It is one of the few specialties where buyers are still paying strong prices, along with cardiology, retina, and orthopedics with surgery centers. The reason is the exit market: Cardinal Health and Cencora have paid billions for urology platforms in the past year, which gives sponsors confidence they can sell what they build. That confidence flows down to the price they will pay you, though a single practice still receives a far lower multiple than a platform.
" - q: "What is a single urology practice worth compared with a platform?" a: "Reported multiples are roughly 3.5 to 5 times EBITDA for a single practice, 9 to 12 times for a platform, and 12 to 15 times for a platform with surgery centers and oncology. The spread is the widest of any specialty we cover. It means the platform captures most of the value created by combining practices, which is the argument for taking rollover equity and also the reason to look hard at where that equity sits in the waterfall.
" - q: "Why are drug distributors like Cardinal Health and Cencora buying urology platforms?" a: "Urology practices buy and administer expensive drugs, especially for prostate cancer, and run radiation oncology and lab services. A distributor that owns the practice controls that drug volume. Solaris Health sold 75 percent to Cardinal Health for $1.9 billion in late 2025, and Cencora paid $4.6 billion for OneOncology, which had absorbed United Urology, in February 2026. These strategic buyers pay more than another private equity fund would, which is why platform multiples in urology are reported at 12 to 15 times.
" - q: "How is my share of the lithotripsy partnership or radiation center taxed when we sell?" a: "Most of these ancillaries are held in separate partnerships or LLCs. Selling your units is capital gain except for your share of what Section 751 calls hot assets: cash-basis receivables and depreciation recapture on the equipment inside. A lithotripter or a linear accelerator that was expensed with bonus depreciation produces ordinary income up to the amount you deducted, and under Section 453(i) that income is recognized in the year of sale even if you are paid over time. See how a practice sale is taxed.
" - q: "What percentage of urologists are already in private equity groups?" a: "We do not publish a number because the one that circulates comes from a sell-side tracker whose methodology is not clear. It suggests that a large share of urologists working in tracked platforms are under private equity or strategic ownership, but that is a share of a selected group, not of all urologists. What is clear is that the largest platforms have consolidated quickly and that independent groups are fewer each year.
" - q: "Will I keep my in-office dispensing and drug margin after the sale?" a: "The revenue stays with the practice, but the profit from it is part of what you sold. After closing, drug margin flows to the platform and you are paid under your employment agreement, typically a base salary plus a productivity formula. If a strategic buyer such as a distributor owns the platform, the drug supply relationship may also change. Ask how the productivity formula treats drug administration and whether any of that margin reaches physicians.
" - q: "Should I sell if I am the only urologist in my market?" a: "Be careful. A single practice is priced at the low end of the range, roughly 3.5 to 5 times EBITDA, and a buyer that adds you to a platform will hold you to a non-compete that covers your whole market. If your practice has real ancillaries, a buyer may pay more for them than the practice multiple suggests, but you should model staying independent against the offer over ten years, not three.
" llms_summary: "Guide for urologists considering a private equity offer in 2026. Urology remains an active specialty because strategic buyers have paid high prices for platforms: Solaris Health sold 75% to Cardinal Health for $1.9 billion (late 2025); United Urology joined OneOncology (2024), which Cencora bought for $4.6 billion (February 2026); US Urology Partners recapped to General Atlantic (April 2025); Urology America joined GI Alliance/Cardinal (April 2025). Reported multiples: roughly 3.5 to 5x EBITDA for a single practice, 9 to 12x for a platform, 12 to 15x with ASC and oncology. The share of urologists under PE is described qualitatively because the only figure comes from a tracker with unclear methodology. Covers ancillaries (lithotripsy, lab, pathology, radiation oncology, ASC), Section 1245 recapture and Section 751 hot assets, personal goodwill, self-referral rules, and who should not sell." ---Urology is one of the few physician specialties where private equity is still buying and, more important, still selling at high prices. The overall market for physician practice deals fell 18 percent in 2025 and roughly half again in the first half of 2026. Urology moved against that trend because the exit door is open. In late 2025 Solaris Health sold 75 percent of itself to Cardinal Health for $1.9 billion. United Urology had joined OneOncology in 2024, and in February 2026 Cencora bought OneOncology for $4.6 billion. US Urology Partners was recapitalized to General Atlantic in April 2025, and Urology America joined GI Alliance, itself majority owned by Cardinal Health, the same month.
Two of those four transactions were sales to strategic buyers, meaning drug distributors rather than other private equity funds. That pattern runs across gastroenterology, retina, and oncology as well, and it is the main reason urology multiples have held up while dermatology and dental multiples have softened. A sponsor that believes Cardinal or Cencora will pay 12 to 15 times EBITDA for a finished platform can afford to pay more for the practices it assembles into one.
How much of urology is already consolidated is harder to say. A figure that circulates in sell-side reports suggests that a large share of the urologists working in tracked platforms are under private equity or strategic ownership. We do not repeat the number because the tracker's methodology is unclear and it measures a selected group rather than all urologists. What is clear from the deal list is that the large regional groups have mostly chosen a side, and the remaining independent groups tend to be smaller.
A buyer values your group as a multiple of EBITDA, the practice's yearly profit before interest, taxes, depreciation, and amortization, after your pay has been restated to a market salary. Reported ranges in urology are wide, wider than in any other specialty on this site.
| Type of deal | Reported multiple range | What it usually looks like |
|---|---|---|
| Single practice (add-on) | Roughly 3.5 to 5x | One to a handful of urologists, limited ancillaries, joining an existing platform |
| Platform | Roughly 9 to 12x | Regional group with lab, pathology, lithotripsy, and a management team |
| Platform with ASC and oncology | Roughly 12 to 15x | Adds surgery centers and radiation oncology; the profile strategic buyers have paid for |
The spread between a single practice at roughly 3.5 to 5 times and a finished platform at 12 to 15 times is the argument the buyer will make for rollover equity: you sell at the low multiple, but your rolled shares participate at the high one. That argument is real. It is also incomplete, because your rollover sits behind the lenders and the sponsor's preferred return, and because the second sale has to happen for you to see it. The second bite page covers how often it has.
What raises a urology group's multiple is ancillaries. Lithotripsy, a clinical lab, in-house pathology, radiation oncology, in-office dispensing, and an ASC each add profit that does not depend on a urologist's hands, and buyers pay more for profit that survives a partner's retirement. Sub-specialty depth in oncology, a roster more than ten years from retirement, and clean numbers that survive a quality of earnings review also help. What lowers it: a group that is mostly professional fees, heavy reliance on one hospital for OR time, ancillary arrangements that may not fit the self-referral exceptions after a change in ownership, and partners who plan to leave inside the employment term.
The structure follows the general market. Seventy percent cash and 30 percent rollover is the textbook 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, so read the letter of intent for how much of the headline number is cash on the closing date. The rollover equity page explains what the rolled portion is and how the waterfall works.
The scrape is 20 to 30 percent of practice profit, according to the Commonwealth Fund's April 2026 report. Your base salary typically falls to 40 to 50 percent of your total compensation from 60 to 80 percent before the deal, with the rest paid on productivity at roughly $40 to $70 per work RVU. In urology the productivity formula deserves extra attention because so much of your pre-sale income was not RVU-based at all. Lithotripsy distributions, lab and pathology profit, radiation oncology technical fees, and drug margin were partnership or practice income, and after closing they belong to the platform. Whether any of that reaches you depends on the formula. The scrape and income repair page works through what to ask.
Employment agreements are a three-year minimum with a clawback of part of your cash if you leave early, and five-year terms are common. The non-compete is tied to the sale of a business, so it survives even in states that restrict employment non-competes. In a specialty where a single group may cover an entire metro area, that covenant can mean leaving the region if you leave the platform.
Hospital relationships matter more in urology than in dermatology. Many groups depend on a hospital for operating room time and robot access, and some hold call coverage or co-management agreements. Those contracts belong to the platform after closing. Ask how the price treats a contract that expires inside your employment term.
Urology has more moving parts in its tax picture than almost any other specialty because the ancillaries that drive the price are usually held in separate entities with expensive equipment inside them. The tax page explains the general rules. Here is where they bite in urology.
A lithotripter, a linear accelerator, lab analyzers, and pathology equipment are often expensed with bonus depreciation, which is 100 percent for property acquired after January 19, 2025, or under Section 179, with a $2.5 million limit. When the entity holding that equipment is sold, gain up to the depreciation you took is ordinary income under Section 1245, taxed at up to 37 percent federal. Under Section 453(i) that recapture is recognized in the year of sale even if part of the price is paid later. A radiation oncology center with a recently purchased accelerator can produce a recapture bill that surprises a seller who expected capital gain on everything.
Most of these ancillaries are owned through 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 regardless of how the purchase agreement labels the sale. Because each ancillary entity may have its own depreciation history and receivables, ask your CPA for a Section 751 estimate for each one before you agree to a price.
The same Section 751 analysis applies to ASC units. The buyer typically wants the ASC inside the deal because it is part of the profit being purchased and because the strategic buyers who pay 12 to 15 times want it there.
Drugs you hold for in-office dispensing or infusion are inventory, Class IV on Form 8594, and produce ordinary income when sold. In a group with a large oncology practice this line can be meaningful.
A urologist whose referral base rests on his or her own reputation may be able to sell personal goodwill directly, which is capital gain and, for a C corporation, avoids a second layer of tax. It requires that you not already be bound by an employment agreement and non-compete with your own practice. Watch the covenant allocation as well. Moving $2 million from goodwill to the non-compete costs roughly $300,000 or more in additional federal tax on the same price. The after-tax proceeds calculator lets you test allocations before the lawyers do.
The ancillaries that make urology valuable also make it exposed. In-office lab, pathology, imaging, and radiation oncology all rely on exceptions to the federal self-referral rules, and a change in who owns the practice and who employs the physicians can change whether the arrangement still fits. Health care counsel should confirm each arrangement survives the new structure before closing. A buyer's lawyers will do this for the buyer; you need someone doing it for you.
Medicare payment policy has been pushing procedures from hospitals to surgery centers and pressing on the technical component of in-office services. The direction favors groups that own the site of service and works against groups that only bill the professional fee. Drug reimbursement for the prostate cancer therapies that urology practices administer is set by federal formulas that change year to year, and the distributor-owned platforms are buying in part to manage that exposure. None of this is unique to a private equity sale, but a buyer will build it into the price and you should understand how.
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. New York requires 30 days' written notice to the Department of Health for material transactions, and the New York page explains how a deemed asset sale of a New York practice stays taxable in New York even for a seller who has moved. Florida has no income tax and no corporate practice of medicine rule, but a practice's exemption from clinic licensing can lapse when ownership moves to an MSO. The Florida page covers the 60-day change-of-ownership filing.
For every lithotripsy partnership, lab, pathology entity, radiation center, and ASC, list the depreciation taken, the receivables on hand, and your ownership share. That gives your CPA what is needed for a Section 751 estimate, and it tells you how much of the price will be ordinary income.
Ask, in writing, whether each in-office ancillary continues to fit its self-referral exception under the proposed structure. Do this before exclusivity begins, while you can still walk away.
Use the calculator for the after-tax cash, then compare it with ten years of your current ancillary income and professional fees. In urology this comparison is closer than the headline multiple suggests.
The specialties hub shows how urology terms compare with gastroenterology and ophthalmology, the two other specialties where strategic buyers have set the price.