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.

Most surgeons track collections, not what they actually keep per clinical hour. In this article, I walk through a real‑world style example of a 2.4M orthopedic practice and show how overhead, tax structure, retirement plan design, and debt service combine to create a much lower effective hourly rate than most surgeons expect—and how targeted structural changes can raise that rate without adding a single additional case.