INDUSTRY · HEALTHCARE AND WELLNESS
Selling a healthcare or wellness business in Quebec
With 25% of the Quebec population set to be 65 or older in 2031 and healthcare spending projected at $399 billion in Canada, demand is structurally protected. But in healthcare, value sits in regulated intangibles — voting rights reserved for professionals, patient files, continuity of care — and the buyer pool is dictated by the professional orders.
The healthcare and wellness market in Quebec
25%
Of the population will be 65+ in 2031
ISQ
$399B
Canadian health spending in 2025
CIHI
6.3x
Average multiple, dental acquisitions
Dentalcorp, Q2 2025
Quebec’s private healthcare and wellness sector isn’t a monolithic industry — it’s a mosaic of sub-segments (dental, veterinary, physiotherapy, optometry, pharmacy, senior residences) bound together by shared demographic dynamics and fragmented by distinct regulatory frameworks. As with professional services, the sale logic is closer to transferring a practice than to transferring assets — trust and the licence to practise are the real assets.
The tailwind is structural: people 65 and older could make up a quarter of the population by 2031 (Institut de la statistique du Québec), Canadian health spending is projected at $399 billion in 2025 (12.7% of GDP, CIHI), and the chronic bottleneck in the public system is pushing a growing share of the population toward the private sector.
For the owner of a Quebec SME in healthcare looking at an exit, that adds up to a near-safe-harbour status, largely inelastic to economic cycles — a quality institutional buyers are willing to pay for in solid files above $3 million in revenue.
Consolidation is real but segmented. In dental, Dentalcorp acquires at an average of 6.3x pro forma EBITDA (Q2 2025). In optometry, FYidoctors completed 22 acquisitions in 2025 to reach 370 locations. Oversight of the health professions falls under the Ministère de la Santé et des Services sociaux du Québec (MSSS), whose framework sets buyer eligibility in each sub-segment.
In physiotherapy, Lifemark (Loblaw) is consolidating aggressively in Quebec — Axo Physio, Physiothérapie Universelle. In veterinary, more than 20% of hospitals in Canada are corporate (VetStrategy, IVC Evidensia). On the other side, small senior residences (fewer than 30 units) are going through a wipeout: their number dropped by half between 2015 and 2023 in Quebec (CIRANO).
What’s different about selling in healthcare
The steps for selling a Quebec SME apply to a clinic like any other business, but what’s actually being sold is different. The buyer isn’t paying for inventory or machines — they’re paying for an ecosystem of trust, tightly regulated practice licences, and recurring patient flow. Advising on the sale of a Quebec healthcare SME is often where file discipline shifts the multiple far more than the clinic’s raw performance.
Professional orders dictate the buyer pool
In Quebec, full ownership (voting shares) is reserved for professionals registered with the relevant order. In dental, 100% of voting rights have to be held by dentists. In pharmacy, the P-10 Act reserves ownership exclusively for pharmacists — no corporate structure is allowed.
In physiotherapy, the rule is more flexible (more than 50% of voting rights). For corporate buyers (funds, consolidators), that forces MSO structures (Management Services Organization) that separate administrative management from professional practice.
EBITDA normalization is inverted
Unlike other SMEs where the owner’s salary is added back to EBITDA, in healthcare it’s the opposite. If the owner generates $500,000 in clinical production and pays themselves dividends without a formal salary, the buyer will have to hire a practitioner to replace them (35 to 45% of production).
Normalized EBITDA is what’s left after that deduction — a difference that surprises many sellers.
Patient files are legal liabilities
The patient database is the heart of the goodwill, but its transfer is subject to Law 25 and to the regulations of the professional orders (cessation of practice, qualified custodian, patient notice). A "paperless" clinic with a compliant, modern system justifies a premium — an obsolete system or paper files create diligence friction.
Typical multiples
Valuation benchmarks have to be broken down by sub-segment: the basis of valuation varies (normalized clinical EBITDA, percentage of revenue, or real estate yield for senior residences), and the most useful public sources often come from consolidating acquirers — with the usual limits when transposing to SMEs. The gap in multiples from one industry to another is particularly sharp in healthcare, where consolidators pay a platform premium that’s rarely accessible to an individual practitioner-successor.
Multiple ranges — Healthcare and wellness businesses
Base: Normalized EBITDA (after deducting the owner’s clinical replacement cost)
Dental clinics (multi-practitioner)
Dentalcorp: acquisitions at 6.3x on average (Q2 2025, pro forma EBITDA after rent). EBITDA above $1 million attracts consolidators. Solo practices: often valued at 70-100% of revenue.
Veterinary clinics
Stratified by size: ~5x for EBITDA of $500K-$1M, up to 8.5x for $1M-$5M. Emergency and specialty practices command an additional premium. More than 20% of the market is corporate.
Community pharmacies
Buyer pool strictly limited to pharmacists (P-10 Act). Also valued as % of revenue (70-100%). Pressure on operating margins (inflation, Bills 41/67 expanded scope of practice).
Physiotherapy and optometry
Active consolidation (Lifemark, FYidoctors — 22 M&A deals in 2025). Optometry benefits from the clinic + retail mix (eyewear), lifting margins.
These ranges are indicative and combine data from consolidator acquisitions (Dentalcorp, Lifemark, FYidoctors) with North American proxies (Simmons, First Page Sage). Consolidator multiples often include synergies and don’t necessarily reflect SME prices. Solo practices are often valued as % of revenue (70-100%). Senior residences are valued on real estate cap rate (6-8.5%). Sources: Dentalcorp Q2 2025, Focus IB, CIRANO, Extencia.
What pushes the multiple up
- Diversified clinical production (multi-practitioner, hygiene > 40%)
- Stable team of practitioners tied by non-compete clauses
- Recurring revenue (recalls, prevention plans, renewals)
- MSO structure or platform ready to integrate a consolidator
- Compliant digital files (Law 25, professional orders)
What pushes the multiple down
- Dependency on the key practitioner (80-100% of production by the founder)
- Corporate structure non-compliant with the order’s requirements
- Obsolete equipment requiring immediate CAPEX
- Paper files or outdated systems (diligence friction)
- Senior residences under 30 units (regulatory pressure, negative margins)
Who buys healthcare businesses in Quebec?
Identifying the right buyer depends on the rules of the professional order governing the sub-segment and on the size of the business. Ownership constraints create a market where the "best price" isn’t always the highest multiple — it’s the most executable offer in a compliant buyer pool. A broker specialized in selling businesses in Quebec structures the process so the two buyer logics — professional succession and consolidators — can coexist without being decided prematurely, and without exposing the clinic to local competition.
Who buys and why
Default regulatory buyers — professional orders require voting rights to be held by members. Dominant for small practices (< $1M revenue). In pharmacy, this is the ONLY allowable profile (P-10 Act).
Dentalcorp, FYidoctors, Lifemark, VetStrategy — they target multi-practitioner platforms with EBITDA above $500K. They use MSO structures to get around ownership restrictions. They buy at 6-8x and integrate at 12x+.
Chartwell, REIT funds — target large senior residences (100+ units). Real estate yield logic (cap rate 6-8.5%), not clinical logic. Small senior residences (< 30 units) are generally excluded.
Indicative proportions based on segment-level transaction dynamics (Dentalcorp, FYidoctors, Lifemark, Chartwell) and the regulatory constraints of the Quebec professional orders. The exact breakdown by sub-segment isn’t publicly available.
The acquisition of Axo Physio by Groupe Santé Universelle (a Lifemark/Loblaw subsidiary, summer 2024) illustrates the dominant logic in rehabilitation: Lifemark bought out 100% of the shares of this Quebec network of ten clinics across the Capitale-Nationale and Portneuf regions — not to fold the operations together, but to plug the local patient flow into its national ecosystem of more than 3 million annual visits.
In dental and optometry, consolidators use MSO structures to get around ownership restrictions: the corporate entity buys the equipment, the lease, and the commercial goodwill, then "leases" those facilities to the professional through management fees. A clinic already structured to make that setup easy attracts a crowd of financial buyers and speeds up the transaction. The dynamic echoes what happens in professional services firms, where the line between a commercial asset and a practice regulated by an order creates the same kind of discount if it isn’t prepared upstream.
Frequently asked questions — Selling a healthcare business
Can a non-professional investor buy my clinic?
Yes economically, but not directly in voting control. Professional regulatory bodies (dentists, optometrists, veterinarians) require voting rights to be held by members in good standing. Corporate buyers get around that restriction through MSO structures (Management Services Organization): they buy the assets (equipment, lease, goodwill) and sign a management contract with the professional. Strict exception: in pharmacy, the P-10 Act reserves ownership exclusively for pharmacists — no MSO structure is allowed.
Why is EBITDA preferred over rules of thumb (% of revenue)?
The "85% of revenue" rule of thumb ignores operating costs. Two clinics with $1 million in revenue don’t have the same value if one runs 25% margins and the other runs in the red. On top of that, EBITDA normalization in healthcare is inverted: you have to deduct the clinical replacement cost of the owner (often 35 to 45% of their production). Without that adjustment, profits are artificially inflated and the valuation will be disconnected from the market.
What happens to patient files when a clinic is sold?
Clinical files aren’t commercial inventory — they’re subject to Law 25 and to the regulations of the professional orders. The seller has to formally notify the order, transfer the files to a qualified custodian, and send a written notice to patients informing them of the transaction and of their right of access. A "paperless" clinic with a modern, compliant system justifies a premium.
Do I have to stay on after selling my clinic?
Almost always, yes. Buyers are buying your reputation and your trust relationship with the community. Offers almost always include a retention clause of 12 to 36 months, during which you practise as an associate. A portion of the price (earn-out) is often conditional on maintaining revenue during that period. The idea of handing over the keys and leaving immediately only works if the clinic already runs entirely on associate practitioners.
Does the new tax treatment (capital gains at 66.7%) affect the sale?
Yes, directly. Since June 2024, the capital gains inclusion rate has risen to 66.7% for corporations and for individuals above $250,000. At the same time, the lifetime capital gains exemption (LCGE) was boosted to $1.25 million. For MSO structures (asset sales), the corporation will pay more tax. Sellers should push for hybrid planning (a combined sale of shares and assets) to maximize the LCGE.
Why are small senior residences hard to sell?
The regulatory burden (certification, sprinklers, standards) and the inability to raise rents at the pace of inflation have triggered a wipeout: the number of senior residences with fewer than 30 units has dropped by half between 2015 and 2023 in Quebec (CIRANO). For those small facilities, the operating business often has no positive commercial value left — only the underlying real estate asset is recoverable. Large senior residences, on the other hand, are valued as institutional real estate assets (cap rate 6 to 8.5%).