Becker's ASC Review

6 ASC MANAGEMENT Where independent practice stands across 5 specialties By Francesca Mathewes W hile physicians are increasingly shiing towards hospital, health system or private equity-owned practices, the state of independent practice looks different from specialty to specialty. Here's where independent practice stands across five physician specialties: Anesthesiology • Consolidation within anesthesia is accelerating, in large part due to efforts by large anesthesia groups such as Dallas-based US Anesthesia Partners and Melville, N.Y.-based North American Partners in Anesthesia. • In May, the Federal Trade Commission resolved an antitrust case against Welsh Carson, Anderson & Stowe which was tied up in a lawsuit alongside its portfolio company, U.S. Anesthesia Partners. In January, the FTC reached a settlement with Welsh Carson, requiring the company to limit its involvement with USAP and notify the commission of specified future acquisitions and investments in anesthesia and other hospital-based physician practices. e FTC has finalized that consent order, according to a May 20 news release. e FTC's case against USAP continues to proceed in federal court. • Independent anesthesiologists tend to earn their peak average income at between 15 and 21 years of experience, according to Medscape's salary explorer. • Independent anesthesiologists earn about 10% more than their employed peers, averaging $591,000 annually compared to $542,000. Cardiology • e number of private equity-backed cardiology platforms has more than doubled since 2022, according to a 2024 report from KPMG Corporate Finance. ese platforms now operate in nearly 20 states, with particularly heavy activity in Florida and Texas. • Cardiovascular Associates of America and US Heart & Vascular are the two largest PE-backed cardiology platforms in the U.S. e platforms are backed by Webster Equity Partners and Ares Management, respectively. Both platforms were founded in 2021. • Beyond PE, health systems dominate cardiology employment. Over 70% of cardiologists are now employed by hospitals or large systems, according to the American College of Cardiology. • Despite trends towards consolidation, Becker's has reported on several recently developed cardiology platforms that center physician independence and autonomy, including Lynwood, Wash.-based CardioNow. Founder and CEO Mahesh Mulumudi told Becker's that while this sort of venture is relatively new in cardiology, he expects that the recent success of independent practices like CardioNow will inspire more cardiologists to make the jump from employment. • "ey're going to be on the sidelines and watching your stories before they can jump in," Dr. Mulumudi said. "at's my view of this. Because I talk to a lot of people that are interested, but they don't have the gumption to do it. … And aer starting this, I spoke with a few cardiologists who would call me and say, 'Hey, how would you advise me if I want to do this?' So that's one of the things I keep hearing." Gastroenterology • While gastroenterology deal activity has declined sharply over the past three years, momentum is expected to continue as independent practices pursue consolidation to gain scale and modernization benefits, according to a Q1 2025 corporate finance report from KPMG. • Despite the downturn, consolidation remains a strategic priority for many GI groups seeking to enhance their capabilities through electronic health record systems, modern endoscopy equipment, specialized soware and ancillary services. • Nearly 10% of U.S. gastroenterologists now work in PE-owned practices, and from 2019 to 2023, at least 108 GI practices were consolidated. • "e last one to two years in the Dallas-Fort Worth area there 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," Gregory Brennan, MD, a gastroenterologist in Mansfield, Texas, told Becker's. "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. Ophthalmology • Ophthalmology has the highest rate of private practice physicians at 70.4%, according to the American Medical Association's Physician Practice Benchmark Report. • However, there has still been recent deal activity by at least one major consolidator in the physician practice space. Brentwood, Tenn.-based Surgery Partners quietly expanded its footprint in ophthalmology through an acquisition of Dallas-based Key- Whitman Eye Center, executives said during the company's May 13 earnings call. • Private equity has demonstrated solid interest in ophthalmology. According to a 2024 report by VMG Health, ophthalmology- focused physician groups saw the most private equity mergers and acquisitions in 2023, along with dental and internal medicine practices. Orthopedics • More than half — 54% — of orthopedic surgeons continue to work in independent settings, according to the AMA report. • Orthopedic surgeons are paid on average slightly more in a

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