Who Owns Your Doctor? Private Equity and Southern Oregon Healthcare, Part 2 of 4
In 2020 or 2021 — the exact date is not publicly disclosed — Oregon Medical Group, a physician-founded primary care practice in Lane County, was acquired by Optum, a subsidiary of UnitedHealth Group, the largest health insurance company in the United States. At the time of the acquisition, Oregon Medical Group had been serving Eugene and the surrounding area for decades, built by the physicians who practiced there.
What followed over the next five years has been documented in public testimony, legislative hearings, and local news coverage. Physicians who refused to sign new contract addendums — which required higher patient volume quotas and included significant pay cuts — left the practice. Support staff was reduced, so the doctors who stayed had to perform administrative tasks that medical assistants had previously handled. The practice ended its entire obstetrics and gynecology service line. The dermatology department closed as physicians left. Osteopathic medicine services disappeared. As of mid-2025, patients were still receiving notices that their doctors had departed.
One physician described her departure this way: she had a limited number of years left in her career and wanted to spend them practicing medicine the way she had trained to practice it. She knew that was unlikely under Optum management. She left. Her noncompete agreement required her to find a new job more than 25 miles from the clinic’s offices. She moved to Portland and left primary care entirely. The patients she had been seeing in Eugene found new providers or went without.
This is not an outlier story. It is the most thoroughly documented Oregon example of a pattern that the national research literature has now confirmed across hundreds of acquisitions in dozens of states. And it is the pattern that is approaching Southern Oregon.
What the Research Shows
The evidence base on PE healthcare ownership has grown substantially in recent years, driven by academic researchers who finally got access to the transaction data needed to measure effects systematically. The findings are consistent enough across studies that “mixed to harmful” has become the standard academic summary — and that summary understates the negative findings in several key categories.
The most comprehensive review to date, published in The BMJ in 2023, analyzed 55 studies across eight countries, primarily in the United States. The review found PE ownership in healthcare was most often associated with higher costs to patients and mixed to harmful impacts on quality of care. Specific findings across the reviewed studies included higher mortality rates, lower patient satisfaction, higher rates of complications, and reduced staffing levels.
A separate 2023 study focused specifically on hospital acquisitions found that Medicare patients at PE-owned hospitals suffered a 25 percent increase in hospital-acquired complications following acquisition, including a 38 percent increase in central line bloodstream infections — a category of complication that is almost entirely preventable under adequate nursing staffing and infection control protocols.
On pricing, a 2023 study found that PE-owned hospitals’ net income rose 27 percent following acquisition, driven largely by price increases of 7 to 16 percent for procedures. PE-affiliated specialists negotiated prices 6 percent higher for cardiology and 10 percent higher for gastroenterology procedures compared to independent practices. The average negotiated price for a new patient visit was $147 at independent practices, $155 at PE-affiliated practices, and $180 at hospital-affiliated practices. Every dollar above the independent baseline comes from somewhere — patient cost-sharing, insurance premiums, or public program budgets.
More than 60 percent of physicians surveyed in studies of PE-owned practices expressed negative views of PE involvement in healthcare. Physicians at PE-owned practices were less likely to report high autonomy, job satisfaction, or intent to stay with their employer, and more likely to burn out. PE firms frequently require physicians to sign non-disclosure agreements preventing them from speaking to media without prior approval, and have threatened to terminate physicians who reveal how PE ownership affects care quality.
The number that puts this in context for a region already struggling with provider retention: independent physicians practicing in rural areas declined 43 percent over just five years, from nearly 22,000 in January 2019 to 12,467 in January 2024. In 2024, just 42 percent of physicians worked in private practice, down from 60 percent in 2012. Southern Oregon’s independent practitioner base is part of a national trend that is not reversing.
The Medicaid Trap
For Southern Oregon specifically, there is a dimension of the PE evidence that is more consequential than the national averages suggest. It concerns Medicaid patients — the working families and lower-income households who receive coverage through AllCare Health and Jackson Care Connect in Jackson and Josephine counties.
PE-owned healthcare businesses use their negotiating scale to extract higher reimbursement rates from commercial insurers. A chain the size of Upstream Rehabilitation, operating BenchMark Physical Therapy clinics across multiple states, has significantly more leverage at the contracting table than an independent PT practice owner in Grants Pass. That leverage translates into higher commercial rates.
But higher commercial rates create a parallel incentive: to shift patient mix toward commercially insured patients and away from Medicaid patients, whose reimbursement rates are set by the state and not subject to negotiation. A 2022 study found Medicaid acceptance was lower at PE-owned urology practices compared to non-PE practices. When hospitals raise prices through market consolidation, resources get redirected toward facilities serving privately insured individuals — who are disproportionately higher income — at the expense of Medicaid patients.
The practical effect in this region: AllCare and Jackson Care Connect negotiate contracts with the providers in their network on behalf of the region’s Medicaid enrollees. If PE-owned PT and dental chains use their market leverage to push Medicaid rates down or decline Medicaid participation where the economics don’t work for the fund, the patients left behind are the ones already facing the longest waits and the fewest alternatives. The extraction dynamic hits the most vulnerable population hardest.
When Bankruptcy Is the Exit
The leveraged buyout structure that generates PE returns in good scenarios creates catastrophic outcomes in bad ones. Because the acquired business is responsible for the acquisition debt, a business that struggles operationally — whether from market changes, management failures, or overpayment at acquisition — faces a debt load that can drive it into insolvency before any turnaround is possible.
The most consequential recent example is Steward Health Care. At its peak, Steward operated 31 hospitals across eight states, making it one of the largest private hospital operators in the country. It was acquired by private equity, loaded with acquisition debt, and then sold back to its own physicians — who then sold it to a different PE firm that took on more debt and sold the real estate out from under the hospitals in a sale-leaseback transaction that generated immediate returns while committing the hospitals to rent payments they couldn’t sustain. Steward filed for Chapter 11 bankruptcy in May 2023. Two hospitals closed permanently. Others came within days of closure. Nurses and physicians went to work not knowing whether the hospital would still be open at the end of their shift.
No Southern Oregon hospital is currently owned by private equity. Asante is a nonprofit regional health system; Providence operates under a Catholic health system’s nonprofit structure. But the pattern that produced Steward — PE ownership of community hospitals, sale-leaseback of real estate, extraction through debt — is active in rural markets across the country. In 2024, Prospect Medical Holdings, another PE-backed hospital chain, closed multiple rural hospitals as it faced financial collapse. In each case, the community lost infrastructure that had taken decades to build.
The closest recent Oregon example outside the hospital context is a dialysis center in Tillamook that was abruptly closed when its PE owner determined the location was not financially productive. Dialysis patients cannot simply miss appointments. They require treatment multiple times per week to survive. When PE ownership determines that a rural market doesn’t meet return requirements, the business closes. The community has no recourse.
The Market PE Is Looking For
Private equity targets markets with specific characteristics: reliable cash flow, fragmented ownership among many small independent businesses, limited regulation, aging ownership cohorts looking for exit options, and demonstrated demand that is unlikely to disappear.
Southern Oregon checks every box.
The region has a documented primary care shortage — fewer than 60 primary care providers per 100,000 residents against a state average of 83. The shortage itself creates demand pressure that makes healthcare businesses here more valuable, not less. Many of the region’s independent practitioners are approaching retirement age, and the succession problem is real: there is no easy mechanism for an independent dentist in Grants Pass who wants to retire to transfer the practice to a young clinician who can’t afford to buy them out. PE acquisition offers a clean exit at a premium price.
The regulatory environment in Oregon has become more hostile to PE physician acquisitions following SB 951, but dental and physical therapy remain unprotected — and those are the sectors where PE is currently most active nationally. Optum, which now has Optum-acquired physician practices in Eugene, Portland, and Corvallis, has been methodically moving down the I-5 corridor in Oregon. Southern Oregon is the next major population center south of Corvallis. It is not speculation to suggest that this region is in the acquisition planning horizon of multiple national healthcare consolidators.
What You Don’t Know You Don’t Know
There is a particular quality of PE healthcare ownership that distinguishes it from other kinds of business change, and it matters for Southern Oregon residents who want to make informed decisions about their care.
PE firms frequently require acquired clinicians to sign non-disclosure agreements. When the quality of care at a PE-owned practice declines — when the staffing ratios drop, when the appointment slots get packed tighter, when the referral decisions start being influenced by which specialists are in the same ownership network — clinicians who notice and object may be legally prohibited from saying anything publicly.
The Oregon Medical Group physicians who left did speak publicly, largely because Oregon’s noncompete law gave them some protection after they departed. But the physicians who stayed, and who continue to see patients under Optum management, operate under NDAs that constrain what they can say about their working conditions and the care they’re providing.
This information asymmetry is structural. Patients who don’t know that their provider is PE-owned, and who have no mechanism to find out, cannot make informed decisions about their care. They cannot advocate for themselves at the contracting table. They cannot vote with their feet in any meaningful way when access is limited. The transparency problem is not incidental to PE healthcare ownership — it is a feature of the model.
The next article in this series addresses how to recognize the different ownership models operating in Southern Oregon, what each model means for your care and for the local economy, and how to find out who actually owns your provider.
This is the second article in a four-part series on private equity and healthcare in Southern Oregon. Part 1 explained the PE mechanism and how it arrived in Southern Oregon. Part 3 addresses the distinctions between private equity, franchises, and clinician-owned chains. Part 4 covers Oregon’s new law, its gaps, and what this region can demand. We welcome responses, corrections, and partnership inquiries at reimagine-healthcare.org.