For physician practices, uncertainty is not new. What is new is the scale and velocity of the forces currently reshaping the healthcare landscape and the degree to which those forces are political rather than purely economic or clinical. There was a time when strong operations, solid financials, and a good local reputation could largely insulate a group from external shocks. Today, however, even well-managed large practices find themselves navigating challenges like policy decisions, regulatory actions, and payer shifts that often originate far away from the communities they serve.
The physician leaders I've been speaking with describe this moment as one defined less by market cycles and more by policy cycles. These groups are not scrambling or failing; they are stable, often growing, and led by smart, engaged clinicians. But even they are facing questions without straightforward answers: What will reimbursement look like in two or three years? Will regulatory scrutiny make partnerships harder to complete? Will telehealth remain reliably reimbursable? What happens if Medicare Advantage rules continue to undergo substantial changes year after year? And how do you plan for all of this when the political climate seems to rewrite the script every year, or even every few months?
These aren't abstract concerns. They influence valuations, deal structures, staffing, technology investments, and even a practice's ability to remain independent. That's why the most critical strategic choice right now isn't whether to sell, partner, or stay the course. It's whether, and more importantly how, to prepare early enough to evaluate those paths from a position of strength.
The Political Landscape Is Redefining What Stability Means
One of the defining features of today's environment is the way political debates and regulatory decisions intersect with the core economics of physician practices. Reimbursement, staffing, compliance, contracting, and operational structure are all being influenced — sometimes subtly, sometimes dramatically — by decisions made at the federal and state levels.
Reimbursement is the most immediate example. Medicare cuts are no longer occasional policy adjustments; they have become a recurring pressure point that erodes margins and constrains investment. Practices with thin or uneven payer mixes feel this most acutely, but even large, multi-site groups experience the cumulative impact. The uncertainty around value-based care only amplifies this issue. Different payers are taking different approaches, and the required administrative lift varies widely. Practices are being asked to build infrastructure for models whose long-term reimbursement pathways remain unclear.
Administrative burden reflects a similar dynamic. Every year, prior authorization is cited as a top frustration for physicians. Both major political parties agree that the system needs reform, yet real progress has been slow. Meanwhile, federal oversight of Medicare Advantage has pushed insurers to impose tighter documentation standards and more conservative approvals. Practices now experience a form of administrative volatility driven as much by policy pressure on insurers as by internal utilization management decisions.
Regulatory scrutiny of consolidation is another major force. The FTC and DOJ have made it clear that they intend to examine healthcare mergers and acquisitions (M&A) more aggressively, including those involving private equity and physician roll-ups. This affects how buyers structure deals, how they evaluate potential partners, and how quickly they are willing to move. It also affects sellers, who now need to demonstrate operational integrity, compliance readiness, and strategic fit in far more detail than in previous years.
Contracting dynamics are shifting as well. Insurers are adapting to political debates around Medicare Advantage audits, Medicaid funding, and Affordable Care Act subsidies. These issues shape payer behavior, often in ways that create new constraints for practices. Contract terms may shift in response to insurers managing their own exposure, leaving practices with even less leverage and even more uncertainty.
The workforce crisis has become political too. Physician shortages are deepened by visa delays, creating gaps in services that practices cannot easily fill. States are expanding scope-of-practice authority for non-physician providers at different rates depending on the political climate. Rising wages and staffing turnover continue to drive up operating costs. Practices are left planning not just for how to attract and retain talent, but how to adapt when the talent simply isn't available.
Transparency and reporting rules introduce another layer of complexity. Federal mandates have pushed hospitals and insurers to publish detailed pricing information. Even when such rules are not aimed directly at physician groups, the ripple effects often reach them. Technology upgrades become necessary. Contract negotiations take on new dimensions. Multi-site groups operating across state lines face inconsistent enforcement, which complicates compliance planning.
Telehealth's future is similarly cloudy. The pandemic expanded virtual care rapidly, but many of the waivers that supported that growth were temporary. States and federal agencies are still debating long-term licensing rules, HIPAA compliance standards, and reimbursement parity. Practices that built integrated hybrid models now find themselves unsure whether those investments will continue to pay off. Tightening telehealth reimbursement and regulation could push more care back into the exam room, but do practices have the staffing to handle that influx?
And hovering over all these individual issues is the broader debate about the future of American healthcare itself. Renewed discussions around Medicare for All on one side and proposals to strengthen the private market on the other may sound like opposite visions, but both ultimately point toward the same pressure point: lower reimbursement for providers. Public-option models, cost-control strategies, and increasing scrutiny of the role of private capital shape market expectations long before any bill becomes law. Even when reforms stall, the political signaling alone influences how insurers, investors, regulators, and large health systems behave — often in ways that tighten margins and shift risk downstream to physician practices.
It's no exaggeration: policy forces have become a primary driver of practice stability. And that means strategic decisions made without expert guidance carry more risk than ever.
Why Going It Alone Has Become Too Risky
Not too long ago, a well-run practice could weigh its strategic options with a fairly simple framework. Today, the variables involved in selling, partnering, or expanding have multiplied. It's clear that timing matters more. Preparation matters more. The ability to interpret regulatory signals matters more. And the cost of missteps — entering a deal without adequate readiness, choosing the wrong partner, misjudging valuation, or misunderstanding compliance requirements — is significantly higher. The risk isn't just in making a bad decision. The real danger is losing access to the best decisions because preparation was late, insufficient, or incomplete.
I've seen how practices that navigate this environment without experienced M&A advisory support often underestimate how political shifts influence buyer behavior. They may not understand how a payer trend in their state affects valuation. They may not recognize red flags in a letter of intent or governance structure. They may have gaps in financial reporting or compliance documentation that could have been addressed earlier with the right guidance. They may rely on outdated benchmarks or incomplete assumptions about how the market views their specialty.
In this environment, even small miscalculations can cost a practice leverage that is difficult, if not impossible, to regain. It's an outcome I hate to see, especially when it could have been prevented.
Evaluating Strategic Paths
Despite the volatility, large physician groups still have meaningful strategic options. The key is evaluating them with full awareness of the broader landscape.
Consolidating or joining an MSO
For many practices, scale offers protection. Joining a larger group or affiliating with a management services organization (MSO) can provide stability through shared infrastructure, greater negotiating power, improved technology access, and operational support. In a political environment where compliance expectations are rising and payer dynamics are shifting, these advantages can be significant.
But consolidation works only when there is genuine alignment. Governance structures, compensation models, expectations around autonomy, and cultural fit all matter. A practice that consolidates without fully understanding these dynamics may find that it traded one form of uncertainty for another. This is where advisory guidance becomes essential, not only to assess the opportunity, but to negotiate terms that protect the practice's long-term mission and viability.
Recapitalizing or bringing in a strategic partner
For growth-minded physician groups, capital can open doors to expansion, modernization, and diversification. Strategic partners can help a practice invest in ancillary services, technology, and physical infrastructure that might otherwise be out of reach.
However, in today's environment, the structure of these deals requires careful scrutiny. Federal and state attention on private equity means buyers are more cautious, diligence is more rigorous, and the terms of control and governance vary widely. Practices need a clear understanding of what they are giving up, what they are gaining, and how the deal positions them for future regulatory shifts. Experienced M&A advisory support helps ensure that the partnership strengthens the practice rather than constraining it.
Staying independent, intentionally (at least for now)
For groups with healthy balance sheets and strong operations, staying independent remains a valid and sometimes optimal path. Independence tends to offer agility and the ability to make fast, local decisions. But it shouldn't mean inaction. This is the time to streamline processes, strengthen leadership depth, invest in technology, and monitor market trends closely.
A well-prepared independent practice can move quickly — and more importantly, intelligently — when the right opportunity arises, whether that means joining a platform, bringing in a partner, or expanding on its own terms. Independence works best when it's intentional, not reactive.
Common Thread: Knowledge and Preparation
Across all these paths, one theme is consistent: knowledge and preparation translate to leverage. The practices that begin understanding and evaluating their options early — long before pressure forces a decision — are the ones best positioned to capitalize on opportunities and avoid missteps.
Preparation means learning about your value, knowing your numbers, documenting your strengths clearly, identifying risks before a buyer does, and aligning leadership around the long-term vision. It means anticipating how political and regulatory shifts may affect your specialty or your region. And it means receiving guidance from professionals who understand the market, the policy climate, and the nuances of healthcare transactions.
Waiting for clarity is no longer a viable strategy. The environment is too volatile, and the implications of late preparation are too significant. But unpreparedness is still a choice — and one that practices can avoid.
At VERTESS, we emphasize education and readiness. When a practice has a firm grasp of its growth story and the nuances of deal structure, it gains better control over its future. Even if the decision is to stay independent, the exercise of preparing for a transaction builds internal discipline and strategic clarity that benefits the organization immediately.
What You Do Today Defines Your Options for Tomorrow
The forces shaping healthcare — including policy, payment, technology, and the workforce — will continue to evolve faster than most can predict. The medical practices that we have seen succeed through periods of change are the ones that invest in evaluating their options early. They have a clear view of their value, define their priorities, and surround themselves with experts, including a healthcare M&A advisor, who have guided and supported similar organizations through this same crossroads.
The steps you take now will determine which opportunities remain available down the road. Whether you ultimately decide to consolidate, partner, or remain independent, the key is to make that decision from a place of information, confidence, and readiness.
In a market where change is constant, preparation is the most powerful form of stability.
If your practice is beginning to explore its options, having an experienced advisor can make all the difference. VERTESS works exclusively with healthcare organizations, helping physician leaders understand their value, strengthen their position, and connect with the right strategic or financial partners. Whether your goal is to sell, bring in capital, or simply prepare for the future, we're ready to help you navigate the process.