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The last sentence is key. In emergency medicine by dulac89

for privately ownned "democratic" groups, it is usually a few senior partners with a controlling interest looking to get out of patient cate or greatly reduce their clinical workload that orchestrate the sale

Alternatively, the PE-backed group approaches the hospital and offers a lot of money to put the Emergency Department contract up for bid but essentially the deal is already closed before the RFP is put out. Often, the current group is not even told that the contract is up for bid

The second situation has happened twice in our area, a few years ago Peninsula Emergency Physicians found out that their contract had been put up for bid, and won, by EMCare (Now Envision). Poof...just like that a 40 year old business ceased to exist, and the partners/owners could become employees of EMCare or go work elsewhere. Then, last fall, Richmond Emergency Physicians, the private group that staffs many of the hospitals in the Richmond area, was told they are being replaced by Vituity, with no option to rebid the contract. I told that story elsewhere in the thread