Lessons from Graham Young on Building a Physician-Led Orthopedic MSO

Allegrow presents a deep dive into our conversation with Graham Young, Senior Vice President of Mergers & Acquisitions and Business Transformation at U.S. Orthopaedic Partners (USOP). In this feature-length analysis, readers will find practical insights and actionable takeaways for healthcare executives, practice owners, and administrators navigating the complex intersection of physician culture, M&A, and platform growth.

The interview covers Graham’s unlikely journey from aspiring pediatric surgeon to corporate strategy and then to M&A leadership, how USOP grew to 55 sites and 300 orthopedic providers in a condensed time frame, and the operational and cultural lessons learned while integrating disparate practices across states. This article recreates that conversation in a structured format, pulls key quotes and principles, and expands on strategies any physician-led MSO or acquiring organization can apply today.

Graham Young’s Unplanned Route into Healthcare M&A

Graham Young did not grow up dreaming of a career in mergers and acquisitions. Like many who find themselves leading complex operating platforms, his path was circuitous and shaped by a combination of early clinical ambition, practical realities, and evolving opportunities.

Initially intent on becoming a pediatric surgeon, Graham prepared for the MCAT and pursued the physician track. As life redirected his route, he joined Johnson & Johnson and spent 15 years in roles spanning strategy, negotiation, ASC (ambulatory surgery center) development, and frontline sales. This practical combination, clinical empathy tempered with commercial and operational experience, enabled him to transition from corporate health care into the M&A arena.

By 2019, he joined The Thrusten Group in Chicago to begin building an orthopedic platform at a time when national orthopedic platforms were rare. That platform-building experience, learning physician dynamics, developing P&Ls, and negotiating deals, shaped Graham’s perspective: the financial valuation and deal mechanics are only part of the equation; the more complex work is understanding and aligning physicians.

What US Orthopaedic Partners Is, and How It Evolved

USOP is a physician-majority, physician-led management services organization (MSO) supported by two financial sponsors, FFL and The Thrusten Group. The MSO model at USOP focuses on administrative, operational, and strategic support while preserving physician leadership of clinical governance.

Key facts about USOP’s growth and footprint:

• Founded (technically) in October 2020
• About 300 orthopedic providers
• Approximately 1,700 employees
• 55 site locations across Louisiana, Mississippi, and Alabama

Graham emphasizes that physician relationships and referral networks drove the platform’s rapid growth in the first two years. Physicians who joined early helped identify other groups to bring into the platform, creating momentum and a geographically coherent regional strategy. Those physician-led connections remain central to USOP’s sourcing and acquisition approach.

The M&A Environment: From “Land Grab” to Strategic Discipline

The years immediately after 2020 represented a unique M&A market for physician practices. Very low interest rates, the appetite for consolidation, and the emotional pull of a fast-moving M&A environment created a “land grab” dynamic. Some physicians joined platforms because they could access capital and a vision of scale; many were motivated by FOMO (fear of missing out).

Graham points out a critical shift: early diligence focused heavily on finance and compliance. In contrast, current diligence must be more forward-looking—integrating operational fit, cultural alignment, and post-transaction integration opportunities (the upside you can realize by running practices better together).

Where the earlier era celebrated speed of aggregation, the present emphasizes creating durable systems and predictable integration playbooks. High interest rates and a tougher capital environment have pushed platforms to demonstrate how they will deliver operational improvements, not just deploy capital.

Why Physicians Join Platforms: Real Advantages Beyond Capital

For physicians, selling a practice or partnering with an MSO is at once strategic and intensely personal. Graham identifies several core advantages that a well-run platform delivers, advantages that are often the true drivers behind transactions, not just the headline valuation.

Practical advantages include:

• Shared best practices: Platforms can collect data across similar practices and distribute what works, patient access strategies, revenue cycle tactics, scheduler workflows, perioperative pathways, and more.
• Operational scale: Centralized purchasing, contracting, legal, HR, and back-office systems reduce overhead and spread fixed costs across a larger base.
• Recruiting and physician development: A dedicated physician recruiter allows smaller practices to grow headcount faster than they could alone, enabling expansion of services and ancillary lines.
• Investment in ancillaries: Building PT, MRI, ASC, and imaging services at scale becomes feasible when a platform can justify capex across multiple sites.
• Negotiating leverage: Payer negotiation, commercial bundle deals, and partnerships with health systems are more viable when multiple aligned practices collaborate under one platform.

Perhaps the most compelling advantage is the ability to rapidly apply winning clinical and operational practices across a network: “Many of the good ideas … have originated out of one of our practices,” Graham notes. The platform is only as strong as its practices, but when those practices are stitched together, collective learning accelerates performance improvements.

What M&A Teams Look For Beyond the Balance Sheet

Financials matter, but Graham insists that clinical reputation often tops the checklist. Clinical reputation isn’t a simple metric; for USOP, it’s defined by how physicians across the region regard a target practice. Who would they want to share ownership with? Who has clinical standards and reputations they respect?

USOP sources targets via an internal physician committee that provides on-the-ground intelligence, names of clinicians, their reputations, and whether a practice has the ancillaries and infrastructure that indicate potential for scale. The physician committee is integral to answering the question: Does this practice fit us clinically and culturally?

Other traits that matter beyond pure financials:

• Clinical leadership and peer reputation
• Ancillary capabilities or latent opportunity to add ancillaries
• Existing operational infrastructure (billing, RCM practices) that can be integrated
• Willingness of physician leaders to engage in governance and joint decision-making
• Geographic fit with the platform’s expansion strategy

Balancing Physician Empowerment with Corporate Guardrails

Physicians rightfully prioritize clinical autonomy. For a physician-led MSO like USOP, Graham explains, the structure is designed to preserve clinical decision-making while instituting business-level guardrails that ensure platform stability and growth.

USOP’s governance model illustrates this balance:

• Clinical governance board: Practices retain clinical control of care protocols and clinical policy through formal charters and governance structures. This is crucial both legally (in states with corporate practice of medicine laws) and culturally.
• Physician board that represents practices: An enterprise-level physician board, with representation from each acquired practice, meets regularly to provide input on strategic decisions and to voice on-the-ground concerns.
• Operational decision-making: Business, financial, and operational choices remain the responsibility of the MSO, but success depends on physician alignment; physicians create the revenue, and their buy-in matters.

Graham underlines the importance of legitimate physician participation: providing an authentic voice, through regular meetings and meaningful roles, drives buy-in and reduces friction during change.

Denovo vs. Acquisition: When to Build and When to Buy

Growth strategies generally fall into two camps: organic de novo growth (building new practices and sites from scratch) and acquisitions/bolt-ons (buying existing practices). Both options have trade-offs.

Graham describes the logic USOP applies:

• Denovo approaches are appealing for ancillaries, building surgery centers, imaging centers, and therapy sites, because the platform can select optimal locations and create modern processes from day one.
• Acquisitions make more sense for core physician practices, especially established groups with strong community brands. A long-standing five-physician practice with decades of local equity is far easier to scale when you acquire it and then invest in growth (recruiting, ancillaries) rather than trying to replace that legacy through a greenfield build.

Graham’s practical rule-of-thumb: buying an established practice often delivers a faster return on invested capital because brand equity and referral relationships are already in place. Conversely, denovo builds are longer-term and require more investment in time and marketing to reach critical mass.

Brand Strategy: Preserve Local Equity or Create a Unified Banner?

Branding is a frequent and emotional sticking point in physician acquisitions. For many physicians, the brand is an extension of their practice’s identity, its reputation built over decades. Graham acknowledges this sensitivity and explains USOP’s pragmatic approach.

Early on, USOP preserved existing practice brands to honor local equity and minimize disruption. Over time, however, the platform began exploring opportunities to roll practices under a larger, more recognizable regional brand where it made strategic sense, particularly when the consolidated brand would deliver broader market recognition and patient access across the state.

Key considerations in the brand decision:

• Length of relationship: The longer a practice has been on the platform, the more trust exists, and the more open physicians are to brand consolidation.
• Market coverage and recognition: A single state-wide brand may increase recognition and referral flow more than multiple small names.
• Patient experience and marketing efficiency: Consolidated brands often lower marketing costs and enable more consistent patient journeys.

Graham highlights that brand transitions should not be rushed; the decision must be rooted in physician trust, community perception, and a clear operational case for consolidating names.

Communication: The Single Most Important Integration Tool

“You cannot overcommunicate.” That simple maxim forms the backbone of USOP’s integration playbook. Frequent, clear, and multi-directional communication mitigates fear and accelerates alignment.

“I don’t think you can overcommunicate. Because every communication, someone hears something a little differently.”

Graham describes a three-tiered communication strategy:

1. Platform to physician stakeholders: Strategic updates, integration timelines, transparency on business plans, and what the MSO will deliver.
2. Practice leadership to frontline leaders: Translating high-level strategy into operational changes for managers and staff, this step is critical and often overlooked.
3. Frontline leaders to their teams: Clear day-to-day guidance so staff feel informed and empowered rather than surprised.

Effective communication is not merely about volume; it must be clear, consistent, and tailored to the audience. A CEO-level message that never filters down to schedulers or clinical assistants accomplishes little. USOP deliberately invests in cascading communications and measuring whether messages reached and were understood by each layer of the organization.

Integration Pain Points: EMR, RCM, and Culture

Integration is where strategy meets execution, and also where deals often encounter the most challenging work. Graham identifies three high-friction areas that require significant planning and patience.

EMR Migrations

Consolidating practices onto a single electronic medical record (EMR) facilitates analytics, population health, and consistent workflows. USOP recently completed a significant migration to Modernizing Medicine after determining that a unified EMR was a strategic priority. The migration was grueling, time-consuming, emotionally draining on staff, and high-stakes in terms of continuity of care.

Lessons for EMR projects:

• Plan migrations carefully; allow ample time and dedicated resources.
• Recognize that an EMR migration is not just an IT project; it is an organizational change management initiative.
• Use migrations to standardize mapping and reporting, yielding better apples-to-apples comparisons between sites.

Revenue Cycle Management (RCM)

RCM harmonization often unlocks financial upside but also takes a long time to realize. When practices come with varying RCM systems and policies, centralizing billing, coding, and collections requires both technical integration and training.

RCM consolidation benefits include:

• Lower overall administrative costs
• Faster collections with standardized workflows
• Improved denial management through centralized expertise

But the initial months (or longer) can see temporary dips in performance while staff adjust and claims get remapped. Expect the process to take patience and ongoing follow-up.

Cultural Alignment

“Culture” is frequently cited as essential, but Graham urges nuance. For an MSO operating across diverse Southern cities, culture is not monolithic; it should preserve local community identity. USOP views itself as a “melting pot” that must respect the cultural texture of each community. New Orleans differs from Oxford, Mississippi, and retains elements that attract both patients and physicians.

Approach to culture alignment:

• Define the platform culture you want to create, but allow local variations that matter to recruitment and patient satisfaction.
• Standardize operational elements (HR, payroll, holidays) where it makes sense and preserve clinical autonomy where local identity matters.
• Use physician governance and recurring face-to-face forums to shape a shared culture over time.

Business Transformation: Three Priorities for Scalable Growth

Graham’s dual role, M&A and business transformation, reflects the synthesis required to attract future acquisitions: the platform must be operationally attractive today and credible about its future vision. He defines three transformation priorities that should guide MSOs’ intent on sustainable growth.

1. Improve Patient Access and the Front Door Experience

Patient access is the first battleground. Making the patient experience feel effortless, mirroring the reception, personalization, and convenience of top-tier consumer services, creates loyalty and referral momentum. Specific tactics include:

• Streamlining phone and online scheduling
• Using technology (even simple geolocation or geotracking) to greet patients when they arrive
• Reducing redundant data entry at check-in
• Measuring wait times and first-contact resolution

Graham imagines a patient experience analogous to a five‑star hotel: employees know the patient by name and make the visit frictionless. This human-touch vision is both competitive and increasingly expected.

2. Reduce Administrative Burden Between Payers and Practices

Prior authorizations, denials, and payer friction consume clinician and staff time and sap morale. Reducing this administrative overhead allows clinical staff to return to patient-facing care and reduces burnout.

Potential solutions include:

• Centralized prior authorization teams
• Automation and AI-assisted workflows to prepare and submit authorization requests
• Enhanced payer-contract management to reduce ambiguous rules
• Clear analytics to monitor denial trends and intervene proactively

Reshaping the payer-practice relationship is not an overnight fix, but incremental reductions in friction compound across a platform.

3. Use Data to Define “Best” and Optimize Clinical Staffing

Data is the strategic differentiator. Platforms that can answer operational and clinical questions with crisp data will outperform peers. Examples of the type of questions platforms should answer:

• At what point in a physician’s career should a mid-level provider be hired?
• How should patient scheduling mix shift from new-visit-heavy to maintenance-heavy as a physician ages?
• What marketing channels attract the ideal patient profile for a given specialty or region?

With a unified EMR and standardized RCM, these questions become answerable. Data-driven staffing and marketing choices reduce waste and align resources with demand.

A Vision for USOP: Regional Scale, Better Access, and Smarter Operations

Graham projects a multi-pronged future for USOP. The platform will continue to expand regionally across the Southeast, scale ancillary de novo assets such as ASCs and imaging sites, and increasingly offer an attractive, credible operational model to prospective physician partners.

Key elements of the vision:

• Expand footprint throughout the Southeast with regionally aligned acquisitions.
• Build out de novo ancillaries strategically after acquiring physician talent in the market.
• Create a more recognizable regional brand in select markets while preserving local brands during transitional phases.
• Invest in technology, RCM consolidation, and standardized patient access pathways to make the platform genuinely better for physicians and patients.

Graham notes that the platform can move quickly when market conditions permit. The rapid scale USOP achieved, 55 locations and 300 providers in roughly 18 months, illustrates what is possible when capital, physicians, and operational processes align. Yet, the present environment rewards patience and disciplined integration.

Practical Advice: Honesty, Empathy, and Business Rigor

When asked for advice to those engaged in M&A, whether physician sellers or executives pursuing roll-ups, Graham offers counsel rooted in human decency and practical rigor.

“Honesty goes so much farther than I think we give it credit for. In the moment, you’re balancing vision and capability. The other side is going through an emotional process as well and is looking for honesty and empathy.”

Specific recommendations:

• Be transparent and empathetic: Selling physicians want to be treated as partners, not checklist items. Open communication and humility build trust.
• Keep emotions out of business decisions: Recognize that both staying independent and selling can be the “right” choice. Outcomes should not be treated as personal judgments.
• Invest in integration capability: Build playbooks for EMR migration, RCM consolidation, and cultural onboarding before you scale rapidly.
• Lean into physician governance: A formal physician board and a clinical governance charter make clinical stakeholders feel respected and engaged.
• Measure outcomes: Track clinical, operational, and financial KPIs during integration to detect early slippage and prove upside.

Graham also reiterates the enduring value of private practice. In an ideal world, private practice is the “gold standard.” But the modern landscape, with rising cybersecurity needs, AI, and compliance complexity, often compels smaller practices to partner with platforms to stay competitive.

Recommended Reading and Cultural Touchstones

When asked about formative books, Graham cites Lois Lowry’s The Giver, an unexpected but revealing pick. The Giver explores the friction between a seemingly utopian society and the hidden cost of enforced uniformity and conformity. Graham uses the book as a mental model for understanding how rigid systems can numb individual agency, a useful lens when thinking about centralized platforms that must avoid flattening local identity.

That lens serves as a reminder: platform leaders must be careful not to impose a single culture that undermines local strengths and community fit. Instead, use governance and integration playbooks to preserve what matters most to patients and physicians.

Lessons for Healthcare Executives and Practice Owners

For executives building MSOs and for practice owners considering a partnership, the USOP experience offers several replicable lessons:

1. Start with clinical credibility

Validate every deal with physician input. Clinical reputation and peer respect are more predictive of long-run success than short-term revenue numbers. Build acquisition committees that include current physician leaders with active relationships and clinical assessment capabilities.

2. Invest in integration before you need it

Create standard operating procedures and integration playbooks, EMR, RCM, people, and brand transition protocols, before you scale. Waiting to build integration capabilities until after a wave of acquisitions can create chaos and erode value.

3. Keep patients at the center of operational design

Improving patient access and reducing friction yields better patient retention, conversion, and net promoter scores, and it is often overlooked in favor of back-office savings. The first step in sustainable growth is providing an excellent and reliable patient experience.

4. Use data to guide resource allocation

Acquisition is only the first step; the platform must optimize staffing, marketing, and ancillary investments. Data will tell you where to hire a mid-level, which clinics need an MRI to improve throughput, and which markets warrant a new ASC.

5. Emphasize communication and transparency

Over-communicate, then test for comprehension. Messages should cascade, with leaders ensuring frontline staff understand and can act on changes. Communication is not done until it results in the desired operational behavior.

Closing Reflections

The story of US Orthopaedic Partners illustrates both the promise and the complexity of physician-led MSOs. Rapid growth is possible when a platform aligns capital, physician trust, and operational capacity. Yet, scale without integration discipline risks unsustainable complexity. The most successful platforms combine:

• Clinical-led sourcing and governance
• Clear operational playbooks for EMR and RCM consolidation
• Data-driven decision-making that optimizes staffing and marketing
• Patient-centered access and experience as a competitive priority
• Transparent communication and honest relationships with selling physicians

Graham Young’s pragmatic approach, honest, clinically focused, and operationally rigorous, offers a roadmap for others who seek to build physician-first platforms that scale without losing what made their practices valuable in the first place.

FAQ: Common Questions About Physician-Led Roll-Ups and Integrations

Q: What is a physician-led MSO, and why does it matter?

A physician-led management services organization (MSO) is an entity that provides non-clinical administrative support—billing, HR, IT, contracting, and finance, while physicians retain clinical control. Physician leadership matters because clinicians are the revenue drivers and key decision-makers for care delivery. When physicians feel respected and have a meaningful role in governance, alignment and outcomes improve.

Q: How should a physician evaluate whether to join an MSO or remain independent?

Consider the following checklist:

• Can the MSO demonstrably improve operational performance (RCM, payer contracting, ancillaries)?
• Will physicians retain meaningful clinical governance and control?
• Does the valuation and deal structure match the long-term goals of the partners?
• Is there a culture fit and trust with the acquiring team and its physician leaders?
• Does the MSO have a clear plan for integration, including timelines and measurable outcomes?

Q: What are the costs and benefits of keeping an acquired practice’s brand?

Keeping a local brand preserves community equity, minimizes patient disruption, and respects physician identity. However, multiple small brands raise marketing costs and may limit cross-market recognition. A phased approach preserves brand initially and considers consolidation after demonstrating operational benefits, often balancing these trade-offs.

Q: How long does an EMR migration typically take during an integration?

EMR migrations can vary widely based on practice size, data complexity, and custom workflows. Small clinics can take months; large or multi-specialty organizations can take a year or more from planning to stabilization. The timeline should be treated as a project that requires dedicated teams, extensive training, and contingency planning for patient safety and revenue continuity.

Q: How can platforms reduce payer friction and administrative burden?

Strategies include centralized prior authorization teams, automation for repetitive workflows, payer analytics to identify and fix denial root causes, and improved contract management to clarify coverage rules and reduce surprises for staff and patients.

Q: What governance structures work best for physician-led platforms?

Successful structures often include:

• A clinical governance board with decision rights over protocols and care pathways
• An enterprise physician board representing each practice
• Regularly scheduled meetings (bi-weekly or monthly) for transparency and issue resolution
• Clear escalation paths for disputes between clinical leadership and the MSO

Q: What are the signs that an acquisition is not a good fit?

Warning signs include:

• Poor peer reputation or unresolved quality concerns
• Significant misalignment on governance and or autonomy
• Unrealistic expectations about the integration timeline or upside
• Poor financial hygiene (e.g., chronic denials, unclear contracts, weak collections)

Q: How should a platform measure integration success?

Key performance indicators should include:

• Clinical quality and outcomes metrics
• Operational KPIs: average days in A/R, denial rates, scheduling conversion
• Patient experience measures: NPS, wait times, check-in satisfaction
• Employee engagement and retention metrics
• Financial performance: EBITDA margin, revenue per provider, ROI on denovo investments

Final Takeaway

Building a regional, physician-led orthopedic platform requires blending respect for clinical identity with disciplined business transformation. From preserving local brands to consolidating EMRs, from expanding ancillaries to standardizing patient access, the work is both technical and human. Graham Young’s experience at USOP demonstrates that honesty, consistent communication, clinical governance, and patient-first operational improvements are the levers that create durable platforms. For leaders inside healthcare organizations, those are the levers worth mastering.

For a complete, first-person conversation with Graham Young on these topics and more, Allegrow’s original video interview is an essential listen. It provides context and anecdotes that enrich these written takeaways and offer additional nuance for leaders preparing for the next phase of growth.