Solo Internal Medicine Practice, 24-Year Houston Primary Care

$1.3M

Revenue

$858K

SDE

2.6x

Multiple

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Full Editorial Writeup

This is a single-physician internal medicine practice with an outpatient, primary-care focus in the greater Houston metro. The solo physician-owner has operated it continuously since 2002 (24 years) and built a large, stable, loyal patient panel. At roughly 35+ patient visits per day, the owner is running near a single provider's capacity ceiling, which is both a sign of durable demand and a clear lever for expansion.

The economics are clean and consistent. Gross revenue was approximately $1.35M in 2025, $1.29M in 2024 and $1.39M in 2023, a remarkably flat six-year history, on reported cash flow of $858K. The payor mix is heavily commercial (about 55%) and Medicare (about 40%), with a small cash-pay tail (about 5%), which is exactly the profile a buyer wants: diversified, insured, and low collection risk.

What makes this notable is the transition structure. The retiring owner has committed to stay actively involved for at least two years, a far longer runway than the typical 90-day solo-physician handover, which materially de-risks the patient and referral transfer. The listing frames the ideal buyer as an existing primary-care or multi-specialty group, an individual physician-buyer, or a group looking to layer in NP/PA capacity and pursue value-based care and capitation on the Medicare book.

Why we like it

Earnings quality is strong for a solo practice: $858K cash flow on $1.35M revenue is a 64% margin, and the six-year revenue history barely moves (1.39M, 1.29M, 1.35M across 2023-2025). That kind of flatness through COVID and inflation signals genuinely sticky demand rather than a spike you are buying at the top of.
The moat is the patient panel and payor mix. A 24-year established base with 55% commercial and 40% Medicare is diversified, insured, and low on collection risk, and primary-care patients rarely switch doctors without a reason. Buying that relationship base is far cheaper than building it from zero in a competitive Houston market.
Market tailwinds are real. Houston is a high-growth metro, an aging Medicare population supports value-based care and capitation upside, and primary care is squarely essential demand that people do not cut in a downturn. The Medicare skew specifically opens a capitated growth model the current owner has not tapped.
The operator advantage is unusually good here. The retiring physician has committed to at least two years of active involvement, which is far longer than the typical solo-doctor handover and dramatically de-risks the patient and referral transfer that usually kills these deals.
The single-provider capacity ceiling is upside disguised as a constraint. The owner sees 35+ visits a day at near-full capacity, so adding an NP, PA, or second physician converts unmet demand into revenue without needing to win new patients from scratch.

How to improve it

Add mid-level capacity fast. The owner is at his ceiling at 35+ visits a day, so recruiting an NP or PA in the first 90 days captures demand that is already walking in the door. This is the single highest-ROI move and it also reduces single-provider key-man risk.
Stand up a value-based care and capitation strategy on the Medicare book. With roughly 40% Medicare, moving eligible patients into a Medicare Advantage or ACO arrangement can shift revenue from fee-for-service toward higher-margin, recurring per-member economics. Model this carefully before committing.
Audit and renegotiate the commercial payor contracts. A solo doctor rarely has leverage or time to push rate increases, so a group buyer with scale can often lift reimbursement on the 55% commercial mix. Even a few points of rate improvement drops almost entirely to the bottom line.
Tighten revenue-cycle management. Review denial rates, days-in-AR, and coding accuracy, since solo practices frequently leave money on the table with under-coding and slow collections. Cleaning this up can lift collected revenue without adding a single patient.
Extend hours and add ancillary services. With a loyal panel, layering in in-office labs, chronic-care management billing, annual wellness visits, and remote patient monitoring adds recurring revenue streams the owner has likely never billed. These carry high margins against an existing patient base.
Build a second referral engine. The practice runs near capacity today, but a formal relationship with local specialists, urgent cares, and Medicare Advantage plans creates a reliable inbound pipeline for the added provider so the new capacity fills quickly.
Document and systematize before the owner leaves. Use the two-year runway to codify protocols, referral relationships, and patient-communication norms so the practice does not depend on one physician's memory. This directly protects enterprise value at your own exit.

Diligence notes

Confirm how much of the $858K cash flow is true transferable earnings versus the owner physician's clinical production. A large share of this SDE is one doctor personally seeing 35+ patients a day, so you must model the cost of replacing that clinical labor with a hired physician and see what actually remains as owner-independent profit.
Scrutinize the payor contracts and reimbursement rates. Verify the 55% commercial / 40% Medicare / 5% cash split against remittance data, check contract assignability on a sale, and confirm no single payor or capitation arrangement is driving outsized concentration risk.
Analyze patient panel age and attrition. A 24-year practice may carry an aging patient base and an aging referral network, so review active patient counts over the last three years, visit frequency, and how many patients are tied personally to the retiring physician versus the practice.
Validate the lease and location. The practice runs from a leased 2,700 SF space at $6,880 per month, so confirm remaining term, renewal options, and rent escalators, since a capacity-driven expansion may require more space than the current footprint allows.
Verify credentialing, licensing, and compliance. Confirm the physician's malpractice history, Medicare enrollment standing, any prior audits or clawbacks, and how quickly a new provider can be credentialed with each payor, because credentialing delays can strangle cash flow during transition.
Pressure-test the retirement timeline and buyer type. The owner cites retirement in 2029 with two years of involvement, so pin down exactly what active involvement means, whether he keeps producing clinically during that window, and how patient relationships will formally transfer before he exits.

Source

Originally listed on BizBuySell. View original listing →