Breaking into High-Barrier Healthcare Markets (CPOM Observations)

^redacted‌ you're a G for renewing IBIS!!! This data has been incredibly useful context as we’ve been working through our NY healthcare acquisition. One thing the ophthalmology data reinforces is how fragmented the space still is, despite years of PE interest; especially once you factor in CPOM states and sub-$3M revenue clinics. We’ve been fortunate enough to be closing on a Manhattan-based refractive surgery clinic, and the experience has made the barriers very tangible because normally regulatory complexity, physician alignment, and operational nuance eliminate most buyers before they even get started. Interestingly, once we got deep into our current first deal, a second opportunity (Brooklyn) surfaced quickly and it wasn't because we were shopping, but because credible operators in hard markets tend to see follow-on opportunities once trust is established. The broader takeaway for anyone thinking about CPOM-heavy markets (not just ophthalmology) is if you can assemble the right structure, team, and compliance muscle to get through the first asset cleanly, the dynamics flip fast. Deal flow increases, competition thins out materially, and capital becomes much easier to attract. In those environments, the first deal is the bottleneck, but after that, the runway opens up.