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After the Deal: What Happens to Patients and Physicians When Practices Take Investment
An MSO, private equity or health-system offer usually arrives with a promise that patients will not notice a thing. The published evidence lets a physician test that promise against what happened to prices, volume, quality, staffing and physician autonomy in practices that already took the money. Most of that evidence comes from specialty practices, not concierge medicine, and this brief says where the gaps are. It ends with a checklist of protections to raise with counsel before signing.
New in October 2026. Prompted by an unresolved exchange at the Concierge Medicine Forum 2026, and built on peer-reviewed studies, a federal review and enforcement records.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
After private equity buys a physician practice, studies most often find higher prices and more volume. Commercial spending rose 4% to 16% depending on specialty, in the studies a 2025 federal review summarized. Quality is the thinnest part of the record. The best studies of gastroenterology and primary care found no measurable change, and the GAO found no study strong enough to say what investment does to quality. Clinician turnover rises, and nurse practitioners and physician assistants make up more of the staff. Patient experience in the front office and on the bill has barely been measured, and CMT found no published study of what happens after a concierge practice takes investment. Treat the deal documents as the place where patient experience is protected. Clinical governance, reserved powers, fee changes, patient communication and exit terms belong in writing.
Do prices go up after a practice takes private equity money?
Usually, in the studies available. Increases range from about 3% to 11% for prices actually paid, depending on specialty and study, and are larger where one investor owns a big share of a local market.
Go to the full answer ↓Does quality of care fall?
The evidence does not show that clearly either way. Gastroenterology and primary care studies found no measurable change, a systematic review rated quality effects mixed to harmful, and the GAO found no rigorous causal study of physician practices.
Go to the full answer ↓What happens to staff and physicians?
Turnover rises. Studies find more clinicians entering and leaving acquired practices, with nurse practitioners and physician assistants added faster than physicians. Surveyed physicians in PE-owned practices reported lower professional satisfaction.
Go to the full answer ↓Is there evidence about concierge practices specifically?
Very little. Corporate affiliation among concierge and DPC practices grew sharply from 2018 to 2023, but CMT found no published study of prices, quality or patient experience after a concierge practice took investment.
Go to the full answer ↓What is happening with regulators?
The FTC challenged a Texas anesthesia roll-up in 2023 and settled with its private equity backer in 2025. Oregon passed a law in 2025 limiting MSO control over clinical and business decisions in physician practices.
Go to the full answer ↓What should I ask for in a deal?
The checklist in Part 5 covers clinical governance, decisions reserved to physicians, patient communication, fee changes and exit terms. It produces questions for counsel, not legal conclusions.
Go to the full answer ↓“Patients won’t notice.” Will they?
At the Concierge Medicine Forum 2026, a presenter walked through how outside investors build concierge platforms: start with one larger practice, then add smaller ones, often with a management services organization (MSO) as the vehicle. Moving back-office staff into an MSO, the presenter said, should be invisible to patients. They would call the same number and see the same people.
An attendee disagreed. Patients feel it, the attendee argued, at the front desk, on the bill and in whether their doctor still seems to be in charge. The presenter allowed that problems can grow once an MSO serves many practices. The session ended there, with the question open.
This brief puts that question to the published evidence. It is a fair question for any physician holding an offer, and the research on what happens after practices take investment has grown quickly since 2021.
Concierge medicine is already part of this market. The largest national concierge network, MDVIP, has been majority owned by Goldman Sachs Asset Management and Charlesbank Capital Partners since October 2021, when it reported about 1,100 affiliated physicians.3 Industry Research Among concierge and DPC practices combined, the independently owned share fell by about a quarter in five years.2
Nearly all of the outcome research covers specialty practices, mainly dermatology, ophthalmology, gastroenterology and anesthesia, with primary care studies arriving only in 2025 and 2026. CMT found no published study of what happens to prices, quality, staffing or patients after a concierge practice takes investment. A concierge practice earns much of its revenue from a membership fee and runs a small panel, so specialty findings about claim prices and volume may not carry over directly. The findings below are the closest evidence available, not a description of concierge deals.
Prices rise in most studies, and so does volume
Prices are the best-studied outcome, and the pattern is fairly consistent. A 2023 systematic review in The BMJ found 12 studies of costs to patients or payers: nine found harmful effects, three found no effect, and none found a benefit.4 Population Data
The largest specialty study compared 578 acquired dermatology, gastroenterology and ophthalmology practices with 2,874 controls. Allowed amounts per claim rose $23, or 11%, relative to controls.5 Population Data An earlier dermatology study found routine visit prices 3% to 5% higher about 18 months after acquisition, with no significant effect on total dermatology spending.8 Population Data The GAO’s 2025 review summarized the field this way: limited studies, with “some evidence of price increases for commercial insurance,” and commercial spending up 4% to 16% depending on specialty.1 Population Data
More patients, more services
Volume moved too. In the 2022 specialty study, unique patients rose 25.8% and new patient visits 37.9%, and the share of established-patient visits billed as longer than 30 minutes rose 9.4%.5 Acquired gastroenterology practices performed 12.1% more colonoscopies per physician, although volume was already rising before the deals.7 Population Data
Primary care looks different. In Medicare claims for 225 primary care practices acquired from 2016 to 2022, physicians billed about 30% more services and practices saw about 11% more patients. Most of the added services were preventive, including a rise of more than 20% in annual wellness visits.9 Spending per physician rose about 15%, while spending per patient did not change.10 Population Data The authors read that as more care for more people, not costlier care per person.
Market share matters
Prices tend to rise more where one investor dominates. By 2021, a single private equity firm held more than 30% of at least one specialty in 108 metropolitan areas.11 Population Data A 2023 report from the American Antitrust Institute and UC Berkeley found that in highly penetrated markets, prices rose about 1.5 to more than 3 times as much as in markets overall.12 Practice Insight The FTC made a similar argument in court, alleging that a Texas anesthesia group raised each acquired practice’s rates to its own higher rates.13 Policy and Law These are allegations, not findings.
In a fee-for-service specialty practice, patients may never see a price change on a claim. In a concierge practice they see it directly, because the membership fee is the price. If an investor’s return depends on fee increases, more members per physician or add-on services, patients will notice. That is CMT’s inference from how membership practices earn revenue. No study has tested it.
Quality, patient experience, staffing and autonomy
The attendee at CMF was asking about these outcomes, and they are harder to measure than price. Here is what CMT found, and where the record is silent.
| Outcome | What studies found | Where the evidence comes from | Evidence type |
|---|---|---|---|
| Clinical quality | No statistically significant change on six colonoscopy quality and safety measures, including incomplete procedures and adverse events.7 In primary care, no meaningful change in all-cause or preventable hospitalizations; a small drop in emergency visits did not hold up under other follow-up periods.14 | Gastroenterology (commercial claims); primary care (Medicare, 2016 to 2022) | Population Data |
| Quality across health care | Of 27 studies on quality, the BMJ review rated the overall effect of private equity ownership as mixed to harmful.4 The GAO found no study that sufficiently examined the causal effect of private equity on quality.1 | Many settings, not only physician practices | Population Data |
| Access and patient experience | The GAO found no study of access that met its standards, for any type of owner.1 One dermatology study found more appointment availability at private equity clinics.4 CMT found no study of front-office service, billing experience or patient satisfaction after acquisition. | Dermatology; federal review | Population Data |
| Staffing | Clinicians were more likely both to join and to leave acquired practices, and advanced practice providers increased each year while physician counts did not change significantly.15 In primary care, acquired practices gained 0.39 clinicians each (12.2%), but exits rose by 0.22, mostly among nurse practitioners and physician assistants.16 Another primary care study found about 17% more physicians and 40% more NPs and PAs.9 | Derm, GI, ophthalmology (2014 to 2019); primary care (2018 to 2022) | Population Data |
| Physician autonomy and satisfaction | In a survey of 525 physicians, 60.8% viewed private equity in health care negatively. Professional satisfaction was 44.8% among PE-employed respondents and 74.4% among others, but only about 5% of respondents worked for a PE-acquired entity.17 | American College of Physicians research panel | Practice Insight |
Practice mix shifts too. By 2017, private equity-owned dermatology practices had four advanced practitioners for every 10 dermatologists, compared with three at other practices.8 Population Data More clinicians can mean more appointments. It can also mean a patient who joined for one physician is seen by someone else. In a membership practice, that difference goes to the heart of what the fee buys.
The research counts claims and clinicians. What patients notice is who answers the phone, who sets the fee and whether their doctor still has the final word.
The hospital evidence is more troubling, and the American College of Physicians cited it in a May 2026 position paper calling for transparency, stronger antitrust enforcement and protection of physicians’ clinical autonomy.18 Practice Insight Hospitals are a different setting from office practices, and CMT does not carry those results over to them.
The case for investment, the case for caution, and where regulators are
Investment is not one thing. A physician-led MSO that pools billing for six practices is a different deal from a private equity roll-up built to resell in five years. Most of the research identifies private equity ownership and cannot separate those structures.
The case for investment
Independence is getting harder to afford. Physician groups told the GAO that practice expenses have grown faster than revenue, and AMA data show the most common reasons physicians sell include negotiating higher payment rates and easing administrative burden. Affiliating with an MSO was described as one way to stay independent.1 Population Data
Investors told the GAO that capital can bring quality tools and better scheduling.1 In primary care, acquired practices added clinicians and delivered more preventive care, and short-term hospital and emergency use did not worsen.9,
The case for caution
Prices and spending rise in most studies, and more where an investor holds a large share of the local market.4,
The primary care authors themselves describe their quality findings as “suggestive of minimal short-term impact rather than definitive evidence of patient benefit.”14 CMT found no study that follows acquired practices through a second sale.
Where regulators are
The FTC sues U.S. Anesthesia Partners and its private equity backer, Welsh Carson, alleging a roll-up of more than a dozen Texas anesthesia practices that cost Texans “tens of millions of dollars more each year.” The FTC chair says the agency will keep challenging “serial acquisitions, roll-ups, and other stealth consolidation schemes.”13 Policy and Law
A federal court dismisses Welsh Carson from the case; the case against USAP continues.19
The FTC finalizes an order requiring Welsh Carson to limit its involvement with USAP and to notify the FTC of certain future investments in anesthesia and other hospital-based physician practices.19 Policy and Law
Oregon enacts Senate Bill 951. It bars MSOs from controlling physician hiring and pay, schedules and patient load, clinical protocols, coding, pricing and payer contracts, and it voids most noncompetes for clinicians. New MSO arrangements are covered from 2026; existing ones have until 2029.20 Policy and Law
The GAO publishes its review of physician consolidation and finds no study strong enough to show the causal effect of private equity on quality.1
The FTC and USAP announce an agreement in principle, and the court stays the case while a settlement is finalized. Terms were confidential as of June 2026.21
The American College of Physicians calls for closing transparency gaps in health care private equity and protecting clinical autonomy.18 Practice Insight
After this deal, who decides how many patients you see, what the membership fee is and what happens when the investor sells? If the answer is not “you,” in writing, patient experience depends on the goodwill of people who may not be there in five years. That is CMT’s editorial reasoning, not legal advice.
Protections to ask for before you sign
Check each protection your current draft addresses. The meter shows coverage, and the list below it names the areas with open items. Each open item is a question to take to your health care attorney. This tool does not judge whether any term is lawful, enforceable or right for your practice; that depends on your state and your deal.
Deal protections checklist
Clinical governance
Reserved powers
Patient communication
Fee changes
Exit
“Healthcare may be a process, but the patient should never feel processed.”
Michael Tetreault, Editor-in-Chief, Concierge Medicine Today. Commentary from the CMT Media Desk, labeled as CMT’s view, not a research finding.22 CMT original
The reason respondents cited most often for leaving a prior doctor was feeling like a number (n=1,085).23 Industry Research
CMT reading: If a deal changes the front office, billing or the physician’s time, members will feel it in exactly this way.
CMT Patient Study: people searching for a concierge or membership physician through CMT, January 2013 to December 2024. Self-selected, not nationally representative and not peer-reviewed; DPC patients excluded. CMT original
Read past the price findings
The best evidence covers specialty claims. For a concierge practice, the questions that matter most are fee, panel and who decides, and the research has not reached them yet.
Write the protections down
Promises that patients will not notice belong in the contract: reserved powers, fee rules, a continuity plan and exit terms, reviewed by counsel.
Tell patients first
Members chose a relationship with you. Explain the change yourself, in plain language, before they hear it from anyone else.
How this brief was built
The question came from a session at the Concierge Medicine Forum 2026. CMT used AI-generated summaries of the session recording only to frame the question; no speaker is named or quoted, and nothing said in the session is treated as evidence. CMT then searched for peer-reviewed studies of private equity acquisitions of physician practices (JAMA Health Forum, Health Affairs, BMJ, JAMA Internal Medicine), a federal evidence review (GAO), Federal Trade Commission enforcement records and one state statute. Every source in the reference list was opened in October 2026. Where the original article was paywalled or blocked, CMT relied on a university, foundation or trade summary and says so in the reference.
The BMJ systematic review pooled observational studies, not randomized trials, so CMT labels its findings Population Data rather than Clinical Trial Evidence; the label follows the design of the studies underneath. An American Hospital Association estimate cited by the GAO is labeled Industry Research because it is a trade association figure, not a peer-reviewed one.
Concierge and DPC were kept separate. The only membership medicine figure in this brief, from Health Affairs, is labeled “concierge and DPC combined” because the authors did not report ownership for concierge practices alone. No DPC-only data appear. The checklist in Part 5 generates questions for counsel. It does not say whether any contract term is lawful, enforceable or advisable in your state.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- What happens to membership fees, panel sizes, patient retention and physician turnover after a concierge practice takes MSO, private equity or health-system investment. No published study measures it.
- How patients experience the change in the front office, on the phone and on their bills. Studies measure claims, not patient experience.
- Long-run effects. Most studies follow practices for only a few years after acquisition, and the primary care studies are newer still.
- Effects of physician-led or physician-owned MSOs compared with investor-owned ones. The research mostly identifies private equity ownership and does not separate deal structures.
- The terms of the FTC’s proposed settlement with U.S. Anesthesia Partners, which were confidential as of June 2026, and how other states will treat MSO control.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- U.S. GAO. Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation (GAO-25-107450). September 22, 2025. files.gao.govFunding: federal (U.S. GAO report)
- Zhu JM, Marsh T, Huntington A, Polsky D, Song Z. Growth in number of practices and clinicians participating in concierge and direct primary care, 2018-23. Health Affairs. December 2025. doi:10.1377/hlthaff.2025.00656. www.healthaffairs.orgFunding: mixed: federal (Agency for Healthcare Research and Quality, R01HS029467) and foundation (Commonwealth Fund; NIHCM Foundation)
- MDVIP. Goldman Sachs Asset Management and Charlesbank Capital Partners complete acquisition of MDVIP primary care network (press release). October 14, 2021. www.mdvip.comFunding: not stated (company press release)
- Borsa A, Bejarano G, Ellen M, Bruch JD. Evaluating trends in private equity ownership and impacts on health outcomes, costs, and quality: systematic review. BMJ. 2023;382:e075244. doi:10.1136/bmj-2023-075244. Full text via University of Chicago Knowledge repository. knowledge.uchicago.eduFunding: not stated (no funding statement in the full text CMT opened)
- Singh Y, Song Z, Polsky D, Bruch JD, Zhu JM. Association of private equity acquisition of physician practices with changes in health care spending and utilization. JAMA Health Forum. 2022;3(9):e222886. Summary via NIHCM Foundation Research Insights. nihcm.orgFunding: not stated on the page CMT opened; the NIHCM Foundation lists a related NIHCM policy research grant to Dr Zhu (2021 to 2023)
- Singh Y, Radhakrishnan N, Adler L, Whaley C. Growth of private equity and hospital consolidation in primary care and price implications. JAMA Health Forum. 2025;6(1):e244935. doi:10.1001/jamahealthforum.2024.4935. jamanetwork.comFunding: foundation (Arnold Ventures; Patient Rights Advocates grant to Dr Whaley)
- Arnold DR, Fulton BD, Abdelhadi OA, et al. Private equity acquisition of gastroenterology practices and colonoscopy price and quality. JAMA Health Forum. Published June 20, 2025. Summary via UC Berkeley Petris Center. petris.orgFunding: not stated (summary page)
- Braun RT, Bond AM, Casalino LP, Qian Y, Zhang M. Private equity in dermatology: effect on price, utilization, and spending. Health Affairs. 2021. doi:10.1377/hlthaff.2020.02062. Summary via Weill Cornell Medicine, Department of Population Health Sciences, May 3, 2021. phs.weill.cornell.eduFunding: not stated (university news summary)
- Singh Y, et al. Private equity acquisitions in primary care: changes in utilization, spending, and workforce. Health Affairs. May 2026. Summary via Brown University news release, May 20, 2026. www.brown.eduFunding: foundation (Arnold Ventures and the Commonwealth Fund), per the Brown University release
- Epocrates. Medicare payments fuel private equity in primary care (summary of Singh Y, et al., Health Affairs, May 20, 2026). May 21, 2026. www.epocrates.comFunding: not stated (news report)
- Abdelhadi O, Fulton BD, Alexander L, Scheffler RM. Private equity-acquired physician practices and market penetration increased substantially, 2012 to 2021. Health Affairs. 2024;43(3):354-362. doi:10.1377/hlthaff.2023.00152. Summary via NIHCM Foundation Research Insights. nihcm.orgFunding: foundation (NIHCM Foundation, in part), per NIHCM
- Scheffler RM, Alexander L, Fulton BD, Arnold DR, Abdelhadi OA. Monetizing Medicine: Private Equity and Competition in Physician Practice Markets. American Antitrust Institute, UC Berkeley Petris Center and Washington Center for Equitable Growth. July 2023. Summary via UC Berkeley School of Public Health. publichealth.berkeley.eduFunding: foundation (Arnold Ventures), per UC Berkeley
- Federal Trade Commission. FTC challenges private equity firm’s scheme to suppress competition in anesthesiology practices across Texas (press release; allegations in a complaint). September 21, 2023. www.ftc.govFunding: federal (Federal Trade Commission publication)
- Health Exec. Investor-bought PCPs carry on like nothing much has changed, with caveats (summary of a JAMA Health Forum study of Medicare patients in private equity-acquired primary care practices, published May 8, 2026, senior author Yashaswini Singh). May 12, 2026. healthexec.comFunding: not stated (news report)
- Bruch JD, Foot C, Singh Y, Song Z, Polsky D, Zhu JM. Workforce composition in private equity-acquired versus non-private equity-acquired physician practices. Health Affairs. 2023;42(1):121-129. doi:10.1377/hlthaff.2022.00308. Summary via NIHCM Foundation Research Insights. nihcm.orgFunding: not stated on the page CMT opened; the NIHCM Foundation lists a related NIHCM policy research grant to Dr Zhu (2021 to 2023)
- Zhu JM, Huntington A, Giuriato M, Polsky D, Song Z. Private equity acquisition of primary care practices: modest growth in clinicians offset by increased clinician exits. Health Affairs. 2026;45(3):261-268. doi:10.1377/hlthaff.2025.01159. www.healthaffairs.orgFunding: not stated (abstract page; full text paywalled)
- Zhu JM, et al. Physician perspectives on private equity in health care. JAMA Internal Medicine research letter. March 11, 2024. Summary via HealthDay. www.healthday.comFunding: not stated
- American Journal of Managed Care. Private equity oversight gaps threaten patient safety, ACP warns (summary of Johnson D, Manaker S, Algase LF, Watkins C Jr. Regulatory framework for private equity and corporatization in health care: a position paper from the American College of Physicians. Annals of Internal Medicine, published online May 26, 2026). May 26, 2026. www.ajmc.comFunding: not stated (news report summarizing an ACP position paper)
- Federal Trade Commission. FTC approves final order with Welsh Carson (press release). May 20, 2025. ftc.govFunding: federal (Federal Trade Commission publication)
- Reed Smith. Oregon enacts strict new corporate practice of medicine law (summary of Oregon Senate Bill 951, signed June 9, 2025). July 2025. www.reedsmith.comFunding: not stated (law firm commentary)
- Eydis S. Antitrust case against USAP paused amid settlement talks. Becker’s ASC Review. June 1, 2026. www.beckersasc.comFunding: not stated (news report)
- Concierge Medicine Today. Media Desk: quotes from the Editor-in-Chief, FAQs and data. Accessed October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published; no outside funder) CMT original
- Concierge Medicine Today. Your Patients Aren't One Audience. They're Four (CMT Patient Study). Patient inquiries to CMT, January 2013 to December 2024; self-selected respondents searching for a concierge or membership physician; DPC patients excluded; not peer-reviewed or nationally representative. Accessed October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-conducted; no outside funder) CMT original
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
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