To gain autonomy, some doctors are teaming up with private equity

As private practice shrinks and consolidates into corporate-owned healthcare chains, care costs are increasing, and physicians say they’re losing independence.

In recent years, doctors have tested new strategies to break that pattern. One is by unionizing within health systems; another is banding together into “clinically integrated networks” to gain shared resources without selling to a chain.

But some physicians have found another way to stay afloat. They’re arguing that private equity (PE) can provide autonomy, even though some economists warn this model can result in the same issues as other forms of corporate consolidation.

“I think this narrative that PE is always a bad thing is completely incorrect,” hematologist and oncologist David Eagle, who’s president of the American Independent Practice Association, an independent physician advocacy organization, told Healthcare Brew.

Eagle works for New York Cancer and Blood Specialists, which lists 60+ locations on its website. Though it’s part of a PE-backed oncology management services organization (MSO), he said clinicians at the medical practice still make care decisions.

“MSOs helped keep independent practice sustainable in a setting where that’s really just becoming much harder to do,” he said.

Declining independence

The portion of doctors in private practice has fallen from 60% in 2012 to 42% in 2024. Nearly half of physicians in 2024 said they work for hospitals or hospital-owned groups in a survey from trade group the American Medical Association (AMA), with a growing portion at practices owned by PE (6.5%) or other entities, like insurers (4.6%).

The AMA survey also found most physicians who sold their independent practice to a hospital, insurer, or PE firm were motivated by practical concerns—mainly, cost pressures.

Though consolidation can increase efficiency, hospital and, increasingly, PE acquisitions are also generally linked to higher prices without increases in care quality, per a September Government Accountability Office report.

“In addition to consolidation, there’s this emphasis on maximizing returns for shareholders, even if it comes at the cost of what’s in the interest of patients or healthcare workers,” Yashaswini Singh, a healthcare economist and assistant professor at Brown University’s School of Public Health, told us.

October 2025 research, which Singh co-authored, found PE-backed practices negotiate lower prices for cardiology and gastroenterology procedures than hospital systems but still broker higher prices with insurers than fully independent practices. Some research suggests hospitals bought by PE are more likely to lose assets, physicians are more likely to leave, and patients have higher complication rates and lower satisfaction.

But Orlando cardiologist Adam Waldman told us a PE-backed physician network—the Cardiovascular Associates of America (CVUSA)—gave him more freedom in caring for patients and designing his schedule.

He co-founded a chain in 2023, the Cardiovascular Center of Florida, backed by CVUSA. The physician network provides financial, technical, and legal resources but does not influence medical decisions, he said.

“I can’t tell you how many patients say to me, ‘Wow, you spent so much time with me. You look so much more relaxed,’” Waldman said.

Breaking up is hard

Many physicians don’t want to be in independent practice, but for those who do, it’s often difficult to avoid going corporate, Singh said.

“If the only choice to remain open in operations and keep your practice financially viable is to partner with PE or a health system, then I think that reveals a fundamental flaw in the way the system is designed,” she said.

Once physicians do join a hospital system, they are often limited by noncompetes that dictate when they can leave and where they can go, Michael Quinn, a Florida attorney representing physician groups and co-founder (alongside Waldman) of Pendulum Physician Advisors, a firm that helps hospital-employed physician groups negotiate and explore independent practice, told us.

In some cases, a noncompete isn’t even necessary to squelch competition if one or two health systems dominate the local market, Eagle said.

“You’re competing with hospital systems that employ physicians and can direct referrals, and the hospitals are reimbursed better [by insurers] for the same services,” Eagle said.

As this market pressure increases, so does PE’s presence. Though hospitals are the biggest consolidators, PE acquisitions of US physician practices are rocketing fast, from 75 deals in 2012 to 484 in 2021, per a Commonwealth Fund report.

PE is especially focused on acquiring or building specialty practices within areas like cardiology, the report found. A 2024 report published in the Journal of the American College of Cardiology found 342 cardiology clinics had been acquired by PE between 2013 and 2023, with 94+% of those acquisitions happening during or after 2021.

Singh, however, pointed to alternative strategies to promote physician independence. Indiana, for instance, created a physician practice ownership tax credit in 2024 that gave a subsidy to primary care physicians who had ownership interest in certain practices. The state expanded the credit to more types of care in 2025.

“I empathize with the argument that partnering with a PE firm might offer some autonomy to physicians that they are unable to get in their hospital-employed arrangement,” Singh said. “The price of that autonomy, or perceived autonomy, is higher societal costs.”