If you run a physician practice in Tampa Bay, you may have noticed the calls picking up. Private equity groups and larger practice platforms are reaching out more often, moving faster once they do, and asking sharper questions about your operations than they did even a year ago. That pattern is not a coincidence. It is the leading edge of a consolidation wave that is expected to keep building through the second half of 2026.

Private equity now represents more than 90 percent of physician practice transactions, and cardiology, gastroenterology, and orthopedics groups in particular are drawing sustained buyer interest. What matters for your practice is not the size of the trend. It is what happens the moment a deal actually reaches your desk, and how much of the outcome gets decided by a lease you signed years before any of this started.

Real estate quietly shapes the deal from there. Most physician leases were written for stability, not for a change of ownership. Two clauses tend to matter most when a sale happens: the change of control clause, which determines whether an ownership change triggers new landlord approval or new terms, and the assignment provision, which governs whether the lease can transfer to a new owner at all. A practice that has never reviewed either one may not find out how they read until a buyer’s attorney does, mid-negotiation.

That timing is a risk. A landlord who senses leverage during a pending sale can extract a rent increase, shorten a renewal option, or slow the deal down entirely while terms get renegotiated. None of that reflects poorly on the practice. It reflects a lease that was never built with a sale in mind, because at the time, a sale was not on anyone’s radar.

What a Lease Review Involves

A practical review does not require a transaction to already be in motion. It comes down to a handful of specific questions, answered plainly:

Can the lease be assigned to a new owner without landlord consent, or does consent get triggered automatically the moment equity changes hands? Some leases treat a change in ownership structure the same as a full assignment, even if the physicians and the practice name stay exactly the same.

What happens to the remaining term if ownership changes? Some landlords have the right to terminate or renegotiate on a change of control, others do not, and the difference often comes down to language buried in a section nobody reads until it matters.

Do renewal options, expansion rights, or exclusivity clauses survive a sale, or are they personal to the current ownership? A buyer values these. A landlord, sensing an opportunity to reset terms, sometimes does not want them to carry over.

Is there anything in the lease tied to specific individuals, like a personal guaranty from a founding physician, that would need to be restructured regardless of how the deal itself is structured?

None of these questions require legal training to ask. They do require someone who reads commercial leases for a living to answer with confidence, because the language is rarely as clear as it should be.

A Common Scenario

Picture a mid-sized specialty group in Tampa Bay that has been approached by a regional platform. The clinical and financial due diligence goes smoothly. Then the buyer’s attorney flags the lease: the assignment provision requires landlord consent for any transfer, defined broadly enough to include this exact transaction, and the landlord has thirty days to respond. That thirty-day window becomes a point of leverage nobody anticipated. The landlord uses it to ask for a rent increase in exchange for a timely consent. The deal does not fall apart, but the practice gives up value simply because nobody looked at that clause until a buyer’s team did.

This is not a rare story. It is close to the default outcome when real estate gets treated as background paperwork instead of a deal term in its own right.

Getting Ahead of It

The groups that come out ahead in this environment are the ones who look at their real estate before a buyer does. That means knowing, in plain terms, what the lease actually allows, and having those answers ready well before a term sheet shows up. It also means understanding what leverage exists on the other side of the table. A landlord with a strong tenant in a strong building has less incentive to create friction than one hoping to reset an under-market lease at the first opportunity.

For a practice that is not currently considering a sale, this is not a call to act. It is a reason to get an honest read on where you stand, on your own timeline, without a buyer’s clock running. For a practice already fielding calls, it is the difference between negotiating from a position of information and negotiating from a position of catch-up.

Real estate rarely makes or breaks a physician group transaction on its own. But it is one of the few pieces of the deal a practice can get in order well ahead of time, at no cost beyond the time it takes to ask the right questions.

Frequently Asked Questions About Physician Group Deals and Your Lease

Questions? Contact Carleton Compton directly: ccompton@hcrealtygroup.com | (813) 397-1444