Why the Best Clinicians Are Becoming the Worst Employees — The Ownership Revolution

Hamza Asumah, MD, MBA, MPH

The most talented doctors and dentists are quitting. Not medicine—but employment.

They’re tired of being operators in someone else’s business. And they’re building their own.

The Great Realization

Medical and dental schools train you to be a clinician. They don’t train you to be a CEO. They teach anatomy, pharmacology, diagnosis, treatment. What they don’t teach: cash flow management, capital structures, business model design, or go-to-market strategy.

For decades, that was fine. You graduated, joined a practice or started your own, saw patients, sent bills, collected payments, and lived a comfortable middle-class life.

But the economics have fundamentally changed.

Insurance reimbursement rates are flat or declining. Costs—staffing, supplies, real estate, compliance—are rising. If you don’t own the business model, someone else will. And they’ll pay you a salary to execute their vision, not yours.

A 2024 AMA survey found that 68% of physicians under 45 express interest in business ownership or partnership. That’s not a fringe movement. That’s a generational shift.

Clinical Autonomy ≠ Financial Freedom

Here’s the uncomfortable truth most clinicians discover too late: you can be the best doctor in the world and still be broke. Or worse—comfortable but trapped in a high-income prison where you’re exchanging time for money with no equity upside.

Clinical excellence doesn’t build wealth. Ownership does.

When you own equity in a scalable business, you benefit from:

• Operational leverage: Your business generates revenue beyond your personal clinical hours
• Multiple expansion: Your business becomes worth more than the sum of its revenue
• Exit optionality: You can sell your equity for a significant payout, not just retire and lock the doors

The new healthcare entrepreneur understands this distinction viscerally.

Three Paths to Ownership

So what does modern healthcare ownership actually look like?

Path One: The Scalable Practice

This isn’t your grandfather’s solo practice. You’re building systems from day one. Every process is documented. Every role has clear accountability. Technology enables leverage. And you’re planning location number two before location one is profitable.

The goal isn’t to own a job. It’s to build an asset that can operate without you—or that you can eventually sell. Think: franchiseable, scalable, systematized.

Path Two: The Platform Partner

DSOs (dental service organizations) and MSOs (medical service organizations) are the private equity-backed platforms consolidating independent practices. Here’s the model: you sell your practice to the platform but stay on as a clinical partner with equity in the larger organization.

You keep practicing. But now you have centralized back-office support, better payer negotiations, access to growth capital, and participation in the platform’s eventual exit—typically within 5-7 years.

PitchBook data shows PE-backed healthcare clinics grew 36% from 2020-2023. This model has moved from niche to mainstream.

Path Three: The Virtual-First Network

Instead of building physical locations, you build a digital care platform. You assemble a network of clinicians delivering care virtually, united by shared technology, branding, and infrastructure.

You own the platform. You own the patient relationships. You scale without real estate overhead.

Companies like Carbon Health are doing this right now—building nationwide care networks that operate more like SaaS businesses than traditional medical groups. They’re attracting venture capital, not just private equity, because the unit economics are fundamentally superior.

The Playbook

If you’re a clinician thinking “I want to build something,” here’s where to start:

Get business literate. You don’t need an MBA, but you need the fundamentals. Cash flow. Profit margins. Cap tables. Valuation multiples. There are books (read “The E-Myth Physician” and “Traction”). There are courses. There are mentors. Invest in your business education the way you invested in your clinical training.

Build systems, not just skills. A business that requires your presence every day is a job, not an asset. Document your processes. Create training protocols. Hire talented people. Build a team that can execute without micromanagement.

Think value, not just revenue. Investors value profitability, growth rate, and scalability. A $5 million practice with 25% margins is worth more than a $7 million practice with 10% margins. Focus on building a business model that can grow without proportional cost increases.

Get comfortable with capital. Scaling requires capital—bank loans, strategic investors, or private equity. Learn how to pitch. Learn how to structure deals. Learn how to protect your equity while accessing the resources you need.

The Dividing Line

We’re witnessing a fundamental bifurcation in healthcare careers:

Track One: Clinicians who remain pure operators—skilled, respected, well-compensated, but ultimately working for someone else’s equity upside.

Track Two: Clinicians who become owner-operators—building scalable platforms, capturing equity value, and ultimately creating generational wealth.

Neither path is wrong. But only one path builds assets.

The next generation of clinicians must think in systems, not shifts. In platforms, not patients. In enterprise value, not hourly rates.

Because the future of healthcare belongs to the builders, not just the doers.