Which Physician Services Specialties Have the Largest PE-Backed Tuck-Ins?

Tuck-in transactions are a key tool for private equity (PE)-backed physician services platforms to strategically expand their footprint and gain depth in various markets. This analysis compares the size of tuck-in transactions across different physician services verticals, with a particular focus on the number of physicians at acquired practices.

To arrive at our conclusions, we consulted our PE in Physician Services Deals Database, an Excel file containing all publicly-announced deals in 15 physician services specialties dating back to mid-2022. The Excel spreadsheet includes metadata such as acquirer’s PE sponsor, target’s location, and number of physicians and locations of the target practice. The subscription product (updated monthly) can be accessed here.

A quick note on methodology: We typically define a PE platform transaction as one that results in a new portfolio company, and a tuck-in transaction as one that is executed by a platform group. However in this case we limited our analysis to tuck-in transactions in which the target practice (in almost all cases) did not have an existing sponsor or was not an existing platform, removing deals such as Cardiovascular Associates of America’s merger with Novocardia, Schweiger Dermatology Group’s acquisition of United Skin Specialists, and US Fertility’s combination with Ovation Fertility, among others. We also restricted the analysis to verticals in which there were at least 10 publicly announced tuck-ins during the period of analysis, from July 2022 through April 2024, and only included transactions in which we could manually verify the number of physicians at the acquired practice either at the time of the acquisition or after.

Here’s what we found:

Urology Deals Are Big

The average number of physicians involved in a tuck-in transaction in the Urology vertical far outstripped other verticals, at almost 20 (19.2). This may be influenced by the relatively small number of publicly announced PE-backed tuck-ins during the period of analysis, but we also note that urology groups tend to be large: according to the American Urological Association, almost 40% of urologists in private practices work in a group with at least 7 practicing urologists, and that figure includes more than one-fifth (22% share) working in practices with more than 15 practicing urologists.

Urology’s high average was boosted by a few large deals that we tracked, including the partnership between Solaris Health (backed by Lee Equity Partners) and UroPartners in Illinois, which brought 61 physicians to the platform, and the partnership between US Urology Partners (backed by NMS Capital) and Urology of Indiana, which involved 40 physicians.

Cardiovascular Leads the Second Tier of Larger Tuck-Ins

Though not as sizable as the Urology vertical, three others we analyzed – Cardiovascular, Gastroenterology, and Orthopedics – averaged a double-digit number of physicians at partnered practices in tuck-in transactions.

Cardiovascular led the way from this group, with an average of about 14 physicians at partnered practices. While there was a sizable range in size of these transactions (from a low of 1 to a high of 53), the median number was 13, indicating that this average of 14 was not heavily influenced by outliers.

Cardiovascular Associates of America (CVAUSA; backed by Webster Equity Partners) was the most active acquirer in this vertical during the period of analysis, and its average tuck-in size was slightly above-average at just over 15. (Again, this omits CVAUSA’s merger with Novocardia.)

Gastro Tuck-In Size Is Heavily Influenced by Some Outliers

Gastroenterology, on the other hand, had a sizable amount of smaller (sub-10 physicians) deals, but was influenced by some large tuck-ins. Those include GI Alliance’s partnership (backed by Apollo Global Management) with Connecticut GI and its 82 physicians, and Unio Health Partners’ partnership (backed by Triton Pacific Capital Partners) with inSite Digestive Health Care, and its 70 physicians.

In fact, the median number of physicians involved in a PE-backed Gastroenterology tuck-in was a much smaller 6.

Almost Half of Orthopedics Tuck-Ins Involve Double-Digit Physicians

Orthopedics tuck-ins, for their part, were more consistently distributed, with 45% of the deals tracked involving a double-digit number of physicians at the partnered practice. This suggests that the overall average of 10.3 was less likely to be influenced by a couple of huge deals, though the median number of physicians involved in tuck-ins was smaller than the mean average, at 8.

Larger tuck-ins were also executed by a few platforms rather than being the domain of just one or two: tuck-ins involving more than 20 physicians were made by HOPCo (backed by Audax Private Equity and Linden Capital Partners), OrthoAlliance (backed by Revelstoke Capital Partners, which had 2 such tuck-ins), Spire Orthopedic Partners (backed by Kohlberg & Company), and United Musculoskeletal Partners (backed by Welsh, Carson, Anderson, and Stowe).

To generate these and many more insights for yourself, subscribe to our PE in Physician Services Deals Database (in Excel format) here.

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