ÉTALON ADVISORY SERVICES
A valuation tells you what your practice is worth. Advisory answers what to do about it.
The financial decisions that shape the outcome of a practice transition are rarely made at the negotiating table. They are made years earlier — in how the practice is structured, how income is positioned, how succession is planned, and how capital is prepared to move.
Étalon Healthcare works alongside physicians across the full ownership lifecycle: the planning years, the transition itself, and the financial architecture that follows. The financial advisor background means that financial planning depth is built into every engagement — not referred out after the valuation is done.
The Ownership Lifecycle
STAGE 1
Building
STAGE 2
Partnering
STAGE 3
Transitioning
STAGE 4
After the Sale
Physician Compensation Advisory
Physician compensation arrangements must satisfy the Stark Law fair market value standard. Étalon Healthcare provides compensation plan design and FMV opinion letters for healthcare organizations and physician groups — opinion letters that are defensible on their face, not boilerplate adjusted to fit.
- Productivity-based, equal-share, and hybrid compensation models
- FMV opinion letters for compensation arrangements
- Call coverage and stipend FMV analysis
The practices that transition well are the ones built with the end in mind — not because a sale is imminent, but because good financial structure is good practice management regardless of timing. Most valuation firms appear at the point of transaction. The more valuable engagement is the one that happens two or three years earlier — when there is still time to reduce key-person dependency, document operational systems, optimize revenue mix, and build the kind of practice a buyer actually wants to acquire. Business succession planning, capital structure, estate planning, and ownership structure are not exit concerns. They are the foundation that determines what options are available when the moment comes.
- Business succession planning and ownership structure
- Pre-transition financial positioning — coordinated with Étalon Financial
- Capital structure, key-person planning, and income positioning
A buy-in or buyout is one of the most consequential financial decisions a physician makes with another physician. It should be grounded in an independent valuation — not in what feels fair, not in what a colleague once heard was standard, but in what the practice actually supports. An independent opinion protects the relationship as much as the transaction.
- Independent practice valuation for partnership transactions
- Buyout structure and financing advisory
- Buy-in pricing and equity allocation analysis
Timing, structure, buyer type, and earn-out terms shape the outcome as much as the practice's underlying value. Selling to a private equity group, a health system, or an independent buyer produces materially different outcomes — financially and operationally. An asset sale and a stock sale are treated very differently by the IRS, with significant consequences for after-tax proceeds. The offer that appears most attractive at the LOI stage is not always the one that holds through closing. Capital advisory — how proceeds are structured, how installment notes interact with your broader financial picture, what tax treatment applies to each component — is as consequential as the transaction terms themselves. Étalon Healthcare works through the full picture before decisions are made.
- Pre-transaction financial positioning and value preparation
- Buyer type analysis — private equity, health system, independent
- Capital structure, proceeds planning, and transaction advisory (with legal counsel)
The financial mechanics of a practice transition — installment notes, capital gains treatment, earnouts, and structured proceeds — continue long after closing. How those mechanics are structured before closing determines much of what follows. Étalon Healthcare advises on the capital structure of the transaction: proceeds design, installment note terms, earnout mechanics, and buyer-specific transaction structure.
The personal financial planning that follows — estate planning, investment architecture, retirement income, charitable giving, and wealth transfer — is handled through Étalon Financial. The two practices are designed to work in sequence: Étalon Healthcare for the transaction, Étalon Financial for what comes next. Many physician clients engage both.
- Proceeds structure and capital design — coordinated with transaction terms
- Earnout mechanics, installment note terms, and buyer-specific capital structure
- Post-transaction capital advisory — Étalon Financial for personal financial planning