Selling your primary care practice is one of the most significant decisions of your career. In New Hampshire, the current market presents unique opportunities for physician-owners, but realizing your practice’s full value requires careful preparation and strategy. This guide provides an overview of the landscape, key factors to consider, and the steps involved in navigating a successful sale, helping you move forward with confidence.
Market Overview
The demand for primary care in New Hampshire is strong and growing. Projections indicate a need for a nearly 29% increase in primary care physicians by 2030 just to maintain the status quo. This demand, coupled with provider shortages, particularly in rural areas, creates a favorable environment for sellers. For a potential buyer, an established practice represents an immediate solution to patient access and a turnkey entry into a stable market.
At the same time, the landscape is shifting. The move toward value-based care models is changing how practices operate and generate revenue. Buyers, especially larger, more sophisticated groups, are looking for practices that are not only profitable today but are also positioned for the future of healthcare. This combination of high demand and an evolving payment environment means that buyers have strong buyer interest, but they are also more discerning than ever.
Key Considerations for a Seller
Beyond market dynamics, a buyer’s perception of your practice’s value is shaped by factors well within your control. Preparing these areas before you begin the sale process can significantly impact your outcome. Think about how you would present these to a potential acquirer.
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Your Team’s Future
A major concern for any buyer is continuity of care. The stability of your clinical team is a huge asset. Are your key physicians, PAs, and NPs likely to stay after a transition? Having clear agreements and understanding their long-term goals is not just a detail; it’s a core component of your practice’s value. A practice with a committed team is seen as far less risky. -
Your Patient Panel
A loyal and stable patient base is the lifeblood of a primary care practice. Buyers will analyze your patient demographics, insurance mix, and patient retention rates. A practice with a strong community reputation and a well-managed patient panel demonstrates predictable revenue, which is a powerful selling point. -
Your Operations
How efficiently does your practice run? Modern, streamlined operations, supported by a functional EHR and practice management system, are highly attractive. It shows a buyer they are acquiring a well-oiled machine, not a fixer-upper that will require significant investment and a steep learning curve.
Market Activity
The national trend of healthcare consolidation is very active in the primary care space, and New Hampshire is no exception. We are seeing significant interest from a new class of buyers beyond local hospitals or physician groups. Private equity firms and large, well-capitalized healthcare companies see primary care as a cornerstone of the healthcare system and are actively seeking to invest.
While you may not see a multi-billion dollar deal like CVS Health’s acquisition of Oak Street Health in your town, the strategy behind it trickles down. These buyers are looking to build regional networks and find well-run practices to serve as platform investments. For you, this means access to new types of strategic partnerships that can offer financial security, reduced administrative burden, and resources for growth, often while preserving your clinical autonomy. The key is knowing how to find these buyers and position your practice for their playbook.
The Sale Process at a Glance
Selling your practice is a structured process, not a single event. Understanding the phases can help you prepare for what is typically a 6 to 12-month journey. Rushing any of these steps or entering them unprepared is where deals often fall apart or value is lost.
| Phase | What It Really Means for You |
|---|---|
| 1. Preparation & Valuation | This is the foundation. It involves organizing your financials and getting a realistic, defensible understanding of what your practice is worth. |
| 2. Confidential Marketing | Reaching out to a curated list of qualified buyers without your staff, patients, or competitors knowing you are exploring a sale. |
| 3. Negotiation | It’s more than just price. This is where you structure the deal terms that align with your financial and personal goals. |
| 4. Due Diligence | The buyer puts your practice under a microscope. This is where organized preparation prevents surprises that could kill the deal. |
| 5. Closing & Transition | The final legal steps and the beginning of a smooth handover that protects your legacy and ensures continuity of care for your patients. |
What’s Your Practice Really Worth?
Many practice owners mistakenly believe their practice’s value is a simple multiple of its annual revenue. While that can offer a rough estimate (often 0.5 to 0.7 times revenue for primary care), sophisticated buyers look at a more meaningful metric: Adjusted EBITDA. EBITDA stands for Earnings Before Interest, Taxes, Depreciation, and Amortization, and it represents the true cash flow of your business.
The “Adjusted” part is where the real story is told. We work with owners to normalize financials by accounting for one-time expenses or owner-specific perks, like a car lease run through the business or an above-market salary. This process often reveals a much higher profitability than you might see on paper. Buyers don’t just buy your past performance; they buy this future potential. Presenting a clear, professional calculation of Adjusted EBITDA is the first step toward securing a premium valuation.
Life After the Sale
Successfully closing the deal is a major milestone, but your work isn’t done. The decisions you make during negotiations will shape your future for years to come. It’s important to think through what you want your post-sale life to look like from the very beginning.
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Your Role After Closing
Do you want a clean break and to retire immediately? Or would you prefer to continue practicing for a few years with less administrative hassle? Your answer will influence the deal structure, potentially through an employment agreement or an earnout, where you can earn additional proceeds by hitting certain performance targets post-sale. -
Your Financial Future
The structure of your sale has massive tax implications. How the deal is allocated between assets, goodwill, and your non-compete agreement can dramatically change your net, after-tax proceeds. Furthermore, some deals involve rolling over a portion of your equity into the new, larger entity, giving you a chance for a “second bite at the apple” when that entity sells in the future. -
Your Legacy
You’ve spent years building a trusted practice and a dedicated team. A well-planned transition ensures that your patients continue to receive excellent care and that your staff is treated fairly. Protecting this legacy is often just as important as the financial outcome.
Frequently Asked Questions
What is the current demand for primary care practices in New Hampshire?
The demand for primary care in New Hampshire is strong and growing, with a projected need for a nearly 29% increase in primary care physicians by 2030 to maintain current levels. This demand, alongside provider shortages especially in rural areas, creates favorable market conditions for sellers.
How is the value of a primary care practice in New Hampshire typically assessed?
Practice value is often assessed using Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization), which reflects the true cash flow of the business. Adjustments are made to normalize financials by removing one-time expenses or owner-specific perks, potentially revealing higher profitability than what appears in basic revenue multiples.
What key factors should a seller prepare before putting their practice on the market?
Sellers should prepare several areas: the future stability of their clinical team, patient panel demographics and retention, and operational efficiency including up-to-date EHR and practice management systems. These factors increase the attractiveness of the practice to buyers by reducing risk and demonstrating predictable revenue.
What does the sale process typically involve for a primary care practice in New Hampshire?
The sale process generally includes these phases: 1) Preparation & Valuation, 2) Confidential Marketing to qualified buyers, 3) Negotiation of deal terms, 4) Due Diligence by the buyer, and 5) Closing & Transition, ensuring a smooth handover and continuity of care.
What considerations affect a seller’s life after selling their practice?
After selling, sellers should consider their role post-sale (retiring immediately or continuing part-time), the financial and tax implications of the deal structure, and protecting their legacy by ensuring patient care continuity and fair treatment of staff. Options like employment agreements or earnouts can influence these aspects.
