A bill introduced in Congress this month would make it illegal for private equity funds, insurers and most for-profit corporations to own or control a physician practice. Doctors have been responding to it in my feed since. Most of them, including several I respect a great deal, have landed in the same place. Physicians did not sell because they stopped wanting to own their practices. They sold because the math stopped working. Take those buyers out of the market, and the practices still need to sell to someone.
They are right, and it bears repeating. Adjusted for the rising cost of running a practice, Medicare’s payment to physicians fell by about a third between 2001 and 2025. A practice that loses money every year does not stay independent because a statute says it should.
I think that argument is sound. I also think it stops one room short.
I am the chief clinical officer of an anesthesia management company backed by private equity. I also hold equity in the company. As introduced, this bill could require companies structured like mine to restructure or divest. That is a stake, and you should weigh everything here with it in mind. In my view, ownership is where this problem shows up, not where it starts. It starts as an economics problem and a governance problem, and the bill reaches neither at its root. It leaves the payment problem where it found it, and it answers the governance question only for the practices it covers.
The concern behind the bill deserves its full weight first. Clinicians have watched decisions about their work move further from the bedside, and some of those moves followed a change in ownership. Those experiences are real. The strongest version of the concern is that some owners add a return requirement on top of the budget, and the staffing plan is where it gets paid. Where I would push is on what we are measuring when we decide an owner is the problem.
What the Stop Corporate Takeovers of Physicians Act regulates
The headline is ownership. A practice would have to be majority owned and controlled by licensed practitioners. The more interesting part is further down, in the limits on management companies. A management company could not control hiring, work schedules, compensation, staffing, credentialing, clinical standards, coding, pricing or payer contracts, among twelve items in total. As introduced, it would take effect in a year, and existing arrangements that do not comply would be required to divest.
The proposed list of limitations is, in reality, a list of governance decisions. Who decides how many people are in the building. Who decides what they are paid. Who decides who gets hired. Who decides the clinical standard. Most of them are decisions patients feel. The bill’s answer to my first question below is a licensed practitioner in control.
Then the bill makes the answer depend on who owns the practice. Hospitals and nonprofits are exempt from the ownership limits. The exemption covers any hospital, including shareholder-owned ones, and “hospital-affiliated clinics,” a term the bill never defines. If the concern is a return requirement sitting on top of the staffing plan, that mechanism can exist under any owner, and the exemption does not ask whether it does. A hospital-employed group would still have someone deciding staffing levels, compensation and hiring. So would a physician partnership. So does every practice in the country. The decisions stay when the owner changes. What the bill changes is who must hold them, and only in the practices it covers.
Three questions for any owner
I sit where those decisions meet the clinical work. In anesthesia they are unusually concrete, because what we provide is coverage. A room runs or it does not. Someone decides how many rooms run after three in the afternoon, how many rooms each clinician covers, and what happens when a clinician says a patient is not ready for the case on the schedule.
Each of those decisions has an owner. Not a shareholder. A person. The ownership debate rarely asks who that person is.
So here is the test I would apply to any practice, whoever holds the equity. A private equity platform. A health system. A partnership of physicians who have practiced together for thirty years. It is also the test I would run before taking a leadership role inside any of them.
Who can overrule a clinical staffing decision, and does that person hold a license? Every organization has a budget, and every budget eventually meets a staffing plan. That is where the economics problem lands. When payment falls in real terms, the difference is absorbed somewhere, and under any owner the staffing plan is the likeliest place. The question is what happens when a clinician says the plan is unsafe. If the escalation path ends with someone who has never been responsible for a patient in that room, that is the problem to fix, whoever owns the practice.
Where is the clinical standard written, and who can change it? A standard that lives in one experienced physician’s head leaves when they do. A standard that is written down and measured by clinicians can be defended to a hospital, a board or a buyer. A standard that is never measured is a preference.
What happens to the first two answers when the owner’s horizon arrives? Every owner has one. A fund has a hold period. A health system has an operating budget and a margin target. A physician partnership has a founding generation that eventually wants to retire. They are not equal. A fund’s horizon is the only one with a date on it. That makes it the most predictable risk, and the easiest to ask about in advance. The horizon is not the problem. The problem is when the first two answers change because the horizon moved closer, and the clinicians and patients carry that risk without being asked.
Holding my own company to it
I owe these answers too. I will not grade my own organization (or any, for that matter) in public, so hold me to the questions instead. They are the same ones I would want a clinician to ask before joining us, and the same ones I would want a hospital to ask before signing with us.
What patients meet
A patient on the morning of surgery does not meet a cap table. They meet the clinician at the bedside. They also meet the consequences of whoever decided how many rooms that clinician was covering, what standard they were practicing to, and whether anyone was measuring it.
Congress may change who is allowed to own the practice. Whether or not it does, ask who is allowed to govern it.
Sources: AMA, Medicare physician pay since 2001; H.R. 10444, bill text; Stop Corporate Takeovers of Physicians Act, one-pager, introduced September 16, 2026.
I love the line about the patient meeting the clinician at the bedside and never the cap table, David! Asking who a clinician calls when they say a patient isn't ready is such a concrete way to test any group. Have you seen that question change someone's decision to join??