Everyday Oral Surgery Perspectives: Reasons to Not Sell Your Practice to a Private Equity Group(with Bob Spiel, MBA, and Nate Williams, CPA)
Mar 11, 2026
Bob Spiel, MBA, former hospital/surgical center CEO turned practice consultant, and Nate Williams, CPA/CFP who advises dentists on deals, challenge the rush to sell to private equity. They dissect valuations, work-back years, rollover equity and dilution. They warn about loss of control and outline alternatives to corporate buyouts in short, punchy takes.
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Private Equity Seeks Cash Harvest Not Clinical Improvement
- Private equity's aim is industry capture: raise prices, strip costs, harvest cash, then exit for investors.
- Bob argues PE involvement historically hasn't improved care in medicine and risks similar harms in dentistry and oral surgery.
DSO Offers Inflate Value With EBITDA Multiples
- DSOs advertise much higher headline multiples but they primarily value practices by EBITDA, not collections or goodwill.
- In the example a $3M practice with $750k EBITDA gets marketed as 8.5x ($6.375M) versus a private buyer paying ~$2.75M, exposing the multiple-driven messaging.
Work Back Means You Recreate The Value You Sold
- Most DSO deals include a multi-year work-back during which the selling doctor creates the EBITDA the buyer now owns.
- In the sample 5-year work-back the seller generates $3.75M of EBITDA that effectively reduces the true purchase price by that amount.