Published: January 14, 2025

The Imperative of Succession Planning

Ensure your practice continues to serve your community effectively while preserving the value you've built over years of dedicated service.


Rahul K. Shah, MD, MBA AAO-HNS/F Executive Vice President and CEORahul K. Shah, MD, MBA
AAO-HNS/F Executive Vice President and CEO
As 2024 drew to a close, I found myself reflecting on my father's unexpected passing from a myocardial infarction in December 2023. Dr. K.R. Shah lived an extraordinary life, transforming countless lives through his pioneering work in electrical engineering from which he leveraged philanthropy.

From humble beginnings, he built a premier engineering consulting firm that advanced electrical power safety nationally and internationally. Beyond his professional achievements, he established schools in his hometown, enabling hundreds of students to access education and pursue college degrees. His sudden death thrust my senior mother into leadership of their firm—though fortunately, they were able to sell the business months later. For years, I had urged my father to develop a succession plan and build a team that could lead without his 24/7 physical presence. Although he appreciatively listened, the action came too slowly. This experience taught me a crucial lesson: dealing with succession planning for your life's work may not be easy, but it is inevitable—either you plan for it, or circumstances will plan it for you.

This lesson has further come to life in my recent practice visits. The importance of succession planning and evolving a practice became particularly evident during visits to Albany ENT & Allergy Services in New York and the Centers for Advanced ENT Care (CAdENT) in Maryland. These visits and dozens of discussions with doctors highlight a common challenge in medicine: When practices have physicians of similar age and tenure, succession planning becomes particularly complex, hinging on the recruitment of the next generation of practitioners. This recruitment isn't always straightforward, especially in certain geographic areas with challenging payer environments. Unfortunately, many times, it comes down to luck—is there someone who wants to be in a certain area to practice? And luck is not a sound succession strategy.

The question then becomes: What options exist for practices when multiple otolaryngologists want to transition to the next phase of their careers simultaneously? This isn't unique to otolaryngology; it's a challenge across medicine as physicians seek ways to unlock the value of their practices. We see similar patterns in ophthalmology practices wrestling with expensive equipment investments, dermatology groups balancing medical and cosmetic services, and orthopedic practices managing surgery centers alongside clinical care. Although recruiting the next generation of leaders remains the most obvious and linear succession strategy, practices must increasingly explore alternatives to release equity and transfer operational responsibilities through various models.

Increasingly, strategic partnerships and management organizations have emerged as viable succession planning tools for medical practices. When physicians proactively develop their succession strategy, they maintain leverage in these discussions and can choose from multiple paths forward. Those who wait until circumstances force their hand often find their options limited and less favorable. Partners (of which there are myriad types) can provide a strategy, offering both immediate value realization for retiring partners and operational support for continuing physicians. For instance, cardiology groups have successfully leveraged strategic partnerships to manage the increasing complexity of imaging centers and outpatient procedures, while gastroenterology practices have used these arrangements to expand their ambulatory surgery center networks. However, these opportunities are most advantageous when approached as part of a thoughtful, forward-looking succession strategy rather than a reactive, hasty solution.

Marc Dubin, MD, CMO, ENT Specialty Partners and AAO-HNS/F Board member, introduced me to the concept of practice evolution, which has crucial implications for succession planning. Practices have internal life cycles but exist within an ecosystem where external factors significantly impact their trajectory. To remain relevant—whether in terms of contemporary care, financial stability, or community impact—practices must evolve. This evolution includes succession planning, which should neither start too late nor remain static.

I'm reminded of a story where a new COO at a prestigious hospital was asked about her succession plan on her first day. This mindset has already influenced my approach as CEO of the Academy, merely months into my role. I'm actively considering how today's decisions will impact my eventual successor and whether we're building the right structures and processes to keep the Academy relevant and contemporary in an uncertain future.

I also recently had the privilege of a lengthy dinner with AAO-HNS/F Past President Gavin Setzen, MD, filled with laughter, war stories, and mutual respect. When I asked him about his succession plan, his characteristic honesty led to an illuminating discussion about what effective succession planning entails. Between his practice, Albany ENT & Allergy Services, and Dr. Dubin's, I've observed two distinct approaches to succession planning, though I'm certain many more variations exist.

As you begin the new year, I encourage you to ask yourself: What is your succession plan? Have you and your partners had this crucial conversation? Academicians are not immune and are perhaps in a more difficult position as often succession planning is made by those who are not in “the room where it happens.”

Workforce 1500x845So, what are some potential next steps? It is imperative to assess your practice's current state and timeline—when do key physicians plan to transition, what is the competitive landscape for your practice with regards to recruitment, how is the potential talent pipeline in your area? (Perhaps the AAO-HNS 2023 Otolaryngology Workforce Report can shed light on some of these questions.) 

Second, evaluate your market position and growth potential to understand what might attract the next generation. Develop a detailed financial valuation of your practice to understand its true worth. Create a concrete recruitment and mentoring strategy for bringing in new talent.

Most importantly, consider exploring multiple succession pathways simultaneously—whether it's internal succession through junior partners, merger with a complementary practice, partnership with a larger healthcare organization, or working with strategic partners. We've seen successful transitions across specialties: groups combining with larger multispecialty organizations to maintain independence while gaining operational support, practices implementing phased buy-ins for junior partners, and practices creating innovative partnership models with hospitals.

Remember, the goal isn't just to plan your exit, but to ensure your practice continues to serve your community effectively while preserving the value you've built over years of dedicated service, indeed the most value-creative period of your career. I do not have all the answers; indeed, no one does as each practice is unique. You are best positioned to ideate succession planning for your practice or academic situation; all I ask for 2025 is to “just do it” with regards to thinking about the evolution and succession of your practice.

This column aims to educate members and amplify your voices, but it must also occasionally challenge conventional thinking to avoid becoming stale and irrelevant. Like the practices we serve, this column too must evolve. As we look ahead, I hope our programming at OTO Forum, April 25-26, in Alexandria, Virginia, and the AAO-HNSF 2025 Annual Meeting & OTO EXPO, October 11-24, in Indianapolis, Indiana, will help balance scientific advancement with practice management insights, enabling you to evolve your practice and develop robust succession strategies for the future.

Voices O Oto 1500x845 V3For more on my conversations with Dr. Dubin and Dr. Setzen, listen to our Voices of Otolaryngology podcast episodes:

Success Is Intentional
Voices of Otolaryngology: Evolving Your Practice to Stay Relevant




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