Dr. Lisa Piercey on Entrepreneurship Through Acquisition
Dr. Lisa Piercey is a physician, entrepreneur, and author who helps mid-career professionals find freedom through business ownership while investing in healthcare companies that strengthen rural communities.
About Dr. Lisa Piercey
Dr. Lisa Piercey is a physician, healthcare entrepreneur, and author of Natural Born Entrepreneurs, a forthcoming guide for mid-career professionals who want to break free from the corporate ladder and build lasting impact through business ownership.
With deep roots in West Tennessee, Dr. Piercey has spent her career focused on expanding access to healthcare in rural and underserved communities. A former hospital executive and Tennessee Commissioner of Health, she now acquires and grows small healthcare companies through models like search funds and independent sponsorship. Her portfolio includes mission-driven businesses such as a reopened rural retirement home and a wound care specialty pharmacy—investments designed not just to succeed financially, but to strengthen the communities they serve.
Lisa’s entrepreneurial path reframes what business ownership can look like. Instead of chasing start-up unicorns, she focuses on buying and operating stable, existing businesses that solve real problems. This approach—known as Entrepreneurship Through Acquisition (ETA)—has become her platform for teaching others how to step into ownership without starting from scratch.
About the Book: Natural Born Entrepreneurs
Her upcoming book, Natural Born Entrepreneurs (releasing October 28, 2025), blends personal narrative with practical, step-by-step instruction on sourcing deals, financing acquisitions, closing transactions, and leading in the critical first 100 days. Written for professionals between 35–55, the book offers a roadmap to freedom, fulfillment, and financial stability that goes far beyond the typical startup story.
Resources
Lisa Piercey Website
Natural Born Entrepreneurs: COMING October 28, 2025
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Spencer: Dr. Lisa Piercey . Welcome to Signature Required.
Lisa: Thanks for having me.
Spencer: You are a physician, a healthcare entrepreneur, and the former Tennessee Commissioner of Health. You're also the author of Natural Born Entrepreneurs. We have a lot to be able to cover here today.
Lisa: Looking [00:01:00] forward to it.
Spencer: So you choose which one should we start off talking about first?
Lisa: That's a, that's a good question. You know, people ask me what I do, and that's a difficult answer for me. That's right. And, sometimes it feels like I didn't do it right, but man, I wouldn't have done it any other way because it hasn't been a linear path. And so, it makes it difficult when people ask my kids or my parents, you know, what does your mom do?
Lisa: What does your daughter do? And the answer is, somewhere, doctor turned, hospital administrator did a stint in state government and now a business owner. And so in my mind, those pieces go together, but it's a, it's an unusual path I'll admit.
Spencer: So what type of doctor were you? Let's start there. So what was your traditional educational background?
Lisa: Sure. I'm a pediatrician by training and I'm actually sub boarded in child abuse pediatrics, which a lot of people don't even know that that exists. But it's a. Subspecialty, just like any other specialty, like pediatric [00:02:00] cardiology or pediatric gastroenterology, my subspecialty evaluates children for suspected abuse and neglect, and that's the one thing that has remained constant throughout my career.
Lisa: I have never stopped seeing patients. Now I cut way, way back a long time ago, and I haven't been in full-time practice since about 2010, but I've never stopped seeing patients about a half day a week. Just saw 'em last week.
Spencer: Hmm. That is really heavy. When I meet doctors that are in pediatric oncology dealing with childhood cancer, I always look at them and say, one, when you were looking at the whole menu of things to do, how did that one jump off the page?
Spencer: And two, how do you ever separate work from the rest of your life? Because I feel like some of the things that you carry. Just. I don't know how you put 'em outta your head.
Lisa: It's a legitimate question and one I get with fair [00:03:00] frequency, like, why that? Why did you choose that? And I'm, I'll be honest, I didn't wake up one day and say, oh, that sounds fun.
Lisa: I think I'll do that. Like many things in our lives and our careers, I was influenced by a mentor and I had a mentor. In my general pediatrics training, who I just identified with, I was a young working mother. She had had, you know, school age kids. And so I was looking to her, how do I balance this career in medicine?
Lisa: And having what was one, and then was pretty quickly four kids. And so she, she and I just resonated in one day. We were going to our normal Wednesday afternoon clinic, which in residency speak is your continuity clinic. It sort of mimics what a private practice would be and I noticed we weren't going to the same spot.
Lisa: And I said, Deb, where are we going? And she said, oh, we're going down to the advocacy center. Okay, fun field trip. And I remember seeing kids that [00:04:00] had been sexually abused, intentionally burned and made, you know, have like forced to make methamphetamine all in the same day. And I got home that evening and I distinctly remember cooking dinner and putting a plate down in front of me and thinking.
Lisa: Oh, I can't eat. I feel sick.
Yeah.
Lisa: And then the, the same thing happened the next Wednesday afternoon and I said, no, ma'am, I'll pass. I, this is not for me. And she promptly told me to get in the car. And so mm-hmm. Over time she really taught me. That even though this is an unpalatable kind of experience, this is an incredibly needed service.
Lisa: And so that's the second part of the answer, which is, you know, how do you separate, I focus on the things that are the good I. The parts that are needed, the, the needs that are being met. And yeah, there are some things that haunt you and that always haunt you. But it's much outweighed by the good that you're doing.
Carli: I don't even know how we pivot from that, [00:05:00] because that is so profound.
Carli: you have a huge focus on rural healthcare. That's something that you're really passionate about throughout your whole career. Right.
Carli: Everything you touched. So it probably started in that clinic back in the day. It
Lisa: absolutely was. That was part of the equation. I have a passion for all things rural, because I'm a first generation college graduate, grew up on a farm, daughter of a. As best I can tell, fifth generation farmer and, and now mother to a emerging farmer, which makes me very proud of the rural roots.
Lisa: But we know that rural areas are highly underserved in access to healthcare, in affordable healthcare, transportation, to even get things. Things that we take for granted every day. And so whether it is a vulnerable and underserved child or a wound care population that can't get out and drive, I see those recurring themes as just being underserved.
Lisa: Hmm.
Spencer: There's a. prayer that Carli and I have only [00:06:00] been brave enough to pray a couple times, which is, Lord, break our hearts for what breaks yours. It's one of the most dangerous prayers ever you've ever, read And I see traces of that in your story, that you were confronted by something that no one wants to have to see.
Spencer: And. The Lord broke your heart in seeing it in your community and what you can do about it, and as a high achiever, I can imagine leaving that is something that you just couldn't, couldn't live yourself with. Right? I,
Lisa: I couldn't, I couldn't do it. And it's the thing that keeps me going back every Friday afternoon to see patients.
Carli: I think it's really powerful that you still see patients. Every Friday because it's not, what I hear you saying is you said it's, oh, no one else will. And you know that's not true. But I actually think you probably do it more because it's a tethering to what your calling is. And it's not so much that there aren't other people, [00:07:00] it's that if you don't have that impact on your own life, perhaps you're more nervous that you won't have the guardrails of what
Lisa: you're called to do if you're not there.
Lisa: Hundred percent. A hundred percent. And at the end of the day. Right, wrong or indifferent, I'm still just a physician.
Mm-hmm.
Lisa: That's, that's who I am. And that informs all of the different things that I've done since then. But at the core, I'm still a physician. And so yes, it tethers me to who, kind of what my self concept is.
Lisa: Mm-hmm. And because that's what I wanted to be since I was a young child, was a physician. I didn't even know some of this other stuff existed. And the other thing, just in, in basic terms, man, it's muscle memory for me. I like to do something that is fun and I don't have to really think about, and interacting with patients and families just comes naturally to me.
Lisa: Sometimes in business it's, it's pretty hard.
Spencer: Alright, well then moving the clock forward, you become the Tennessee Commissioner of Health. So what was the journey from a practicing physician to say, you [00:08:00] know. Life is not hard enough. I need some state government.
Lisa: Well, yeah, that was, that was an interesting transition.
Lisa: There was an important piece in between the two when I came out of full-time practice. The reason I came out was because I had gotten my MBA and enjoyed the business aspect of it. And all your
Carli: spare time.
Lisa: Well, you know, the funny part is, is I was tempted to have a fifth child and my husband told me to get a hobby.
Lisa: And so I got an MBA instead. And then the, the whole desire to have a fifth child went away very quickly. And so, ran hospitals and medical, large medical groups for several years, basically a decade doing just that. But over the last several years of my hospital administration career, it was primarily rural hospitals and delivery of care in rural areas where they don't have access or they don't have as good of access.
Lisa: And when Governor Lee ran, he ran on a platform of rural issues, economic development, workforce, and essentially reached out and [00:09:00] said, Hey, I care about rural things. Healthcare is not my jam, if you will. But I hear it's yours. And so how about we put those two things together? And so the intent was that we would work on all things rural healthcare and in, in Indeed we did, we got about 14 months down the road before the pandemic.
Lisa: And you know, as they say, the rest is history. Mm-hmm. So we spent most of those last three years of his first term working on pandemic and crisis management. But that was the impetus for getting in state government. Was to work on rural access at a broader scale.
Spencer: So how did you transition out of public service back into private life and what was that like? You Yeah,
Lisa: great question. So I, I told you I'd, I'd run hospitals for 10 years and.
Lisa: It was muscle memory and I enjoyed doing it. And when I say hospital, I also mean large medical group, multi-specialty clinics, lots of clinics. 'Cause that's the background I came from. I just always just assumed that's what I would go back into and I [00:10:00] didn't really contemplate anything else. And then when the time came, when the, when the first term was starting to wind down and I knew I didn't really have a second term in me.
Lisa: Mm-hmm. Because of the first term was so exhausting. I just assumed I'd go back into hospital management, so I started pursuing that path and had two or three pretty prominent level conversations of jobs that five years ago, 10 years ago, I would've said. Oh, that will never happen to me, that I would never get to that level.
Lisa: And so on one hand it was like, you've got these offers in front of you that are just out of this world, but man, I couldn't get excited about it.
Yeah. Mm-hmm.
Lisa: And so it's like, what's wrong with me? And, and it was a, it, it's not overstated to say it was an existential moment. And so I got to thinking, well, what, what do I wanna do?
Lisa: And it was a long time before I came up with that answer. And I remember a very pivotal [00:11:00] conversation with my executive coach, longtime executive coach that I'd had for several years. And he said, make sure you're running towards something and not just away from something else. And it was so profound to me.
Lisa: I was out for a walk when we were talking. I remember which intersection I was standing at when he said that, because it just literally stopped me in my tracks. And it took a lot of reflecting to say, am I really running towards something or am I just trying to get away from something that I don't wanna do anymore?
Lisa: And what I kept coming back to was the theme of autonomy, and I wanted the ability to have control over my time, have control over my income, but more so have control over my own risk reward proposition and be able to say. [00:12:00] I wanna do it my way and I'm willing to take the risk for it, but I wanna be rewarded for that.
Lisa: And so I, you know, like most people thought, well, I should start a startup.
Carli: You're literally speaking his heart song, risk reward, risk management, like you two are two peas in a pod.
Spencer: That's incredible. I, that's one of the best articulations of entrepreneurship mm-hmm. That I've heard, and I've never heard it.
Spencer: Articulated in that way, especially that motivation that took so much discipline to see all of these opportunities that most of the world is going to say here is security and certainty, and you've just finished this time working in state government. You're having an opportunity to parlay that into this and to have the discipline to say, I'm not excited by any of that.
Spencer: And to go in a pathway of [00:13:00] entrepreneurship that you're not blind to the risk either of saying, many entrepreneurs don't succeed. Right. Either at all or certainly in their initial efforts towards moving forward. So once you started to recognize that entrepreneurship was the next pathway for you, what then?
Lisa: Yeah. Well, I, the first thing that hit me was the feeling that I was doing it wrong. That I, you know, because I had these offers, I had these opportunities, and clearly my family and friends knew that as well. Like, what's wrong with you? And, and you know, it was this, it hasn't always been this clear in my head.
Lisa: It's like I, I've gotta do something different and, and I mentioned. Creating a startup because I think where I'm coming from, and not only my, my comments today, but also the book in general is [00:14:00] geared towards mid careerist. It certainly applies to folks earlier in their career, but I'm talking about people who have had those corporate reps in mm-hmm.
Lisa: For 5, 10, 15 years. Like, this is fine. It's working well. They compensate me well. I've got a good lifestyle. But there's something missing and it was that entrepreneurial spirit. And so like most. Everybody, particularly mid careers, oh, I'll start a startup. And so I started a consulting startup and you know, it, went great.
Lisa: It, I, it, it grew quickly. But after about six months, I'm like, wait, this is directly tied to my time. I am once again swapping my time for money. And whereas I could, you know, dial it up or dial it back as I needed to, and that was more control than I had previously. It was still not that proposition that the balance that I wanted.
Lisa: And so in that consulting I was doing a lot of investor consulting, helping investor source [00:15:00] deals, helping them do due diligence, o obviously just for healthcare. Helping them raise financing. And it's when I became familiar with the ETA model Entrepreneurship through acquisition, which I was completely unfamiliar with that. I thought I started going down those boxes of autonomy, time, mission, money, and I'm like. I think that's it. And now that I'm on the backside of it, that was totally it.
Spencer: So many people have the misconception that entrepreneurship requires the reinvention of the wheel, that you have to come up and invent something new and start from absolute zero.
Spencer: And how Carli and I have built, at least the first 50% of our companies, was through acquisition through. Acquiring things that we saw opportunities to do it better. And only then once we understood the pain points of the customers that we were trying to [00:16:00] solve, did we have the ability to create some other businesses from scratch that were unique to the space?
Spencer: And I'm so thankful to hear you. Articulate that distinction because most people view acquisition as something that is the fourth or fifth or the sixth step and not the first. So, if you maybe can just talk a little bit about where the book fits in and how that is capturing your journey and. Maybe give us the detail of where the inspiration was, like, okay, I've got something here that I need to write.
Lisa: Sure. Yeah. I mean, my issue with a startup was very practical, which was a, I had no idea of anything new. I, I'm a. Scientist, I'm an operator, not particularly the creative [00:17:00] type. So I didn't have a new idea to start a startup business. And oh, by the way, there was just the practicality of life that these four teenagers who were in high school when I was in state government are now going into college and, you know, eventually going to get married in the next few years.
Lisa: And so from a practical standpoint, I couldn't stop that lifestyle. And go to zero and build from scratch. Yeah. As if I were 26, 28 years old.
Mm-hmm.
Lisa: And so I, I didn't know, I just had exactly the same misconception that you mentioned, which is, oh, I thought people started a business and then they started acquiring and they, then they started, you know, getting bigger that way.
Lisa: I didn't know you could flip the script, but when I became familiar with the model through all of this investor consulting, I thought, wait just a minute, this. Business already has a profit, it already has bones, it already has all of the things. It just [00:18:00] needs some operational help. It needs some efficiency, it needs some scale.
Lisa: I know how to do that.
Mm-hmm.
Lisa: And then the problem became, okay, I think that's the way I wanna do it, but man, I don't know how to do that. And it became very clear. And I say this with humility. I've been blessed with a lot of things. I've, I'm educated, I've got resources, and I had no idea where to start.
Lisa: And I thought. If I don't know where to start, there's probably some more people that don't know where to start. And so let me do a review of the literature. There are a handful of books out there, two primary ones, but after that, that's about it. Mm-hmm. And so. Not only did I need the education, I knew there were other people that needed the education.
Lisa: So I essentially wrote the book I wish I had had when I was doing it
Carli: well. And another misconception I think is when people think about acquiring, they think, okay, I'm gonna buy a dumpster fire. I'm so smart, I'm [00:19:00] gonna go pick out a dumpster fire that I can go fix all the things and I'm gonna pay this much money for it, and then I'm gonna turn it into a billion dollar enterprise.
Carli: Right? And something that I know that you're writing about is. Hey, why don't you find a good business for a fair price and then turn it into an excellent business instead of try to take a dumpster fire to mediocre. And we have done both. Oh yeah. And so I'm speaking from experience. And so I know
Lisa: that's something that you're educating on too.
Lisa: That's right. That's right. And I can't take credit for that. That's a Warren Buffet. You know, it's better to buy a fair business at a good, I'm sorry. Better to buy a good business at a fair price than a fair business at a good price and. When you have those deals that are too good to be true, oh, there's a reason for that.
Lisa: They are too good to be true. and it's not to say people can't, you know, stop the dumpster fire and, and, and make it better, but it's so much more predictable and enjoyable when you can take something that has a [00:20:00] good foundation. And profits on day one and then grow it. Here's my pediatrician analogy.
Lisa: I think about these businesses like adolescents. I like to buy adolescent type businesses, and that doesn't necessarily mean they've only been around 10 or 15 years, but they've got the right bones. They know how to act in public. They can get themselves in and out of the car. They can do all of the basic things.
Lisa: They make a profit, but they need help growing up. They need help maturing. They need help getting bigger and so. In reality that can look like efficient processes the right technology stacks, having the right training and onboarding systematized processes. Prime example, the three companies I have right now, every one of them are in sales and not a single one.
Lisa: How to CRM when I walked in and they were doing just fine, but you just talk about the efficiency that you gain by putting in a basic tool like that. Yeah,
Spencer: I've had a couple friends that have written books over the [00:21:00] years, and usually they're on one end of the spectrum of saying, Spencer, I've never done anything harder in my life and I will never write something again.
Spencer: Or they loved the process and it opened up a new avenue of expression that. This is gonna be the one of 10 or 20 or as many as they get the opportunity to write. So for those that are listening that maybe haven't written their first book, but they too have a story, what would you tell 'em to do?
Lisa: I actually just got this question from a friend the other day because they were talking about, I've always wanted to ride.
Lisa: I've got, I've got an idea, I've even got a title. Which by the way, the title was the absolute last thing that came from me because I, I knew once I put a title on it, it was real.
Yeah. Which,
Lisa: that was tough. But as I told him, write 200 words. And then write 200 words the next day. And I encouraged him to do it for whatever time period.
Lisa: [00:22:00] Felt a stretch, but not terribly uncomfortable. 30 days might been have been a lot, but 10 days or seven days, because you can get a lot out those first few days. And then when the grind starts, it's easy to give up on. So in, in your example, you know, one and done or one of many. I did really enjoy the process, but it was more the setting the goal and completing the goal.
Lisa: There was no doubt it was a slog during it. It took, it took a full year. And that, that was my goal. That's where I came up with 200 words a day is like, you might write 550 today, but if you feel good, but today you're gonna have to do 200. And that means instead of taking a nap on the plane. You're gonna write and instead of reading the book you wanna read while you drink your coffee.
Lisa: It's when you write. And so, it's, it's one of the, it was, it was a thing for me of setting a goal and accomplishing it. And I, I can't promise I'll do another one, but it was fun.
Carli: Do you [00:23:00] find yourself writing. Even journaling or writing things down differently. After you spent a year writing 200 words a day, I'd imagine that became second nature to you.
Carli: Do you now write more often or are you like, I am taking a huge sabbatical from the written word for as long as possible? Fair
Lisa: question. Fair question. No, I find myself writing more, yeah, but more in the business context because whether it's the book or an investor update or whatever, my. Passion lies in translating technical and complicated unapproachable information and translating it into more common speak.
Lisa: And again, we're talking earlier about sometimes it doesn't feel like you're doing it right. Sometimes it doesn't feel like you're doing it right when you're. Simplifying concepts, but I go back to my full-time clinical practice days or really any clinical practice day. I can go in as a physician and I can use all the, what, what I [00:24:00] call $10 words.
Lisa: I can use all the big words, all the fancy medical terms, and it makes me feel and sound smart. But if my patients leave, in my case, my, the parents of my patients leave and they don't understand what I've said. Mm-hmm. I've been wholly ineffective. Yeah. And so that's the approach I took to patients. That's the approach that I took to the book, which is I think a lot of very accomplished and intelligent professionals think, oh, I don't know what EBITDA is.
Lisa: I can't do that. I don't know how to calculate a debt service coverage ratio. Like, let me break it down for you. It's really not that hard. Mm-hmm. And, and that's, that's the tone I took.
Carli: I really wish you were my econ 1 0 1 professor, because I hated that.
Spencer: Lisa, you said earlier, and I thought you were telling a joke when you were saying it, that you know there's one or two books out there that address this topic.
Spencer: I thought you were gonna laugh and say there's actually like 2 million business books out there. But I think it kind of revealed that the book that you have written here is [00:25:00] really targeted towards something different that I, I don't yet grasp. So help me understand the distinction between the joke that I thought you were telling of like.
Spencer: I'm just writing another book amongst 2 million and hoping to stand out versus what you articulated earlier that you were searching for something and there was really only one or two books out there, and maybe they didn't do a great job of articulating what you wanted. So can you. Bring that out to me a little bit more.
Lisa: Sure. And I think that literally the two books that I referenced, and, and to be fair, there are some others, but there's really only two that, that rise to the top. The Harvard Business Review how to buy a small business by the two Harvard professors and then by then Bill by Walker Diebel. And both of those are, are fantastic and informative books.
Lisa: They are geared, in my opinion, they are geared towards the Ivy League, NBA graduate. Hmm. And the reason for that is because ETA, that was the whole impetus for [00:26:00] ETA programs they were born and built out of, and they fight over it. Stanford, Yale, Harvard, so I'll just say all three of them. Stanford thinks they're the winner, and that they started in the eighties and started building these ETA programs and clubs and curricula at these Ivy League schools.
Lisa: And so for a long, long time. The people who launched entrepreneurship through acquisition, also interchangeably, called search funds. Were 26-year-old MBA Ivy League grads, and those books are written for that. Okay. I have an MBA, it's not from an Ivy League school, but I, I know the concepts, I know what they're talking about, and so it was fine.
Lisa: But what I couldn't find in those books is how does this apply to me as I think I was. 44 or 45 years old at the time, and I wasn't just, couldn't just go out and do whatever whenever, move wherever. I had the constraints of a mere, a mid-career professional. That's what I wasn't seeing out there. [00:27:00] So those books are great.
Lisa: They helped inform me, but mine is geared more towards use your network, use your experience, take that, take the the situation that you're in and leverage it for good because we don't all have a full 40 year runway in front of us. Hmm.
Carli: What I think is really interesting about having the two of you sit here right now is that you both kind of figured that out the hard way without anyone telling you.
Carli: You had some mentors and models and books and education, but no one really told either of you how to do that, and now your passion is teaching. Hmm. You through writing a book, you through this podcast or the, it used to be webinars, this desire to take what you learned the hard way and maybe just make it a little bit easier for other people.
Lisa: I, for me, the moment it clicked, actually there were two moments in the whole process that clicked for me. One was. You know, I was at one of these women in finance or you know, some type of industry social event. And there was [00:28:00] an investment banker who I had a great deal of respect for and revered him as being very successful in his profession.
Lisa: And I was telling him what I was doing and he pulled me aside and he goes, I wish I could take you to lunch one day. And you just kind of download what you've learned because he said, I've. Desperately wanted to do that, and I have no idea where to start. Mm-hmm. And I remember thinking, if that guy doesn't know how to do it, I, there's probably other people out there.
Lisa: The other thing was that I, I'd always sort of had like many people do this itch to write, and maybe it did come from wanting to teach and being able to put it on paper, but I couldn't find the right topic to write on. Heaven forbid I wasn't gonna write about politics and I wasn't gonna, I wasn't gonna write an autobiography.
Lisa: I don't think anybody wants to read that anyway. But I was talking to one of my investors and in fact my very first investor, and I was telling him about an issue, a roadblock, or I'll say a speed bump that I had in, in my largest transaction to date. And it had all the [00:29:00] twists and turns and he said, man, you should write a book about that.
Lisa: And I thought, that's it. I should write a book about that. And so it's, it's very technical. It goes step by step. You know, the first third of it is a little bit of my story, but the why and what, what makes for a good business to buy? What are the characteristics? Spoiler alert is not a dumpster fire.
Lisa: And you know what the what and the why. And then the back two thirds of the book is just a very technical how in. Plain language. It's got bolded concepts, so you'll see this concept and here's a plain language instruction on what it, what it means and how it fits into the overall puzzle. And it goes chronologically from sourcing a deal and writing an LOI all the way through closing and the first a hundred days.
Lisa: Hmm.
Spencer: Another similarity that I see in our stories is the. Willingness to put in the time on the ground level and to see [00:30:00] what. The customers experiencing what the people that you're trying to serve are experiencing your colleagues. I mean, you were in that hospital and you were staying up late, drinking the bad coffee.
Spencer: You knew it, and you experienced it at the entry level, at the highest level. And from that, your entrepreneurial ideas really flowed. And I can connect to that 'cause in the logistics world that I come from. And I was driving in a FedEx truck, Carli and I, together for two years delivering boxes running from dogs.
Spencer: And it's only when you appreciate how awful it is to make a left turn in logistics that you're like, you know, right Turns are far superior and. There's a software to be developed around that. And now UPS has a piece of software called Orion, where they will literally engineer the entire day to [00:31:00] avoid a singular left turn.
Spencer: They will have you make three right turns in the navigation to avoid one left turn due to not only the difficulty mm-hmm. Of making a left turn and having to stop, but it's also where a high number of accidents come from. Mm-hmm. So anyway, it's learning these types of pieces that ultimately make you a more successful entrepreneur.
Spencer: And I really appreciate that you stayed in your focus of healthcare because. It would've been easy when you received that phone call to say, are you going towards something, or are you running from something? To maybe say, you know, I've had my fill of healthcare, like I've gone through rural hospitals.
Spencer: I've seen. Horrible child abuse cases. I've lived through the pandemic and COV and all the rest. I'm ready for something new. But instead, you found and went back to your strengths and just [00:32:00] reinvented it in a way that I think a lot of people are hungry for that have done that. 10, 15, 20 years in the corporate space, they're in that mid-career and I think natural born entrepreneurs equips them with a skillset to have the confidence to say, alright, I can go and have this next chapter of my life be one where I get that autonomy of schedule and autonomy of income, and have the ability to create value.
Spencer: A
Lisa: Absolutely, and, and I'll admit my bias comes in here because the two books that I mentioned, not only were they geared towards new grads, they were geared towards people with a blank slate and there, and there's something to be said for that. Mm-hmm. And a lot of investors like to invest in new newly minted MBAs because they're moldable and they're teachable, and they're quite agnostic in the industry that they're in.
Lisa: Nothing wrong with that. I do take a little bit of, [00:33:00] maybe it's too strong to say contrarian view to the typical search fund industry, which is cast a broad net, be industry agnostic, and you know, you're just looking for strong financials and strong business model. Okay, fine. You some people are, some people know how to do that.
Lisa: For me, all I know how to do is healthcare, and I think it gives operators and professionals a leg up because what could look. Very strong on paper. If you know the industry and you know, operational throughput and processes, you can very quickly go, but what about that? Or wait just a minute, that's not gonna work.
Lisa: One story that comes to mind is when I was looking for, when I was doing my traditional search fund, was actually looking in the pharmacy space, I found a. Very lucrative pharmacy. It was up up in the Chicago area, which was outside of my geography, but I was willing to look at it because the numbers were so good.
Lisa: I like to stay in the south. But it was a, a three, for example, [00:34:00] 340B HIV pharmacy. I know that doesn't mean much to, to most people outside of healthcare, but it, it, all it did was dispense HIV medications through the 340B government reimbursement program. Very lucrative, low cost, high margin model.
Lisa: Very scalable. But if you weren't in that industry, you wouldn't know that that 340B program has been on the chopping block for 10 years.
Lisa: And so you take, so that helps you identify that industry knowledge helps you identify concentration issues that you would never get into otherwise. Mm-hmm.
Lisa: So 85% of that revenue was in that program, which could have been gone overnight. And so I don't know how that business is doing now, but I passed on it because of that. Mm-hmm.
Carli: And because it was in the north
Lisa: and because Chicago's really cold,
Carli: we've lived there. And it is indeed very bold. Okay, glad. I glad I didn't do that.
Carli: Yeah, we came back as fast as possible. So, Lisa, to bring it full circle here, as we get to the end, we learned about your clinical background and how that's really informed everything you've done, but your heart for [00:35:00] the rural community. How are you still with the companies you're invested in today as it.
Carli: Practical tactician of medicine, how are you still serving that mission?
Lisa: Thanks for asking because that's the most important part to me. And when you talk about creating an investment thesis, that's part of my thesis is serving rural and underserved populations. And so the three companies I have today, one is a specialty pharmacy in the wound care space and.
Lisa: Whereas not all wound care patients, but most wound care patients are older and sicker and poorer, and they have struggles with social determinants of health or social drivers of health, namely affordability and transportation. And this one that I bought was. A perfect answer to addressing some of those affordability because all we dispense is generic antibiotics.
Lisa: And because antibiotics can sometimes be interchangeable, we're able to substitute things that [00:36:00] insurance coverage the insurance covers, because if it's not affordable, patients can't access it. So it overcomes the affordability barrier. It also is a mail order model to where. They don't have to have a car to go to the pharmacy, and in fact, they don't even have to have a car to go anywhere.
Lisa: The medicine comes to them often because they've been seen by an in-home provider, and so I love that one because it just gets right to that core of serving the underserved. Same kind of thing. In my senior living business, it's in my rural hometown where older couples, their adult children have moved off and oftentimes one of the spouses will get terminally ill or pass away, and then that widow or widower is there alone.
Lisa: Isolated, depressed, doesn't eat, might fall. And instead of going directly into a nursing home, that independent living environment offers them the ability to stay in that rural community. And then my most recent one is work site wellness, which admittedly is a little bit, a little [00:37:00] bit different than that traditional rural access.
Lisa: But we serve wellness programs. For small and mid-size employers. And so it's bringing that health and wellness and fitness component to smaller employers. You know, employees of smaller companies that might not have the benefit, but they still just need that same health and wellness education that all the other larger employees do.
Lisa: So I, I, that's why I just can't imagine being more fulfilled in what I do because it gets all of that autonomy that I wanted, but it helps me still fulfill that mission.
Spencer: I. Lisa, the number one thing that I end up coaching people through when they're thinking about entrepreneurship through acquisition is saying, Spencer, that all sounds great, but acquisition requires a lot of money, and I don't have the money, or I'm gonna bet my entire net worth on this purchase.
Spencer: Do you speak to. The realities of financing and really the capital [00:38:00] structure in your book as well.
Lisa: I hate to admit this part, but that's probably the largest component of the book. Okay. I hate to admit it because that, to me, that's not really the sexiest part, but it, it is absolutely the most needed because I, like you hear entrepreneurs fall into a couple of different categories.
Lisa: I'm gonna. Take everything. I have my whole nest egg. I'm going to leverage all of the debt I can get and do this. I'm like, Hmm, you might not want to do that. Let's not get too risky here.
Mm-hmm.
Lisa: And on the other side of that, you've got some influencers out there, no money down. And you can do this with no money.
Lisa: Like, well, no, that's not true either. You're gonna have to put some of your own money in and more than anything, you're going to have to raise money. Yeah, both on the debt and equity sides of the capital stack. And so the biggest two chunks of the book are on debt financing and on equity financing and everything from how do you make an [00:39:00] investor pitch deck, what is the right cadence to reach out to investors and what are all my debt options?
Lisa: And I tell a story in the book and 'cause it's absolutely true. When I was raising debt for my largest acquisition to date. It was literally the very week that the Silicon Valley Bank collapse happened. Oh my gosh. Well, you talk about how people get nervous giving out debt then, and so just strategies of, oh, there's this different kind of debt financing called mezzanine debt, that they sit on both sides of the stack.
Lisa: That model has worked very, very well for me. I, I talk about SBA financing, although I don't have an SBA loan. I tell people how to do that and so lots of different options. There's private debt, there's all kinds of different sources of that. And so that's one of the barriers that I want entrepreneurs to, to learn to overcome is you don't have to write a check, you don't have to leverage your retirement account.
Lisa: There are ways to do that, but you have to have all of your ducks lined up before you can go [00:40:00] solicit that debt or equity.
Spencer: I'm really glad you cover it because I think people hearing you talk about you pursuing these passions that really define your life and you've devoted a lot of your mental capacity to spiritual capacity to your family, the sacrifices that you've made.
Spencer: It's incredible, and I can just imagine people hearing it and saying for them personally, I've got something that I wanna do. Mm-hmm. But I need to understand how to get there financially, because that's usually the number one roadblock that people have. So I think it's justified that as much time gets spent there.
Spencer: Yeah. So one thing that we do to wrap up every podcast is I have a series of short fill in the blank sentences to read to you. Okay. It's gonna be dangerous, so That's all right.
Spencer: Sounds fun. Let's go. Alright, here we go. A top lesson I've learned from buying businesses is. Blank.
Lisa: [00:41:00] A top lesson I've learned from buying businesses is do not get emotionally involved. Emotional involvement will cause you to make bad decisions and it's difficult, but you have to keep the objectivity.
Spencer: That's excellent, counsel. Alright. You're one of one. Okay. Alright. Nailed it right there. Second question. What most people don't realize about rural healthcare. Is the blank.
Lisa: What hardly anyone recognizes about rural healthcare is that it's not a smaller and simpler version of urban healthcare.
Hmm.
Spencer: Oh, that's a lot of depth there.
Lisa: I need you to say more. He, he gave me a word limit, but I'll, I'll try. I, I, again, use the pediatrician example because everything is framed in my mind about that. Just like children aren't small adults, you can't cut the dose in half. You can't because they have different physiology. It's a different approach to medicine in kids.
Lisa: It's a different approach to rural healthcare. The ideologies are different, the demographics are [00:42:00] different, the infrastructure is different, and so it can't be a smaller or shrunken version of urban healthcare. That's where I see most urban investors who wanna invest in rural healthcare get it wrong.
Spencer: Mm-hmm. That's really good.
Spencer: Last one. The biggest misconception about mid-career reinvention is blank.
Lisa: The biggest misconception about mid-career reinvention
Lisa: is that I have to. Give up everything I've done in the past to make a pivot.
Hmm.
Lisa: The reason that that is a misconception and that's not true is because in my story as as strange and as my dad would say, discombobulated as it looks, there's a pivot point in each one, and I can trace back like seven degrees of Kevin Bacon, how I got to where I was.
Lisa: And so it doesn't mean I'm no longer a physician. It doesn't mean I'm no longer a healthcare administrator. It means I've taken those skills and those lessons and leveraged them [00:43:00] into the next step.
Spencer: Hmm. Dr. Lisa Piercey . Thank you for being here with us on Signature Required. Congratulations. Thank you. On your book and your career, natural Born Entrepreneurs is going to make its way onto Carli and I's shelf, perhaps the bookshelf that we have right here behind us.
Lisa: I hope so. I hope so. Yeah.
Spencer: We'll have to get your signature on that. Of course. And it's really fun to get to hear about your passion and how much of your life you have devoted towards not only healthcare, but healthcare in Tennessee. And that really comes full circle for what we're trying to accomplish here on the podcast.
Spencer: So thanks for being such an advocate for our state.
Lisa: Thanks for letting me talk about it.
