Private Equity in Pain: Implications for Pain?

[drusso]

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Will Flanary on Instagram: "Can massive non-profit health systems PLEASE just stop selling out their local doctors for private equity? I promise there are better ways to save money that don’t involve tanking morale morale and worsening patient care t

14K likes, 379 comments - docglauc on July 3, 2026: "Can massive non-profit health systems PLEASE just stop selling out their local doctors for private equity? I promise there are better ways to save money that don’t involve tanking morale morale and worsening patient care through staffing and...

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[au bon pain]

I’m grateful (in retrospect) that very early in my career a PE group swooped in and quickly destroyed what was otherwise a great place to work. Those 8 months were a painful crash course into the raw realities regarding “the business of healthcare” and being a cog in their machine. I didn’t have kids then and my wife’s job was flexible, so it was fairly easy to pivot away from the hellscape this PE group had created.

This experience has heavily informed every job/career move I’ve made since then, as well as how I now protect my patients and myself.

 

[mille125]

There were zero PE backed pain groups in my state in 2015. Now at least a dozen probably more. I don't think any of them have cashed out for the second sale or even grown much.

Definitely worse patient care. No question about that

 

[nvrsumr]

Since the cost of capital (interest rates) jumped I have seen way less pe activity locally. I was hit up by 5 groups in 18 months about 5 years ago.

The mbas were all exactly like the Jonny hilbrant/PE guy meme

 

[mille125]

Since the cost of capital (interest rates) jumped I have seen way less pe activity locally. I was hit up by 5 groups in 18 months about 5 years ago.

The mbas were all exactly like the Jonny hilbrant/PE guy meme

They are definitely still out there talking to pain guys. Rheum/Neuro infusion suites are their new targets of late.

 

[DrSpine]

I’m grateful (in retrospect) that very early in my career a PE group swooped in and quickly destroyed what was otherwise a great place to work. Those 8 months were a painful crash course into the raw realities regarding “the business of healthcare” and being a cog in their machine. I didn’t have kids then and my wife’s job was flexible, so it was fairly easy to pivot away from the hellscape this PE group had created.

This experience has heavily informed every job/career move I’ve made since then, as well as how I now protect my patients and myself.

This is me in a nutshell.

 

[zenmedic]

I’m grateful (in retrospect) that very early in my career a PE group swooped in and quickly destroyed what was otherwise a great place to work. Those 8 months were a painful crash course into the raw realities regarding “the business of healthcare” and being a cog in their machine. I didn’t have kids then and my wife’s job was flexible, so it was fairly easy to pivot away from the hellscape this PE group had created.

This experience has heavily informed every job/career move I’ve made since then, as well as how I now protect my patients and myself.

Could you elaborate on what you learned for fellows feeling out their first job?

 

[au bon pain]

Could you elaborate on what you learned for fellows feeling out their first job?

It could be a boring textbook, but probably the highest-yield macro PE-relevant things you should consider are:

Who actually calls the shots in terms of practice structure and how it operates?
If you will have no meaningful control, then is the decision-maker a physician?
Do they actually still see patients, and, if so, is the level of practice support they get within the same ballpark as what you’d get?
Do they live near and/or work at the clinic or are they 10 states away?

These things are important because one of the best ways to hedge that decision-makers will actually do the right thing is if they’re in the trenches with you experiencing all the various ramifications of practice-level decisions.

If the person who dictates that you have to do a two level TFESI as a “first-step” for basically any patient who come in, allots patients only 5 minutes of face time with you, or wildly understaffs the place to the point where patients’ heads explode when nobody answers the clinic phone…you want said decision maker to get their share of taking the heat from patients et al. Otherwise, you become the face of somebody else’s mess and you will, like it or not, serve as their reputational and liability shield.

 

[zenmedic]

It could be a boring textbook, but probably the highest-yield macro PE-relevant things you should consider are:

Who actually calls the shots in terms of practice structure and how it operates?
If you will have no meaningful control, then is the decision-maker a physician?
Do they actually still see patients, and, if so, is the level of practice support they get within the same ballpark as what you’d get?
Do they live near and/or work at the clinic or are they 10 states away?

These things are important because one of the best ways to hedge that decision-makers will actually do the right thing is if they’re in the trenches with you experiencing all the various ramifications of practice-level decisions.

If the person who dictates that you have to do a two level TFESI as a “first-step” for basically any patient who come in, allots patients only 5 minutes of face time with you, or wildly understaffs the place to the point where patients’ heads explode when nobody answers the clinic phone…you want said decision maker to get their share of taking the heat from patients et al. Otherwise, you become the face of somebody else’s mess and you will, like it or not, serve as their reputational and liability shield.

Great advice. Thanks.