Private equity offers orthopedic surgeons big multiples and polished pitch decks—but the real story lives in the fine print. This article walks through how rollover equity, compensation resets, EBITDA ‘engineering,’ and PE hold periods actually work in many orthopedic deals. It then shows, with a simple $4M practice sale example, how planning around personal goodwill and deal structure can change a surgeon’s federal tax bill by hundreds of thousands of dollars. If you’re an orthopedic surgeon being courted by private equity, this is the pre‑dinner framework to read before you say yes—or no.