I am a general surgeon employed by a hospital system in the southeast.
PE / VC don't add anything other than trying to skim a profit off the top of medicine, like any other capitalist. Dermatology is a lucrative practice. They don't have to work in hospitals, so they set their own hours. VC/PE's are doing the long game - purchase a practice (dermatology / anesthesiology, orthopedics ) and reward the current partners who basically get to receive compensation for their future earnings. In return, the current partners accept a lower salary going forward. Lucrative with guaranteed $$$ for senior partners with a few years left to practice. For new partners not so much. And definitely not for new hires. The problem is that the cost of establishing a new practice is overwhelming. You can plant a stake as a new physician in a town, but then you have to rent an office / furnish it / equip it / and employ people without any guarantee that you will get patients.
Or, when you graduate with $300k debt, you take the job that pays you $200k / year guaranteed with no risk, but accept the fact that you will be earning less than you generate. And I'm sure there's a non compete clause (I have one).
What will happen, over time, however, is that less and less people will choose that subspecialty, just like what happened to pilots.
Of course, then the VC/PE will just close shop and walk away.
In general surgery, our reimbursements have been lower than any other surgical subspecialties for years, but our saving grace is that you really can't have a hospital without a surgeon. Here in SC, there are ZERO self employed general surgeons. 30% of what we do are urgent/emergent interventions, and tons of people here in SC have either medicaid or no insurance. When I became a hospital employee, my salary tripled. Before that, if I made > $150k that was a good year. And that's 80 hour work weeks.
Because that was typical around the nation, general surgery went from being one of the most competitive residencies to one of the least. My senior partner (10 years older) was top 5% of his class. I was top 25%. For about 5-10 years, all you needed to get a residency spot was to graduate from medical school. It's recently become more competitive, probably bc most of us are employed, boosting our salaries.
Hospitals make their money from the facility fees. I do all my surgeries in my hospital system's hospitals, not the competitor's hospital.
Dermatology is one of, if not the hardest, medical professions to match in, because for whatever reason, their reimbursements are high.
For example, if I do a laparoscopic appendectomy on an 80 year old, I get $623 (CPT 44970). They'll spend a couple of days in the hospital which is not chargeable by me bc 90 days of post op care is included in the fee.
A dermatologist that cuts off a 1.5 cm skin cancer in his office gets $251 to cut it off (CPT 11602) and $307 to close the wound (12032). No nights / weekends / and pretty stressless procedure (to me).
Anyway, VC/PE want some of that revenue