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October 2, 2024 18 mins

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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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron C Higgins (00:04):
Welcome to Beyond the Stethoscope Vital
Conversations with SHP.
As we take a summer break toprepare for Season 5, we're
revisiting some of our mostinsightful episodes.
In this episode, we dive intothe post-pandemic private
practice landscape with CraigKilgore, the CEO of Coastal
Vascular and Vein Center.
Ceo of Coastal Vascular andVein Center, craig shares with
us his extensive experience inIT, finance and executive

(00:31):
administration to explore thechallenges and opportunities
that face private practicestoday.
Craig discussed theconsolidation of payer
landscapes, shifting volumelevels and ongoing staffing
challenges.
He offers practical strategiesfor fostering growth, embracing
innovation and engagingphysicians and staff.
Additionally, craig highlightsthe benefits of owning property
and diversifying businessstrategies, while addressing

(00:52):
concerns about declininginterest in private practice and
staff retention.
If you liked this episode,please be sure to rate and share
the podcast in your favoritepodcast app.
It really helps us reach morelisteners.
Share the podcast in yourfavorite podcast app.
It really helps us reach morelisteners.

Jason Crosby (01:17):
Thank you for tuning in and let's dive into
this vital conversation withCraig Kilgore.
Kind of piggyback previouspoints, because you've hit on
this, the point of you've gotpayer consolidation.
You've got consolidation in theprivate practice market in
terms of going the employedroute, 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

(01:41):
were.
And then you get staffing,still a concern.
So you got these variables outthere that still present this
challenge to the group.
As you mentioned, you'vetransitioned recently from an
ENT to a vascular group, butstill a specialty private
practice setting that all eachexperienced those same variables
and challenges.
What sort of staffinginitiatives, way that you've

(02:04):
engaged your staff members orthe physicians to kind of keep
the morale, the culture in apositive, moving fashion,
whether it's a benefits thing ora team function or even a
strategic initiative that, guys,we need to keep this practice
moving forward and here's a kindof a strategic objective we're

(02:24):
going to work collectively toattain.

Craig Kilgore (02:27):
Well, it's kind of my opinion is that you know
people like to be part of anorganization that is moving
forward.
You know they don't like to bestuck in a stagnant organization
.
So I think you know, bydemonstrating that the, you know
the physicians are interestedin growing, interested in

(02:51):
innovation.
You know, like innovation,whether it's ancillaries, you
know growth, so you know that'sa big part of any practice
success.
Private practice success ismaking sure that you have, you
know, the appropriateancillaries and that you are,
you know, supporting themlegally.

(03:12):
You know, not illegal butappropriately, and that's always
the first thing.
But then, you know, actuallylooking at diversifying a little
bit.
So do they own their property,do they own their real estate.
That's a business strategy andso that was a very successful
one, you know, in my Charles andme and T days.

(03:35):
So you know it got to the pointwhere you know they now own all
their locations and even some,you know, commercial and even
some commercial properties.
So they went beyond just thepractice of real estate but into
commercial.
So that's a success story initself.
The vascular surgery group islooking to do similar things,

(04:01):
maybe not so much in thecommercial area but in the
practice-owned properties, andso they just recently completed,
before I joined, a new officewith an ambulatory surgery
center in Somerville.
It's a development calledNexton, and so I see those kind

(04:21):
of things as people like to bepart of something that has
purpose or something that'sgrowing.
And you know, a lot of times Iget it the risk associated with
growth to some physicians,depending on their career, their
stage in their career, are they?

(04:43):
within 10 years of retirement orare they at 40 and going to
work for another 20 plus years?
I mean, a lot of that impactstheir interest in growth and
expansion.
But that's what I like to do.
I don't like to have to sitbehind a desk and count nickels.

(05:03):
I like to be active and growingand it's been pretty successful
, I think over my career.
But I think if you look atother successful independent
groups, they've done the samething.

Jason Crosby (05:20):
Yeah, that's some great points.
What I gathered there, hearingyour response, was the practice
itself is one thing, but youdon't have to get timid with
growth because of the practice.
You still and in your caseyou've got an ASC potential to
grow via that path.
You've got real estate as apotential opportunity to help.

(05:42):
So looking at the totalfinancial overall picture is
more than just simply visits inyour practice.

Craig Kilgore (05:49):
Correct.

Jason Crosby (05:50):
Are you seeing that a lot more?
You're really active in theadministrator type networks, as
you mentioned, and yourexperience, what you're seeing
in South Carolina in particularAre you seeing that quite a bit.

Craig Kilgore (06:00):
It's kind of a mixed bag, you know.
It's kind of.
Again, I think a lot of it hasto do with the career cycle of
where physician owners are.
The big things are you have tohave a core group that's going
to support a growth plan.

(06:21):
But I would say yes, and Ithink it's actually, you know,
going to, you know, expand, youknow, because of the CON loss
that changed in South Carolinaand so, you know, we can now go
and open an ambulatory surgerycenter without having to go

(06:42):
through the regulatory CONprocess.
Now you still have thefinancial constraints.
You better, you know, get thoseserious concerns, but you have
to be able to, you know,demonstrate that you can meet
your debts.
But I think that most groupsare finding that they can, and

(07:02):
so, yeah, I think that's you'regonna see more of that in South
Carolina just because of theelimination of the CON laws.

Aaron C Higgins (07:13):
That sounds like a really positive change
for South Carolina.
And here in Georgia we stillhave CON laws.
There's a lot of discussionaround how should those change
or evolve or go away?
So it'll be interesting to seewith our neighbor to the north
how successful that's been foryou all, because I think our

(07:33):
markets are fairly similar in alot of our key cities.
So it'll be fascinating towatch and obviously that's, I
think, a positive thing.
So let's go negative.
Nelly, here for a second.
From your perspective, whereyou're sitting as CEO, what do
you feel like your challengesare going to be for the next I

(07:54):
don't know three, five, 10 years?

Craig Kilgore (07:57):
Yeah Well, we've already touched on staff, so
that's obviously going to be thenumber, probably the highest or
the greatest concern.
The other issue that we'reseeing and again I touched on a
little bit but the number ofphysicians actually coming out
wanting to go into privatepractice, and so we're already

(08:19):
seeing trends that you knowfewer and fewer want to be part
of a private practice, more andmore want to be in an employed
setting.
So it's going to really, youknow, limit the number of
physicians for the specialists.
More so I think it's very mucha factor for specialists, more

(08:43):
so than the primary care.
I just know in ENT, my recentexperience there's, I think,
maybe hold me to this number,but I think there's 350,.
You know fellows that come outannually and third of those are
looking to do a subspecialtyfellowship.

(09:05):
A third of those are looking todo go to work for somebody and
like a hospital system, and soyou basically have 120, you know
ENTs coming out that arepotentially looking at private
practice for the entire country.
So that's a real challenge.
I'm not sure of this vascularnumbers yet, but I don't think

(09:27):
they're that much different,maybe even fewer, because a lot
of the vascular surgery trainingprograms that are the more
technology advanced andinnovative ones are probably
fairly limited to.
So, yeah, it's going to be, youknow, staff and staff retention
and training.
And then it's going to beproviders physicians we have

(09:51):
plenty, I think we have enoughyour PAs coming out, nurse
practitioners and certainly, youknow, with their expansion of
their scope of practice, youknow, I think that's going to
meet the needs for a lot of theprimary care practices and
communities.
But you know this, specialistsare going to be really in high

(10:12):
demand and there's not enoughsupply coming out.

Aaron C Higgins (10:16):
Yeah, and I think you're right.
Coming from my own background,in private practice and in the
specialties I was in I was invascular and in cardiology we
couldn't replace our retiringproviders fast enough.
We would get someone fresh outof medical school with, you know
, half a million dollars inschool debt and, yeah, we

(10:40):
couldn't replace them fastenough because the difficulty
was they had so much debt theycouldn't go hang a shingle on
their own.
So it's certainly a challengeeverywhere.
So, in a happier ending sort ofquestion, looking back and even
looking forward here, wherewould you define success?

(11:01):
Where would, as a CEO and evenas a private practice, what does
success look like for you?

Craig Kilgore (11:07):
You know it's always been.
You know, my goal in workingwith physicians to see them, to
see their success, you know, forthem to, you know, thrive in
practice growth for them to, atleast you know, maintain a good
you know income and benefits,but also for them to have a good

(11:29):
quality of life, practice, agood balance, you know.
So it's things like that thatmake me happy.
You know, at the end of the dayit's not easy to obtain, but,
you know.
But I think that gives me thegreatest success.
And you know I wish I could getmore young folks interested in

(11:52):
private practice.
You know, because I think it'sbeen such a great career.
It is demanding and I'll saythat I mean unfortunately
there's way too many nightmeetings and stuff like that
because physicians are workingduring the day.
So it's not attractive to a lotof people.
But it is a very rewardingcareer and I think it's been.

(12:16):
I've enjoyed it.
You know I like what I do and Iwant to keep doing some of it.
I don't want know that I wantto do the day-to-day grind for
10 more years, but I certainlyenjoy the development and the
growth aspects.
That's what I really enjoy.

Jason Crosby (12:33):
Great feedback, craig, maybe to sort of you, you
know.
Wrap this loop back to ouroriginal question to and to
Aaron's last one to you.
So we're both located nearuniversities that have health
systems, universities that havehealth administration type
programs.
Speak to those that might belistening that you know you came

(12:53):
in through a different route,the IT and finance path.
You know a lot of these folksare getting the MHSAAs or maybe
the MBAs.
Speak to them, if you will,about okay, you're starting out,
you're in this new, challengingenvironment.
Here's a couple of littlenuggets from someone that's been
there, done that, as to how tohave a smooth entry into this.

Craig Kilgore (13:11):
Yeah, that's great.
That's great because at EMTthey actually do have an
internship program within USC,so they'll take two, three of
the students for a semester tocome and work.
And I'm not as close to thatObviously I'm not there now, but

(13:32):
still very familiar with whatthey were doing.
But the biggest thing is youhave to get.
You have to get your handsdirty, you know, and you have to
learn it.
You can't.
It's not like there isn't atextbook, you know, for practice
management.
You know there is there.
I say, say that, but you reallyyou got to get your hands dirty

(13:53):
.
You got to sit at the frontdesk.
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.

(14:13):
So is more geared to hospitaladministration than it is
private practice.
But I'm actually on a committee, advisory committee, you know,
with the USC, you know, to helpgive some exposure, you know, to
the private practice world.
So you know it's not foreverybody, again, you know, but

(14:36):
those that are ambitious and arewilling to put the effort, the
time and the commitment in itcan be extremely beneficial,
rewarding to them personally andfrom a career standpoint.

Jason Crosby (14:54):
Great recommendation.
I wish I could have asked youthat a couple of decades ago
myself.
You still got time.

Craig Kilgore (15:02):
Jason Come on.

Jason Crosby (15:03):
That's great feedback, craig, and with your
background, I think folks willdefinitely appreciate it.
And so well, we've asked a lot.
Strategically placed a UT hatright over his shoulder, and so

(15:24):
for those like myself in Georgiacountry, sec country, that's
the first thing you see.

Craig Kilgore (15:33):
It's all in good fun.
I love SEC football.
I love football, so love SECfootball, but kind of have a
passion for Tennessee Falls.

Jason Crosby (15:45):
Hey, there's nothing better than the fall,
Nothing better than a good fallSaturday in the south for
football.
So, yes, most certainly agreewith that.
Well, Craig, on behalf of Aaronand I, SHP, we really
appreciate your time.
This was great insight.
We'll be sure to include allthe information we can in our
show notes and we thank youagain.

Craig Kilgore (16:04):
Sure, I hope something was beneficial to
someone out there, so Iappreciate the opportunity.

Aaron C Higgins (16:10):
Yeah, thank you for coming, Craig Yep.

Jason Crosby (16:15):
You've been listening to Beyond the
Stethoscope Bottle Conversationswith SHB.
This has been a production ofStrategic Healthcare Partners.

Aaron C Higgins (16:23):
Your hosts are Jason Crosby and me, Aaron C
Higgins.
This episode was produced andedited by Nyle Weed.
Our social media contentproducer is Jeremy Miller.

Jason Crosby (16:35):
The transcriber is Heather McKnight and our
executive producers are MikeScribner and John.

Aaron C Higgins (16:39):
Curry For more information about SHP, the
services we offer, including theback library of episodes,
episode transcripts, links toresources that we discussed and
much more.
Please visit our website atshplccom slash podcasts.
Thank you for listening.
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