A new report from Irving Levin Associates and HealthCareMandA.com said mergers and acquisition (M&A) activity “surged” among physician medical groups in the first quarter of the year, with 48 deals confirmed.

The sharp increase is 78 percent above the 28 acquisitions publicly announced in the final quarter of last year and 109 percent above the 23 deals from the first quarter of 2016.

Hospitals and health systems were behind seven of the medical group deals, while private equity firms also announced seven, a figure that doesn’t including transactions involving physician medical groups backed by private equity firms. Nine of the groups acquired in first quarter deals had 20 or more physicians.

“Physicians are quickly realizing that not affiliating with larger entities, whether health systems or large medical groups, is going to make the practice of medicine more difficult in the future,” Lisa Phillips, editor of the Health Care M&A Report, said in a press release.

According to the report, the most prolific buyer was MEDNAX with five acquisitions as part of an early 2017 buying spree. Envision Healthcare acquired four groups, including Sunshine Radiology, while Dermatology Associates and Epiphany Dermatology reported three acquisitions each.

Only one of the deals disclosed the purchase price: the $2.3 billion sale of Surgical Care Affiliates to Optum, a subsidiary of UnitedHealth.  

M&A activity was down in other healthcare sectors. In a separate report, Irving Levin Associates reported a 45 percent year-over-year drop in senior care acquisitions.