Physician transactions continue to reshape the practice landscape across the U.S., from rural independents to consolidated urban groups.
Becker’s spoke with three physicians in different regions to understand how these transactions, including mergers, acquisitions and shifts in ownership, are playing out locally.
Question: How would you describe the current landscape of physician transactions in your region?
Gregory Brennan MD. Gastroenterologist in Mansfield, Texas: The last one to two years in the Dallas-Fort Worth area that have been several physician transactions with both primary care and specialty groups. I have seen both the formation of large multispecialty groups and the splinting off of others. I have definitely seen a trend in more primary care and internal medicine practices joining hospital groups or changing hands. I think in general it is harder for smaller practices to keep up with consolidation and remain independent. One of the biggest specialty transactions recently was the Cardinal Health and GI alliance announcement in November 2024.
David Rinehart, MD. Primary Care at South Point Family Practice Belmont (N.C.): I am in primary care and mostly know about that. We have our scattered direct primary care practices, a hybrid direct primary care, a mostly independent group that recently took private equity capital but did not give up control. But the majority of primary care in our area is employed by health systems, which exert significant control over the landscape. As we look at more rural areas there are a few more independent practices. I see pros and cons to each model. Everyone seems to be adequately busy in primary care, as far as I can tell. Each group seems reasonably happy with their space at this point. I think that diversity is good for patient care.
Roxanne Tyroch, MD. Owner and Operator of Intellimedicine, PA (El Paso, Texas): In Texas during 2025, physician transactions are subject to new regulations, particularly concerning noncompete agreements and reporting requirements for healthcare transactions. Senate Bill 1318, effective Sept. 1, 2025, will introduce stricter limits on the duration, geography and buyout amounts for physician noncompete agreements. We still have not had success with minimizing the burden of prior authorization in Texas with the Gold Card plan. However, recently there are changes at the national level proposed by American Health Insurance Plans to simplify the process. In 2023, the Texas Medical Association filed multiple lawsuits challenging the implementation of the federal No Surprises Act, specifically targeting provisions related to the Qualifying Payment Amount calculation and the Independent Dispute Resolution process. These lawsuits struck down certain regulations and challenged the methodology being used for calculating the QPA, which is used as a benchmark in the IDR process. Physicians all across the nation are now having a more equitable experience for out of network payments. One of the most challenging aspects of private practice is that many practices have not recovered from the losses incurred during the pandemic. Staffing shortages persist and this drives up payroll costs in the setting of declining reimbursements. Many practices are still paying off loans taken out during the pandemic that were not forgiven. Artificial intelligence is being used primarily in terms of decision support and scribe services but some large institutions across the country are using it in much broader ways.
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