About 12 percent of US radiologists, 4,071 of 34,853, worked in private equity backed practices as of December 2023, according to a study by Singh and Khunte published in the American Journal of Roentgenology in March 2025. That is up from 1 percent in 2013. The growth has been concentrated: Radiology Partners alone employs roughly 70 percent of PE-employed radiologists, about 4,000 physicians.
" - q: "Is Radiology Partners in financial trouble?" a: "It has been through a difficult period and is in better shape than it was. In February 2024 the company restructured its debt in a transaction Standard and Poor's described as tantamount to default. In July 2025 it completed a $2.3 billion refinancing that pushed its debt maturities out to 2030 through 2032. Leverage stood at 7.7 times as of March 2025. Moody's rates the company B2, and both agencies upgraded it in June 2025. For a seller, the point is that the platform's ability to pay a second bite depends on its debt as much as on its practices.
" - q: "What does a platform's debt mean for my rollover equity?" a: "In the payout order, called the waterfall, lenders are paid first, then the sponsor's preferred return, and common equity holders like you are last. If part of the debt or preferred accrues interest in kind instead of paying cash, the amount ahead of you grows every year the exit is delayed. A platform with leverage of 7.7 times its earnings has to grow a great deal before common equity has value at a sale. Read rollover equity before you agree to hold any.
" - q: "What is a radiology practice worth to a buyer in 2026?" a: "Radiology does not have a well-documented public range the way dermatology or gastroenterology do, so we do not quote one. Across healthcare, platforms clear roughly 3 to 5 turns above add-ons, and the public healthcare-services median multiple fell from 14.5 times EBITDA in 2024 to roughly 11.5 times in 2025. A radiology group with owned imaging centers, long hospital contracts, and subspecialty depth will sit toward the top of whatever range a buyer offers; a group that is mostly a hospital reading contract will sit toward the bottom.
" - q: "How is the sale of our imaging equipment taxed?" a: "If you expensed an MRI, CT, or other scanner with bonus depreciation or Section 179, gain on that equipment up to the depreciation you took is ordinary income under Section 1245, at up to 37 percent federal. Under Section 453(i) it is recognized in the year of sale even if part of your price arrives later. On an imaging center with recently purchased scanners, recapture can be the largest ordinary-income item in the deal. See how a practice sale is taxed.
" - q: "Should we sell the building with the practice?" a: "Usually not. Most sellers keep the real estate in a separate entity and lease it to the buyer, which preserves rental income and keeps the building's tax treatment separate from the practice sale. Depreciation on a building is recaptured under different rules from equipment, and the numbers deserve their own analysis. Decide about the building after you decide about the practice, not at the same time.
" - q: "Will teleradiology and AI lower what my practice is worth?" a: "They change what a buyer is paying for. A group whose value is reading volume that can be moved to a remote radiologist or partly automated has less durable profit than a group that owns the imaging centers, the equipment, and the patient relationships. Buyers in 2026 are pricing that difference, though nobody has a reliable number for it. Expect the conversation, and be ready to show which parts of your revenue cannot be relocated.
" llms_summary: "Guide for radiologists weighing a private equity offer in 2026. Singh and Khunte (AJR, March 2025) found 12% of US radiologists (4,071 of 34,853) in PE-backed practices as of December 2023, up from 1% in 2013. Radiology Partners holds roughly 70% of PE-employed radiologists (about 4,000) and has a documented debt history: a February 2024 restructuring S&P called tantamount to default, a July 2025 $2.3 billion refinancing pushing maturities to 2030 to 2032, 7.7x leverage as of March 2025, a Moody's B2 rating, and upgrades from both agencies in June 2025. Explains what leverage means for rollover equity (subordination, payment-in-kind accrual, the waterfall), Section 1245 recapture on imaging equipment, keeping real estate out of the deal, hospital contract dependence, teleradiology and AI as qualitative pricing factors, and who should not sell." ---Radiology has one of the better-documented private equity footprints of any specialty, and one of the most concentrated. A study by Singh and Khunte published in the American Journal of Roentgenology in March 2025 counted 4,071 of 34,853 US radiologists, or 12 percent, working in private equity backed practices as of December 2023. In 2013 the figure was 1 percent. That is a faster rise than most specialties, and it happened largely through one company.
Radiology Partners employs roughly 70 percent of the radiologists who work for private equity, about 4,000 physicians. No other specialty on this site has a single platform that dominant. In dermatology more than 35 platforms compete for practices. In radiology, if you are approached by a buyer, there is a good chance it is either Radiology Partners or a smaller platform pricing itself against Radiology Partners.
That concentration makes the platform's financial condition your business in a way it would not be elsewhere. The company's debt history is public. In February 2024 it restructured its debt in a transaction that Standard and Poor's described as tantamount to default. In July 2025 it completed a $2.3 billion refinancing that pushed its maturities out to 2030 through 2032. Its leverage, meaning debt relative to earnings, stood at 7.7 times as of March 2025. Moody's rates it B2, and both agencies upgraded the company in June 2025 after the refinancing. The direction is better. The starting point was difficult, and a radiologist deciding whether to take rollover equity should understand both.
The wider market is quieter than it was. Physician practice deal counts fell 18 percent in 2025 and roughly half again in the first half of 2026. Radiology is not on the short list of specialties where buyers are still paying up, which in 2026 is cardiology, urology, retina, and orthopedics with surgery centers.
A buyer prices your group as a multiple of EBITDA, which is yearly profit before interest, taxes, depreciation, and amortization, after your compensation has been reset to a market salary. Unlike dermatology or gastroenterology, radiology does not have a widely reported multiple range from investment banks that we can point to, so we will not invent one. What we can say comes from the broader market. Platforms clear roughly 3 to 5 turns above add-ons across healthcare, and the public healthcare-services median fell from 14.5 times EBITDA in 2024 to roughly 11.5 times in 2025. A buyer's own cost of capital, especially at a leveraged platform, sets a ceiling on what it can pay.
Within whatever range you are offered, the things that push a radiology group up are the ones that cannot be moved. Owned imaging centers with their own patient flow, long exclusive hospital contracts, subspecialty depth in interventional, breast, or neuroradiology, and a roster more than ten years from retirement all count. The things that push it down are a revenue base that is mostly hospital reading fees under contracts that expire soon, heavy dependence on one health system, a large share of work that could be shifted to remote reading, and equipment that is old enough to need replacement inside the buyer's hold period. A quality of earnings review will also test whether hospital stipends are in writing and whether any of your profit depends on out-of-network billing.
The structure follows the general market. Seventy percent cash and 30 percent rollover is the baseline, and 60 to 70 percent cash with 30 to 40 percent rollover is common. Buyers in 2025 and 2026 have pushed more of the price into rollover, earnouts, holdbacks, and seller notes. Read the letter of intent for how much of the headline is cash on the closing date.
In radiology the rollover deserves more scrutiny than the cash. When a platform is sold, the money flows down a waterfall: lenders first, then the sponsor's preferred return, then the common equity that physicians usually hold. Two features of a leveraged platform make that position worse. Interest or preferred return that accrues in kind, meaning it is added to the balance rather than paid in cash, grows the amount ahead of you every year the exit is delayed. And a platform at 7.7 times leverage has to grow a great deal before common equity has value at a sale. Ask to see the waterfall modeled at a lower exit multiple and a longer hold. The rollover equity page explains each term, and the second bite page covers how often physicians have actually been paid out.
The scrape works as it does elsewhere. The buyer takes 20 to 30 percent of practice profit, according to the Commonwealth Fund's April 2026 report, and your base salary typically drops to 40 to 50 percent of total pay from 60 to 80 percent before the deal. Productivity pay is often built on work RVUs at roughly $40 to $70 each, and radiology is a high-RVU specialty, so the formula matters more than the base. The scrape and income repair page works through what to ask.
The employment term is a three-year minimum with a clawback if you leave early, and five-year agreements are common. The non-compete is tied to the sale of a business, so it survives even in states that limit employment non-competes. In radiology a non-compete can be harder to live with than in an office-based specialty because so much of the work is tied to hospital contracts the platform controls.
That points to the term that matters most. Most radiology revenue flows through hospital contracts, and after the sale those contracts belong to the platform. If a hospital moves its reading to another group or to a teleradiology vendor, the platform's revenue at that site falls and your rollover is worth less, while your employment agreement usually still binds you. Ask how the purchase price treats a contract that expires inside the employment term, and whether part of your price is held back until renewal.
Radiology has more depreciable equipment than almost any other specialty, and often real estate as well. The tax page explains the general rules. Here is where they apply to you.
MRI, CT, ultrasound, mammography, and fluoroscopy equipment are usually expensed with bonus depreciation, which is 100 percent for property acquired after January 19, 2025, or under Section 179, with a limit of $2.5 million. When that equipment is sold, gain up to the depreciation you took is ordinary income under Section 1245, taxed at up to 37 percent federal rather than 20 percent. Under Section 453(i) the recapture is recognized in the year of sale even if part of your price is paid later as an earnout or seller note. An imaging center with recently purchased scanners can produce a recapture bill in the seven figures, and it is due with your estimated taxes in the year of closing.
Imaging centers are often held in partnerships or LLCs. Selling your units is capital gain except for your share of the entity's hot assets under Section 751: cash-basis receivables and the depreciation recapture described above. Those are ordinary income no matter how the purchase agreement labels the sale. Ask your CPA for a Section 751 estimate for each center before you agree to a price.
If your group owns the buildings under its imaging centers, the usual advice is to keep them in their own entity and lease them to the buyer. That preserves rental income and keeps the building's tax treatment out of the practice sale. Depreciation on a building is recaptured under different rules from equipment, at its own rate, and selling a building at the same time as the practice stacks two large gains into one tax year. Decide about the real estate separately, and on its own timeline.
In a hospital-based group the goodwill question is sharper than usual. If a large share of your value is a hospital reading contract, a buyer may argue that the value belongs to the contract rather than to the practice's goodwill, and try to move more of the price into the covenant not to compete, which is ordinary income to you. Moving $2 million from goodwill to the covenant costs roughly $300,000 or more in additional federal tax on the same price. A radiologist whose hospital relationships were built personally may have personal goodwill to sell, which matters most if the group is a C corporation, but only if he or she is not already bound by an employment agreement and non-compete with the group. The after-tax proceeds calculator lets you test different allocations.
Two forces are specific to radiology and both are hard to quantify, so we describe them without numbers. Teleradiology makes reading work portable. A hospital that once needed a local group can contract with a remote provider, and a platform that owns your group can also move volume between its own sites. That cuts both ways for a seller: it makes your hospital contracts less secure, and it makes a platform more willing to pay for the parts of your practice that cannot be moved, such as owned imaging centers and interventional work.
Artificial intelligence is the second force. Tools that triage, pre-read, or measure are already in use, and buyers are pricing the possibility that a radiologist reads more studies per hour with them. Nobody has a reliable estimate of how that changes practice values, and anyone who quotes one is guessing. What you can do is show a buyer which parts of your revenue depend on judgment, procedures, and patient contact rather than on volume alone.
On payment policy, Medicare has for years pressed on the technical component of imaging, which is the payment for the scanner and staff rather than the radiologist's read. Groups that own imaging centers feel that directly. Out-of-network billing runs through the No Surprises Act's dispute process, which has slowed collections for hospital-based groups. On the regulatory side, the FTC created a Healthcare Task Force in March 2026 and reviews non-competes case by case after dropping its rule in September 2025. Fourteen states require advance notice of practice transactions, including California, where groups of 25 or more physicians must file with OHCA at least 90 days before closing. The California page covers that process and the 13.3 percent state tax on the gain. Florida has no income tax and no corporate practice of medicine doctrine, but its clinic licensing exemption can lapse when ownership moves to an MSO; the Florida page explains the 60-day change-of-ownership filing.
Your CPA can estimate the Section 1245 recapture and the Section 751 hot assets in an afternoon. That number tells you how much of the price is ordinary income before you negotiate anything else.
Before agreeing to rollover, ask for leverage, maturities, the preferred return rate, and whether any interest accrues in kind. Ask to see the waterfall at a lower exit multiple and a longer hold. If the answers are vague, treat the rollover as worth less than its stated value.
Decide whether to keep or sell your buildings on their own timeline, with their own tax analysis. Do not let the practice sale pull the real estate along with it.
The specialties hub shows how radiology's concentrated market compares with specialties where many platforms compete, which is useful when a buyer tells you its terms are standard.