Physician Services
Selling Your
Physician Practice?
Clinical expertise built the practice. The right partner can grow and monetize it.
Merritt Healthcare Advisors represents independent physician groups across medical and surgical specialties, from orthopedics and podiatry to cardiology and gastroenterology. We focus on sell-side mandates, helping our clients find the right private equity firm, family office, or strategic platform to support their next phase of growth.
The Decision Point
Standing Still Is Now a Choice.
Staying independent used to be the default, and it rarely took a second thought. Today it has to be a considered choice, made with real numbers.
Few physicians set out to run a business. They build a practice around their patients and a standard of care they believe in, and the business grows up around it. Years later, the same physician is weighing reimbursement pressure against rising overhead, recruiting associates against platforms that can outbid them, and deciding whether to fund the next ancillary service or location, while the share of the week spent practicing medicine keeps shrinking.
The question of what comes next rarely arrives all at once. A partner sets a retirement date. A key associate leaves for a platform. A neighboring group sells and changes the referral landscape. A payer renegotiation lands harder than expected. Any one of these is manageable, but together they shift the conversation from how to grow the practice to what the owner wants it to become, and whether a partner with more capital and infrastructure is the better route.
Acquisition Context
Build a Platform or Join One.
Physician practice M&A activity peaked in recent years and has since cooled, as more states have tightened oversight of private equity and corporate ownership of physician practices. Even with that pullback, buyers remain active for well-run groups, though they have become more selective about specialty, payer mix, and structure.
Owners weighing a sale face an early fork: keep building until the practice is large enough to anchor a platform, or sell sooner into a group that already exists.
Platform Investment
A platform doesn’t have to look like a headline-making consolidation deal. In practice, platform status is more attainable than the headlines suggest. Most platforms start far smaller: a well-run single- or multi-specialty group that a private equity firm backs as its first acquisition into a market or specialty. Merritt’s own Dr. Jay Pruzansky has personally built and sold a physician group business, then went on to develop and manage multi-specialty ambulatory surgery centers. More in “The Operator’s Perspective” below.
Tuck-In Acquisitions
Many physician practice transactions happen here, as a tuck-in to an existing platform. Large physician platforms are rarely built in a single deal. They grow by adding practices one at a time over many years, each a smaller group choosing to join an organization that already has the infrastructure.
A physician shortage sits underneath this deal activity. National workforce projections point to a growing physician shortage over the coming decade, in primary care and in surgical specialties alike, even after accounting for increases in residency positions. Many specialty physician practices remain independently owned, and that fragmentation keeps drawing strategic and financial buyers to the sector.
Jay Pruzansky, DPM, MBA
Managing Director
Operator Spotlight
Practice Owner. Platform Builder.
One operator’s perspective.
Merritt’s Physician Services practice is shaped by Dr. Jay Pruzansky, a podiatric surgeon who founded and grew a single-specialty physician management group to 19 offices, developed and managed five multi-specialty ambulatory surgery centers, and has consulted on more than $1 billion in healthcare transactions. His experience as an owner, not only as an advisor, informs how our team approaches each engagement.
What Drives Value
What Buyers Pay For in a Physician Practice.
Four factors drive most of what a buyer will pay for a physician practice: recruiting and retention, payer mix, corporate-practice-of-medicine exposure, and how repeatable the clinical model is. Owners who work on these before going to market keep value that would otherwise be negotiated away.
01
Physician Recruiting and Retention
Physician recruiting and retention is the central operating challenge in most specialty practices, and it shows up directly in valuation. A single physician search can be costly, and an unfilled seat is lost production, not just an expense: in high-volume specialties such as orthopedic surgery, cardiology, and gastroenterology, an open position can mean substantial lost billings every month. That pressure compounds against a national physician shortage expected to persist for years. Buyers underwrite recruiting pipeline and retention as carefully as they underwrite revenue, because an unfilled seat caps how much a practice can bill, not just how much it costs to run.
02
Payer Mix and Reimbursement Risk
Specialty largely determines how a practice gets paid, and buyers price the difference directly. Commercial-heavy specialty groups, Medicare-dependent primary care, and lien-based personal injury practices that wait on case resolution carry very different risk profiles. Within any of them, buyers favor diversified, in-network payer relationships and a record of stable reimbursement over dependence on a single payer, referral source, or litigation outcome.
03
Corporate Practice of Medicine and Regulatory Complexity
Physician practices are regulated state by state under the corporate practice of medicine doctrine, and that complexity compounds with multi-state growth. Some states restrict who can own a medical practice far more strictly than others, and a growing number have tightened oversight of private equity and corporate ownership of physician practices in recent years. Owners who can show a clean MSO structure and a well-documented compliance history remove a major source of buyer hesitation before diligence even starts.
04
A Model Buyers Can Repeat
Buyers who plan to keep growing the platform after close pay more for a model they can repeat. Groups with standardized clinical protocols, consistent coding and documentation, and a proven approach to integrating new sites or providers command a premium over single-site or loosely coordinated practices.
By Sub-Vertical
Specialty Shapes Diligence.
Physician services covers a wide range of specialties, and the diligence conversation changes with each. Expect buyers to focus on different questions depending on where your practice sits. Other specialties carry their own emphasis, but the same underlying drivers apply: physician recruiting depth, payer mix, and regulatory complexity, covered above.
01
Orthopedics
Orthopedic groups draw strong buyer interest, in part because surgical volume, ancillary services, and access to a surgery center can each add to value. Diligence focuses on surgeon retention, payer mix, and where cases are performed.
02
Podiatry
Podiatry has attracted dedicated platforms, so well-run groups can see real competition among buyers. Diligence focuses on payer mix, provider retention, and the mix of services behind the practice’s revenue.
03
Cardiology
Cardiology and vascular groups are valued on procedure capability, site-of-care mix, and referral relationships. Diligence focuses on payer contracting, ancillary services such as imaging, and physician alignment.
04
Gastroenterology
GI practices often tie closely to procedure volume and, in many cases, an endoscopy center. Diligence focuses on the ownership structure of that center, payer mix, and physician succession.
Your Options
Selling Isn’t the Only Move.
Majority Sale
This is a common path today. A private equity firm or an existing platform acquires a majority or full stake. Sometimes the practice becomes the platform, the foundation a private equity firm builds around and adds to. Often it tucks into a platform that already exists. Either way, the practice becomes part of a larger network, typically handing its back office, credentialing, and payer contracting to the buyer in exchange for scale.
Minority Recapitalization
A minority recapitalization brings in a growth partner without handing over the keys. The physician owners sell a non-controlling stake, stay in charge of clinical decisions, and use the new capital to fund expansion they couldn’t finance alone, such as new locations, added ancillary services, or physician recruiting. It suits owners who aren’t ready to give up control but want a stronger balance sheet behind the next phase.
Staying Independent
Selling isn’t the right answer for every owner today. Some practices are better served by staying independent for now: closing recruiting, payer-mix, or compliance gaps like those described above, and strengthening their position first, so the eventual conversation with buyers, next year or five years out, starts from a better place.
Representative Experience
Select Physician Practice Transactions
The Advisory Process
From First Call to Close.
01
Confidential Marketing
The practice goes to market quietly, so staff, referral sources, and payers don’t hear about a sale before the owner is ready to tell them.
02
The CIM
The confidential information memorandum tells the practice’s story: its providers, payer mix, clinical model, and financial performance.
03
Buyer Outreach & Screening
Qualified platforms and sponsors with a genuine interest in the specialty are brought in to compete for the practice.
04
IOIs & LOI
Initial bids arrive as indications of interest. The strongest are invited to negotiate a letter of intent.
05
Diligence & Closing
Provider employment terms, clinical governance, payer credentialing, and state compliance are negotiated alongside price, not left until after it.
Timeline: corporate-practice-of-medicine structuring, multi-state licensure, and payer credentialing can add real time to a physician practice transaction. Starting early, before a deadline forces the pace, gives an owner room to work through those steps rather than be rushed by them.
Jay Pruzansky, DPM, MBAManaging Director
Operator Perspective
From Operator to Advisor.
Dr. Jay Pruzansky, Managing Director at Merritt Healthcare Advisors, built his expertise from the inside rather than as an outside advisor. A board-certified foot and ankle surgeon with a doctorate from Temple University School of Podiatric Medicine, he founded and managed one of the nation’s first single-specialty physician management groups, growing it to 19 offices before selling the business. He later developed and managed five high-profile multi-specialty ambulatory surgery centers. He also served on the Health Ventures team at KPMG Peat Marwick, focused on physician group transactions, holds an MBA from Santa Clara University’s Leavey School of Business, and has consulted on more than $1 billion in healthcare transactions.
Having built, run, and sold physician businesses himself, Jay knows what the owner across the table is weighing. Based in California, he works nationally with physicians considering a strategic partnership or transaction in a competitive environment.
Sale
Single-Specialty Physician Management Group
Grew to 19 offices before Jay sold the business.
Developer · Operator
Multi-Specialty ASC Development
Developed and managed five high-profile multi-specialty ambulatory surgery centers.
These are Jay’s personal, pre-Merritt transactions as an owner and operator, not engagements advised by Merritt Healthcare Advisors.
Frequently Asked Questions
Common Questions From Physician Owners.
How do buyers value a physician practice?
Buyers do quote a multiple of earnings, but it’s shorthand for a forward-looking view: they project what the practice will earn and discount it at their own cost of capital. That’s why provider recruiting depth, payer mix, and regulatory history carry as much weight as last year’s results, and why the value-driver work above belongs before a practice goes to market, not after.
Who makes clinical decisions after a deal?
It depends on the structure. A minority recapitalization is designed to leave day-to-day clinical control with the physician owners, while a sale to a platform usually means deeper integration and less independence. Governance terms, including who decides on hiring, scheduling, and clinical protocols, can be negotiated into either structure, and that negotiation is a large part of an advisor’s job.
How long does a physician practice sale take?
There’s no single answer, because corporate-practice-of-medicine structuring, multi-state licensure, and payer credentialing can each add time, particularly for practices operating in more than one state. Starting early, before you’re under pressure, gives you room to work through those steps without rushing.
Can I sell my practice without an advisor?
Some owners do, but a practice sale is typically the biggest financial transaction of a physician’s career, and it happens once. The buyer across the table negotiates deals like it routinely. An advisor brings that same repetition to the owner’s side.
What does an advisor add if a buyer is already interested?
Interest from one buyer is a starting point, not a result. Going direct means negotiating one-on-one against a team that does this routinely and faces no competing offer. An advisor brings in other qualified buyers and shapes the terms, including governance and provider employment, not just the price.
Start a Conversation
Considering a Sale or Partnership for Your Practice?
A first conversation commits you to nothing. Whether you’re considering a full sale, a partnership, or simply want to know what your practice is worth today, reach out for a confidential discussion of your options.
Thought Leadership
