As the Physician Medical Group (PMG) market evolves, geography remains a key factor influencing deal activity across the United States. While much of the focus in healthcare M&A tends to center around active specialties or prolific buyers, geography also offers insights into a deeper understanding of the market.
There are several questions that come up when thinking about the importance of geography in terms of the M&A market. What states have seen the most activity? Do the most active states differ based on specialty? And how do regulations impact activity in each state?
According to data captured in the LevinPro HC database, since the start of 2024, there have been 627 PMG transactions reported in the United States. Since the start of 2025, there have been 192 PMG deals.
Dental practices have been the top physician specialty targeted by investors and dealmakers, with 316 transactions on the books in the past 18 months, followed by internal medicine at 42 deals.
In this article, we’re examining some of the most active states and markets for investments in the physician space, exploring the unique dynamics shaping dealmaking. The article also explores certain challenges each state presents for investors.
FLORIDA
In the past 18 months, activity has been strongest in the Florida market, with 82 deal announcements, driven by a demographic shift over the past few years. Not only is the state seeing a significant surge in population growth, but an estimated 22% of Florida residents are 65 and over, promising constant utilization for providers.
Additionally, Medicare Advantage (MA) enrollment is high in Florida, which has a two-fold effect. Larger physician groups are better equipped to manage the demands associated with MA patients, due to the increased access to administrative resources. As a result, independent physician practices often face operational disadvantages, giving them strong motivation to sell and align with a larger organization. And these larger physician groups that manage MA populations under value-based care models are especially attractive to investors due to their potential higher revenue streams.
Furthermore, in 2019, Florida scaled back large portions of its Certificate of Need (CON) program, specifically for specialty hospitals, according to a 2021 article written by Arnall Golden & Gregory, LLC. With looser CON laws in place, there is an increase in the ability to buy medical practices, further drawing investors into the state.
Of the 82 deals announced in Florida, 39 of them have been in the dental specialty with buyers such as Heartland Dental (eight deals) and Parkview Dental Partners (three deals). Eye care had nine transactions with Eye Health America (three deals) and Florida Eye Specialists (two deals). Orthopaedic was also active with six transactions. Cardiology and dermatology also had four acquisitions each.
One of the biggest deals in Florida was Eye Health America’s, founded by LLR Partners, Clemson Eye and The Eye Associates, purchase of Quigley Eye Specialists in February 2025, adding 20 physicians to its network. Quigley Eye Specialists, based in Bonita Springs, Florida provides a full range of ophthalmology and optometry services across southwest Florida. The practice was founded in 1988 and has 10 locations in Florida.
CALIFORNIA
The state with the second-highest activity since January 1, 2024, is California, with 62 PMG transactions. While California is the most populated state (it has an estimated 39.5 million people, as of May 2025), it recently went through a period of population decline due to high mortality rates from COVID-19, a slowdown of international migration, and high cost of living, which caused people to move out. Despite this, California still has a large senior population that needs medical care.
In addition, a bill was reintroduced in February 2025 to strengthen the Corporate Practice of Medicine (CPOM) doctrine in California. CPOM prevents corporations and other non-physicians from owning or controlling medical practices.
Private equity groups and their portfolio companies accounted for nearly 55% (34 deals) of the transactions in the state for just the last 18 months. There were 26 deals done by independently owned dental offices, including dental services organizations. There were two health system deals; the buyers were Montage Health and Cedars-Sinai Health System. If this bill does go into effect, one can only wonder how PMG activity in the state will be impacted. It’s likely that activity will slow down significantly, or we will see various investors move into the market.
Dental was the most active specialty in California (35 transactions) over the last 18 months, with buyers such as MB2 Dental Solutions (nine deals), U.S. Oral Surgery Management (six deals) and Silver Creek Dental Partners (five deals). Dermatology practices were targeted in seven deals, including four announced by Golden State Dermatology. PhyNet Dermatology LLC also reported two acquisitions in California. There were also three transactions each for eye care and plastic surgery groups.
Over the last 18 months, only one PMG transaction was announced in California that had a disclosed price. That deal was Cardinal Health. Inc’s acquisition of Integrated Oncology Network LLC (ION) for $1.1 billion. Cardinal Health is a multinational healthcare services company that provides pharmaceutical and medical products and services in the United States and worldwide. ION is a radiation oncology management and cancer center development company that partners with hospitals and physicians. It has operations in more than 30 countries and approximately 48,000 employees globally. ION includes more than 50 practice sites in 10 states, representing more than 100 providers.
TEXAS
Texas was the third most active state for PMG deals, totaling 46 acquisitions from the last 18 months. This is driven, once again, by a surge in population growth but also strong economic opportunities and low cost of living incentivizing people to live in the state.
But also, in contrast to California, Texas is much more business-friendly when it comes to regulations, incentivizing investors to push in. While Texas does have CPOM, there are several exceptions that allow corporations to buy in the state. For example, if a company partners with a physician or management services group, it can buy physician practices in Texas. Additionally, Texas has no ban on corporate practices of medicine, meaning private equity and other corporations can directly employ physicians or medical practices.
Texas’ willingness to work with companies in the medical field can be directly seen in its statistics. Out of the 46 PMG deals in the last 18 months, 30 of them were completed by private equity firms and/or their portfolio companies. The rest are independently owned practices. No health systems have announced PMG purchases in Texas since before January 1, 2024.
There were 22 dental transactions reported in Texas, led by MB2 Dental Solutions (four deals), Specialized Dental Partners (five deals) and Straine Dental Management (two deals). There were four dermatology transactions with DermCare Management, LLC, accounting for three of the deals and Epiphany Dermatology with one. There were three eye care and three management service organization transactions.
The largest deal in Texas by purchase price was Cencora, Inc.‘s $4.6 billion acquisition of Retina Consultants of America (RCA). Cencora, formerly known as AmerisourceBergen, is a drug wholesale company and a contract research organization that was formed by the merger of Bergen Brunswig and AmeriSource in 2001. RCA is a specialty platform created by the acquisition and merger of Retina Consultants of Houston, Retina Group of Florida, Long Island Vitreoretinal Consultants and Retinal Consultants (Northern California). It has more than 50 physicians on staff, at time of closing.
The target with the most physicians on staff was Urology America, which GI Alliance purchased in April 2025. Urology America, based in Austin, has more than 50 physicians on staff. It was acquired alongside Potomac Urology Center, based out of five locations in Washington, D.C., with 11 physicians on staff.
NEW YORK
The final state to highlight is New York with 38 PMG transactions. Like the other states, New York has a large population, but it also has multiple large healthcare systems (NYU Langone, Mount Sinai Health System and Northwell Health, for example) that draw in healthcare professionals. With multiple large health systems, New York can provide care in a variety of specialties that other states may not be able to. It should be noted that while many of the New York deals occur around the New York City metropolitan area, the rest of the state is not lacking deals.
Additionally, New York enforces CPOM rules alongside the federal Stark Law that prohibits physician self-referrals. However, investors can operate through management service organizations (if structured properly to comply with both federal and state regulations). At the start of 2025, New York introduced a review mechanism that requires public disclosure of all private equity-backed healthcare acquisitions. This means investors will need to navigate public notice provisions in order to avoid additional regulatory scrutiny. With the tighter laws on purchasing medical practices in New York, investors may face a more difficult road ahead.
There were 19 dental transactions with buyers such as MB2 Dental Solutions (six deals) Dental365 (three deals) and Northwell Health (one deal). Eye care reported six acquisitions with Cayagua Health (which was created by the merging of two independent hospitals: Cayuga Medical Center in Ithaca and Schuyler Hospital in Montour Falls) reported one deal. Orthopaedic saw three reported deals. The active buyers were Northwell Health, NYU Langone Health and Fulton-Montgomery Medical who announced one deal each. Other active specialties in New York include gastroenterology (one deal), internal medicine (two deals), oncology (two deals) and OB/GYN (one deal).
OneOncology Inc. acquired New York Oncology Hematology (NYOH) in April 2025, marking the largest number of physicians on staff in a New York-based PMG group over the previous year and a half. A team of 33 oncologists ran NYOH at the time of closing.
OneOncology is a national network of independent community oncologists with more than 1,000 cancer care providers caring for approximately 615,000 patients at more than 339 sites nationwide. In April 2023, OneOncology was acquired by TPG Capital and Cencora from General Atlantic. In addition to its 33 oncologists, NYOH has 26 advanced practice providers on staff who operate out of eight locations in New York.
