Is private equity destroying primary care or (gasp!) helping it be more efficient?

For the modern physician, the landscape of practice has undergone a seismic shift in less than a decade. The image of the independent practitioner — the "captain of the ship" who owns their office and manages their own staff — is rapidly becoming a historical relic. As of early 2026, a staggering 82% of practicing doctors are employed by hospitals or corporate entities, a new high that leaves only 18% of physicians in physician-owned settings. Among the most debated drivers of this consolidation is private equity. While often portrayed in a "vampire" narrative of asset-stripping and extraction, a study from Brown University suggests that in the realm of primary care, the reality is far more nuanced.

The Brown study: A challenge to the consensus

In a study published in Health Affairs, health policy researchers at the Brown University School of Public Health tracked data from 225 primary care practices acquired by PE firms between 2016 and 2022. Their findings challenge the one-size-fits-all criticism of private investment. Instead of the expected staffing cuts and reduced services, researchers found that PE-acquired practices saw 11% more patients and provided 13% more services per individual patient.

The driver of this change appears to be a hyper-focus on preventative care and administrative efficiency. For instance, Medicare annual wellness visits — a comprehensive checkup that independent practices often struggle to complete due to documentation burdens — increased by more than 20% under PE ownership.

“Our prior work has highlighted specific harms from private equity firms acquiring and consolidating physician practices, including higher prices for patients and insurers,” says Yashaswini Singh, lead study author and an assistant professor at Brown. “This study is a reminder that the relationship between private equity and patient care is more complicated than it first appears, and financial incentives shaped by payment policy play an outsized role in how private equity operates.”

This cost efficiency has a direct impact on the bottom line. While individual patient spending remained stable, total Medicare spending per doctor rose by 15%, driven by the sheer volume of services billed under Medicare’s fee-for-service model.

The staffing divergence: Primary care vs. the hospital

One of the most striking contradictions revealed by the Brown study is in staffing. In other sectors, such as hospitals and nursing homes, PE is notorious for "lean" models. Research in the Annals of Internal Medicine shows that PE-acquired hospitals often see an 11.6% drop in full-time employees, with salaries in emergency departments and ICUs falling by 18% and 16%, respectively.

However, the Brown team found that primary care practices followed the opposite trajectory. These practices hired 17% more physicians and 40% more nurse practitioners and physician assistants. This suggests a strategy of scaling up to meet increased volume rather than cutting to the bone.

“Research has documented real harm from staffing cuts following private equity involvement in other settings, as in the case of hospitals and nursing homes, but we must resist a one-size-fits all takeaway,” says Singh. “What we see in primary care is more nuanced: practices grew their teams and drew on both physicians and advanced practice providers in the short term.”

The human cost: Autonomy and clinical integrity

Despite the quantitative gains in patient access and preventative screenings, many physicians remain deeply skeptical of the corporate model. The Physicians Advocacy Institute notes that corporate entities now own 63.9% of all physician practices in the U.S., a massive increase from just 29.8% in 2018.

“The corporate takeover of physician practices continues unabated, causing fundamental changes in how physicians practice medicine in this country,” Kelly Kenney, CEO of PAI, told Medical Economics. “Whereas corporate owners have a fiduciary responsibility to their shareholders, physicians always have an ethical responsibility to their patients. Now is the time to adopt policies to protect against corporate interference in physicians’ medical decision-making. Corporate profits must never take precedence over patients.”

This ethical clash is not just theoretical. For many, it is personal. Marco Fernandez, an anesthesiologist, told Medical Economics that the "extraction" model prioritizes profit over the quality of the patient experience. He recounts a heartbreaking personal example where his mother suffered in an inpatient hospice unit due to inadequate nursing care provided by a PE-owned staffing agency.

"They consolidate, and then they try to figure out how to reengineer the practice to maximize and extract profits,” says Fernandez. “They raise prices, and they cut expenses by decreasing nursing staff and replacing physicians with nonphysicians... Private equity cuts and cuts, and patients are the ones who are suffering.”

Similarly, Robert McNamara, co-founder of Take Medicine Back, told Medical Economics about the risks of replacing board-certified physicians with cheaper alternatives:

“These are companies where investors look for opportunities to get back a 15% to 20% return on investment within a five- to seven-year period,” says McNamara. “The company determines who sees patients. Private equity says, ‘What’s the business decision here? Is it going to be a board-certified doctor, or is it going to be a nonphysician practitioner? How can I get away with the cheapest model?’”

The new playbook: From consolidation to "Operational Excellence"

The private equity industry itself acknowledges that the "easy money" of simple consolidation is gone. According to the Bain & Company Global Healthcare Private Equity Report 2026, the focus has shifted from "raw consolidation" to "operational excellence.” Investors are now targeting specialties where they can solve specific financial headaches, such as oncology (specialty pharma costs) or cardiology (the shift to value-based care).

Kara Murphy, co-leader of Bain’s healthcare team, told Medical Economics that the value-creation playbook has expanded:

“Investors are increasingly focused on operational excellence, including improvements in access, workflow and care coordination enabled by the use of data, analytics and AI; deeper physician alignment; and sustainable, organic growth. Physician groups remain a popular investment theme... though the pace of investment has eased since 2021 in part due to macro challenges.”

This shift includes heavy investment in healthcare IT and generative AI, aimed at hitting the "Rule of 60"—a performance metric where the sum of revenue growth and profit margin exceeds 60%. For the clinician, this might mean more sophisticated revenue cycle management or tools designed to reduce administrative burnout, though the ultimate goal remains the maximization of the platform's value for a future sale.

The regulatory counter-response

The rapid rise of PE has not gone unnoticed by policymakers. Oregon recently enacted the nation’s strictest limits on corporate interference in healthcare, and Indiana has expanded the attorney general’s powers to investigate corporate ownership. Furthermore, the federal government has intensified its scrutiny of consolidation, forcing investors to focus more on demonstrating clinical excellence and compliance than in previous years.

Jared Rhoads told Medical Economics that every buyout is a "voluntary exchange" by physician-owners. However, he also issued a warning about financial maneuvers that allow firms to "privatize their gains while socializing their losses" through bankruptcy and land sale leasebacks.

He said the empirical case against PE in health care is far from settled. When a PE firm tries to increase the value of a practice, they aren't trying to make it worse; they are trying to improve it so they can eventually sell it for a profit.

A call to reclaim the profession

For the individual physician, the "efficiency" of private equity remains a profound paradox. The Brown University study provides evidence that PE can, under certain conditions, expand access and improve the delivery of preventative services like wellness visits and screenings. Yet, the study also leaves open the questions of reduced clinician autonomy and long-term burnout.

Fernandez said that physicians have more power than they realize to shape the future of the industry. Whether through grassroots advocacy or participation in organized medicine, the goal is to ensure that the sophisticated operating models championed by investors do not come at the expense of the patient-physician bond.

Ultimately, Singh’s conclusion at Brown perhaps best summarizes the challenge for the medical community:

"In many other settings, my colleagues and I have documented clear harms from private equity. This study posits a different question: Under what market conditions and incentives can private equity actually deliver on the promises it makes around expanding access and improving care — and how do we create more of those conditions?”