This is my input from a recent VIN post and thought I would add it to the archive as there are many mobile sonographers or potential ones in the sonopath community. Your input is very welcome. This is my summary after years in this field as mobile practuce value is a black art and does not follow the same pathway as a fixed practice purchase.

>>>I have been doing mobile US since 2001 and did US in practice as a GP for 4 years prior and brought in mobile sonographers of acvr, acvim, and gp sonographers to take a second look at my own work or do the case outright when I was a GP in a facility. I scanned as a GP in mobile starting in Feb 2001 with my scans in part overread by one of the top sonographer in the field (ABVP) with much less technology than today. Then scanned as abvp in 2003 and have been running a group of 6 Dr/sonographers (2 acvim, 1 abvp and 3 gps) since 2006. I read cases from all walks of clinical sonography but only those that are willing to improve to get to the level necessary to make an accurate dx but they have to be solid coming in before moving on to improve.

So I have seen it all in this field and dealt with it all good and bad and this is the scenario: I have corrected misdx from GP sonographers, acvr, acvim and rdms and they have adjusted or correct my dx over the years as well….its the art of vet med and results of different views and is just reality. But this reality leads to how these situations are dealt with which translates into the value perception of a practice. I assure you my team always takes the high road which goes into the value of the practice listed below…professionalism of the practice and translates partially into value.

A mobile business has value in

1) Sonographer abilities (GP, RDMS, ACVR ,ACVIM whatever) to make the dx efficiently and have sold return clients and solid value perception. This, in a sale, is of high value if it is passed on to the one buying it and the person buying it follows suit but this is the caviat but has nothing to do with the sale price or the title of the sonographer but in the purchaser’s abilities to follow in line with what has been established. For example, I have seen radiologists make just as many mistakes as GPs with similar number of scans under their belts. Internists same thing and are all over the map in sonography abilities; some fantastic and others very rudimentary. Many radiologists prefer upper level imaging to sonography and hence, are not great sonographers. Other radiologists are phenomenal sonographers. its an individual thing and preference and nothing wrong either way. Don’t ask my to read a CT or a skull rad for example. There are others that do this better. So the practice value related to the title of the owner is a very very relative and individual thing and if you arent a radiologist buying a practice from a radiologist there will be lost clients that want a radiologist. This has to be taken into consideration wiht the history and transition of a practice and translates to individual worth of what you are looking at purchasing. Conversely, the practice has little value if the current owner is not adequately prepared in comparison to the potential new owner. A better prepared sonographer can build a better established practice competing with one that has significant deficits.

2) Boarded is a plus but not essential. To name drop some top well tested non boarded mobile sonogrpahers: Marty Henderson, San Antonio, Shawn Carey, Los Angeles, and emerging entities such as Lindsey Daniels in Atlanta and Mac Daniels Atlanta and NJ, Lauren Costa, Staten island just to name a few. All of these GP sonographers have a solid business with solid transferable clients and followings and could scan my pet any day of the week and i would have full confidence in their abilities to get the views and make the interpretation of nearly everything that comes across the probe. The more difficult cases such as congenital cardiac or shunts they may send out for confirmation remotely but knowing when to do that is also key to the success of the business. Should the purchaser follow in stride with the good will and abilities established? That’s the caviat. The purchaser must be willing to adapt to the established workflow and fit well with the established clients that can take years to build which is where the value of the practice  lies.

3)Equipment: solid US and 3 probes, and support materials 50k max/sonographer in the practice depending on the age of the equipment and sw ugrades and such.

4) Fixed practices are sold at 80-100% (or go by IBIDA formulas) of 1 year gross but, as a colleague said prior in this thread, “the practice is worth what you can get for it.” Mobile practices are worth just the equipment if the owner isn’t established with market good will. I assure you if you buy a practice where the established owner leaves suddenly and the new face comes in the practice will either tank if the new face isn’t as prepared, or client-adaptable, or at least take a “new face” dip in revenue that may take months to years to reestablish depending on the competition present. Clients will more often go for a less prepared established face first before they will go to a new face even if the new face is more prepared and let the others test out the waters. At least they know what they are getting which is easier for them. This is the dilemma bringing on new associates even in an established practice such as mine.

5) This is the subject I and Doug Casey will be presenting bout at IVUSS in Jackson this October to plug IVUSS ( http://www.ivuss.com/ ) if anyone is further interested in continuing this discussion and others live in the Grand Tetons:)

6) If the practice to buy has bad edges to it, poor sonographer prep, bad attitude,unethical behavior or business practices, bad relationships, and mediocre equipment>>>start your own.

If the practice has a solid following with a talented sonographer that is willing to teach you in a transition process over time at least a year depending on your abilities, and the practice has solid footing in the region, then go by the 80-100% of 1 year gross scenario. You are purchasing good will and education that is unprecedented. That is the value. To build this on your own without being a solid 100% ability to get every diagnostic view in < 15 minutes including congenitals and shunts, whether dx yourself or remote interps involved the views still have to be obtained efficiently, there will be misdx in your future that will kill your development as a practice. You will wish you would have gone the mentorship and purchase route with a lot of toil, sweat, $, and headaches in the mix. If you are solid in all the mentioned abilities going in then it makes sense even though there will be sticky politics as noone likes change and a lot of defense played out there and can get very very ugly at times.

Mobile sonography is extremely challenging in all aspects. We are put on the spot every time and have to be right…every time or we get the blame. Its not for the weak at heart and there are lives at stake. We only see medical cases day in and day out. No vaccines, crazy owners, anal glands an other tedious time consuming things. We see medicine and do business and establish and foster client relationships. A solid mobile practice will see 5-30 cases in a day. Think of the odds of getting every one of those right every time. That takes all the education we can muster and all the cases you can see and follow up on and then we just start to know what we are doing. Is that a challenge you want to have not being fostered by someone who has been there and gone through the curve?

6)Consider a partnership where a person brings in value either in degree (and or letters after the name, $, sweat equity, and good will (bringing new clients that weren’t there before). then blend in over time so there is less out of pocket and both parties win and work toward achieving goals. Business relationships only last of there is a 50/50 balance in work input, good will, income over time, and benefits. 60/40 leaves for sustenance but abrasive moments and 70/30 or worse crash and burn. But there is strength in numbers and 2 balances better than one in all ends.

Sorry for the long post but many have asked me this over the years so i figured I would take the opportunity to give them a link to go to.