Your veterinarian, your HVAC contractor, your dentist, the odds that at least one of them now answers to a private equity firm you have never heard of are considerably higher than they were a decade ago. Corporate ownership of general veterinary practices has climbed from roughly 8 percent in 2011 to about 50 percent today. This magazine has spent recent issues making the case that buying an existing small business beats starting one from scratch. It is time to examine honestly who is actually doing the buying, and what it means when the buyer is not a retiring owner’s neighbor but a Wall Street-backed platform with a five-year exit plan.
This magazine recently argued that America’s coming wave of retiring baby boomer business owners represents one of the great entrepreneurial opportunities of this decade, a genuine, well-financed path for an individual buyer to acquire an established, cash-flowing business rather than gamble on a startup. That argument remains true. It is also, this magazine believes, incomplete without acknowledging who else has noticed the exact same opportunity, and moved considerably faster and with considerably more capital than any individual buyer ever could. Private equity has spent the past decade quietly consolidating some of the most familiar, most local corners of the American economy, and the pace has only accelerated. Understanding the actual scale of that consolidation, and the genuine, documented concerns it has raised among regulators on both sides of the Atlantic, is necessary before anyone can answer whether Americans should be worried about it.
The Local Business That Isn’t Local Anymore
The veterinary industry offers the clearest, most measured example of how far this trend has already gone. Private equity firms invested an estimated $45 billion in U.S. veterinary sector deals between 2017 and 2022 alone, and corporate ownership, private equity firms and the larger platforms they control, now accounts for roughly 25 to 50 percent of general veterinary practices and an estimated 75 percent of specialty and emergency veterinary clinics. Industry researchers at Mordor Intelligence found that corporate and PE-backed share of the veterinary market has grown from approximately 8 percent in 2011 to roughly 50 percent by 2025, one of the fastest consolidations of a genuinely local, trusted professional service in recent American economic history. Independent clinics still hold roughly 51 percent of veterinary sites nationwide, a fact private equity’s own industry trackers describe not as evidence of a healthy independent sector but as “the remaining runway,” language that makes plain the expectation that consolidation continues rather than levels off.
Fast Facts
8 to 50 percent: Growth in corporate and private-equity-backed share of the U.S. veterinary market, from 2011 to 2025
$45 billion: Private equity investment in U.S. veterinary sector deals between 2017 and 2022
42 percent: Share of all U.S. middle-market M&A activity in 2024 accounted for by healthcare deals alone
52: Named private equity platforms actively acquiring home services businesses, HVAC, plumbing, roofing, and pest control, as of 2026
8x to 15x: Typical EBITDA multiple private equity platforms pay for veterinary practices, compared with roughly 2.5x to 2.7x for the average Main Street business sold to an individual buyer
May 2024: The FTC and DOJ jointly launch a formal inquiry into serial acquisitions and roll-up strategies across the U.S. economy
How Big This Has Actually Gotten
Veterinary medicine is not an outlier. Healthcare deals of all kinds, dental, dermatology, behavioral health, medical spas, accounted for a striking 42 percent of all U.S. middle-market mergers and acquisitions in 2024, with total transaction volume up 57 percent year over year. Home services has followed close behind: industry trackers counted 52 named private equity platforms actively acquiring HVAC, plumbing, roofing, and pest control businesses as of 2026, alongside 49 named platforms in healthcare services alone. These are not abstract statistics attached to faceless conglomerates. Apex Service Partners, backed by Alpine Investors, led disclosed HVAC deal volume in 2025. ARS and Rescue Rooter, backed by GI Partners and Charlesbank Capital Partners, and Service Champions and Wrench Group, backed by Leonard Green Partners and TSG Consumer Partners, now operate as national multi-trade platforms built entirely from what were once independent, family-run local businesses. Heartland Dental, one of the largest dental support organizations in the country, is owned by KKR, one of the largest private equity firms in the world, alongside Ontario Teachers’ Pension Plan.
The Playbook, Explained
Understanding why private equity has moved into these specific industries, veterinary care, dentistry, home services, requires understanding the actual mechanics of the strategy, known in the industry as a roll-up. A private equity firm acquires an initial “platform” business, typically one already generating $5 million to $10 million in annual profit, and then spends three to five years acquiring dozens of smaller, independent competitors, folding each into the platform’s shared back-office systems, professional management, and centralized purchasing. The platform’s earnings grow from that initial $5 million to $10 million range to $30 million to $80 million or more, and critically, the valuation multiple buyers are willing to pay expands right alongside it, from roughly 5 to 7 times earnings at the platform’s founding to 10 to 12 times earnings, sometimes higher, once the platform sells to an even larger acquirer or goes public. This dynamic, industry professionals call it multiple arbitrage, explains directly why private equity can and does pay retiring business owners so much more than an individual buyer ever could: a veterinary practice that might fetch 2.5 to 2.7 times earnings from an individual buyer using an SBA loan, the same range this magazine documented in its recent examination of small business valuation, can command 8 to 15 times earnings from a private equity platform, precisely because that platform’s own eventual sale price depends on aggregating dozens of practices like it into something considerably larger than the sum of its parts.
What Regulators Are Worried About
That gap between what an individual buyer can pay and what a private equity platform can pay is exactly what has drawn sustained scrutiny from federal antitrust regulators. In May 2024, the Federal Trade Commission and the Department of Justice’s Antitrust Division jointly launched a formal Request for Information targeting serial acquisitions and roll-up strategies across the entire U.S. economy, specifically naming housing, construction, agriculture, distribution, and professional services, alongside an earlier, healthcare-specific inquiry conducted jointly with the Department of Health and Human Services. Then-FTC Chair Lina Khan was blunt about the concern driving the inquiry: “Firms can use serial acquisitions to roll up markets, consolidate power, and undermine fair competition, all while jacking up prices and degrading quality.” The agencies identified two specific transaction patterns they found most troubling: “strip-and-flip” deals, in which a private equity owner extracts a business’s most valuable assets before offloading what remains, and roll-ups themselves, a long series of individually small acquisitions, each one too small to trigger mandatory federal merger review on its own, that nonetheless add up to substantial market consolidation entirely outside regulators’ normal field of view.
Regulators overseas have reached similar conclusions using more direct language. The United Kingdom’s Competition and Markets Authority found that consolidation in the veterinary sector produced what its chief executive called an “absolutely huge drop” in the share of independent practices, and the agency launched a parallel market study into private dentistry in March 2026. The Netherlands’ Authority for Consumers and Markets went further still, concluding directly that private equity buy-and-build strategies “can result in local dominance, increased price and reduced quality of service,” and formally called for expanded power to review smaller transactions that currently evade traditional antitrust thresholds entirely.
“Firms can use serial acquisitions to roll up markets, consolidate power, and undermine fair competition, all while jacking up prices and degrading quality.”
— Lina Khan, then-Chair, Federal Trade Commission, May 2024
The Case for Not Panicking
Fairness requires taking seriously the strongest arguments against treating this trend as an emergency, and there are real ones. The International Center for Law and Economics, responding formally to the FTC and DOJ’s own inquiry, argued that neither existing enforcement experience nor the broader economic literature actually supports fundamental changes to antitrust law for this category of transaction, cautioning against imposing substantially higher reporting burdens on ordinary business transactions without clear evidence of consumer harm across the board. There is also a more practical consideration this magazine has raised in its own coverage of the retiring baby boomer ownership wave: a genuinely large share of small business owners nearing retirement have no succession plan and no individual buyer waiting in the wings, and a well-capitalized private equity buyer willing to pay a premium price can represent the difference between an orderly business transition and a business that simply closes its doors, taking its jobs and services with it. Private equity ownership also brings real professionalization, shared administrative systems, better technology, standardized safety and compliance practices, that a single overworked owner-operator often struggles to fund alone. And the regulatory posture itself has shifted somewhat since the Khan-era FTC issued its 2024 inquiry; more recent analysis of antitrust enforcement trends found that deals under roughly $500 million now receive considerably less in-depth review, even as agencies continue investigating the most competitively sensitive roll-ups and state attorneys general increasingly take up scrutiny the federal government has scaled back.
What This Means for the Business Down the Street
Held together, these threads describe a genuine tension rather than a simple villain story, and this magazine believes readers deserve that honest complexity rather than a tidier narrative in either direction. The same wave of retiring owners this magazine has encouraged individual entrepreneurs to step into is being met, in the specific industries where recurring revenue and customer loyalty make consolidation most profitable, veterinary care, dentistry, HVAC, pest control, by institutional capital capable of outbidding an individual buyer by a factor of three to five times on valuation alone. That is not, by itself, evidence of wrongdoing; a seller accepting the highest legitimate offer for a business he spent decades building is doing exactly what any rational owner should do. It does mean the character of American small business ownership is shifting in ways worth watching closely, away from the locally owned, personally accountable model this country has always associated with Main Street, and toward a national network of platforms whose ultimate owners are pension funds, endowments, and institutional investors several steps removed from the exam room, the service truck, or the dental chair where the actual work gets done.
The Bottom Line
Should Americans be worried about private equity buying up Main Street? The honest answer is neither the alarmist one nor the dismissive one. The consolidation is real, well-documented, and accelerating, not slowing, in exactly the industries, veterinary care, dentistry, home services, where Americans interact with a business owner’s judgment and character most directly and most personally. Regulators on two continents have independently reached the same concern, that roll-up strategies can raise prices, degrade service, and consolidate local markets in ways ordinary merger review was never built to catch. At the same time, the alternative to private equity stepping in is too often no succession at all, a business that simply closes when its aging owner retires with no buyer in sight. The right response is neither blanket condemnation of an entire investment strategy nor uncritical acceptance of it, but the kind of close, ongoing attention this magazine intends to keep paying: to which industries are consolidating fastest, to whether the regulators charged with watching this get the tools and the will to actually do so, and to whether the American small business, the genuinely local, personally owned kind this country has always taken pride in, still has a fighting chance to remain exactly that.
References
Proskauer Rose LLP, “When Small Deals Add Up: Antitrust Scrutiny of Serial Acquisitions in Veterinary and Dentistry,” March 2026
Octus, “Private-Credit Exposure to Veterinary Rollups Shows Growing Dispersion,” February 2026
CT Acquisitions, “Private Equity Veterinary (2026): The Consolidation Report,” citing Mordor Intelligence, May 2026
CT Acquisitions, “2026 PE Platforms by Sector: 288 US Roll-Ups Across 32 Sectors”
CT Acquisitions, “Private Equity Roll-Up Strategy: 2026 Complete Guide”
OpusConnect, “Healthcare Roll-Ups: PE Strategy Faces New Pressures,” August 2025
Federal Trade Commission, “FTC and DOJ Seek Info on Serial Acquisitions, Roll-Up Strategies Across U.S. Economy,” May 2024
Legal Dive, “FTC leans on aggressive view of ‘unfair practices’ as it joins DOJ in call for roll-up information”
FTI Consulting, “Antitrust Rewired: Growing Need for Vigilance on Private Equity,” April 2025
Morgan Lewis, “In The Know: Antitrust Enforcement Trends for Private Equity M&A,” December 2025
International Center for Law & Economics, “ICLE Comments to FTC and DOJ on Corporate Consolidation Through Serial Acquisitions and Roll-Up Strategies,” January 2025
