Myth #5: Private Equity Forces Medical Groups to Cut Corners on Patient Care

“As private equity firms make it rain on healthcare companies, some in the industry worry that patients will pay the price.”

So begins a recent Modern Healthcare article on private equity’s entry into areas including Ophthalmology, physician staffing services, and Dermatology. AMA President Dr. Barbara McAneny is quoted as calling this trend “just another wave” in a broader tide of consolidation. But to read most of the press around PE in Dermatology is to imagine that we’re handing over our specialty to Bernie Madoff. In this view, any Dermatologist practicing in a PE-backed group is merely an instrument of profit-seeking villainy; our “conflict of interest” means we no longer see our patients as people, but as dollar signs.

I joined Dermatology Associates of Wisconsin, the group practice that became Forefront, because of its values, its culture, and its focus on patient care. None of those have changed with the backing of PE—even while our access to resources and support certainly has. Forefront’s doctors enjoy PE backing but have retained decision-making power over every inch of the group’s operations. When asked by an interviewer how aware he was of PE involvement in Forefront, one Dermatologist answered, “It’s invisible to me honestly. I have almost no awareness of it. To me, Forefront is the doctors, it’s the [central support] people who are there to help me…” The invisibility of PE plus the utility of our shared central services and support staff is, to our minds, the ideal configuration. PE is our bank, but our physicians are our backbone.

Put another way: our physicians use PE instrumentally, not the other way around.

How exactly are those resources put to work on behalf of patients? And how do those investments translate to superior patient care? The answers boil down to quality and access.


Forefront Dermatologists choose their own staff, decide what new treatments to invest in, and make any adjustments to their practice that they think necessary. We believe we provide the best care to our patients when we practice with complete clinical autonomy (but without the administrative burden we would take on as solo practitioners). The Board-certified Dermatologist I mentioned above joined Forefront in 2015 via a partnership with his successful independent group practice. As he told an interviewer, “the reality of practicing with Forefront dramatically exceeds my expectations—I'm actually a better physician now, a far better physician now than I was 2 years ago or 3 years ago.”

I believe in the formula “happy doctors = happy patients,” but I also know that we need the evidence to support it. That’s why we use our IT resources to give physicians detailed data about how their care compares to Medicare averages. These comparisons give physicians a fuller picture of their behavior, and can confirm with data their sense that they’re providing optimal care. We use these comparisons to monitor how we’re doing as a group as well, which is how we know that our 2016 biopsy rates were significantly lower than Medicare’s. Because we were tracking these same rates before we brought on a PE partner, too, we can see that our rates are no higher now than they were then.

Critics of PE might claim we track this data to sniff out new opportunities for profit. I can’t speak for all PE-backed groups, but I can say with certainty why we track this data: because we want to ensure that our patients are getting the safe, high-quality care they deserve—and because our Dermatologists want to know that’s what they’re providing.

The imperative to hold ourselves to a higher standard also drives the work of our dedicated compliance team, which monitors our group practice to ensure that we’re complying with all applicable regulations. We also have a coding review team that keeps our coding consistent and accurate. While these functions may sound ancillary to patient care, they actually provide an invaluable perspective on its quality. With the extra eyes of these teams, Forefront Dermatologists can be confident that they are providing superior patient care while gaining insight into areas where they can fine-tune their approach. And that is a feedback loop that very few solo or group practices are able to offer.

Finally, when we look at our patients’ reviews, they give our providers a rating of 4.8/5 over our history (more than 24,000 reviews). We also survey these patients. We score over 90% in the categories most directly linked to the patient-physician relationship: “The quality of care provided by my provider” and “The provider thoroughly explained my condition and treatment recommendation.” Both of these areas indicate that at Forefront, our patients get the time, attention, and expert care they need.


How many Dermatologists determine where they practice based primarily on patient need? Most of us make that decision based on what’s best for our career and our families. We care deeply about the patients we see wherever we go, of course, but few of us take patients into account beforehand, during what we understand to be a highly personal life choice. If we were really serious about tackling our specialty’s profound access problem, though, that decision-making might look different.

At Forefront, we are doing something about the access problem. And even the most vehement critics of PE must concede that it is improving access for patients in underserved areas.

I can talk about unmet patient needs from personal experience. When Forefront opened up a part-time clinic in Chilton, Wisconsin (population 3828), the number of aggressive skin cancers I saw in my first month there was astounding. Which is exactly why we need to go into more towns like Chilton. People there don’t need Dermatological care more than people living in Miami, or LA, or Chicago. But when they are in need, their only options require lengthy travel, months waiting for an appointment, or both.

In the past two years, Forefront has brought Board-certified Dermatological care to underserved areas across the Midwest. We’ve opened new Forefront locations in Moline, Illinois; Grayslake, Illinois; Oconomowoc, Wisconsin; and Grand Haven, Michigan.