Guide to Selling a Oncology Practice in New Hampshire

The New Hampshire oncology market is changing. With fewer than 15% of practices remaining independent, a clear trend toward consolidation is creating a unique window of opportunity for practice owners like you. Selling your practice is a major decision, and success depends on understanding today’s buyers and preparing correctly. This guide provides insights into the current market, valuation, and the steps required to achieve a premium outcome while protecting your legacy.

Market Overview

The decision to sell your practice doesn’t happen in a vacuum. It is influenced by the market around you. Right now, the New Hampshire oncology market is defined by two powerful forces.

A Consolidating Landscape

Large health systems and corporate groups are actively looking to expand their footprint in New Hampshire. This means independent oncology practices are prime acquisition targets. For owners, this trend presents both a challenge to long-term independence and a significant opportunity for a strategic exit. The question is no longer just if you will be approached, but how you can control the conversation when you are.

Strong Market Demand

Underpinning this trend is the simple fact that oncology services are in high demand and spending is growing. Global spending on cancer medicine is projected to reach $409 billion by 2028. In New Hampshire, consistent patient needs and a shortage of oncologists in rural areas mean that established practices are incredibly valuable to buyers seeking to enter or expand in the region.

Key Considerations

When a potential buyer evaluates your oncology practice, they look at more than just your financial statements. They are buying your reputation, your patient base, and your team. Highlighting your practice’s role in the New Hampshire community is critical. Buyers want to see strong referral patterns and positive patient outcomes. They also assess the strength of your clinical team. New Hampshire’s healthy pipeline of younger oncologists can be a key selling point, signaling stability to a new owner. The key is framing these assets to show a buyer how your practice solves their strategic needs, whether it’s expanding their service area or enhancing their clinical capabilities.

Your story is one of your most valuable assets.

Market Activity

We can see these market dynamics playing out in real time. The recent acquisition of Catholic Medical Center by HCA Healthcare for $110 million is a clear indicator of the transactions happening in New Hampshire. While your practice is different from a large hospital, the underlying motivations are the same. Understanding what buyers want and what pressures drive owners to sell can help you position your practice effectively.

Here is a look at the motiviations we see in the market.

The Sale Process

Selling a practice is a structured process, not a single event. It begins long before you speak to a potential buyer. The first step is preparation, which involves organizing your financial and operational documents to tell a clear, compelling story. Next comes a professional valuation to establish a credible asking price. Only then do you confidentially approach a curated list of strategic buyers. The final stages, due diligence and negotiation, are where many deals encounter problems. This is when the buyer scrutinizes every aspect of your practice. Thorough preparation is the best way to ensure this phase goes smoothly, protecting your value and leading to a successful closing.

Practice Valuation

Determining what your oncology practice is worth is part science and part art. Sophisticated buyers don’t use simple rules of thumb. They use a detailed approach to find the true value.

Here are three core components of a professional valuation.

1. Finding Your True Profitability. Buyers look at Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization). We find this number by taking your net income and adding back owner-specific costs like excess salary or personal expenses. This often reveals your practice is significantly more profitable than it appears on paper.
2. Applying the Right Multiple. The multiple applied to your Adjusted EBITDA depends on your specialty, size, growth potential, and provider team. An associate-driven practice with over $1M in EBITDA might see a 5.5x to 7.5x multiple, while others will be different. It is not one-size-fits-all.
3. Telling Your Growth Story. Numbers alone are not enough. Buyers pay a premium for a compelling growth story. This narrative highlights your strong community standing, potential for new services, and strategic fit, turning a good valuation into a great one.

Post-Sale Considerations

Your role doesn’t have to end the day the deal closes. In fact, many buyers want the selling physician to remain involved to ensure a smooth transition. This is where the structure of your deal becomes important. You can negotiate options that protect your financial future and your legacy. For example, an “earnout” can provide you with additional payments if the practice hits certain performance targets post-sale. A more powerful option can be an “equity rollover,” where you retain a stake (often 10-30%) in the new, larger company. This gives you a voice in the future and the potential for a second, often larger, payday when the new entity is eventually sold. Planning for the right post-sale structure ensures your transition is on your terms.