As concierge care grows, corporatization raises new questions about autonomy

Concierge and direct primary care are often framed as an escape hatch from big-system medicine; smaller panels, less paperwork, more control. But new research suggests corporate ownership is expanding quickly inside these models, creating a tension at the heart of the pitch: As more practices scale, will the autonomy clinicians are chasing hold up, or start to erode?

In an interview with Physicians Practice, Jane Zhu, M.D., of Oregon Health & Science University, details the results of a study she led that looked at just how quickly these practice models have grown since 2018.

Physicians Practice: So over that same five-year period, 2018 to 2023, you found there was a 576% increase in these models that were becoming corporately owned. The big pitch for concierge and DPC is always that this is a way to save independent medicine. Is corporatization threatening the autonomy doctors are looking for by getting into these structures?

Jane Zhu, M.D.: I was surprised by that finding in particular because, as you mentioned, concierge and DPC practices are sold as a way to offer benefits to clinicians; smaller patient panels, reduced administrative burden, greater autonomy, all these positive things. But at the same time, if we’re also seeing rising corporatization and ownership in these models themselves, that can directly take away from some of the benefits of these models.

So I think, as these models grow, we really need to focus on how they respond to the foundations of clinical care, and whether this ownership shift itself could run counter to those principles that are driving these models in the first place. That’s worth monitoring over time.

Whether corporatization is actually threatening these models is less clear. As I mentioned, our sample is probably not comprehensive of every single practice. But given that there’s such increased growth, I think that’s definitely cause for concern and really requires monitoring.