Practice Values, Liquidity and Risks

As of October 17, 2025, the DJIA, Gold and Silver (via their ETFs, GLD and SLV as a proxy) are up Year to Date 10%, 80% and 60%, respectively.

Practice values YTD are about flat for a static practice and slightly up over 2024 for a growing practice. If a practice’s collections are declining, in the IDSO world, it is unsellable until it returns to growth.

Some Listened; Most Did Not

For the last two years, I have been preaching or proselytizing that doctors should consider monetizing their practice values today, not later. My logic was that doctors should sell into value rallies and enter into an IDSO partnership when their practice is growing.

proselytize
/ˈpräs(ə)ləˌtīz/
Verb: convert or attempt to convert (someone) from one religion, belief, or opinion to another.

Fortunately for our growing clients, we completed $130+ million of IDSO partnerships last quarter.

The reality is that for the last two years of my proselytizing, I have been right. You would have been better off to monetize your practice and prudently diversify your investments than wait for an increase in your practice value; probably the largest asset in your portfolio.

While values for growing practices are UP, not down over the last two years, they have not increased as fast as alternative investment opportunities including the S&P 500 (UP 59% in 24 months) and simple, risk-free interest (5%) on the cash they would have received in an IDSO partnership. But that is water under the bridge. We cannot change the past. It is the future that I am worried about…

Today’s Issues

This week we were forced to suspend our marketing efforts for two great practices; one initially valued at $10+ million and another at $15+ million. Why? We updated their quarterly numbers to 09.30.25 and both experienced a $100,000+ decline in EBITDA during Q3.

Due to these clients’ declining collections and EBITDA, neither will command the values they could have achieved 90 days ago. In fact, both would draw ZERO bidders at high values. IDSOs will only bid high values on GROWING practices.

Through no fault of their doctors, these two practices are now shrinking. And shrinking practices are not attractive to IDSO partners. If they return to growth over the next year, we may be able to help them, but in the meantime, they just left what WAS a collective $25 million in value un-monetized. That is $25 million they cannot invest in the S&P, Gold, Silver or just earn 5% risk free on the cash. And practice values a year from now are an unknown.

Now vs. Later

Timing your IDSO partnership is critical. You must act when your practice is growing. If your practice begins to shrink, it becomes undesirable. For those doctors waiting to squeeze another X$ of EBITDA out of their dental practice before starting the IDSO partnership process, there is a risk. If you begin to shrink, you will have to wait until you can show a year of return to growth. That could take a year, or years.

Fortunately, today, if you continue to grow after your initial partnership, you will be paid for that growth in the first two years after your partnership via an Earn Out. By partnering today, you lock in today’s high values for growing practices and get paid again for your growth at the end of year one and again at the end of year two. You also avoid the “zero-value” problem if your practice declines.

We have had many growing clients where the Earn Out payments resulted in millions of dollars of additional value! However, if you shrink, you have lost nothing and sold into a rally, at the peak, gained liquidity, reduced risk and achieved a diversified portfolio. This may or may not be the peak in practice values, but it is definitely NOT the bottom.

The Canary in the Coal Mine?

Take a look at insider buying/selling at U.S. public companies since October 13, 2025. Out of the hundreds of filings, all were to SELL, except for two.

These officers, directors and large shareholders of U.S. public companies are selling. It may be telling you something about their view of the future values of everything…

Time for a Conversation!

If we have not completed an initial value of your practice, or updated your numbers recently, let’s have a conversation. Reach us at 964-300-2644, text 972-914-7705 or email Blog@LargePracticeSales.com

P.S. Our Advisory Board continues to surprise many doctors… take a look!

Author
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Chip Fichtner

Principal at Large Practice Sales

Chip Fichtner, CoFounder of Large Practice Sales has completed over $1.0 billion in IDSO partnerships in the last 24 months with dozens of IDSOs nationally. He has built, bought and sold companies in a variety of industries and has been featured in numerous media outlets. His tolerant wife of 34 years allows him to live on his airplanes visiting clients every week.