PE Primary Care Added Physicians, Saw More Patients, and Billed More. The Study Couldn't Measure Burnout.

Analysis by DPC Insider
#private equity#primary care research#physician burnout#Health Affairs#payment models#DPC identity#analysis
Sources: Private equity acquisition can expand primary care use by expanding workforce, study finds · Hint Health Releases 2026 Direct Primary Care Trends Report

A Brown University study published in Health Affairs last week found something most DPC physicians probably didn’t expect to read: primary care practices acquired by private equity firms hired more doctors, saw more patients, and delivered more preventive services.

Researchers at Brown’s School of Public Health analyzed 225 PE-acquired primary care practices using Medicare claims data from 2016 to 2022. After acquisition, those practices saw about 11 percent more patients overall and provided roughly 13 percent more services per patient. Medicare annual wellness visits jumped more than 20 percent. Workforce expanded: practices hired 17 percent more physicians and 40 percent more nurse practitioners and physician assistants. Per-patient spending stayed flat even as physician billing rose 30 percent.

Lead author Yashaswini Singh, an assistant professor of health services, policy and practice at Brown, framed the results carefully: “The relationship between private equity and patient care is more complicated than it first appears, and financial incentives shaped by payment policy play an outsized role.”

That second sentence is the one DPC physicians will recognize from the inside.

What PE Optimizes For

Fee-for-service medicine pays for encounters. Annual wellness visits have a CPT code. Preventive counseling has a CPT code. Adding NPs and PAs increases billable throughput. PE ownership adds capital and operational discipline to push harder on what fee-for-service already rewards. So PE primary care looks good by fee-for-service metrics because that is what the model is built to run on.

Singh’s observation about payment policy describes something DPC already understands from practice. DPC practices don’t bill per encounter. A patient texting their doctor at 9 p.m. doesn’t generate a CPT code. An extra 20 minutes on a complicated case doesn’t appear in a claims dataset. The payment structure creates different behaviors, and different behaviors produce different outcomes. The Brown study measured fee-for-service outcomes. PE practices, unsurprisingly, scored well on them.

What the Study Left Out

The authors were honest about what they couldn’t see. Medicare claims data counts visits, codes, and billing. It can’t assess whether patients’ health actually improved over time. It can’t measure clinician burnout, which research has consistently tied to large panel sizes and volume-driven schedules. The study covered a relatively short follow-up period, so it can’t say whether the workforce expansion held as conditions settled.

There is one finding worth reading carefully: clinician exits also rose after PE acquisition, by about 0.22 per practice. Workforce grew, but so did turnover. That pattern appears across PE-owned healthcare broadly. Practices hire because the model needs throughput. The conditions that produce burnout, compressed schedules and large panels, don’t change with the ownership structure. So the exits follow.

The 2026 Hint Health DPC Trends Report, released in April, documented what a different payment structure produces. DPC practices reported a 48 percent reduction in clinician burnout. Average panel sizes in DPC dropped to around 500 patients, compared to around 2,000 in fee-for-service. The model generates different outcomes because the incentives are different, and Singh’s framing covers both cases equally.

What This Means

If you run a DPC practice, this study is worth knowing for two reasons.

The first is practical. When patients or employers ask what makes DPC different from a well-managed employed practice, this study doesn’t challenge your model. Your model doesn’t compete on billing volume or wellness-visit throughput. Those metrics don’t overlap with what you’re measuring.

The second is longer-term. The research community is beginning to study primary care ownership with more rigor. That’s good for DPC, because the outcomes DPC actually tracks, burnout, panel size, visit length, and long-term relationship continuity, are exactly the outcomes PE studies can’t capture yet. The methods will catch up. When they do, the picture will look different than what claims data shows.

Singh said it directly: financial incentives shaped by payment policy drive what practices do. DPC changed the payment policy. The outcomes follow from that, and so far nobody has built the instrument to measure them from the outside.