The entry story has been told. Goldman Sachs and Charlesbank hold MDVIP. Revelstoke holds a concierge platform. Frontier is building employer-facing DPC infrastructure. Marathon Health and Premise Health are scaling the advanced primary care model for large employers. The capital has arrived and the deal terms are public.
The exit story has not been told, and it is the more important one.
Private equity firms hold physician practices for three to eight years before generating returns through a sale, and in nearly all instances, that sale is a secondary buyout, where the practice is resold to another PE firm with a larger fund. Of more than 800 physician practice acquisitions studied across dermatology, ophthalmology, and gastroenterology in recent PE research, over half exited within three years of the initial investment.
Concierge and DPC have not existed under PE ownership long enough to generate a full data set on exits. But the incentive structure, buy, scale aggressively, sell for a higher multiple, is the same structure documented across every other specialty where PE has operated at scale, and the incentive structure does not change because the specialty does.
Membership-based cash flow is a different revenue structure than procedural billing. But the incentive to scale before an exit does not depend on how the revenue is generated. It depends on whether size increases the multiple. In direct care, it does.
The mechanism is called multiple arbitrage. A PE firm acquires a platform practice, then combines smaller practices trading at lower valuation multiples into a larger network that commands a higher multiple purely because of its size. The combined platform, once scaled and recapitalized, can trade at 12 to 14 times EBITDA or more upon exit. The firm profits from the difference between what it paid to assemble the platform and what a larger buyer pays for the assembled result.
That means growth is not a byproduct of the PE thesis. Growth is the PE thesis. The faster the platform scales, the higher the exit multiple.
For the independent physicians watching MDVIP enter year five under the same ownership, or watching Revelstoke’s first concierge platform investment mature, the operative question is not whether the current owner delivers good care today. MDVIP has held its position since 2014 with reported patient satisfaction above 97 percent, and that longer hold is a genuine counterpoint to the faster exit cycles documented elsewhere.
MDVIP operates as a network affiliation model, not a direct acquisition platform. Physicians own their practices and pay MDVIP for the brand, infrastructure, and referral system. Goldman Sachs and Charlesbank own the license company, not the clinics. That structural difference is why MDVIP has not needed to consolidate and flip a portfolio the way Premise or Frontier eventually will. But the license company itself is still an asset built for eventual sale. A longer hold is not the absence of an exit. It is a delayed one.
Premise Health is already living this cycle. OMERS Private Equity acquired Premise from its previous owners in 2018. Premise’s most recent transaction, a merger with Crossover Health, closed in February 2026, five months before this article. The exit happened. The re-entry happened. Most of the employers, physicians, and members inside that platform never saw either one coming.
In one study of PE practice sales, physicians in PE-owned practices were 16.5 percentage points more likely to leave within two years of an exit. Two years post-sale, only 44 percent of physicians remained at PE-owned practices, compared to 60 percent at practices with no PE ownership history. The financial incentives that kept physicians in place after the initial acquisition often expire when the PE firm exits, and the practices left behind sometimes carry fewer assets and more liabilities than they did going in.
This is not an argument against capital in independent medicine. Practices need infrastructure, and physicians have legitimate reasons to seek liquidity. It is an argument that the exit stage carries a risk this market has not yet priced.
For operators building in this space now, that is the diligence question that matters most. Not what the current owner promises about care model preservation. What happens contractually, financially, and operationally at the moment of exit, and who absorbs the disruption when it happens.
For investors evaluating the category, that is the underwriting question. A concierge or DPC platform’s value proposition rests on physician-patient continuity. If the exit event predictably drives physician turnover, the asset that commands the premium multiple is degrading the exact continuity that justified the premium.
Private equity typically pays a physician a multiple of forgone future income to acquire the practice, often taxed at the more favorable capital gains rate. That is a real and rational reason for a physician to sell. It is not, on its own, evidence that the model the physician built will still exist after the second or third change of ownership.
Independent medicine’s growth story has been told at the acquisition stage. The stage that determines whether the model survives is the one nobody in this market has priced in yet.
Editor’s note: Neither the author nor her company have any relationship with the companies mentioned.
Photo credit: Flickr user Eva Blue
Dana Y. Lujan, MBA, CHFP, CRCR, is founder of Wellthlinks, a healthcare advisory firm that connects providers and employers to design compliant, innovative care models. With more than 20 years of experience in healthcare operations, contracting, and compliance, she has advised health systems, physician groups, and employers on strategies ranging from value-based contracting to direct primary care adoption. Her thought leadership has been published on KevinMD and Medium, where she writes on innovation, compliance, and employer health strategies. She is passionate about building sustainable models that improve access, reduce costs, and strengthen trust between employers, providers, and employees.
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