Can a buyer of a medical practice be required to take over the seller's existing patients on record?

Generally, no — a buyer, as the physician who will actually be providing care, retains their own professional judgment about which patients they take on, and patients themselves retain the right to choose whether they want to stay with the incoming physician at all. A purchase agreement can certainly be structured around an expectation that the buyer will take over the existing patient base as part of what makes the practice valuable, but this works through patient choice and physician acceptance, not through a mechanism that automatically assigns patients the way a lease or equipment might be assigned.

In practice, most medical practice sales involve a notice process where existing patients are informed of the change and given the opportunity to continue with the new physician or seek care elsewhere, and the value of the practice being sold often reflects an expectation — but not a guarantee — that most patients will choose to stay. A buyer who wants more certainty about patient retention might negotiate purchase price adjustments tied to actual patient retention over a defined period, rather than trying to force an outcome that ultimately depends on individual patient choice and the buyer's own clinical acceptance of new patients.