Key Takeaways
- Fewer than 70 plastic surgeons enter private practice directly from residency each year, against 13,399 practices nationwide.
- The median medical school graduate owes $215,000, practice loan rates have gone from 4.85% to 8.25% since 2021. Associates are turned off from taking on more debt in order to purchase a plastic surgery practice.
- Most MSOs require two surgeons, which makes bringing an associate into a partnership the highest leverage move available ahead of a transition.
Two decades ago, a plastic surgery practice owner had two exit options. Sell to an associate, or close the doors. Today there is a third.
More and more owners are entering into partnerships with management services organizations, or MSOs, that absorb the operational burden of running the business, let the surgeon focus on the clinical work, and provide a structured runway out of the practice when the time is right.
It was not just the natural evolution of consolidation that has increased the number of surgeons choosing this path, but a combination of forces between the high cost of debt, the limited supply of eligible plastic surgery graduates, and more.
How Many Plastic Surgeons Are Actually Able to Buy a Practice?
Far fewer than most owners assume.
In 2025, there were 13,399 plastic surgery businesses operating in the United States. The American Board of Plastic Surgery counts 7,749 board-certified plastic surgeons actively practicing as of January 2026, and roughly 244 new surgeons complete plastic surgery residency training in the United States each year.
Most of those graduates are not going into private practice at all.
A study in Aesthetic Surgery Journal Open Forum tracked 1,551 plastic surgery residency graduates across 73 programs. Between 2013 and 2015, 40.1% went directly into private practice or a community hospital. Between 2020 and 2022, that number fell to 28.3%. Over the same stretch, the share heading to fellowship instead climbed from 43% to 55%.
Run that against a 244-graduate year, and you get roughly 69 plastic surgeons walking directly from residency into private practice.
The demand for plastic surgeons in the United States far outpaces the supply of them. And the ones coming out of training are not stepping into a practice and purchasing it outright.
Why Aren’t Younger Plastic Surgeons Buying Practices?
Start with what they owe before they earn a dollar.
The median medical school graduate in the class of 2025 finished with $215,000 in education debt. Fifty-nine percent owe more than $200,000 and 28% owe more than $300,000.
Now add what it costs to borrow on top of that.
Prime sat at 3.25% through all of 2021. It is 6.75% today. Actual SBA loans to physician practices above $350,000 carried a median rate of 4.85% in fiscal 2021. In fiscal 2026, through the end of June, the median is 8.25%.
On a $2 million, ten-year acquisition note, that spread is the difference between $21,067 a month and $24,531 a month. An extra $3,464 every month. $41,565 a year. $415,651 over the life of the loan.
Then there is the part almost no owner thinks about, which is getting approved at all. The Federal Reserve’s Small Business Credit Survey, published this past March, found healthcare was the worst performing industry in the country for full loan approval. SBA loans specifically were the single hardest product in the survey to clear, at 32% fully approved and 40% denied outright.
So, picture the transaction from the other side of the table. You are asking a 38-year-old surgeon carrying $215,000 in student loans to sign personally for a $2 million note at 8.25%, to buy an asset whose value depends on being in the operating room five days a week for the next twenty years.
Taking the job at an existing MSO becomes the rational move for many graduates, instead of taking on additional debt.
Who Is Buying Plastic Surgery Practices?
More than $3.1 billion in institutional capital flowed into plastic surgery and aesthetic medicine over the five years through mid 2024. Peer-reviewed work in Aesthetic Surgery Journal found that between 2000 and 2023, the volume of acquired plastic surgery practices grew 4,300% and the capital behind those acquisitions grew 7,630%.
Take a practice doing $2.5 million in revenue with $350,000 of EBITDA, which is earnings before interest, taxes, depreciation, and amortization, the number a buyer uses to measure what a practice actually earns after normalizing for how the owner runs it.
In a doctor-to-doctor sale, a practice at that earnings level generally transacts somewhere in the range of three to four times EBITDA. Call it $1.05 million to $1.4 million. And the individual buyer has to finance it, which usually means a bank note, seller paper, or both, with a meaningful share of your proceeds arriving over the following seven to ten years.
The same practice as an MSO partner generally prices closer to five to six times. Call it $1.75 million to $2.1 million, with the majority arriving as cash at closing and the balance as rollover equity in the partnering group.
What You Need To Know About The Buyers
If you have never heard of the groups doing this, that is normal.
There are dozens of buyers active in the plastic surgery and aesthetics market right now, and the roster changes constantly. Some are surgeon-founded MSOs. Some are private equity-backed platforms making their first or second acquisition. Some are established multi-state groups with a decade of operating history. They differ enormously in what they pay, how they structure a deal, what they expect from you after closing, and how they treat the surgeons already inside their network.
TUSK maintains access to 100+ qualified buyers across the healthcare practice market. We’ve made it our mission to connect practice owners with the right group that aligns with their practice culturally and maximizes value for the owner. While not every plastic surgery practice will qualify for an MSO partnership, we believe it is increasingly important for owners to understand all their options.
How Do Associates Fit Into This Picture?
The associate who cannot buy your practice can still become your partner. A surgeon four years out of school and carrying student debt is not clearing a two million dollar acquisition note. A minority stake in a practice is a much smaller number, and it is the kind of number a lender approves without much friction. As the doctor-to-doctor path has narrowed, that has become the realistic route into ownership for the next generation of plastic surgeons.
This has greatly benefited plastic surgery practice owners, as most MSOs will not partner with single-surgeon practices. They are valuing cash flow that must hold up after you step back, which means what they want is continuity of care. In some transactions, we see associates purchase equity in the practice from the owner, or the owner gifts it as a sign of goodwill in the sale. It’s a win-win-win scenario for the selling plastic surgeon, the associate, and the MSO.
Explore Every Path Before You Need One
None of this means an MSO partnership is automatically the right answer for you, as I mentioned earlier. Doctor-to-doctor transactions still happen, and for some practices it is genuinely the better outcome.
The point is that owners need to explore all their options as we continue to see a downward trajectory of private practice ownership among younger generations of surgeons.
Look at your options to sell your plastic surgery practice and look early.
If you are a solo surgeon, the most valuable thing you can do right now is understand what adding an associate would do to your options. It may open an MSO partnership that is not available to you today. It may create a doctor-to-doctor buyer where none existed. It may do both. This is a decision that has to happen well before you want to be finished operating.
If you already have a second surgeon, you should understand what your practice is worth, get to know the different buy-types, and outline what you’re looking for on the day you step away from the practice.
And if you are five to ten years out and not sure any of this applies to you yet, it actually does. The more you know and the sooner you do so, the better.
The Part That Isn’t Going to Reverse
HRSA projects plastic surgery at 74% supply adequacy by 2038, among the lowest of any specialty it tracks. There will be fewer plastic surgeons available to buy practices in ten years, not more.
That is the whole reason the third option matters. MSOs can pay considerably more than an individual ever could, and they offer opportunities for surgeons to grow that can be difficult to achieve without the capital they offer.
If your plan still assumes a younger surgeon writes you a check one day, it is worth pressure testing that now, while you have real time to build toward the alternative.
Frequently Asked Questions
Can I still sell my plastic surgery practice to an associate?
Yes. Selling to an associate or another plastic surgeon remains a common path for single provider practices, particularly those generating less than $2 million in revenue. For multi provider practices above $2 million, an MSO partnership is often the stronger option, both because it preserves continuity of care and because it typically pays more.
Why are younger plastic surgeons struggling to afford the purchase of a practice?
Two factors: education debt and the cost of borrowing. The median medical school graduate carries $215,000 in education debt before taking on any practice loan. SBA rates on physician practice loans above $350,000 have risen from a median of 4.85% in 2021 to 8.25% in 2026.
What is an MSO partnership for a plastic surgery practice?
An MSO, or management services organization, is a company that partners with multiple plastic surgery practices and centralizes their operational and administrative functions, typically billing, human resources, marketing, purchasing, and technology. Surgeons who partner with an MSO retain their clinical practice and continue making all medical decisions.
