Private Equity owns half of medical specialists in some markets

… adding Private Equity’s “skim” to a doctor’s bill is unlikely to improve your medical care.

This is the result of the lack of any antitrust enforcement. It is driving “greedflation”.



In some areas, you won’t have to worry about the skim on the doctor’s bill. You’ll have to worry about a doctor being made available at all. Missouri’s legislature passed a law aimed at solving the backlog of appointment slots to see doctors in outstate areas by eliminating prior restrictions on LNPs. Those required any diagnosis, treatment or prescription by an LNP to be signed off by a licensed doctor within 75 miles. Makes sense.

The new law eliminates the requirement that LNPs operate in a collaborative practice agreement. The goal of course being to allow more mundane “routine” consultations to be handled by LNPs without the delay of getting review / approval from a doctor. LNPs still have to review their work with their doctor “supervisor” at least once every two weeks. One can imagine how little attention both LNP and MD will devote to such a review bunched up into one session per fortnight.

This law may simply be catching up to what is already happening with a nod and a wink. However, because it will now be explicitly LEGAL for LNPs to do much more work, it seems likely insurance companies will GUARANTEE that happens by rewarding visits with an LPN with higher re-imbursement rates or lower co-pays than seeing a doctor. Actual doctor visits might be restricted unless an LPN is seen first (just like today how a GP must be seen first to get a referral to a specialist). In other words, the new regulation does NOTHING to solve the underlying problem of an insufficient supply of DOCTORS. It’s merely approving the official transfer of more “doctor” work to “non-doctor” staff.



I’d be fine with getting my doctoring from an AI bot, as long as I’m not being charged for the full price of a doctor’s office visit. For year’s I’ve been ordering my own lab tests and only saw a doctor once a year to get my prescriptions refilled. (That’s changed now that I’m on Medicare because all the lab work is “free”, (i.e., no cost sharing).)

I noticed that in France people rarely see specialists. If you have say arthritis, they send you to a rheumatologist for diagnosis and a treatment plan, but the treatment is carried out by your Family Practice physican. You’re not going back to the specialist to get a prescription refilled if everything is stable.

That said. I understand how people who live in some of the Red States can get shortchanged by the madness reigning down from the State Capitol.



That’s a different problem. You’re unlikely to get a medical specialist to practice in a rural area. The people that need advanced care will have to travel to the city. Maybe you can do some of it with tele-medicine visits, but anything hands-on has to be done in town.


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A specialist realistically requires a fairly large population from which to draw a limited number of patients. It is pretty much impossible for a rural population to be able to support any medical specialist (except maybe a veterinarian for farm animals). Rural areas want general purpose medical practitioners to serve most of the areas’ residents.

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I just called an AI bot. Seemed friendly enough.

The bot told me to wait for the human hours. Very helpful. I am impressed.

Hopefully the company’s accountants can not count the costs.

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Vets are the ultimate generalist. They work on multiple species. Even your basic “dog and cat” vet works on two. Get into rural vets and they work on dogs and cats and horses and cows and pigs and goats and sheep. Basically everything other than people.

Even specialist vets have a big generalist component. Got a dental vet? They work on dogs and cats and horses and cows. A heart and lung vet? Ditto. Same for ortho and eyes.

There are only a few vets that can really specialize. Some might only work on horses if there are enough horses in the area. Or cattle near large milk areas or feed lots (raising cattle for meat).

I’d say that every vet is a generalist in at least one dimension (system or species), with rare exceptions.



Can’t read the article (paywall); is the article stating that a single firm owns more than half the specialists in certain markets or that half of the specialists are owned by various private equity firms?

On a related tangent, here is the thing that always bothers me about this topic (privately owned healthcare buying up businesses). Nothing keeps a doctor or a facility from being non-profit. It seems like all the angst is focused on the equity firms (the buyer) and not on the hospital/doctor who sold out in the first place. Additionally, if these private equity firms are really so terrible (definitely not arguing that they are not as I support public healthcare), then why don’t these medical professionals either refuse to sell, or simply decide to compete more cheaply with a non-profit alternative?

If care is worse and costs higher, certainly there should be a market for non-profits to operate (and not at a loss).

The buy price is VERY attractive to the seller (the doctor(s) who own the practice), so it is not a rational choice to NOT sell. Plus, part of the deal is (usually) the doctor(s) agree to become employees of the purchased business for a set period of time at a stated rate of pay. So the choice is sell (and get locked in) or not sell. That can work IF the doctor is not undercut by other “bought out” practices OR if the buyer enters into exclusive contracts with the hospitals in the area (to be the hospitals’ sole provider of this medical care/practice), so the non-selling doctors are “locked out” of the hospital market.