Selling Your Dermatology Practice Without the IRS / State Tax Hit
The dermatology MSO consolidation wave is one of the largest in healthcare. Schweiger Dermatology Group, Forefront Dermatology, Pinnacle Dermatology, Advanced Dermatology and Cosmetic Surgery, US Dermatology Partners, Riverchase Dermatology, Anne Arundel Dermatology and Epiphany Dermatology are paying 6-12x EBITDA. A $2M EBITDA practice = $12M-$24M sale.
The math: $15M dermatology practice sale
Assumptions: $15M, 75% goodwill, 15% equipment ($2.25M in lasers, biopsy and Mohs), 10% inventory + product.
Dermatology-specific tax wrinkles
- MSO structure. Most consolidator deals run through MSO/Friendly PC structure. APA governs §453 mechanics.
- Clinical vs cosmetic revenue split. Clinical (insurance) lower multiple, cosmetic (cash pay) higher.
- Mohs surgery sub-practice. Separately valued; high-equipment, high-margin sub-business.
- Cosmetic product retail (Obagi, SkinCeuticals, ZO Skin Health). Inventory carve-out, ordinary income.
- Pathology lab carve-out. If practice owns dermpath lab, separately valued.
- Laser equipment §1245. Fraxel, V-Beam, Excimer, Picosure: high recapture exposure.
What is the tax bill on your practice sale going to be?
Send me the sale price and rough basis. Within one business day I'll email you the actual number and the Seller's Guide to §453. If it doesn't fit your deal, I'll tell you that plainly.
No retainer · no obligation. Hans Goldstein, a licensed insurance agent (CA Insurance License #4273294), will contact you and may discuss insurance products, including annuities.
When this fits
- $3M+ sale
- MSO-platform buyer
- Strong cosmetic + clinical mix
When it doesn't
- Solo derm with minimal goodwill
- Mostly equipment sale
How I work
Hans Goldstein, EA, IRC §453 specialist. Admitted to practice before the IRS. Placements with highly rated life insurers (A or better by A.M. Best or equivalent) in all 50 states. Free fit-check.
Find out what your practice sale tax bill actually is, and what you can do about it
No retainer. On a funded structure, the insurer pays a one-time commission of about 4% of the amount structured to the brokerage firm that places it (Hans’s share is about 2.4%; no trail). It is built into the annuity pricing, not a separate fee.
Find out what your tax bill actually looks like before you sell, including the parts your CPA may not raise until the return is already being prepared.
Most people find out what they owe after the sale closes, when nothing can be changed. A short conversation now tells you the number, which layers apply to your situation, and which options are still open while the sale is still in front of you.
- What you will actually owe: federal, the 3.8% surtax, recapture and your state
- Which of those layers you can still do something about
- Whether spreading the sale changes the number in your case
Hans Goldstein · 213-414-2808 · Hans Goldstein: Tax & Exit Planning · This is an educational conversation, not tax advice. Bring your CPA in before you file.
Hans Goldstein, a licensed insurance agent (CA Insurance License #4273294), will contact you and may discuss insurance products, including annuities.
Educational. Not tax or legal advice.
Run your specific numbers
The calculator runs your sale through real 2026 federal + state tax brackets and shows §453 savings vs lump sum side-by-side.
Run the calculator → 213-414-2808