Taking Over a Medical Practice 2026: Valuation, Financing, KV Procedure

How is a medical practice valued?

Valuation is the central lever. In practice three methods are in circulation:

1. Multiplier method (quick check): practice value = annual fees × 0.35 to 0.55. With general practitioners often at the lower end, with specialists with low material-cost shares (radiologists, ophthalmologists) at the upper end. This method delivers a house number for the first round of negotiations — no more.
2. Substance-value method: book value of inventory + receivables + market value of practice rooms. Only works for investment-heavy practices without significant goodwill (for example on closure without a patient base).
3. Modifizierte Ertragswertmethode: transferable profit × capitalisation factor. This method is the BSG standard in disputes over market value and delivers the most robust results.

The Federal Social Court ruled in its judgment of 14 December 2011 (case no. B 6 KA 39/10 R): if no agreement is reached between the departing Vertragsarzt and the applicants, the admission committees determine the market value under the modified income-capitalisation method. The transferable practice profit of the last three years, adjusted for special effects and an imputed entrepreneurial salary, is the benchmark. Judicial review is possible but limited — the valuation discretion of the committees is wide.

What concretely determines the practice value

The range of market values is wide. A general-practitioner solo practice with 1,200 cases per quarter in a medium-sized city typically lies between 250,000 EUR and 450,000 EUR. A specialist practice (such as orthopaedics, dermatology, gynaecology) with the same case load can achieve 500,000 EUR to 900,000 EUR. For radiology or ophthalmology practices with high-priced equipment, seven-figure values are quickly reached.

Six factors materially determine the valuation:

• Transferable profit of the last three years, adjusted for special factors (private withdrawals, investments, one-off KV back-payments)
• Patient base: stability (proportion of regular patients), age structure, regional ties
• KV seat: blocked or open planning area, supply level
• Location: ownership or rental of the practice rooms, location, accessibility, parking
• Staff: takeover of employees, staff structure, contracts
• Investment backlog: renovation needs, age of equipment, IT infrastructure

In my advisory practice I regularly see that sellers overestimate goodwill and buyers underestimate the investment backlog. A professional valuation — often by an auditor or specialised Steuerberater — costs 4,000 to 8,000 EUR and provides the robust basis for negotiation.

Financing options 2026

The classic route runs through apoBank, which has for decades been the market-leading practice financier in the medical professions sector. Competition comes from Sparkassen, Volksbanken and some private banks with medical-professions specialist units.

apoBank practice financing

apoBank offers standardised practice financing with the following typical conditions (as of 2026):

• Interest-rate fixation of 10 or 15 years, nominal interest depending on creditworthiness and market between 4.2 and 5.8 per cent
• Tilgungsstreckung in the first two build-up years possible (interest-only payments)
• Up to 100 per cent purchase-price financing with a very good practice outlook
• Security: usually transfer for security of the practice equipment plus self-debtor's guarantee
• Combination with KfW loans (KfW entrepreneur loan, ERP founder loan) is supported

apoBank typically requires: management accounts (BWA) and tax assessments of the practice for the last three years, a valuation report, a business plan for the first three to five years and a creditworthiness assessment of the applicant.

Hausbank mixed financing

Hausbanken outside the apoBank world often offer mixed financings with portions through KfW subsidised loans and portions through Hausbank loans. Advantage: often cheaper interest rates with very good creditworthiness. Disadvantage: less sector know-how, longer processing times, often more conservative loan-to-value limits (often 70 to 80 per cent).

Seller loan

A practically underestimated option is the seller loan. The departing Vertragsarzt finances part of the purchase price himself (typically 20 to 40 per cent), often on comparable conditions to the Hausbank but with softer security requirements. That has two advantages: it signals the financing banks the seller's confidence in the practice outlook, and it reduces the external loan amount — both ease the creditworthiness check.

In advisory meetings I regularly encounter the assumption that a seller loan is an "emergency solution for weak practices". The opposite is true: in valuable practices, the seller loan is often part of a thoughtful handover design — particularly when the handover is to run gradually via a BAG (Berufsausuebungsgemeinschaft, professional joint-practice partnership) interim model.

The KV Nachbesetzungsverfahren from the buyer's perspective

In blocked planning areas — which are most urban areas and many specialities — the KV decides on the choice of successor under § 103 Abs. 4 SGB V. The procedure runs in three phases.

Phase 1: advertisement

The departing Vertragsarzt applies to the KV for the advertising of his seat. The KV publishes the advertisement in the KV member journal or online; the application deadline is usually six to eight weeks. Applicants must hold the Approbation, fulfil the specialism-specific requirements and provide evidence of personal willingness to take over the practice.

Phase 2: selection by the admission committee

The admission committee (composed on a parity basis of KV and health-insurance representatives) selects according to the criteria of § 103 Abs. 4 Satz 4 SGB V: professional suitability, length since Approbation, duration of medical activity, waiting-list position, personal ties to the location. Family and economic ties to the departing Vertragsarzt may only be considered to a limited extent.

The Federal Social Court ruled in its judgment of 11 December 2013 (case no. B 6 KA 49/12 R): the admission of a doctor by way of practice succession requires the existence of a continuable practice. The point of application is decisive. In addition, only applicants who have the will to continue the practice come into consideration — a period of five years is in any case sufficient; an immediate relocation of the seat to another region would be impermissible.

Phase 3: economic agreement

Once the admission committee has selected an applicant, the economic agreement on the purchase price begins. Here the departing Vertragsarzt has a strong position: if he reaches agreement with all applicants on a purchase price, this deprives the admission committees of the power to determine the market value — the valuation result is then freely negotiable.

In practice, it is worthwhile for buyers to use the valuation report as a negotiation framework rather than as a fixed anchor value. A discount of 10 to 20 per cent compared with the report can regularly be achieved — particularly if the practice has specific weaknesses (investment backlog, high share of older patients, unfavourable rental contracts).

Tax treatment of the purchase price

The tax structuring of the purchase price is the underestimated lever in the takeover deal. Three components are treated differently:

Goodwill: depreciation over three to five years

The practice value (goodwill) is depreciable as an intangible asset. The depreciation period depends on the expected useful life — the tax authorities usually accept three to five years, in justified cases up to ten years.

The Federal Fiscal Court (Bundesfinanzhof, BFH) ruled in its judgment of 21 February 2017 (case no. VIII R 7/14): the Vertragsarztzulassung acquired by the buyer of a contract-physician practice is an independent, non-depreciable intangible asset, to the extent that a surcharge over the market value (Ueberpreis) was paid for it. If the new partner of a joint-practice partnership bears the acquisition costs of the admission himself, the asset is acquired by him — with corresponding tax consequences for accounting. Practical consequence: the buyer should clearly separate practice value (depreciable) and pure admission surcharge (non-depreciable) in the contract.

Inventory: linear or declining depreciation

Equipment, IT, practice furniture are depreciated according to the general depreciation tables — typical useful lives lie between eight and fourteen years. The declining depreciation of 25 per cent reintroduced from 2024 (for acquisitions in 2024) can noticeably reduce the tax burden in the early years.

Seller loan: interest as a business expense

Interest on the seller loan is fully deductible as a business expense (§ 4 Abs. 4 EStG). With a seller loan of 100,000 EUR at 5 per cent, 5,000 EUR per year flow tax-reducing into the practice profit-and-loss account.

Example calculation: tax savings

An internist takes over a practice at age 34 for 450,000 EUR. Allocation in the purchase contract: 320,000 EUR goodwill (depreciable over 5 years = 64,000 EUR p.a.), 80,000 EUR inventory (over 10 years = 8,000 EUR p.a.), 50,000 EUR admission surcharge (non-depreciable). Financing 100,000 EUR via seller loan at 5 per cent (5,000 EUR interest p.a.), the rest via apoBank.

The annual tax saving in the first five years (at top tax rate of 42 per cent plus solidarity surcharge): around 77,000 EUR depreciation and interest expense p.a. × 44 per cent marginal rate = around 33,900 EUR tax saving per year. Over the first five years that adds up to around 170,000 EUR — almost 38 per cent of the purchase price in tax-related liquidity relief.

Three structural models for the takeover entry

The classic 100 per cent direct takeover is not the right model for every buyer. In my advisory practice I work regularly with three alternatives.

Model 1: direct takeover of the solo practice

The classic for young specialists with a clear self-employment decision. Advantages: full economic control, simple tax structure, clear goodwill depreciation. Disadvantages: full entrepreneurial risk from day one, high liquidity need, no transition phase.

Model 2: BAG entry with later takeover

The buyer first joins an existing Berufsausuebungsgemeinschaft (BAG) with the departing Vertragsarzt. Over one to three years there is a shared practice phase during which patients, staff and practice processes are handed over. The older partner then withdraws. Advantages: soft transition, lower initial risk, valuation correction possible if needed. Disadvantages: more complex contractual structure, two BAG admission procedures, goodwill valuation shifts.

Model 3: MVZ entry as an employed doctor

The buyer starts as an employed doctor in a Medizinisches Versorgungszentrum (MVZ) into which the practice has been merged. The later takeover as a partner can be structured. Advantages: induction without entrepreneurial risk, often with a profit share, easier compatibility with family. Disadvantages: lower income ceiling, less structuring room, dependence on the MVZ holding structure. How an MVZ structuring is set up in practice is shown in Mandate: doctor GbR and MVZ.

Practice case: GP practice takeover with a BAG interim model

An anonymised case from my advisory practice illustrates the BAG model concretely. A 36-year-old GP specialist (previously employed in an MVZ) wanted to take over a GP solo practice in the Frankfurt suburbs in 2024. Seller: a 64-year-old GP with a classic solo practice (around 1,350 cases per quarter, three employees, rented practice rooms, valuation report 480,000 EUR).

Three problems emerged in the first conversation. First: the applicant had 90,000 EUR of equity but needed 480,000 EUR plus start-up financing — apoBank signalled a 350,000 EUR direct commitment, 130,000 EUR open gap. Second: the seller wanted a soft transition over 18 months, out of concern for his long-standing patient base. Third: the KV had recently advertised the planning area for GPs as open — three competing applicants.

We combined three levers. First a BAG interim model for 18 months in which the seller remained with a 25 per cent share and the buyer entered with 75 per cent. That cut the immediate purchase price to 360,000 EUR, staying within the apoBank direct commitment. Second a seller loan of 120,000 EUR at 4.8 per cent for the 75 per cent entry, repaid from the running practice profit over the first five years. Third a careful KV application emphasising the willingness for permanent ties to the location — the admission committee chose our client over the competing applicants.

The result after 24 months: the seller has withdrawn, the 25 per cent residual share was taken over as planned at a reduced price of 110,000 EUR (valuation discount because case numbers had slightly declined in the meantime). 92 per cent of the patient base has remained. For tax purposes, the staggered takeover allowed the goodwill depreciation over two tranches — a liquidity advantage of around 18,000 EUR over the first three years compared with the direct takeover. The apoBank financing is running as planned, the seller loan has been repaid on schedule.

The BAG interim model is my most common recommendation for takeovers above 400,000 EUR. It solves three problems at once: liquidity peak for the buyer, transition wish on the seller side, and patient retention in the critical transition phase. A precondition is a reliable relationship between the partners — otherwise the model only shifts the conflicts into the BAG phase.

Comparison of the three structural models

What you as a buyer should do now

Anyone planning a concrete takeover should tackle four steps in this order:

1. Commission a valuation report. Before you enter into purchase-price negotiations, you need an independent market value under the modified income-capitalisation method. Cost: 4,000 to 8,000 EUR. Without this report you negotiate blind — and banks will not finance you anyway.

2. Financing meeting with apoBank and a Hausbank. Compare two offers, ideally with a seller loan as a building block. The interest difference of 0.3 to 0.8 percentage points adds up to five-figure amounts over 10 years.

3. Tax structure agreed with a Steuerberater. Allocation of goodwill / inventory / admission surcharge in the purchase contract, depreciation strategy, seller-loan interest. This is the lever with the highest ROI in the entire takeover process.

4. Strategically prepare the KV application. Evidence of suitability, ties to the location, specialist focus areas. With several competing applicants, the quality of the application decides — a generic standard application often loses against one that is substantively differentiated.

Frequently asked questions

What does an average GP practice cost in 2026?

A general-practitioner solo practice with around 1,200 cases per quarter in a medium-sized city has a market value of 250,000 to 450,000 EUR. In urban agglomerations or particularly attractive locations, prices of 500,000 EUR and more can also be called. The multiplier method typically yields 0.35 to 0.55 times the annual fees.

How high is the goodwill share of the purchase price typically?

In classic solo practices the goodwill share is usually between 60 and 80 per cent of the purchase price. The remainder falls on inventory and, in blocked planning areas, on an admission surcharge. The clean allocation in the purchase contract is decisive for tax purposes, because only the goodwill is depreciable and the admission surcharge is non-depreciable under BFH case law.

Can the seller guarantee me the practice succession?

No. The selection decision in the Nachbesetzungsverfahren is taken by the KV admission committee under the criteria of § 103 Abs. 4 Satz 4 SGB V. Family and economic ties to the seller may only be considered to a limited extent. The seller can negotiate the purchase price but cannot determine the selection.

What is an MVZ employment with takeover option?

In the MVZ model the buyer begins as an employed doctor on a typical employment contract with a written option to enter later as a partner or to take over the practice in full. This model significantly reduces the initial risk but brings lower income ceilings and less structuring room. It is particularly common with young doctors with family planning or undecided self-employment preferences.

How long does the Nachbesetzungsverfahren take in practice?

From the application of the departing Vertragsarzt to the admission of the successor, six to twelve months typically pass. Phase 1 (advertisement) takes six to eight weeks, phase 2 (selection by the admission committee) two to four months, phase 3 (economic agreement plus admission decision) a further two to four months. With competitor disputes or objection proceedings it can extend to 18 to 24 months.

Should I speak to the bank before or after the KV selection?

Beforehand. Banks usually expect a conditional financing commitment already at the time of the KV application — that is a suitability signal for the admission committee. The final payout naturally only follows once all approvals are in place (admission, purchase contract, BAG approval where applicable), but the conditional commitment has to be in place early.

What risks do I see most often in takeovers?

Three recurring risks from my advisory practice: (1) Valuation without a report — the buyer pays 10 to 25 per cent too much. (2) Tax structure without advice — 50,000 to 100,000 EUR of tax-related liquidity relief left on the table. (3) Patient retention underestimated — with a hard handover without a BAG interim phase, the patient base can drop by 20 to 35 per cent in the first twelve months. All three risks are avoidable through early preparation.

A personal conversation?

If you are planning a concrete takeover — whether as a young specialist with your first self-employment or as an experienced doctor relocating — a structured initial consultation is worthwhile in which we go through your starting position, the practice key figures and the financing and tax options.

Book a free initial consultation — by video call or in person in Liederbach near Frankfurt.

Related topics for doctors taking over and doctors in private practice

• Inheriting a medical practice: what your heirs (maybe) will get — the seller and heir perspective: Gnadenquartal, Berufstraegerklausel, three protective structures.
• Mandate: doctor GbR and MVZ — structuring and sale — anonymised practice case with three doctors in a GbR practice community, building an MVZ holding structure.
• Start succession planning early: why 10 years' lead time is decisive — whoever enters as a buyer should plan their own succession in parallel.
• Holding structure: tax advantages, set-up, legal forms — with MVZ shareholdings or several practice locations, often the more elegant structure.
• Relief discount § 13a/13b ErbStG: business assets 2026 — the relief rules also apply to freelance practices — for the later handover to the next generation.

External sources and statutory texts

• § 103 SGB V at gesetze-im-internet.de — Admission restrictions and re-appointment procedure
• § 95 SGB V at gesetze-im-internet.de — Vertragsarztzulassung
• § 4 EStG at dejure.org — Business expenses and goodwill depreciation
• § 7 EStG at dejure.org — Depreciation rules for inventory
• BSG, judgment of 11 December 2013 — B 6 KA 49/12 R — Continuable practice as a prerequisite for succession admission
• BSG, judgment of 14 December 2011 — B 6 KA 39/10 R — Market value under the modified income-capitalisation method
• BSG, judgment of 19 July 2023 — B 6 KA 5/22 R — Withdrawal of admission in case of non-exercise
• BFH, judgment of 21 February 2017 — VIII R 7/14 — Vertragsarztzulassung as an independent intangible asset
• BFH, judgment of 9 August 2011 — VIII R 13/08 — Practice value at acquisition as an opportunity package including admission
• apoBank practice financing — Standard conditions for practice financing in the medical professions sector

Legal position: 2026.