Build or buy
Employment, startup, acquisition, modernization, staged succession, and affiliation solve different problems. Compare them on the same horizon, with the same owner compensation, debt, time, tax, family, clinical, and downside rules.
Six credible paths
Preserve flexibility and lower capital exposure while testing whether the job can provide ethical autonomy, income, benefits, mentorship, and a credible ownership path.
Employment agreement, compensation definitions, decision rights, benefits, restrictions, management tolerance
Design backward from the care model, local demand, right-sized capacity, working capital, payer timing, staffing, and household runway.
Local capacity file, facility program, total project capital, critical path, 48-month reserve model
Test what remains after the seller: patients, procedures, payers, people, systems, site, liabilities, and buyer-repeatable cash.
Seller records, five transfer bridges, downside affordability, lease and transition gates
Treat purchase price, catch-up capital, technology conversion, workflow change, training, and patient disruption as one project.
Acquisition bridge, phased capital plan, conversion dependencies, first-100-day plan
Create time to test philosophy, patient relationships, operations, financing, and control before a full transfer.
Decision-rights map, milestone-based buy-in, price method, failure and exit terms
Compare cash at close, employment, management services, decision rights, restrictions, contingent value, equity, and exit—not only the headline multiple.
Whole-period value, autonomy matrix, service audit, scenario-weighted contingent value
Common comparison contract
No option gets optimistic assumptions unavailable to the others.
Can you deliver the pace, procedures, appointment philosophy, access, and care you believe are right?
Are clinical compensation and unpaid management labor separated from ownership return?
Are practice working capital and household reserve separate, and does the downside case survive?
Which patients, payers, staff, systems, facility conditions, and relationships actually remain?
Who decides, what can change without you, what restrictions survive, and how do you leave?
What record controls the decision, and what fact would make you pause, renegotiate, or walk?
Clinical pay, ownership cash, benefits, debt, management labor, household reserve, guarantees, terminal value, control, evidence, and exit remain separate. Open gates cannot be averaged away.
Build sequence
Patients, payer/fee model, procedures kept and referred, appointment philosophy, staffing, hours, owner load, and growth ceiling.
Trade area, provider FTE, patient-segment access, payer participation, wait-time calls, staffing, real estate, and credible entrants.
Separate difficult-to-add-later infrastructure from easy-to-add-later equipment; expose site and lease fatal flaws.
Connect bid scope, change orders, equipment, financing, working capital, credentialing, and delay to one reserve.
Connect the owner mandate, operating program, five budgets, fatal-flaw gates, bid scope, change control, and opening dependencies—then continue into the local market, First 48 Months, and Delay Cost tools.
Buy sequence
Clinical non-negotiables, procedures, pace, owner hours, access goals, management load, income floor, reserve, and walk-away rules.
Demand → contact → appointment → arrival → care → collection → retention → referral, with a denominator and period for every rate.
Seller-only care, buyer clinical exclusions, patient/referral loss, buyer-specific payer/fee effects, and separate collection loss—each with an overlap check.
Separate first-year timing, restore required labor and capital, fund working and operating reserves, and compare credible alternatives without consuming protected household cash.
The acquisition workbench carries the buyer mandate, five non-overlapping dollar adjustments, separate first-year timing, practice sources and uses, household reserve, safety checks, seller-document requests, and a readable Excel workbook in one review.
Succession sequence
Compare continuing ownership, associate succession, staged buy-in, private sale, seller financing, independent merger, and DSO or group affiliation on one after-tax horizon.
Keep cash, debt payoff, tax, costs, notes, holdbacks, earnouts, rollover equity, earned clinical compensation, control, patient terms, restrictions, and post-close obligations separate.
Keep the decision portable
Use the local project tools to preserve safety checks, sources, reviewers, contradictions, pause conditions, and the next document request on your own device.
Open the Local Project File