Hi Cousin Rufuss,This type of business has all sorts of problems...

Hi Cousin Rufuss,
This type of business has all sorts of problems with valuation.
I think they are more properly valued like a mining company with a limited life mine.
With the "mine", being the very expensive, limited life doctor contract.
When the contract runs its course, you have to buy another one.
Therefore a lot of the "earnings" are needed to pay off the initial capital expenditure.
These companies need to amortize their goodwill/contracts, as if they will be worth zero, which is what they may well be worth, when the short term contracts has run out. Interesting to see what the "profits" are, if that is done.
So unless they have a cheap source of ophthalmologists,I struggle to see how it isn't just a sophisticated "ponzi" scheme.
Doctors and management win, any crumbs left over for anyone else, purely accidental.

cheers

Disclosure:interested in this sort of business, as a similar one, previously failed to understand the above principle, and discovered that the "goodwill" they purchased from me, was worthless when the contract ran out.