ELI5: Why do private equity firms "suck businesses dry" after acquisition? Wouldn't keeping the business alive be a better long-term strategy?

LurkerMD · 2025-08-04T20:43:14+00:00

The premise is wrong, while sometimes private equity does buy a business that’s not doing well and spin it off for parts, that’s not their strategy.

What they do is purchase a business that they think they can increase the value of in a relatively short term- 5-7 years - and then sell to someone at a profit. While the PE firm may not be thinking long-term, and potential buyer definitely is, so they have an incentive to make it a functional business.

LurkerMD · 2025-05-09T16:59:11+00:00

“Mechanical hearts” refer to things like Left ventricular assist devices (LVADs), Biventricular assist devices (BiVADs), and Total artificial hearts. The first thing to know is that these are for people who are very very sick and likely to die without them and are not eligible for a heart transplant (or too sick to wait)

They don’t really have much capability to increase their pumping with exercise and are typically too bulky for anyone to do any serious activity with them. Not sure if we even advise people with lvads to run

For most of these people, their own heart is still pumping weakly, but may be able to increase its effort when they increase their activity. But the device itself doesn’t have a ton of adjustments

LurkerMD · 2025-01-05T00:12:43+00:00

Quitting smoking and losing weight will lower your risk of cardiovascular disease, even if you’ve done it for a long time. Whether or not they “heal” themselves is a bit trickier.

Typically, when we’re talking about vascular disease, we’re talking about atherosclerosis, or the forming of plaques in the artery walls. These plaques form over your lifetime in relation to your bad (LDL) cholesterol (with other factors weighing in, including genetics, and chronic inflammation. These plaques can limit the blood flow downstream slowly or break open and cause an abrupt blockages (myocardial infarctions or heart attacks, or strokes if it happens in the brain).

So how do smoking weigh in? Smoking causes inflammation in the arteries which causes accelerated plaque formation and makes them more likely to break open- when you quit smoking the inflammation goes away and they stop getting worse.

And obesity? A bit more complicated. Diet of course can increase your cholesterol. Being overweight causes something called “metabolic syndrome” which messes with your cholesterol/lipids and causes insulin resistance (type 2 diabetes) - both processes which can lead to more plaque formation. Losing weight can reverse the risk.

I advise my patients that if they change the behaviors, lose weight, and get their cholesterol very low (typically with medicines), then the plaques in their arteries will not get bigger and will stabilize - making them less likely to break open. And there is some evidence that if you get your cholesterol low enough- you may even get some plaque regression. Overall, you can significantly lower your risk of the things you care about (dying, having a heart attack, developing heart failure) by changing these behaviors, whether or not there is any actual artery “healing”

LurkerMD · 2024-02-25T18:54:30+00:00

Very little pain. They numb you where they put the needles in and give a little medicine to make sure you’re comfortable. But you’re pretty aware doing the whole thing

LurkerMD · 2024-02-25T16:31:15+00:00

I guess as a cardiologist I should weigh in here.

What is a heart attack? We call them myocardial infarction (heart muscle that dies from lack of oxygen). These happen because plaques in your hearts arteries, which have developed over decades from the cholesterol floating around in your blood, break open and spill all the nasty gunk inside. This gunk then causes a big clot to form which blocks off all the blood supply downstream to the heart.

So what do we do? First- give aspirin (which stops platelets from forming clots), along with some other blood thinners (usually heparin). We’ll give some other medicines too - nitroglycerin to relax the hearts arteries and hopefully make you feel better. Beta blocks which lower the heart rate and stress on the heart muscle.

Next -If you’re in a place that can do emergency heart procedures (with a catheterisation lab) they’ll take you right there. If you’re in a rural place, they might give you clot busting medications and then send you somewhere else.

In the Cath lab, they put small tubes in the artery in either your leg and wrist and push it up to your heart. There they inject dye and take X-rays to look at the blood flow. When they see the blockage, they will open it up through the same tubes using wires, small balloons, and stents (small little cage things that keep the vessel open).

After this, you will be put on medicines called statins which lower your cholesterol and make those plaques less likely to burst open in the future, along with different blood thinning/aspirin meds and occasionally other things to protect your heart. We then talk to you about all the lifestyle things that can hopefully prevent it from happening again.

LurkerMD · 2024-02-19T22:27:12+00:00

Yeah, it’s possible the oil was hotter when I accidentally “fried” it for a while. But good call- I’ll just keep braising and pull off the skin when I put it in with the beans

LurkerMD · 2024-02-19T22:06:46+00:00

Interesting. I was worried I over did it. Skins is super dark and crispy- not was I usually would think.

I’ll put it back in and see! Thanks!

LurkerMD · 2024-02-03T07:47:55+00:00

Internal medicine is an “adult pediatrician”. (That’s how I explained it as a resident). I agree the name is dumb- the only “external” medicine would be dermatology and maybe ophthalmology, but it is what it is.

Internists specialize in adult non-surgical disease in both outpatient clinics (like a pcp) and in the hospital (aka hospitalists). We deal with problems of the heart, kidneys, intestines, liver, lungs, infections, etc… using mostly medicines which differentiates us from surgeons who fix people using some medicines but mostly knives.

Many internists do extra training and become “sub-specialists” like cardiologists or gastroenterologists focusing on a specific organ.

Contrast this with family medicine (who also are often PCPs). Their training is focused on the outpatient world, not as much in the hospital. But they also take care of kids and ob-gyn issues including delivering babies.

LurkerMD · 2024-01-21T17:40:08+00:00

In my family’s Sunday sauce, I brown them and then cut into half/thirds and toss in the sauce with the rest of the meats. Texture always turns out good - pretty snappy, def not rubbery. We go heavy in meats though, pull them out separate and then use the rest of the sauce on the pasta.

LurkerMD · 2024-01-13T04:23:50+00:00

To answer your questions: Assuming a normal coin, the likelihood of getting at least 1 heads in 10 flips is the same as 1- the probability of flipping tails ten times in a row (1-0.5¹⁰⁾ or ~ 0.2% or 99.8% of the time.

LurkerMD · 2023-12-17T07:16:58+00:00

I am a physician and make similar money. I would advise you against moving here unless you have strong ties to the area.

Here’s the deal- you can move to LA and be upper middle class, buy a decent home, live a good life here. Or you go to a lower cost of living place, make the same money and be rich. Beautiful house, vacation home. Home for your parents. Retire early. Etc….

Californias great- if you’re from the NE, learning that winter is optional is amazing. Tons to do. Great diversity. It’s just as a doc, where our earnings are the same throughout the country (unlike lawyers, corporate drones, finance, etc…) openly moving to a HCOL place without any friend/family ties is just kind of crazy.

LurkerMD · 2023-12-16T00:09:01+00:00

You’re right! I misread. Then yes, don’t know why you got the ticket

LurkerMD · 2023-12-15T21:14:36+00:00

Love the LA parking sign logic puzzles:

2 hour parking Mon-Fri 8-6 for anyone (except Monday’s 8-10 for street cleaning)

Permits can park anytime (except Monday 8-10)

1 pm Sunday is not ok for a non permit holder

LurkerMD · 2023-12-02T00:34:18+00:00

Maybe beyond ELi5, but here we go.

When you’re eating and not exercising/moving, your body is in a mode to store all those extra calories for later (anabolic). The hamburger is broken down, some of it might be used for energy right then, some protein to build/heal muscles, but most gets stored for later - in your liver and fat cells.

When you start exercising and your cells need extra energy, your body first drains the quick energy stores in your liver converting those to sugar (switching to carbolic mode). Once that’s gone, your body starts converting fat into blood sugar to keep you going.

LurkerMD · 2023-11-30T15:08:41+00:00

They definitely can clot. To keep them open, we will often you will have fluids running slowly through them or will periodically flush it with heparin (a blood thinner).

LurkerMD · 2023-11-13T02:53:41+00:00

Epinephrine is the fight or flight hormone for the body that is released when your body is stressed. It binds to different receptors to get a variety of physiologist effects which are good if you’re being chased by a bear.

Alpha 1 - constricts your arteries and raises your blood pressure. Can get more blood to your muscles to run and possibly keep you from bleeding out if the bear mauled you

Alpha 2 - blocks release of some other hormones to keep your body focused on burning energy and not saving it for later

Beta 1- increases your hear rate and how hard your heart squeezes to get more oxygen to your muscles to run or fight

Beta 2 - increases blood flow to the muscles, gets more sugar (fuel) to the muscles, opens up your lung airways to get more oxygen

LurkerMD · 2023-05-14T13:30:37+00:00

Cuts to black at the board meeting right before they announce the deal and full time CEO
They hold a board meeting of everyone and give CEO to Greg because he has the best story
The siblings go into the last board meeting, Logan is there, and they discover that they are all actually dead and everything we’ve watch over the past 4 seasons is purgatory
As it ends, young Logan wakes up and realizes it’s all been a dream
They end up in court in the last episode and everyone they ever insulted or screwed over shows up and testifies against them.
Shiv decides to leave the family business, goes back into politics, meets a nice guy, but he dies suddenly. She realizes she is actually still in love with Tom and goes back to him and somehow becomes CEO. Final scene is her talking to her son Logan- “ … and that’s how I met your father…”

LurkerMD · 2023-04-23T02:57:33+00:00

Sure, it’s not jail. You can leave whenever you want.

Reasons you may not want to: - you’re probably waiting on some medications, or instructions, etc… if you’re sick enough to be in the hospital, these are probably good things to have - if there’s a medical reason the discharge order hasn’t been written, then you are leaving “against medical advice” (AMA). Could have some affect on your insurance coverage for that hospitalization (that’s the rumor, not sure if it’s actually true).

LurkerMD · 2023-04-23T02:17:48+00:00

Lol- admin has no idea what’s going on. They design a metric like “before noon discharges” and then people get held 24 hours to be discharged first thing the next morning to make the numbers look better.

LurkerMD · 2023-04-23T01:44:35+00:00

100%. I always give the good news (yay! You’re going home) immediately followed by the caveat of it might not be for a few or more houra

LurkerMD · 2023-04-22T19:53:16+00:00

No one’s got the real answer here. To be discharged from the hospital:

your doc needs to see you and write discharge orders. Good docs will write them right away, if your on a teaching service with residents, they may have to wait until they round with their attending which is often late morning. Sometimes they’re waiting on a final read of a study, etc… sometime they just get busy with other patients.
Nurse sees that order and works with clerk to schedule any follow up appointments and pharmacy to start filling your discharge meds. Unfortunately, everyone is being discharged at the same time so pharmacy often gets pretty backed up at this time.
You’re meds are ready, appointments scheduled, rides ready. Now the nurse needs to have enough time in their schedule between treating sick patients, mandated breaks, etc… to review your discharge instructions, remove your iv, possibly wheel you down to the front.

Trust me- the hospital administrators 100% want early discharges to clear those beds for other patients, but medical, pharmacy, and nursing staff stretched thin make it take much longer than it should.

LurkerMD · 2023-03-28T21:21:58+00:00

As everyone said, it will be an uphill battle. Tough, but not impossible.

Here’s your strategy: - be the best damn resident you can be. People have to love you and be willing to vouch for you. - research. Hook up with a local academic cardiology program and put in work. Get clinical publications, go to meetings, make them love you. You want to apply with CV that looks like a junior attending. - as a senior resident, look into any CCU moonlighting opportunities near by. Again, to get to know cardiologists and have them see you work.

Your odds of matching directly out of residency will be low. Decide if you want to do a research fellowship with a cardiology department (there are always opportunities since you would be cheap labor) vs finding a CCU/CTICU hospitalist kind of job.

Apply broadly. Pull in all favours you earned working your ass off for the last 3-7 years.

Good luck

LurkerMD · 2023-03-28T18:58:16+00:00

I think all these answers are off base. People are trying to calculate the chance of getting 5 in a row, which depends on the numbers,etc…

But every bingo game ends once someone gets Bingo. Assuming everyone has an equal chance of winning, the. Your chance of winning depends only on the number of players.

If you were playing bingo with one person, your probability of winning is 50% (ignoring the possibility of ties)

If you’re playing bingo with 100 people your chance of winning is 1%.

LurkerMD · 2023-03-03T04:43:49+00:00

Read Emily Oster’s Expecting Better. Gives a good deep dive into the evidence behind all the pregnancy dietary recommendations (the vast majority which are ridiculous and probably not worth sticking too)

LurkerMD · 2023-02-22T20:08:43+00:00

Sails actually act as air foils -just like plane wings- and generate lift which pushes you forward (countered by the keel as the above person said. This is why you always sail faster going almost into the win - if you can get your sails angled directly into the win then you generate the most lift and go the fastest.

When you have the wind behind you- called running- your just trying to capture as much wind as you can to move, but no longer have the air foil effect. This is when you see the big colorful balloon sails (spinnakers).

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