Yes — but growth now means something different than it did five years ago. The old playbook of competing on broad, in-market keywords and outbidding the next-largest local provider doesn’t hold up against a consolidator with centralized budgets and no urgency to be profitable on any single ad. If your growth strategy still depends on winning that auction, growth is going to get harder every year, not easier.

But the practices that are still growing in PE-saturated markets aren’t growing by winning that fight. They’re growing by changing which fight they’re in.

Private equity-backed groups are built for scale and efficiency across many locations — which means they’re optimized for broad, predictable, high-volume patient acquisition. They are not built to chase smaller, specific audiences that require custom content, a niche angle, or a slower trust-building cycle. That’s not a flaw in their model; it’s simply not what the model is for. It’s also exactly the space where a single, well-positioned independent practice can move faster and go deeper than a centralized marketing team ever will.

Growth in this environment generally comes from one of three places: a specific patient niche the bigger groups aren’t targeting, an upstream audience that hasn’t started searching for the procedure yet, or a level of local trust and authority that a multi-location brand structurally can’t replicate. Practices that pick one of these and commit to it tend to keep growing. Practices that keep trying to out-bid a budget with no ceiling tend to plateau, then shrink.

The honest answer is that the market hasn’t closed — it’s just stopped rewarding the old strategy. The independent practices growing right now figured that out before their CPL forced the issue.