Who Owns Anesthesia Now: The FTC Settlement, the Private Equity Buyback Wave, and What Ownership Does to Anesthesiologist, CRNA, and CAA Jobs

Two questions decide most anesthesia staffing outcomes in 2026, and neither is clinical: who owns the group, and who signs the coverage contract. Everything downstream — pay bands, ratios, call burden, whether a room opens on Monday — follows from those two answers.

This is the third installment in a series that has looked at the demand side (the 2026 stipend boom) and the supply side (the training pipeline). The subject here is market structure: who has been buying anesthesia practices, what the federal antitrust case has actually produced, and why a meaningful number of groups are now trying to buy themselves back.

How much of U.S. anesthesia is owned by private equity?

Groups owned by private equity or publicly traded companies grew from 3.2% of the national anesthesia market in 2009 to 18.8% by 2019, and each of the five largest independent anesthesia practices in 2009 was acquired over that decade, according to a Health Affairs Scholar analysis cited by Becker's ASC.

Practice-level counts run higher than market-share counts. Roughly 20% of anesthesia practices had been acquired through private equity physician practice buyouts by 2020 per a 2020 JAMA Network study, and that share reached approximately 33% by 2024 according to a June 2026 AMGA Consulting white paper (Becker's ASC). The same white paper reports that about 33% of anesthesiologists had been absorbed through such acquisitions as of 2020 (Becker's ASC).

Measure	Figure	Year	Source
PE- or public-company share of national anesthesia market	3.2%	2009	Health Affairs Scholar
PE- or public-company share of national anesthesia market	18.8%	2019	Health Affairs Scholar
Anesthesia practices acquired via PE buyout	~20%	2020	JAMA Network
Anesthesia practices acquired via PE buyout	~33%	2024	AMGA Consulting
Anesthesiologists absorbed via PE acquisition	~33%	2020	AMGA Consulting
Anesthesiologists among physicians in PE-acquired groups	33.1% (1,894 of 5,714)	2013–2016	Anesthesiology, June 2026 review
Annual PE investment in U.S. healthcare	$41.5B rising to more than $200B	2010 to 2021	Anesthesiology, June 2026 review

Anesthesia was not incidentally consolidated; it was a preferred target. A June 2026 review in Anesthesiology found that 19.4% of all PE-acquired practices between 2013 and 2016 (69 of 355) were anesthesia groups (Anesthesiology, June 2026).

Did consolidation actually raise anesthesia prices?

Yes, and the effect sizes across independent studies land in a consistent band of roughly 18% to 30%. After U.S. Anesthesia Partners acquired most large anesthesia practices in Houston and Dallas, commercial anesthesia prices increased 18% within six months and nearly 30% within two years, per a University of Chicago Booth School of Business study cited by Becker's ASC.

The pattern replicated outside Texas. A National Bureau of Economic Research working paper by researchers at Yale, Northwestern and the University of Chicago found the same 18% six-month increase and 25% to 30% two-year increase across 18 non-Texas roll-up markets, with no measurable improvement in anesthesia quality, and found Herfindahl-Hirschman Index increases often exceeding 1,000 points and sometimes 2,500 (Becker's ASC).

A separate 2022 study put the average post-acquisition price increase at 26%, and the Colorado attorney general's office alleged USAP charged reimbursement rates 30% to 40% higher than competing Denver-area groups while demanding subsidy increases as high as 1,200% (Becker's ASC). These are different methods measuring different markets and they should be read as a range, not reconciled into one number.

What did the FTC's April 2026 USAP settlement actually require?

The public answer is that nobody outside the negotiation knows yet, because the terms are confidential. The Federal Trade Commission announced an agreement in principle with U.S. Anesthesia Partners to settle the litigation and restore competition for anesthesia services in Texas, stating plainly that "the substance of the agreement is confidential at present to facilitate the negotiations USAP must undertake to execute the settlement" (FTC).

The FTC's leverage is explicit rather than implied: "If USAP fails fully to execute the settlement, the FTC will return to district court to litigate these unlawful acquisitions" (FTC). The Commission vote authorizing the preliminary settlement was 2-0, and any stipulated final order requires both a Commission vote and District Court approval.

Procedurally, the case is paused rather than closed. The FTC and USAP filed a joint motion to stay on April 23, 2026, the Southern District of Texas granted the stay on May 26, 2026, and the parties are working through a 180-day implementation window with Texas divestitures expected but buyers and asset perimeters not publicly disclosed, according to a private-equity roll-up tracker maintained by CT Acquisitions. That tracker is a market-participant publication rather than a court record, so treat its procedural detail as reporting to verify rather than as an official filing.

The sponsor-side remedy is already final and is the more durable constraint. Welsh Carson operates under a consent order running 10 years from its May 2025 effective date that holds its USAP ownership at a minority pro rata level, limits it to a single non-chair board seat, requires prior FTC approval for any new investment in any U.S. anesthesia business, and requires 30-day advance notice of any acquisition of any other U.S. hospital-based physician practice regardless of specialty (CT Acquisitions). For anesthesia dealmaking, a 10-year pre-approval requirement on a major sponsor is a larger structural change than any single divestiture.

Why are anesthesia groups now buying themselves back?

Because the initial contract terms from the 2015–2019 consolidation wave are expiring and the arithmetic has changed. Copractica executives report a trend of sellers from that wave now past their initial terms and weighing whether infrastructure and scale are still worth autonomy and a slice of collections; one member group that sold to a large national group six or seven years ago bought itself back and has since doubled in size (Becker's ASC).

Scale itself has not become worthless — USAP still employs approximately 5,000 clinicians nationally (Becker's ASC). What has changed is that clinically integrated networks now offer similar contracting and administrative scale without an equity transfer.

What does consolidation mean for anesthesiologists specifically?

Anesthesiologists bear the labor-side cost of the model. By 2023, anesthesiologists at PE-backed groups were regularly expected to work more than 80 hours per week, often with reduced compensation relative to what they had been promised at acquisition, per the June 2026 AMGA Consulting white paper (Becker's ASC). AMGA's own framing is that the absence of that pressure is now a recruiting asset: "stable employment, reasonable workloads, and meaningful compensation, without the extractive pressures of a PE ownership model, can be a compelling differentiator in recruitment."

For anesthesiologists evaluating an offer, ownership structure and contract vintage predict workload better than the stated FTE. A group three years into a platform's hold period and a group nine years in are different employers with the same name.

Who is consolidating CRNA staffing, and what are payers doing about it?

CRNA consolidation is happening on the staffing-agency side rather than the practice side. CHG Healthcare announced on August 11, 2026 that it acquired KREWE Anesthesia, a CRNA-founded firm launched in 2022 that provides locum tenens staffing, workforce management, and coverage solutions, and that reports approximately 84% annual clinician retention (Business Wire; deal counsel confirmed by Latham & Watkins).

Payers are simultaneously squeezing the CRNA billing pathway that independent practice depends on. UnitedHealthcare reduced reimbursement for QZ-billed CRNA services by 15% in selected states in October and removed payments tied to several add-on and qualifying-circumstance codes, and Anthem Blue Cross Blue Shield plans in Ohio, Missouri, Connecticut, New York, Nevada and Maine reduced QZ reimbursement to 85% of the physician fee schedule effective Nov. 1 (Becker's ASC).

QZ policy is where payer strategy and staffing model intersect most directly: a cut to QZ payment makes independent CRNA practice less viable and pushes volume back toward medically directed care-team billing. Anthem separately adopted a policy in Connecticut, New York and Missouri that calculates allowable anesthesia time from CMS physician work time values rather than documented time across CPT 00100 through 01999 (Becker's ASC).

Why are CAAs the asset consolidators want most?

Because certified anesthesiologist assistants combine a material wage differential with an expanding legal footprint, which is exactly the profile a platform strategy rewards. A market tracker states the case bluntly: "CAA labor costs run materially below anesthesiologist labor costs while delivering comparable care under medical direction," and "CAA-friendly states are positive supply asymmetry: limited current competition, expanding labor pool, and material wage differential versus anesthesiologists" (CT Acquisitions).

CAA pay is rising fast enough to show the competition. The average annual salary for anesthesiologist assistants was $247,000 as of April 2026 based on Marit Health's compilation of 170 salaries, with the 90th percentile at $327,000; advertised base pay ceilings reached $350,000 in the first quarter of 2026, up from $330,000 in the fourth quarter of 2025, per a May 2026 BagMask.com report (Becker's ASC).

New-graduate economics tell the clearest story about scarcity. The average starting salary for a new CAA graduate is $239,000, with an average sign-on bonus of $34,500 and average relocation bonus of $8,000 across 59 new-graduate salaries (Becker's ASC). Employers do not pay a $34,500 sign-on bonus for a role with slack supply.

What should hospital and ASC leaders ask before the next contract cycle?

Three questions do most of the work. Ask a bidding group where it sits in its sponsor's hold period, because workload and turnover risk track that more closely than the pro forma. Ask which anesthetist mix the coverage model assumes and whether CAA authorization exists in every state the contract covers, since a ratio that is legal in one state may be unavailable in the next. Ask how the revenue assumptions handle QZ policy changes, because a model built on independent CRNA billing in an Anthem or UnitedHealthcare market has already lost margin someone will have to fund.

The federal antitrust posture has shifted toward slower dealmaking rather than reversal. The Welsh Carson order and pending USAP divestitures change who can buy, not who already owns.

A note on the data

Ownership and price figures in anesthesia come from studies with different denominators and should not be combined. Market-share estimates (3.2% to 18.8%) count revenue or covered market while practice-count estimates (20% to 33%) count practices, and the AMGA white paper's 33% appears in reporting as both a 2024 practice share and a 2020 anesthesiologist share, so the figure should be read with its label attached. Price-effect estimates of 18%, 26%, and 25% to 30% come from separate studies in separate markets and are presented above as a range rather than averaged. The USAP settlement terms are confidential, so any account of what it requires is inference until a stipulated final order is filed. CAA program counts also disagree: one tracker cites ASA data showing 17 accredited AA programs, while NCCAA lists 23. Compensation figures drawn from job postings and self-report platforms reflect advertised pay, not a profession-wide survey.