Build to Sell Even If You Never Plan To
80% of chiropractic practices never sell. They just close. Dr. Stuart Bernsen, founder of Chiro One Wellness Centers (160 locations, sold at 9x EBITDA), breaks down the difference between a Main Street exit and a Wall Street exit, and why every practice should be built to sell even if you never plan to.
Episode Details
80% of chiropractic practices never sell. They just close. After a career of building, all the time, energy, and money invested into the business simply evaporates when the doors lock for the last time. Dr. Stuart Bernsen has spent the last two decades trying to change that math at scale. He founded Chiro One Wellness Centers in 2007, scaled it to 160 locations across North America, and sold a 60% stake to private equity in 2017 at nine times EBITDA, which is essentially unheard of in chiropractic. He went back to test the exit market again in 2022.
Stuart was in private practice for 16 years before he founded Chiro One. He knows what it feels like to build a high-volume, high-profit office that's so personality-driven a patient drove past, didn't see his truck in the parking lot, and turned around. The patient wasn't coming for the chiropractic. He was coming for Stuart. That's the moment Stuart realized his practice wasn't a business. It was him with overhead.
In this episode, Stuart breaks down the three hats every practice owner wears: clinician (in the chair), operator (running the business), and shareholder (creating value). Most chiropractors only ever wear two. He explains the difference between a Main Street exit (doctor-to-doctor, 1 to 1.5x profit) and a Wall Street exit (institutional buyer, 2 to 5x profit), and why specialization can actually hurt your enterprise value, not help it. Upper cervical, 80% personal injury, or any technique-specific practice is harder to sell at scale because it's harder to replicate.
The conversation also covers how the chiropractic acquisition market has changed dramatically since 2010. When Stuart first tested the market that year, he spent every investor presentation defending chiropractic as a healthcare service. By 2022, every investor he met already had an investment thesis around chiropractic. The practice consolidation wave that hit physical therapy, dental, dermatology, GI, and ophthalmology over the last 15 years is now starting in chiropractic. Prices are moving up. The window is opening.
If you're a single-location chiropractor who's never thought about exit, a multi-location operator wondering what your enterprise value actually is, or an owner who plans to keep practicing forever but wants the option, this episode is the operating manual from someone who's been on every side of the transaction, including running the publicly-traded chiropractic playbook.
Key Takeaways
- 80% of Chiropractic Practices Never Sell: They just close. A career of work evaporates when the doors lock. The fix isn't finding a buyer at the end. It's preparing the practice to be sellable years before you want to sell.
- Main Street vs Wall Street Exit: A doctor-to-doctor sale (Main Street) typically sells at 1 to 1.5x profit. An institutional sale to private equity or VC (Wall Street) can sell at 2 to 5x profit depending on size and scale. Different buyer pools, different math, different practice structure required.
- The Three Hats: Every practice owner wears three roles. Clinician (in the chair), Operator (running the business day-to-day), and Shareholder (returning value on the time, energy, and money invested). Most chiropractors only ever wear two. Exit value lives in the shareholder hat.
- Specialized Practices Are HARDER to Sell: Counterintuitive but true. Upper cervical-only or 80% personal injury practices are hard to transfer because they're hard to replicate at scale. General practices that don't depend on a specific technique are more valuable to institutional buyers because they're more standardizable.
- The Personality-Driven Practice Trap: One of Stuart's patients drove by his clinic, didn't see Stuart's truck in the lot, and turned around. The patient was coming for Stuart, not the chiropractic. If your patients only see you, your practice's value is you.
- Plan 3-5 Years Before You Want to Sell: Practices that transfer to non-close associates typically drop 30-50% in revenue at handoff. Stuart spent 2 years preparing his original practice for transfer and it actually grew during the transition. The earlier you start preparing, the more value transfers with the deal.
- First Action: Record Everything You Do: Why, how, when. Stuart's COO followed him around with 3x5 cards documenting what was already happening. Standard operating procedures emerge from recording, not inventing. Useful even if you never sell. Critical if you ever do.
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