Orthopedic surgeons rarely realize how much practice value is created long before a buyer shows up.

This article breaks down a three‑year succession runway designed for independent orthopedic practices: Year 3 focuses on systemization and personal goodwill documentation, Year 2 on associate hiring and referral mapping, and Year 1 on buyer engagement, deal structure, and tax planning.

You’ll see how hospital productivity benchmarks, surgeon‑dependent revenue, ASC equity, and properly documented personal goodwill can change EBITDA multiples and after‑tax proceeds by seven figures at exit.

Independent orthopedic practices used to set the productivity standard. That dynamic has flipped—hospital-employed surgeons now lead on work RVUs, and sophisticated buyers are using those benchmarks to model lower post-sale revenue in private practices. In this article, we walk through how normalized EBITDA, RVU assumptions, and hospital infrastructure advantages are changing what your practice is worth, and outline three concrete steps to protect—and potentially increase—your exit value.

Most orthopedic surgeons look at tax returns and assume that number is what their practice is worth. In reality, buyers use normalized EBITDA—adjusted for owner pay, personal expenses, and one-time costs—to decide what they’ll actually pay. This article shows how to estimate normalized EBITDA and use it to negotiate from a position of strength.