“Medicine has an internal culture of hard work and long hours, particularly in the years while doctors are training. But traditionally, this was understood as something that would, later on, begin to ease, or at least be under the control of the individual doctor. In addition, specialties such as anesthesiology, radiology, and dermatology were also understood by tradition to offer a more balanced lifestyle. Those were precisely the practices targeted by private equity, which saw the lifestyle practices as an opportunity.
“Over the 2010s and into the 2020s, the platformization of medical practices spread, with new targets including dermatol-ogy (376 deals), ophthalmology (276 deals), and gastroenterology (120 deals). .10 A 2023 study by health economist Richard Scheffler found price increases ranging from 1.5 to over 3 times higher than pre-acquisition. Those might seem justified if the quality of care improved. But whether it has been the long hours, the cost-cutting, or whatever else, the quality of care has generally stayed the same, or decreased, after private equity acquisitions. In 2023, another group, led by Alexander Borsa of the Department of Sociomedical Sciences of Columbia University, conducted a meta-study (a study of studies) of fifty-five empirical studies that assessed the impact of private equity platform ownership on vari-ous forms of medicine. The study concluded:
The most unequivocal evidence points to PE ownership being associated with an increase in healthcare costs to patients or payers, primarily by increased charges and negotiated higher rates with payers. Evidence across studies also suggests mixed impacts of PE ownership on healthcare quality, with greater evidence that PE owner-ship might degrade quality in some capacity rather than improve it.”
“The service industries-by some measures, the mainstay of Western economies-had long resisted the centralization of eco-nomic power. Whatever their imperfections, they have, at least, been independent. But all this started to change in the 2010s. What is happening in the platformization of medicine is akin to a change in economic class for doctors. They are transitioning from being a professional guild with control of their own human capital back to being a laboring class, members of the proletariat.”
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