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Succession, Sale or Stay: The Concierge Physician's Exit Decision
Nearly a quarter of active U.S. physicians are 65 or older, and fewer than one in five still work in physician-owned practices. For the founders of membership practices, the question is no longer whether an exit is coming, but who decides what happens to the relationships.
Updated October 2026: evidence grades replaced with evidence types; funding disclosed on every source.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
Physician ownership is shrinking fast: 82% of U.S. physicians now work for hospitals, health systems or corporate entities, and 23.9% of active physicians are 65 or older. Concierge practices are valuable precisely because the relationships are personal, which also makes them fragile in a handoff. There are three broad paths: internal succession, outside sale or partnership, and a planned wind-down. Each can work. The worst outcome is no plan. Start five years out, and test any offer against the due-diligence questions in Part 4.
“Your patients didn't join a practice. They joined you. The best succession plan starts years before you leave, with you personally introducing the physician who will carry that relationship forward.”
How urgent is succession for concierge physicians?
Very, for many. 23.9% of active U.S. physicians were 65 or older in 2024, and membership practices are often built around one founder's relationships.
Go to the full answer ↓What are my real options?
Internal succession to an associate, a sale or partnership with a network, MSO, private equity firm or health system, or a planned wind-down with a transition for members. Part 2 compares them.
Go to the full answer ↓What happens to physician satisfaction after a private equity sale?
In a 2024 JAMA Internal Medicine study, physicians in PE-owned practices reported high professional satisfaction far less often than others (44.8% vs. 74.4%). The PE group was small.
Go to the full answer ↓What should I ask before I sign?
Who controls clinical decisions, panel size and fees after closing? What are the non-compete and earn-out terms? What happens to members if targets aren't met? The full list is in Part 4.
Go to the full answer ↓Where can I read more on MSOs and private equity?
CMT Brief No. 21, The Handwriting in the Card, covers the ownership models and evidence in depth.
Go to the full answer ↓An aging workforce in a consolidating market
Consolidation has reached membership medicine. Corporate-affiliated membership medicine practices, concierge and DPC combined, grew about 576% between 2018 and 2023; the study did not report concierge separately.4 In 2025, a private equity firm acquired Griffin Concierge Medical, a multi-site Tampa practice.5 For many founding physicians, the first serious succession conversation now starts with an unsolicited offer.
Three paths, honestly compared
| Internal succession | Sale or partnership | Planned wind-down | |
|---|---|---|---|
| What it is | An associate physician buys in over time and takes over the panel | A network, MSO, private equity firm or health system buys all or part of the practice | The founder retires and helps members transition elsewhere |
| Member continuity | Highest, if the successor is introduced early | Varies; depends on post-sale panel and fee decisions | Lowest; members must re-establish care |
| Founder control after exit | Shared, then none | Defined by contract | None |
| Financial return | Usually paid over time | Often largest upfront, with earn-outs or rollover equity | Little or none for goodwill |
| Biggest risk | No successor found, or poor fit | Loss of the culture members joined for | Member harm and reputational damage |
| Lead time | 3 to 5 years | 1 to 2 years for a well-run process | 1 year or more |
Lead times are CMT editorial estimates for planning, not measured data.
A concierge practice's value is the relationships. Every exit plan should be judged by what happens to them.
What the evidence says about life after outside capital
Physicians are skeptical. In a 2024 JAMA Internal Medicine research letter, 61% of 525 physicians viewed private equity in health care negatively. Physicians working in PE-owned practices reported high professional satisfaction less often (44.8% vs. 74.4%) and less autonomy (48.3% vs. 66.3%) than other physicians. Only about 5.5% of respondents worked in PE-owned settings, so those comparisons rest on a small group.6 Practice Insight
A NORC and PAI survey summarized in the 2026 PAI report found most employed physicians say ownership transitions hurt care quality and their autonomy.2 None of these studies focused on concierge practices.
CMT Research Brief No. 21, The Handwriting in the Card: MSOs, Private Equity and the Future of Concierge Medicine, compares the four main ownership models and the satisfaction evidence across medicine and dentistry in depth.
Before you sign: the due-diligence questions
Use these with your attorney, accountant and adviser. The answers belong in the contract, not in a conversation.
Clinical control
- Who decides panel size, visit length and access standards after closing?
- Can the buyer change clinical protocols or add services members didn't join for?
Members
- Who sets fees and fee increases?
- What happens to members if the practice misses financial targets?
- How will members be told, and when?
Money
- How much is paid at closing vs. earn-out or rollover equity?
- What triggers earn-out payments, and who controls those triggers?
Your future
- Non-compete scope, geography and length
- Employment term and how either side can end it
- What happens if you become disabled or die before the deal completes?
Succession readiness
What the data show about who will own these practices next
Concierge medicine can work at every career stage. CMT's Editor-in-Chief describes “late-career doctors choosing to finish well, find a sustainable pace and yet still want to dive deeper into healthcare's more complex questions with their patients.”8 CMT could not verify data on the age of concierge physicians specifically, the share with written succession plans, or member retention after a founder transition.
These figures describe direct primary care (DPC), not concierge medicine. DPC usually operates outside insurance billing at lower monthly fees. They are shown here, separately, for context only and should not be read as concierge data.
In a Direct Primary Care Alliance survey of 465 DPC practices (October to November 2024), the mean age of DPC physicians was 46, and nearly 10% started DPC straight from residency.9 Practice Insight DPC founders skew younger than the physician workforce overall, so DPC succession questions differ from those facing concierge founders.
Start five years out
Succession done well is gradual: introduce the successor, then hand over.
Contract for the relationship
Write member protections into any deal, not just price.
Lead the transition
Tell members early and personally. Their trust is the asset.
How this brief was built
CMT reviewed AAMC workforce data, the Physicians Advocacy Institute and Avalere Health employment report, a JAMA Internal Medicine survey of physician views on private equity, and public reports of concierge practice transactions. Transaction values and deal terms are rarely public, so this brief does not estimate valuations. Nothing here is legal, tax or financial advice. Ownership figures come from Health Affairs (via Johns Hopkins) and combine concierge and DPC, so they are labeled as membership medicine; MDVIP figures are company-reported; DPC physician age appears only in a separate, labeled DPC box.
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
- Age distribution and succession readiness of concierge physicians specifically.
- Member retention after a founder retires or a practice is sold.
- Typical deal structures and valuations for concierge practices, which are rarely disclosed.
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
- Association of American Medical Colleges. 2025 U.S. Physician Workforce Data Dashboard: key findings (2024 data). www.aamc.orgFunding: not stated (conducted and published by the AAMC)
- Physicians Advocacy Institute and Avalere Health. Physician employment trends and practice acquisitions report (data as of January 1, 2026). Summary via Indiana State Medical Association, September 2026. ismanet.orgFunding: not stated (conducted by Avalere Health and published by the Physicians Advocacy Institute)
- 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)
- Johns Hopkins Carey Business School. Fee-based primary care is rapidly rising in U.S., hastening doctor shortages for the public. December 2025. carey.jhu.eduFunding: not stated (university news release)
- Becker's ASC Review. PE firm acquires physician-owned Florida practice (Griffin Concierge Medical and Revelstoke Capital Partners). October 2025. www.beckersasc.comFunding: not stated (news report)
- 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
- MDVIP. MDVIP celebrates its momentum: 100 consecutive quarters of growth milestone and new Boca Raton HQ (press release). February 4, 2026. mdvip.comFunding: industry (MDVIP press release)
- 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
- Direct Primary Care Alliance. State of Direct Primary Care report (2024 survey, 465 respondents), as reported by Medical Economics, July 29, 2026. www.medicaleconomics.comFunding: not stated (conducted and published by the Direct Primary Care Alliance)
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.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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