By Physician Growth Partners
June 2025
Since inception, private equity has held a controversial place within the urology space. Through its initial investment in Chesapeake Urology Associates, prominent private equity firm Audax Group created United Urology in 2018. The market has been divided on whether the “private equity model” could be successful in urology. Primary concerns from private practices considering healthcare private equity Management Services Organizations or other strategics (“MSOs”) centered around physician compensation growth, clinical governance and decision-making, and whether there would truly be a “second bite.”
With the benefit of time and experience, physicians and urology practices are now able to clearly observe the meaningful and positive impact private equity has had on the independent urology landscape. As a result, many independent practices are reevaluating the opportunity to partner with an MSO, as recent outcomes have helped validate the long-term viability and sustainability of the model.
MSOs have consistently demonstrated 25% to 100% income growth over the first 36 months of partnership. This growth stems from a variety of avenues, including incremental ancillary services (IOD, lab, research, radiation oncology, ASC, among others), as well as material cost savings from scale (e.g., drug purchasing, vendor contracts, insurance premiums, staffing costs). These changes have had a significantly positive impact on independent physician compensation. What was initially viewed with skepticism is now a leading attraction for independent urologists considering private equity. While physician compensation is declining across healthcare – due to reimbursement cuts and rising costs – urologists who have partnered with regional and national MSOs are among the few to see annual increases in compensation.
Time has also provided a better perspective on the perceived loss of decision-making and local autonomy. While MSOs (PE-backed or otherwise) have always emphasized their commitment to local governance and clinical autonomy, many physicians remained unconvinced. With dozens of practices and thousands of physicians now having partnered with private equity, it has become indisputable that private equity can coexist with urologists without impeding local autonomy or a physician leadership team’s ability to manage their practice.
Lastly, many urologists have long expressed reservations about the true value of “rollover equity” in private equity deals – often placing little faith in equity held in national MSOs. Despite dozens of successful case studies in other specialties, urologists remained skeptical, noting that “it hadn’t happened in urology.” As of Summer 2025, however, three PE-backed MSO platforms in urology have gone through successful “second bites,” generating substantial returns for both physician shareholders and private equity partners. With Unio Health and Solaris Health being the final two platforms yet to undergo a second bite, there’s no reason to doubt that physician shareholders in those groups will see similarly compelling returns as their peers at United Urology, U.S. Urology Partners, and Urology America.
For the many urology practices that have yet to explore private equity/MSO options, 2025 presents a unique and potentially valuable inflection point. With most of the initial questions and concerns now answered, there is a proven track record of success to give urologists confidence. What was once a risky strategy full of unknowns is now a well-paved path to long-term sustainability and practice development.
The urology sector in 2025 is experiencing robust M&A activity, fueled by strong investor interest in the specialty’s stable revenue streams, recurring patient demand, and favorable demographics. High-profile transactions over the past 12–18 months underscore the market’s momentum, with private equity-backed platforms and strategic consolidators actively acquiring independent practices to build scale and enhance care delivery. Upon recent market activity, just Solaris Health and Unio Health remain as the two, urology-focused, private equity backed management service organizations.
Recent deals highlight the sector’s attractiveness:
These transactions reflect strong investor confidence in urology’s long-term potential. Valuations are rising, particularly for high-performing, multi-physician practices with robust ancillary revenue, driven by an anticipated urologist shortage and growing patient demand. For independent urologists, this dynamic environment offers opportunities to partner with leading platforms but also intensifies pressure to align with larger groups to remain competitive and operationally efficient.
For independent groups, this activity brings key considerations:
If you’re an independent urology group considering your next chapter, we’d welcome a conversation. Contact us to learn more about how we can help you navigate this important decision.