Podcast Summary: The State of Private Equity in Healthcare with Amber Walsh

Podcast: Becker Business (Becker Private Equity Podcast)
Host: Scott Becker
Guest: Amber Walsh, Partner, McGuireWoods LLP
Date: December 11, 2025

Episode Overview

This episode features Scott Becker in conversation with Amber Walsh, a lead healthcare private equity partner and executive committee member at McGuireWoods LLP. Together, they dissect the current dynamics of private equity (PE) in healthcare, exploring trends in deal activity, evolving strategies for value creation, clinician alignment, the emergence of continuation vehicles, and regulatory expectations for 2026. Walsh lends her unique perspective, grounded in her experience advising on both buy-side and sell-side healthcare transactions.

Key Discussion Points & Insights

1. Shifts in Private Equity Healthcare Deal Activity

• Current Dealmaking Environment

  • The exit market has slowed over the past 18 months (since mid-2024), but deal activity remains steady, albeit below the frenzied peaks of 2020-2022.
  • Growth is predicted to be "slow but steady" into 2026, with particular investor interest in areas beyond traditional physician practice management (PPM).

  "There's still a lot of busyness and a lot of deal making going on within healthcare private equity right now."
  — Amber Walsh, [02:53]

• Areas of Investor Focus

  • Strong movement toward:
    • Tech-driven healthcare platforms
    • Facility-based services (e.g., surgery centers, imaging)
    • New care delivery models (value-based care, concierge medicine)
    • Highly specialized medical areas
  • Traditional PPM and dental platforms remain active, but with more disciplined investment.

  "We're seeing activity, but...I would characterize it overall as slow and steady...nowhere near where we were a couple of years ago."
  — Amber Walsh, [04:25]

2. Value Creation: Beyond Bolt-ons and Cost-Cutting

• Evolution of Value Creation Strategies

  • PE firms are moving past reliance on simple add-on acquisitions and immediate cost reduction.
  • Sophisticated funds now engage in rigorous, early planning for value creation, integrating all deal advisors from the outset.

  "[It's] really encouraging because this is putting your money where your mouth is, where you expect your advisors and all of your resource support to understand what you're trying to do and help build the deal around that."
  — Amber Walsh, [07:54]

• Advisor Engagement

  • Advisors are expected to understand and assess the value creation plan early, adapt diligence and documentation accordingly, and voice concerns if plans seem unworkable.

3. Clinician Alignment & Trust: Lessons Learned

• Key Factors Influencing Physician Satisfaction

  • The climate of prolonged hold times and slower exits is creating friction for physicians, especially those promised a quick "second bite at the apple" via rollover equity.
  • Overpromising exit timelines is now recognized as a mistake; savvy investors are increasingly cautious.

  "Those promises are now coming back to bite them because you have frustrated physicians...That is an unfortunate set of circumstances that I think the savvy investors have been so much smarter about in recent years..."
  — Amber Walsh, [11:07]

• Organizational and Leadership Shifts

  • Successful platforms prioritize multi-level clinical leadership, embedding practicing physicians at regional levels for local engagement and best practice exchange—not relying on a lone, detached CMO.
  • There is heightened focus on the multigenerational physician workforce (from baby boomers to Gen Z) and its differing priorities.

  "...pushing down and having multiple layers of clinical and operational leadership...also communicating the needs of the local physicians. And it's become such a focal point..."
  — Amber Walsh, [12:32]

  • PE platforms are devoting increased resources and time to clinician alignment, reflecting a broader industry concern for physician retention, satisfaction, and reduction of burnout.

4. Recapitalizations & Continuation Funds

• Emergence and Significance

  • Internal recapitalizations and single-asset continuation vehicles have become prominent, offering partial liquidity to investors and physician equity holders when traditional exits are delayed.

  "...the general partner is able to at least kind of satisfy some of the investors that are harping on the fact that you haven't quite exited, whereas others are perfectly satisfied to continue to grow the platform..."
  — Amber Walsh, [17:39]

• Industry Impact

  • This trend keeps deal flow active and accommodates diverse investor appetites within prolonged hold periods.

5. Regulatory and Market Outlook

• Anticipating 2026

  • Amber Walsh expresses optimism about gradual improvement in both deal volume and regulatory stability.
  • Continued state-level oversight is expected, but no dramatic, anti-physician-ownership policies are foreseen.

  "I do feel good looking into 2026...I expect continuing...state level [regulatory activity]...but I don't expect there to be anything as dramatic as what we experienced the last couple of years..."
  — Amber Walsh, [18:35]

Memorable Quotes & Moments (with Timestamps)

• On the Evolving Market:

  "There's still a lot of busyness and a lot of deal making going on within healthcare private equity right now."
  — Amber Walsh, [02:53]

• On Value Creation:

  "...the value creation conversation is happening on a broader basis more consistently and with more kind of devotion early on in a deal process..."
  — Amber Walsh, [06:15]

• On Physician Equity Frustrations:

  "...those promises are now coming back to bite them because you have frustrated physicians..."
  — Amber Walsh, [11:07]

• On Clinical Leadership:

  "...having multiple layers of clinical and operational leadership where you have physicians sitting at those more regional levels..."
  — Amber Walsh, [12:32]

• On Generational Differences:

  "...baby boomers are still at least 20% of the working physician population. Yet of course we have Gen Z physicians who are now coming out of fellowship. And so you have this broad array of generations..."
  — Amber Walsh, [14:11]

• On Continuation Vehicles:

  "...the continuation vehicle...has contributed to ongoing deal flow for the industry as well in the past 18 months or so."
  — Amber Walsh, [17:45]

• On Regulatory Environment and Optimism:

  "...I am very optimistic for 2026."
  — Amber Walsh, [19:27]

Noteworthy Segments (Timestamps)

• Introduction & Amber's Background: [01:00]–[02:31]
• State of PE Healthcare Market: [02:31]–[04:51]
• Value Creation Strategies: [04:51]–[08:09]
• Clinician Alignment & Trust: [08:09]–[15:13]
• Recaps & Continuation Funds: [15:13]–[18:17]
• Outlook & Closing Thoughts: [18:17]–[19:49]

Takeaway

Amber Walsh provides a nuanced, optimistic outlook for private equity in healthcare, highlighting industry adaptation toward better alignment with clinicians, more thoughtful and integrated value creation planning, and steady, if subdued, deal activity. With lessons learned from previous cycles and a maturing approach to physician engagement and regulatory compliance, the sector looks poised for steady improvement—absent major regulatory shocks—in 2026.