Succession Planning and Exit Strategies For Plastic Surgeons

Succession Planning For Surgeons – Resources For Plastic Surgeon Practice Transitions and Exit Strategies

Succession planning is a crucial but often delayed conversation for many plastic surgeons. After decades of training, dedication, and patient care, surgeons build not only a medical practice but also a legacy. Yet when it comes time to step back or transition, many find themselves unprepared, leaving both patients and staff facing uncertainty. Planning early helps ensure your practice continues to thrive and that your years of investment translate into lasting value.

Whether you are nearing retirement age or simply looking ahead, succession planning is about more than exit strategies. It involves preserving goodwill, protecting your staff, safeguarding patient relationships, and making informed financial decisions. By considering your options in advance, you can maximise practice value and create a smoother handover, rather than facing rushed decisions later.

This article explores the key pathways available to plastic surgeons, from mentoring a younger colleague to selling to a corporate group, pivoting to non-surgical services, or winding down operations. With resources, examples, and advice tailored to the realities of private practice, you’ll gain insight into how to approach transition with confidence and control.

Mature Plastic Surgeons ask their colleagues and advisors about practice transition, succession planning and retirement plans. Whether you are 60, 65 or 70+, planning for the future of your practice is essential. START EARLY!

• Want to plan your practice exit strategy?
• Want to sell your plastic surgery practice in future?
• Want to find a plastic surgeon for succession?

Here are some resources that can help.

Succession Options and Exit Strategies for Plastic Surgeons

Most Plastic Surgeons take one of these 6 options for practice transition

1. Find a Younger Plastic Surgeon successor to take over the practice (can take 3 to 5 years) – See Steve Look at Paradigm Search Group in USA.
2. Join a Bigger Group of Surgeons near your location (that will provide Practice Management Services for you)
3. Pivot from a surgical practice into a non-surgical medspa practice – Offer injectables & skin clinic services and act as an advisor for a decade
4. Sell your practice to a Corporate Buyer or larger Rollup Group -usually funded by Venture Capital or Private Equity – usually prefer a surgeon group or busy medspa to a solo older surgeon.
5. Sell your practice to an Academic Institution or Private Hospital wishing to expand into Cosmetic Plastic Surgery or Aesthetics – the new “Priv-ademics” model. see ARSA model below.
6. Close Your Practice Down and Sell Your Practice Assets – database, website, domain or phone number – to another surgeon for a low price (refer your past patients to a colleague).

If you have one, you could also sell your ASC / Day Surgery Centre to a Private Hospital Group or redevelop the property into mixed use.

Groups Interested in Buying Aesthetic Practices in Australia

These groups are mostly consolidating Injectables / laser Clinics, Medspas, Dermatology or Cosmetic Physician Practices rather than an older solo plastic surgeon practice.

• Aura Medical Group – Deb Farnworth Wood etc
• Silk Laser Clinics – ASX-listed company
• Artisan Aesthetics Group Pty Ltd
• Aesthetic Partners / Me Aesthetic – contact Costa Koulouris at Me Clinic Melbourne

Nikki Katz is a clinic broker that may be able to help you sell your clinic or practice

Groups Interested in Buying Aesthetic Practices in USA

• There are many corporate groups and platforms (Most backed by Private Equity) interested in buying clinics.
• See the BIG LIST of potential corporate buyers for your plastic surgery practice
• There are about 20 Dermatology Management Companies (DMCs) that are also interested in buying Plastic Surgery practices
• Lately, they have been interested in buying group plastic surgeon practices or practices with large medspa (to reduce keyman risk of a solo surgeon)

Useful Consulting Resources for Transitioning or Selling Your Plastic Surgery Practice

• USA Exit Planning Consultant – Inspiring Effective Leadership – Enrique Fernandez – ASPS USA Member Plastic Surgeon – retired at 61 after colon cancer diagnosis (Speaks at conferences) https://www.enriquefernandezmd.com/
• Tom Ferkovic USA Medic Management – https://www.medicmgmt.com
• Michael Byrd USA – https://www.ByrdAdatto.com

Practice Valuation Methods for Plastic Surgeon Practices

How Much is a Plastic Surgery Practice Worth?

The most valuable parts of your aesthetic practice are probably

• your office building / consulting suite,
• your operating room (OR) or Surgery Centre (ASC)
• the Medispa part of the practice with a proven track record of consistent sustainable earnings.

These assets can be valuable based on your location and other similar industry sales.

To create value from your actual plastic surgery practice (patient database, equipment, I.P., fitout, goodwill) you will most likely need to spend 3 to 5 years finding and nurturing your successor surgeon buyer or working for your corporate buyer on a contract.

Selling Your Practice to a Younger Surgeon Successor

A good solo plastic surgeon practice might be able to sell to a surgeon successor for about $250k to $1 million – paid over time.

The surgeon purchaser typically starts as an associate on a salary for 2 to 3 years then starts acquiring equity. See the blog on Equity Transfer options.

Selling Your Practice to a Corporate Group or Platform

A corporate buyer or platform wants to buy a sustainable future income stream – based on the surgeons continuing to work in the practice.

• For a solo surgeon this might be your adjusted EBITDA times a set multiple – say 3x to 5x EBITDA – depending on your age, keyman risk, systems, I.P. location and surgeon contracted salary arrangement etc
• For a group practice the EBITDA multiple may be higher – say 4x to 7x EBITDA – again depending on the number of surgeons, risk, systems, unique I.P., location, past income,  Brand reputation, and contracted surgeon arrangements.

Your practice EBITDA (Earnings before Interest, Tax, Depreciation and Amortisation) will be affected by

• The surgeon contract that you sign and it’s surgeon fee arrangement, inclusions/restrictions. For example, in the USA,  you might agree to be paid 25% to 40% of your surgeon fees. In Australia, maybe 50 to 60% of your surgeon fees.
• Taking out any of your personal expenses – travel, motor vehicle, phone, laptop, insurances etc etc
• Staff Liabilities – accrued holiday and leave pay for example

A corporate buyer will most likely pay much more for your practice than a surgeon successor (maybe 2 or 3 times as much) but will typically

• require a LOT of detailed Due Diligence to ensure the accuracy of your financials and QOE report and identify any potential risks.
• take over full control of the practice and make many changes (some that you will disagree with)
• aim to reduce expenses and run the practice much more efficiently
• reduce corporate risks by implementing stricter financial controls, software and operational policies

Be aware that the corporate representative who makes promises and negotiates the sale of your practice is most likely NOT the one you will end up working with on a daily basis. Make sure that everything you want is written in the contract. This may include non-compete clauses, use of photos and reviews, limits on travel for conferences and specifically what happens if the platform fails or sells to another group.

You will most likely be offered a combination of cash and shares in the purchasing entity. For older surgeons, your peers will probably advise you to take a bigger cash component (less shares in the entity).

If you want some more ideas about Practice Succession or Lifestyle Retirement options – please contact Dave Staughton for a chat about your options

References about Surgeon Retirement and Plastic Surgery Practice Succession Planning

• Reflections on a Career in Plastic Surgery: A National Survey of Retired Surgeons
• A Plastic Surgeon retires – a pdf article
• How to Properly Plan Your Succession – Article from Medaesthetics Magazine Article
• Retired Surgeons’ Reflections on Their Careers
• Plastic surgeons over 50: practice patterns, satisfaction, and retirement plans – PRS2008 121(4)
• Retired Not Dead: Thoughts Plastic Surgical and Otherwise – PRS 209 Nov  – Robert Goldwyn
• Developing an effective succession plan for your practice: why should I care?  2010 FPS Article by Catherine Maley

References on an Exit Strategy and Selling Your Practice

• ASPS USA Article – Retiring from practice requires an exit strategy
• Are you needing to sell your plastic surgery practice? – plan 3 to 5 years ahead!
• Don’t retire your practice; ‘transition’ it
• Retirement: A Primer for Plastic Surgeons

Useful Books on Succession Planning and Successful Transition to Retirement

• BOOK – How Much is Enough – Making Financial Decisions that create Wealth and Wellbeing – by Arun Abey and Andrew Ford
• BOOK – Retired Not Dead : thoughts Plastic Surgical and Otherwise – by Robert M Goldwyn 2008 296 pages
• BOOK – Succession – Are you Ready?  by Marshall Goldsmith
• BOOK – Halftime – moving from Success to Significance by Bob Buford 
• BOOK – Beyond Half Time – Practical Wisdom for your Second Half  by Bob Buford
• BOOK – Finishing Well – The adventures of Life beyond half time by Bob Buford

FAQs about Succession Planning for Plastic Surgeons

 

Succession Timing & Planning FAQs

Q: When should I start planning my succession if I don’t plan to retire for 10 years?
The best time to start is now. Even if retirement feels far away, planning a decade in advance allows you to groom a successor, stabilise finances, and position your practice for maximum value. Corporate buyers and younger surgeons often want several years of consistent performance and systems in place before committing.

Q: How long does it usually take to sell a plastic surgery practice in the USA?
It often takes 12–24 months from first conversations to closing a deal. Finding the right buyer, completing due diligence, and negotiating contracts all take time. If you’re mentoring a successor, expect 3–5 years before full transition.

Q: What happens if I suddenly become ill or unable to operate before I have a plan in place?
Without a plan, your practice risks losing patients, staff, and financial value quickly. An emergency succession plan should always be prepared, naming a colleague or locum surgeon who can step in temporarily. This ensures continuity of care and preserves practice goodwill.

Q: Can succession planning help reduce burnout before retirement?
Yes. By bringing in associates or restructuring your role, you can offload surgical load and reduce stress. Some surgeons find succession planning allows them to work fewer hours while maintaining income and extending their careers.

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Successors & Staff FAQs

Q: How do I find and mentor a suitable successor surgeon?
Start by hiring an associate or fellow with the right skillset, values, and personality. Mentorship can take three to five years, during which you gradually introduce them to patients, staff, and referrers. Structured equity transfer options allow you to reward loyalty and align long-term goals.

Q: What if no younger surgeon wants to take over my solo practice?
Solo practices are becoming harder to transition. If a successor cannot be found, alternatives include merging with a group, selling to a corporate platform, or pivoting to a non-surgical business model. In some cases, winding down the practice and selling assets may be the most practical option.

Q: What if my successor surgeon leaves after I transition?
Contracts should include retention agreements, performance incentives, or staggered equity transfer to keep successors committed. Without these safeguards, the practice risks losing both patients and value.

Q: How do I talk to my staff about succession planning without scaring them?
Be open but strategic. Present succession as a long-term plan that ensures stability for staff and patients. Involve senior team members early, highlight potential career opportunities, and reassure them that thoughtful planning prevents abrupt disruptions.

Q: Can my spouse or children be involved in succession?
Yes. Some practices transition to family members if they are licensed surgeons. Others involve spouses in management or ownership of real estate or non-surgical components. Estate and tax planning are critical if family succession is the goal.

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Corporate Buyers, Platforms & Private Equity FAQs

Q: How do private equity firms typically structure deals with plastic surgeons in the USA?
Most deals are structured as partial cash payouts combined with equity in the management company or platform. Surgeons are usually required to stay on for 3–5 years under an employment agreement.

Q: Are private equity groups more interested in medspas or surgical practices?
Medspas are often more attractive because of recurring revenue, scalability, and lower key-person risk. Surgical practices are purchased, but buyers prefer those with group structures, multiple revenue streams, or established brand reputation.

Q: What happens if a private equity platform that buys my practice is later sold?
This is common. Most private equity firms plan to sell within 5–7 years. That means your practice may be sold again to another group, possibly with different policies or style of leadership. Your contract should address what happens to your role and income if ownership changes. On the upside you make get more money (Second bite of the apple), on the downside performance expectations and culture may change.

Q: Can I still be an “owner” after selling to private equity?
Yes, but usually through minority equity in the practice management (MSO) company, not your original practice. This gives you some upside if the platform sells again, but you won’t retain much control.

Q: What mistakes do US surgeons often make when negotiating a sale?
Common mistakes include overestimating goodwill, failing to hire an experienced healthcare attorney, agreeing to overly restrictive non-competes, underestimating tax implications, and not securing lifestyle protections in the contract.

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Financial & Valuation FAQs

Q: What multiple of EBITDA can a US plastic surgery practice expect from a corporate buyer?
Multiples vary widely. A solo practice may receive 3x–5x EBITDA, while a multi-surgeon or surgery centre-based group might command 5x–8x. Practices with large non-surgical revenue streams often attract higher multiples.

Q: How do US surgeons prepare their practice for sale to maximise value?
Key steps include: cleaning up financials, removing personal expenses from the books, tightening HR policies, ensuring HIPAA compliance, upgrading digital systems, and building recurring non-surgical revenue.

Q: How do taxes affect the sale of my practice?
Tax implications can be significant. Asset sales, goodwill payments, and earn-outs may be taxed differently than stock or equity sales. Working with a tax advisor early can help structure the deal in the most advantageous way, especially around capital gains.

Q: What’s the difference between selling “assets” vs “equity” in my practice?
In an asset sale, the buyer acquires your equipment, patient records, and goodwill, but not your entity. In an equity sale, the buyer takes over the entire legal entity, including liabilities. Corporate buyers often prefer asset sales, while sellers sometimes prefer equity sales for tax reasons.

Q: What role do earn-outs play in US practice sales?
Earn-outs are common. They mean part of your sale price is contingent on hitting revenue or profit targets in the years after the sale. While this can increase payouts, it also ties your future compensation to the buyer’s management decisions.

Q: Should I sell my practice real estate separately?
Often yes. Keeping ownership of your office or ASC real estate allows you to lease it back to the buyer, creating a long-term income stream. Many surgeons separate the sale of the practice from the sale of the building for maximum flexibility.

Q: How do payer contracts or insurance relationships affect practice value?
In the USA, most cosmetic surgery is self-pay. However, if your practice has insurance-based reconstructive work, those payer contracts add value. Clean relationships with insurers and hospitals make a practice more attractive.

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Legal & Compliance FAQs

Q: What legal issues are unique to US succession planning for plastic surgeons?
Non-compete agreements, Stark Law considerations, HIPAA compliance, and state-specific corporate practice of medicine laws all affect deals. Every state is different — for example, some restrict non-physician ownership, complicating private equity structures.

Q: What is a Quality of Earnings (QOE) report, and why does a US buyer demand it?
A QOE is a financial due diligence review prepared by accountants to validate your practice’s earnings. Corporate and private equity buyers use them to confirm revenue, adjust for personal expenses, and assess stability before finalising valuation.

Q: What are the risks of signing a long non-compete after selling my practice in the USA?
A restrictive non-compete could prevent you from working in your city or region for years after you leave. Some contracts even limit consulting or speaking roles. Always negotiate the terms, radius, and duration carefully.

Q: How do US malpractice liabilities impact succession?
Any pending malpractice claims or insurance issues can scare off buyers. Buyers will want proof of “tail coverage” to protect against future claims from past surgeries. Without it, your sale price may be reduced or delayed.

Q: How do staff liabilities affect practice valuation in the USA?
Buyers will account for accrued vacation, retirement benefits, and employment law risks in valuation. Any unresolved HR issues, improper classifications, or high turnover may reduce your practice’s attractiveness and sale price.

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Lifestyle & Legacy FAQs

Q: Can my practice continue if I only want to work part-time or stop operating but keep consulting?
Yes. Many surgeons transition into advisory or non-surgical roles, offering injectables, laser, or skin services while stepping away from the OR. This hybrid model can extend your career for years.

Q: Can I sell my practice but keep working under a new arrangement?
Yes. Many surgeons choose to sell equity while remaining contracted employees or consultants. This provides liquidity while allowing them to continue operating and mentoring.

Q: Can I keep my practice name after selling?
It depends on the contract. Corporate buyers usually want the name and branding included. If your name is tied to the practice, you may need to negotiate whether you can continue using it elsewhere.

Q: What lifestyle changes surprise surgeons most after selling?
Many underestimate the cultural shift. You may lose decision-making power, face reporting requirements, or feel constrained by corporate rules. Lifestyle fit is as important as financial payout.

Q: How do I protect my legacy after succession?
Clearly communicate your wishes for branding, patient care standards, and long-term vision. Consider writing a “legacy statement” or formalising values within contracts to ensure your name and work are honoured.

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Market & External Factors FAQs

Q: Do hospitals or universities buy cosmetic practices?
Yes. The rise of “priv-ademics” means some institutions are expanding into aesthetics. They may purchase practices that align with their strategy, especially those with surgery centres or strong reputations.

Q: How much does location matter when selling a practice?
Location is one of the biggest factors. Practices in affluent urban areas attract higher multiples. Rural or competitive markets may limit value unless paired with unique services or dominant local presence.

Q: Are valuations different in large cities vs smaller US markets?
Yes. Practices in New York, Los Angeles, Miami, or Dallas typically command higher multiples. Smaller or mid-market cities may get lower offers unless they’re regional leaders.

Q: What happens if negotiations with a buyer collapse?
This is common — many deals fall through. Always have backup options and keep your practice running strong. Don’t let staff or patients sense instability.

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Patient & Reputation FAQs

Q: Is my patient database really worth anything to a buyer?
Yes, but only if it’s high quality. An up-to-date, well-engaged database with loyalty programs and consistent communication adds significant value. Buyers look for recurring revenue opportunities.

Q: Should I tell patients about my succession plan?
Eventually, yes. Patients value continuity and may be more likely to stay if you personally introduce your successor. Announce only when the transition is secure.

Q: What happens to patient photos, reviews, and social media after I sell?
Ownership of digital assets should be clarified in the sale contract. In the US, buyers often want these for future marketing, but regulatory and ethical considerations must be factored in. If you don’t own the rights to your before and after photos it makes it harder to practice elsewhere.

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Advisors & Support FAQs

Q: What kind of advisors should I hire for succession planning in the USA?
At minimum: a healthcare attorney, a CPA with medical practice experience, and possibly a broker or consultant. Larger deals may also require wealth managers and estate planners.

Q: Should I hire a broker or consultant to help with selling my practice?
Yes. Brokers and consultants familiar with medical practice transactions can introduce buyers, manage negotiations, and set realistic valuations. They also protect you from pitfalls in complex contracts.

Q: Can I change my mind after selling?
Usually not. Once contracts are signed and funds transferred, the deal is binding. Some earn-outs allow limited buy-back options, but this is rare. Be certain before committing. You may be able to work in another practice depending on your non-compete clause.

Taking Early Action on Succession Planning

Deciding how and when to transition your practice is one of the most significant milestones in a surgeon’s career. The right approach will depend on your personal goals, financial needs, and the structure of your practice. Whether your focus is on leaving a legacy, securing financial freedom, or ensuring continuity of patient care, early preparation is the key to achieving a successful outcome.

Every succession journey is different, but they all share one principle: the earlier you start, the more options you will have. Taking three to five years to plan and prepare not only increases practice value but also gives you time to align with the right partners, negotiate terms, and protect what you have built. A thoughtful approach will help you transition on your terms, rather than out of necessity.

If you are starting to think about practice succession, now is the time to explore your options. Speak with trusted advisors, connect with brokers or corporate groups, and most importantly, define your own vision for the next stage of life. By planning ahead, you can ensure your practice legacy is secure and set yourself up for a rewarding and fulfilling future.

Further Reading about Succession Planning

• Equity and Ownership Models for a Plastic Surgery Practice
• Options for Equity Transfer and Succession in a Plastic Surgery Practice

Disclaimer: This article is for educational purposes only. It is not legal advice. Each state, country, and jurisdiction has its own healthcare and corporate laws. Always seek independent legal, tax, and financial advice before entering into any ownership changes or equity transfer arrangements.