What a CV Can't Show: How I Think About Hiring Surgeons

On October 15, I sat on the "Inside the Hiring Room" panel at Plastic Surgery The Meeting in Houston, part of the Senior Residents Conference. The format was open floor: senior residents asked their questions directly, and the panel answered. I was one of the private practice representatives, and the rest of the panel was academic program chairs and leaders.

I joined PRMA in 2006, I've spent the years since helping build it, and I also lead Clinical Operations at ARSA. The overall model for bringing surgeons in is similar across the practices in ARSA, though each practice runs it in its own way.

The residents wanted to know how to differentiate themselves and put their best foot forward. We told them to start building relationships as early as possible, because the people who will speak for you are the people who have watched you work and grow professionally. I also told them that how you treat people who can't advance your career is a strong indicator of the kind of person you are, and of how attractive a candidate you are. We see these things when we evaluate candidates.

We also told them that even if a position isn't posted, if you're interested in a practice, reach out. Not all positions are posted, and even when they are, the need is often there before the post goes out. Reaching out shows the initiative and ownership of a career that I look for most, and it lets you see the practice up close: how people respond, what they value, and whether it's somewhere you'd want to build.

It's also relationship building in its simplest form. The practice learns who you are before there's a decision to make, and you start becoming someone they can speak for. Even when nothing is open, you've made a connection that can matter later, at no cost beyond a short, honest note.

Across PRMA and ARSA, the same thing keeps proving true: a CV tells you what a surgeon can do alone. At PRMA, the offer letter goes out first. It runs about 3 pages and covers what a surgeon most wants to know before signing anything: salary, benefits, time off, how progression works, and what it takes to become a partner. The contract comes after the letter is signed, and by then the conversation that matters the most has already happened.

Fit is harder to see than skill.

Technique can be taught and judgment developed. Whether a surgeon will work inside a system is harder to see, and it decides how the first years go. As PRMA's team grew, the harder question became whether the system could deliver the same standard beyond a small number of surgeons, which I describe on The Story page. The surgeons I've seen sustain a career the longest weren't necessarily the most talented, a point I made in What I Would Tell a Surgeon Facing a Forced Career Transition. They were supported by a system.

Every surgeon I've worked with gives everything they have. Whether the practice can put that effort to its best use depends on fit.

At PRMA we use a behavioral profile (Culture Index) as one input, alongside interviews and references. It matches a person's working style to the role and the team, and it shapes how conversations, especially hard ones, are framed so they land most constructively.

Reading between the lines.

References are where hiring goes soft, because people rarely say anything negative about someone they've worked with. The skill is in the questions. Ask about situations, not the person, and listen for what's missing. Warm praise for technical skill followed by silence about the team tells you something.

Four questions carry most of the weight for me. Is this person a builder and resourceful, or someone who needs rigid structure, and what would they need around them to do their best work? Are they a team player? Do they have a good aesthetic eye, which matters a great deal in plastic surgery? Finally, how do they treat people who can't advance their career? The answer to that last one holds up when nothing is at stake.

Preventing a bad hire matters more than securing a good one.

What the letter promises, and what it asks.

At PRMA, the letter lays out the levels and the financial thresholds for moving between them, along with the path to partnership. Partnership depends first on meeting the financial metrics. After that come the things a spreadsheet can't hold: contributing to the practice and building referral relationships. A surgeon who waits for patients to arrive and does little beyond showing up won't make partner. Ownership of a career is the quality I look for most.

Feedback, guidance, and mentorship run through every level at PRMA.

The philosophy and structure are the same for every candidate, and every candidate sees their terms before the contract exists. The details adjust to the person: a surgeon fresh out of training needs something different from one joining after years in practice.

If you're the candidate.

The first thing to settle is whether you want to practice in a group at all. A surgeon who prefers to work alone will struggle in any group, however much it has to offer. Building something worth building takes infrastructure and support, and a group supplies both. What it asks in return is that you work as part of a team. When it fits, it feels like finding your tribe. Solo practice suits some surgeons well, and the same honesty applies there.

Ask the practice what the path to partnership looks like. Specific answers mean something. Vague ones do too.

The academic leaders on the panel agreed on one more point: over-negotiating counts against a candidate. They read it as a sign of someone who will be hard to please. Nickel-and-diming after the terms are agreed, or maneuvering at the last minute for a little more, is very off-putting, and many said that at that point they feel forced to walk away.

Academic offers also leave little room to negotiate, because the institution sets the terms and the leaders have little control over what they can offer.

Ask your questions early and plainly, and settle what matters to you before the offer is close to final. At some point the candidate has to trust the practice. That's one reason I like the offer letter first: the real conversation happens early, and the contract that follows is easy.

None of this means signing terms you don't understand. Have your own attorney read any contract before you sign it.

---

Related reading: What I Would Tell a Surgeon Facing a Forced Career Transition →

The Wall I Kept Hitting: Why Every Venture Started the Same Way →