---
title: "A partnership track, a buy-in, or a practice sale"
canonical: "https://www.joinandwise.com/crossings/partnership-or-sale"
checked: "2026-10-21"
claim: "andwise:crossing/partnership-or-sale@2026-10-21"
license: "CC BY 4.0"
---

# A partnership track, a buy-in, or a practice sale

A partnership track ends in a vote and a price; a practice sale can replace both. This page sets out ownership trends, the arithmetic the site can do, and where it stops.

**The decision:** A partnership vote and buy-in, or an offer to buy the practice from a hospital, a corporate buyer or a private-equity firm.

## What changes

- 82.0% of physicians were employed by hospitals, health systems or corporate entities on January 1, 2026, and 63.9% of practices were owned by them. ([PAI-Avalere, Physician Employment Trends and Practice Acquisitions 2018–2026](https://www.physiciansadvocacyinstitute.org/PAI-Research/PAI-Avalere-Health-Report-on-Physician-Employment-Trends-and-Practice-Acquisitions-2018-2026); checked 2026-10-21)
- In the AMA's Physician Practice Benchmark Survey, the share of physicians in private practice fell from 46.7% in 2022 to 42.2% in 2024, and the share in private-equity-owned practices rose from 4.5% to 6.5%. ([AMA, Physician Practice Characteristics in 2024](https://www.ama-assn.org/system/files/2024-prp-pp-characteristics.pdf); checked 2026-10-21)
- Studies of Medicare billing data found more physicians leaving after private-equity deals. In 200 ophthalmology practices acquired from 2014 to 2021, physician exits rose 13 percentage points. When a private-equity owner later sold a practice, its physicians were 16.5 points less likely to still work there two years on. Billing data do not show which physicians were owners, so neither study separates owners from associates. ([Singh et al., Health Affairs 2025;44(3):280, physician exits after PE acquisition (ophthalmology)](https://doi.org/10.1377/hlthaff.2024.00974); [Berquist, Klarnet and Dafny, JAMA Health Forum 2025, physicians after PE exits](https://doi.org/10.1001/jamahealthforum.2024.5376); checked 2026-10-27)
- Not measured: No source in Andwise's research measures how long partnership tracks run, or how often a track ends without a vote.

## Who is paid for what

- **The existing partners.** No published source recorded yet. Not part of its role: Valuing the practice on the incoming physician's behalf.
- **A private-equity buyer.** No published source recorded yet. Not part of its role: Explaining what a sale does to an associate's partnership track.

## Costs that come later

- The buy-in price and how it is financed → The years after the vote, as the partner income difference repays it — https://www.joinandwise.com/decide/partnership
- Non-competes in the purchase, employment and equity agreements → Leaving the practice after a sale — https://www.joinandwise.com/contracts/noncompete

## Deadlines

- The partnership vote — Set in the contract
- A buyer's offer window — Set by the other party

## Tools

- [Partnership buy-in arithmetic](https://www.joinandwise.com/decide/partnership): Months to recoup the price, financing interest, and the share implied by head count.
- [What changed in a renewal contract](https://www.joinandwise.com/contracts/renewal): The employment agreement before and after a sale, clause by clause.
- [Non-compete laws by state](https://www.joinandwise.com/contracts/noncompete): Each state's rule, with citations.

## Questions

### Counsel

- Which agreements carry a non-compete: the purchase agreement, the employment agreement, an equity agreement?
- What happens to the partnership track if the practice is sold before the vote?

### The practice's valuer or a CPA

- How was the buy-in price calculated, and what does it include: hard assets, receivables, goodwill?
- How is the buy-in financed, and how is each part taxed?

Andwise computes the buy-in arithmetic and quotes the agreements. It does not value a practice or say whether a buy-in or a sale price is fair; that is a valuer's and counsel's work.

## Sources

- [PAI-Avalere, Physician Employment Trends and Practice Acquisitions 2018–2026](https://www.physiciansadvocacyinstitute.org/PAI-Research/PAI-Avalere-Health-Report-on-Physician-Employment-Trends-and-Practice-Acquisitions-2018-2026)
- [AMA, Physician Practice Characteristics in 2024](https://www.ama-assn.org/system/files/2024-prp-pp-characteristics.pdf)
- [Singh et al., Health Affairs 2025;44(3):280, physician exits after PE acquisition (ophthalmology)](https://doi.org/10.1377/hlthaff.2024.00974)
- [Berquist, Klarnet and Dafny, JAMA Health Forum 2025, physicians after PE exits](https://doi.org/10.1001/jamahealthforum.2024.5376)

Reviewed 2026-10-27; oldest source check 2026-10-21. General information, not legal, tax or financial advice. The site describes what the law and rules say; it does not say whether a clause is enforceable or what you should do.