What Every Candidate Should Know Before Choosing a Practice Model
As plastic surgeons explore private practice opportunities, particularly outside of traditional employment or hospital systems, two compensation structures come up frequently: 1099 independent contractor arrangements and overhead-sharing models.
While these options may sound similar on the surface—both offering autonomy and income potential—they are fundamentally different in structure, risk, and long-term upside. Understanding these differences is critical before committing to a practice opportunity.
This article breaks down each model and highlights key considerations for surgeons evaluating these paths.
What Is a 1099 Plastic Surgery Opportunity?
A 1099 arrangement classifies the surgeon as an independent contractor, not an employee. The practice pays the surgeon for services rendered, typically based on a percentage of collections or a per-procedure fee.
Key Characteristics of a 1099 Model
- Surgeon receives a Form 1099, not a W-2
- No benefits (health insurance, retirement, paid time off)
- Surgeon is responsible for all personal taxes, including self-employment tax
- Compensation is often volume-based
- Little or no ownership or equity
Typical Practice Responsibilities
- Provides facility, staff, and equipment
- Handles billing and collections
- Retains control over pricing, branding, and business decisions
Pros
- Faster entry into practice
- Minimal administrative burden
- Predictable per-case or percentage-based income
- Lower personal financial risk
Cons
- No equity or long-term asset creation
- Limited control over operations
- Net income can be misleading once taxes and expenses are considered
- Income is directly tied to cases performed—no leverage
What Is an Overhead-Sharing Opportunity?
An overhead-sharing model is closer to true private practice ownership. The surgeon typically bills and collects under their own entity and pays the practice a defined percentage or flat fee to cover shared expenses.
This is sometimes referred to as a “rent-and-split” or practice-within-a-practice model.
Key Characteristics of Overhead Sharing
- Surgeon collects 100% of professional fees
- Pays a set percentage or fixed fee for overhead (staff, rent, supplies)
- Surgeon operates as a separate business entity
- Greater control over scheduling, pricing, and case mix
Typical Overhead Includes
- Office space and OR access
- Clinical and administrative staff
- Supplies and equipment
- Marketing or administrative support (varies by agreement)
Pros
- Higher net income potential
- True entrepreneurial model
- Transparent cost structure
- Ability to build a personal brand and patient base
- Often a pathway to full ownership or buy-in
Cons
- Higher financial risk
- Requires business and financial management skills
- Income variability, especially early
- Surgeons must manage taxes, insurance, and compliance
Key Differences at a Glance
| Factor | 1099 Model | Overhead-Sharing Model |
|---|---|---|
| Legal Status | Independent Contractor | Practice Owner / Tenant |
| Income Structure | % of collections or per case | 100% of collections minus overhead |
| Tax Responsibility | Surgeon | Surgeon |
| Benefits | None | None |
| Operational Control | Limited | High |
| Financial Risk | Low–Moderate | Moderate–High |
| Equity / Long-Term Value | None | Possible |
| Ownership Pathway | Rare | Common |
Which Model Is Right for You?
The right structure depends on career stage, risk tolerance, and long-term goals.
- Early-career surgeons may prefer a 1099 model for simplicity and stability.
- Entrepreneurial surgeons often favor overhead sharing for autonomy and income growth.
- Surgeons seeking eventual ownership or practice buy-in typically find overhead sharing to be a better fit.
It is also important to remember that not all agreements are created equal. Overhead percentages, expense definitions, marketing expectations, and exit terms can vary widely—and significantly affect take-home pay.
Final Thoughts
Both 1099 and overhead-sharing opportunities can be excellent paths into private plastic surgery practice—but they are not interchangeable. What matters most is understanding:
- How you are paid
- What expenses you are responsible for
- How much control you truly have
- Whether the opportunity aligns with your long-term goals
Before signing any agreement, candidates should seek experienced legal, tax, and practice advisory guidance and carefully model realistic net income scenarios.
Choosing the right structure upfront can shape not only your income—but your professional freedom and satisfaction for years to come.
If you are a plastic surgery practice seeking to recruit a plastic surgeon to join your practice, or a candidate seeking a practice opportunity please contact David Smith wiht ESA Medical Resources to learn how we can assist you. Email david@gotplasticsurgeryjobs.com or call/text 270-266-1024.
