Selling your plastic surgery practice is one of the most important financial decisions of your career. For owners in Ohio, the current market presents both unique opportunities and complexities. This guide provides a clear overview of the landscape, from understanding your practice’s true value to navigating the sale process. Properly preparing for your exit is the key to securing your legacy and maximizing your financial outcome. It is a journey that requires a plan.
Timing your practice sale correctly can be the difference between average and premium valuations.
Market Overview
The Ohio plastic surgery market is robust and competitive. With a strong base of talented surgeons and high patient satisfaction, practices in the state are attracting significant interest from buyers, including private equity firms looking to enter or expand in the Midwest. This creates a favorable environment for practice owners who are considering a sale. However, it also means that buyers are more sophisticated than ever. They are looking for well-run, profitable practices with clear growth potential.
Here’s a snapshot of the Ohio market:
1. Talent Pool: Ohio is home to approximately 436 plastic surgeons.
2. Reputation: Surgeons in the state maintain a high average patient rating of 4.49 stars.
3. Buyer Interest: The market is seeing increased activity from both strategic buyers and financial investors, like private equity.
Understanding your practice’s current market position is the first step toward a successful transition.
Key Considerations
Before you dive into financials, it is important to clarify your personal motivations. Are you selling for retirement, to reduce administrative burdens, or to partner for growth? Your answer shapes the entire transaction. Selling the practice you built is a major emotional and financial event. You need to consider what your post-sale life will look like, especially if you plan to continue working. Will you be happy with less autonomy? Answering these questions early helps define what a “successful” outcome truly means to you. This is also the time to begin assembling your advisory team of M&A, legal, and financial professionals to protect your interests.
Your specific goals and timeline should drive your practice transition strategy.
Market Activity
A major trend in Ohio and across the country is the rise of private equity (PE) investment in aesthetic medicine. It is important to understand how these buyers operate.
The Rise of Private Equity
PE firms are not other surgeons. They are financial investors who are highly skilled in acquiring and growing businesses. Their goal is to professionalize a practice’s operations, increase its profitability, and eventually sell the larger group for a significant return. They have teams of experts in finance, marketing, and operations to achieve this.
What This Means for You
When you negotiate with a PE firm, you are not just discussing a price. You are negotiating complex deal structures, employment agreements, and future performance targets. They understand how to structure deals that favor them. To ensure a balanced outcome, you need an advisory team that operates at their level of sophistication and has navigated these exact scenarios before.
Private equity’s influence in healthcare continues to grow.
Sale Process
A successful practice sale does not happen overnight. In fact, we advise owners to begin planning three to five years before their target exit date. The active sale process itself typically takes 12 months or more. It begins with professional preparation, including a formal valuation and organizing your financial and legal documents. Next, your advisor confidentially markets the practice to a curated list of qualified buyers. After initial offers are received, the process moves to due diligence, where the buyer conducts a deep review of your entire operation. This is often the most challenging phase. It culminates in a final negotiation of the purchase agreement and, finally, the closing.
The due diligence process is where many practice sales encounter unexpected challenges.
Valuation
What is your practice really worth? Sophisticated buyers typically determine value using a multiple of Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization). Adjusted EBITDA is your net profit after adding back owner-specific and one-time expenses to show the true cash flow of the business. This figure is then multiplied by a number (the multiple) that reflects your practice’s risk and growth profile. A higher quality practice commands a higher multiple. For practices with over $1M in EBITDA, multiples can often range from 5.5x to 7.5x or more.
| Factor | Lower Multiple | Higher Multiple |
|---|---|---|
| Provider Model | Owner-dependent | Associate-driven, multiple providers |
| Service Mix | Primarily surgical | Diversified surgical & non-surgical |
| Financials | Messy, unorganized books | Clean, professionalized financials |
| Facility | Outdated equipment or decor | Modern, updated facility |
Valuation multiples vary significantly based on specialty, location, and profitability.
Post-Sale Considerations
The journey does not end when the sale closes. Your pre-sale planning must account for what comes next. You need to map out your new role, whether that is as a lead surgeon in the new organization, a part-time associate, or a retiree. Many modern deals also include structures like earn-outs, where a portion of the price is tied to future performance, or rollover equity, where you retain a minority stake in the new, larger company. Understanding these components is critical. Finally, a proactive tax strategy is needed to ensure you preserve as much of your hard-earned proceeds as possible.
Every practice sale has unique considerations that require personalized guidance.
Frequently Asked Questions
What factors influence the valuation of a plastic surgery practice in Ohio?
The valuation is typically based on a multiple of Adjusted EBITDA. Factors affecting this multiple include the provider model (owner-dependent vs. associate-driven), service mix (surgical vs. diversified), financial organization, and the state of the facility (modern vs. outdated). Practices with clean financials and diversified services command higher multiples.
How important is timing when selling a plastic surgery practice in Ohio?
Timing is crucial as it can significantly impact the sale price. Proper timing, ideally planning your sale 3 to 5 years in advance, helps you prepare thoroughly and market the practice when buyer interest and market conditions are optimal, potentially leading to premium valuations.
What role do private equity firms play in the Ohio plastic surgery market?
Private equity firms are increasingly active buyers looking to acquire and grow practices. They bring financial expertise, aiming to professionalize operations and increase profitability. Negotiations with PE firms involve complex deal structures, requiring experienced advisors to ensure balanced outcomes.
What are the key steps involved in selling a plastic surgery practice in Ohio?
The sale process includes: preparation with valuation and organizing documents, confidential marketing to qualified buyers, due diligence where buyers review the practice, negotiation of purchase agreements, and closing. The entire process often takes 12 months or more.
What should sellers consider about their post-sale plans?
Sellers should plan for their new role post-sale, whether continuing as a lead surgeon, part-time associate, or retiring. They should understand deal components like earn-outs or rollover equity, and develop a tax strategy to preserve proceeds from the sale.