Most Physicians Down on Private Equity in Healthcare

Most physicians have negative views of private equity involvement in healthcare, according to a survey of internal medicine physicians.

Among the 525 physicians who responded, 60.8% viewed private equity involvement negatively, Ryan Crowley, BSJ, of the American College of Physicians (ACP), and colleagues reported in JAMA Internal Medicine.

Only 10.5% viewed private equity involvement in healthcare as positive, and 28.8% were neutral, the authors noted.

A subset of respondents who were employed by private equity were less likely to report high professional satisfaction (being “extremely” or “somewhat” satisfied) compared with doctors who didn’t work for private equity-owned clinics (44.8% vs 74.4%), Crowley and colleagues reported.

They also reported having less autonomy (48.3% vs 66.3%), the researchers found.

“Our findings suggest that many physicians view private equity ownership with caution, and with concern particularly around influence over clinician decision-making and long-term well-being,” Jane Zhu, MD, of Oregon Health and Science University in Portland, who was the first author on the paper, told Medpage Today. “These concerns are important to take seriously and to study carefully.”

Private equity investment in healthcare has increased in recent years, and recent studies have started to raise concerns that private equity ownership can impact patient care and increase physician burnout. And last week, the Federal Trade Commission announced a joint investigation into private equity and “corporate profiteering.”

To better understand physician perceptions about private equity, Crowley and colleagues assessed data from the ACP’s IM Insider Research Panel, involving 1,397 ACP members and non-members. The survey was open from January 5-31, 2023, and of the 925 eligible panelists, 525 responded (56.8%).

Most respondents were general internal medicine physicians (67%); 70.3% were salaried employees and 21.9% were owners or partners in physician group practices.

A total of 5.5% worked for a private equity-acquired healthcare entity, and nearly 10% reported that private equity had expressed interest in buying their practice.

A substantial proportion of physicians also felt private equity ownership was worse or much worse than independent ownership (52%) and not-for-profit hospital or health system ownership (49.3%), the researchers found.

Most found private equity ownership unfavorable for physician well-being (57.7%), healthcare spending (57%), and health equity (51.2%) — though they said healthcare innovation could be one positive.

Crowley and colleagues also found that fewer physicians employed at private equity-backed institutions reported being extremely likely or somewhat likely to remain with their employer compared with those not involved with private equity (44.8% vs 77.8%).

“The sample of private equity-affiliated physicians is small, but may point to broader implications for hiring and turnover if physicians are less satisfied working in private equity-involved practices,” Crowley told MedPage Today.

“Private equity owners rely not only on willing sellers, but also on a satisfied clinical workforce, so the reasons for these perspectives are important to consider,” Zhu added.

In an accompanying editor’s note, Cary Gross, MD, of the Yale School of Medicine in New Haven, Connecticut, and Giselle Corbie, MD, MSc, of the University of North Carolina at Chapel Hill — both of whom are associate editors at JAMA Internal Medicine — said the results “raise two important questions about the downstream effect of the commodification of U.S. healthcare.”

The first concerns confronting the moral injury among clinicians who “may be torn between two conflicting agendas: (1) the physical and mental health of their patients, and (2) the financial health of the health systems’ owners.”

The second asks whether the growth of private equity will exacerbate health inequity, as it focuses on healthier, better-insured patients.

“Before putting up ‘for sale’ signs across the health care system, it is incumbent on physicians, regulators, and professional societies to call for more evidence and to ensure patient access to high quality care — before it is too late,” Gross and Corbie wrote.

Sailesh Konda, MD, of the University of Florida Health System, who has conducted research on the influence of private equity in dermatology, told MedPage Today that doctors “from all over the country have shared with me their negative experiences with private equity-backed groups placing profits over patients.”

“However,” Konda noted, “many physicians are unable to voice their concerns publicly due to non-disparagement clauses in their contracts.”

Konda said the study will help advance the conversation about private equity investment in healthcare, especially within government agencies that are beginning to scrutinize these ownership models. But he emphasized that those agencies will need to hear directly from physicians who are experiencing the issues outlined in this research.

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