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5 Things to Negotiate Before Buying into Another Practice

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Before you enter into a partnership with an established practice, there are 5 things you must negotiate to help ensure your success.

Because buying into an established plastic surgery practice can be one of the fastest ways to accelerate your career. You gain infrastructure, reputation, staff, systems, and patient flow without starting from zero.

But equity alone does not guarantee influence, security, or long-term satisfaction.

The difference between successful partnerships and painful separations usually comes down to what was clarified before the buy-in.

Here are five things every younger surgeon should negotiate before becoming an owner.

1. Decision-Making Authority

Many younger surgeons assume equity automatically means equal say. It often does not.

You must clearly define:

  • Who makes financial decisions
  • Who controls hiring and firing
  • Who controls marketing spend
  • Who approves capital investments
  • How disagreements are resolved

If the senior surgeon has been making decisions alone for 15–20 years, transitioning to shared decision-making requires structure, not assumptions.

Questions to clarify:

  • What decisions require unanimous agreement?
  • What decisions can be made independently?
  • What happens if partners disagree?

Clarity here prevents emotional conflict later.

2. Financial Transparency

Before buying equity, you should fully understand how the practice actually operates financially.

That means reviewing:

  • Profit and loss statements
  • Balance sheets
  • Payroll structure
  • Compensation formulas
  • Retirement contributions
  • Debt obligations
  • Overhead percentages

Many surgeons buy into revenue without fully understanding expenses.

Revenue does not equal profit.

Ownership means understanding the financial structure, not just participating in it.

3. Marketing Control and Patient Attribution

This is one of the most overlooked issues.

If all marketing promotes only the senior surgeon, you may remain dependent on their reputation indefinitely.

You should clarify:

Will you have your own website presence?

Will marketing funds support your growth?

How are leads assigned?

Can you build your own brand within the practice?

Can you retain your before-and-after photos?

Can you retain your reviews?

Your reputation is a long-term asset. Make sure you are building one. 

4. Exit Terms Before Entry

This sounds pessimistic, but it is actually strategic.

Every partnership agreement should clearly define:

  • What happens if someone leaves
  • Non-compete terms
  • Buyout formulas
  • Timeline of payout
  • Patient transition rules
  • Ownership of intellectual property

You are not planning failure.

You are preventing chaos.

Many disputes occur not because partnerships fail, but because exit terms were never clearly defined.

5. Cultural and Vision Alignment

This is the most underestimated factor.

Financial deals fail more often because of misaligned expectations than poor math.

Ask yourself:

Do we share growth goals?

Do we agree on reinvestment vs distributions?

Do we agree on expansion?

Do we agree on staffing philosophy?

Do we agree on patient experience standards?

Do we agree on risk tolerance?

If one partner wants aggressive growth and the other wants stability, conflict becomes inevitable.

The best partnerships share:

  • Values
  • Vision
  • Work ethic
  • Communication style
  • Growth philosophy

Technical skill builds practices and alignment sustains them.

Final Thought

Buying equity should move your career forward, not create friction you never anticipated.

The point is to approach partnerships not just as clinicians, but as future business leaders.

That means asking thoughtful questions.

Understanding structure.

Thinking long term.

Because the real goal isn’t just becoming a partner.
It’s becoming the right partner in the right structure.

The smartest surgeons don’t just ask:
“What does this practice earn?”

They ask:
“How does this practice operate?”

That question alone can change your future.

If you’re considering a partnership or buy-in this year, schedule a confidential Practice Growth Review and we can map out the smartest structure for your situation.

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Rated 5 out of 5
"Catherine outlined a plan that put key metrics in place, gave us a clear plan to follow throughout the year and trained our staff to increase their conversions by at least 10%. Since engaging with Catherine, I’m happy to report that revenues are up 15% over the last three months - 22% in the last month alone! I highly recommend Catherine’s consulting services to any practice looking for “best practice” additions to their operation."
drsigal 3
Robert Sigal, MD
"I have finally tapped into the most efficient way to grow my cosmetic practice and that is to “fish in the pond of my own patients”. When patients return to my practice, over 85% will purchase another service, product, or procedure. Not only was it worth over $200,000 in revenues this past year, it also reminds my patients I’m still around so they don’t wander off to my competitors. Catherine’s group has far exceeded our expectations and goals we had set up for them to achieve."
Victor Ferrari, MD
Victor Ferrari, MD
"Our consult conversions were running at 40-50%. Then we attended Catherine’s online training and implemented her strategies. They immediately increased conversion rates to 75-80%."
Anthony Corrado, MD
Anthony Corrado, MD
"I know how to run a profitable practice; however, it was not without major staff issues, inefficiencies and unproductive drama. With Catherine's guidance, I reorganized staff, set up processes for them to carry more of the workload and hold them accountable so I have more time to focus on patient care. The changes we put in place and the staff training to convert more callers and consultations will easily increase my revenues by 15% as well as save us time, money and costly mistakes. "
Evan Sorokin, MD
Evan Sorokin, MD
"Working with Catherine and her team has been very profitable. We’re only half way through the year and I’m up $200K and I’m booked out for the next 2 months even though we typically go into our slow summer months now. Her recent promotion brought in an extra $63,782 with more surgeries scheduled. I never realized how much money was sitting in my patient list but I’m a believer now!"
Plastic Surgeon Consulting Services
Robert Langdon, MD
"Catherine Maley has one of the best Marketing Minds in the aesthetic industry, bar none. She understands the aesthetic patient and she also understands the challenges and frustrations we face as aesthetic surgeons. You will benefit from Catherine's tools whether you are new in practice or a seasoned professional.Turn to Catherine for guidance - she knows what she's talking about."
Edwin Williams, MD
Edwin Williams, MD
“Catherine’s Cosmetic Patient Marketing Service has been a great addition to our practice-building overall plan. While we still invest in our online presence, we also found immense value in the internal marketing efforts. We especially like that all results are tracked so we know we are getting a great return ... last year it was 1,148% and no staff time was used. That’s a much easier way to grow my cosmetic practice.”
Mark Mason, MD
Mark Mason, MD
"Catherine Maley turned our practice around. We converted more consultations in one week than we did in an entire month. Our practice went from a painful 50% no show rate to a remarkable 85% show rate. Even more impressive was our close ratio - from 35% to 80% and still increasing. We would recommend her to any practice that’s looking to not only increase their profits today, but sustain a healthy flow of income for many years to come. Thanks Catherine!"
Sam Assassa, MD
Sam Assassa, MD
"Catherine found me the best patient care coordinator I could have asked for. She worked out a payment plan that was fair to me and motivating to my coordinator. She also provided training tools to help my coordinator convert better, even though she was already experienced. The results have been phenomenal. So good, in fact, that my income increased 250% and I’m booked out for 3 months. Don’t waste any more time or money doing it yourself. Outsource to someone you trust!"
Andrew Lofman, MD
Andrew Lofman, MD
"Since we’ve been working with Catherine and her team for the past 5 months, we’ve brought in $79K in surgeries and have booked an additional 17 surgical procedures and 20 non-invasive body procedures since then. This does not include the additional new patient referrals and revenues we are seeing from the on-going nurturing of my current patient database."
Verne Weisberg, MD
Verne Weisberg, MD
"I had given my staff the goal to convert at least $35K per week in surgeries AND I gave them the tools to help which was Catherine’s Online Learning Center at More Patients Academy. They watched Catherine’s modules and implemented her strategies and converted $80K! That equaled a 2,550% ROI. Nice!"
Adam Stein, MD
Adam Stein, MD
"Catherine outlined a plan that put key metrics in place, gave us a clear plan to follow throughout the year and trained our staff to increase their conversions by at least 10%. Since engaging with Catherine, I’m happy to report that revenues are up 15% over the last three months - 22% in the last month alone! I highly recommend Catherine’s consulting services to any practice looking for “best practice” additions to their operation."
Robert Sigal, MD
Robert Sigal, MD
"I have finally tapped into the most efficient way to grow my cosmetic practice and that is to “fish in the pond of my own patients”. When patients return to my practice, over 85% will purchase another service, product, or procedure. Not only was it worth over $200,000 in revenues this past year, it also reminds my patients I’m still around so they don’t wander off to my competitors. Catherine’s group has far exceeded our expectations and goals we had set up for them to achieve."
Victor Ferrari, MD
Victor Ferrari, MD
"Our consult conversions were running at 40-50%. Then we attended Catherine’s online training and implemented her strategies. They immediately increased conversion rates to 75-80%."
Anthony Corrado, MD
Anthony Corrado, MD
"I know how to run a profitable practice; however, it was not without major staff issues, inefficiencies and unproductive drama. With Catherine's guidance, I reorganized staff, set up processes for them to carry more of the workload and hold them accountable so I have more time to focus on patient care. The changes we put in place and the staff training to convert more callers and consultations will easily increase my revenues by 15% as well as save us time, money and costly mistakes. "
Evan Sorokin, MD
Evan Sorokin, MD
"Working with Catherine and her team has been very profitable. We’re only half way through the year and I’m up $200K and I’m booked out for the next 2 months even though we typically go into our slow summer months now. Her recent promotion brought in an extra $63,782 with more surgeries scheduled. I never realized how much money was sitting in my patient list but I’m a believer now!"
Robert Langdon, MD
Robert Langdon, MD
"Catherine Maley has one of the best Marketing Minds in the aesthetic industry, bar none. She understands the aesthetic patient and she also understands the challenges and frustrations we face as aesthetic surgeons. You will benefit from Catherine's tools whether you are new in practice or a seasoned professional.Turn to Catherine for guidance - she knows what she's talking about."
Edwin Williams, MD
Edwin Williams, MD
“Catherine’s Cosmetic Patient Marketing Service has been a great addition to our practice-building overall plan. While we still invest in our online presence, we also found immense value in the internal marketing efforts. We especially like that all results are tracked so we know we are getting a great return ... last year it was 1,148% and no staff time was used. That’s a much easier way to grow my cosmetic practice.”
Mark Mason, MD
Mark Mason, MD
"Catherine Maley turned our practice around. We converted more consultations in one week than we did in an entire month. Our practice went from a painful 50% no show rate to a remarkable 85% show rate. Even more impressive was our close ratio - from 35% to 80% and still increasing. We would recommend her to any practice that’s looking to not only increase their profits today, but sustain a healthy flow of income for many years to come. Thanks Catherine!"
Sam Assassa, MD
Sam Assassa, MD
"Catherine found me the best patient care coordinator I could have asked for. She worked out a payment plan that was fair to me and motivating to my coordinator. She also provided training tools to help my coordinator convert better, even though she was already experienced. The results have been phenomenal. So good, in fact, that my income increased 250% and I’m booked out for 3 months. Don’t waste any more time or money doing it yourself. Outsource to someone you trust!"
Andrew Lofman, MD
Andrew Lofman, MD
"Since we’ve been working with Catherine and her team for the past 5 months, we’ve brought in $79K in surgeries and have booked an additional 17 surgical procedures and 20 non-invasive body procedures since then. This does not include the additional new patient referrals and revenues we are seeing from the on-going nurturing of my current patient database."
Verne Weisberg, MD
Verne Weisberg, MD
"I had given my staff the goal to convert at least $35K per week in surgeries AND I gave them the tools to help which was Catherine’s Online Learning Center at More Patients Academy. They watched Catherine’s modules and implemented her strategies and converted $80K! That equaled a 2,550% ROI. Nice!"
Adam Stein, MD
Adam Stein, MD
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