Private equity activity in gastroenterology is slowing in frequency, even as deal sizes and consolidation momentum grow. This shift is reshaping the specialty and raising new challenges for independent GI groups and ASCs.
Key Takeaways
Deal volume is falling fast
GI PE transactions plunged by 50% from 2022 to 2023 (26 to 13 deals). This mirrors a broader healthcare slowdown, where overall PE deals fell 16.2% in 2023.
Bigger, more strategic deals
The slowdown hasn’t stopped major players like GI Alliance, Gastro Health, and United Digestive from expanding. Their moves now focus on add-on acquisitions and recapitalizations, such as GI Alliance’s $785M partnership with Apollo Global Management.
Mega-deals redefining the market
Optum’s SCA Health acquisition of U.S. Digestive Health (250+ providers, 40 practice sites, 24 ASCs) in early 2025 highlights the scale of consolidation. Some see expanded resources; others fear the loss of physician autonomy.
Reimbursement pressure adds urgency
Gastroenterologist compensation fell 3% year over year (2023–2024), even before inflation. Shrinking pay combined with larger but fewer exits makes the stakes higher for practices.
Regulatory scrutiny is intensifying
States are stepping in:
- Oregon: Requires physicians to retain majority control in medical groups.
- Pennsylvania: Strengthened AG authority to review or block healthcare M&A.
With GI among the most PE-consolidated specialties, these policies could directly influence how fast — and how far — future consolidation moves.