The Go-No-Go Decision When Your Practice is Already Hitting £500K
I was in Vienna for the ESCRS 2023 conference and a surgeon asked me a killer question: Go private or stick with the NHS part-time now that you’re earning ±£500K from your practice? Well, I’ve thought it over and here are my two cents based on what I’ve seen work for others.

Consider

• • Profit Margins: I’ve seen doctors gross a lot, but net a little. How much of that £500,000 is the actual profit? It’s crucial to nail down your financials before making any moves. Chances are, a lot of it is profit right now. Jump in with both feet, and you can expect to cut that in 1/2.
  • NHS Ties: You’re part-time with the NHS. Are there long-term contracts, interests or responsibilities you have to consider? One of my clients decided he loved the work so much – no amount of money was enough to jump.
  • Growth Metrics: Aim for a 6% quarterly growth goal. Are you ready to risk the investment? If not, you might want to wait before leaping.
  • Team Capabilities: Do you have the staff to go full-time? I’ve seen practices crumble because they scaled too quickly. Make sure your team is ready for the ride.
  • Life Goals: What’s your big plan? Looking to sell down the road, or is this a lifetime commitment? That answer guides a lot of these other questions.

Clear Goals:

• • Income Goals: Decide on the income you’d need to feel comfortable leaving the NHS. One of my clients set a 6-month target. She hit it and made the switch.
  • Think Long-term Valuation Aims:You’re eyeing a 5x multiple in 10 years. What needs to happen yearly to get there? Plan that out. You’ll need systems and top people to pull it off.
  • Personal Balance:Don’t underestimate this. Going full-time private is going to shake up your work-life balance. Family and friends *will* miss you. Think it through.

Guaranteed side-effects:

If you’re in your 40s, it’s a pivotal time. Your risk tolerance might not be what it was in your 30s, but you’ve still got runway ahead. It’s a double-edged sword:

• • Upside: You’ve got the experience and likely the financial cushion to take calculated risks.
  • Downside: A bad business move now has less time for recovery compared to 10 years ago.
  • Increased Scrutiny:You’ll get attention. Not all of it good. Expect more eyes on your financials, compliance, and operations.

The Income Game:

Now, about the money. If you nail that 6% quarterly growth, you could grow £250K (profit) to about £1.75M annually in 10 years. Selling at a 5x multiple? That’s a £6.25M exit.

Sticking with a hybrid model makes it harder to project. But chances are, focusing solely on your private practice will boost both growth and valuation in the long run.

The choice between going fully private or sticking with an NHS hybrid model boils down to your priorities: wealth, impact, or a balance of both. Knowing what you’re playing for simplifies this pivotal decision.

Reflect on your goals, consider the practicalities, and choose the path that aligns with your vision for the future. Remember, it’s not just about the financials; it’s about crafting a career that brings satisfaction and makes a difference.