Although I am generally an optimist, I am pessimistic about the entry of private equity (PE) into healthcare, particularly primary care. Although I could imagine a world in which PE does some good—making money by reducing waste in medical care—mostly what I see is milking more money from payers while, at best, not hurting anyone.
What does make me optimistic are bright medical students actually trying to collect data so we can know the truth about the effects of these changes in healthcare.
Adam Cifu
“Primary care today just isn’t the same as it used to be,” is something I have heard from plenty of primary care physicians. These physicians began their practice in an era that, from where I sit as a second-year medical student, looks almost unrecognizable. Most physicians are employees now, not owners: a recent report found that, as of the start of 2026, roughly 82 percent of practicing physicians were employed by a hospital or other corporate entity, up from around 25 percent in 2012.
Amid the drastic wave of upscaling, consolidation, and corporatization that has swept across US healthcare in recent decades, private equity (PE) has become the most recent villain. And indeed, the existing evidence on PE in healthcare is not encouraging. A widely cited study in JAMA found that hospitals acquired by PE firms saw a 25.4 percent increase in hospital-acquired adverse events relative to matched controls, driven largely by falls and central line infections. Research on procedural specialties has documented meaningful price increases once PE enters a market.
PE can threaten hospitals, physicians, and patients. In a highly publicized case in Massachusetts, for example, the PE-backed Steward Health Care sold hospital land and entered into a sale-leaseback agreement with a real estate investment trust. The capital raised from the sale likely returned to the PE investors rather than being invested in the individual Steward hospitals. Then, facing high rent on the land they sat on, the hospitals fell behind on invoices to medical supply vendors, eventually leading to bankruptcy. A recent paper in BMJ found a pattern between real-estate investment trusts, including PE, acquisition of hospitals, and resulting bankruptcy. There is also evidence that physician turnover rises after PE acquisition. Taken together, this body of literature suggests that PE investments in healthcare may do more harm than good.
However, there’s a twist. PE investors see primary care practices as entirely different businesses than inpatient or specialty care.
My colleagues and mentors at Brown have been investigating whether the overwhelmingly negative findings of PE’s impact on healthcare extend to primary care. In Health Affairs, we found that PE acquisition of primary care practice increased the number of billed services and the number of patients each physician saw. A meaningful share of that increase came from preventive care, particularly the Medicare Annual Wellness Visit. Patients in acquired practices were more likely to see a greater number of distinct physicians and APPs, with the latter growing at a faster rate than in matched controls. In JAMA Health Forum, we looked specifically at acute care outcomes such as all-cause hospitalizations, potentially avoidable hospitalizations, and ED visits in the traditional Medicare population.
We didn’t find any compelling short-term improvement in health outcomes, with the only significant finding being a small decrease in all-cause ED visits. Even this finding did not persist across sensitivity tests nor was it clinically meaningful. And in MCRR, we found no meaningful effect on the delivery of low-value care after PE or hospital acquisition. Our findings on increased utilization and cost of care align with the broader literature that shows PE-driven consolidation is associated with billing for higher-intensity visits, increased patient volume, and higher prices due to a practice’s greater market power.
In summary, PE’s effect on primary care seems to be more billing and more preventive care documentation, without clear harm to acute outcomes or an effect on low-value care.
A few questions that are worth sitting with: Does more billing mean more services were delivered, or does this represent more thorough documentation for the same services that were already being provided? And if it does mean more services, is this clinically beneficial? It’s also probably too early to see PE’s long-run effects on primary care because most of the deals are recent (after 2019). Since most of our evidence comes from traditional Medicare (a fee-for-service system), it tells us less about what happens under Medicare Advantage, in the employer-sponsored insurance space,1 or other value-based payment designs, where the incentives to over-bill or under-treat run in different directions.
Zooming out, capital investment in health care isn’t going anywhere, and I’d argue it’s hard to judge if PE is worse than the hospital-based consolidation that preceded it. PE does not have to be the villain. Capital is essential, and when deployed well, has real power to do good. However, when investors’ focus is on short-term return, typically five to seven years, the incentives don’t always align with what patients – or physicians – need over the long run.
The deeper issue is market power – on both the insurer and provider sides – and our patients ultimately absorb the cost of that power, whether through bills or premiums. The average annual premium for family coverage through an employer hit $26,993 in 2025, up 6 percent from the year before, outpacing both wage growth and inflation. Regardless of who owns the practice down the street, it is ordinary households footing the bill for the system’s growth. The right response is not a blanket ban on PE ownership, but more transparency into all ownership structures, more measured interpretation of the evidence as it accumulates, and less appetite for one-size-fits-all policy before we understand what is happening.
What does this mean for future physicians? Perhaps we won’t know anything different since most of us will likely never experience being a physician/small-business owner, but will I increasingly feel like a cog in a corporate machine? What does this mean for physician retention, job satisfaction, and the quality of a patient-physician relationship? I worry that in a setting where workforce shortages are already acute, consolidation from PE or other large capital investment may further worsen retention in primary care.
I think about my father’s educators, and why primary care physicians of that era are remembered with such nostalgia. It was never really about the tools they had. It was about autonomy and about a physician-patient relationship that wasn’t mediated by anyone’s ROI calculation. Whether the essence of that model of care can survive the current wave of consolidation, PE or otherwise, remains to be seen.
Meehir Dixit is a second-year medical student at the Pritzker School of Medicine, University of Chicago. He obtained a B.A. in Public Health from Brown University, where he spent time during his undergraduate studies and gap year leading and collaborating on various projects within health services research, ranging from private equity in primary care to contract terminations in the Medicare Advantage program.
He is deeply grateful to Dr. David Deshpande, Professor Yashaswini Singh, Dr. Ira Wilson, Margherita Rampichini, and his parents, Dr. Ninad Dixit and Dr. Trupti Dixit, for their crucial support in shaping this essay and his journey thus far.
