4. The Physician's Path

You became a physician to care for people, not to run a company. This episode is built for doctors, especially primary care physicians, who own a practice they were never trained to run. 

Host John Lay, founder of Three Circles Agency, explains in plain language what a practice is actually worth (and the salary-adjustment that decides the real number), why patient loyalty to you personally can make a practice hard to sell, and how these deals are legally structured. That includes the Corporate Practice of Medicine doctrine, the MSO model (and the 2025 state moves in Oregon and California to tighten it), and the two federal laws every physician should know by name: the Anti-Kickback Statute and the Stark Law. 

Then the three real choices: sell and move on, stay independent and strengthen, or partner through an MSO and keep practicing with the business weight lifted. 

General education, not legal advice; work with healthcare counsel on the specifics.

Sources:

• Singh, Y., Song, Z., et al. (2022). JAMA Health Forum 3(9). PE-acquired practices: charges per claim up approx. 20%, amounts collected up approx. 11% vs. controls. 
• DeTienne, D. R., McKelvie, A., & Chandler, G. N. (2015). Journal of Business Venturing 30(2). Stewardship exit motive. 
• Recent 2024-2025 primary-care consolidation studies, JAMA Health Forum and Health Affairs: office-visit prices 8-11% higher at hospital- and PE-affiliated practices; PE resale associated with higher physician turnover. 
• Anti-Kickback Statute, 42 U.S.C. §1320a-7b(b); 
• Stark Law, 42 U.S.C. §1395nn; 
• Texas Occupations Code / 22 TAC §177.17; 
• 2025 Oregon and California MSO restriction laws. 
• American Medical Association, Physician Practice Benchmark Survey (Kane, 2024): private practice 42.2% in 2024, down from 60.1% in 2012; physician ownership 35.4%, down from 53.2%; approx. 76% in early 1980s; PE-owned practices 6.5% in 2024.

Disclaimer. Job or Asset is produced by Three Circles Agency (TCA) and is provided for general informational and educational purposes only. It does not constitute, and should not be relied upon as, legal, tax, accounting, financial, investment, valuation, or medical advice, and it is not a solicitation or offer to buy or sell any business, security, or financial product. Listening to this podcast, contacting TCA, or downloading any TCA material does not create an attorney-client, accountant-client, fiduciary, broker, or advisory relationship of any kind. TCA is a business-consulting firm. It is not a law firm, accounting firm, registered investment adviser, broker-dealer, or licensed business broker, and it does not provide legal, tax, or investment advice. Always consult your own qualified, licensed professionals before making any decision regarding the purchase, sale, financing, structuring, taxation, or operation of a business or practice. Statistics, multiples, interest rates, and figures mentioned are believed accurate as of the recording date but are general in nature and subject to change; they may not apply to your situation. Academic research is cited to illustrate ideas and mechanisms; practitioner and industry figures are estimates that vary by business, market, and time. Any client examples are illustrative composites and do not depict real, identifiable clients. The views expressed are those of the host. TCA makes no warranty as to the a...