Selling your primary care practice in Nebraska is a significant decision, and right now, the market presents a unique opportunity. With growing demand and a shifting ownership landscape, understanding how to position your practice is critical. This guide provides a clear overview of the current market, key steps in the sale process, and how to approach valuation. We will help you navigate the path toward a successful transition for you, your staff, and your patients.
Nebraska’s Primary Care Market: An Environment of Opportunity
The market for primary care in Nebraska is strong and growing, projected to reach $2.1 billion by 2025. This growth is happening alongside a significant physician shortage. Between 2017 and 2023, the state saw a net loss of primary care physicians, and today, 14 counties have no primary care doctor at all. This creates high demand for established practices like yours. Buyers, from health systems to private equity groups, recognize the vital role of primary care and are actively looking for opportunities to expand their footprint. Your practice is not just a business. It is a critical piece of community healthcare infrastructure, which makes it an attractive asset in the current environment.
Key Considerations for a Successful Sale
Selling a practice involves more than just finding a buyer. A successful transition requires careful planning around several critical areas. Overlooking these can jeopardize the deal, your staff, and the legacy you have built.
Protecting Confidentiality
From the moment you consider selling, confidentiality is key. You need a process that allows serious buyers to conduct due diligence without alerting your staff, patients, or competitors prematurely. A single leak can disrupt your practice. We manage this by vetting buyers and using strict non-disclosure agreements.
Securing Your Team’s Future
Your staff is one of your practice’s most valuable assets. A buyer will want to see a clear plan for retaining key team members. Addressing your staff’s future early in the process ensures a smooth transition and preserves the continuity of care that your patients depend on.
Navigating Rural Dynamics
If your practice is in a rural community, you face unique challenges but also hold unique value. Buyers understand the difficulty of recruiting to these areas, which makes your established presence and staff highly attractive. Framing this correctly is essential to demonstrating the full value of your practice.
Your legacy and staff deserve protection during the transition to new ownership.
What’s Driving Market Activity
You are not alone in considering a sale. Across the country, and here in Nebraska, practice owners are transitioning away from ownership. The share of physicians in private practice fell from over 60% in 2012 to just 46.7% in 2022. Why the shift? Many doctors are looking for relief from mounting administrative burdens, reimbursement pressures, and a desire for a better work-life balance. This has fueled a steady stream of acquisitions by larger health systems and private equity-backed groups who have the infrastructure to manage these challenges. This activity creates a competitive environment for quality practices, giving sellers who are well-prepared significant leverage.
The Path to a Successful Sale: A 5-Step Process
A successful practice sale is not an event. It is a structured process. Running a competitive process ensures you’re engaging the right buyers on the right terms, protecting your interests at every stage. We guide our clients through five key phases.
- Preparation and Valuation. This is the foundation. We work with you to analyze your financials, normalize your earnings, and prepare the key documents needed for due diligence. A comprehensive valuation report is created to establish a defensible asking price.
- Confidential Marketing. We identify and approach a curated list of qualified buyers from our proprietary database. This is done confidentially to protect your practice, with all interested parties signing a non-disclosure agreement before receiving sensitive information.
- Negotiating Offers. We create a competitive environment to solicit multiple offers. We then help you analyze the letters of intent, not just on price, but on terms, structure, and cultural fit for you and your staff.
- Due Diligence. The chosen buyer will conduct a deep dive into your practice’s financials, operations, and legal standing. Our preparation in Step 1 is designed to make this phase smooth and prevent surprises that can derail a transaction.
- Closing and Transition. We work alongside legal counsel to finalize the purchase agreement and coordinate the closing. We also help you build a post-sale transition plan to ensure continuity of care for patients and a smooth handover to the new ownership.
Preparing properly for buyer due diligence can prevent unexpected issues.
Understanding Your Practice’s True Value
Many owners mistakenly believe their practices value is a simple multiple of revenue. Sophisticated buyers, however, look deeper. The true measure of value is based on Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization). This figure represents your practice’s real cash flow after “normalizing” for owner-specific expenses like an above-market salary or personal vehicle costs. These “add-backs” can significantly increase your stated profitability and, therefore, your valuation. A typical solo primary care practice might see a lower multiple, while a larger, multi-provider practice with efficient operations will command a premium. The key is to build a financial story that a buyer can trust. An accurate valuation is the first step toward a successful exit.
A comprehensive valuation is the foundation of a successful practice transition strategy.
Planning for Life After the Sale
The day you sign the closing documents is not the end of the journey. The structure of your deal has long-term implications for your finances, your staff, and your personal legacy. Proper planning for the post-sale period is just as important as the negotiation itself.
| Consideration | Why It Matters | What to Plan For |
|---|---|---|
| Staff Integration | A smooth integration retains your loyal staff and ensures practice stability for the new owner. | Negotiating retention bonuses or employment agreements for key staff as part of the deal. |
| Patient Transition | Your patients need to feel secure. A well-communicated transition maintains goodwill and patient loyalty. | Crafting a joint communication plan with the buyer to inform patients of the change in ownership. |
| Your Role | Will you retire immediately or stay on for a period? Your involvement can be a key value driver for the buyer. | Defining your post-sale role, compensation, and timeline clearly in the purchase agreement. |
| Financial Structure | An earnout or equity rollover can increase your total proceeds but adds complexity and risk. | Understanding the specific targets for an earnout and the long-term potential of any rolled equity. |
Thinking through these elements beforehand ensures there are no surprises and that the transition honors the hard work youve put into building your practice.
The right exit approach depends on your personal and financial objectives.
Frequently Asked Questions
What is the current market environment for selling a primary care practice in Nebraska?
The market for primary care in Nebraska is strong and growing, projected to reach $2.1 billion by 2025. There is a high demand due to a significant physician shortage, with some counties having no primary care doctors at all. Buyers such as health systems and private equity groups are actively seeking opportunities to acquire established practices.
What are the key steps involved in selling a primary care practice in Nebraska?
The sale process involves five key phases: 1) Preparation and Valuation, 2) Confidential Marketing to qualified buyers, 3) Negotiating Offers focusing on price and terms, 4) Due Diligence by the buyer, and 5) Closing and Transition to new ownership with a post-sale plan.
How is the value of a primary care practice in Nebraska determined?
Value is based on Adjusted EBITDA, which considers real cash flow after normalizing for owner-specific expenses like above-market salary. Buyers assess profitability beyond simple revenue multiples, and larger, multi-provider practices typically command a premium valuation.
What considerations should be taken for the staff during the sale of a primary care practice?
Protecting your staff’s future is critical. Planning early to retain key team members helps ensure continuity of care and a smooth transition. Buyers look for clear plans like retention bonuses or employment agreements for key staff in the sale terms.
What should owners plan for after the sale of their primary care practice?
Owners should plan for staff integration, patient transition communication, defining their post-sale role and compensation, and understanding the financial structure such as earnouts or equity rollovers. Proper planning avoids surprises and supports a stable transition honoring the owner’s legacy.