Your members already
trust your floor.
She's doing the same workouts and gaining weight. She thinks the gym stopped working. Here's what the data says, and how coordinated care keeps her journey inside your walls.
Done with you, not for you.
You decide how it works in your practice. Nobody owns us, so we can build it around you.
- You decide. Which services, which days, which room, and how involved you want to be.
- We build it with you. Not a box we drop on your doorstep. You oversee every piece, and you can change your mind.
- Nobody owns us. No outside investor sets our rules, so we can shape the model around your practice and your life.
The cost of standing still.
Before we talk about what could change, here's what the research says the current model costs gym owners. Every number links to its source.
Margins, hours and burnout
- Fitness operators reported a median EBITDA margin of 22.1% in 2025. High-profit operators spent 32.4% of revenue on payroll, compared with 42.5% for lower-profit operators. (Industry benchmark of 244 operators running nearly 27,000 facilities, so it leans toward larger companies. A single-location gym can look very different.) (Health & Fitness Association, 2026; industry data, not peer-reviewed)
- At one large fitness center, 63% of new members quit before month three. The funnel has to be refilled just to stand still. (Sperandei et al., 2016)
- Your coaches carry weight too: in a US survey of fitness professionals, 33% of personal trainers met the threshold for personal burnout and 29.6% for work-related burnout. (Snarr & Beasley, 2022)
We couldn't find a reliable published figure for gym owners' weekly hours, so we left it out. We never invent a number.
What it costs to keep going this way
- Every member who quits in the first 90 days has to be replaced before you grow at all.
- Payroll is the line that separates high-profit operators from the rest, and every coach who burns out costs you twice: once when they leave and again to replace them.
- Members who can't get answers about weight, sleep and hormones take the question, and eventually the membership, somewhere else.
Questions worth sitting with
- What would it mean for you to stop living on the January refill?
- What happens to your margin if churn stays exactly where it is?
- If there was a way for members to find their next step without leaving your building, what would that change for them, and for you?
Where your practice and your life are headed.
“It's not what you do, it's where you're going.”
Before: thin margins, long days, running on empty
- A median 22.1% EBITDA margin among larger operators, with payroll as the swing line. (Health & Fitness Association, 2026; industry data, not peer-reviewed)
- Most new members gone before month three in one large study. (Sperandei et al., 2016)
- Coaches at risk of burnout. (Snarr & Beasley, 2022)
- Working IN the business: staffing, classes, promos, repeat. ()
After: where you're going
- Your gym becomes a hub in a wellness network, so members have more reasons to stay.
- Coordination and education run on systems we install and run with you. Your team keeps coaching.
- Your floor becomes the place that “gets it” for women in midlife.
- Time to step back and lead the business instead of covering every class.
The “after” describes what the model is built to do, not a promise of results. We describe buying back your time in plain words because we haven't measured it yet. When partners have documented results, we'll show them here with written consent.
What if this was possible?
What if members found their next step inside your walls, and you got your evenings back?
“If that was possible, I don't even know what I'd do. My life would change.”
What we hear from owners when they picture it.
More time for the people at home. Being there for your kids. Choosing what's next instead of having it chosen for you.
Thinking about selling because you're exhausted? Selling is an irreversible decision, and it's yours to make. Before you make it, see what's possible. No consultant retainer, no equity, and nothing to sign to find out.
Your patients are already looking.
The question isn't whether they want this kind of help. It's where they'll find it. Every number links to its source.
- More than a quarter of fitness members belong to more than one facility, and over 75% of studio users keep at least one other membership. (Health & Fitness Association, 2025; industry data, not peer-reviewed)
- 60.2% of US women ages 40 to 59 tried to lose weight in the past year. (CDC NCHS Data Brief 313, 2018; government data, not peer-reviewed)
- 12% of US adults are currently taking a GLP-1 medication (15% of women). About 1 in 6 users got it from an online provider and 1 in 10 from a medical spa, outside their usual doctor's office. (KFF Health Tracking Poll, Nov 2025; independent opinion poll, not peer-reviewed)
- 90% of women 35 and older report at least one menopause symptom (five on average). Women spend an estimated $13 billion a year treating them, more than $10 billion of it on nonmedical options, much of it outside a clinician's office. (AARP Research, 2024; association survey, not peer-reviewed)
- 48.1% of adults 50 to 80 have bought an at-home medical test, and 82% are interested in using one in the future (87% of women). (Rager et al., 2024; University of Michigan National Poll on Healthy Aging; university source, not peer-reviewed)
Most of these are national figures, not numbers about your practice. They show what people are already seeking, often somewhere else.
How much of your work is episodic?
Every number links to its source. Industry and government figures are labeled as not peer-reviewed.
- In a study of 5,240 members at one fitness center, 63% of new members quit before month three, and fewer than 4% were still active at 12 months. (One center in Brazil, so read with care.) (Sperandei et al., 2016)
- US fitness facility membership hit a record 77 million in 2024. More than a quarter of members belong to more than one facility, and over 75% of studio users keep at least one other membership. (Health & Fitness Association, 2025; industry data, not peer-reviewed)
- About one in three members (32%) took part in small-group training and 23% used a personal trainer in 2024. (Health & Fitness Association, 2025; industry data, not peer-reviewed)
What your patients are living with
- At the start of the menopause transition, the rate of fat gain doubled and lean mass began to drop, even when habits didn't change. (Greendale et al., 2019)
- Strength training still works: a 2026 meta-analysis of 126 studies (4,019 women) found similar strength gains before and after menopause. (Isenmann et al., 2026)
- Midlife sleep problems are common and can drain energy for training. (Baker et al., 2018)
What's happening, and what changes.
- Many of your most loyal members are women 40 to 60.
- They ask your staff about hormones, sleep, nutrition and recovery. Your team can coach the workout, not the medicine.
- So she goes elsewhere for the rest, and some cancel because they think the gym “stopped working.”
- A membership alone is easy to compare on price.
- Her bigger health story happens outside your walls, so her loyalty does too.
- Every January you refill the funnel, and every spring it drains.
- We install a coordination system that turns your gym into a hub in a wellness network, done with you.
- When a member needs clinical answers, she's connected to licensed pros in the network. Her workouts stay with you.
- On-site services, like a blood draw by a licensed phlebotomist, can happen in a private room at your facility, ordered by her licensed clinician.
- Your trainers get education built on peer-reviewed research, so the floor becomes the place that “gets it.”
- Trainers stay in their lane. Clinicians deliver medicine. We coordinate.
We don't publish the whole playbook here. We walk you through it in a conversation, after a webinar.
The 70/20/10 approach.
Proven business systems
Nothing fancy or new. Just how a well-run practice runs: follow-up, scheduling, education, coordination and measuring what changes.
Your industry
What's specific to fitness: memberships, coaches, the January rush and the members who stall in midlife.
Your day
You're our client too. If you have four kids and want to be home by 3, we build for that. If you love your schedule, we protect it.
The 70/20/10 split is how we plan our work with you, not a research finding.
Care that comes to her, where she already goes.
Maria used to leave her 6 a.m. class, drive across town for bloodwork, wait, and still make it to work late. Now a licensed phlebotomist is set up in a private room at her gym. She cools down, the draw is done, and the front desk hands her a cold brew with oat milk, because they remember. Her results go to her licensed clinician, typically back within days, and her coach hears what matters for her training, with her consent.
And often, Dr. Pat Pachciarz® is right there in person: shaking hands, learning names and laughing along the way.
“We'll be laughing along the way. If it costs us a few coffees and some candy for the kids, that's not too bad.” — Dr. Pat Pachciarz®
Lab work is ordered and reviewed by the patient's own licensed clinician and performed by a licensed phlebotomist. Availability depends on your space and your state's rules.
Before and after coordination.
Before: episodic, chasing the next visit, working IN the practice
- Churn math: refill the funnel every January.
- Members leave to get answers you can't give.
- Working IN the business: staffing, classes, promos, repeat.
- Competing on price.
After: a coordinated, flowing methodology
- A coordinated, flowing methodology around each member.
- Members find their next step without leaving your building.
- You can breathe, step back and look at your business.
- Members don't have to go anywhere else to be known.
Partner stories will appear here, with written consent, once results are documented. We never invent or promise results.
What we do. What it saves you. What it costs.
- Install the coordination, follow-up and education systems in your practice
- Build and run them with you, while you decide how they work
- Connect your patients to trusted pros in the network, with consent
- Build your name online with education from peer-reviewed research
- The nights you spend on follow-up, content and marketing
- Patients lost between visits and after discharge
- A consultant retainer or an equity partner to “fix” the business
- Starting cold with every new patient
- Zero up front. The value comes first.
- Then a flat, fair-market rate. Set in advance, not tied to referrals or patient volume. Never a percentage of patient revenue, never a per-referral fee.
- No equity, ever. No ownership stake.
The terms, plainly
- Zero cost up front. The value comes as we go.
- A flat, fair-market rate. Set in advance, not tied to referrals or patient volume. Never a percentage of patient revenue, and never a per-referral fee. No one pays or is paid for referrals.
- No equity, ever. No ownership stake. If you want to go to private equity someday, great.
- It's a license. We install the systems and coordinate everything, done with you. You oversee it.
- We grow as you grow. When partners do well, more practices join. That's how we grow, within every compliance rule.
- Built around the patient experience. We get to know your patients, and care comes to the places they already visit.
Yes, a steadier, more predictable practice can follow. But we lead with the patient experience, because that's what earns it.
Every path has a right and a wrong.
There's more than one way to bring coordinated, functional care into a practice. Here they are by what they do, with what the research says. Pick the one that fits you, even if it isn't us.
Option: A franchise model
You buy into a brand and follow its rules.
Can go right: A known brand, a playbook and training on day one.
Can go wrong: Ongoing fees, such as royalties, advertising and renewal fees, are part of the deal for as long as it lasts. Federal rules require them to be disclosed up front for a reason. (FTC Franchise Rule, 16 CFR 436; government data, not peer-reviewed)
Option: A licensing model
You pay to use someone else's system, often with ongoing fees.
Can go right: Faster than building from scratch, without buying a whole brand.
Can go wrong: Fees can continue for as long as you use the system, and terms can change at renewal.
Option: Selling to private equity
Capital now, but you may give up control and your patient relationships.
Can go right: Money now, plus back-office support. It's a real and common path: private equity deals for physical therapy clinics went from 4 in 2010 to 175 in 2023, and the share of dentists affiliated with private equity nearly doubled, from 6.6% to 12.8%, from 2015 to 2021. (Reddy et al., 2025; Nasseh et al., 2024)
Can go wrong: Prices often rise: after acquisition, allowed amounts per claim rose 11% at acquired physician practices compared with similar independent ones. (Singh et al., 2022)
Option: Building it yourself
Full control, but also the full cost and time.
Can go right: Every decision is yours. Concierge and direct primary care practices grew 83.1% from 2018 to 2023, so independent models can work. (Zhu et al., 2025)
Can go wrong: It takes time to fill: only 31.2% of direct primary care practices in a national survey reported a full panel. (Qiu et al., JABFM (in press))
Option: A done-with-you coordination partner (us)
We build it with you, inside the practice you already run.
Can go right: Zero up front, then a flat, fair-market rate, set in advance, not tied to referrals or patient volume. No equity, ever, and no percentage of patient revenue.
Can go wrong: We're new. Our first proof partners start in October 2026, so we don't have documented results to show you yet.
We describe models by what they do and never name companies. Studies describe averages, not any one deal. Talk with your own attorney before you sign anything.
It's not one-size-fits-all.
Every practice is different, so every setup is too. Choose the pieces that fit your space, your patients and your week.
A patient success coordinator on site
Someone who knows every patient's name and next step. In a six-state study, NPs in practices with the most care-management and referral structure reported less burnout (19.3% vs 31.4%). (Schlak et al., 2023)
A phlebotomist on site
Blood drawn where patients already are, which can help keep costs and travel down. The average medical visit takes 121 minutes of a patient's day, and between 6.8% and 62% of lab tests in outpatient care weren't followed up, per a systematic review. (Ray et al., 2015; Callen et al., 2012)
An NP in the office or by telehealth
In person on the days that make sense, virtual on the days that don't. 37.0% of US adults used telemedicine in the past year, including 42.0% of women. (CDC NCHS Data Brief 445, 2022; government data, not peer-reviewed)
Some, all or none of the above
Start with one piece and add the rest later, or never. It's your call.
Clinical services are provided by independent licensed professionals under their own licenses. What's possible depends on your space and your state's rules.
Straight numbers, because you asked.
It's never about the money first. But you deserve honest math. Here's what a mature in-practice functional wellness and metabolic clinic with one full-time NP could bring in.
Reasonable expectations
150 members × $129 = $19,350
+ 10 new members × $199 onboarding = $1,990
An estimate
250 members × $179 = $44,750
+ 20 new members × $199 onboarding = $3,980
What happens when you really put your effort behind it
300 members × $199 = $59,700
+ 25 new members × $199 onboarding = $4,975
+ GLP-1 management add-on = $4,500 (assumption)
See the full math and assumptions →
We're there every step of the way to help you.
Your family is protected. The business doesn't die with you.
This is a side value. It's there if you ever want it, and it's not the point. Here's what it actually means.
Now your family is protected. God forbid something happens to you, the business doesn't die with you. Your patients are cared for and your family keeps the value you built.
What it means in real life
- Your family is protected. If something happens to you, the business doesn't die with you. Your patients keep their care, and your family keeps what you built.
- Fewer hours, steadier income. When more of your care is built around ongoing relationships, you can spend fewer hours in the practice and have more predictable income coming in. You don't have to keep chasing the next new patient.
- From lifestyle owner to value creator. The practice can keep growing without you having to be in the room for every hour of it.
- Room to breathe. As the pressure comes down, your own wellbeing can improve too, with more time for rest, family dinners and the life your work was meant to support.
These are things that can happen, not promises. Every practice is different, and results depend on your situation.
- 58% of US business owners in a 2023 national survey had no written, formal transition plan (83% in 2013). (2023 National State of Owner Readiness Report; association survey, not peer-reviewed)
If you ever want to look at the numbers, we're here. If you already have someone, great. We simply collaborate with them. That's why we do it.
“Why are you helping me?”
People ask Dr. Pat Pachciarz® this all the time: “Why are you helping me?” The answer is simple: because we both benefit. When both people benefit, that's influence that's moral and ethical.
A rare window to build community
The next two to three years are a rare window to connect with people and build real community. With so much uncertain about jobs and the economy, we want people to have a softer landing, or at least to know their options.
Someone else will coordinate your patients.
- Members will keep looking for help with weight, sleep and labs.
- Someone will coordinate it for them, maybe the clinic down the road, maybe an app.
- When they do, your gym becomes one more membership she can cancel. Coordination is moving toward the places people already go. The question is whether that's your floor.
That's not a threat. It's where care is heading. We'd rather it run through the people patients already trust.
We're starting in Aurora, Illinois, and building carefully, one practice at a time, because trust can't be rushed.
It's never been about the money.
- It's never been about the money. It's about giving you more time to connect with your patients.
- Yes, we benefit too, and we say so plainly. But this is an ecosystem: when your patients are better served, every practice in the circle does better.
- We'd rather be your collaborator for twenty years than your vendor for one.
“Did I have time to build a 14th company? No. But I saw it, and I was fed up watching good people get hurt, unable to do what they really want.” — Dr. Pat Pachciarz®
What we've seen go wrong
Practices that sold to private equity and lost their patients.
We've watched owners sell and then lose control of the care and the relationships. The research shows clinician turnover tends to rise after these deals: physicians at acquired practices were 6 percentage points more likely to leave, and after a later resale, 16.5 points less likely to stay. (Bruch et al., 2023; Berquist et al., 2025)
Wellness add-ons that weren't structured correctly or legally.
We've seen add-on clinics set up without the right ownership, referral or payment structure. That's why we start with structure, and why anything that touches referrals or payment goes to your own legal and compliance advisors. (From what we've seen, not a research finding.)
Franchise or licensing deals that looked great at the start.
But what happens when it's ongoing? Federal rules require franchisors to disclose ongoing fees like royalties, advertising and renewals because they keep coming for as long as the deal lasts. (FTC Franchise Rule, 16 CFR 436; government data, not peer-reviewed)
We're not here to plug in a revenue line. We want to be your collaborator.
How we got here
- Dr. Pat Pachciarz® saw this fragmentation first in finance: every expert was good, and nobody was calling the play.
- Then he lived it in his own functional medicine journey: separate appointments, separate labs, and nobody connecting them.
- It took a decade to build the systems behind The Pinnacle Group. Because they're systematized now, we could build this in a month, which frees us to focus on people.
- We'll go slow, because trust lasts. We're here to be a strategic partner for the long haul.
How could this fail?
Only if no one builds it. So we're building it, starting in Aurora, Illinois.
Technology will never replace human connection.
Our systems handle the repeat work so people can do the human work: remembering names, stories and what matters to each patient.
- The Harvard Study of Adult Development, begun in 1938 and now directed by Dr. Robert Waldinger, is one of the longest-running studies of adult life. Its researchers report that close relationships, more than money or fame, keep people happy throughout their lives, and are better predictors of long and happy lives than social class, IQ or even genes. (Harvard Gazette, 2017; university source, not peer-reviewed; Harvard Study of Adult Development; university source, not peer-reviewed)
“Trust is the hardest thing to scale, and the best thing to scale.”
She sees more pros than you know.
- 36.7% of US adults used at least one complementary health approach in 2022, up from 19.2% in 2002. Meditation (17.3%) and yoga (15.8%) led; acupuncture use more than doubled to 2.2%. (Nahin et al., 2024)
- Medicare patients saw a median of 2 primary care doctors and 5 specialists across 4 practices in a year. (Pham et al., 2007)
Straight answers
Does my gym become a clinic?
No. Your gym stays a gym. Licensed professionals work under their own licenses, and Pinnacle Coordinated Wellness is the coordination layer. It is not a medical office.
Why do members leave so fast?
Research on one large fitness center found 63% of new members quit before month three. Members often stall in midlife and blame the gym. Coordinated support gives them answers and more reasons to stay connected.
Do I need extra space?
A private room for short visits helps. We look at your floor plan with you before anything is installed, and we only use spaces that fit.
I'm burnt out and thinking about selling. Is this for me?
Maybe. Selling is an irreversible decision, and it's yours to make. Before you make it, see what's possible when coordination, follow-up and education are installed and run with you, with no consultant retainer and no equity. A fast no is better than a forever maybe, so join a webinar and decide.
What does ‘done with you, not for you’ mean?
You decide how it works: which services, which days, which room and how involved you want to be. We build and run it with you, and you can change it as you go. Nobody owns us, so we can build it around you.
Do patients really want these services?
Many are already looking. About half of women with bothersome hot flashes in one large review waited more than 6 months to seek care (DePree et al., 2023), 60.2% of women 40 to 59 tried to lose weight in the past year (CDC NCHS Data Brief 313, 2018; government data, not peer-reviewed), and 48.1% of adults 50 to 80 have bought an at-home medical test (Rager et al., 2024).
Is the clinic revenue on this site what I'd earn?
No. Those are estimates of clinic revenue potential for a mature clinic, not promises. Clinic revenue belongs to the independent clinical practice. A host practice is paid a flat, fair-market rate for its space and any real services, and our fee is a flat, fair-market rate too, set in advance, not tied to referrals or patient volume. Plan on 12 to 24 months, and only 31.2% of direct primary care practices in one national survey reported a full panel (Qiu et al., JABFM (in press)).
What does it cost to start?
Zero up front. The value comes as we go. After that it's a flat, fair-market rate, set in advance and not tied to referrals or patient volume. Never a percentage of patient revenue and never a per-referral fee.
Do you take equity or ownership in my practice?
No. Never. No equity and no ownership stake, ever. If you want to go to private equity someday, great. We grow as you grow, because when partners do well, more practices join.
What does 'it's a license' mean?
We license our systems to your practice and install them with you: coordination, follow-up, education and the network. It's done with you, not for you. You decide how it runs, oversee it and entrust us with coordinating for your patients, and we earn that trust.
Is Pinnacle Coordinated Wellness a medical office?
No. It is a coordination company. It does not diagnose, treat or prescribe. Clinical care is provided by independent licensed clinicians in their own practices.
When is the next practitioner webinar?
Webinars come first, and dates will be announced soon. Join the list on this page and we'll email you the dates.
Join an upcoming practitioner webinar.
Free education before any conversation about working together. Dates will be announced soon. Leave your email and we'll send them first.
A fast no is better than a forever maybe. Come, listen and decide. Either answer is a good one.
- What the research says about the patients you already serve
- How coordinated care works around a practice like yours
- Straight answers on cost, compliance and what we never do
Where the numbers come from
Research findings describe published studies. They are not promises about any one practice or patient.
- Health & Fitness Association (HFA). 2026 Fitness Industry Benchmarking Report (press release, Oct 7, 2026): 244 operators, nearly 27,000 facilities, 40 countries; 2025 results. https://www.healthandfitness.org/fitness-industry-growth-is-translating-into-stronger-profits/ industry data, not peer-reviewed
- Sperandei S, Vieira MC, Reis AC. Adherence to physical activity in an unsupervised setting: explanatory variables for high attrition rates among fitness center members. J Sci Med Sport. 2016;19(11):916-920. doi:10.1016/j.jsams.2015.12.522 peer-reviewed
- Snarr RL, Beasley VL. Personal, work-, and client-related burnout within strength and conditioning coaches and personal trainers. J Strength Cond Res. 2022;36(2):e31-e40. doi:10.1519/JSC.0000000000003956 peer-reviewed
- Health & Fitness Association (HFA). 2025 US Health & Fitness Consumer Report: Expanded Insights (press release, Oct 30, 2025; survey of 18,000 US residents). https://www.healthandfitness.org/new-hfa-data-shows-how-77-million-us-fitness-facility-members-work-out/ industry data, not peer-reviewed
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. doi:10.1172/jci.insight.124865 peer-reviewed
- Isenmann E, Geisler S, Havers T, et al. It's never too late: the impact of resistance training on strength and body composition in females across the lifespan. J Sci Med Sport. 2026;29(10):1174-1185. doi:10.1016/j.jsams.2026.03.002 peer-reviewed
- Baker FC, Lampio L, Saaresranta T, et al. Sleep and sleep disorders in the menopausal transition. Sleep Med Clin. 2018;13(3):443-456. doi:10.1016/j.jsmc.2018.04.011 peer-reviewed
- Nahin RL, Rhee A, Stussman B. Use of complementary health approaches overall and for pain management by US adults. JAMA. 2024;331(7):613-615. doi:10.1001/jama.2023.26775 peer-reviewed
- Pham HH, Schrag D, O'Malley AS, et al. Care patterns in Medicare and their implications for pay for performance. N Engl J Med. 2007;356(11):1130-9. doi:10.1056/NEJMsa063979 peer-reviewed
- Mineo L. Good genes are nice, but joy is better. Harvard Gazette, April 11, 2017 (on the Harvard Study of Adult Development). https://news.harvard.edu/gazette/story/2017/04/over-nearly-80-years-harvard-study-has-been-showing-how-to-live-a-healthy-and-happy-life/ university source, not peer-reviewed
- Harvard Study of Adult Development (study website). Director: Robert Waldinger, MD. See also Waldinger R, Schulz M. The Good Life. Simon & Schuster; 2023. https://www.adultdevelopmentstudy.org/ university source, not peer-reviewed
- Martin CB, Herrick KA, Sarafrazi N, Ogden CL. Attempts to lose weight among adults in the United States, 2013-2016. NCHS Data Brief No. 313. 2018 (data table: women 40-59). https://www.cdc.gov/nchs/products/databriefs/db313.htm government data, not peer-reviewed
- KFF. Poll: 1 in 8 adults say they are currently taking a GLP-1 drug (KFF Health Tracking Poll, Oct 27-Nov 2, 2025; 1,350 US adults). https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/ independent opinion poll, not peer-reviewed
- Sauer J, Mehegan L, Williams AR, et al. The Economic Impact of Menopause: A Survey of Women 35+ and Employers. AARP Research, January 2024 (national survey of 1,510 women 35+ with at least one menopause symptom, Sept 2023). doi:10.26419/res.00720.001 association survey, not peer-reviewed
- Rager JB, Kirch M, Singer DC, Solway E, Malani PN, et al. Use of at-home medical tests among older US adults: a nationally representative survey. Inquiry. 2024;61:469580241284168. doi:10.1177/00469580241284168 peer-reviewed
- University of Michigan Institute for Healthcare Policy and Innovation. National Poll on Healthy Aging: At-Home Medical Tests (adults 50-80, July 2022). https://ihpi.umich.edu/national-poll-healthy-aging/national-findings/home-medical-tests university source, not peer-reviewed
- Schlak A, Poghosyan L, Rosa WE, et al. The impact of primary care practice structural capabilities on nurse practitioner burnout, job satisfaction, and intent to leave. Med Care. 2023;61(12):882-889. doi:10.1097/MLR.0000000000001931 peer-reviewed
- Ray KN, Chari AV, Engberg J, Bertolet M, Mehrotra A. Opportunity costs of ambulatory medical care in the United States. Am J Manag Care. 2015;21(8):567-574. https://pmc.ncbi.nlm.nih.gov/articles/PMC8085714/ peer-reviewed
- Callen JL, Westbrook JI, Georgiou A, et al. Failure to follow-up test results for ambulatory patients: a systematic review. J Gen Intern Med. 2012;27(10):1334-48. doi:10.1007/s11606-011-1949-5 peer-reviewed
- Lucas JW, Villarroel MA. Telemedicine use among adults: United States, 2021. NCHS Data Brief No. 445. 2022. https://www.cdc.gov/nchs/products/databriefs/db445.htm government data, not peer-reviewed
- Reddy M, Li G, Singh Y. Trends in private equity acquisition of US physical therapy clinics, 2010 to 2024. J Am Acad Orthop Surg. 2026;34(8):e1136-e1143 (epub Oct 2025). doi:10.5435/JAAOS-D-25-00650 peer-reviewed
- Nasseh K, LoSasso AT, Vujicic M. Percentage of dentists and dental practices affiliated with private equity nearly doubled, 2015-21. Health Aff. 2024;43(8):1082-1089. doi:10.1377/hlthaff.2023.00574 peer-reviewed
- Zhu JM, Marsh T, Polsky D, Huntington A, Song Z. Growth in number of practices and clinicians participating in concierge and direct primary care, 2018-23. Health Aff. 2025;44(12):1473-1481. doi:10.1377/hlthaff.2025.00656 peer-reviewed
- Federal Trade Commission. Franchise Rule, 16 CFR Part 436 (disclosure requirements, including Item 6: Other Fees), and A Consumer's Guide to Buying a Franchise (Sept 2020). https://www.ecfr.gov/current/title-16/chapter-I/subchapter-D/part-436 government data, not peer-reviewed
- Singh Y, Song Z, Polsky D, Bruch JD, Zhu JM. Association of private equity acquisition of physician practices with changes in health care spending and utilization. JAMA Health Forum. 2022;3(9):e222886. doi:10.1001/jamahealthforum.2022.2886 peer-reviewed
- Qiu K, Chandarana S, Huffstetler A. The characteristics of direct primary care practices in the United States: a national survey. J Am Board Fam Med. In press (accepted June 2026); 465 practices. https://www.jabfm.org/content/characteristics-direct-primary-care-practices-united-states-national-survey peer-reviewed
- Bruch JD, Foot C, Singh Y, Song Z, Polsky D, Zhu JM. Workforce composition in private equity-acquired versus non-private equity-acquired physician practices. Health Aff. 2023;42(1):121-129. doi:10.1377/hlthaff.2022.00308 peer-reviewed
- Berquist B, Klarnet A, Dafny L, et al. Sale of private equity-owned physician practices and physician turnover. JAMA Health Forum. 2025;6(2):e245376. doi:10.1001/jamahealthforum.2024.5376 peer-reviewed
- Exit Planning Institute. 2023 National State of Owner Readiness Report (survey of US business owners; 2013 comparison). https://exit-planning-institute.org/hubfs/Member%20Center%20Resources/2023%20National%20State%20of%20Owner%20Readiness%20Report.pdf association survey, not peer-reviewed
Other professions: Chiropractors · Physical therapists · Nurse practitioners · Personal trainers · Nutritionists · Dentists · Mental health therapists
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