Some anesthesia groups that sold to private equity-backed national platforms are reversing course and buying their practices back and reforming as independent groups.
Stan Morton, CEO of Copractica, a Dallas-based clinically integrated network for independent anesthesia practices, told Becker’s how one member group sold to a large national group six or seven years ago, then bought itself back out. The group did not want to rebuild the management infrastructure it had given up in the sale, Mr. Morton said, so it reformed inside Copractica’s CIN, which handles billing, payer contracting and back-office functions for its member practices.
“They’ve been able to get their independence, autonomy and control back,” he said. “And from a revenue standpoint, they have not had to take a pay cut to be able to go do that.”
The group has doubled in size in the past two-plus years, Mr. Morton said, and the health system it works with has identified it as a preferred partner for growth.
Anesthesia has been rapidly consolidating for years. A 2020 study published in JAMA Network found that roughly 20% of anesthesia practices had been acquired through PE physician practice buyouts. By 2024, that share had grown to approximately 33%, according to AMGA Consulting’s analysis.
“Private practice physicians are becoming more and more rare in American healthcare. This is by design and is not random,” Kenneth Candido, MD, CEO and president of Chicago Anesthesia Associates, told Becker’s in 2024. “Large systems are siphoning off private practice physicians and are buying or consolidating practices exponentially. Those who hold out find a shrinking referral base, as those formerly loyal to them are being compelled to exclusively refer within the system. It is a dirty business and a dirty, underhanded game that administrators are playing to monopolize their business models.”
Only 44% of physicians owned their practice as of 2022, according to an American Medical Association report, compared with 76% in the early 1980s. The report cited regulatory and administrative burdens and economic pressures that have forced physicians to shift to hospital and health system settings.
However, Copractica executives are seeing a trend of sellers from the 2015-2019 consolidation wave now past their initial contract terms and weighing whether the trade, infrastructure and scale in exchange for autonomy and a slice of collections still makes sense.
According to Erik Hemingway, CFO of Copractica, the private equity model carries a structural cost independent groups avoid. He said with Copractica, “there’s no Wall Street payment off the top” and no “unnecessary cost layer.”
Regaining independence, however, does not erase the market pressures that drove the original sale. Small practices still struggle to gain leverage with payers and face rising subsidy demands.
The share of ASCs expecting to pay anesthesia stipends, for example, jumped from 28% in 2024 to 44% in 2025, according to a VMG Health report, a 57% increase. Additionally, 67% of ASC leaders ranked anesthesia coverage among their top three financial challenges for 2026, making it the most commonly cited operational concern heading into the year.
Using a shared CIN rather than operating as a full standalone operation allows practices to regain clinical and financial control while keeping access to shared contracting and revenue cycle infrastructure.
“There’s nothing more unnerving than feeling like your back’s against the wall, and having to choose between two options you don’t like,” Mr. Morton said.
There are still roadblocks for many anesthesia physicians looking to buy back their practices. Many healthcare M&A attorneys say those transactions are typically governed by the equity and employment agreements physicians signed when they sold to a platform. In a March 2026 analysis, attorneys at Nixon Peabody said those agreements commonly give the company the right to repurchase a departing physician’s equity, often distinguish between “good leaver” and “bad leaver” departures that affect the repurchase price, and may require physicians to sell their remaining equity if the platform itself is sold.
The firm also noted that physicians who regain independence frequently remain subject to restrictive covenants, including noncompete provisions, and that buyout terms are largely dictated by the contractual framework negotiated at the original sale rather than the valuation at the time of departure.
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