Selling your Ortho & MSK practice is one of the most significant decisions of your career. In Nevada, a unique combination of factors has created a prime opportunity for practice owners. High demand, driven by population growth and a statewide physician shortage, is converging with a wave of consolidation. This guide provides an overview of the current market, the sale process, and how to position your practice for a successful transition. Navigating this landscape requires careful strategy.
Nevada’s High-Demand Market
The market for Ortho & MSK services in Nevada is exceptionally strong. The state ranks 45th in the nation for active physicians per capita, creating significant unmet patient demand. This is amplified by rapid population growth, especially in areas like Clark County. As a result, many parts of Nevada are designated as Health Professional Shortage Areas.
This environment is further shaped by demographics. The average age of a physician in Nevada is over 56, suggesting an upcoming wave of retirements. For practice owners considering a sale, this confluence of high demand and shrinking supply creates a favorable seller9s market. Sophisticated buyers, from large regional health systems to private equity platforms, recognize this opportunity and are actively looking for high-quality practices to acquire.
Key Considerations for Your Practice
Thinking about a sale goes beyond market timing. You must also look inward at your practice to prepare for a successful transition. How you approach these areas can directly impact your final valuation and the smoothness of the sale.
Your Operational Readiness
A well-run practice is a valuable practice. Buyers look for operational efficiency, such as streamlined billing and coding, often managed by a Central Billing Office (CBO). They also assess the strength of your clinical and administrative team. A practice that doesnt depend entirely on the owner is far more attractive and commands a higher value.
Your Personal Exit Goals
What do you want your future to look like? A sale isn’t a one-size-fits-all event. You might want a complete exit to retire. Or, you might prefer to sell a majority stake to a Management Service Organization (MSO), take some chips off the table, and continue practicing with fewer administrative burdens. We find that control isn’t a binary choice. Structures like minority recapitalizations can preserve your clinical autonomy while providing financial security.
Your Ideal Buyer
Finding the right cultural and strategic fit is just as important as the sale price. Do you want your practice to be absorbed into a large hospital system, or would you prefer a partner who will invest in growth while preserving your practice’s legacy? Identifying your ideal buyer persona early helps focus the entire process.
Current Market Activity
The Nevada MSK market is not just promising in theory; it is active. We are seeing a distinct trend of consolidation, creating larger, more integrated care platforms. A key example was the 2021 merger of Tahoe Fracture & Orthopedic Medical Clinic with Spine Nevada, which formed the largest musculoskeletal care platform in the state.
This activity is drawing significant attention from investors. Groups like Healthcare Outcomes Performance Company (HOPCo) are expanding their footprint in Nevada, signaling confidence in the long-term growth of the state’s MSK sector. This local activity mirrors a national trend of private equity investment in orthopedics. For owners, this means there is a growing pool of well-capitalized buyers looking for practices just like yours, creating a competitive environment that can drive premium valuations.
A Look at the Sale Process
A successful practice sale doesnt happen by chance. It follows a structured, confidential process designed to protect your interests and maximize your outcome. While every sale is unique, the journey generally follows a clear path.
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Preparation and Valuation. This is the most important phase. It begins long before your practice is on the market. We believe the moment you start thinking about selling in 2-3 years is the exact right time to begin preparing. This involves organizing your financials, understanding your practice’s true earning power (Adjusted EBITDA), and getting a professional valuation. Buyers pay for proven performance, not just potential.
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Strategic Go-to-Market. We dont just “list” your practice. A professional process involves creating a compelling narrative and confidentially approaching a curated list of qualified strategic and financial buyers. This creates competitive tension that drives up value.
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Negotiation and Due Diligence. This is where a deal is made or broken. An advisor helps you negotiate not just the price, but the terms of the deal, which can have massive implications for your tax liability and future obligations. They also manage the buyer’s due diligence process to prevent surprises.
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Closing and Transition. Once the deal is signed, the final step is ensuring a smooth transition for your staff, patients, and yourself. This involves careful communication, legal transfer of assets, and management of medical records.
How Your Practice is Valued
Many owners are surprised to learn what their practice is truly worth. Most brokers have a limited view, but sophisticated buyers value a practice based on its Adjusted EBITDA013Earnings Before Interest, Taxes, Depreciation, and Amortization. This isn’t the same as the net income on your tax return.
We calculate Adjusted EBITDA by taking your reported profit and adding back owner-specific personal expenses and any above-market owner salary. This gives a true picture of the practice’s cash flow. That Adjusted EBITDA figure is then multiplied by a “multiple.” For a multi-provider Ortho & MSK practice with over $1M in EBITDA, multiples can often range from 5.5x to 7.5x or higher, depending on growth, payer mix, and other factors. Most practices are undervalued until their EBITDA is properly normalized and their growth story is framed for buyers.
Planning for Life After the Sale
The moment the sale closes is not the end of the story. Planning for what comes next is critical to ensuring the transition protects your legacy and secures your financial future. This planning should happen long before the final negotiations.
| Consideration | Why It Matters |
|---|---|
| Your Next Chapter | Defining your role post-sale, whether you continue working for a set period or retire immediately, is critical for your personal and professional satisfaction. |
| Staff & Patient Care | A structured transition plan for your team and patients ensures continuity of care. This is a key part of protecting the goodwill you’ve built over decades. |
| Financial Structure | The structure of your sale has major implications. How you receive payment, through cash, an earnout, or by retaining equity (rollover), will dramatically affect your after-tax proceeds and long-term wealth. |
These elements are not afterthoughts. They are key deal points that must be negotiated. The right advisory team can model different scenarios to help you achieve your personal and financial goals.
Frequently Asked Questions
What makes the Nevada Ortho & MSK market unique and favorable for selling a practice?
Nevada has a high demand for Ortho & MSK services due to population growth and a statewide physician shortage, ranking 45th nationally for active physicians per capita. This unmet patient demand, coupled with an aging physician workforce and a trend of consolidation, creates a favorable seller’s market with many well-capitalized buyers actively seeking quality practices.
What operational factors should I focus on to increase the value of my Nevada Ortho & MSK practice before selling?
Buyers look for operational efficiency such as streamlined billing and coding, ideally managed by a Central Billing Office (CBO). A strong clinical and administrative team that reduces dependence on the owner also increases the practice’s attractiveness and value. Demonstrating efficient operations and a capable team can lead to a higher sale valuation.
How is the valuation of an Ortho & MSK practice in Nevada typically determined?
Valuation is primarily based on Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization), which adjusts reported profits by adding back owner-specific personal expenses and above-market owner salary. This adjusted figure is then multiplied by a market multiple, often ranging from 5.5x to 7.5x or higher for multi-provider practices with over $1M in EBITDA, depending on factors like growth and payer mix.
What are common buyer types for Nevada Ortho & MSK practices and how should I select the ideal buyer?
Common buyers include large regional health systems, private equity platforms, and Management Service Organizations (MSOs). Selecting the ideal buyer depends on your personal goals and cultural fit preferences ‚Äî whether you want to fully exit, maintain some clinical autonomy, or partner with an entity that will invest in growth while preserving your practice’s legacy.
What should I consider in planning for life after selling my Nevada Ortho & MSK practice?
Planning for life after the sale is critical and includes defining your role post-sale (retiring or continuing work), ensuring a smooth transition for staff and patients to maintain continuity of care, and structuring the sale payment (cash, earnout, equity rollover) to optimize after-tax proceeds and long-term wealth. Early planning with an advisory team is essential.