The first thing a buyer does is replace your owner compensation with the market cost of the clinical work you actually perform. If you see patients four days a week, the buyer has to hire or retain a doctor to replace that production, and the cost of doing so comes out of profit before the multiple is applied. This is the step that surprises owners most, because a practice that looks highly profitable when the owner takes a modest salary can look ordinary once a market-rate associate salary is substituted. Understanding this before you go to market is the difference between a realistic expectation and a disappointing one.
Optical dispensary margin is a large share of the profit in most practices, and buyers look closely at capture rate, frame inventory turns and whether the dispensary is genuinely managed or simply present. Alongside it, the recall system is the closest thing an optometry practice has to recurring revenue: a practice that reliably brings patients back on schedule has predictable future earnings, which is exactly what a multiple is paying for. Managed-care mix sets the ceiling on both, since heavy dependence on plans with low reimbursement caps how much of that volume converts to profit.
Two practices with identical collections can sell at very different multiples because the multiple measures risk, not size. Buyers pay more when there is associate coverage so the practice does not stop if one person is unavailable, when the patient base is broad rather than concentrated in a few referral sources or employers, when the lease is assignable with real term left, and when the financials are clean enough to survive diligence without rework. They pay less when the practice is genuinely the owner. Most of what moves your number is fixable, but it takes a year or two, which is why the useful time to ask what your practice is worth is well before you intend to sell.
It is valued the same way, but your continued clinical work is treated as a cost rather than a benefit. The buyer substitutes market-rate compensation for the production you provide, applies the multiple to what remains, and then negotiates your post-closing arrangement separately. Many owners do stay on for a period, and a well-structured transition can support the price, but the compensation you receive for working is a separate matter from the value of the practice itself.
Usually not as a separate business, but its profit is a significant part of the adjusted EBITDA the multiple is applied to, and buyers scrutinise it closely. Frame and lens inventory is commonly settled separately at an agreed value, in the same way prescription inventory is in other healthcare settings. A dispensary with a strong capture rate and disciplined inventory turns lifts both the profit and the multiple.