I’ve practiced long enough to feel when something in medicine shifts before we ever find the words for it.

You notice it in the pacing first. 

The clinic schedule tightens. 

Appointments come closer together. 

The day starts to feel less like a conversation with patients and more like a conveyor belt that never slows, never breathes, never asks whether the work still feels like care.

And then someone mentions new ownership.

Or “restructuring.”

Or “efficiency alignment.”

And you understand, even before the meeting starts, that the center of gravity has shifted.

Private equity doesn’t walk in wearing a name tag. It shows up in the form of dashboards, metrics, targets, and quiet phrases like margin optimization and throughput. It shows up in how leadership talks about patients, not as people, but as volumes, units, encounters, productivity curves.

And if you’ve been in medicine long enough, (I graduated from residency in 2005) you can feel when the soul of the work starts getting priced.

I’ve worked in spaces where investment was framed as rescue. Where clinics were struggling, margins were thin, and staff were exhausted long before anyone signed anything. I understand the appeal of structure, resources, and “business expertise.” I understand why people hope it will fix what medicine hasn’t yet figured out.

But here is what I also know:

Care changes when profit becomes the main narrator.

You start seeing decisions that are technically defensible, but ethically hollow.

Close the clinic that serves the poorest neighborhood — the payer mix is bad.
Extend hours in the one across town — higher reimbursement, better numbers.
Reduce appointment length — more visits, more revenue.
Hire cheaper, leaner, faster — not always safer, not always better.

And when physicians raise concerns, the response often sounds like a language none of us learned in medical school or training:

“This model isn’t sustainable.”
“We have to be competitive.”
“This is industry standard.”

Meanwhile, patients feel the shift before anyone admits it.

They wait longer.
They see more strangers.
They repeat their story to new faces every visit.
They sense, in subtle, painful ways,  that time with them is being rationed.

And we feel it too.

We stay late charting because the schedule leaves no room to think.
We internalize impossible expectations and call it “resilience.”
We grieve silently for the type of medicine we trained to practice, the kind that allowed presence, curiosity, and care that moved at the pace of a real human life.

And if you are a woman, a physician of color, or someone already fighting to be heard, the weight compounds.

Because now you aren’t just advocating for patient safety, you’re pushing against a financial machine that does not always recognize safety as value.

I don’t believe every investor is indifferent to patients. I don’t believe every acquisition is harmful. Some systems stabilize. Some communities gain access. Some practices survive because capital stepped in.

But intention does not erase impact.

And when the system constantly asks:

“How much does compassion cost?”
“How many minutes is dignity worth?”
“How many visits before we break even?”

something sacred begins to thin.

I am not writing this as a policy paper. I’m writing it as someone who has sat in exam rooms with people whose lives do not fit easily onto spreadsheets. I have listened to stories that need time, silence, patience, things that don’t convert neatly into revenue.

Private equity brings discipline to business models.

But medicine is not a business model.

It is a relationship. Fragile, human, dependent on trust.

And when trust becomes collateral, quality cannot survive untouched.

I don’t think the question is whether money belongs in healthcare. The real question is:

Who gets to decide what “value” means?

And what happens when the people who deliver the care and the people who live inside the outcomes no longer have a voice in that decision?

I still believe we can build systems that honor both sustainability and humanity. Systems where clinicians lead alongside analysts. Where patients are not line items. Where investment serves care rather than reshaping it in its own image.

But we cannot fix what we refuse to name.

And what I am naming is this:

When profit takes the driver’s seat, medicine feels the costs but forgets its purpose.

And we deserve better than that.

Our patients do too.

Trisza L. Ray DO practices Family Medicine in Tulsa, Oklahoma