Nobody is asking this out loud. They should be.
Consider any mid-sized American city. A physician shortage that predates the pandemic. A growing population. Enough employer density to attract outside capital. A physician opens an independent concierge or DPC practice. The panel fills. The model works. The relationship medicine covenant holds.
Then the room changes.
Around 63 percent of physician transactions in 2023 were attributable to a PE firm or their portfolio companies. That number did not shrink in 2024 or 2025. Health care private equity hit a record $191 billion in disclosed deal value in 2025. The firms writing those checks have already been named. This is the question that follows.
The capital did not stop at the hospital door. It followed the physician into the membership model.
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Independent physicians now share markets with PE-backed employer platforms that signed large employer contracts before most of them knew they were competing. With corporate-affiliated concierge brands whose marketing budgets dwarf what an independent practice can spend in a year. With venture-backed midlevel platforms offering lower membership fees because their overhead structure replaces physicians with midlevel providers.
The question is not whether private equity belongs in health care. That debate is settled by the checkbook. The question is what happens when a physician looks up and realizes the market he or she built a practice for has been restructured while seeing patients.
The price floor is already dropping. A venture-backed platform offering membership medicine through nurse practitioners does not need to match the independent physician’s fee. It only needs to be cheaper.
Employer relationships are already spoken for. PE-backed platforms arrived with sales teams, actuarial models, and broker relationships that take years to build independently. By the time a physician approaches a 500-person employer the contract is signed. Brand recognition no longer favors the small practice. When a globally recognized health system opens concierge medicine two miles away, the independent physician is not the most credible name in the room anymore. And the referral network built over years is quietly redirecting inside corporate networks with no independent access point.
Private practices can no longer rely on brute-force volume to drive profitability. But independent physicians in membership models were never competing on volume. They were competing on relationship. On access. On the phone call that gets answered on a Saturday. On the physician who walks into the room already knowing the patient’s history, the family, the context that no algorithm captures.
Those are not soft advantages. They are the reason patients pay membership fees in the first place. They are also the first things that change when ownership structure shifts and scale becomes the priority. The independent physician who protects those advantages structurally, before the market pressure arrives, is the one who still has them when $191 billion in capital is competing for the same patients.
This is not an argument against capital or against the platforms building at scale. It is an argument for clarity. The physicians who understand what they are competing against, and why the model they built still has an advantage when it is protected, are the ones who make decisions before the market makes them.
The physician who asks this question now still controls the answer. The one who waits will learn that someone else already did.
This essay is cited in the KevinMD records on direct primary care and private equity and corporate medicine.
Dana Y. Lujan is a health care strategist and operator with more than twenty years of experience across payers, providers, and health systems. She is the founder of Wellthlinks, a consulting firm that helps employers and providers redesign care models through concierge and direct primary care, and author of The CEO Physician: Strategic Blueprint for Independent Medicine. Dana has led multi-state network development, payer contracting, financial modeling, and compliance initiatives that strengthen provider sustainability and employer value. She previously served as president of the Nevada chapter of HFMA and is pursuing a JD to expand her expertise in health care law and compliance. She has been featured in Authority Magazine and publishes on KevinMD, MedCity News, and Medium, where she writes on health care innovation, direct primary care, concierge medicine, employer contracting, and compliance. She has forthcoming BenefitsPRO. Additional professional updates can be found on LinkedIn and Instagram.
