Private equity unlikely to dominate cardiology despite hype
Private equity investment in cardiology continues to generate strong reactions across the specialty. However, the actual footprint of such ownership remains relatively small and is unlikely to become dominant, according to Jerry Blackwell, MD, MBA, FACC, president and CEO at MedAxiom, an ACC company, and a practicing cardiologist at Ballad Health in Kingsport, Tennessee.
He presented on private equity at the American College of Cardiology (ACC) 2026 annual meeting and spoke with Cardiovascular Business in the above video interview. Blackwell said concerns about private equity have often outpaced the reality of its actual market presence.
“It's a topic that has created great emotion inside the specialty,” Blackwell said. “It's just another way of infusing capital, another ownership model inside of cardiology, but it has some generally negative connotations because folks think it's only about the money.”
Private equity companies have entered cardiology because the subspecialty has undergone a dramatic transformation in practice ownership over the past decade. Independent physician-owned practices made up about 90% of the ownership model in 2012. But due to federal reimbursement policies, this changed rapidly over the past decade to where 90% of cardiologists are now employed by health systems or are private equity owned. However, Blackwell noted private equity ownership still accounts for only a small portion of the specialty.
“Private equity ownership in cardiology now only represents about 5% to 10% at maximum,” he said.
That relatively modest market share contrasts sharply with the level of concern the topic generates among physicians.
Blackwell believes structural barriers will limit further expansion of private equity in cardiology. Regulatory pressures, reimbursement challenges and competition from hospitals also create obstacles that make widespread consolidation difficult.
“It's exceedingly unlikely to become dominant,” he said. “Private equity has a real strategy. They've gone after many elite groups here early on, and private equity is not for every group, and private equity doesn't want every group.”
Why investors are interested cardiology practices
Private equity firms have targeted cardiology because of its growing procedural volume, aging patient population, and opportunities to improve operational efficiency through scale. But like any investment, the goal is ultimately financial return.
“They may infuse capital and switch things up with business management models, but at the end of the day, they're there to make back their investment,” Blackwell explained.
The typical private equity model involves acquiring a stake in a physician practice, providing capital and management support, and then selling the investment several years later at a higher valuation. That timeline can create tension with the long-term nature of physician-patient relationships, he said.
“The private equity model is to sort of change owners after five to 10 years in an attempt to flip it and make money,” Blackwell explained. “But the relationship for patients and physicians is usually measured over 25 or 50 years.”
Balancing private equity risks and opportunities
One of the key themes of Blackwell's presentation was encouraging cardiologists to evaluate private equity objectively rather than viewing it solely through a negative lens. He argued that every healthcare ownership model—whether it is nonprofit hospitals, for-profit health systems, insurers, or independent physician groups—must generate financial returns to remain viable.
“The question is how do you go about it?” he said. “It's not just the money, it's sort of how it happens.”
Blackwell said physician groups considering a private equity partnership should ensure they have strong leadership and access to experienced legal and financial advisors who understand the complexities of such transactions.
“It’s very important that there’s one or more folks in the physician group that listens very carefully and either are experts themselves, or get good advice,” he said. “There are some traps and some pitfalls.”
Many cardiology leaders have argued that physicians must remain in control of clinical decision-making regardless of ownership structure. Blackwell agreed that physician leadership is essential, noting that most private equity arrangements maintain a separation between the management organization and the physician practice.
Competition may benefit the market
Blackwell also suggested that private equity's presence could provide benefits by introducing another ownership option into a healthcare landscape increasingly dominated by large health systems.
“The glass-half-full person could say this is just another ownership model,” he said. “That diversity of ownership actually creates anti-fragility. Competition is important in the marketplace.”
He acknowledged concerns that financial priorities could potentially supersede patient care, but he believes market forces will ultimately determine which models succeed.
“If the notion is private equity is only about the money and that supersedes what happens with the patient, well, that's a horrible thing,” Blackwell said. “My personal belief is the marketplace is going to sort that out.”
For now, he contends cardiologists should focus on understanding both the opportunities and risks associated with private equity rather than allowing emotions to drive the discussion.
As consolidation continues across healthcare, Blackwell expects private equity to remain a visible, but limited player in cardiology.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]