We've been getting a lot of questions on whether or not 2023 will be a good year to open a practice. The answer is, as it often is, it depends. In this episode, Scott McDonald goes through what signs to look for in a particular area to know if it is good time or not for that location.

I had a little BrainStorm Session with my Demographic Colleagues about the Mid-Term Election. Most of us came to the same General Observations. One of the big takeaways is that experts should really be cautious about claiming to know a great deal about the future of demographics in the U.S., we just don't have all the answers we thought we had. That does not sound hopeful, but it is true.

These very smart people noted that there were certain trends in current demographics that they would like to ignore. That is what this session is about. The decline in the birthrate is especially important in our discussions. It seems strange that the mainstream media is ignoring the recent changes in the job market. The housing market, especially in the single-family, owner-occupied sector is largely ignored in the national media. We assume this is due to the fact that these reporters are not living in these communities. They are not concerned with consumer debt because they are affluent. Most reporters who own homes are on a fixed-rate mortgage. In fact, the important news stories touch them hardly at all.

This episode is an acknowledgment that there are some important trends and news stories that you hear little about that are not on the elites' radar screen but will be quite important to doctors who want to establish practices.

This episode has so much detail, we do not have a "Short Version." I had to be complete.

I define the differences between these types of sites. In a nutshell, it is important to make the distinction early on that it is more than population size and growth rate. The rural sites are not necessarily more or less desirable. The biggest difference is in population density. Rural sites are more spread out. They have more homogeneity in their lifestyles, In each practice-community area, there are different liabilities and benefits. I mention these in the narration. Demographers are generally cool (at least for now) on urban locations. They are losing population in the post-Covid world as costs, including taxes and other business expenses rise. Suburban locations seem to be the least attractive for reasons I will discuss in the episodes.

I am not saying all practices have to locate in certain neighborhoods. It is certainly true that suburbs carry far less risk. Rural practice sites seem to be struggling to get a sufficient patient base, especially with the rising costs of fuel. So we have here a balance between ideal practice locations, their benefits, and liabilities. This episode contrasts all of these.

These episodes represent a word of caution regarding your source of demographic information on data and analysis. There are lots of amateur demographers who have entered the field recently. True, they may be well-meaning. These "newbies" are usually getting rehashed" data from a source within the Federal or State bureaucracy]that purports to tell you about changes in demographics.  It isn't necessarily true that the data is wrong. The biggest danger to doctors, consultants, and brokers is that they often make claims about the viability, and risks of practice site analysis.  

Several Clients have mentioned that Southern California is not looking so good as the place to purchase or to start-up a practice. Back "in the day," growth (and glamour) seemed eternal in the five mega-counties found in the area (Orange, San Diego, Riverside, San Bernardino, and Los Angeles Counties). For the first time EVER, the area is losing population. Among demographers, this has been known as the "California Exodus." True, the birth rate has declined (it has lost at least one Congressional Seat) but there are some other things going on. This episode defines some of the trends. The Governor and the State Legislature are agreeing to raise taxes, restrict water distribution, and the raise the prices on land development.

This episode takes about where these trends are occurring and where they are NOT occurring. We also discuss other trends that are important to keep an eye on. This would include an idea of where the middle class has gone. For doctors who want and idea of what is going on (and WHERE it is going on), this can be an important episode.

We have been asked about the viability of New York City as a place to practice for a long time. We thought this might be a good time to clear the air and make a definitive statement on it right now. As the nation's largest city, it is certainly a viable option. Still, the City is losing (a little) a population of -0.3 % per year.

From the standpoint of a very large and dynamic community, that is not bad. There are also indications that many of the people who left are going to come back.

But there is a severe bit of caution that goes along with this. The returning population is older and much less "family-friendly" than before. The large numbers of Young Adults are not as likely to come back. From an employment perspective, this might work out. Recall that those who left NYC for New Jersey and Florida still love the Big Apple but are not "starting out" as they did before.

This MAY turn out to be a big problem in the future. Crime and a housing shortage are certainly not helping. But, on the other hand, the rules that have defined other urban areas are not as true in this area. That has made many demographers more hopeful about NYC's future. Still, the nature of the City is unique.

As I have written before, NYC is more of a collection of small cities and villages crammed in an urban setting.

To KNOW the opportunities and risks of such an evolving and diverse community requires special help. Doctor Demographics is there for you, no matter what type of practice you are considering.

In this episode, I discuss the specific aspects of demographics that are causing all the craziness. And it is worth considering in some detail how folks seem to want to look at politics as a "blood sport." No, I don't discuss much the morality of choosing one side or another. Assigning blame is unwise. But it is true that if you are going to choose an area to purchase or start a practice, some places are going to look much better than others. Hey, that is my job. Right?

In this episode, we have taken a deep dive into two concepts that will determine your future practice success or failure. Please understand: They are not mutually exclusive. Rather, they are factors of potential that doctors must understand.

Many people (including doctors and practice owners) do not grasp. Even our competitors are a little foggy about their meaning. The first is the difference and relationship between race and ethnicity. The viability of practice often (increasingly) depends on a thorough understanding of the differences. Last week, we discussed "Hispanic" countries and populations. This week we are examining their culture, nation of origin, and language. We have expanded the discussion to include other countries. But we want you to see how this can influence the potential of this information in your practice.

The other concept (which heavily predicts success or failure) is demographics and psychographics. Both are vital to understanding the risks and rewards of a particular site on your potential business success. They are not the same thing at all. In the end, they are the key to promoting your practices and managing any new growth you may have.

Still, this is only a start.

We are also announcing that in September, we are going to offer a webinar on the best places to practice ortho, oms, emergency care, and endo in the United States. Stay tuned!

I only wish there was sufficient time to discuss all I have learned about the Hispanic population in a single episode. Nevertheless, I have created a long and short offering about Hispanics that will provide a little insight into these important groups of people. Not a day goes by that we don't hear about their immigration numbers. The Southern Border is being crossed into the United States by ever larger numbers and this may prove vital to your practice. Who are they? How do you reach them? Are they ALL desirable as a patient base? This episode is just a start to understanding the "Hispanic Switcheroo." And in this very short version of this episode, you will doubtless learn some important facts that you may not have heard before, I have often said that Hispanics are an important part of our national growth. Practices need this information. As an experienced Hispanic marketer, what I have to say might surprise you!

In the last couple of weeks, I have been asked by subscribers to the Podcast for the locations that are winning and losing population. Rather than break them down by states, I have looked at the Metropolitan Areas that the U.S. Census Bureau has identified as those that are likely to grow or shrink.

This week, we are looking at sites in the United States that are looking more hopeful.  These locations are economically strong and show signs of growth.  Many are manifesting strong economies or improved employment trends. Unfortunately, the short version of this episode can only lightly pass over the location.  Still, I think it will stimulate your thinking.

Let's face it, the U.S. is looking at a period of economic risk and potential decline.  Interest rates are surely going to rise.  Still, that is no reason to sit on your hands while opportunities to grow are just over the horizon.  

This episode explores the places where the potential for growth (and wealth) can be found. These are the places that still have risks but the risks are mitigated.

I hope you will allow Doctor Demographics to explore with you the places that have Promise!

Every year, we publish a list of the sites that are "Risky." We call these areas the "Kiss of Death" Sites.  If you are considering one for purchase or a start-up, we want you to think twice. The factors that make these locations less-than-desirable, change each year.  For example, in recent years, locations that had high unemployment were risky.  But at this time, unemployment has not been a major factor in what makes a good or bad location.  Rather, this year, locations that have above-average crime are undesirable.  Perhaps more important, locations that have the high cost of living, rising taxes (income and property) and a reduced birth rate are having a more difficult time,  Almost without exception, they are losing population.

It has been true for a long time that brokers, realtors, and even demographers have considered only a very narrow number of factors in determining practice site viability.  Traditionally, this may have been due to a misunderstanding of how to interpret the available data.  We knew, for example, if the population surrounding a practice site was growing or shrinking. We certainly could tell if the competition around a location was increasing relative to the population.  Terrific!  But the science of demographic analysis has grown and deepened while the users of these numbers have not kept up.  And there is little surprise why this is so: it is heavy lifting!

I believe (as many researchers do) that we are heading for an economic downturn soon. The only way to thrive during these times is to get the research and then make a plan and THEN you have to stick to it. That is what this episode is all about. But you need to make your plans soon!

What goes up will invariably come down. It is a basic law of gravity, economics, and demographics. We can simply not hope that things will stay the same (either good or bad). Frankly, we are at a time when it appears the World is sliding into a Recession. This has long been predicted. So, with this in mind, we have to assume that there is going to be a "wobble."

This episode discusses the ways that you can work with these local and national trends to build a new patient base that is educated and ready to work. We will discuss the priorities of these migrants, where they might settle, and what you can do to attract them to your practice. Please be aware that Doctor Demographics can identify where the new immigrant residents are moving, what they want from your practice, and how to attract them.

Doctors often find themselves influenced by locations that OTHER doctors are considering for purchase or development. This session explains how this is both good and bad. It also features the parts of the U.S. that are good bets and those that are not. For more information, visit us at: https://doctordemographics.com

Finding a location is tough.  But there are non-demographic factors that can offer you a serious hint about places that show potential for practice locations or may serve as a warning NOT to go there.  This session is about how retail sales is a sign of the good or back potential for practice.

It has long been popular to place practice in a "Medical Plaza" for various healthcare offices. There was a sense of unity and protection for these practices. This podcast deals with the issues that you might keep in mind. But the rationale for these centers is shifting. This video is a must-see!

In order to do proper practice viability or best sites report, knowing a practice's borders and boundaries is all-important in order to offer geographic "context" for the site, Yes, we will discuss isochrones, proxemics, and centers of gravity.  This is very useful stuff!

In this episode, Scott Mcdonald dives into why you should put a practice where the perfect place is as well as the three traditional demographic imperatives for practice: economic growth, population growth, and socioeconomics.

He said, "A rising birth rate is one indicator of who can step into your practice and benefit from it." And remember, the percentage of people tends to be even more important than how much they're earning. Also, when it comes to choosing a location that shows the most economic potential, you will have to move in because of job opportunities. Thus, moving target is going to determine so much of your success.