Josh Swearingen 00:05

Good evening, everyone, and welcome to the TUSK Practice Sales webinar. Tonight, we’re going to be diving into a plastic surgery mergers and acquisitions market update, and we’re just thrilled to talk to you a little bit about what happened in 2024 and what we think is going to happen moving into 2025 My name is Josh Swearingen. I am thrilled to be here this evening. I have about 20 years in the healthcare management environment. I’ve worked running an MSO, and I helped build an MSO, ultimately selling one of them off to a private equity backed sponsor. I’ve also had the opportunity to work as a buyer in the healthcare markets, valuing and looking at practices similar to those that you own. And I now work representing sellers in the market, trying to ensure that they receive the maximum value for their business. In my side time, I’ve also had a chance to run and build a medical aesthetics business on the Med Spa space that I recently sold and exited from that so thrilled to be here again and now my colleague.

Elizabeth Macready 01:13

Hi. Good evening, everyone. My name is Elizabeth McCready. I’m a director here as well at TUSK. A little bit about me, my background is a little over 15 years in healthcare space. Throughout that period of time, have had the opportunity to hold a variety of different roles. Ultimately, my passion and my background is in helping healthcare companies run better organizations at every stage of their business. So, I’ve had the opportunity to be not only consultative with privately owned healthcare practices on the operations side, worked in healthcare practices operationally and clinically, but also worked on the buy side, leading acquisitions for some more prominent healthcare private equity backed MSO groups. I had my first experience working with aesthetics when I was a senior manager at Invisalign, which is an orthodontic aesthetic product with some clinical function, obviously, with as it relates to oral health, and really became passionate about the merging and the intersect between healthcare and aesthetics. I came on board with TUSK, and now I have the opportunity to represent sellers and helping you understand your options at the point in time where you’re thinking about and preparing to sell your business. A little bit about TUSK is, we are a nimble company. We have 14 dedicated team members. However nimble we are, we outsize that you know, the size of our company with the years of experience behind us combined, we have over 50 years of investment banking, M&A and private equity experience, we have about over 120 years of healthcare experience, and have overseen over a billion dollars in healthcare transactions. You know, during those 200+ transactions, we’ve gotten the opportunity to, you know, spread our wings in the healthcare space and gain knowledge and experience that we hope helps you leverage our team’s experience during your sale process. So, one of the things about TUSK that is unique to us and how we relate to the finance world, and the intersect between finance and healthcare is that a large part of our team has a diverse background, not only in finance and investment banking, but also working in other facets of healthcare as well. So, you’ll see on the screen an overview of just some of the companies that are have aided in the experience that our team has accumulated over the years. And you’ll see names such as, you know, GE, aviation, platinum, dental care, some distribution companies and that wide range of knowledge and experience we feel helps us not only to be able to best represent your business and market, but to relate and empathize with what you deal with every day. Our team, we go beyond just numbers on a spreadsheet, and we really seek to understand you as a business owner and a healthcare provider and the passion that you have with caring for your patients.

Josh Swearingen 04:41

Thank you, Elizabeth, appreciate that. So, I’d say, to say the least, one of the more influential factors that kind of weighed on the market over the course of 2024 was the upcoming election, and now that that’s behind us, and we have some clarity over what you know the next four years are going to look like. I. We’re starting to see some significant movement in the space that had been frozen previously, largely just because of the fear of the unknown. With President Trump taking over in a super majority in the House and the Senate, we do anticipate seeing an uptick in how private capital flows, which means that there are going to be a lot of private equity groups out there who have been sitting largely on the sidelines over the last couple of years, who will be attempting to deploy capital into the market over the next several years, which is good for the conversation that we’re having tonight, because inherently it tends to drive valuations up and open up the market to a more competitive environment. In addition, as we look at the interest rate environments, it’s important to understand how deals are structured and whenever, whenever you’re interacting with a private equity group and you’re discussing kind of the overall structure of a buyout, there is a percentage of it that is, is indeed captive capital. It’s kind of it’s those private equity funds that they have sitting in the bank from their investors that they’re partially utilizing to fund some of these acquisitions. But then there’s also a portion of it that is always tied to a loan or a note, which obviously the interest rate environment impacts it tremendously. So the hope is that as we start to see the FED easing, and we start to see rates decreasing a little bit, that will actually open up the floodgates for that capital to be again deployed in the near future, and it should speed up transactions, or the rate of transactions, in the future simply because they’re not quite they’re not going to be as expensive for the buyers.

Elizabeth Macready 06:45

If I can just weigh in with an example to give some context behind how the interest rates impact buyers ability and appetite to invest in the market, we were given some information from a buyer that we have a relationship with in the healthcare space, a private equity backed group, and with the decrease in the back half of the year in the interest rates, they were able to save over a million dollars, just simply in interest payments annually that fell to their bottom line that they’re planning to reinvest into the market through acquisition. So, if that helps to give some context to how interest rates impact you know, the sale of your business, that’s a very real thing, then basically frees up that money to be used in other ways, which ultimately benefits you as a seller.

Josh Swearingen 07:37

Yeah, that’s actually a great a great point, Elizabeth and I would say, even to take that a step further, if you if you look at the transactions that did occur throughout the course of the year, and I know, you know, in the conversations that we’ve had with buyers, you did start to see a little bit of a discounting of the deals. So instead of paying, you know, a 5x or a 5.5x, the buyers may come in with at a 5x or a half a turn lower simply to offset some of that additional capital cost on the back end. So ultimately, this, this, this plays out very, very well for all involved. It’s better for the buyers. It increases valuations for the sellers, and capital markets keep moving, and it creates a more competitive environment. So, point, point, well, taken.

Elizabeth Macready 08:24

Okay, so we’re going to hop to plastic surgery market update for 2024 and some of the trends and learnings that we found along the way this year. So, it’s probably no secret to anyone at this time that private equity is really seeing and garnering an increased interest into plastic surgery due to a couple of factors, but mainly, you know, the overall market opportunity that’s presented has just driven this outsized interest into investing into the space. So overall, many of us, and you all that I have conversations with regularly have experienced this increase in consumer interest and aesthetic procedures. And so, we’ve seen that overall, 5% increase from 2022 to 2023 in consumer-based investment into cosmetic procedures. And so, we can point to probably a lot of cultural shifts and technological shifts that have allowed for that to happen. But the way that that impacts private equities interest is they start to see these high growth rates and shifting consumer interest, and they start to become interested in investing in other ways, such as acquisitions and building platforms and finding ways to become part of that growth opportunity. So, if you’ll see on the left-hand side, there is a graph here. Essentially this graph shows in the dark blue on the left the deal activity in all of 2022 in the plastic surgery space. And if you compare that to the light blue on the right, if you look at that graph, which is basically just the first half of 2023 so January to June, the amount of deal activity equaled the entire year of 2022, deal activity. So, we’re starting to see that kind of transfer over from growth, operationally, procedurally. You know, the breath of the industry growing in terms of consumer reach and interest in their own personal wealth, well-being and aesthetics and that filtering over into how we’re seeing this deal activity pick up in the market. So a couple of things to note about the investor interest we spoke previously on the previous slide, about that increase in acquisitions that we’ve seen and experienced, that we have a lot of relationships with buyers, private equity groups that have made similar investments in other verticals of healthcare, starting to turn their attention towards plastic surgery and reaching out to us and expressing interest in wanting to find platforms to invest in into plastic surgery. So overall, you know, we’ve seen this surge take place. 63% of deals that were done in 2023 were in aesthetics. That’s a pretty huge number. That’s up from 3% in 2017 you know. And what’s important to understand in how investors are looking at your particular office, they’re favoring practices with medical, cosmetic, and aesthetic services. So, if you’re a plastic surgeon, who you know, you’re able to diversify the amount of procedures, the types of procedures that you’re offering the office. And you’ve made that leap to implement not only surgical, you know, traditional surgical procedures that you were trained in, but then also non-surgical procedures and toxins and lasers and things of that nature. These are where we start to see the investors really start to really look for these types of diverse procedure mixes and types of practices that they’re willing to invest in. So that’s something that’s important to note. What they’re essentially offering for you as an individual practice owner are a couple of different things. A, it’s the ability to centralize operations and spread overhead over larger revenue. So, as these groups begin to continue to acquire more locations, that allows for some economies of scale and synergies to take place, which can help with the overall function of running the organization in a more broad and comprehensive way. And essentially, ultimately, what that should allow you to do as a as a provider, is to focus more intently on your patients and your procedures and getting the best outcome for your patients. When the private equity firm is providing the value that they should and can in the market as it relates to the healthcare space, they’re able to take off the burden of business, you know, day to day, some of the managerial burden that you experience day to day, everything that kind of takes your time and attention away from ultimately, taking care of patients is what they look to alleviate from your shoulders. And so that provides a lot of upside and a lot of opportunity for doctors who are looking for that type of relationship and looking for that growth opportunity. One an important point, however, is that we are early innings in the consolidation wave of plastic surgery. It is a, you know, relatively narrow market in terms of the number of specialists and plastic surgeons. However, you know, as that continues to mature, and we start to see this map expand, and we have more dots on the map of acquisitions that have been done. It’s important to know that, you know, the valuations over time may compress as the runway progresses along. So you know, at the end of the day right now, there’s a lot of activity happening, and it’s the right time, if you’re a doctor who has this in your five to 10 year horizon of completely exiting your business, that there is a pathway for you here, and you know this hopefully helps give you some context as to how private equity is going to view some of the elements of your business.

Josh Swearingen 14:19

I think it’s interesting as you look at this, because as you look at how the market kind of evolves, and we’re going to actually get into this a little bit more later, there’s kind of a balancing act between being too early and being too late. And you can get to into a situation where you’re too early and there just aren’t enough buyers out there, so there’s not really any way to actually set the market. There’s no competition. If you’re looking at being purchased, there’s, there’s one party that’s in play. And because there’s no competition, they can kind of set the value wherever they want. And then on the back end of that, when it becomes overly consolidated and there are too many players out there, those players eventually. Need to start taking bigger bites of the apple, and they end up acquiring other larger players. So, then the market is essentially established at the high end, and the mid-tier kind of gets lost in the middle or the private practices ultimately get lost in the middle. And I think we’re really kind of in a sweet spot right now where there are enough acquiring entities to kind of create a competitive environment. But we haven’t evolved so far that they’re really, really looking at acquiring each other as of yet, they’re still looking at private practices as the highest valuation, and that’s really kind of the sweet spot that you want to be in as a private practice owner, and really the segment of the market that we’re going to be in for probably the next several years. So, I just wanted to add that on.

Elizabeth Macready 15:46

Well said. So why enter the market? One thing that you know I mentioned in previously is that we have noticed this trend of private equity backed groups that we have awareness of, and maybe we’ve had dealings with and other verticals of healthcare are finding investments in plastic surgery. So, there’s a couple of examples on the screen of private equity firms that have investments, not only in now plastic surgery, but they may be operating under a different name and a different managed service organization brand in a different vertical. And so why that’s important is that you know, when you work with a representative or broker like TUSK, we’re able to leverage that relationship and some of our knowledge of this group, their track record as well, to be able to arm you with the most information possible prior to making that leap and selling your business to a particular buyer, for instance. So, you know, it’s an important point to understand as it relates to how the market is shaping up and who some of these players are and the capital that’s backing them.

Josh Swearingen 16:57

Yeah, I think on the backside of that, you know if you’re considering going through a process like this, and you get into a situation where you have several people bidding on your business or competing for your business, you’re going to see a lot of terminology from a lot of organizations that you’ve never heard of, and the process Is, is very difficult for someone who’s not actively in the investment banking community every day. So, I think from our perspective, understanding that, you know, there are players in the space that have a long history of provider based healthcare platforms, versus players that may be competing for your business, that are in manufacturing or are in, you know, who knows, restaurants or something like that. I think having a really good feel for who these players are and who they represent, and who’s actually the money behind the MSO is critically important, because it can really inform not just what your how your process is going to go and what your experience is going to be post close, but ultimately how that business is going to going to perform long term, because there’s ultimately going to be a reasonable amount of rollover equity that’s tied up in these deals. So, you’re essentially investing in the parent business, and you want to ensure that whoever’s running that business has done this a few times and can give you some level of comfort in the value of that equity. Okay, so I think when you’re talking about private equity moving into the space, and you’re talking about MSOs and platforms and things of that nature, I think it’s actually really helpful to take a little bit of a step back and look at where we are within consolidation, not just in the plastic surgery space, but also where we’ve been in other verticals previously. So, if you look at medical consolidation, which, gosh, started probably 30 years ago, maybe even longer than that, it’s around 85% consolidated, and that’s largely consolidated under the university and hospital system umbrella. So, you see very, very few private practitioners out there that are operating independent primary care offices. And if you skip up and you look at dental consolidation, dental consolidation is probably in the 30 to 35% consolidated range. And there are estimates kind of all over the place, but that that’s really kind of where the average hits. And then I would say that they are really in kind of the glory days of private practice consolidation, which we’ll talk about here in a minute. And then plastic surgery is very, very early on that 3 to 5% range just kind of getting started, just seeing a lot of initial platform development and private equity groups throwing their hat into the ring, trying to get in in these early stages. So, all of that, bears different results for each of those respective or verticals. But I think it’s, I think as we get further into this conversation. It’ll make a lot more sense. So, along those lines, when we’re talking about kind of that consolidated range, you know, that 0 to 10% consolidated, which is where, where we are currently in plastic surgery, that’s really where you see a lot of large, multi-site groups getting developed. Most of the buyers out there are pure private equity groups or family funds, venture capital, things of that nature. And they’re looking for an initial investment that has some reasonable infrastructure in place, maybe a management infrastructure, a benefits infrastructure, things like that. Might be multiple locations as well, and are usually, usually bringing in roughly 2 to $5 million in EBITDA. And then once you get over that kind of 10% consolidated range, you’ve then gotten to a point where you have enough platforms out there that you can create a competitive environment for private practices. And then that next phase, which we’re going to be tipping over into over the next couple of years, is really that kind of 10 to 40% consolidated growth for an industry. This is where dentistry is currently. And the benefits of those that you start to see all of these larger groups that are that are looking to bring on, bring in, add on practices, they’re not necessarily focused on a really large scale purchase, because they’ve made that initial investment, they’re really looking at complementing that investment with additional assets to surround it and help build around so you can usually start seeing some of the smaller groups, the 250,000 to 2 million in EBITDA businesses that get folded into these larger platforms. And that’s how these organizations kind of pick up scale and grow quickly. And then on the back end of this, and this is, fortunately for us, really, really far down the road at this point, is the 40% consolidated plus range. And that’s, you know, obviously medical is in that currently. There are other verticals that are in that veterinary as well, in that currently, and those are the markets in which you have a lot of large scale groups that are out there, and they’re no longer really focused on the private practices, because they really need something a little bit meatier to move the needle for their growth. So, you see large groups buying up kind of small and mid-tier groups, and large groups merging with other large groups, and so on and so forth. And this is where you see consolidation as a whole speed up, because you’re bringing all of these large assets together, but the market for private practices starts to decline somewhat precipitously because you don’t have nearly as many buyers who are interested in a smaller scale acquisition. And again, this is where medical is where, if you’re a small private practice right now and you’ve been able to kind of weather the storm, maybe in a fee for service or concierge, type of environment, you don’t have a lot of acquirers out there who are interested in bringing your business in. So, your exit strategy is essentially work until you either find someone else to take over the concierge business, another doctor, or ride off into the sunset. And then I think, over the next, you know, 5 to 10 years, what we’re really going to see is a move from private practice. Many of those, those initial private practices, are going to be large scale private practices building out the platform, and that’ll shrink to around 60% of the market. And this is these are all kind of pressure tested by dentistry and medical and some other some of the other healthcare verticals that are out there, these are pretty consistent with what we’ve seen in each one of these verticals over the last 30 years. Your middle market, which are your kind of your mid-range group practices, probably, I don’t know, 2 to 25, 30, 35 locations will make up a large percentage of the market, or much larger percentage of the market. And then you’ll see the elite groups grow somewhat, somewhat sizably as well. So, you can see how this all starts to funnel away from the private practice model into the group practice model and as this happens, and we won’t notice it as much in plastic surgery, because it’s not a it’s a largely fee for service business, but it’s this scale that allows these groups to negotiate payer contracts, negotiate supply contracts, and things of that nature, that really helps them to differentiate themselves from a competitive standpoint.

Elizabeth Macready 24:29

So due to a lot of the changes that Josh walked us through relative to the consolidation in the market, what that means is that there’s a different buyer profile that’s entered the marketplace. So, what I mean by that is that, traditionally, as a plastic surgeon, maybe in a group with other plastic surgeons, or as a sole proprietor, you have a pretty you know, kind of clear cut way of eventually exiting your business, which was find another plastic surgeon to sell your business to, that person gets bank financing, or there’s other type of way to finance the structure of the of the sale. And you know, the changing of hands occurs, and then you’re on your merry way into retirement. That was really, you know, up until recently, when private equity became more and more interested and invested in consolidating the plastic surgery space and the med aesthetic space in general, really, the primary pathway for exiting the profile has shifted, whereas today the buyer profile, you know, is leaning more towards these managed service organizations which we’ve been discussing. So, timeline wise, you know, we have a different set of expectations. In the days of old, of, you know, selling to another plastic surgeon or another medical provider, you know, you know, you got about a six month transition timeline. It’s pretty clear cut and revenue and banks are very tied into the valuation of your business. With this new buyer profile, with private equity and private equity’s involvement, it’s a whole different ball game. Essentially, most private equity firms are not looking for sellers who are looking to exit their business immediately. And that’s an important note in that that requires a longer runway of planning as they will look for a three to five year transition timeline. So if you’re a plastic surgeon, and you think, you know, you know, maybe I’ll want to sell in five years, and you’re thinking mentally, you’ll want to be down, done with producing in the business in a five year time period, now’s the time really, to think about, you know, how you can start to plan that and maximize that so that you know, if you decide to go down this path and really take advantage of this heightened interest in the market with private equity groups, that you’re able to you know time that sale appropriately, so that you know you can fulfill the obligation of that three to five year period and maximize your returns on a partnership with private equity. So, the buyer profiles changed. Obviously, there is still a place and a pathway for private transactions selling to another plastic surgeon. That is still happening, and it still will continue to happen. However, with this new buyer profile answering in the market, it’s important to understand the nuance differences and how a private equity group will look at your business value it differently and have a whole different set of expectations for you pre and post-sale. So, what are some of the key characteristics driving higher valuations. We have these conversations with sellers and potential sellers and business owners all the time. It really comes down to, you know, four elements. First, you know, if you own a plastic surgery business and you have multiple providers that are producing in the business, which means, you know, you’ve sort of, although it can be counterintuitive, you sort of have found an opportunity or a way to delegate some of the productivity to other producers in the business and/or have multi-site locations that are open and operating. What that does is it reduces what is viewed as key man risk in selling the business. And then that’s something that we see impacting, I think, maybe especially since plastic surgery is a highly specialized field, um, you know, probably especially in the plastic surgery field, impacting valuations either positively or negatively, depending on how you’ve decided to build that business and weave that into place over a period of time. So, more providers, great multi-site that’s great, obviously, in that process, maintaining margins, keeping a healthy business and keeping the financials front and center is also important to consider. Second is a diversified service offering. So, we talked a little bit previously about, you know, the sort of conjuncture between the surgical and non-surgical offerings. Non-surgical, you know, gaining steam. There’s all kinds of new technologies coming out all the time that are, you know, reduce recuperation time, making, you know, bringing, just opening up the market and bringing more people into the medical aesthetics, quote on quote, space with interest, then willing to spend money. People want to look good, and the barrier of entry is becoming lower and lower. So, if you’re able to capitalize that and diversify the service offerings in your business, that’s a big plus that we see also driving higher valuations. The third thing is having a growth mindset. I spoke previously about what the new quote on quote, buyer is looking for and a big part of that is growth opportunity. They don’t want a declining practice. They don’t want someone who just wants to hand them the keys and take their foot off the gas pedal. They’re really looking for people, practice owners and doctors who have a mentality of wanting to continue to grow their business. And I’ve built a business that is able to continue to grow above and beyond you know your tenure in working in the office down the road. And then lastly, really just the size of your EBITDA, which is just a if you’re not familiar with that term, earnings before, interest, taxes, depreciation, amortization. This is a financial term that we use, and private equity uses to value your business. If you’re not familiar with what your adjusted EBITDA is, we’re happy to help you figure that out and understand that better. But essentially, your free cash flow in the business modeled in with some industry specific considerations help us get to a place where we understand what that EBITDA number is. If you’re in the million dollar plus range, we start to see the valuations become really competitive. And you know so knowing that number, if you have a goal for retirement or a goal for what you want to hit in order to make it work for you, both personally and financially and professionally, to make that leap. And you’re in this range, you know, definitely reach out to us and let’s have a conversation. But in the in the transactions that we have led in market that that are able to command, you know, these higher valuations, that’s where we start to see, you know, these four things in alignment with each other really start to create the competitive buying atmosphere that we see the highest valuations happening right now. Yeah,

Josh Swearingen 32:11

I want to add to that. I think we’ve actually hit somewhat of a sweet spot as well, because we do have a reasonable number of strategic buyers. Those are existing MSOs with existing platforms already in place, and they have a little bit of scale, a little bit of infrastructure, and they’re looking at adding to that, but they’re willing to take on practices that are a little bit smaller than, you know, platform status. So, you get north of that 1 million in EBITDA. It’s a very, very attractive range for a strategic buyer. But in addition to that, you have a lot of private equity groups that have been sitting on the sidelines waiting to get in, and they’ve had a hard time locating that strategic investment, or that initial platform investment, or the group that they’ve been looking for. So rather than, you know, starting off at two and a half, three, $4 million in EBITDA to build out their platform. They’re willing to take a chance on a little bit smaller group, if there are a couple of providers, and if they’re they have a growth mindset and things like that. So, you’re actually seeing private equity groups dip into the private practice market on the smaller side, if they can find the right owner and the right business to invest in, even if they understand it’s not quite the size range they were looking for. So, once you get over that 1 million in EBITDA and trailing 12 month EBITDA, you start to open yourself up to a broader range of buyers, and it becomes very competitive out in the space. So, and as a case study of this, you know, we had a deal that we took to market a few months ago, and I’m running it and, you know, it’s a very attractive plastic surgery business, north of 3 million in EBITDA. The doctor is very growth minded. It’s only one location, so it’s not, it wouldn’t ordinarily be worthy of a platform investment, but it’s large enough. And the doctor actually has multiple providers and has kind of a scaled infrastructure in place. So, he has a couple layers of management and a marketing person, human resources person, so the beginnings of that are all there, along with the EBITDA that most of these groups are looking for. And we went really broad with this, and we talked about it a couple times throughout the course of this presentation. But you know, when we when we take a business to market, our goal is to provide a really or help run a really competitive process. And we went out to 300 prospective buyers within a few days, had 61 non-disclosure agreements from qualified buyers after I opened up the data room to those, to those buyers. You know, you kind of work through all their questions. You do qualify some of them, you disqualify some of them. You know, after conversations, you get a feel for what they’re looking for. And we already have a very good idea of what our seller is looking to attain out of this, be it both from a financial standpoint and from a kind of quality of life, goals, aspirations standpoint. And we’re able to whittle that down to a much smaller group, and ultimately received 8 indications of interest out of that group that were in line with evaluation that we thought was reasonable, and out of that, we’ve ironed it out to about 4 letters of intent, and we’re zeroing in on a final Loi that will be signed that is approaching a double digit multiple on this business, and the doctor has found a very good, very good fit for the business. Is extremely happy with all the interactions that he’s had with various buyers, and the fact that he’s really been able to canvas the market and see what’s out there, and kind of finally tune this down to the buyer that he felt best about at a valuation he was very comfortable with. So, kind of bringing this all to my head here, what are some key takeaways that that we’ve noticed over the last year and are anticipating moving into the coming year? I think, I think it’s safe to say that private equity interest in plastic surgery is going to remain incredibly high, and it’s only going to grow and accelerate. And I think I’ll skip a couple of points here, but I think that a lot of that is due to market economics that are going to drive a more aggressive M&A cycle, and there being a tremendous amount of capital sitting on the sidelines, waiting over the last couple of years to be deployed. And I think that that, I mean, I think that really bodes well, not just for 2025 but probably for the next three to four years, as we look out into the future, I think that, you know, we’re really entering the golden age of private practice ownership in plastic surgery. You know, we’ve seen this in other verticals, where generational wealth can be created. You can take the business that you’ve worked your entire life on and help monetize that take some chips off the table. And we’re at an early enough phase where your rollover investment in some of these, some of these platforms that you’re gonna have an opportunity to invest in can appreciate astronomically during the first 5, 10, 15 years of formation and ownership. And I think that in many cases, we see, we talk about it, we talk about the second bite of the apple. But, you know, we’ll see a deal where the seller may take, you know, 60, 70% cash of close, and then that 30 or 40% in equity rollover ends up being worth exponentially more than the cash at close on the back end, and that’s really a way for you to capture some of that generational wealth out of the value of your business. Buyers will be very aggressive in attempting to keep the purchasing environment free of competition, and I’m going to skip another couple of points here to get to the bottom. But you know, you see this in the number of unsolicited offers that go out into the space. And undoubtedly, many of you have received a letter or an email or a postcard in the mail from a plastic surgery group saying that they’re interested in your business and they’re going to value it at a high level, and they’d love to have a conversation about that, and it bodes very well for the buyer if they’re able to control the entire process and keep competitors out of that process. So, I think you’re going to see more and more aggressive efforts to attempt to control as much of this front to back as possible. So, for those of you that love getting those emails and those phone calls and those postcards. It is only just begun, and you’re going to start hearing about it everywhere from every colleague that you have. So, I think you could probably prepare yourself for that. You know, to close out this slide, I think that practices are going to hit. You know, that ideal seller profile are going to trades at a high premium. So if you can hit all of those, those four points that Elizabeth spoke about earlier, within your business, or if you’re working towards that, and you’re, you know within striking distance of all four of those, I think that you’re going to see your practice trade at a premium over what else is available in the marketplace. And I think that that’s a fantastic opportunity for many business owners out in the space.

Elizabeth Macready 39:01

Timing truly is everything and I think that’s something that often gets, you know, we take for granted in viewing, you know, the sale of a business, and so, I talked to many business owners who you know, as you get to know the market dynamics on a macro level, which we’ve talked through some of those today, you can start to align your timeline against the opportunity in the marketplace. And I, I can’t stress enough how many times we’ve run into sellers on the back end of that rush, or that level of interest, if you will, where kind of the ship has sailed. And then we have these sort of late adopters who want to, you know, sell their business. But unfortunately, you know, the timing is really important here. So, we have in the plastic surgery and med aesthetic space, it’s a very, very good time. And if you’re even at all considering you. Your options with selling your business, or you’re just curious about the valuation or the process, we’d love to have that conversation with you on a more one on one level. And you know, please reach out to us if you’re curious at all and you’re ready to start planning for that exit.

Josh Swearingen 40:17

Well, that concludes our time. This evening, we actually ran out of time to take questions along the side so, if you submitted a question, we will certainly be getting back to you within the next day or so. But we really appreciate you joining us for our plastic surgery year-in review webinar, and we look forward to catching you the next time. Thanks a lot. Bye.