Trends in Physician Practice Management and Urology Investments with Amber Walsh of McGuireWoods LLP 8-28-25

Summary

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Becker Private Equity & Business Podcast

Episode: Trends in Physician Practice Management and Urology Investments

Date: August 28, 2025
Host: Scott Becker
Guest: Amber Walsh, Executive Committee Member, McGuireWoods LLP

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Episode Overview

This episode explores current trends in physician practice management (PPM), with a particular focus on private equity investments in urology practices. Host Scott Becker speaks with Amber Walsh, who provides insights into the state of PPM deals, the unique characteristics that make urology a resilient and attractive specialty for investors, current "hot" areas within urology, and other specialties seeing activity. The discussion touches on market caution due to economic and regulatory factors, as well as the evolution of practice integration and ancillary revenue streams.

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Key Discussion Points & Insights

1. Market Trends in Physician Practice Management

• Increased Caution in Deal-Making (00:33):
  Amber observes that over the last 18 months there’s been “more intensive regulatory scrutiny” and a “deeper dive into really the most attractive investment opportunities.”
• Impact of Economic Climate (01:10):
  The boom years of 2020–2022 have given way to a market environment marked by caution from both “private equity investors and debt investors.”
• Q2 2025 Data (01:52):
  • Deals are ongoing, but there are “fewer” and they “take a little bit longer to get done.”
  • Primary drivers: “state level transactional review processes” and “economic uncertainty.”
• Consistency of Trend (02:16):
  The careful approach has been a “pretty consistent theme over the past 18 months, possibly even as long as two years.”

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2. Why Urology Remains Resilient

• Resilience and Recession Resistance (02:55):
  Urology is described as “a little bit more recession proof than some other specialties,” with most procedures being “long established” and often not elective.

• Diverse Revenue Streams (03:28):

  • Ancillary services within urology practices: “ASC investments, pathology, independent pharmacy dispensing, infusions, diagnostics, genitourinary cancer treatments, clinical research, and radiation therapy.”
  • These integrations offer “opportunity for care, better care, but also ways to save money for the health care system.”

• Investment Rationale (04:55):
  Urology practices present “a lot of opportunity” and can be supported “through growth capital” by investors.

  Quote:
  “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.”
  — Amber Walsh [04:55]

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3. Hot Investment Areas Within Urology

• Oncology and Ancillary Revenue (05:55):

  • Oncology treatments, clinical research, and in-house pharmacy dispensing are areas of high focus.
  • Quoting Amber:
    “Clinical research and that independent pharmacy dispensing… both bring revenue into the practice, but also increase accessibility for the patient.”
    — [05:59]

• Market Drivers (06:20):

  • “Staggering number” of genitourinary cancer diagnoses each year is a major market driver.
  • Demographics: An aging population, with “10,000 people turning 65 every day in the United States.”

• Structures and Scale (06:53):

  • Presence of large specialty groups (e.g., United Urology) and the role of private equity MSOs.
  • Integration into multi-specialty oncology platforms.

  Quote:
  “It’s been kind of an interesting way to see different builds and growth in urology.”
  — Amber Walsh [07:41]

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4. Other Active Specialties

• Orthopedics and Women’s Health (08:00):
  Several orthopedic deals and some women’s health transactions announced in Q2.
• Elective/Cosmetic Caution (08:12):
  Less activity in “purely electives” such as cosmetics and some dermatology practices, reflecting economic caution.
• General Outlook (08:28):
  “You still see some interest in those areas too. So I don’t think anything is really off the table. It’s just… there’s more discernment.”

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Notable Quotes & Memorable Moments

On deal caution and regulatory scrutiny:

“…much more kind of deep diving into really the most attractive investment opportunities. There’s been 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 [00:42]

On urology’s resilience:

“Generally speaking, most of the procedures are long established…not considered to be elective or even things that can really be put off. And there’s a lot of ancillary services that are natural extensions of the physician’s own personal services.”
— Amber Walsh [03:10]

On areas of profitability:

“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…a lot of practices look at as opportunities to both bring revenue into the practice, but also increase accessibility for the patient.”
— Amber Walsh [05:56]

On discernment in specialty investments:

“It’s just a period of time when there’s more discernment is what I would say.”
— Amber Walsh [08:39]

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Important Timestamps

• 00:33 — Amber Walsh on increased regulatory scrutiny and overall caution in PPM.
• 02:55 — Why urology remains resilient and attractive for investors.
• 05:55 — “Hottest” areas in urology: oncology, clinical research, independent pharmacy.
• 08:00 — Other specialties seeing investment: orthopedics, women’s health.
• 08:39 — Current climate: “more discernment” rather than blanket enthusiasm.

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Summary

This episode delivers a timely, expert overview of physician practice management trends, placing a spotlight on urology as a specialty with unique resilience and multiple integrated revenue opportunities. Amber Walsh details the shift toward heightened caution and regulatory review, the diversification within urology practices, and what makes certain ancillary services especially attractive. Listeners gain insights into the broader deal environment, as well as where private equity is focusing attention within and beyond urology today.

Transcript

[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?

[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.

[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?

[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.

[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?

[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.

[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?

[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.

[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.

[B]

Thank you, Scott.