Updated: June 2026
Published by Physician Growth Partners
The urology sector has reached a pivotal inflection point. A limited supply of high quality, scaled practices combined with aggressive consolidation by corporate and private equity backed strategic buyers is driving valuations back toward the record levels seen in 2021 and 2022. For independent urology practices, these factors provide an optimal environment to evaluate liquidity and strategic partnerships.
This intense buyer appetite is driven by aging demographic profiles, sticky patient volumes, profitable ancillary service lines, and a national shortage of urologists that shows no sign of correction in the near term. Corporate consolidators such as Cardinal Health and private equity backed groups like US Urology are pursuing scaled practices to expand market share, enhance vertical integration, and further benefit from economies of scale. However, recent changes to the CMS Physician Fee Schedule are altering the margin profile of traditional models. This report draws on the latest market insights, recent transactions, and Physician Growth Partners’ experience and perspective on the urology M&A landscape to help you better understand current market dynamics and determine whether now is the right time to evaluate a transaction.
The broader urology services sector sits at a highly lucrative crossroads of clinical necessity and operational scale. The market size for urological services in the United States was approximately $77 billion in 2024 and is expected to expand to $88 billion by 2027, a compound annual growth rate upwards of 5%.1 There are more than 14,000 practicing urologists in the U.S., clustered near metropolitan areas; and a staggering 60% of counties in the United States do not have a practicing urologist, necessitating travel for those in rural areas.1,2 Expanding care to untapped areas presents a unique value opportunity for those that can afford the logistical hurdles.
Demand fundamentals are fueled by the rising prevalence of renal diseases, prostate and bladder cancer, and an expanding aging population that has chronic conditions that need to continue to be treated. In contrast, provider supply is structurally constrained. The industry is facing a growing provider shortage as retirements continue to outpace the number of new physicians entering the field. The median age of a urologist in the United States is 55 years, and further, 29.8% of the urology workforce is aged 65 years or older.2
These factors are key drivers behind the attractiveness of the urology sector for private equity investors and strategic consolidators, given the substantial advantages created through economies of scale and enhanced ancillary capabilities such as in-office dispensing pharmacies, advanced pathology labs, and ambulatory surgery centers.
Valuations within the urology sector are heavily driven by operational scale, ancillary service mix, provider age demographics, and geographic density. Based on PGP’s firsthand experience advising urology practices, scaled and sophisticated groups are achieving premium valuations in the low double-digit EBITDA multiple range, while smaller add-on practices generally trade in the high single digits. Multiples vary based on scale, ancillary capabilities, growth trajectory, geography, and infrastructure.
Recent reference points solidify these valuations at historic highs. The benchmark transaction of the most recent cycle occurred in November 2025, when Cardinal Health, via its subsidiary, The Specialty Alliance, completed its acquisition of Solaris Health, the country’s largest urology platform, which brought 750+ providers and 250+ clinical locations into a unified multi-specialty alliance.3 Additionally, General Atlantic, one of the more prominent healthcare growth investors, executed a major investment in U.S. Urology Partners in April 2025, further validating the subsector’s long-term investment outlook.4
Key valuation drivers by service line:
| Service Line | Key Valuation Driver |
|---|---|
| Ambulatory Surgery Centers (ASC) | Surgical volume, payor mix, capacity utilization, patient retention |
| In-Office Dispensing (IOD) & Pharmacy | Drug profitability, reimbursement trajectory, compliance |
| Radiation Oncology | Referral network, payor dynamics, in-house oncologist, regulatory compliance |
| Advanced Pathology & Labs | Regulatory compliance, internal capture, EHR integration, clinical infrastructure |
| Clinical Urology | Geographic density, operational infrastructure, provider recruitment, managed care contracting |
The urology buyer universe consists of several distinct acquirers:
| Date | Target | Acquirer | Commentary |
| April 2025 | U.S. Urology Partners | General Atlantic | 290+ providers / 80+ locations |
| April 2025 | Urology America | Specialty Alliance (subsidiary of Cardinal Health) | ~110 providers / 30 locations |
| April 2025 | Potomac Urology | Specialty Alliance (subsidiary of Cardinal Health) | 14 providers / 7 locations (2 ASCs) |
| August 2025 | Wisconsin Institute of Urology | ThedaCare | $16.5 million enterprise value |
| Nov 2025 | Solaris Health | Cardinal Health (The Specialty Alliance) | $2.4 billion enterprise value / ~19.0x EBITDA multiple |
| December 2025 | United Urology Group | OneOncology | ~$600 million enterprise value / 16.0 – 18.0x EBITDA multiple |
| April 2026 | Urology of Indiana | U.S. Urology Partners | ~75 providers / 14 locations |
PGP is one of the most active advisors in the Urology sector and has represented over nine independent urology groups in transactions with private equity and strategic buyers.
A few recent notable PGP urology transactions are as follows:
These transactions further established PGP as one of the most active advisors in the sector, delivering strong outcomes for its clients and reaffirming the market’s continued appetite for high-quality practice assets.
PGP’s firsthand experience believes that it is a great time to evaluate a potential transaction given the following factors:
Increased State Restrictions: State legislature has continued to impose stricter rules on investors and strategic buyers seeking to invest in the provider sector. Recent policy changes in Oregon and California have added new limitations and increased reporting requirements, prompting many investors to avoid or reduce exposure to these states. Physician Growth Partners (PGP) believes that additional states are likely to adopt similar restrictions and reporting obligations in the future, which could hinder practices’ ability to transact.
Continued Pressure from Health Systems: There is ongoing pressure from health systems that are leveraging their market dominance to bring urology services in-house and limit opportunities for independent urology groups in surrounding areas. According to AMN Healthcare’s 2024 Physician Recruiting Report, Urology is now one of the most difficult specialties to recruit for. As the supply of urologists continues to shrink, health systems have stepped up their recruitment efforts by offering competitive salaries, signing bonuses, and institutional stability that independent practices often struggle to match. The result is an increasingly uneven playing field, making it harder for independent urology groups to attract and retain talent.7
A Tightening Reimbursement Environment: Medicare reimbursements for urology procedures have fallen more than 40% in inflation-adjusted terms from 2002 to 2024, while practice operating costs have continued to rise.8 This has created a widening financial gap that is increasingly pushing independent urology groups toward consolidation or hospital employment.
Substantial Institutional Dry Powder: Private equity investors and strategic consolidators entered 2026 with significant reserves of uncommitted capital to deploy. This liquidity ensures a deep bench of extremely motivated buyers, protecting the urology sector from broader macroeconomic credit tightening and sustaining transaction volumes.
Succession and Estate Planning Optimization: The urology workforce is at a generational inflection point. With the median urologist now 55 years old and nearly 30% aged 65 or older,2 many senior physicians are looking to monetize the practices they built over decades. Younger urology partners are increasingly open to a transaction and joining a larger platform to be able to gain additional recruitment support, operational expertise, and ancillary service access.
Impact of the Corporate Practice of Medicine on Clinical Operations
Recent media attention regarding corporate involvement in the practice of medicine, particularly driven by private equity investments in independent practices, has shaped recent legislative actions and influenced public opinion. The reality is that private equity firms are not created equal. Some groups have no business participating in healthcare, while others have proven to be true partners. Many urology practices have successfully partnered with buyers to access the resources and infrastructure needed to scale, all while preserving physician autonomy and clinical independence.
Many of today’s buyers learned from mistakes made in the past and have properly structured their governance in a way that allows physicians to retain control of the practice of medicine. Their operational focus is squarely on initiatives that drive growth without touching patient care: recruitment and funding guarantees, group purchasing, payor contracting and RCM efficiency, expansion of ancillary services, and strategic footprint expansion. The investors that alleviate these burdens for physicians while allowing them to completely control the provision of care, thus allowing such physicians to be more efficient and care for more patients, are the groups who have come out on top in physician practice investing.
While public sentiment is partially uninformed, it is critical for independent practices to conduct their own diligence on all prospective partners, to fully understand how clinical governance would look following a transaction.
The urology transaction ecosystem has reached a definitive phase of maturation. As early private equity investments reach the end of their typical investment hold periods, the market is observing significant recapitalizations and strategic acquisitions, evidenced by the recent consolidation of urology assets by Cardinal Health, OneOncology, and others. This clear proof of concept has eliminated historical physician skepticism regarding the long-term viability and income growth potential of the MSO framework.
This secondary exit cycle creates an extremely favorable environment for independent practices who have not yet tested the market. Strategic buyers and recently recapitalized platforms are aggressively deploying capital to complete accretive add-on acquisitions to further densify their presence in existing geographies. This competition translates directly into higher EBITDA multiples, lower seller risk, and highly flexible partnership opportunities. Many leading consolidators have reached a scale that gives prospective partners a meaningful track record to evaluate, offering a clearer picture for assessing how the platform supports local groups and whether the fit is right.
For independent operators, the window to capitalize on favorable valuations is well aligned with current market dynamics. Furthermore, an increasingly complex regulatory and compliance environment disproportionately impacts smaller, office-based practices. Partnering with a scaled corporate or private equity-backed platform provides the operational infrastructure and capital necessary to expand ancillary service lines, mitigate risk, and capture regional market share.
Sources & Citations
Physician Growth Partners · This content is provided for informational purposes only and does not constitute legal, financial, or investment advice. All transaction data sourced as cited. © 2026 Physician Growth Advisors, LLC. All rights reserved.