The caseload dropped by nearly half the day Tish Singer, MD, took ownership of her practice. Where she once moved through 15 to 25 diagnostic patients daily under hospital management, she now sees ten. That reduction is not a concession. It is, she argues, the entire premise.
"Those ten women have my full time and attention to get the care they deserve," Singer said. In breast radiology, where an abnormal mammogram can set off weeks of anxiety before a diagnosis is reached, that attention is not incidental. It shapes what is clinically possible. Under her independent model, a patient who comes in with an abnormal mammogram can receive the screening review, a diagnostic mammogram, and a biopsy on the same day. In the hospital-based, insurance-driven system she left, that sequence was broken across multiple appointments, not because the medicine required it but because insurance would not reimburse the full workup in a single visit. "Now, I can do all of these things in one day," she said, "saving time, energy and stress for the patient and giving that patient answers faster."
That single procedural change captures something the broader debate about private equity in medicine tends to lose in abstraction. The spreadsheet logic that governs corporate-owned practices does not announce itself as a threat to patient care. It shows up as a billing rule, a scheduling constraint, a referral pattern that prioritizes throughput. Hospitals, staffing groups, and entire specialties have been absorbed into private equity portfolios at a pace most patients never see. The consequences tend to be felt one appointment at a time.
"Our current healthcare system is broken much like a totaled vehicle. Instead of trying to revive that vehicle, it is time that we create something new."
Singer is not interested in reform arguments that start from the assumption that the existing system is worth preserving. The analogy she reaches for is blunt: a totaled car. The frame matters because it forecloses a certain kind of institutional patience, the belief that with enough advocacy or policy pressure, corporate medicine can be nudged back toward something physician-led. Singer's position is that the vehicle is already gone. What comes next depends on whether physicians are willing to act accordingly.
"Physicians need to be brave and need to be leaders to take back the healthcare system from private equity and from insurance companies," she said. The word brave is doing real work in that sentence. Leaving a hospital system, absorbing the financial and administrative risk of independent ownership, and rebuilding a practice around clinical values rather than volume metrics is not a neutral career move. Singer made it. The question her example raises is how many others can, and what the specialty landscape looks like if they don't.
