The $10M Mistake Surgeons Keep Making

When plastic and cosmetic surgeons finally look up from the operating table, it is often after years of relentless focus on patient care and building a reputation. However, the truth is that the best time to think about succession is not decades into practice—it is at the very beginning. Ideally, planning should begin during residency or early in a surgeon’s career, when the foundation for long-term success can be established. Too many physicians wait until they are only a few years from retirement to consider their options, leaving them scrambling for solutions and, often, abandoning practices they have spent a lifetime building. Early planning avoids that outcome, turning a career’s work into lasting value for families, staff, and patients.

The story is often similar: a well-intentioned physician toils in his or her craft for 30 or 40 years, barely lifting his or her head from work. Only when they are a year or 2 from retirement do they start asking friends whether anyone would like to take over. The “search” is informal, the candidates are unvetted, and the deal falls apart because there is no structure, no transition, and no plan in place for success. The owner walks away with nothing—no legacy is preserved, no additional wealth is created for his or her family, and no continuity is maintained for staff and patients.

This reluctance to plan is happening even as the business of cosmetic surgery is booming. The global industry was valued at approximately $67 billion in 2021, and analysts expect it to surpass $200 billion by 2031, with an annual growth rate of around 11.6%.¹ Demand has surged as pandemic backlogs clear, social media normalizes aesthetic procedures, and aging baby boomers seek rejuvenation. In a 2022 survey of surgeons, 76% reported higher demand for procedures, and nearly one-third said demand had at least doubled.¹ With 88% of patients aged 20 to 64, this demographic tailwind shows no sign of abating. Investors have taken note: the first half of 2023 saw 30 sponsor-backed deals in aesthetic practices, matching 2022’s full-year record, and more than $3 billion in capital has been invested across roughly 400 clinic transactions over the past 5 years. In this high-growth environment, a practice that is well-run and sale-ready commands significant value, making early planning even more essential. 

On the other end of the surgical spectrum, recent graduates have an incredible opportunity at hand. With proper education and direction, they can participate in debt reduction, loan forgiveness, signing bonuses, and excellent compensation as an associate. This opportunity can significantly impact lifetime earnings and generational wealth.

The key is to start early, ideally while surgeons are still in residency, or at least 5 to 10 years before they plan to exit. Two young surgeons partnering to buy an established practice and build it up over a few years can create life-changing value and the opportunity to participate in multiple recapitalization events throughout a 30-year career. Additionally, the staff and patients will enjoy stability throughout this well-defined business process that will in no way be disruptive or interfere with clinical care. 

HOW SUCCESSFUL SURGEONS BUILD SUCCESSION VALUE

Succession planning is not a single event; it is the cumulative result of years of deliberate and effective management practices. Physicians who exit gracefully tend to share several characteristics.

Minimal participation requirements exist. Being a board-certified physician specializing in plastic or cosmetic surgery sets the stage for quality and excellence within elective surgery but also translates to value for the organization at the time of recapitalization and sale. Ideal business practices—including an organic and inorganic web presence, market dominance, a strong online reputation, and profitable and efficient financial reporting—indicate value to potential buyers.

The best-prepared surgeons cultivate both reputational capital and financial value. They obsess over patient outcomes and office culture, knowing that goodwill transfers to the next generation. They also plan for growth by adding physicians or mid‑level providers, expanding service lines, and embracing innovative technologies. Momentum signals opportunity to prospective buyers.

Finally, physicians who exit gracefully invest in people. Mentorship and recruitment are essential in a field facing a shortage of qualified providers. Surgeons who succeed in succession devote time to train young doctors, share their knowledge openly, and build a pipeline of talent that can carry the practice forward. The return on this investment far outweighs the time it takes.

WHY DOCTOR-LED PARTNERSHIPS MATTER 

As private equity moves deeper into healthcare, surgeons must understand the differences between investment models. Traditional funds often seek quick returns and may heavily influence clinical decisions. Doctor‑led partnerships, by contrast, align capital with clinical judgment. They give surgeons autonomy over treatment plans and practice operations while providing access to financing and shared services. In a doctor‑led management services organization, physicians can monetize their equity without surrendering control.

Doctor‑led partnerships ensure that the investment is channeled into sustainable growth rather than short‑term extraction. Surgeons retain control of clinical decisions while accessing the capital and infrastructure needed to expand services, adopt advanced technologies, and invest in staff. This approach also benefits patients and staff. When an experienced surgeon plans to step back, doctor‑led networks can help integrate new providers into an existing practice, preserving jobs and continuity of care. Rather than selling to a distant corporate owner, surgeons can partner with peers who value the same standards and ensure that reputation, culture, and clinical excellence endure.

ADVICE FOR SURGEONS OVER 50

If a physician is approaching the later stages of their career, the most crucial step is to begin opening their mind to the opportunities that exist. Learn more about the process and options. Review financial statements with an accountant who is familiar with preparing for a sale. Establish an accrual basis of profit and loss. Formulate a comprehensive understanding of the tax implications of a W-2 wage earner as an employee versus the common independent practice subchapter S filing with deductions. Focus on the 3 tiers of compensation within a consolidated framework: cash for acquisition, revenue per procedure, and equity within the company. The final determination of post-close cash, ongoing procedure-based compensation, and equity proportions must be proposed, negotiated, and finalized before signatures are placed on contracts. Perhaps most importantly, seek partners or networks that align with your values and are transparent about the process. The biggest mistake is ignorance, and it is inexcusable.

One common myth is that physicians are somehow incapable of good business practices. That notion is insulting and inaccurate. We are all excellent learners. Diving into valuations, tax structures, and growth strategies is not beyond us as physicians; however, it is understandably outside our routine comfort zone. My advice is to embrace the discomfort: learn the language of investment banking, read about multiples and EBITDA, ask questions, and engage those within the industry, such as me. Your practice will be stronger for it.

Most physicians take considerable pride in building and expanding their practices. We have all invested thousands of hours in perfecting surgical techniques, refining processes, negotiating contracts, and mentoring colleagues. All physicians owe it to themselves, their families, and their patients to dedicate an equal effort to understanding the current options available to them. By thinking strategically about succession and by sharing knowledge with peers, we can preserve the integrity of our profession and build wealth for the next generation of surgeons.

The concept is consistent with core fundamental principles. Take the time to learn, plan, and understand that change happens over decades, not months. Whether a physician is just beginning their career or contemplating retirement, the best time to develop a surgical exit plan is now. The future of cosmetic plastic surgery most certainly involves surgeons who think and act like business leaders. Don’t delay.  Plan your exit like a surgeon.

1. Hyde Park Capital. Plastic surgery market update: summer 2023 outlook. Hyde Park Capital. Published August 2023. Accessed December 8, 2025. https://hydeparkcapital.com/wp-content/uploads/2023/08/HPC-Plastic-Surgery-Outlook-Summer-2023.pdf