Urology Sector Insights

Urology Market at a Glance^1,2

The US urology market is highly fragmented with over 50 percent of practices serviced by one physician and less than ten percent of US practices having more than ten physicians

In 2020, 13,352 urologists were licensed in the US with approximately 85.7 percent providing patient care for at least 25 hours (“practicing urologist”)

Of the US practicing urologists, 10.5 percent maintain their primary practice in non-metropolitan areas (in comparison to 20 percent of Americans living there, see graph below)

Telemedicine utilization increased substantially to 71.5 percent, up from 11.9 percent during 2019

Majority of new patients wait less than 3 weeks, whereas approximately 24 percent of patients wait for an initial appointment at least 4 weeks

~ $17.7B	Estimated 2020 US market size
~ 393k	Average urologist salary
~ 62%	US Counties lack a primary urologic practice
51%	Of practicing urologists in private practices
~ 18.8k	Average annual urologic patient cost

Urologists to Population Ratio by State

Distribution of Urology Practices

4,223
Urology
Practices

Non-Metropolitan Areas are Dominated by Older Urologists

As the older physicians retire, there will be a healthcare void

Number of Office Locations per Practice

1 American Urological Association
2 IBIS World

Urology Private Equity M&A Activity

Private Equity Platforms

Platform	Founded	Locations
	2020	179
	2016	95
	2018	24
	2021	23
	2020	21

Private Equity Urology Deal Volume

Leading Factors Driving Interest in Urology and Overall Consolidation Among Practices

Macro-factors:
Supply and Demand

Adults aged 65 or older utilize urologic services at a 3-fold higher rate than the general population
The “graying of America” is expected to increase from 15% in 2016 to 22% by 2035
Urologist physician shortage is expected to reach 32% by 2030, driven by attrition of the aging provider population

Change in the
Workplace Setting

Practices are seeing an increase in the percent of employed providers
Female demographic continuing to grow among practicing urologists
Majority of female urologists are under the age of 45 while majority of male urologists are older than the age of 65

Integrated Offerings: ASCs, Lab, Oncology and Other

Highly fragmented oncology market structure
Estimated TAM for potential integrated offerings is approximately $47 billion
Lithotripsy, ultrasound and lab services offer the easiest potential for integration with urology
Low competitive environment compared to other physician specialties resulting in the opportunity to integrate with urology

Recent MAT
Legislation

The Drug Addiction Treatment Act of 2000 (DATA 2000) permits physicians who meet certain qualifications to treat opioid dependency with narcotic medications approved by the FDA –including buprenorphine – in treatment settings other than opioid treatment programs (OTP).
The Comprehensive Addiction and Recovery Act of 2016 (CARA) addresses the opioid pandemic and endorses the use of MAT for OUD.
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act is a broad package of Medicaid, Medicare and public health measures to address the opioid epidemic. It works with the Opioid Crisis Response Act of 2018.

Economies
of Scale

Rate pressures from new Medicare rating along with increases overall in operating expenses pose an undue burden on private practices
2022 CMS Final Rule outlines a 3.71% payment reduction across the urology specialty

AMB Investment Banking Snapshot and Deal Team

AMB focuses on lower middle-market healthcare niches where consumerism and fragmentation meet to disrupt traditional healthcare channels. We typically advise companies with EBITDA of $5M to $20M and an average enterprise value of $100M. AMB’s research-oriented approach to business development has resulted in a vast network of strategic and financial sponsor relationships that yield industry leading intelligence and optimal outcomes for our clients.

Gordon A. Maner

Chief Executive Officer
843-405-1106 Direct
gordon.maner@ambwealth.com

Mikel Parker

Managing Director
843-501-2183 Direct
mikel.parker@ambadvisors.com

Ryan Loehr, CPA

Managing Director
843-405-1108 Direct
ryan.loehr@ambadvisors.com

Johnny Cross

Vice President
843-371-8596 Direct
johnny.cross@ambadvisors.com