For physicians and staff inside your practice, an ownership change can feel seismic, but in the broader healthcare market, mergers and acquisitions (M&A) are measured less by emotion and more by economics — how many deals close and whether they align with or disrupt industry expectations. 

Deals in the ambulatory/outpatient space have not disappeared after hospital and system M&A cooled dramatically earlier this year, but they are changing shape: Physician platforms, ambulatory surgery centers (ASCs), and payer‑owned primary‑care footprints kept expanding through a mix of bolt‑ons, joint ventures, and de novo growth. The message for independent practices: even if you’re not selling, the market is moving around you. 

A Sept. 23, 2025, MGMA Stat poll found that 85% of medical group leaders had no ownership change this year at their organizations, whereas about 2% went through a merger, 3% bought another practice, and 8% were acquired by another entity. Another 3% reported “other.” The poll had 421 applicable responses. [Editor’s note: Percentages do not total 100% due to rounding.] 

Among the “other” respondents, ownership outlooks were mixed, reflecting instability and adaptation. Some noted recent or pending transitions — retiring partners, splintered partnerships, or hospital acquisitions — while others pointed to unique structures like an ESOP model or shifts between MSO and private ownership. A few expected continuity under remaining or new physician owners, but many acknowledged that small practice pressures make long-term stability uncertain. 

What’s the outlook for the next five years? 

Practices that were acquired

Leaders of groups acquired this year largely expressed confidence that their new structure will remain stable for the next five years, often citing stronger financial footing, partner alignment, or physician commitment to independence. Some, however, voiced doubts about longevity, pointing to leadership changes, owner retirements, or concern that hospital or corporate buyers may not fully understand their specialty or patient needs. 

Practices that acquired others 

Leaders of organizations that acquired other practices were split: Some stressed growth and partnerships as keys to long-term stability, while others anticipated eventual sale or merger. Several noted that small practices struggle to survive, making consolidation both necessary and challenging. 

Practices with no ownership change this year 

Among respondents with no ownership change, most expect their current model to hold for the next five years, citing independence, physician alignment, financial stability, or nonprofit/academic structures. Many emphasized physician ownership, with plans to add partners or successors as owners retire. Others referenced success in value-based care, deep community roots, or strong balance sheets as reinforcing stability. 

Still, a minority anticipated disruption tied to reimbursement, staffing costs, or consolidation, with some already exploring mergers, hospital ties, or private equity. Overall, while optimism for independence remains strong, many acknowledged reimbursement volatility, leadership transitions, and buyer interest could still drive ownership changes for a significant subset of practices. 

Ownership migration continues, just not evenly 

The American Medical Association’s latest landscape update confirms the long‑running drift away from physician‑owned practices. By 2024, just 42.2% of physicians worked in private practices (down from 60.1% in 2012), 34.5% worked in hospital‑owned settings, and 6.5% reported private‑equity ownership — figures reflecting payment pressures, regulatory burden, and the cost of infrastructure. Those same forces also shape outpatient deal logic: buyers promise scale economics and contract leverage; sellers seek stability and capital. 

The economic drivers: margin pressure meets throughput gains 

MGMA’s 2025 data reports and polls show the same reality: costs keep outpacing revenue, squeezing margins. In physician‑owned groups, leaner staffing helps contain expenses; in hospital‑owned enterprises, total operating costs remain structurally higher, often requiring subsidies from parent systems. Labor dominates — support staff alone typically represents roughly a quarter of practice revenue, and total labor can run 50%–60% of outlays. 

Productivity patterns also shifted. As the 2025 Provider Compensation and Productivity data report showed, private‑practice clinicians report more encounters and higher collections, but hospital‑/system‑owned peers logged higher median wRVUs in primary care and surgery. For instance, private‑practice PCPs posted 16.1% more collections and 12.2% more encounters than system‑owned peers, yet lower median wRVUs; APPs in private practice saw notable gains in both. That combination — throughput gains without proportional RVU growth — explains why many independents feel “busier but not better off.” 

Our 2025 State of Private Medical Practice report adds context: Independents are relying on incremental innovation — new scheduling models, targeted tech like scribes/AI, and selective partnerships — to offset payer and cost pressures. Survival is less about a single big bet and more about a portfolio of small, compounding improvements. 

Hospital‑/system‑owned enterprises: Portfolio pruning, fewer big deals 

With uneven margins, many health systems are re‑evaluating their mix of physician assets instead of chasing large, headline‑grabbing mergers. Kaufman Hall’s Q1 2025 readout showed a slump in system‑to‑system deals, many involving distressed sellers; Q2 stayed muted, dominated by smaller divestitures. Expect more portfolio “right‑sizing” — clinic sales, service-line JVs, and ASC partnerships — rather than blockbuster mergers in the near term. 

ASCs: consolidation, complexity, and joint ventures 

ASCs remain a very active corner of the outpatient landscape, with growth being fueled by a steady shift of higher-acuity cases — orthopedics, cardiology, and spine among them — into outpatient settings, as well as by ongoing consolidation among the biggest players.

By the end of 2024, VMG Health estimated USPI's footprint at more than 500 centers, with SCA around 320 and AmSurg at 250. Even so, roughly two-thirds (67%) of ASCs remain independent, leaving ample room for further roll‑ups and JVs. Tenet/USPI, for example, has been doubling down on both acquisitions and new builds as health systems shed inpatient costs and chase outpatient surgical growth. 

For independent groups, ASC participation offers strategic and tactical value: physician control of access and block time, better patient experience, and potential equity returns. But rising anesthesia and labor costs, plus modest annual ASC fee schedule updates, mean the pro forma needs disciplined assumptions on staffing yield and payer mix. 

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