I unfortunately don't have a lot of helpful info, but my first takeaway from looking at these businesses is to have an experienced attorney who has structured these deals / MSOs before. Corporate Practice of Medicine laws can be really complex and vary widely from state to state, which can become a headache if the practice is in multiple states or is in only one but eventually expands. In terms of physician rollover, it is imperative in my opinion to have them roll over a meaningful equity amount post-close, which can vary in both $ and % amounts. I've seen a put/call structure in a few deals, where the physician has the right to put a certain % amount of their ownership each year and the buyer has the right to call a certain % amount. The ones I have seen were structured at an agreed upon multiple at the time of initial close and spanned 3-5 years. Also, the successful ones I have seen have always gotten the physician to agree to a lengthy and strict non-compete once he/she exits the business.

I've been wondering about this as well, following!

Yes, if the physician is looking to retire tell him to get a doctor that he trusts that you can hire to perform the duties and have the owner train him for a transitory period, so the patients get used to the new guy.

Or you get a physician that can fulfill the job and get the owner to train him for a[redacted]month transitory period.

That's the most important part.

There is an excellent podcast on this. https://open.spotify.com/episode/7saquW1GL0TMNvrYqrRXKc?si=MeOKLpkyQQ-YF1XTt9IsKA

Matt drop me a note I can share my view. James

James taught me everything I know about this topic.

We would often acquire practices (technically an asset purchase) where the physician(s) would be getting ready to retire - their main motivation for the buyout. But we'd always have a succession plan in place - get a new grad in there that is hungry for business that can slowly take on the retiring MDs patient panel. I don't know much about physician's retaining equity, because I was on the hospital side of med group acquisitions, but as far as keeping the MDs motivated, structuring pay as base + incentive seemed to work well and keep them practicing and productive for some time. In my experience, non-compete's are somewhat of a challenge and it is highly unlikely they will be enforced. Can always add a non-compete buy out clause.