I’m not going to tell you that nothing changes when you sell your practice, because that isn’t true. You are inviting a new group into a business you built from the ground up, and the way some things run will look different a year later than they do today. That doesn’t mean change is bad.
Change is coming to your practice whether or not you ever talk to a buyer. Reimbursement rates keep fluctuating. Labor costs continue to climb, and the associate you were hoping to hire next year is likely being recruited right now by a group down the street with a bigger budget and a full-time recruiter on staff. If you plan to be in the chair for another decade, you are going to make real investments in technology, space, and people, and you will make them with your own capital and balance sheet. If you plan to be out in five years, you still have to solve for what happens to your team and your patients when you go.
Change is inevitable. The question becomes whether you are the one choosing the terms of that change, or whether you are absorbing whatever the market hands you.
Why Healthcare Practice Owners Sell Their Practice
Some owners are looking at retirement in the next three to five years and want to know the transition will be handled well for their team, their patients, and their own financial picture. Some are nowhere near finished practicing and actually want a partner who can carry the operational weight so they can go back to being a clinician. Plenty of owners sit somewhere in the middle, wanting to take some chips off the table now while staying involved in the growth of the practice for years to come.
Those are meaningfully different situations that call for meaningfully different partners. If you have fifteen years of practice ahead of you, the growth plan matters just as much as the valuation the buyer places on the practice. If you have four years ahead of you, what matters most is ensuring you’re maximizing valuation while making sure the transitionary period leading up to the day you walk out of the practice is managed smoothly.
The part most doctors don’t realize until they’re in it
Before I joined TUSK Practice Sales, I was on the buy-side. When we found a practice we were interested in, we would build a complete picture of your business. This included studying your collections, your payer mix, your production by provider, your staffing costs, your lease, your growth over the last three years, and how much of that growth depends on you personally. By the time an offer was put in front of you, buyers know your practice nearly as well as you do.
The buyers have done a tremendous amount of homework on you. You should be doing the same. At TUSK, we meet with buyers monthly to understand their focus areas, how their business has performed, and any insights on potential recapitalization conversations. We’re connecting with our past clients that are 1 – 8 plus years into a partnership with these groups to understand how they operate in the space. This is all information that will help practice owners know the buyers and gives them the control to put every buyer on a comparable scale relative to each other.
The Questions to Ask Buyers
You have the power in your hands to select the right partner for your practice. Below are some key questions you need to ask:
Who Is The Investor Behind the Platform?
Nearly every group that approaches you has an investor or private equity group behind it, and that investor is working against a timeline. A platform that recently raised new capital will have a different focus than one that is eighteen months away from selling to its next investor. This matters most if you are keeping equity in the business, because the timing of that next transaction shapes what your retained ownership is eventually worth.
Ask To Spend Time With A Doctor Who Is At Least A Year Past Their Close
That doctor will tell you things no presentation ever will, including what surprised them, how their day-to-day has changed (if at all), and what they would have done differently if they could do it again. Your advisor should be able to make that introduction, and the better groups will offer it before you have to ask.
Understand What They Are Actually Trying To Change
Most buyers are not looking to change how you practice. They aren’t clinicians, and they know it. The reason your practice is attractive to them in the first place is the clinical judgment and the reputation you have built, and interfering with either one would work against their own investment. What they are typically trying to do is provide support in areas surrounding your clinical work: recruiting, purchasing, human resources, billing, marketing, and the administrative load that has been pulling you away from patients for years.
What Does Integration Actually Look Like?
Many buyers will want to move quickly, but in phases. Ask whether the name on the building changes, whether your practice management software changes and who handles that transition, what moves to a central office and what stays with your team, and how long each piece takes. Groups that have done this well many times will have a clear answer ready.
What Happens To Your Team?
You wouldn’t be here without your team. Compensation, benefits, paid time off, role changes, and how and when the news gets communicated to the people who have worked alongside you for years are all things that you should be discussing. You have more say in this than you think you do, particularly while the group is still working to win the deal.
Your Role, Your Compensation, And Your Exit
What you will do after closing, how you will be paid for it, how long you are committed, and what happens if you decide to leave earlier than planned are all negotiated by your advisor before the letter of intent gets signed.
Your advisor should also be able to show you what the next five years look like in actual dollars, starting the day the deal closes and running through the day you walk out of the practice for the last time. That means your compensation, the value of what you keep in the business, and what you are giving up along the way compared with staying independent. Until somebody has put those numbers in front of you, you don’t have enough information to say yes to anything.
You Need More Than One Buyer at the Table
Every question above needs something to measure against. When one group is the only group at the table, you can get answers to all of it and still have no idea whether those answers are good, because you have nothing to hold them up against. A doctor with one interested buyer and a doctor with several are having two completely different experiences. The doctor with options can ask harder questions, take more time, and walk away from a group that doesn’t fit. That is what being in control of this process actually looks like.
Where To Start
If you are somewhere in the range of thinking about selling your practice, the most useful thing you can do is get clarity on what the next five years of your life look like, and what a partner would have to be able to do to get you there. Once you know that, evaluating groups becomes a much more straightforward exercise that keeps you in control. You will be much more prepared for the day change begins with your new partner.
That’s the conversation I have with doctors most days. If you are weighing this and want to talk through what your own criteria should be, I’m happy to be a resource whenever the timing feels right.
