Private equity firms are not good at medicine. They're good at operations. And a study published last week proves it in a way that's uncomfortable for people (like me) who spend a lot of time telling physicians they don't have to sell their practice to grow it.

Brown University researchers tracked 225 primary care practices acquired by PE firms between 2016 and 2022, and published the results in Health Affairs on May 20. The headline findings: PE-acquired practices saw 11% more patients, hired 17% more physicians and 40% more nurse practitioners and PAs, and billed for 30% more services. Most of that increase came from preventive care. Annual wellness visits alone jumped more than 20%.

Per-patient spending stayed the same. The practices got more people through the door and kept them healthier while doing it.

This has everything to do with operations.

The Part Nobody Wants to Admit

The instinct when you hear "private equity in healthcare" is to reach for the pitchfork. And there are real reasons for that. A separate Health Affairs study found that physician turnover increased in PE-acquired practices. Only 14% of physicians think PE funding is good for the future of healthcare. The Milbank Memorial Fund called MSOs the "corporate backdoor to medicine" and flagged the regulatory gaps that let them operate with almost no oversight. Those concerns are legitimate.

But here's what I keep coming back to: PE firms looked at independent primary care and saw what most practice owners were too busy to see. Administrative tasks eat over 40% of a physician's workday. Annual wellness visits generate real revenue but require documentation infrastructure most small practices don't have. Scheduling inefficiency, slow billing cycles, understaffing at the front desk. These are solvable problems. Private equity was able to prioritize the system failures in a way that netted them more cash.

You don't need a private equity firm to run an efficient practice. You need the discipline to build systems like one.

What PE Actually Does When It Acquires a Practice

Strip away the financial engineering and the roll-up strategy, and PE firms do four things when they walk into a primary care practice:

They hire. More physicians, more APPs, more support staff. The Brown study showed 17% more doctors and 40% more NPs and PAs. That's not cutting costs. That's increasing capacity so the practice can see more patients without burning out the physicians who are already there.

They optimize billing. More services billed, tighter revenue cycle management, fewer claims falling through the cracks. It's about capturing the revenue that's already there and being left on the table.

They invest in front-desk operations. Medical practices miss 42% of incoming calls, costing an average of $150,000 annually in lost appointments. PE firms fix this immediately because it's the lowest-hanging revenue fruit in any practice.

None of these require PE ownership. Every single one is available to a physician-owned practice that decides to treat operations as seriously as clinical care.

How to Build the Playbook Without Selling Your Practice

The good news is that the tools and structures that used to require PE-level capital are now accessible to independent practices.

Independent Physician Associations (IPAs) give you collective bargaining power with payers, shared administrative resources, and technology access without giving up ownership. NPR covered the IPA movement earlier this year, and it's growing fast among physicians who want autonomy with scale.

Physician-friendly MSOs handle the non-clinical work (billing, HR, compliance, vendor contracts) while you retain clinical ownership. At least 13 new MSOs launched in 2025 specifically designed to help physicians stay independent. Not all MSOs are the corporate backdoor. Some are built by physicians, for physicians.

AI and automation tools are closing the gap fast. AI receptionists handle scheduling, refills, and insurance questions. EHR-integrated billing platforms tighten your revenue cycle. Automated wellness visit workflows solve the exact documentation problem that PE threw bodies at. The technology exists. The question is whether you're using it.

And then there's the thing PE can never replicate: your brand. Patients overwhelmingly prefer independent practices over corporate-owned ones. They trust the doctor-patient relationship more. They stay longer. They refer more. That's not an operations advantage. That's a branding advantage. And it only works if patients can actually find you, which means your digital presence and local SEO have to be as disciplined as your clinical care.

PE can buy operational efficiency. It can't buy the trust that comes from a physician who owns what they built.

The Real Competition Isn't PE. It's Your Own Reluctance to Systematize.

The Brown study should be a wake-up call, but not the kind you'd expect. The threat isn't that PE firms are coming for your practice. It's that they've proven what's possible when someone treats a medical practice like a business, and most independent physicians still resist doing the same.

You survived medical school. You can learn to build a business plan and run an efficient operation. The physicians who thrive in 2026 and beyond won't be the ones who avoided PE. They'll be the ones who stole PE's operational playbook and paired it with something no firm can replicate: a practice that belongs to them, a brand patients trust, and a digital presence that makes all of it visible.