When Assumptions Meet Reality in Practice Purchases

Practice acquisitions are often presented as logical, numbers-driven decisions.

A valuation is prepared. Lending is approved. Contracts are signed.

On paper, everything works.

Yet some practice purchases still struggle, not because anything was unlawful, poorly executed, or reckless, but because real-world behaviour doesn’t always follow financial assumptions.

This gap between assumption and reality is where many otherwise “sound” deals begin to unravel.

When the Deal Is Feasible, but the Outcome Isn’t

In practice acquisitions, it’s entirely possible for all professionals involved to do their job well:

• Valuations can be reasonable
  
• Lending decisions can be justified
  
• Legal documents can be sound
  

And still, the financial outcome deteriorates after settlement.

Why?

Because certain risks don’t sit neatly within any single area.

They emerge between:

• Contracts and cashflow
  
• Valuations and human behaviour
  
• Debt commitments and revenue timing
  

And they often only become visible once the deal is already locked in.

The Fragility of Goodwill

One of the most misunderstood elements of a practice purchase is goodwill.

Goodwill is not a static asset. It isn’t guaranteed by a contract. And it doesn’t exist simply because it was paid for.

In practical terms: Goodwill only exists if it converts into cashflow and debt is indifferent to how long that takes.

Where patient loyalty, referral patterns, or practitioner relationships are central to revenue, timing matters enormously.

If revenue transitions more slowly than expected, even temporarily, the financial pressure can escalate quickly when debt commitments are fixed and ongoing.

When Timing Becomes the Problem

In some post-acquisition scenarios, what actually drives stress isn’t profitability in the long run, it’s cashflow timing in the short run.

For example:

• Revenue may arrive later, or at lower levels, than forecast
  
• Personal income dependency may be higher than anticipated
  
• Buffers between expectation and reality may be thin
  

To manage cashflow gaps, buyers may need to supplement income elsewhere.

That external work reduces time in the practice. Reduced time slows patient stabilisation.
Slower stabilisation extends the cashflow gap.

Nothing has gone “wrong” in isolation, but the interaction between assumptions, debt, and behaviour creates a feedback loop that’s difficult to unwind.

Why These Risks Are Easy to Miss

These dynamics are rarely obvious at the transaction stage because:

• Legal documents naturally focus on enforceability, not behavioural timing
  
• Lending decisions assess serviceability, not transition friction
  
• Valuations rely on historical performance, not future human response
  

Each perspective is valid, but none fully captures what happens between settlement and stability.

That’s why some of the most costly outcomes in practice purchases don’t come from poor advice, but from decisions made without integrated financial clarity before commitments become fixed.

The Question That Often Matters Most

In practice purchases, the most important pre-decision question is rarely:

“Can this deal be completed?”

A more useful question is:

“What happens financially if revenue behaves differently, while commitments stay the same?”

That question is far easier to explore before documents are signed, debt is locked in, and assumptions harden into financial obligations.

Final Thought

Practice ownership can be an excellent long-term decision.

But success is rarely determined by the deal alone. It’s shaped by how assumptions, timing, cashflow, and human behaviour interact once the transaction is complete.

Understanding that interaction early, before momentum takes over, is often what separates a stable transition from a stressful one.

A Note on Decision Readiness

Situations like this are rarely obvious in advance, particularly when decisions involve multiple moving parts across cashflow, lending, structure, and future commitments.

Before major steps such as practice purchase, partnership, or significant debt, some doctors choose to complete a Financial Health Check to identify areas of misalignment or timing risk before decisions are finalised.

The purpose isn’t to provide advice or recommendations, it’s to surface blind spots early, while there’s still room to adjust.