Guide to Selling a Radiology Practice in Buffalo, NY

The market for selling a radiology practice in Buffalo is more active than ever. We’re seeing intense interest from private equity groups and large strategic partners, driven by the shift toward outpatient imaging. Recent sales of local practices like Windsong Radiology and Southtowns Radiology prove that buyers are paying premium values for well-run Buffalo practices. Understanding this landscape is the first step toward a successful sale. Proper preparation and timing are critical to maximizing your outcome.

Market Overview

The Buffalo radiology market is shaped by a few powerful trends. If you’re a practice owner, you are likely already feeling their effects. These same trends are what makes your practice so attractive to buyers right now.

The Rise of Private Equity

The radiology field has many independent practices. This makes it a prime target for private equity firms like US Radiology Specialists and RadPartners. They seek to build large networks to gain better reimbursement rates and operational efficiencies. For an independent practice, partnering with these groups can provide significant resources and financial stability.

The Outpatient Advantage

More and more, imaging services are moving out of hospitals and into independent facilities. Patients and payors prefer this for lower costs and greater convenience. This positions well-run independent diagnostic testing facilities (IDTFs) as highly valuable acquisition targets for both hospital systems and larger consolidators.

The Regulatory Environment

New York’s Certificate of Need (CON) laws can limit new competition, which potentially increases the value of your existing, approved practice. At the same time, the federal No Surprises Act has added complexity to billing and negotiations with payors. Aligning with a larger partner that has experience navigating these rules is a key reason many owners decide to sell.

Key Considerations

When you think about selling, the final price is important. But it’s also about securing the future for your staff and protecting the legacy you’ve built. The best outcomes we see are from owners who start planning years before they want to exit. Buyers pay for proven performance, not future potential. Waiting until you’re ready to leave is often too late to make the changes that maximize value.

Sophisticated buyers will look closely at your technology, especially how efficiently you use your PACS and any AI tools. They will also analyze your patient volume, referral sources, and financial history. Getting your practice’s story and numbers in order long before a sale is one of the most important things you can do. It can be the difference between an average offer and a premium one.

Market Activity

The consolidation trend is not happening somewhere else. It is happening right here in Western New York. The moves by your peers and competitors are the strongest signal that the time to evaluate your own position is now.

Here are two recent Buffalo sales that show the opportunity:

1. The Windsong Radiology Partnership. In late 2020, Windsong Radiology, one of the area’s largest practices, partnered with the private equity-backed US Radiology Specialists. This was followed by a sale of their office real estate for over $28 million. This shows a common two-step strategy: first a practice partnership, then a real estate transaction.

2. The Southtowns Radiology Acquisition. In late 2023, Buffalo’s second-largest operator, Southtowns Radiology, sold its three imaging centers to Rezolut, another private equity platform. The physician-owners made a deal to continue running the sites, showing that a sale doesn’t always mean walking away.

These deals prove that sophisticated buyers see immense value in the Buffalo market. For other practice owners, this activity creates both a clear opportunity and a reason to plan strategically.

The Sale Process

Selling your practice involves a lot more than just finding a buyer. It is a process that requires careful management to protect your interests and achieve the best price. An unsolicited offer might seem attractive. It is rarely the best offer you can get.

A successful sale usually follows a clear path. It begins with preparing your practice and its financial story. Then, we discreetly identify a curated group of the most suitable financial and strategic buyers. This is not about listing your practice for sale. It is about creating a confidential, competitive environment where multiple qualified buyers are bidding for your practice. This creates leverage for you. The final steps involve negotiating the best terms, navigating the detailed buyer due-diligence process, and closing the deal. Many deals fall apart during due diligence. Proper preparation is the best way to prevent that.

Valuation

One of the first questions every owner asks is, “What is my practice worth?” The answer is more complex than a simple rule of thumb. Sophisticated buyers value your practice based on its Adjusted EBITDA, which stands for Earnings Before Interest, Taxes, Depreciation, and Amortization.

This is not the same as the net income on your tax return. Adjusted EBITDA gives a truer picture of your practice’s profitability by adding back owner-specific and one-time expenses. Many owners are surprised by how much higher their Adjusted EBITDA is.

Here is a simplified example:

This Adjusted EBITDA figure is then multiplied by a “multiple” (e.g., 5x, 7x) to determine your practice’s total value. That multiple depends on your specialty, size, growth rate, and reliance on owner-physicians. Getting this valuation right is the foundation of a successful sale.

Post-Sale Considerations

Selling your practice does not always mean hanging up your coat the next day. Many owners are concerned about losing control or being forced to retire before they are ready. The truth is, most buyers want you to stay involved. Your clinical expertise and leadership are part of what they are buying.

Modern deals are often structured to align everyone for future success. You might be offered an “equity rollover,” where you exchange a portion of your sale proceeds for ownership in the new, larger company. This gives you a chance at a “second bite of the apple” when that larger company is sold years later. Deals can also include “earnouts,” where you receive additional payments for hitting performance targets after the sale. These structures can be very rewarding. They also require careful planning to ensure your goals are protected.