The Benefits of Private Practice: A Q&A with Joel Schlessinger, MD, FAAD

While selling to and working for private equity–backed platforms may have its perks, many long-time private practitioners warn that the advantages of private practice are often not fully appreciated until it is too late. Practical Dermatology Chief Cosmetic Surgery Editor Emeritus Joel Schlessinger, MD, FAAD, discusses key considerations for any dermatologist contemplating a sale to private equity.

What are the benefits of staying in private practice?

In a word: control. One of the most crushing aspects of medical-related burnout is the loss of control, and thus the depersonalization of the physician experience. Moral injury may arise from overwork and staffing reductions, which can lead to ethical lapses. When these occur in private practice, the physician-owner retains the responsibility as well as the potential for personal consequences. While that may or may not prompt changes, the essential difference is that the physician has the authority to make and implement decisions. In private equity–owned practices, by contrast, such challenges are often imposed on staff without warning or involvement from those affected. This disconnect can result in deep personal regret and shame, with downstream consequences such as burnout and depression.

Many dermatologists willingly relinquish ownership to private equity, hoping for reduced stress and fewer responsibilities. However, the reality may be harsher, not just with the first set of owners but with subsequent owners each aiming to extract more profit to justify the next “bite of the apple.”

What counters would you offer to the appealing aspects of private equity, such as financial gain and reduced management responsibilities?

Management time and demands may diminish greatly after selling to private equity, but that comes with the trade-off of the joy of doing what you want to do and the lack of agency. Becoming a dermatologist typically requires great drive and ambition, making it unlikely that this trait would suddenly vanish once employed. It is unrealistic to assume that such individuals would no longer wish to improve processes, effect change, or determine their own destiny.

Do patients notice a difference?

Speaking only as someone who has always been in private practice, I can say that many patients who transition from private equity-owned clinics to ours express delight at the difference. We staff primarily with RN/BSNs and offer a care model that supports same-day work-ins and same-day procedures. Many former patients of equity-owned practices often say they appreciate this.

How important is it to public health that a significant portion of practices remain private?

Recent articles have documented reduced physician staffing at private equity-owned dermatology practices and unbalanced ratios of physician assistants to dermatologists.^1-3 High biopsy rates in these practices have been noted both in mainstream publications and journal articles, which have also raised concerns with reports of management expectations related to procedural volume per provider. This is not only concerning; it is sickening.

Legislation to curb the widespread pervasive takeover of the medical profession by private equity firms has been advanced in several states but generally faces fierce lobbying opposition and ultimately failure. While physicians may be unable to match private equity’s financial influence, they can resist by continuing the honorable and time-tested tradition of treating their own patients without being owned by a for-profit entity.

What are your tips for keeping a private practice viable in today’s climate?

It is important to realize that there is no perfect practice model and there will always be ups and downs in the regular practice of medicine. There will be days when staff may frustrate you (or be frustrated by you), and there will be days when patients may take issue with everything, from your care to the water cooler. This is just part of the deal, but the tradeoff is the ability to forge your own personal connection to your patients without having a soulless corporation determining the method and style of practice you report to each day of your professional existence. Selling to private equity is easy, but getting out from the clutches of it is hard once inside the system. Think twice before giving up your valuable identity. 

References

1. Konda S, Francis J, Motaparthi K, Grant-Kels JM; Group for Research of Corporatization and Private Equity in Dermatology. Future considerations for clinical dermatology in the setting of 21st-century American policy reform: corporatization and the rise of private equity in dermatology. J Am Acad Dermatol. 2019;81(1):287-296.e8. doi:10.1016/j.jaad.2018.09.052

2. Creadore A, Desai S, et al. Insurance acceptance, appointment wait time, and dermatologist access across practice types in the US. JAMA Dermatol. 2021;157(2):181-188. doi:10.1001/jamadermatol.2020.5173

3. Hafner K, Palmer G. Skin Cancers Rise, Along With Questionable Treatments. The New York Times. https://www.nytimes.com/2017/11/20/health/dermatology-skin-cancer.html. Published November 20, 2017. Accessed August 29, 2025.