Guide to Selling a Plastic Surgery Practice in North Carolina

Selling your Plastic Surgery practice in North Carolina is a significant financial and emotional milestone. For many owners, it represents the result of a lifetime of work. The process involves much more than finding a buyer. It requires careful preparation, a deep understanding of the market, and a clear strategy to protect your legacy and financial future. This guide provides key insights to help you navigate the journey, whether you are years away from a sale or actively considering your options.

Market Overview

The market for plastic surgery practices in North Carolina is active, driven by several key factors. Many successful surgeons are approaching retirement age and looking to secure their financial future. At the same time, a growing number of practice owners are choosing to sell for strategic reasons rather than just lifestyle changes.

A Market of Transition

A significant number of practice owners are at or near the typical retirement age of 64. This demographic shift is creating a steady stream of high-quality practices becoming available. For these owners, a sale is not just an exit. It is a way to unlock decades of built-up equity, ensure their patients and staff are left in good hands, and fund their next chapter in life.

The Rise of Strategic Partnerships

Beyond retirement, many plastic surgeons are selling to gain the support of a larger organization. Partnering with a private equity group or a regional health system can offload administrative burdens, provide capital for growth, and expand service lines. This allows you to focus more on clinical work while benefiting from the efficiencies and resources of a larger network.

Key Considerations

Thinking about a sale involves more than just market timing. It’s a personal journey that requires careful planning. Before you go too far down the path, you need to align your personal goals with the realities of a transaction. Acknowledging the emotional component is the first step. Selling a practice you built from the ground up is a major life decision.

You also cannot navigate this process alone. A successful sale requires a team of advisors, including legal counsel familiar with healthcare transactions, a valuation professional, and an M&A advisor to manage the process. In North Carolina, this is particularly important due to state-specific regulations. The states Corporate Practice of Medicine (CPOM) laws dictate who can own a medical practice, which directly impacts the types of buyers you can consider and how a deal must be structured. Navigating these rules incorrectly can put a transaction at risk.

Market Activity

The current market shows strong interest in well-run plastic surgery practices. Buyers, particularly private equity investors and large medical groups, use a metric called Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization) to determine a practice’s value. Think of this as your practice’s true cash flow. The purchase price is typically calculated as a multiple of that number. Larger, more profitable practices command higher multiples because they are seen as less risky investments.

The difference can be significant, as shown in the table below.

These numbers are not set in stone. The final multiple depends on factors like your location, provider mix, and growth potential. An experienced advisor can help frame your practices story to justify a premium valuation.

Sale Process

A successful practice sale is a marathon, not a sprint. From the day you decide to sell to the day the money is in your bank account, the process often takes 12 months or more. This is why we advise owners to start planning two to three years before their target exit date.

The journey begins with Preparation. This is where we work with you to clean up your financials, organize key documents, and develop a strategy. Next comes valuation and the creation of marketing materials that tell your practices story. We then confidentially approach a curated list of qualified buyers to create a competitive environment. After initial offers are received, we move to negotiation, followed by the most intensive stage: Due Diligence. Here, the buyer scrutinizes every aspect of your practice. Proper preparation is what makes this stage smooth instead of stressful. The final step is navigating the legal contracts to a successful closing.

Valuation

Determining what your practice is truly worth is more of an art than a science. While formulas provide a baseline, the final price comes from a structured process that accurately frames your practice’s value to the right buyers. At its core, the valuation of your plastic surgery practice comes down to three key elements.

1. Start with Adjusted EBITDA. As we mentioned, this is your practice’s true profitability. The first step is to “normalize” your financials. We analyze your expenses to identify and add back things like an above-market owner salary, personal auto leases, or other one-time costs. This single step can often increase your practice’s valuation by revealing cash flow that buyers care about.

2. Apply a Market Multiple. Once we establish a true EBITDA, we apply a valuation multiple based on current market data for similar plastic surgery transactions. This multiple is influenced by your practice’s size, reliance on a single surgeon, and growth trajectory.

3. Account for Goodwill. Goodwill is the intangible value of your practice. It is your reputation, your established patient base, and your brand in the community. While it is not a line item on your balance sheet, it is a critical component of your final sale price and is established through expert negotiation.

Post-Sale Considerations

The transaction is not over once the papers are signed. What you do the day after the sale is just as important as the deal itself and should be planned for well in advance. What will your role be? Many buyers will want you to continue working for a period of 2-5 years, which can be structured as a standard W-2 employment agreement. The terms of this agreement, including your compensation, schedule, and level of autonomy, are key points of negotiation.

You also need a plan for other critical loose ends. If you own the building your practice operates from, you must decide whether to sell the real estate with the practice or become a landlord by negotiating a long-term lease with the new owner. This decision has significant tax and financial implications. Finally, you will need to arrange for tail medical malpractice insurance to cover you for any claims that may arise from your time as an owner. Planning for these post-sale realities is a critical part of a successful transition strategy.