another vgh board failure: company not sold, page-4

Natnicnak,

ONT is fairly thinly trading despite its good numbers.

I am not sure how you control costs, as most medical practices generally run quite efficiently, particualrly the specialist ones. The recruitment of new docrtors is by buying practices that creates the massive debt problem they have. The major difference between ONT and VGH is debt $2.74M vs $100M.

For joining to be attractive, the benefits need to be substantial, otherwise it is not that hard to enter the market on your own, even for an ophthalmologist. A roll up needs to offer substantial efficiency advantages, but the reality is that such advantages may not be achievable.

The margins are too thin for the spoils to be spread to too many players and stakehoders in the company, unless it is run very well, creates a brand that is a "must be part of" or creates flexibility to move in and out of an an employee that is more productive and professionally satifying than doing it alone. Not sure how many of these VGH has achieved. Leveraging market referral advantages will get increaingly difficult and scrutinised.