EP528: The Current State of Primary Care—Inevitable or Fixable? Will It Be Private Equity to the Rescue? With Yashaswini Singh, PhD

Hello, all you Relentless Tribe members. Here's the backstory for this episode. Remember episode 519 with Lisa Rosenbaum, MD, where we played a high-stakes kind of game show called "Is the Current State of Primary Care an Absolute Inevitability, or Is It a Needless, Suboptimal Inefficiency?" In that conversation, Dr. Rosenbaum, who was my contestant, made a compelling point. She said that if we want to fix primary care, we probably have to pay our primary care clinicians more. We need to invest in them and level up teams and infrastructure. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Now, if you have listened to Relentless Health Value for any length of time, you know you can count on me for a rant any given Tuesday about ceasing to pay way too much to corporatized consolidated, for example, health systems, especially the ones that already have quite robust endowments and huge real estate portfolios. Their crocodile tears do not move me. Same with other corporate intermediaries. Sharks with great PR departments. But yeah, it's hard to argue that our frontline primary care clinicians are chronically underfunded and relatively underpaid. So, when private equity enters the primary care chat with bags of capital, I could think, "Great! Primary care is finally gonna get the investment that it deserves." But riddle me this: If private equity gets in the mix and there's now more money flowing, will primary care actually get better? Or will the doctors and other clinicians on the ground and the patients they care for become, I don't know, pawns in just one more healthcare inflationary business model? Said another way, is the capital actually gonna build sustainable whole-person care, or is it just corporate arbitrage in a different Halloween costume? So, when I heard health economist Dr. Yashaswini Singh had just completed a whole bunch of research into private equity investing in primary care, I was on it like white on rice. I wanted to find out if this professional capital will actually or actually has been translating to better outcomes for patients or not. And to find out, I put Dr. Singh through the exact same three-category game show categories that I went through with Dr. Lisa Rosenbaum but specifically relative to private equity, PE-backed primary care clinics. So, with Dr. Rosenbaum, we talked about primary care kind of writ large and the inevitabilities and the kind of decimation of primary care that we see across the country. This show today is specifically … so, same three categories, which, let me remind you, are these three that we tackle: Cognitive atrophy amongst clinicians. That's what we talk about first, the de-skilling of primary care. Secondly, primary care becoming referral machines as a, is that inevitable? And then thirdly, we examine transactional fragmentation versus continuity of care. So, for each of these categories we go through, is it inevitable that this is gonna happen; or is this something that potentially, if a practice is purchased by private equity, can be avoided? <