteln durch das Gesundheitsministerium beim Kauf von persönlicher Schutzausrüstung und Pandemiebedarf nach einem COVID-19-Notfalldarlehen des IWF untersucht. Kreditinstitute müssen eine strenge Aufsicht und schwerwiegende Konsequenzen für Steuerhinterziehung und Betrug aufrechterhalten, die einen direkten Druck auf Regierungen ausüben, die von Krediten abhängig sind, um ihre Haushaltsdefizite zu beseitigen.

Die Biden-Regierung kann durch ihren strategischen Ansatz für den Handel in der Region auch sofort gegen Korruption und antidemokratische Maßnahmen vorgehen. Im Gegensatz zu anderen Teilen Lateinamerikas, in denen sich die Vereinigten Staaten zurückgezogen haben, bleiben die Vereinigten Staaten in Mittelamerika der größte Handelspartner. Eine große Menge kommerzieller Aktivitäten, einschließlich 10 Milliarden US-Dollar in Exporte aus der Region in die Vereinigten Staaten, wird durch das Freihandelsabkommen Dominikanische Republik-Zentralamerika (CAFTA-DR) erleichtert. Die Überprüfung der Handelsbedingungen angesichts von Korruption und demokratischem Rückfall könnte große politische Auswirkungen in der Region haben.

Dafür gibt es Präzedenzfälle: In Nicaragua, haben die Vereinigten Staaten bereits auf die Verfolgung politischer Gegner und Wahlmanipulationen durch die Ortega-Regierung mit der Drohung reagiert, die Teilnahme des Landes an CAFTA-DR zu überprüfen. Handelsabkommen enthalten Bestimmungen zu Arbeitnehmerrechten und zur Unterstützung von Organisationen der Zivilgesellschaft, von denen einige von diesen Regierungen bedroht werden. Auch wenn diese Bedingungen in der Vergangenheit nur mangelhaft durchgesetzt wurden, ist dies keine Entschuldigung dafür, sie in Zukunft gleiten zu lassen, damit die Repression nicht mit Handelsprivilegien belohnt wird. Die Überprüfung bestehender Handelsabkommen ist ein unmittelbarer Schritt in Richtung Rechenschaftspflicht, die die Verwaltung übernehmen kann.

Handelsabkommen müssen auch US-Unternehmen zur Rechenschaft ziehen, indem Transparenzstandards innerhalb globaler Lieferketten gefordert werden und sichergestellt wird, dass Unternehmen nicht von Steuerhinterziehung, Bestechung oder Zollbetrug profitieren. Die Durchsetzung hoher Rechtsstaatlichkeitsstandards ist gut fürs Geschäft: Investoren und Handelspartner streben nach Vorhersehbarkeit und es ist nicht zu erwarten, dass sie auf Länder setzen, in denen die Regeln den Launen einzelner Führer unterliegen. Eine Überprüfung von CAFTA-DR könnte sowohl Korruption und Autoritarismus bekämpfen als auch die wirtschaftliche Gesundheit in der Region langfristig stärken.

Die Ursachen der Migration aus der Region liegen nicht zuletzt in der eigenen Geschichte der Vereinigten Staaten vor Ort, die oft autoritäre Regime stärkte und den Grundstein für die heutigen Machthaber legte. Aus historischen, kulturellen und Diaspora-Beziehungen sowie aus wirtschaftlichen Gründen behalten die Vereinigten Staaten einen enormen Einfluss in der Region. Sollte es versuchen, seine Schulden bei den Menschen in der Region zurückzuzahlen, wäre es ein guter Anfang, die Beamten, die von ihnen stehlen, zur Rechenschaft zu ziehen – und sich auf eine Politik zu konzentrieren, die das Leben in der Region für normale Bürger gerechter macht.

Observe the Cash – Right this moment’s Veterinary Enterprise

Is practice ownership right for you? If it’s time, consider three options.

Practice ownership only pays off financially and in other ways if you have the right practice at the right time and at the right price.

It’s 3 in the morning, cold, dark and rainy. I’m 3 or 4 years old and sitting in the backseat of my dad’s truck as he heads out to deliver another calf or fix another prolapsed uterus. Fast-forward a few years and dad has traded in the life of a mixed-animal practitioner to build a small-animal hospital. My new memories are filled with me running around the clinic, locking myself in cages, and playing with puppies and kittens. Another year or so goes by and dad grows the hospital to the point that he has time for “Ice Cream Thursdays” in the afternoon with me and my sister. He still works most Saturdays, but we are able to run our family’s cattle operation and, during the summers, load the camper and explore the country.

Not knowing any better, I assumed that all practice owners and their families enjoyed a similar lifestyle. I thought that veterinary medicine, while a passion, was just a career and that all practice owners built sustainable, profitable businesses that allowed them to enjoy the fruits of their labor.

Unfortunately, the more immersed I became in our profession, the more I realized that what I saw growing up was more of an outlier than the norm. Whether it’s practice owners I meet at conferences or veterinary students and friends interviewing for jobs and relaying their experiences, I’ve seen the other side of the coin. For many veterinarians, practice ownership means long, grueling hours of managing a business and its employees, a responsibility for which practitioners tend to receive minimal, if any, formal training. They pour their heart and soul into a hospital, only to find that when they’re ready to retire, their practice, because of years of poor financial management, isn’t the nest egg they expected.

Are You Ready?

For an article about practice ownership, I realize I’m off to a dismal start. I’m not doing the next generation of owners any favors. My point is that ownership is what you make it. It can be:

  • A gateway to practicing a level of medicine of which you are proud.
  • A step toward financial security.
  • A vehicle for the work-life balance of which you dream.

Alternatively, it can be the pursuit of a passion that drains you, burns you out and leaves you holding an empty bag at retirement.

Success, happiness and fulfillment come down to preparation and the decision to work on the business and not just in the business. The choice is yours.

Speaking to a group of Veterinary Business Management Association students, I asked why they were interested in practice ownership. Readers, please take a moment to reflect on where you are in your career, what you love about it and what you feel is lacking. If you don’t own a practice, think about what ownership could mean for you personally and professionally.

The VBMA students listed these reasons that practice ownership is appealing.

  • I can be in charge.
  • I can practice a certain level of medicine.
  • I can build my team and formulate a clinic culture.
  • I can enjoy the freedom that comes with successful practice ownership.
  • I can reap the financial rewards of successful practice ownership.

Most of the reasons are self-explanatory, but let’s examine the last one. I’ve rarely met anyone in our profession who got into it for the money, but that doesn’t mean money isn’t an important result. In other words, the financial reward of being a veterinarian might not be why we do what we do,  but it is often a tangible benefit.

Multiple Paydays

The 2018 Well-Managed Practice Benchmarks Study showed that practice owners earned almost 25% more than associate veterinarians and that an associate with six to 10 years of experience and earning a median income of $93,000 took home $213,611 less a year than a practice owner. Where does all the money come from? I love walking practice owners through an exercise to convey just this.

Start with this question: What do you get paid to do as an associate veterinarian? I’m not asking how you get paid — salary, ProSal, straight production or hourly — I’m asking what you get paid to do. The answer: You get paid to show up and practice medicine. When you’re not working, you’re not getting paid. When you retire, what happens to your paycheck? It stops the day you stop.

Now, think about a practicing hospital owner. How does she get paid? If she’s running a profitable business, she should be getting not only biweekly checks but several more. As a practice owner, you should be able to pay yourself through the following means:

  • Compensation for your role as a producing veterinarian. You’re on the payroll.
  • Compensation for your role as a manager. Even as a practice owner who loves management, I still employ a practice manager at each of my hospitals. I recommend leveraging a manager, but that doesn’t mean you as the owner shouldn’t receive a small cut of management compensation when you take an active role. From 3% to 5% of gross revenue should be shared with anyone involved in management. In my hospital, the manager usually gets 3% and my partner and I each take 1%.
  • A return on investment (ROI) check. In most cases, you’ll need to put money into the hospital. With any such investment, you should expect a return. Don’t confuse your production paycheck with your ROI. I target a 10% return on my investment each year under the rationale that the stock market, on average, returns about the same. I don’t go higher than 10% because I want to make sure I can reinvest in the hospital and offer profit-sharing to team members.
  • A rent check. If you own the real estate, I suggest that you create a legal entity to hold the real estate and another legal entity for your clinic. Your real estate company charges your clinic fair-market rent, just as if you were paying a landlord. Your real estate company then covers the mortgage. The spread between the mortgage and rent payments flows to you as the owner.
  • Equity in the practice and the real estate you own. When associates quit working, the money is gone. When the owners of a well-run hospital sell, they should receive a chunk of change for their equity.

How to Get Started

At this point, you’ve hopefully reflected on what practice ownership could mean for you. To those of you ready to take the next step, let’s blaze a trail.

I suggest to veterinary students, and say the same to experienced practitioners, that they consider these steps:

  • Determine your values, mission and vision (your North Star). If you don’t know where you’re going, the odds of getting there are slim.
  • Define your practice ownership goals. Take the SMART (specific, measurable, action-oriented, realistic, time-based) approach. Written goals help keep your eye on the ball.
  • Build and hone your business, leadership and communication skills. Jumping in without them will position you to miss many of the benefits of ownership.
  • Learn the economics of veterinary medicine. This is connected to the previous point, but I’m talking about interpreting financial statements, practice management information system reports and key performance indicators.
  • Assemble a network of advisers, such as a consultant, broker, attorney, practice valuator, lender and mentor. People in your network might tell you about a hospital that has not yet been listed publicly.
  • Study models of practice ownership and practice types. Identify what would best align with your values, mission and vision.

As you map a path to ownership, realize that there is no rule of thumb as to a right or wrong time to act. Some associates practice for five or 10 years before leaping. I’ve known a few who jumped into ownership the day they walked out of veterinary school.

Winding our way along the path to buying or starting a practice, let’s explore three options: the startup, the buy-in and the buyout.

The Startup

When many of my veterinary mentors graduated in the 1980s, the traditional path was to work for a couple of years and then create a startup. This remains a valid path. I’m in the middle of doing it myself, so I can speak about the positives and negatives from experience.Let’s begin by reviewing five advantages of a startup.

  1. You need a business plan. I put this in the advantage column because skipping or skimping on a business plan is easy when you’re buying an existing practice. You more than likely need one to get financing. When done right, a business plan will lay out concrete steps for success before you gamble hundreds of thousands of dollars or more.
  2. You pick the location. You’ll want to practice where the patient need and client demand warrant a new clinic. I’ve seen veterinarians choose a certain area because that’s where they wanted to live. Unfortunately, their failure to analyze demographic data came back to haunt them. In addition to studying the demographics, consider simple things like street visibility and parking. My clinic partner and I ran into this issue early in our startup journey. We loved several locations, but the parking was so limited that we worried about not having enough foot traffic. Ultimately, we chose a location that could support clients who walked or drove.
  3. Build what you want. I’ve toured a lot of beautiful, well-laid-out veterinary hospitals. I’ve also seen some that left a lot to be desired. One of the fun but time-consuming aspects of doing a startup is that you can lay it out as you want — a veterinary architect comes in handy — with the main limitations being money and space.
  4. Practice the way you want. When you buy out an owner, you’ve got staff and clients trained to do things a certain way. With a startup, the only limitations to how you practice are your knowledge, team and client demand.
  5. Get a clean start. Unlike buying an existing hospital, there is no staff culture to adjust, no bad reputation to mend and no outdated equipment to replace.

Now, here are some hurdles if you opt for a startup.

  1. Financing can be difficult to find. I’m not saying you can’t get a loan for a startup. My practice partner and I have several letters of approval sitting on our desks. However, I’ve found that not having an existing practice’s financial track record makes things more difficult when you approach a lender.
  2. You might not start as soon as you’d like. Two friends of mine pushed back their grand opening by a month because of unforeseen delays in the build-out of their mixed-animal hospital. Expect delays with contractors and leases. You’re setting yourself up for frustration if you don’t set a realistic timeline.
  3. Initial income is absent. Unlike buying an existing hospital and having its projected monthly revenue and expenses, with a startup you’ve got nothing but a business plan and financial expectations. It’s nerve-wracking when your financial success depends only on projections.
  4. It’s all on you. Depending on the size and type of startup, you might wear more hats than you ever thought possible — CEO, medical director, manager, receptionist. The list goes on. No one can do all these jobs well. You might have to do it for a while, but your saving grace lies in your ability to leverage your business plan and support network to eventually hire the team you need.

A startup can be a thrilling ride, but if you’re looking for something a little less risky, the next option might be for you.

The Buy-In

For the purpose of this article, when I write about a buy-in, I’m talking about acquiring a minority or majority stake in an existing hospital. You have at least one other partner. The appeals of a buy-in are:

  1. Less risk. Assuming you understand the clinic’s financials and you have partners with whom you share similar medical, leadership and management philosophies, a buy-in tends to be less risky.
  2. Your investment should pay for itself assuming you have the practice valued correctly. I am pretty good at determining the fair market value of a hospital, but I still hire an outside valuator just to be safe. I’ve seen veterinarians overpay by tens or hundreds of thousands of dollars after trying to save a little money on a valuation. Your investment should pay for itself through ROI checks. Of course, the return on investment and an increase in the value of your equity only happen if the practice is profitable and structured appropriately.
  3. You can be creative with the financing. When students or associates tell me they want to be an owner but don’t have the money, we talk about a buy-in. Bank financing aside, which can be a good option, I’ve had friends buy in to hospitals without money down or a loan. This can be accomplished through sweat equity or by forgoing the production component of your compensation.
  4. Mentorship. If you’re worried about not having the knowledge to run a hospital, buying in could allow you to be mentored by someone more experienced.

Here are the potential downsides of a buy-in.

  1. The process can be slow, from obtaining financing to working with attorneys on critical legal agreements.
  2. Until you own the majority, you’re not in charge. I’ve heard countless times about practice owners who tell a potential partner how excited he or she is to entertain fresh ideas and new protocols. Unfortunately, old habits die hard. Unless you are the majority owner or stipulate something in the operating agreement, you don’t get the final say.
  3. Beware the golden handcuffs. Imagine this: A veterinary practice owner is starting to think about his transition. He partners with you and commits to selling the clinic to you at some point. You buy in, the clients love you, the staff respects you and you’re a top producer. The primary owner, now able to work less, watches the money pour in and the value of his hospital grow. All of a sudden, he thinks that keeping you handcuffed to the hospital through a minority stake is better. The scenario doesn’t describe every practice owner but beware of the possibility. A side note: If you get fed up, decide to sell your share and jump ship, be mindful of any noncompete agreement you signed.

If embarking on a startup or buying into a hospital isn’t up your alley, consider the last option.

The Buyout

A buyout, also known as a turnkey deal, refers to purchasing an existing veterinary practice in its entirety. You could do this as the new sole owner or in partnership with someone. Here are the positives.

  1. It’s like the buy-in in that you’re buying something with a foundation. Even if you haven’t been working at the clinic and don’t know its culture and clientele, the financial documents and reports gathered during the due diligence should provide a fairly clear picture of what you’re buying. You’ll know about revenue, expenses, client trends, staff numbers and tenure, equipment, and facilities, to name a few.
  2. You’ll have instant income. Assuming the clinic forward-booked clients, you’ll have appointments on the schedule when you take over.
  3. The investment should pay for itself. (See “The Buy-In.”)
  4. You’ll have more autonomy. If you’re the sole owner, you make the decisions. You’re ultimately responsible for everything.
  5. Financing should be easier. Assuming that the practice has value and is priced fairly and that you’re not a financial risk yourself, banks should jump at the opportunity to help you achieve your dream.

As for the negatives, the market for veterinary practices is cut-throat. Three associate veterinarians who took jobs at clinics where the owners were committed to selling to them called me to report that the owners reneged and instead decided to sell to corporate consolidators. As a private practice owner, I know the difficulty of buying a hospital at fair market value when a corporation is ready to offer a price you can’t match.

Also, assuming you can land a hospital you want, know that investing in a buyout tends to cost more than when you buy in. Unless you’ve got a partner, you’re responsible for everything, so make sure you’ve got the money to cover the monthly mortgage payment.

Another potential risk of buying a hospital outright is client and staff turnover. If you’re like me, one of the reasons I love buying a hospital is for the challenge and reward of watching what happens when we improve the culture, quality of care and management. Unfortunately, if change happens too fast or is implemented incorrectly, you risk losing staff and clients. I’ve never seen an ownership transition where some of that doesn’t happen.

When to Partner

Regardless of your path to ownership, I encourage you to examine the value of partnering with a colleague. Just like practice ownership isn’t for everyone and everyone isn’t right for ownership, the same rings true with partnerships.

A mentor once told me that a partnership is like a marriage. I’ve found it to be true. When you approach a commitment like marriage, you’d be wise to explore shared values and philosophies. It’s the same way with a business partner. From medicine to management to communication, the conversations with a partner should occur before you sign on the dotted line. Getting into most partnerships is easier, friendlier and cheaper than getting out of one.

If you decide you can do more with a partner than alone, you will enjoy a host of benefits. These range from complementary strengths, shared responsibilities, shared financial risk and more upside potential in growing the hospital when two or more people are working not just in the business, but also on the business.

On the other hand, having the wrong partner is just as impactful. Working with a maverick, a control freak or someone who doesn’t value you and what you bring to the table will create a nightmare for everyone.

What’s Your Path?

Whether you choose to pursue a startup or purchase all or part of an existing practice, due diligence is paramount. Consider the practice team, the market, the local demographics and the hospital’s financial health. Practice ownership only pays off financially and in other ways if you have the right practice at the right time and at the right price.

Making an educated business decision and preparing for the demands of ownership can be among the most rewarding decisions you make professionally and personally. Practice ownership can deliver freedom, flexibility and fortune.

Stith Keiser  is the CEO of Blue Heron Consulting (bhcteam.com) and an adjunct faculty member at several veterinary schools. His passion for the veterinary profession extends into his role as managing partner in a handful of private hospitals. In his free time, Stith and his wife enjoy the outdoors with their dogs and horses.

LEARN MORE

Veterinary and non-veterinary resources abound for the aspiring and current practice owner. I recommend these books and websites:

  • “The E-Myth Veterinarian,” by Michael E. Gerber and Peter Weinstein
  • “101 Veterinary Practice Management Questions Answered,” by Amanda L. Donnelly
  • “If Disney Ran Your Hospital: 9½ Things You Would Do Differently,” by Fred Lee
  • “Good to Great,” by Jim Collins
  • “Built to Last,” by Jim Collins and Jerry Porras
  • “Start With Why: How Great Leaders Inspire Everyone to Take Action,” by Simon Sinek
  • “The Five Dysfunctions of a Team,” by Patrick Lencioni
  • “The Advantage,” by Patrick Lencioni
  • “21 Indispensable Qualities of a Leader,” by John C. Maxwell
  • “Rich Dad, Poor Dad,” by Robert Kiyosaki
  • AAHA Press Practice Ownership Series: bit.ly/3rsHKRz
  • Partners for Healthy Pets: bit.ly/3f2s6ZR
  • Catalyst Council: catalystcouncil.org
  • Society for Human Resource Management: shrm.org
  • Harvard Business Review: hbr.org

Observe the Cash

Next week, Gulfport voters from across the city will vote who sits on two council seats. We interviewed the candidates and wrote about many aspects of their campaigns and goals over the past few months. This week we reviewed each candidate’s most recent financial report.

A few notes on the following numbers: All data except the average donation includes money candidates who have either been donated or borrowed for their campaigns. We’ve rounded all numbers to the nearest dollar. For a full list of donors, the amount they donated, and other fiduciary information, see this story at thegabber.com. If you would like to see the original reports from the candidates, you can email the city clerk (ldemuth@mygulfport.us) to request them.

Christine Brown, Incumbent, Division 2

Christine Brown has been a member of the city council since 2013. She is her own treasurer and campaign manager.

Total raised: $ 3386

Gulfport Residential and Corporate Donations: US $ 2,886

Percentage of funds raised in Gulfport: 85%

Number of donors: 10

Number of donors from Gulfport: 8

Average donation: $ 191

Donations and Loans: $ 2586

In-kind (trade) donations: USD 800

Business donations: $ 500

Mike Bauer, challenger, station 2

Treasurer: Bill Oetting

Campaign Manager: Kate Bauer-Jones

Total raised: $ 3,214

Gulfport Residents and Businesses donations: $ 1,175

Percentage of funds raised in Gulfport: 37%

Number of donors: 46

Number of Gulfport donors: 16

Average donation: $ 67

Donations and Loans: $ 3,160

In-kind (commercial) donations: USD 54

Corporate Donations: $ 54

Michael Fridovich, incumbent, District 2

Michael Fridovich has been a member of the city council since 2013. He’s his own treasurer. Barry Edwards acts as his campaign manager.

Treasurer: Myself

Campaign Manager: Barry Edwards

Total raised: $ 3,120

Gulfport Residents and Businesses donations: US $ 1,290

Percentage of funds raised in Gulfport: 41%

Number of donors: 25

Number of Gulfport donors: 11

Average Donation: $ 113

Donations and Loans: $ 3,020

In-kind (commercial) donations: USD 100

Business donations: 0

Richard Fried, Challenger, Division 2

Richard Fried does not list a treasurer or campaign manager for his campaign, which is entirely self-funded.

Treasurer: None listed

Campaign Manager: None listed

Total collected: $ 2,454

Donations from Gulfport Residents and Businesses: 0

Percentage of money raised in Gulfport: 100%

Number of donors: 1 (self-financed campaign)

Number of Gulfport donors: 1 (self-funded campaign)

Average donation: 0

Donations and Loans: $ 2,454

Donations in kind (trade donations): 0

Corporate donations: 0

Ian O’Hara, Challenger, Division 4

Treasurer: David Hastings

Campaign Manager: By Committee

Total raised: $ 3808

Gulfport Residents and Businesses donations: $ 3,693

Percentage of funds raised in Gulfport: 95%

Number of donors: 39

Number of donors from Gulfport: 37

Average Donation: $ 69.40

Donations and Loans: $ 2607

In-kind (trade) donations: USD 202

Corporate Donations: $ 148

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Comply with the cash – Instances-Herald

Follow the money

A letter writer recently published by the Times-Herald asked about the dredging of the Vallejo boat ramp, possibly with a loan from the Department of Boating and Waterways. I have been a boater for a long time and have written a lot of letters on the opinion page.

I refer you to the Times-Herald article of December 7, 2001. It noted and described the inadequate dredging that a company was unable to complete on time. After reading their article and using my own eyes, I described numerous reasons why the company was unsuccessful.

There were many letters about the marina and a $ 15 million loan taken out by the Department of Boating – which the city of Vallejo was unable to repay. As time passed and the city went bankrupt, the city refinanced – for a total of $ 17 million. See the letter to the editor dated March 13, 2013.

We come to the date of June 13, 2011. A letter entitled “Pretty Enough To Investigate” has been published. The city’s decision to enlarge the marina by building new docks on the south side of the old marina was flawed. The plan was to ask all of the old harbor residents to move to the new docks, but the old residents didn’t want to move and pay the higher berth rent. The old docks were only about half full and the new docks did not fill as planned. Over time, the city has never dredged the old part of the marina and silted up the old marina – purposely left out of the necessary dredging.

An article dated Jan. 6, 2002 stated that the city had repaid the overdue loan of $ 14.3 million and that the city refinanced the loan and now owed $ 17 million.

I ask and it was never answered why all this misinformation came from the city administrators. Now someone wants the city to contact the Department of Boating and Waterways for a new loan. Hah!

I don’t think the city ever repaid the original loan and to this day I still don’t know the status of that loan. I read in this newspaper that the town went bankrupt and I don’t think the loan has ever been paid – the new marina was never more than half full and was barely able to pay the interest on that loan.

As in the movie “All the President’s Men,” which advises “Follow the Money,” I would think someone should follow the money. Don’t ask for more money.

– Joseph H. Balocca / Vallejo

Vaccination charges comply with the cash in states with large wealth gaps

T.The affluent town of Woodbridge, Connecticut, has less than half the population of neighboring Ansonia, yet it has more people who received a Covid-19 vaccine. The inequality is grave: In Woodbridge, where residents have an average household income of $ 138,320 a year, 19.3% of the population had been vaccinated on February 4, according to the Connecticut Department of Health. In Ansonia, where the median income is $ 45,563 per year, only 7.1% received their first shot.

According to a STAT analysis of vaccine data at the local level in 10 states, Connecticut has the biggest differences in vaccination rates between the richest and poorest communities – a 65% difference the largest wealth gaps. Four other states – California, Florida, New Jersey, and Mississippi – also have significantly higher proportions of people vaccinated in the richest 10% of counties.

The discrepancies vary: in California, residents in the richest areas received 156 shots for every 100 vaccines in the poorest counties, while in Mississippi, residents in the richest counties received 111 vaccinations for every 100 doses in the poorest areas.

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In Washington, DC, the two richest communities have vaccination rates more than double that of the two least affluent ones.

Findings back up hard data on individual reports from across the country that wealthy people were given access to vaccines before those on low incomes. “We are seeing individuals with privileges and access who displace the people who don’t,” said Tekisha Dwan Everette, executive director of Health Equity Solutions in Connecticut and a member of the state governor’s Covid-19 advisory group.

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However, the analysis also shows that some states seem to distribute vaccines more fairly than others. Among the states with the greatest wealth gaps, Texas, Tennessee, New Mexico, Pennsylvania, and Illinois showed no significant income differences in county-level vaccination rates. The analysis excluded states, including Georgia, Louisiana, and Massachusetts, that do not publicly share data on county-level vaccine recipients.

However, because counties can contain different population groups, the analysis is not a definitive indicator of equity. Several experts said they expected more accurate data to reveal inequalities in wealth even in states with fair data at the county level. Racial differences were still evident in some of these states.

Olivia Goldhill / STAT
Sources: State and Washington, DC, Health Departments

Any loophole in vaccinating the rich against the poor inevitably exacerbates racial segregation. Blacks and Latinos are much more likely to live in poverty than white people, and although they died more frequently during the pandemic, they get fewer vaccines than white people.

The data suggests that in some states, the first wave of vaccinations benefited the rich. “There are really two Connecticuts. We as a state need to focus more on that, ”said Tiffany Donelson, executive director of the Connecticut Health Foundation.

Inequality was a feature of the pandemic from the start, Everette said, citing Covid-19 testing sites that were more accessible to wealthier populations. “Instead of learning from this lesson, let’s recreate the privilege,” she said.

It is not enough just to find vaccination sites in different areas with lower incomes: “People travel outside their own geographic area to get vaccinated elsewhere,” she said.

Similar problems have been observed in California. “We’ve heard these stories from people in LA going to Compton or any other part where there are other locations,” said Anthony Wright, executive director of Health Access California.

Government action can help eliminate inequalities. According to Imelda Garcia, chair of the Texas Expert Vaccine Allocation Panel, vaccination centers in Texas need to put aside some of the vaccines for vulnerable communities, work with local leaders, and distribute the vaccine in racially diverse areas. In contrast, California counts are expected to focus on justice, but there are no special requirements, said Darrel Ng, spokesman for California’s Covid-19 Vaccine Task Force.

But the introduction of vaccines in Texas, while not reflecting income inequality, has disproportionately helped the white population State data Show. Racial data has not been recorded for all vaccinations, Garcia said, and more data collection could reveal a fairer distribution: “The data does not reflect what is happening. I can say that the data is missing. “

Similar concerns about lack of data apply to the county-level analysis, as several states with the greatest differences have not published this information. Tracking and sharing this data is one way to improve gender equality, said Julie Swann, director of industrial and systems engineering at North Carolina State University. “When we start measuring who they are reaching in terms of race, ethnicity, or income, they will do the extra things it takes to reach everyone.”

The rush to vaccinate people as quickly as possible may have curtailed equity in the first phase of the rollout. “[States] feared they would lose their allocation if they didn’t move quickly, ”said Swann. “Everyone freaked out.”

Up until now, vaccine distribution has mainly focused on healthcare workers and those over 75. “Justice is our north star for vaccine distribution. When the state launches its new vaccine distribution network, we can target our disproportionate vaccination efforts more precisely to affected communities, “said California’s Ng.

However, the lack of equality for health workers in the first phase also indicates disadvantages that poor communities face. In areas with a shortage of hospitals, which are often poorer rural areas, fewer people are vaccinated. California’s Central Valley, for example, has a far less robust healthcare system than Silicon Valley.

“Those areas that have more health infrastructure and workers, by definition, have received more vaccine,” said Wright of Health Access California.

Health Department spokeswoman Maura Fitzgerald said Connecticut is taking several steps to address vaccine inequality. This includes providing vaccines to people in vulnerable communities and setting up a vaccine phone line for residents without internet.

In New Jersey – where STAT found vaccination rates 28% higher in the richest counties – the health department is working with partners such as places of worship and senior centers to provide education and access to vaccines through mobile clinics and possibly door-to-door vaccinations in areas severely affected by Covid-19, said Ministry of Health spokeswoman Donna Leusner. Washington, DC, has partnered with hospitals, community health centers, and other organizations to achieve justice, a health department spokesman wrote, and approximately 20% to 30% of vaccine supplies are aimed at diverse populations, including homeless shelters and faith-based initiatives.

Meanwhile, Mississippi Department of Health spokeswoman Liz Sharlot said the state is working with black pastors, historically black colleges and universities, and prominent African American doctors to eradicate inequality. And Florida – where the vaccination rate is 23.6% higher in the richest counties – is partnering with places of worship and other locations in underserved communities where the vaccine can be given, a health agency spokesman said. Florida vaccine allocation per county is based on population age 65 and over.

While the elderly are more prone to Covid-19, the distribution of vaccines by age can lead to inequalities. In Connecticut, northeast Hartford has a life expectancy of 68.9 years compared to 84.6 years at West Hartford Center, so a smaller proportion of its residents have been eligible for vaccination. The state only opened vaccinations for 65 to 75 year olds this week. “You are missing a significant portion of the population in Hartford,” said Donelson of the Connecticut Health Foundation.

Online reservation systems have also contributed to the differences. A vaccine distribution system that sets appointments for those who can book them fastest inevitably rewards those with the time and connections. People often have to call around five different health centers to get on a vaccination schedule, said Georges Benjamin, executive director of the American Public Health Association. “It tells you a lot about the lack of planning,” he said.

Online booking systems require a computer, WiFi, and the ability to navigate a complicated system, Wright said. Richer people can more easily take time off and have easier access to the means of transport that need to be vaccinated.

“People who are richer will be more involved in the vaccination rollout,” he said. “It shows how much more we need to do to put in proactive efforts to reach out to the most vulnerable.”

STAT methodology

STAT examined discrepancies in 10 countries with the highest wealth gap. measured by the Gini coefficient, which provided district-level or equivalent local data on population vaccination rates.

For each state, we looked at vaccine distribution rates in the richest 10% and the poorest 10% of the counties. We used federal data for most of the states median household income. In Connecticut, we used vaccine dates and median household income for cities and municipalities. And we analyzed that median household income and vaccination rates for each station in Washington, DC In New Jersey, which has 22 wards, we compared the three richest and poorest counties.

STAT used vaccination rates published on the local Department of Health websites February 6-10. Connecticut, Florida, and New Jersey indicated the percentage of residents who received their first doses; Mississippi provided vaccination doses are administered by the district; California provided vaccine doses are given per 10,000 population; Washington, DC provided the number of residents has been fully vaccinated by the station.