Summary4 min read

Podcast Summary: Becker Business

Episode: Trends in Physician Practice Management and Urology Investments
Host: Scott Becker
Guest: Amber Walsh, Executive Committee Member at McGuireWoods LLP
Date: August 28, 2025

Overview

In this episode, Scott Becker speaks with Amber Walsh, an executive committee member at McGuireWoods LLP, focusing on current trends in the physician practice management (PPM) industry, with a particular emphasis on urology investments. The discussion explores deal flow, regulatory trends, areas of opportunity within urology, and related specialties. The conversation provides actionable insights for investors, operators, and healthcare professionals interested in the evolving landscape of physician practice management.

Key Discussion Points and Insights

1. State of the PPM Sector

Increased Caution and Regulatory Scrutiny
- Over the last 18 months to two years, there has been greater regulatory scrutiny and more intensive due diligence on PPM deals.
- The sector has shifted from the “super boom” era (2020–2022) to a phase where deals are happening more slowly amid economic and regulatory uncertainty (01:03–02:32).
- Quote:
  
  “There's been more, not reluctant, that's not the right word, more caution maybe for private equity investors and debt investors when looking at PPM investments than there had been in the super boom of 2020 through 2022.”
  – Amber Walsh [00:50]
Market Data
- Cites Q2 2025 data from Pitchbook and other sources noting that while deals are fewer, activity persists with an emphasis on quality and compliance (01:25–02:32).

2. Urology as an Investment Opportunity

Recession-Resilient Specialty
- Urology is viewed as a more "recession-proof" specialty with better reimbursement and a strong mix of preventive, diagnostic, and non-deferrable treatments (02:55–04:05).
- Quote:
  
  "A lot of industry stakeholders would describe urology as a little bit more recession proof than some other specialties."
  – Amber Walsh [02:55]
Ancillary Revenue Streams
- Urology practices can integrate various ancillary services including ambulatory surgery centers (ASCs), pathology labs, independent pharmacy dispensing, infusion centers, clinical research, radiation therapy, and more (04:05–05:20).
- These diversifications offer both enhanced care and revenue, plus savings for the healthcare system by keeping certain treatments out of hospitals.
- Quote:
  
  "There's a whole host of things that a urology practice can appropriately kind of integrate within the practice... ways to save money for the health care system, keeping some things out of a hospital when appropriate."
  – Amber Walsh [04:50]

3. Urology: Hottest Areas for Practice Profitability

Oncology and Pharmacy Dispensing
- Major focus on treatments for genitourinary cancers, alongside clinical research opportunities and in-practice pharmacy dispensing, are lucrative and growing areas (05:55–06:45).
- Population Demographics:
  - Rising rates of cancer diagnosis and aging population cited (10,000 people turning 65 daily in the US), creating sustained demand.
  - Quote:
    
    "Some estimates saying, you know, 10,000 people turning 65 every day in the United States. Of course not all of those would receive urological care, but it all is the overlay within urology."
    – Amber Walsh [06:39]
Evolution of Practice Models
- Notable trend in the formation and sale of large single-specialty urology groups with private equity backing (e.g., United Urology, created by Audax and sold to One Oncology).
- Also sees urology integrated into multi-specialty oncology platforms, broadening investment strategies (07:13–07:47).

4. Trends in Other Specialties

Orthopedics and Women’s Health
- Ongoing deal activity in orthopedics and some women’s health, with less appetite for purely elective (e.g., cosmetic, derm) specialties during times of economic uncertainty (08:00–08:47).
- Quote:
  
  "I think that's where people have a little bit more caution that there's going to be some economic impact. So a little bit less in cosmetics and some of the derm practices, but you still see some interest in those areas too."
  – Amber Walsh [08:21]
General Sentiment
- No specialty is off the table, but increased discernment rules current investment decisions (08:35–08:47).
- Quote:
  
  “It's just a period of time when there's more discernment is what I would say.”
  – Amber Walsh [08:39]

Notable Quotes & Memorable Moments

On the cautious investment climate:

"There's been more caution and the Q2 data... that deals are still happening. There are fewer, they are more cautious, they're taking a little bit longer to get done... because of the state level transactional review processes, the economic uncertainty."
– Amber Walsh [01:12–01:29]
Highlighting urology's resilience:

"Procedures, the care, both the preventive care, the diagnostics and then the treatments are generally not considered to be elective or even things that can really be put off."
– Amber Walsh [03:30]
On innovation in urology:

“There's a lot of innovation and some technology that are opportunities in the space.”
– Amber Walsh [03:04]

Timestamps for Important Segments

00:33 – Amber Walsh’s overview of PPM investment trends
02:32 – Discussion shifts to urology’s unique opportunities
04:05 – Details on the ancillary opportunities within urology
05:55 – Examination of the hottest, most profitable practice areas
07:13 – Trends in consolidation and private equity activity in urology
08:00 – Activity and outlook in orthopedics, women’s health, and other specialties
08:47 – Episode close

Tone and Language

Amber Walsh’s commentary is precise, analytical, and rooted in industry expertise, paired with Scott Becker’s thoughtful, inquisitive hosting. The overall conversation balances data-driven observations with strategic investment analysis, maintaining an informative yet accessible tone throughout.

Summary

This episode of Becker Business offers timely, rich analysis of the evolving physician practice management investment landscape, focusing on why urology remains a standout specialty for growth and innovation despite broader market caution. Listeners gain practical insights into sector dynamics, including regulatory scrutiny, diverse revenue streams, and the impact of demographic trends. Amber Walsh’s discussion provides both granular detail and broader context for anyone interested in the intersection of healthcare, investment, and business development.

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Transcript10 lines

[00:00]
A
This is Scott Becker with the Becker Private Equity Podcast and the Becker Business Podcast. We're joined today by Amber Walsh. Amber's on the executive committee at McGuire woods and lives at the intersection of practice law at the intersection of health care and private equity. She's going to talk to us about a subject we've not talked about in some time, which is the physician practice management industry and specifically urology. What you seeing there, what you're seeing in the PPM world. Amber, let me tee it up for you to take it away. What are you watching currently?
[00:34]
B
Yeah, thanks, Scott. So I think a couple of big deals and I'm going to talk about one in particular. A couple of big deals from Q2 and announced for Q3 in the urology space I think are really indicative of what's been happening in the PPM space more generally, but also urology. But just to start with the PPMS sector generally we have had kind of a consistent view. It's been for the past 18 months or so, this more intensive regulatory scrutiny, much more kind of deep diving into really the most attractive investment opportunities. There's been more, not reluctant, that's not the right word, more caution maybe for private equity investors and debt investors when looking at PPM investments than there had been in the super boom of 2020 through 2022. There's been more caution and the Q2 data, Q2 2025 data that is coming out reported by Pitchbook Provident Healthcare Partners always has one, there's a few others. Bain is consistent with that, that deals are still happening. There are fewer, they are more cautious, they're taking a little bit longer to get done because of the state level kind of transactional review processes, the economic uncertainty that we've had for the past couple of months. But this has really been a pretty consistent theme over the past 18 months, possibly even as long as the two years.
[02:32]
A
And it seems like over the last couple years particularly we've seen trouble in the practice management area in what I would as lower margin specialties, especially with higher interest rates. Talk to us about urology and what you're seeing there because urology does have a lot of ancillaries. It's a reasonable reimbursement specialty. What are you seeing in urology specifically?
[02:55]
B
Yeah, that's exactly right. So a lot of industry stakeholders would describe urology as a little bit more recession proof than some other specialties. Generally speaking, most of the procedures are long established, at least the care is long established, although there's a lot of innovation and some Technology that are opportunities in the space, but it has been well known as preventive care for a long time. The procedures, the care, both the preventive care, the diagnostics and then the treatments are generally not considered to be elective or even things that can really be put off. And there's a lot, there's obviously Medicare reimbursement, commercial reimbursement, and there's a whole host generally in your average urology practice, from a small practice of three to seven to a mid sized practice, There are a lot of ancillary services that are natural extensions of the physician's own personal services. And it's really varied in urology because you have the traditional surgical practice investment in like ASCs. Urology is one of the main specialties that are performed in an asc. So you have a lot of ASC investments, but you also have pathology, you have independent pharmacy dispensing through the practice. You have a lot of the infusions and some of the focuses on the diagnostics and treatment around the genitourinary cancers. You have clinical research, radiation therapy. There's a whole host of things that a urology practice can appropriately kind of integrate within the practice. And that's an opportunity for care, you know, better care, but also ways to save money for the health care system, keeping some things out of a hospital when appropriate. There's just a lot of opportunity in urology practices that make it really interesting and something that an investor can look at and think they can really help to support through growth capital.
[05:31]
A
Fascinating. And at one point there's been all these different waves in urology. There was at one point urologists made a lot of money through withotripsy, lupron, other areas, now there's some movement into radiation therapy and linear accelerators. Are there specific areas that are the hottest in urology where, where it's most profitable for practices today?
[05:55]
B
Yeah, you're right. A lot of the oncology treatments is a big focus. But I think the clinical research and that independent pharmacy dispensing opportunities within the practice, those are things that that IODP that a lot of practices look at as opportunities to both bring revenue into the practice, but also increase accessibility for the patient, those are, have gotten a lot of attention. And this is all in the overlay of a staggering number of genitourinary cancers diagnosed every year. It's like 500 cases every year. It's a staggering amount. All with an aging population where you have some estimates and I see lots of different numbers, but some estimates saying, you know, 10,000 people turning 65 every day in the United States. Of course not all of those would receive urological care, but it all is the overlay within urology. And you have some really, really large single specialty groups, including some that have been supported by private equity MSOs like United Urology, formed by Audac, sold recently to One Oncology. But then you also have it sometimes as part of a multi specialty platform, so integrated oncology that the larger oncology network with all different sorts of cancer therapists in there also having urology as part of that platform. So it's been kind of an interesting way to see different builds and growth in urology.
[07:47]
A
Fascinating. Amber, a lot of time on urology today and it's fascinating the connection to oncology. Are there any other specialties that you're seeing some activity in more than other specialties?
[08:01]
B
We are still seeing some of the classic ones. Like there are several orthopedic deals that have been announced in the past couple of months that also came out of Q2. Some women's health there have been a little bit less in the purely electives. I think that's where people have a little bit more caution that there's going to be some economic impact. So a little bit less in cosmetics and some of the derm practices, but you still see some interest in those areas too. So I don't think anything is really off the table. It's just a period of time when there's more discernment is what I would say.
[08:47]
A
No, I think that's a great way to look at it. Amber, again, thank you so much for joining us today on the Becker Private Equity the Becker Business podcast. Always a wealth of information and it precise period of time. You're literally fantastic. Thank you so much for joining us.
[09:01]
B
Thank you, Scott.