Private equity buyers want more concierge medicine, wellness, and longevity companies than are available to buy, according to Cascadia Capital managing director Josh Mastracci, as reported by PitchBook on October 23.[1]
For a physician who spent years building a membership practice, that is a reason to understand the market before someone asks for your financials. Buyer interest can create an opportunity to take money out of the business, fund expansion, or arrange a succession. Whether a deal serves those goals depends on what you receive and what you agree to keep doing afterward.
Before the first call, write down three things: how much cash you want to take home, how long you want to keep practicing, and which decisions you intend to retain. Those answers will help you evaluate an offer long before anyone starts discussing a multiple.
Why buyers are looking at cash-pay care
PitchBook describes investors moving toward services patients purchase directly as insurance-dependent businesses face pressure from reimbursement and labor costs. Concierge medicine sits within that wider interest in cash-pay healthcare, alongside wellness and longevity businesses.[1]
For a membership practice, the business case starts with patients who renew, revenue that recurs, and a service people deliberately choose to pay for. The question for an owner is how much of that value survives a change in ownership.
If nearly every patient joined specifically to see you, a buyer needs a credible plan for retaining those relationships. If several physicians already deliver the same experience and patients renew across the group, the transition looks different. Prepare to explain retention, physician capacity, and how new members find the practice.
Cash payment also means the practice must earn its own patient demand. PitchBook notes that acquiring customers through advertising and referrals can be expensive, while cash-paying patients can leave when their budgets tighten.[1] An attractive membership fee tells only part of the story.
Our overview of private equity in concierge medicine provides the ownership background. The immediate task for a seller is to show how the practice works beyond its founder.
What the $3.4 billion buyout figure tells you
Nixon Peabody's Healthtech PE Monitor, using PitchBook data, reports that average U.S. healthtech buyout size reached $3.4 billion in the first half of 2026, up from $760 million in 2025. The report attributes the increase to a small number of megadeals.[2]
That figure describes the healthtech market. A concierge practice needs valuation evidence from comparable businesses, with attention to its earnings, physician dependence, and growth prospects.
Ask whether the buyer sees your business as a platform, a company around which it plans to build a larger group, or an add-on, a practice joining an existing organization. Private equity buyers commonly use both steps in physician-practice consolidation.[3]
Then ask who will actually buy it. Get the acquiring company's name, its financial sponsor, and the person responsible for running the combined business. Our healthcare private equity firm guide can help you begin that research.
Separate the purchase price from the cash you receive
A buyer can offer an appealing headline price while paying a substantial portion through equity or future performance payments. Nixon Peabody identifies cash at closing, rollover equity, and earnouts as common components of practice transactions.[4]
Consider this hypothetical $5 million offer:
Component | Illustrative amount | What you receive |
|---|---|---|
Cash at closing | $3 million | Cash before taxes, fees, holdbacks, and other applicable adjustments |
Rollover equity | $1.5 million | An ownership interest carried into the buyer's business |
Earnout | Up to $500,000 | Additional payment if agreed targets are met |
Only $3 million in this example is allocated to closing cash, and your net proceeds will be lower after applicable deductions. Have your accountant model the actual amount reaching you and compare it with continuing to own the practice.
For an earnout, ask who controls the expenses, staffing, pricing, and other decisions that affect the target. A payment tied to future profit deserves close attention when someone else will set the budget.[4]
For rollover equity, ask what you own, who gets paid ahead of you, and when you can sell. Debt, preferred investor rights, and departure provisions can materially affect what a physician receives when the larger company eventually changes hands.[5]
Read the employment offer alongside the sale offer
Your future compensation is part of the economics. The American Medical Association cautions that physicians who receive an upfront payment may earn less afterward, depending on the agreement.[6]
Buyers may value a practice using adjusted EBITDA, meaning earnings before interest, taxes, depreciation, and amortization, with adjustments to reflect the expected operation after the sale. Those adjustments can include resetting physician compensation. Reducing an owner's future pay can increase the earnings used to support the purchase price.[3]
Ask for the calculation in writing, including the proposed salary, bonus formula, working hours, call responsibilities, and expected years of service. Compare the sale proceeds and employment income with what you would expect to earn by staying independent over the same period.
For a physician approaching retirement, a large offer tied to several more years of full-time work may not accomplish the intended exit. The transition also needs to work for patients, as our guide to what happens when a concierge doctor retires or sells explains.
Put the membership experience into the operating terms
A buyer may promise to preserve your culture while introducing centralized staffing, technology, and management. The AMA recommends evaluating both the operational benefits and the control an investor will exercise after the transaction.[6]
Translate that discussion into decisions people will make every week:
Who can increase the membership fee or change what it includes?
Who sets patient-panel targets and appointment lengths?
Who approves physician hiring, staffing budgets, and new locations?
Who decides which additional services the practice will offer?
What authority do physicians retain over clinical decisions and referrals?
Ask for examples from practices the buyer already owns, and speak with physicians who have worked under those arrangements. A promise of administrative support is easier to assess when someone can describe the staffing, reporting, and workload after a year.
Healthcare ownership and fee arrangements are governed by state and federal requirements.[4] Have healthcare transaction counsel connect the proposed operating terms to the structure permitted in your state.
Get the important terms settled before exclusivity
A letter of intent (LOI) outlines the proposed transaction before the final agreements. Although much of it may be nonbinding, exclusivity and confidentiality provisions can create binding obligations. Exclusivity limits your ability to negotiate with other buyers for an agreed period.[7]
Before signing, get clarity on the price calculation, payment mix, employment terms, ownership rights, and timetable. The Medical Group Management Association also identifies working capital, escrow, restrictive covenants, and transaction expenses as terms to address at this stage.[7]
Bring your own attorney and accountant into the process before that commitment. Ask them to review the purchase, employment, and equity documents together, including what happens if you retire, leave, or are terminated. Those events can affect both your ability to practice and the value of your remaining equity.[5]
For the first conversation, a concise financial summary and your goals should be enough to establish whether further discussion is worthwhile. Ask what the buyer wants to learn, what it can offer in return, and what the next step would require from you.
FAQ
Does buyer demand mean my practice will command a premium?
The PitchBook report establishes investor interest in the category. Your price will depend on the practice's financials, risks, and the buyers competing for it.[1][3]
Can I sell and keep practicing the same way?
That depends on the operating and employment agreements. Specify the decisions you want to retain and have them reflected in the deal terms.[6]
Should I count rollover equity as retirement cash?
Treat it as a continuing investment whose payout depends on the company's performance and your contractual rights. Model your retirement needs using cash you can actually access.[5]
Keep your practice's public information current on NextMD. Whether you sell, expand, or remain independent, patients need to understand who provides their care and what membership includes.
Sources
Luz, E. (2026, October 23). PE goes out of network in healthcare, for some cash injection. PitchBook News. Cash-pay healthcare buyer demand and Josh Mastracci's observations. Read through Yahoo's syndication of the PitchBook article.
Nixon Peabody. (2026, October). Healthtech PE Monitor: Concentration, Consolidation, and the AI Catalyst, pp. 1–2, data as of June 30, 2026. U.S. healthtech buyout size and deal concentration.
Stout. (2023, January 17). Physician Practices: M&A Trends and Valuation Considerations. Platform acquisitions, valuation and physician compensation adjustments.
Schnipper, M. I., Masucci, M. A., and Barbere, S. R. (2026, May 26). Beyond valuation: Deal structure strategies for practice sellers. Nixon Peabody. Cash, rollover equity, earnouts and practice-sale structure.
Belostock, D. C., and Grant, K. M. (2026, March 17). The second exit: What happens to physician rollover equity when the platform sells. Nixon Peabody. Distribution priorities, departure terms and equity liquidity.
American Medical Association. (2019). Venture capital and private equity investments: Model checklist, pp. 1–3. Physician compensation, independence and operational control.
Katz, H. (2019, August 16). Guide to closing a private equity transaction: Negotiating the letter of intent. Medical Group Management Association. LOI terms, exclusivity and confidentiality.