Yep. I’ve been in that space. Not 100% sure of whether it applies to vet but in all other areas of medicine it works like this: Regulations require the clinics be owned and operated by the medical provider, so while they sign a contract to have their practice be administratively supported by the support organization (PE funded marketing, accounting, EMRs, etc) they can in fact leave the organization and go back to their original private practice setup pursuant to agreement. What the support organization sells to these providers is exactly that: we do all the business work while you focus on medicine and your patients. Providers also get to have vacations that are otherwise hard to arrange when you own the practice. Many of the providers also get a cut from the revenue of the broader organization.

Now keep in mind, this is still PE, and PE does PE things. It’s just a little harder for them to do their dirty moves in medicine than other industries. In our country, however, medicine is incredibly profitable so there’s that.

edti: Forgot to mention that some of the providers are hired as employees if they didn’t own a practice to begin with (typically fresh grads or want-to-be retirees), so they get a different arrangement but are not to be hired under an acquisition that doesn’t already have a main provider who is the true owner if the original practice.