Episode 528

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

Sep 9, 2026

38:49

Health Policy Health Equity Primary Care Global Health Health Economics Public Health

Episode Description

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.

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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?

Again, this is Relentless Health Value. My thanks go out to Aventria Health Group, who is our founding sponsor.

I also very much want to thank Payerset, our 2026 series underwriter. Do go over to their site. They have some very interesting resources dealing with healthcare transparency.

Additionally, my deepest thank yous go to Patient Rights Advocate, which is a nonprofit; and I thank them so much also for their generous donation this year, helping us keep the show on the air.

And with that, here is my conversation with Yashaswini Singh, PhD.

Also mentioned in this episode are Brown University School of Public Health; Center for Advancing Health Policy through Research (CAHPR); Lisa Rosenbaum, MD; Arielle Bose; Aventria Health Group; Payerset; Patient Rights Advocate; Guy Culpepper, MD; Andrea DeSantis, DO, FAAFP; Andrew Tsang; Suhas Gondi, MD, MBA; and Tom Nash.

For a list of healthcare industry acronyms and terms that may be unfamiliar to you, click here.

You can learn more at sph.brown.edu and cahpr.sph.brown.edu. You can also follow Yashaswini on LinkedIn.

Yashaswini Singh, PhD, MPA, is the Thomas J. and Alice M. Tisch assistant professor of health services, policy, and practice at Brown University. Her areas of expertise include healthcare consolidation and corporatization, including by private equity firms, and the downstream effects on healthcare spending, access, quality, and the clinical workforce. Dr. Singh's research has been published in high-impact peer-reviewed journals, featured in national media outlets, and frequently cited in policy discourse. She has presented her research to the U.S. Congress, the Federal Trade Commission, National Conference of State Legislatures, and National Academy for State Health Policy and testified before state legislatures on strategies to address healthcare corporatization.

Dr. Singh has received honors and awards from the American Society of Health Economists, the International Health Economics Association, and AcademyHealth; a teaching award from Johns Hopkins University; and the Community-Academic Research Partnership Award and Richard B. Salomon Faculty Research Award from Brown University. In 2025, Dr. Singh was named an Aspen Ideas Health Fellow, an honor recognizing healthcare leaders with the ability to transform ideas into action.

Dr. Singh holds a PhD from Johns Hopkins University, a graduate degree in international finance and economic policy from Columbia University, and a bachelor's degree in mathematics and economics from Bryn Mawr College. In addition to her academic career, she has extensive private sector experience in antitrust and competition.

00:00 Introduction to this episode.

00:39 EP519 with Lisa Rosenbaum, MD.

03:21 Dr. Singh's research on private equity investing in primary care.

04:16 The three categories covered in today's episode.

05:36 The conversation with Dr. Singh.

05:44 EP474 with Dr. Singh.

06:51 Private equity study in Health Affairs.

06:58 Private equity study in JAMA.

07:02 Findings these private equity studies have found about primary care.

12:00 Does private equity make cognitive atrophy inevitable?

14:49 In PE-backed, single-specialty primary care, is it easier for PCPs to have full-spectrum clinical scope?

17:14 Why perverse financial incentives cause problems but aren't necessarily an inevitability.