Practice:

1. What is the historical adjusted net income for the practice? There’s a reason why this is #1.
2. Is there adequate excess earnings to pay student loan and acquisition debt along with any needed capital improvements? This one is a very close second!
3. Locations more than 25 miles away from a metro area may have a patient base with less PPO participation.
4. Overhead may be less outside of a metro area, especially staff and space costs.
5. If the practice is large and busy enough, would the seller be willing to stay as a producer/mentor?
6. From my observation, the quality and variety of procedures that can be performed is not related to location. Two of the most high-tech practices I have ever seen are deep in central Kansas.

Econmics:

1. Community assistance programs may be available to offset acquisition and/or start up costs
2. Programs may be available in certain areas to offset student loan debt.
3. While financing is generally not a problem for buyers with good credit, local lenders outside of a metro may be more willing to provide financing and in some cases the seller may agree to carry some or all of the debt.
4. If the curb appeal of the office is low, ask yourself what $10,000.00 would do towards the needed improvements and offer accordingly.

Lifestyle:

1. What are the opportunities for spousal employment?
2. Land prices may be less for a business and home location if you are more than 50 miles away from a major metro area.
3. What sort of support do you need for an enjoyable lifestyle? While for me quick access to a Home Depot and a salvage yard is important, some may need a Nordstrom’s.
4. Is there reasonable access to a hospital?
5. Are there acceptable schools and religious connections?
6. What about sports, restaurants and other entertainment?

Probably the best advice I can give to someone who has not yet put down their practice roots (actual ownership, not the promise of some "deal") is to NOT buy a house. The somewhat illiquid current housing market has forced more than one doctor to be a captive in a place they no longer desired to be. Practice opportunities have been passed over because they were on the "wrong" side of a metro from where the buyer lived. First things first; practice and then house. Practice opportunity and then location.