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Recently I’ve been struck by a pattern that keeps surfacing in physician interviews, particularly in ophthalmology, dermatology and gastroenterology (three MD specialties I happen to be interviewing a lot these days). At the start of a typical marketing research interview, I ask respondents to describe their background and practice setting. Increasingly, I’m hearing: “We’re PE-owned.” What once felt more like an anomaly is increasingly a regular response. And when a pattern appears in qualitative interviews across markets and specialties, it signals a broader industry trend -- one we should pay attention to.
Data from the AMA’s 2024 Benchmark Survey confirms just how significantly the landscape has shifted. Only 42.2% of U.S. physicians now work in private, physician-owned practices, down from 60.1% in 2012. Hospital-owned practices increased to 34.5%, and private equity (PE) owned practices rose to 6.5%, with nearly 38% of PE acquisitions occurring after 2019. In short, consolidation is not simply ongoing -- it’s accelerating.
These ownership dynamics matter because they define the governance models shaping clinical decisions. We often think about prescribing behaviors through the lens of individual decisions based upon clinical evidence, patient characteristics and situational variables, and/or payer dynamics. Increasingly, though, a key predictive variable is far more fundamental: who controls the practice itself.
Independent practices tend to emphasize autonomy, entrepreneurial decision-making, and flexibility in adopting innovative therapies -- conditions that can speed uptake when workflow, reimbursement, and patient benefit are well aligned. Hospital-owned practices, by contrast, often operate through standardized pathways, formulary/P&T or technology assessment committee reviews, and centralized budgeting processes. Adoption can be slower, but often broader once system-level alignment is achieved.
PE-owned practices bring yet another governance logic. Recent research and industry interviews highlight that while private equity ownership is far from monolithic, certain features recur: centralized purchasing decisions, capital discipline, productivity and throughput expectations, and more consistent operating playbooks across sites. These elements can influence everything from diagnostic equipment upgrades to the timing and structure of therapeutic adoption.
A recent Commonwealth Fund interview (https://www.commonwealthfund.org/publications/podcast/2025/may/how-private-equity-deals-are-reshaping-your-health-care) with Dr. Zirui Song underscores this variability. PE transactions differ by market, specialty, and financing model, yet they share an orientation toward operational efficiency and return generation that inevitably touches clinical workflow. The pressure isn’t always explicit, but it becomes part of the abiding context in which physicians practice.
Layered onto this is emerging evidence from hospital settings, including studies linking PE acquisitions to increases in certain hospital-acquired adverse events. While these findings aren’t universally generalizable, they reinforce a central idea: ownership changes incentives, and incentives shape workflows.
All of this means that when we evaluate physician behavior purely at the individual level, we risk missing the organizational context that increasingly governs clinical choices.
One of the most intriguing recent contributions comes from research highlighted in Harvard Business Review and published in JAMA Health Forum. Led by Leemore Dafny and colleagues, the study examined what happens not just when PE firms acquire medical practices, but when they eventually exit -- a standard feature of the private equity model.
Analyzing more than 1,200 physicians across 52 PE sales, the researchers found that within two years of the exit, physicians in PE-owned practices were 16.5 percentage points more likely to leave compared to peers in similar non-PE-owned practices. Perhaps more importantly, those who left were 10 points more likely to move to very large practices (over 120 physicians), reinforcing broader industry trends toward consolidation.
This is not simply a staffing story. It suggests that PE ownership, and particularly PE exits, may contribute to the migration of talent into larger, more centralized organizations. For commercial teams, this creates ripple effects: decision-makers shift, committees evolve, and the locus of influence may no longer reside at the site of care but upstream in a corporate office or regional command center.
As consolidation deepens, the question of ownership becomes an essential lens for understanding adoption barriers, educational needs, and messaging strategies. If a practice is newly hospital-owned, clinical autonomy may be intact in year one but narrower by year three as pathways mature. If a practice is PE-owned, purchasing authority might sit with an operating partner or a national clinical leader rather than the physician you’re interviewing. If the practice is independent, time, capital, and administrative bandwidth may be the critical constraints.
These nuances matter not only for message framing but for how we design our research studies. Too often, we treat ownership as a background variable -- something to note but not to analyze. In reality, it is a structural determinant that meaningfully influences prescribing, access, and adoption patterns. The failure to capture it can lead to blurred insights and misplaced strategic bets.
What’s encouraging is that policymakers and regulators are also recognizing the importance of transparency. States like Massachusetts and Indiana have enacted new oversight and reporting requirements for health care transactions involving private equity and other investors, underscoring that ownership is no longer an invisible force in care delivery, but a material variable worthy of scrutiny.
The rise of PE ownership, the continuing expansion of health systems, and the decline of independent private practice collectively represent one of the most significant structural shifts in modern U.S. healthcare. These trends carry real implications for how care is delivered, and how pharma commercial and insights teams engage the clinicians delivering it.
As researchers and marketers, we need to stop treating ownership as a footnote and start treating it as the first question. It frames the environment, shapes the incentives, and defines the decision-making architecture that ultimately governs treatment choices.
In a healthcare landscape where fewer decisions are made by individual physicians and more are shaped by the organizations behind them, that first question -- Who owns this practice? -- may be the key to understanding everything that follows.
Sources: AMA Policy Research Perspective (2024); Commonwealth Fund interview with Zirui Song; JAMA evidence on post-acquisition outcomes; HBR and JAMA Health Forum analysis of PE exits and physician turnover.
