📖 Approx. 3 minutes ／ Updated 2026.06.16
Recruitment difficulties for nurses, pharmacists, and doctors are pressuring management. Management strategies for the era of staff shortages, including utilizing talent pools through group-participating M&A, streamlining through mergers, and local collaboration.
Current Status of Medical Staff Shortages Based on Industry Data
According to a survey by Tokyo Shoko Research, the number of bankruptcies and closures in the medical industry (hospitals, clinics, dental clinics) has remained high in recent years. In 2024, particularly for small and medium-sized medical institutions, the management environment has become more challenging due to the medical fee revision, soaring personnel costs, and rising energy costs.
The Ministry of Health, Labour and Welfare’s Survey on Medical Institutions shows that in some months, the number of new clinic openings has been surpassed by the number of closures, making early consideration of business succession essential for maintaining regional healthcare.
Primary Factors Leading to Deterioration of Management
- Impact of Medical Fee Revisions: Reduction in insurance medical treatment unit prices, stricter facility standards
- Soaring Personnel Costs: Recruitment difficulties for nurses, pharmacists, and administrative staff, and pressure for wage increases
- Burden of Capital Investment: Electronic health record updates, CT/MRI replacements, advancement of medical equipment
- Aging of Clinic Directors and Lack of Successors: Delays in decision-making and underdeveloped succession systems
- Decrease in Patient Numbers: Decline in outpatient numbers in depopulating areas, increase in competing medical institutions
- Rising Interest Rate Environment: Increased burden of interest on borrowings and difficulty in refinancing
10 Early Warning Signs of Management Crisis
- Current ratio falls below 100% (deterioration of short-term payment ability)
- Medical profit margin falls below the industry average (5-8%) for three consecutive periods
- Notices of seizure of medical fees or tax delinquency occur
- Requests for additional loans from financial institutions are rejected
- Negotiations for deferral of lease payments or rent payments
- Delayed salary payments, bonus cuts
- Cancellation of medical equipment maintenance contracts
- Demands for cash transactions from pharmaceutical wholesalers
- Successive resignations of staff
- Requests for additional personal guarantees from the clinic director
Options and Resolution Schemes
The options for dealing with management difficulties are considered in stages according to the severity of the situation.
- Phase 1: Management Improvement (Early Stage) – Cost structure reform, revenue enhancement measures, expansion of credit lines
- Phase 2: Business Succession M&A (Mid-term) – Secure transfer consideration through group participation or third-party succession
- Phase 3: Private Workout/Sponsor M&A (When Debt Adjustment is Necessary) – Succession to a sponsor company after consultation with creditors
- Phase 4: Legal Reorganization (Last Resort) – Reconstruction through civil rehabilitation/corporate reorganization, or liquidation through bankruptcy
Succession “While Still Healthy” is Overwhelmingly Advantageous
In cases of reorganization after becoming insolvent or bankrupt, the transfer consideration is often zero or negative, leaving only the clinic director’s personal guarantee liabilities.
On the other hand, if third-party succession is chosen while the business is profitable, it is possible to secure a transfer consideration that appropriately values the business, while also ensuring staff employment, continuity of patient care, and the continuation of regional healthcare.
Our support track record shows an average period from consultation to closing of 6-10 months for clinics without beds and 9-18 months for medical corporations. Early consultation at the first sign of management deterioration leads to the best outcome.
Frequently Asked Questions
Q. Is it possible to transfer even if insolvent?
A. Yes, it is possible. There are schemes such as sponsor M&A and third-party succession involving creditor adjustments. We have extensive experience supporting cases of insolvency.
Q. Will my creditors or staff know that I consulted you?
A. Information is disclosed only to a limited extent after signing an NDA, and there is no need to disclose it to related parties before the final contract. We strictly maintain confidentiality.
Q. What happens to the clinic director’s personal guarantee?
A. It depends on the transfer scheme. In group-participating M&A, the release of guarantees is incorporated as a condition of transfer. Utilization of the Guidelines for Corporate Executive Guarantees is also possible.
Q. Is succession more profitable than bankruptcy?
A. It is almost certainly more profitable. In bankruptcy, there is little left after liquidation costs and debt repayment, whereas with succession, you can secure consideration based on business value.
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For Medical Institutions Facing Management Challenges
Strict confidentiality, free initial consultation. The earlier you consult, the more options you will have.