Private equity is an increasingly visible part of healthcare delivery. In 2024, 6.5% of physicians worked in private equity-owned practices, reflecting a broader shift in how healthcare organizations are financed, structured and scaled.
But the question facing healthcare leaders is bigger than private equity.
As organizations grow, pursue investment, adopt new technologies and build greater operational scale, leaders across healthcare are navigating a fundamental challenge: How do you improve performance and expand capabilities without losing the culture, autonomy and clinical connection that make an organization effective?
That was the starting point for the Nashville Health Care Council’s recent Crucial Conversation, After the Deal: Protecting Clinical Culture in a Private Equity Environment moderated by Partner at Holland & Knight, Nick Rew
Investment and scale can bring meaningful new capabilities to a healthcare organization, from access to capital and technology to stronger data infrastructure, administrative support and opportunities for growth.
The opportunity is not simply to grow larger. It is to use those capabilities to create greater value for the business, clinicians and, ultimately, patients.
But realizing that value requires leaders to navigate what changes after an investment or transaction, and how those changes are experienced across the organization.
New expectations around governance and decision-making may emerge. Performance and productivity measures may evolve. Incentives and compensation can change. Technology and standardization may become more prominent. Growth expectations may accelerate.
None of these things are inherently at odds with a strong clinical culture. The challenge is how they work together.
For healthcare leaders, the tensions can look familiar:
Growth | Culture
Performance | Engagement
Standardization | Autonomy
Scale | Connection
Technology | Clinical Judgment
These aren't private equity questions alone. They are leadership questions.
Any organization undergoing significant growth, transformation or operational change has to determine how to balance competing priorities without allowing one to overwhelm the others.
Clinical culture, in particular, cannot be treated as something separate from the operating model. The way decisions are made, accountability is established, technology is implemented and performance is measured all send signals about what an organization values.
The evidence around private equity's impact on healthcare is still evolving, and the picture is nuanced.
One study of private equity-acquired ophthalmology practices, for example, found a 46.8% increase in the clinical workforce over three years, alongside a 13-percentage-point increase in annual physician turnover compared with comparable practices.
The takeaway isn't that growth is good or bad, or that private equity produces a particular outcome.
It is that growth and workforce stability do not necessarily move together.
For leaders, that raises a more important question: As an organization scales, are its people experiencing that growth as an opportunity, or as a loss of connection, autonomy or trust?
Culture is Built into the Operating Model
Protecting clinical culture isn't about preserving everything exactly as it was before a transaction, nor is it about resisting change.
It is about being intentional about how change happens.
That means leaders have to consider more than financial and operational performance. They also have to understand how governance, autonomy, accountability, technology and incentives affect the people responsible for delivering care.
The strongest organizations recognize that clinical culture is not simply an HR issue or a communications exercise. It is embedded in the everyday experience of leadership and work: who has a voice, how decisions get made, what gets measured, what gets rewarded and how leaders stay connected to the people closest to care.
Private equity provides one particularly visible lens into these challenges, but the lessons extend well beyond ownership structure.
Healthcare organizations of every kind are navigating growth, consolidation, technology adoption, workforce pressures and rising expectations for performance. The leaders who navigate those changes well will be the ones who can hold multiple priorities at once: financial sustainability and clinical quality, operational discipline and autonomy, scale and connection.
Ultimately, protecting clinical culture is not about choosing culture over performance.
It is about recognizing that culture is part of performance.
And as healthcare continues to evolve, that may be one of the most important leadership conversations to keep having.
The Nashville Health Care Council serves as common ground for the vibrant healthcare community, bringing together leaders from across the healthcare ecosystem to exchange ideas, share perspectives and explore the complex issues facing the industry. Through curated convenings, educational programs and meaningful connections, the Council creates space for candid dialogue, diverse perspectives and productive conversations that might not otherwise happen. As a neutral convener, the Council does not advocate for a particular position or seek consensus. Instead, we bring the right people to the table, foster thoughtful discussion and extend important insights to the broader healthcare community, helping move conversations and opportunities forward while strengthening and elevating Nashville as The Healthcare City.
The Nashville Health Care Council shares recaps and key insights from our convenings to extend the value of these conversations to our broader community. The perspectives and information reflected are those shared by participating experts and speakers and do not necessarily represent the views, positions, or opinions of the Nashville Health Care Council.