Private equity (PE) acquisition of primary care practices was associated with modest increases in that practices' total clinicians, offset partially by an increase in advanced practice provider exits.
So finds a new study, published in Health Affairs this month. It aimed to understand how clinician labor changes in primary care practices after PE acquisition.
The study used IQVIA data on 451 practices acquired by PE from 2018 to 2022, comprising nearly 4,000 clinicians. It excluded PE-acquired practices that lacked at least one year of data before and after acquisition.
The study found that, compared to matched controls, PE acquisition led to a 12% increase in clinicians, a 14% increase in advanced practice providers and 11% increase in physicians. This net gain was partially offset by a 28% increase in clinician exits relative to the pre-acquisition average, and more specifically, a 38% increase in advanced practice provider exits.
Several limitations were cited by the study authors. Given the use of external sources, the study may not fully capture the precise timing and ownership structure. The study focused on workforce structure and size, not changes in productivity, quality of care or financial performance. The study also did not compare workforce changes post-PE acquisition with other types of acquisitions.
The clinician staffing growth may be a function of PE’s roll-up strategies, intentional expansion of clinician capacity or greater flexibility in hiring, the study suggested. A rise in turnover may also indicate professional dissatisfaction and workforce instability. The latter may have implications for access to and continuity of care, the study's researchers said.
“The effects of these workforce changes on long-term practice stability and patient care require further study,” they wrote in the study. “Workforce instability in healthcare is associated with direct costs of training and onboarding, recruitment and retention, and with indirect costs related to disruptions in care continuity, delays in access to care, reduced patient satisfaction and diminished care quality.”
Existing studies in procedural specialties have found larger increases in physician turnover. This may reflect how primary care depends on longitudinal patient relationships, potentially making it harder for physicians to consider leaving abruptly. Nonphysician staff that left at higher rates may reflect that they face different employment conditions, compensation structures and workplace pressures.
By 2036, the U.S. might face a shortage of 40,000 primary care docs. At the same time, the primary care field is undergoing vertical consolidation via affiliations with health systems and acquisitions by PE firms. It is estimated that up to 10% of physicians have been acquired by PE, the study said.
“Future research is needed to increase understanding of whether different workforce changes occur when practices are purchased by other entities, including hospitals and health systems or even large independent practices,” the authors wrote. “As PE and other corporate entities continue to reshape the organization of primary care, further research is needed to assess the implications of these changes on access for patients, care quality and professional satisfaction.”