Due Diligence

With the ever-growing size and complexity of practice transactions, the level of scrutiny selling owners find themselves under has increased. What looks like a very simple operation from the inside is not so straight forward to those on the outside looking in.

Transactions that would ordinarily have taken 3 months to complete have for a multitude of reasons increased to 4 – 6 months. First, risk tolerance of inexperienced buyers is extremely low, they often shell out vast sums of money to consultants that will seek to justify these fees.

Next, landlords and the assignment or negotiation of leases can absorb significant time at the tail end of a transaction. And finally, interest rate hikes and the associated eroding margins have made financing deals tighter and meant increased scrutiny from financiers. All this said, the acquisition of a profitable practice by an owner/operator remains one of the most lucrative financial vehicles in our complicated economy. That’s why it is so important that when picking a buyer, a selling practice owner chooses one that will deliver.

Extravagant offers are not worth the paper they are printed on if they are ill-conceived.

Most vendors have a significant vested interest in the legacy of their practice that goes far beyond the purchase price. We encourage all our vendors to demand a conditional offer, rather than a letter of Intent. As the name suggests, conditional offers give a purchaser the confidence to place an offer on a practice knowing they have conditions in place to correctly understand the target acquisition before completing the sale.

What most people fail to grasp and what Letters of intent don’t appropriately ponder is the existence of conditions to afford comfort to the vendor and allow them an opportunity to have a stake in the tempo a deal takes and in extreme cases an off ramp if they don’t like the direction things are going.

In representing vendors we take great comfort cosigning all conditions and having satisfaction about the status of the terms in our own right as opposed to making the contentment of the purchaser the overarching focus of any transaction.

A vendor should be able to counter examine the purchaser and their intentions just as a vendor is put under the microscope in the form of financial and clinical due diligence. An experienced broker will guide a vendor in an examination of the following, allowing the vendor to build a comfort level with a buyer prior to an offer being accepted or a firm deal going through.

These points are not mutually exclusive, and the list is not exhaustive.

  1. Look at any other offices owned by the buyer. If they are an associate, who do they work with? Have they built tenure in one location, or are they more of a journeyman?
  2. Understand who the buyer intends to work with and verify the credibility of these individuals. Who is their lawyer, banker and accountant?
  3. Engage the associated lawyers, bankers and accountants and understand that they are well intentioned. Do they like the deal for their client? Ask them directly!
  4. Quantify what the buyer’s due diligence looks like and find out who they plan to hire to conduct it. I have seen perfectly good purchasers take bad advice from overzealous consultants, causing them to lose out on deals.
  5. Determine the estimated assignment costs and prepare to absorb them. They are usually small, but they should never be a surprise.
  6. Prepare for an unreasonable landlord and hope for reason to prevail. Landlords are pricklier than ever, and they usually want a personal indemnity.
  7. Find out how buyers’ transactions played out if they’ve purchased offices before. The industry is small, and reputations last. Acquisition histories can be determined from brokerage records and anecdotal evidence. It is a big red flag if there is a history of multiple signed offers and a lack of closed transactions.
  8. Find out how did the previous owner enjoyed the process. There is a story to be told in how a previous acquisition has progressed since the subject individual took possession. We often request a reference from a previous acquisition, and this has helped a vendor sleep better at night.
  9. Look up the buyer on their provincial regulatory authority. Are there any disciplinary proceedings? These investigations are often trivial in nature, but best believe questions would be asked if the shoe was on the other foot.
  10. Prepare the buyer for terms of any associate agreement well in advance. Ensure these terms are fair while respecting the wishes of the outgoing vendor. Experience is key. Many of the individuals we sell a practice for will add untold value in the form of goodwill and mentorship post-sale. A properly motivated previous owner is the ultimate glue during a transition. This contribution is impossible to quantify, and buyers would do well to gravitate toward this kind of owner.
  11. Understand the kind of work they do. Are the styles practiced like yours? Would their philosophy gel with yours and the wider team? A fit is important, and synergies on clinical delivery are helpful to all sides. It’s important for vendors to provide detailed documentation and satisfy all the requests of a buyer. This is what you commit to when you choose to sell a business.

After all, most purchases are share sales and significant corporate and employment legacy is usually inherited. This said, I encourage all vendors to make this conversation a dialogue and know exactly to whom your office being sold.

Many selling owners end up working with this individual for some time and there is an onus on them to prove themselves as an appropriate successor. The happiest clients are the ones that build a great rapport with the new owners. Many vendors have superb assets that would be the envy of many purchasers.

The selected buyer should never forget this important fact. Vendors should consider recruiting the broker, accountant, and lawyer that will fight the hardest for the vendors interests before, during and after this process.

Remember that leverage resides with the selling owner until such a time as they chose to give it up. Buyers should be kept honest, and the dignity of the seller is to be maintained always. The tried and tested way to do this is to expose the opportunity to the open market.

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie has 30 years of experience in the industry as a former banker and now the Chief Operating Officer of ROI Corporation. Please contact her at Jackie.joachim@roicorp.com or 1-844-764-2020.


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Plants growing on piles of quarters

I received a revealing financial statement the other day. From a doctor who practiced as a phenomenally successful associate for many years. As with most Associates, the ownership motive was a large part of her career plan.

The adventure into practice ownership began about three years ago.

She was fortunate enough to be able to locate a property for sale which eliminated the landlord threat. There are too many providers in the immediate area, yet the practice is generating about $750,000 annually. That is about 20 to 30% more income than the average new startup at this early stage.

Data reveals that annual gross income for a three-year-old cold start is under $500,000. There will always be outliers and exceptions.

Let’s look at her financial journey:

  • The last year’s net income (as an Associate) was ~$301,000.
  • First year as an owner net income was ~$5,000.
  • Second year net income was ~$160,000.
  • Third year net income will be ~$225,000

And this is a success story for a three-year-old start up!

Let’s do the math:

  1. During the first three years of ownership her total net income will be ~$400,000.
  1. Had she remained a successful associate, her net income for the last three years would be over $900,000. More likely over $1 million!

What? That’s 60% MORE net income working as an associate versus an owner!

 Now let’s talk about the time invested to start and operate this new practice. I spoke about this in previous articles titled “Ownership Hours” and it is easy to invest 1,000 ‘sweat equity’ hours in the early years.

For this client, I estimate that she invested almost 2,000 hours of unpaid ownership hours. What could she have done with that time had she remained an associate?

Yes, if she were to sell the practice today there is some goodwill to be sold and that will be the return on investment in exchange for the ownership hours invested.

Pride of ownership has no price, and it cannot be appraised.

 Cash flow can be measured.

The law of diminishing returns suggests that goodwill will peak at some point and then because she is not cashing in and realizing the capital gain of the goodwill, each year she does not sell, the time-adjusted present value of her hours goes down.

Ask your accountant about this. If they do not understand, please ask me.

While she is above average and doing very well in my view, she is frustrated, and the economics of ownership are not working out for her.

The staff burden is enormous and that is why she called me the other day.

“Give it another two or three years” is what I suggested, but I do not think she will wait that long.

She is likely to sell the practice and keep the building to collect the rent and go back to being an associate.

They call it freedom from ownership.

No hassles, no staff problems, no landlords, no stress.

Ask yourself; is it better to be an owner or to be an associate?

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie has 30 years of experience in the industry as a former banker and now the Chief Operating Officer of ROI Corporation. Please contact her at Jackie.joachim@roicorp.com or 1-844-764-2020.


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Dont flush practice value down the toilet!

While originally spun from the dental world by Tim Brown, President of ROI Corporation, this story resonates just as profoundly within the realm of optometry.

Reflecting on Tim’s eye-opening narrative. “Why Toilets Matter”, it’s clear that the nuances of practice environment extend far beyond mere aesthetics or functionality. They’re crucial to the very valuation of an optometric practice.

Here’s a curious tidbit that Tim shared, illustrating the point perfectly: A dental office in an older medical building introduced door codes for bathroom access, changing them occasionally.

Sign in dental practiceImagine, if you will, a patient viewing this sign!

This isn’t just about security or modernization; it’s a testament to how amenities, as mundane as bathroom access, can significantly impact a practice’s perceived value.

Amenities such as these aren’t just physical attributes; they’re reflections of how a practice values its staff, patients, and overall operational ethos. And guess what? This wisdom utterly applicable to the optometry world as well.

Tim draws from a decade of hands-on clinical experience before venturing into the appraisal and valuation arena, He has navigated diverse practice settings, each with its unique challenges and comforts. The conclusion? The quality and availability of facilities like bathrooms genuinely matter.

Imagine the daily grind in an optometry practice – it’s a marathon of mental and physical exertion. From the moment you step through those doors, it’s non-stop. The availability of a private space to catch a moment’s breath between patients isn’t a luxury; it’s a necessity.

Yet, disappointingly, this basic requirement remains elusive in many settings. Consider a working mother returning from parental leave, the absence of a private, comfortable space for necessities like breast milk pumping – relegated instead to a cramped public restroom! Disheartening.

Key Point: Minor Details Impact Practice Value

We’ve witnessed firsthand the discomfort of staff and patients sharing a too-close-for-comfort restroom adjacent to the waiting area. The thought of a healthcare professional emerging from such a space, only to engage closely with a patient, underscores a glaring oversight in hygiene and privacy standards.

The dialogue around these issues isn’t new. These seemingly minor details can profoundly affect the morale of your staff, the satisfaction of your patients, and ultimately, the financial valuation of your practice.

In echoing Tim’s sentiments, it’s clear: The gold standard for any healthcare practice, optometry included, must advocate for private bathroom and a dignified, clean space for staff. Let’s not overlook the basics, for in them lies the foundation of our practice’s value and integrity.

Link to Previous Jackie Joachim Articles,

Link to Tim’s original article.

Jackie Joachim, COO ROI Corp

JACKIE JOACHIM

Jackie has 30 years of experience in the industry as a former banker and now the Chief Operating Officer of ROI Corporation. Please contact her at Jackie.joachim@roicorp.com or 1-844-764-2020.


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The independent advantage

Dr. Matthew Harrison, a SW Ontario Independent OD aligned with the Eye Recommend network, presents the case for independent practice with the support of a strong membership group.

Dr. Harrison, a 2013 University of Waterloo grad, provides his definition of “Independent Practice”, a term that is often bandied around and accepted often without a full understanding of its meaning and consequences to practice.

He concludes that independence ultimately is defined as the freedom of choice to selectively utilize the tools you desire to provide the highest level of care.

He advocates that you can have the best of both worlds by aligning with a strong member group such as Eye Recommend, which has 500+ practices across Canada and over 1300 optometry professionals.

The Independent Advantage Dr. Matt Harrison
View Dr. Harrison’s full presentation by clicking the play button above

NextGEN ODs as early as Year 2 can receive a signing bonus of $25,000 when starting with an Eye Recommend practice after graduation.

For more information on the “Eye Recommend” advantage: connect here.

 


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NextGEN OD

Dr. Mark Langer graduated from Pacific University College of Optometry in 2013. He had interned at a number of interesting practice locations, including private practice in Beverly Hills California, an Army Hospital in Europe, a Veteran Affairs Clinic in Hawaii, and a private practice and IRIS location in British Columbia.

While engaging with young ODs and optometry students at the March 2023 NextGEN OD event, it is not surprising therefore to hear him strongly recommend that NextGen ODs step back from the academics and take time to network and build bridges to their future opportunities.

A Mentor’s Advice
While contemplating the “how, what and where’ of his future practice opportunities, a successful private practice owner/mentor offered this advice, “”Pick where you want to live and build a life there”.

Langer took the advice to heart. Building upon the connections previously forged, he landed with IRIS in the BC interior.

Aligning the family around the decision to stay in the Okanagan Valley, Dr. Langer officially partnered with IRIS which perfectly melds his professional career and personal lifestyle – which now includes a family of “three little dudes!”.

He’s appreciative of the professional teams that take the administration burden off his plate allowing him to go home, put on his “Daddy Cape” and enjoy life.

My Path to Practice Partnership at IRIS
View Dr. Langer’s full presentation by clicking the play button above.

Key Point of advice: “Make sure that life outside of work is at the forefront of any decision you make.”


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Dr. Michael Naugle discusses OD Compensation models

The following subject matter is usually not discussed in an open forum, but is essential information for NextGEN Optometrists looking to land their first practice experience. Dr. Michael Naugle, VP of Optometric Partnerships FYidoctors, addressed attendees of the “Opportunities & Options for New Optometrists” event March 29.

The hybrid event reached over 150 attendees, including a live audience at University of Waterloo and online webinar participants.

While Dr. Naugle emphasized the importance of matching personal values and clinical interests with prospective practice opportunities, he noted that compensation is an important factor that can vary considerably in different situations.

USA vs. Canada | Rural vs. Urban
Dr. Naugle addressed the realities of how the geographic setting of a practice could impact OD compensation. He covered the expected differences in net earnings for optometrists in USA versus Canada. He explained how the different compensation models generate the perception that OD incomes are higher in the USA but further explained how other factors come into play to make Canadian compensation potentially more attractive.

Dr. Naugle elaborated on the “pillars of compensation” and presented details on how compensation might vary in different Canadian provinces and in urban versus rural practice settings with specific examples.

How Practice Geography Impacts OD Compensatin
View Dr. Naugle’s full presentation by clicking the play button above.

He advised new optometrists to dive deeper than the simple “percent of total gross billings” as other critical factors will outweigh this “top line” figure, citing specific questions that associate NextGen ODs need to ask to determine the income potential in specific practice situations.

Recently, Dr. Naugle was interviewed by NextGEN OD Ambassador, Nyah Miranda regarding the FYidoctor’s Future Vision Leadership Program.  
Click the link to listen to this recent discussion.

 


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Opportunities for NextGEN Optometrists

Dr. Sophia Leung is at the cutting edge of the transformation of primary care Optometry to the medical model.

As a residency-trained and fellowship-trained optometrist with a clinical emphasis on the cornea, advanced glaucoma, and anterior segment disease, she calls upon her own experience to provide insights on the benefits of residencies and fellowships and provides concrete advice on finding the right match for young ODs.

After spending five years in private practice, Dr. Leung pursued an Ocular Disease and Refractive Surgery Residency in the US followed by an Advanced Glaucoma and Cornea Fellowship.

This led her to her current position as Principal Optometrists at a high volume corneal, cataract, and refractive surgical centre in Calgary, AB.  Dr. Leung is developing an OD-to-OD referral model the enhance patient access to ophthalmologic care that also increases time efficiency for ophthalmologists.

Dr. Leung is a Diplomate of the American Academy of Optometry in the Anterior Segment Section, the first Albertan and Canadian to do so.  She is President-Elect of the Alberta Association of Optometrists.

You can view her full presentation by clicking the play button below.

Dr. Sophia Leung discusses Residencies and Fellowships

Earlier this year, Dr. Leung was the guest on Eye Care Canada’s Eyes Wide Open Podcast.

She and host Dr. Roxanne Arnal discuss their personal and professional insights on mentorship, professional collaboration, and the evolution of optometry. They also delve into stress and practitioner burnout and point to a few interesting reads on the topic.


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next Gen OD webinar

In a uniquely formatted event, Canadian Optometry students were treated to the perspectives of both recent OD grads and insights of seasoned experts showcasing the opportunities and options available to them as they forge their professional careers.

The event was held simultaneously live to 100 students at University of Waterloo, School of Optometry and Vision Science and via online webinar to an expanded North American audience of young Canadian optometry students, including those studying in US Schools, including New England College of Optometry and others.

Bausch + Lomb Canada and Eye Care Business Canada | NextGen OD co-presented the event which was sponsored by B+L partners including Bailey Nelson, Eye Recommend, FYidoctors, and the IRIS Group.

NextGEN OD ambassadors Jenny Lee (OD-4 Univ. of Waterloo) and Nyah Miranda (OD-1 NECO) co-hosted the event, which presented six speakers, which was capped off with a panel Q&A and prize draws of over $1000 valiue.

YouTube Ravi Tanna
Watch Ravi Tanna’s Introduction to the NextGen OD Event – March 29, 2023. Tanna opens the event with his deeply personal account of his Best and Worse days relating to his own eye care.

Speakers Share Perspectives

Dr. Sophia Leung, President-elect of the Alberta Association of Optometrists provided advice on pursuing residencies and fellowships based on her own experience.

Dr. Michael Naugle, VP of Optometric Partnerships, FYidoctors, provided a very detailed assessment of the various OD compensation models, particularly as they relate to practicing in USA versus Canada and in various geographical settings; urban versus rural within Canada.

Dr. Mark Langer, IRIS Practice Owner in BC, shared his unique path to to practice ownership from Pacific College of Optometry (Oregon) to ownership of a community-based practice in the Okanogan Valley, having to wrestle with the decision to practice in Canada versus USA along the way.

Dr. Matthew Harrison, practicing in an Eye Recommend Practice in SW Ontario, shared his perspectives on the benefits of “Independent Practice”, including details on the Associate Signing Bonus Program offered by Eye Recommend.

Dr. Laurie Lesser, Eye Care Director, Bailey-Nelson North America and UK, provided a history of the chill Aussie Brand retailer addressing the importance of work-life balance in an optometric career.

Over $1000 of Prizes

Following the Q&A  , all event attendees were entered into a random prize draw. Here are the winners:

Clinical & Refractive Optometry Annual Subscription/Complimentary CE:
Amanda Leong (UW 2026)

Bailey Nelson Quality Sunwear:
Bethany Lo (UW 2023)

Eye Recommend $100 Gift Cards award to three attendees:|
Amy Wang (UW 2024)
Sarah Long (UW 2025)
Jean Nasta (UW 2026)

FYidoctors $100 e-gift card:
Alexander Rozbacher (UW 2024)

IRIS Group iPAD winner:
Vyshnavi Satyajit (NECO 2024)

Photo Gallery – Live Event Univ. of Waterloo

Live Event Univ. of Waterloo Live Event Univ. of Waterloo Live Event Univ. of Waterloo Live Event Univ. of Waterloo

 

 


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