Is gastroenterology the next darling of private equity? Large GI practice acquisitions exploded in 2019, tripling that of the prior three years. Expansion to new geographic areas doubled in each of the last three quarters of 2019. We see this activity accelerating in 2020 when a significant number of new private equity investors enter the market and physician sellers see high demand for their practices.

Private equity investment in ophthalmology practices has been one of the "hottest" sectors in M&A over the last several years. We believe the market will continue to be strong but our key indicators now signal a transition to Network Growth in 2020 – a more mature phase characterized by consistent add-on acquisitions. There are still open geographies with great opportunity, such as Texas and multiple areas on the West Coast. We project increased deal activity in these areas including large platform acquisitions.

Private equity investment in orthopedic practices is in the early pioneering stage. Twelve private equity firms have participated in major orthopedic and spine practice investments … 6 as LEAD investors and 6 as participating investors. We examine the six lead investors to understand their investment strategy, current geographic footprint, and growth prospects. We also discuss the five issues we believe will drive the future growth of private equity investment in orthopedics.