This practice note focuses on the special merger and acquisition considerations applicable to physician practice acquisitions. The past couple of years have seen a resurgence in the acquisition of physician practices, both by hospitals and by private equity firms. Hospitals and health systems are increasingly looking for clinical integration. Private equity firms see the advantages that large, integrated groups have to offer. Independent physician groups are faced with significant challenges. These include not only continued reimbursement rate pressure, but also reimbursement methodology challenges, such as the Medicare Access and CHIP Reauthorization Act of 2015 (popularly known as MACRA), that fundamentally alter the manner in which physicians are paid and demand implementation of sophisticated and expensive technology that small groups can ill afford. The COVID-19 pandemic has only increased the pressure on independent physicians to integrate.