Podcast - Clinical Independence in the Age of AI and Private Capital

Morgan Ribeiro: Welcome to Counsel That Cares. This is Morgan Ribeiro, the host of the podcast and a director in the firm's healthcare practice. Today, we are diving into one of the most heavily scrutinized intersections in healthcare today, which is the balancing of private equity investment to expand and grow services while preserving clinical independence. With shifting reimbursement incentives and a wave of dental and medical consolidation, how do we in the healthcare industry really ensure that corporate metrics never cross the line into medical decision-making? Joining me to unpack this topic are John Saran, a partner in Holland and Knight's Healthcare Transactions Practice Group, and Dr. Bobby McNeil, a practicing oral and maxillofacial surgeon in Dallas, Texas, who also brings a vital regulatory perspective as a member of the Texas State Board of Dental Examiners. Gentlemen, welcome to the show.

Bobby McNeill: Thank you, Morgan. Please call me Bobby. And it's a pleasure certainly to join you both on this critical and timely conversation.

John Saran: Thanks, Morgan, and thanks for having me back on the podcast here.

Morgan Ribeiro: Of course. Well, first I would love to hear from each of you a little bit more background, so our listeners have that perspective as we dive into the conversation. So, Bobby, we'll have you go first.

Bobby McNeill: Thank you so much, and as you mentioned, I'm an oral maxillofacial surgeon in Texas, and Morgan, I think you're the first person that's actually been able to say that word correctly [the] first time, so kudos to you. And what that means, I treat conditions involving the head, face, jaws, mouth and teeth, and really ranging from things like facial trauma and jaw pathology to wisdom tooth removal. I graduated from medical and dental school and hold both a medical license and a dental license here in Texas. I also have an MBA in healthcare management, completed the Senior Executive Fellows (SEF) Program in public policy at Harvard Kennedy School and I'm currently a part-time law student at Northeastern University School of Law. Of note, my wife, who is also a surgeon, we practice together. She is also my law school classmate, and we do medical missions and ride motorcycles and climb mountains around the world. So, you could certainly say that life is not boring. As you mentioned, I've been in healthcare regulation really for about 10 years now. And I do need to be clear that today I'm speaking in my own personal capacity. These are my opinions, and I'm not speaking on behalf of the board or any other organizations of which I have a leadership role. But I'm really glad to be joining both of you. This is a very timely topic.

And at the outset, I do not see clinical independence as anti-business or anti-growth. I do have an MBA after all, and to me clinical independence is a trust layer that allows these healthcare platforms to grow and to grow responsibly. Private capital can certainly bring value through things like infrastructure and technology and compliance, access and operational support, and all of that is really needed, but that value is durable only if the clinician's independent judgment is protected in reality and not just lip service in documents. And if that trust layer breaks down, the enterprise value becomes much more fragile. And in healthcare, a platform failure is not just a financial event. You know, I see this as a regulator. Patients can be harmed through disruption and loss of access and patient abandonment, and I certainly don't want to see that as a clinician or as a regulator.

Morgan Ribeiro: Right, I completely agree, and I really appreciate that perspective. You obviously have an amazing background, both from the medical side, the kind of business acumen and then now working on the legal component of it too, which is all really valuable as we think about this discussion and that balancing act, right, of keeping the patients in mind, making sure that the clinical aspect is equally important as making sure that these businesses thrive and are around to serve their communities. John, would love to hear your background before we launch into this discussion.

John Saran: Yeah, thanks, Morgan. And I'll just say, I actually met Bobby through LinkedIn adventures. And Bobby kind of talked about his very interesting background and multi-educational background. And we started engaging and he shared some really interesting insights, which kind of gave me the idea to want to have him on this podcast and kind of talk through some of these issues. But as you mentioned earlier, John Saran, healthcare transactions partner based in Chicago. Pretty much since day one of my practice, over 13 to 14 years ago, I've worked on medical platforms, dental platforms, the full spectrum of, I would say, managed professional practice. And I've seen the rise and the fall, I've seen the enforcement actions, I've engaged with regulators, I've helped investors invest in them, I've helped restructure and finance.

And so, I've really seen the full spectrum of these businesses flourishing, and I would say that, come a few years ago, there started to be a focus, especially with some of the large transactions happening in the space. And with physician practices and other professional practices, some of those transactions were not on radars of federal and state governments for various reasons. Maybe it was under the Hart-Scott-Rodino (HSR) threshold for a particular transaction, or maybe a state was set up so that they would review a nonprofit transaction or a hospital transaction, but they had no idea what was happening with respect to the consolidation of physician practices and other professional practice. And so, states really started to really ask questions and start looking into state transactions and started passing laws a few years ago. And interestingly enough, that trend not only started, but then started to evolve as people realized it wasn't just consolidation or that one blip in time when physician practices maybe took investment or merged with others. It also re-raised the age-old question of the corporate practice of medicine and the line between what the medical doctors (MDs) and the doctors of dental surgery (DDSs) do and what the Master of Business Administration (MBAs) do and that constant tension. I said age-old because corporate practice has been around for like 100-plus years. It's not really anything new. I mean, what we're talking about today essentially is the same theory and standards that have been around for a long time, but it's just been a renewed interest. And I would say, in even the last 12 months, we've had some enforcement actions across the country. We've had renewed statutes being passed in Oregon and California and soon, potentially, in Vermont. And it's on the tip of everyone's tongue. And I know, Bobby, you mentioned to me earlier, too, that the American Medical Association just came out with some guidance as well on this. And they've been thinking about that for years as well as part of this overall trend. So, this is definitely a hot topic, and I thought it would be best to hear directly from a clinician as to your views as to that line between the clinical and non-clinical.

Bobby McNeill: John, I love what you said there. It's certainly timely. And I think it's so important for people with your lens and people with my lens to have conversations like this.

Morgan Ribeiro: Yeah, I mean, it certainly feels like the temperature is rising and it's sort of escalating to a point where, you know, I think we need to have some real conversations around what the future looks like, just given so many factors that are contributing to the evolution of healthcare delivery. So, Bobby, I want to turn it back to you as a practicing clinician and as a state regulator in Texas, you were on the front lines of seeing how corporate investment affects the day-to-day healthcare delivery. So just from a broad perspective, why is protecting clinical independence so vital right now?

Bobby McNeill: You know, I think dentistry is certainly a useful place to sort of examine that clinical independence issue for a couple of reasons, one of which is it's structurally less complicated than medicine. Medicine's complicated, medicine's messy. It involves hospital systems, payer influence, pharmacy integration, employed physician networks and these large vertically integrated enterprises, and oftentimes dentistry gives us a much cleaner view of the core question. How do we allow investment and scale while preserving the professional judgment of that clinician? In dentistry, the legal structure is often quite clear. A corporation cannot practice dentistry. Things that John has talked about and likely will talk about. Only a licensed clinician can diagnose, treatment plan and make clinical decisions for the patient. And almost everyone says they support clinical independence, but I think the concern now is moving beyond what people say and frankly what the documents say and asking how these models actually operate in practice. The issue, I believe, is whether the metrics and staffing models and compensation structures and scheduling pressures, protocols, technology, all those things, how they can shape clinical judgment in ways that weaken that doctor-patient relationship. And that's what the American Medical Association was sort of referring to. And I think that's why clinical independence matters right now. As I said, the discussion I don't believe should be anti-capital or anti-growth. As mentioned, private capital can bring real value. But at the end of the day, the clinician still has to be free to practice, to make the decision that's in the best interest for the patient.

Morgan Ribeiro: Absolutely. And, John, picking up on what Bobby just said, it's not just an ethical line, right? It's a strict legal structure. So as a healthcare lawyer, how do you build deals that allow capital to flow into physician and dental practices while keeping regulators, like Bobby, satisfied?

John Saran: I mean, there's a standard model that is used across the industry, and you could use it for physician practices, dental practices, you know, pretty much any licensed profession, frankly. Right? Some of our colleagues are doing it for lawyers. And right now, as an example, in Illinois, Applied Behavior Analysis (ABA) therapy is coming to them as well, and it's required by the end of this calendar year. I think it's important to understand that there's sort of the legal separation in these businesses and then there's the practical separation and what happens really behind the scenes. And we can talk about the legal first and then go to the practical next and also sort of why it's relevant with some recent enforcement actions.

On the legal front, like I mentioned before, corporate practice has been around for 100-plus years, and if you really study, you'll see cases of unlicensed individuals trying to operate dental clinics or provide medical practice and services since the beginning of time. And states originally, you would have to find this law in statutes, regulations, case law and come up with how to structure these businesses. And what the industry came up with, which is the management services organization (MSO), essentially, you put all the non-clinical assets and operations into a separate legal entity, which can be owned by anyone, including investors, or you can take financing from a bank. And then you separate that from the clinical side of the house, which has the professional entity, which typically needs to be owned by a professional. And that entity holds the contracts with payers, the physicians, and engages with the patients. And you sort of have that dual structure with service agreements in place to make sure that there's the appropriate arrangements. And that's what you'll see across the board today. It's rare that I see in 2026 someone that does not have the appropriate structure unless, as I mentioned, if you're in a state like Illinois now where it's moving that particular subset of licensees toward that model.

I think the place, though, where people struggle – and I think has been the focus of states – has been the focus on the enforcement actions, is that practical side of things. I think pretty much now everyone is able to work with law firms like ours to help structure their legal documents, but those that do that and then throw it in the file and then just kind of go off and do whatever they want, that's where they find themselves potentially scrutinized. And it could be from a regulator, it could be from a payer, it would be from patients. I mean, we've seen folks ask questions from a variety of different stakeholders. Obviously, if you engage in a transaction, you might have a law firm like us look at your structure and ask questions. If you get financing, you know, the same. I think what it really boils down to is sort of what is happening in practice. Are the physicians making the clinical decisions? And not just are they doing it in phone calls or emails, are there documented procedures in place? If, let's say, physicians are responsible for hiring and firing clinicians, what does that look like in practice? Are they actually being consulted? Is someone documenting that they reviewed those candidates? And is it in a format that is readily available to be provided to regulators if anyone ever asked those questions? There was a recent settlement in California that focused on some marketing and advertisement issues and allegations, but it also focused on the implementation of a new California law, SB 351. And you can tell by the settlement responses and obligations that the state is really focused on, not just the documents being compliant, but sort of what is happening in practice and do you have the support for that line that is drawn in the sand, and those decisions that are being designated to the clinical side of the house. So, Bobby, I don't know if you've seen that too in your travels and your understanding, but I really think it's not just the legal structure and the nice paper, but now it's sort of what's actually happening in practice.

Bobby McNeill: You know, I think this is certainly where it gets very real for patients. And I'm glad you talked about sort of that governance structure after the legal documents are signed, what actually plays out in practice. And, you know, it usually doesn't start with a corporate executive walking into the operatory and saying, "you must do this procedure" or "cannot refer out these types of complex, high-risk surgical procedures." You know, it's often more subtle. And I should also mention that these can occur across all practice models, not just MSOs and dental service organization (DSO) structures. So, to sort of make it real, John, I'm going to do something that's terrible to do to you. I want you to imagine you're the patient, you're going to see your dentist, Dr. Mary Smith, and you're sitting in that uncomfortable dental chair. Do you feel yourself in the chair right now, John?

John Saran: Yes.

Bobby McNeill: That's the response I would expect, and so an AI program reviewed your X-rays, your intraoral scans, your demographic information, your insurance benefits and prior treatment history. And this program has been optimized to suggest certain types of treatment for you, John. And then it generates a suggested treatment plan that includes several crowns. And all that Dr. Smith needs to do is click that little box to approve it on the computer. But we're going to add another layer to this. Dr. Smith, she's working inside an operational system that tracks her crown production each month. The crowns, those little caps that go onto a tooth after it's shaved down by the dentist. And quite frankly, an office makes more for a crown than they do for a filling – quite frankly, a lot more – but it's more invasive to the tooth structure. And that day, let's pretend it's June 29, the office, they're under their monthly target and everybody knows about it. They're under the target and the system is pushing for case acceptance. And Dr. Smith has already been told last week by management that her crown preparation appointments, they're actually taking too long as well and she needs to reduce her procedure time by 15 minutes to hit corporate benchmarks. So there's you, John. You're sitting in the chair. You probably don't feel great about this situation if you knew about it. And I suspect you wouldn't know much about it and that in your situation, in this little scenario we're doing, this little hypo, it doesn't mean that crowns are unnecessary, they may be completely appropriate, but as the patient, I think you want to know that your dentist is free to say, "no, this is not the right treatment for John," or "John, we can watch this," or "John, a more conservative option right now may be a filling." So, this, I believe, is sort of where separate issues can combine and can become a real clinical independence problem. And I think the risk is often not one isolated lever. It's sort of the interaction of AI recommendations, production metrics, scheduling pressure, insurance information, compensation design for doctors and management expectations. Each one may be perfectly defensible on its own in isolation. But together, they can quietly shape the diagnosis and treatment and, quite frankly, ultimately interfere with that doctor-patient relationship.

Sometimes, though, it can be a single issue. For example, a newer clinician may feel pressure to perform very complex surgical procedures that should be referred out or handled by someone with more expertise. That pressure that they feel could certainly come from compensation design or production expectations or protocols in a culture that just says, "hey, we don't send outside referrals." And from my own perspective, I see complications from this. I'm an oral maxillofacial surgeon, and the complication involves a procedure that had a very complex surgical procedure performed by someone who did not have the right level of experience or support and the consequences to this. They're frankly quite serious, like fractured jaws, permanent nerve injuries, infections, hospitalizations and even death. So, it's not just a clinical problem, it's the system's problem. And it shows why this clinical independence sort of has to include the freedom for the clinician, for the doctor to say, "this is beyond my skill set," or "this patient needs a referral" or "the safest thing is not to do a procedure here." And I think at the end of the day, that's what patient trust is built on. And in healthcare, that patient trust is what durable enterprise value is built on. That whole traditional complaint-based regulation. We often see the end result after the harm has occurred. As regulators, we're generally reactive in nature. We see the smoke, not always the fire before it starts. And that's why modern regulation and modern governance are starting to look upstream at things like incentives and technologies that influence and sort of interfere that doctor-patient relationship. And I know we're sort of moving in that direction.

John Saran: And Bobby, I know we've moved to the next topic, but I know there tends to be a focus on private equity, but this concept of corporate control or between the non-clinical and clinical, it really applies across the board and it's going to look different, but the stakeholders are different for each of the different licensed professionals, whether you're private equity-backed, health system-backed, insurance company-affiliated or whatever. It is all the same, like, what we're talking about here. And each of the different states may focus on one of those stakeholders just depending on the results in their state. Right? There might be a bad result or a good result or whatever, but at the end of the day it's still the core principle that's the same.

Bobby McNeill: I totally agree, and it can be a private practice with an owner doctor and an associate doctor and no non-DSO, non-MSO and these types of situations can be happening. I think regulators certainly look at things at scale, and the blessing is that, at scale, things can be done very, very well and appropriately, but also the opposite.

Morgan Ribeiro: Yeah, and I think this is a good segue. Obviously, a big hot topic in healthcare, really just broadly speaking, is the application of artificial intelligence, particularly in how it's used in the clinical setting. I think in healthcare, you see a lot of it used in the sort of administrative side of practices, and I there's a lot of benefit there, and there's certainly benefit on the clinical side. But how can clinical providers maintain interdependence in this new era of care delivery, right? It's that shiny tool. There's obviously a lot of promise that comes with that, but I think you also have to be careful in how those technologies are utilized.

Bobby McNeill: Morgan, I'm dying to say, AI? Never heard of it. I don't know what you're talking about. But unfortunately, I think everyone has heard that now. And I think the impact of AI in healthcare is certainly still being written. Earlier this year, I had the opportunity to participate in a Brown University program reviewing state legislative activity around AI. I was a regulation scorer. And one of my takeaways was that, when it comes to AI regulation, this is a situation where the airplane is being built while it's still already flying in the air. And I think when it comes to AI – this is especially true through the lens of a regulator – many of us are still trying to understand how these systems are designed, what data they use and how their recommendations show up in that clinical workflow. In dentistry, there's already a concern by some that AI tools could be used not only to identify disease but also increase case acceptance and upsell treatment. And that does not mean AI is bad. AI can certainly help clinicians do things like diagnose earlier, communicate better with patients and improve consistency, but governance and transparency really sort of matters here. And I believe the key question is whether AI supports the clinician's judgment or quietly replaces it. At the end of the day, the clinician must remain free to accept or reject or modify any AI recommendation based on what's best for the patient. So clinical independence in the AI era really requires transparency and documentation and clear governance. The clinician, not the software, not the business model, has to be the one who's responsible for patient care. And I think that's one of the real risks for physicians and dentists. We may be held responsible for clinical decisions shaped upstream by AI systems that we didn't design, we don't fully understand, we may not even appreciate that it's embedded in the system and we may not certainly have meaningful control over it.

Morgan Ribeiro: John, I mean, from your perspective, what do corporate managers risk from a regulatory or enforcement perspective when they do overstep? I think this is sort of beyond and broader than just the conversation around AI, but just broadly speaking, and maybe we start with the federal level first.

John Saran: So, we published a Q1 report a few months ago, and it kind of dove in on the federal developments, but we saw the HSR rules vacated, which would have required five-year lookbacks and a real focus on consolidation strategies. I still think the Federal Trade Commission (FTC), with whatever filings you make, you're still going to be looking at that generally. They did start a task force as well that would study healthcare consolidation. Congress has proposed a few federal statutes that have entered the discussion or reentered the discussion about healthcare consolidation, state transactions involving investors in the healthcare space, corporate control and all of that. Just from speaking with our federal policy folks, I don't see those moving forward this term. But it does show that the federal government is obviously focused on that. And then you're also seeing just a general increase in enforcement with a focus on fraud, which could be in the form of Civil Investigative Demand (CIDs) or Office of Inspector General (OIG) investigations and reviews of claims and whatnot. I wouldn't say there's necessarily a target in any particular stakeholder in the industry when it comes from a federal perspective, but there's just a continued interest in healthcare consolidation with a focus on fraud.

And on the state side, we'll be doing like a Q3 update here in a few weeks, but this year has been a mixed result for states. We've seen the coasts have been successful with Oregon being able to pass their bill late last year and California rolling out their new statute and regulations and a successful enforcement action. We have seen Connecticut finally being able to get one of these transaction bills passed. Vermont is close to getting a corporate control bill passed. It'll be interesting to see where the states go. We haven't seen too many new states come on the board. A lot of the legislation have fizzled out, but I'm starting to see just an evolution, too, for what we're even talking about today in the integration of AI, and as states are starting to even potentially license AI providers, almost like a separate license type. And that raises interesting questions about corporate control, practice, and there's already been some cases out there that have tried to bring actions for issues involving AI. And so, it'll be interesting. That could be where this trend goes in the future. I expect there to be another wave of the state laws next year. I do not expect there to be any meaningful federal updates, at least for a few years.

Morgan Ribeiro: Yeah, and I mean, that's just the trend that we've seen broadly like you said. Right? The federal legislation, it's hard to get to any sort of consensus there. Everything's being kind of pushed down to the states. Bobby, I'd love to turn back to you. What do you see as the role of the Federation of [State] Medical Boards and the American Medical Association (AMA) in this conversation that we're having?

Bobby McNeill: You know, as John mentioned, there are so many things that are happening right now. And I think the American Medical Association and the Federation of State Medical Boards are important here because they sort of show that this conversation's moving into the mainstream of organized medicine and professional regulation. The Federation of State Medical Boards, basically the large national organization to sort of support and represent various medical boards, they recently adopted a report on the oversight of clinical decision-making. I think this was about a two-year process, and the report finally just came out earlier this month. And what stood out to me is that the report does not treat clinical independence as some abstract idea. Frankly, it talks about how the real-world systems that can affect physician judgment, including corporate structures, productivity pressures, financial incentives of payer controls and technology. All those things that we actually discussed earlier, it emphasizes that physicians must retain ultimate authority over diagnosis, treatment, referrals, prescribing and care coordination. And that's what we've been talking about. The American Medical Association, they had that recent adoption this month as well, I think, Resolution 241, that sort of pointed in a similar direction, and the AMA, I think, is focusing more directly on that corporate practice of medicine and MSO structures, physician ownership and governance and really whether non-licensed entities have direct or de facto control over some of these medical decisions that we're talking about.

To me, the key point is that clinical independence is no longer just a sentence in a contract or a paragraph or frankly lip service from the podium. Everybody says it exists. And I think maybe one of the main points that I want our listeners to sort of take away from this conversation. Now the structures and operational systems are being looked at as to how they impact that doctor-patient relationship. And I think the AMA and the Federation of State Medical Boards are certainly moving that conversation upstream, hopefully before harm, before compliance, before enforcement or some of the litigation that John was talking about. Many people, including myself, believe some of this erosion is already starting to happen. And without clinical independence, that trust begins to erode and patients lose trust in their care and clinicians lose trust in the model and regulators start scrutinizing the system like John was talking about and the enterprise value that everyone's trying to build becomes much more fragile.

Morgan Ribeiro: Great. So, I think, you know, we've talked a lot about sort of the lay of the land here and what we're looking at as it pertains to clinical independence and some of the investment that we're seeing in healthcare and some of the regulation and legislation that we are seeing. I want to now switch to solutions. Bobby, from your unique vantage point as both a regulator and a clinician, what can investment platforms like private equity firms do practically to ensure they support the clinic without managing the clinical choices?

Bobby McNeill: You know, it's a great question. I would certainly start with governance – and meaning real governance, not just the language and the management agreement that we kind of just referenced. Investment platforms, quite frankly, should be looking at that Federation of State Medical Board report on clinical decision-making and what states like California are discussing around corporate practice and management structures that John was talking about. You know, as I said, everyone talks about governance, but I don't think everyone's doing it well, and I think real governance means the clinical voice has real authority. And if clinicians are involved in management, and I certainly think they should be, they need to be guardians of that clinical independence. Their role can't be symbolic. They need to be able to ask hard questions about whether production metrics and scheduling systems and compensation design protocols, AI tools and referral policies that are affecting care, just to see what is the impact at the end of the day. And having my MBA lens, you know, all my class, it was a physician-only MBA program. And we understand all these concepts, and you get into a little bit of a gray area because there's appropriate business measures that need to happen for a going concern. And once again, I don't want to come across as anti-business, anti-growth, but you need to have the clinical people involved. And when they have that authority, that authority has to come with responsibility. And if clinician leaders are the ones helping to design or approve systems that shape care, then they also need to be accountable for those downstream impacts of those decisions.

And I think the clinical leadership simply cannot provide cover for a business model. This shouldn't be rubber stamping. You know, it has to protect the patient at the end of the day. And that was big outcomes of the AMA and the Federation of State Medical Board reports, is patient safety. And I sat on private equity panels during my healthcare-focused MBA. And it became clear to me, you know, each group brings a different type of expertise. The finance professionals understand finance. Lawyers, like John, understand legal structures. Operators understand operation management. But physicians and dentists, they understand diagnosis and treatment options and clinical risk and, frankly, the realities of patient care. And that's the lens that I hope to sort of bring to this conversation as a clinician regulator, someone with an MBA in healthcare management and now a law student. And so, practically, I think I would want to see clinician-led governance with actual real authority and protection of the referral judgment, transparency of AI systems like we just talked about and the treatment planning tools. And you need to have anonymous reporting channels and regular audits just to see whether the business systems are actually influencing the clinical decisions, that the clinical independence should not be viewed as a threat to scale and, in my opinion, it's sort of what makes scale trustworthy.

John Saran: Yeah. And our clients always ask us, like, "What can you do? Can you craft us the best legal documents out there?" And I tell them, you can have the best documents that are ironclad from a regulatory perspective, but the best way to preserve your platform and the value and your investment and all of that is just to preserve the clinical autonomy, the relationships with the doctors, that's the best way that you move this forward. Because that's what allows you to work collaboratively, resolve any disputes. You don't have to go back to those documents. And if you do cross that line and you cross it significantly, that's where you run into regulatory scrutiny. You might find yourself with penalties or onerous obligations imposed by the state. You do lose that provider trust over time, which then starts to sort of hydra into other areas, and over time you see some of those platforms just slowly dwindle away because of that. And then, it's just like anything else, right? It's a big industry, but physicians and dentists, they all talk to each other, and you can very quickly lose a reputation when some of those issues arise, and that's the best way to erode the value of your platform.

Morgan Ribeiro: Yeah, I completely agree. I mean, from a deal perspective, I think that that's really important to make sure that we're, as legal counsel, really balancing all of that. And it seems to me, and John, we've talked a lot about this, that a lot of these regulatory and legislative conversations are happening with a view towards the negative and what can happen with private capital coming into healthcare. But there are certainly positives that come from it, particularly if we address a lot of the things, Bobby, that you've mentioned. I'd look to both of you for sort of an answer to this next question, which is just telling us what you see as the opportunity for private equity firms to be a part of the conversation and to be a part of the solution here. John, maybe you can start.

John Saran: Yeah, I mean, I view it as private equity investment into providers. It really helps meet access of care issues in particular states or regions. I mean it costs, Bobby, right, a significant amount of money to build out a new dental office with operatories and all that, and then not just build that one, but then grow over time. Having that access to capital to be able to do so certainly helps, and especially having an expert in the non-clinical side of the business, it frees you up to focus more on that patient care that you like doing and that you went to school for. And also keep in mind too, right, if having a partner that may have other investments and similar platforms and they've learned the best practices, they're able to really leverage all of that into making your business excel, have the time and the capital and the resources to invest in improved compliance programs, the latest AI tools and other things that can really take your practice to the next level. And so, we've seen platforms be very successful when they have that investment. And then we've seen in some of these states where a particular regulatory measure might scare away or particularly target a certain stakeholder. And in some cases, that might be the only source of capital that, let's say, a dentist has when they come out of school. And so, it's one of those things we have to balance all these different considerations so that we don't stifle growth, but also at the same time ensure that clinical independence.

Bobby McNeill: I couldn't agree more. Let the doctor be the doctor. Let the business people be the business people. I loved my MBA because it taught me an entirely different language of which I had not learned in medical school or dental school. And frankly, law school's doing the same thing for me. It gives me a different lens. But knowing the lanes and knowing the negative impact. So everything we're talking about. And as soon as the finance folks step into the operatory, literally or figuratively, some interesting things can happen. And that does not mean conversations can't happen. That does not mean that clinicians should have discussions with other clinicians to say, "Hey, we want to get you up to speed. We want to make sure you're hitting competencies and benchmarks because this is what's good for the practice, this is what good for the patient." But it's when everything sort of combines in a negative way and the lever gets shifted a little too much away from what's in the best interest of the patient, that's when problems happen. And that's when trust breaks down with patients and with clinicians, frankly.

Morgan Ribeiro: Well, I think that's a great place to end. This has been a really enlightening conversation, and protecting clinical independence is clearly not just a checkbox, right, on a form or a document. It's really a foundational pillar that keeps healthcare safe and investment models sustainable to the point you made very early on, Bobby, right? It's built on this trust. And that will ultimately drive the value of a practice or an entity. So Bobby, thank you very much for bringing your very diverse perspective as a clinician, regulator, businessperson, soon-to-be attorney, to the microphone.

Bobby McNeill: It's soon many years, many, many years down the road.

Morgan Ribeiro: John, thank you as always for bringing your perspective of the conversation as well.

John Saran: Yeah, thanks, Morgan.

Bobby McNeill: Thank you to both of you for this opportunity. It's a great discussion, important discussion. I appreciate it.