Private Equity in Anesthesia: Who Owns Your Group and Why It Matters
By Andrew Woodmancey, Managing Director · Published
The short answer: a large share of hospital anesthesia is now provided by companies backed by private equity or other investors. They include national groups such as NorthStar Anesthesia, North American Partners in Anesthesia (NAPA), U.S. Anesthesia Partners (USAP), Envision, Sound Physicians and TeamHealth. In our index of anesthesia job postings, about four in ten postings placed directly by an identifiable employer in the past year came from investor-backed companies. Research links these companies to higher commercial prices, and the Federal Trade Commission reached an agreement in principle to settle its case against USAP in April 2026, though it is not yet final. For a hospital, ownership is not good or bad in itself. It changes who sets the price, how the group behaves at renewal, and what happens if the group decides a contract no longer pays, so it belongs in the contract as well as the due diligence.
Who is hiring anesthesia clinicians
Our index of publicly posted anesthesia job listings from national job boards held 15,946 anesthesiologist and CRNA postings in the 12 months to September 2026. About 65% came through recruiters and do not name the employer. Of the 5,464 that came directly from an employer we could identify and classify:
The investor-backed share is driven by a few national companies. NorthStar Anesthesia placed nearly 15% of all direct postings, NAPA about 9%, and USAP, Envision and TeamHealth about 6% between them. The share was similar for anesthesiologist postings (45%) and CRNA postings (43%).
It varies sharply by state. In Virginia, Illinois and New York, most direct postings came from investor-backed companies; in California, Connecticut, Colorado and Wisconsin, independent groups and health systems placed most of them.
Postings measure hiring, not market share. A company that recruits constantly may be growing, or replacing clinicians who leave, and a stable independent group may post little. Read the figures as who is competing for clinicians in a market, which is what sets the price of coverage.
The national companies
| Company | Ownership | Size, as the company describes it |
|---|---|---|
| NorthStar Anesthesia | Cranemere (since 2018), with TPG Growth retaining a minority stake | Over 3,000 providers at over 195 facilities in 21 states (Cranemere) |
| U.S. Anesthesia Partners | Welsh, Carson, Anderson & Stowe; Berkshire Partners; GIC; physician owners | 4,500+ clinicians at more than 700 facilities in 13 states |
| North American Partners in Anesthesia | American Securities and Leonard Green & Partners | More than 5,000 clinicians and staff at 400+ facilities in 22 states and DC (American Securities); acquired the MEDNAX anesthesia business in 2020 |
| Envision | Its former lenders, since the 2023 bankruptcy restructuring | About 4,000 anesthesia clinicians (about 8,000 across its three specialties) |
| Sound Physicians | Investor group led by Summit Partners, with UnitedHealth’s Optum, which bought the majority from Fresenius in 2018 | 1,200+ anesthesia physicians across 50 hospitals |
| TeamHealth | Blackstone (since 2017) | 750+ anesthesiologists |
The roster changes. MEDNAX left anesthesia in 2020, Envision went through bankruptcy in 2023 and withdrew its management operations from California in 2024, and USAP left Oklahoma in 2024.
What the research says about prices
The most-cited study (La Forgia and colleagues, JAMA Internal Medicine, 2022) followed more than 2.2 million commercial anesthesia claims at hospital outpatient departments and surgery centers from 2012 to 2017, comparing 672 facilities that contracted with an anesthesia management company against 2,992 that did not. After a facility contracted with an anesthesia management company, the amounts paid for anesthesia rose 16.5%. Where the company was backed by private equity, they rose 26%. Most of that is paid by commercial insurers and their members. For a hospital, the same bargaining position shows up at renewal.
Subsidies are the other side. In complaints filed in 2024, a Trinity Health hospital in Syracuse alleged that its anesthesia subsidy rose from a cap of about $4.4 million under a 2018 contract to more than $16 million in 2023, after NAPA bought the practice from MEDNAX in 2020, and a Florida hospital in the same system said it went from paying no subsidy in 2021 to more than $3 million in 2023. Colorado’s attorney general alleged in 2024 that USAP had demanded subsidy increases of up to 1,200%. These are allegations: NAPA denied the hospitals’ claims and USAP denied Colorado’s, and the cases were settled without findings.
The FTC case against USAP
- September 2023: the FTC sued USAP and its founding investor, Welsh Carson, in federal court in Houston, alleging that USAP bought up practices to reach roughly 60–70% of commercially insured hospital-only anesthesia in the Houston and Dallas markets, measured by revenue, and raised prices. USAP denies the claims.
- May 2024: the court dismissed Welsh Carson from the case; the case against USAP continued.
- January 2025: Welsh Carson agreed to an FTC order, final in May 2025, freezing its USAP stake, limiting it to one board seat and requiring FTC approval for future anesthesia investments.
- April 2026: the FTC and USAP reached an agreement in principle to settle. The terms are confidential and USAP admits no wrongdoing; the court put the case on hold until November 2026 while the agreed relief is carried out.
Separately, USAP settled with Colorado’s attorney general in February 2024, agreeing to give up exclusive contracts at five hospitals and to phase out its non-competes in the state, without admitting wrongdoing.
What can go wrong for a hospital
The disruptions of the past few years have not all involved investor-backed groups. Broward Health ended its contract with Anesco, a physician-owned group, in 2025, citing breach of contract after staff reported missed pay, and Methodist Le Bonheur in Memphis replaced a local group in 2024 that, according to the hospital, had lost nearly half its staff. What the cases have in common is a hospital with no fallback.
- A transition that does not staff the rooms. When Providence replaced its anesthesia group at two Portland hospitals in late 2023, surgical volume fell to about half the previous year’s for two months while the new group recruited.
- Clinicians who cannot stay. Non-competes and non-solicitation clauses can stop a hospital from employing the clinicians already working in its rooms when the contract ends. When Renown Health in Reno gave notice to end its contract with a NAPA practice in late 2021, 52 anesthesiologists sued their employer over non-competes that would have barred most of them from practicing within 25 miles; the contract ended in April 2022 and Renown went on to employ 56 anesthesiologists.
- A renewal without alternatives. The Trinity Health hospitals alleged that the cost of buying out non-competes made replacing their group prohibitively expensive at renewal. Colorado’s attorney general alleged that hospital systems with exclusive USAP contracts had not ended them because, at most of their facilities, USAP could not be replaced.
Some hospitals have responded by employing anesthesia themselves: Renown in 2022, Billings Clinic in 2024 and Corewell Health West in 2025. That is not available everywhere: until July 2025 Tennessee barred hospitals from employing anesthesiologists, and the ban still applies in its largest counties, including Memphis and Nashville.
State laws on health care transactions
A growing number of states require notice of, or review, transactions involving physician practices and their investors, and some limit how much control a management company may have over a practice.
| State | What it requires |
|---|---|
| California | 90 days’ notice of covered health care transactions; from January 2026 private equity groups, hedge funds and management services organizations must also file (AB 1415), and private equity groups and hedge funds may not control clinical or billing decisions in physician practices (SB 351) |
| Oregon | Prior review of health care transactions; most physician non-competes void since June 2025; limits on management company control of medical practices from 2026 for new arrangements and 2029 for existing ones |
| Massachusetts | 60 days’ notice of material changes, which since April 2025 include transactions involving significant equity investors such as private equity |
| Washington | 60 days’ notice to the attorney general, extended in 2026 to any change of majority ownership or control of a provider organization |
| Minnesota, Indiana, Illinois, New York, Rhode Island | Advance notice to the attorney general or a state agency for covered transactions, with thresholds that vary (Rhode Island’s by attorney general rule) |
| New Mexico | Prior approval by the state Health Care Authority for covered transactions, including acquisitions of independent practices |
| Maine | From 2027, 180 days’ notice, and state approval, conditions or denial, when private equity or a hedge fund acquires control of a provider |
The details, thresholds and effective dates differ and are changing quickly; check with counsel for your state.
What to put in your contract
- Change of control. Notice if the group is sold or recapitalized, and a right to renegotiate or terminate when it is.
- Termination and transition. A without-cause notice period long enough to replace the group (90 to 180 days in the contracts we have seen), and an obligation to keep the schedule covered during it.
- Clinicians. No restriction on the hospital employing or contracting with the clinicians who work in its rooms if the agreement ends, and no non-competes that would block it.
- Step-in rights. The hospital may bring in other coverage, at the group’s cost, if the group cannot staff the schedule.
- Data. Regular reporting of cases, units, payer mix, collections and staffing, so the subsidy can be checked.
- Subsidy terms. Caps, escalators tied to measurable changes, and a reconciliation the hospital can audit.
National groups can bring recruiting reach, billing systems and payer contracting a local group cannot. Whether that is worth the price is a question for the numbers, not the ownership: what stipends cost per location and running an anesthesia RFP cover the next steps.
Sources
- AOC index of publicly posted anesthesia job listings from national job boards, October 2025 to September 2026; employer ownership classified from public sources.
- La Forgia A, et al. Association of physician management companies and private equity investment with commercial health care prices paid to anesthesia practitioners. JAMA Internal Medicine 2022;182(4):396–404.
- Federal Trade Commission, agreement in principle with USAP (April 2026), and the final Welsh Carson order (May 2025).
- Colorado Attorney General, settlement with U.S. Anesthesia Partners (February 27, 2024).
- Complaints by St. Joseph’s Hospital Health Center (N.D.N.Y. 5:24-cv-00276) and Holy Cross Hospital (S.D. Fla. 0:24-cv-60315) against North American Partners in Anesthesia (February 2024).
- Company descriptions from Cranemere, USAP, American Securities, Envision, Sound Physicians and TeamHealth (2025–2026); news reports in Becker’s ASC Review, KOLO-TV and Action News 5 on the Providence, Renown, Broward, Methodist Le Bonheur, Billings Clinic and Corewell transitions.
- State statutes and agency guidance: California Health and Safety Code (Office of Health Care Affordability), AB 1415 and SB 351 (2025); Tennessee HB 979 (2025); New Mexico Health Care Consolidation Oversight Act; Oregon SB 951 (2025); Massachusetts Chapter 343 of the Acts of 2024; Washington RCW 19.390 and HB 2548 (2026); Maine LD 2201 (2026).