--- title: "Physician Buyout Plan | Tax and Exit Planning for Physicians Selling to Private Equity" description: "Plain-English tax and exit planning for physicians and dentists whose practices are being acquired by private equity. Rollover equity, the scrape, the second bite, and the tax bill, explained before you sign." h1: "Private equity wants your practice. Here is what you keep." lede: "Independent, plain-English guidance on the tax and money decisions inside a private equity practice sale, written for the physicians on the selling side of the table. From a fee-only fiduciary advisor, not a banker or a buyer." eyebrow: "For physicians and dentists with an offer on the table" group: learn order: 1 nav_label: "Home" breadcrumb: "Home" type: WebPage pillar: true cta: true updated: 2026-09-07 llms_summary: "Homepage of Physician Buyout Plan, a site by Qubera Wealth Management for physicians and dentists selling their practices to private equity backed platforms. Introduces the four decisions that set the after-tax outcome (allocation, rollover, structure, state), links to the explanatory and tax pillars, specialty pages for dermatology, ophthalmology, dental, gastroenterology, orthopedics, anesthesiology, urology and radiology, state pages for California, New York, Texas and Florida, an after-tax proceeds calculator, a case study, and a 25-question LOI checklist." ---

Start here

Four decisions set how much of the price you keep

A private equity practice sale is decided in the term sheet, not on the tax return. By the time the purchase agreement is signed, most of the tax outcome is fixed. These four decisions do most of the work, and each has its own page.

Where the market stands in 2026

Roughly halfDrop in physician practice deals in the first half of 2026 compared with 2025PitchBook, as reported by STAT and Fierce Healthcare, August 2026
20 to 30%Share of practice profits a buyer typically takes out of physician pay (the "scrape")Commonwealth Fund, April 2026
13Private equity practice recapitalizations in 2024, down from about 100 a year in 2021 and 2022Foley & Lardner analysis, July 2026
8 to 10 yearsTypical hold period now, up from 5 to 7. The second bite is arriving later than it used to.Foley & Lardner, July 2026

Fewer deals, longer holds, and more of the price paid later in earnouts, seller notes, and rollover. That is a buyer's market on structure, which makes the tax and legal review of the term sheet more valuable, not less. Read should I sell my practice to private equity for the full picture, including the research on what happens to physicians after a sale.

Your specialty changes the deal

Multiples, ancillary income at risk, equipment recapture, and the mood of the buyers all differ by specialty. Each page below follows the same outline so you can compare.

Tools to use before the letter of intent

After-tax proceeds calculator

Enter the headline price, rollover percentage, holdback, the non-compete and consulting allocations, and your state. See the cash you would actually have after tax, and how much moves when the allocation changes. It uses 2026 federal rates and states its limits in plain sight.

The 25 questions to ask before you sign the LOI

A three-page checklist covering the allocation, the rollover terms, the employment agreement, the waterfall, and the tax items that cannot be fixed after exclusivity begins. Free, no email required.

Case study: a dermatology partner's share

How one partner in a four-physician group approached a platform offer: the allocation fight, the rollover decision, the cash balance plan in the final year, and what the after-tax number looked like against the headline.

Forty questions physicians ask

Short, direct answers on the deal, the tax, the salary change, the rollover, and what to do if you have already sold and wish you had not.

When you do not need us

If your offer is a small add-on price from a single buyer, the allocation is probably not negotiable and the real question is whether to sell at all. If you live in a no-income-tax state, your practice is an S corporation more than five years old, and the whole price is goodwill, the federal outcome is already about as good as it gets. If the LOI is signed and exclusivity has started, most of the structural levers are gone. In each of those cases a good CPA and a healthcare transaction attorney are what you need, and we will say so on a call.

Where a fee-only planner earns a place at the table is when the price is large enough that a few points of allocation matter, when there is a real choice about rollover, state residency, charitable giving, or a final-year retirement plan deduction, and when someone needs to model the household's cash flow through a 20 to 30 percent pay cut and an eight-year wait for the second bite. Who we serve describes those situations in more detail.

Who writes this

Nirav Desai is the founder of Qubera Wealth Management, a fee-only fiduciary registered investment advisor in Los Angeles. Qubera works with physicians, business owners, and tech professionals on portfolio construction, tax planning, and business transition planning. Nirav holds an MBA from UCLA Anderson and an MS in Computer Science from USC Viterbi, and has written about investing at keepcalmandinvest.com since 2012. This site is a companion to physicianfinancialplan.com and 1031exchangeplan.com.