Physician turnover surges in private equity-acquired practices, study finds

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Physician turnover rates surged in private equity (PE)-acquired ophthalmology practices, increasing by 265% compared to the baseline turnover rate after acquisition, according to a new study published in the peer-reviewed journal Health Affairs. The sharp rise in physician departures following PE acquisitions underscores the growing impact of PE on physician employment and workforce stability.

As PE continues to expand, the study’s authors call for policymakers to monitor long-term implications on physician employment and turnover — and what they could mean for patient health.

The study was led by Yashaswini Singh, PhD, MPH, a health care economist and assistant professor at Brown University’s School of Public Health, alongside colleagues from Brown University and Duke University.

Yashaswini Singh, PhD, MPH © Brown University

A sharp increase in turnover

The research group analyzed physician employment data from 2014 to 2021, focusing on 200 ophthalmology practices acquired by PE firms. The study focused on ophthalmology practices because the specialty has been a key target for PE investors, with an estimated 10% of the ophthalmology workforce affiliated with PE-acquired practices as of 2019.

Using a difference-in-differences approach, the researchers compared these practices with similar independent practices that were not acquired by PE.

The findings show that, while PE acquisitions led to a 46.8% increase in the total number of employed clinicians, they also resulted in significantly higher rates of physician turnover. The annual percentage of physicians leaving PE-owned practices increased by 13 percentage points post-acquisition, compared to non-PE practices.

“Our estimate of baseline physician turnover rates in non-PE-acquired practices was around 9%, consistent with previous research,” the authors wrote. “Our analysis found that PE acquisitions increased physician turnover rates by 13 percentage points, or 265%, relative to baseline.”

Researchers suggest that factors including administrative demands, loss of clinical autonomy, and pressure to meet financial targets may be driving higher physician departures.

A changing workforce

The study also determined that PE-acquired practices expanded their workforce primarily by hiring both ophthalmologists and optometrists at increased rates. The number of ophthalmologists in these practices rose by 30.7%, while optometrist employment grew by 36.2%.

This workforce expansion aligns with PE’s broader strategy of consolidating and scaling physician practices to maximize profitability.

However, the increase in turnover suggests that the changes in practice management, financial incentives, and workplace autonomy associated with PE ownership may be contributing to physician departures.

Younger physicians are more likely to leave

Researchers found that younger physicians — those under 40 — were more likely to leave PE-acquired practices than their older counterparts. Among physicians under 40, the clinician replacement ratio was 2.28 in PE-acquired practices, compared to 1.08 in non-PE practices.

Meanwhile, physicians over 60 were the only group where departures outpaced new hires in PE-owned practices. The study suggests that financial incentives from the acquisition may encourage older physicians to retire earlier than they otherwise would.

Policy, patient care implications

Physician turnover is a critical issue for health care organizations, as frequent changes in personnel can disrupt continuity of care and patient-provider relationships. High turnover rates also contribute to increased recruitment and onboarding costs for practices.

The researchers urge policymakers to closely track the long-term effects of PE acquisitions on physician employment, patient care, and overall health care costs.

The researchers emphasized the need for future studies to assess PE’s impact on clinical workforce trends in other specialties, particularly primary care, where advanced practice providers are playing an expanding role.