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Tonie Reincke, MD, was midway through a procedure in her South Texas-based vein clinic when a teary-eyed receptionist opened the door and beckoned her to take an emergency phone call.
Reincke, an interventional radiologist, was immediately concerned. If her staff was interrupting patient care, the news was certainly bad. She finished the procedure and assured the patient that she would be back in a minute before stepping outside to pick up the phone.
The emergency call was not from a patient, a fellow doctor, or a family member. Her boss, the private equity CEO in Michigan, was on the line. He wanted her paperwork, standard paperwork that was still being reviewed by her attorney. He’d bullied the receptionist — threatening her job — to convince her to get Reincke on the phone.
“I was so pissed,” Reincke recalled. She accused the CEO of being unprofessional and failing to prioritize patients. “But I knew it was a hill I was going to die on,” she said. By Monday, they were shutting down all the Texas clinics, calling them unprofitable. Reincke was notified by email.
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, The Realities of Affiliation in Primary Care Report 2026 found that
- 64% of primary care physicians surveyed reported that they are affiliated with a hospital or health system.
- The general attitude doctors have about those affiliations was split; 31% were positive, and 37% were negative.
- 72% of doctors in the survey said they believe the rate of affiliations will go up in the next few years.
Across the US, private equity groups are buying up medical practices, consolidating high-value subspecialties such as ophthalmology, autism services, cardiology, and dermatology, and selling them for profit. For some doctors, these sales offer financial relief, management support, or a retirement strategy. But they can also come with deep cuts to physician autonomy, staff, income, and even, as in Reincke’s case, the shuttering of a practice.
Reincke’s partners outvoted her, 2 to 1, when the private equity offer came. It was 2018, just 5 years after she agreed to help her Michigan partners expand into the Houston market and just 3 years after she bought in as an equal partner. Their argument was profit.
The vein clinics were overstretched across their 10 locations, and private equity buyers offered a way to increase profitability. While they made no immediate cash in the sale, Reincke’s partners promised her they’d eventually sell out for a windfall. But she wasn’t interested; money wasn’t her priority. The day private equity moved in, she started saving for her exit.
In the 2 years she was under private equity, Reincke said her autonomy was largely intact. It helped that she was so far away from the other clinics. However, when the employer repeatedly requested that she hand over treatment protocols she developed, Reincke quietly resisted, sensing the trade could cost her some security.
When notice of the clinic closure came in 2020 (after which she did receive a payout), she had saved enough to go out on her own. Her private practice was profitable within 6 months and has remained successful. But just 6 months ago, in 2025, she got word that her former employer had returned to Houston, launching three clinics across town. Reincke’s clinic hasn’t been affected. But her former employer is still using her positive reviews on their Google profile and has even taken appointments from patients requesting to see Reincke. One such patient walked out of the exam room after learning she no longer worked there.
Better Ways Out
Tina McGill, a certified public accountant and healthcare consultant, sees doctors like Reincke every week, many of whom are in worse predicaments and with less agency. “I spend a lot of my time consoling clients and listening to them cry on the phone after they do their private equity deals,” McGill said.
While she’s not against private equity — it works for some of her clients — she makes a living helping doctors avoid bad arrangements, of which there are plenty. Most of them are burnt out, McGill said. Pushback from payers makes cash flow a challenge, and fewer younger doctors can afford to buy in and share the load. Trustworthy chief financial officers and back-end managers are hard to come by. So, a lot of doctors want out; they want to go back to just practicing medicine or equity altogether — often 10-15 years ahead of traditional retirement age.
Then they get a call from a fellow doctor, talking about the promise of private equity, McGill said. “They don’t realize that the doctor is being paid to sell them on the idea.” Or they get a letter of intent offering them $10,000,000 for the business that has come to feel like a huge burden.
These gargantuan offers are a negotiating tactic, McGill warned, an amount meant to get doctors excited so they’ll share financials. Her clients seldom see that amount in the initial offer, let alone in cash.
Typically, clients see 60%-70% of the original offer, and 20%-30% will be in stock, McGill said. So that $10 million bait offer is typically about $3 million cash. There could be a later stock payout, but it’s not guaranteed. Plus, doctors must stay on for 3-5 years, often at a significant pay cut. “I’ve had clients walk out of the negotiations at the last minute because they realize that they can’t actually live on the money they are being offered,” she added.
McGill’s strategy is to help doctors find alternatives to private equity: Burnout solutions, like management help, accounting systems, people to partner with, or profitable downsizing, that don’t require selling their business. As she sees it, doctors who want to keep practicing need a way to retain their investment. Private equity is not for them, McGill said. “Private equity is the endgame.”
A Young Doctor’s Game?
Parul Khator, MD, an Atlanta-based ophthalmologist, gives the opposite advice. She believes — and has experienced — that private equity is a game for young doctors. Private equity is “interested in young doctors we know are going to sustain the practice,” she told Medscape Medical News.
Khator, now 45, joined an ophthalmology practice, Georgia Eye Partners, just out of fellowship and was bought in as a partner in 2014. When her partners came with an offer from Shore Capital, she resisted, holding up the sale for 18 months. But after much research and many conversations with the investment firm’s CEO, she changed her mind.
In 2017, Georgia Eye Partners was purchased by Shore Capital, becoming their platform practice — the business they would use to buy all future ophthalmology practices under the brand name Eye South Partners.
Where the traditional buy-in approach requires young doctors to pay large sums of money in hopes of a payoff later in their careers, Khator said private equity ownership requires less upfront. Young doctors can buy shares as they can afford to.
And for the younger doctors, like herself, who are already in an ownership position, a buyout from private equity is “cash that you’ve gotten at a very young age that you can invest, and if invested properly, you should double every 10 years,” Khator said.
Since the transaction, Eye South Partners has grown from three doctors in Atlanta to more than 400 doctors across 14 states. At this size, the company now offers doctors “a whole slew of resources that you could only find in an academic center…but you’re still in private practice,” Khator said. Things like collective buying power, streamlined billing and reimbursement, a vetted network of experts, and even mini-conferences to help doctors learn new procedures.
But Shore Capital didn’t stick around. In 2022, they exited, selling Eye South to another private equity firm, Olympus Partners. Khator said the transaction didn’t change anything in her day-to-day at the clinic.
Admittedly, not all private equity buyouts go so well. When asked why it worked out for her practice, Khator said, “We got really lucky.” The first private equity partners were looking to build something resilient, and they invited doctor leadership at the highest levels. By the time they sold to Olympus, there were eight doctors on the board of Eye South Partners.
According to McGill, investigating the private equity firm is key before these deals even start. Doctors must know who they’re getting into business with and who they are agreeing to work for over the final years of their career. Before you give away any information, she said, figure out if this is the kind of company you want to be associated with and if they even have the cash flow to see your business through the next 5 years and pay you out, she said. “Because a lot of private equity is going bankrupt.”
And be quick to seek out help. There are financial and legal experts who can help you understand the deal you’re offered, weed through bad advice, and find the best options for your life and business — which might be a sale to private equity, or it might not.
“Because it’s a one-time deal…you only get to sell your practice one time,” McGill said. “It’s your legacy.”
Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, the environment, and anything that affects the way we eat. She has a master’s degree from New York University’s Arthur L. Carter Journalism Institute, New York City, and a master’s in molecular nutrition from Aarhus University in Aarhus, Denmark. You can see more of her work in WIRED, Teen Vogue, Scientific American, and elsewhere.
