Most of you already know I spent years as a full-time hospital physician before transitioning into aesthetic medicine full time over about three years. What I want to talk through today is the messy middle of that: the stretch where you’ve still got your hospital job and your med spa side hustle running at the same time, and you’re trying to figure out when — if ever — to let go of the day job.

I’ll say up front: there’s no right answer to this. But I can tell you how I thought about it, mistakes included. One more note before I get into it — if I’d been the main breadwinner of this household, I’d likely have needed another two years before I could let go of my day job.

First, read your contract — this is a luxury not everyone has

Before we even get to “when,” you need to know whether you actually can.

Physician contracts vary more than people realize. Some simply require disclosure of outside work. Others require approval. I’ve even seen contracts claiming a percentage — or sometimes ownership — of income generated using your medical license outside the hospital.

Whether every version of that is enforceable is another question, but the point is: read your contract carefully.

I’ve worked in academic, private, and community settings, and every contract had some version of an outside-employment clause. Mine allowed me to build my practice, but I did have to disclose what I was doing.

And if your contract allows it, keeping your hospital job while the business is young is probably the safer play.

The field is saturated. Have a plan B.

I opened my practice in Lancaster, PA — not a big city, more of a suburban, small-city vibe. When I opened, I didn’t do much real market research, which in hindsight was probably a mistake. I thought there were maybe five spas near me. It took me two years of practicing to realize there was one right next door. That’s how ignorant I was going in.

And it’s only gotten denser. I was recently talking with someone in this field who told me there are around twenty med spas within twenty minutes of where I live. That was genuinely a little shocking to hear.

The point I’m making: aesthetic medicine is a very saturated field right now. I wish every one of you the best of luck, but the reality is some places just don’t make it. So when you’re mapping this out, have your plan A, your plan B, and some version of an exit plan already secured. Keeping the hospital job and staying board certified in your field is, for a lot of people, exactly that safety net.

My start was slow. Painfully slow.

I’ve said this publicly before, but it bears repeating because I think people assume it was smooth: I was very slow at the beginning. Something like 5 appointments in my first 3 months. Not per week. Total.

Here’s another thing people don’t expect, given that my Instagram does relatively well now: for the first three years, I didn’t use it for marketing at all. I only started building Instagram out more consciously in the past three months or so. Everything before that came from word of mouth and a couple of local print/magazine ads. That’s it.

If you build the business this way — slow, organic, word-of-mouth — it takes a long time before you feel ready to cut hospital hours. And I’ll be honest, “ready” isn’t even the right word. There was a lot of anxiety with it. But I was able to go part-time about two years into the med spa side of things.

For context on the numbers: my first year, I ended with around $100k in revenue — but if you actually run net, it was still net negative. Once you count the first device and the overhead I was carrying, I was meaningfully in the red that year. So don’t let a revenue figure fool you.

But then, even when the numbers weren’t there yet, I noticed something important. I looked forward to clinic days in a way I no longer looked forward to hospital shifts. That wasn’t enough reason to quit — but it was enough reason to keep building.

The rule I actually used to go part-time

Here’s the closest thing I have to a real rule of thumb: I transitioned to part-time once the business could reliably cover its own overhead for about three consecutive months.

Back then I had a smaller space, so my rent was cheaper — around $2,000 — plus consumables. And I’d actually paid for my first device, which was Ultherapy Legacy (I upgraded to Prime about a year later — another story for the future), outright without financing, which helped a lot.

Once the business was consistently paying for its rent, consumables, and basic overhead for a few months running, that felt like a reasonable starting point to pull back on hospital shifts.

But here’s the flaw I didn’t see: a few good months in a row can lie to you. Mine did.

The mistake I made: I didn't understand the seasonality

This is the part I wish someone had told me, and it’s exactly what broke my tidy little rule.

I opened in March, and from March through September that first year, life was genuinely miserable and slow. What I didn’t understand was that June, July, and August are just not a great stretch for a med spa. People are traveling, and even the ones who are around don’t want the downtime that comes with a lot of laser and treatments in the summer sun.

So when things picked up nicely from September through March, I thought I’d made it — and that stretch is exactly what convinced me it was safe to start pulling back on hospital hours. Then the next summer rolled around, June through August, and it was slow again. Much better than the five-patients-a-quarter days, sure, but still slow enough that I picked up some extra hospital shifts through that window just to cover myself.

If I were doing it again, I’d bake the summer dip into my plan before cutting hours, not after.

Going part-time to PRN — then dropping even that

By the end of my second year, I was paying nearly $5,000 a month in rent for two tiny offices (which office you should actually rent, and the price ranges, is a whole separate post I’ll write later). But I’d ended that second year having almost tripled my revenue, and the business could sustain itself day to day. That’s when I moved to a part-time position.

By the end of my third year, I was paying closer to $10,000 a month in rent and machine financing (which financing option to take, and my regrets there, is yet another post for later). But I’d also ended that third year having nearly doubled my revenue from the year before. That’s when I moved to a PRN position.

I didn’t actually pick up much PRN, and the honest reason I kept it at all was the money — I treated it like any other business decision. Here’s the math: a single 12-hour hospital shift paid roughly what I’d generate in one solid, fully booked day at the spa when I made that decision — and I mean profit, not revenue. But as I got busier, a good clinic day started just generating more than I’d make at the hospital. There’s no guarantee, of course; you can have a clinic day with zero or one patient. But on average the spa was winning, to the point where the PRN shifts just started to feel unnecessary.

There was also a bigger reason. I was at a point where I wanted to build this into a larger practice, not just keep it running. And that meant my time was worth more spent on marketing and hiring than on an extra shift — even on a day where I generated no revenue at all, that time was buying me something. So I dropped PRN altogether. That happened this past May, and it was three months after I started hiring staff.

(When and how you should hire is genuinely its own conversation — I’m planning a whole separate piece on it — so I’ll leave it there.)

Where I landed

So that’s the actual arc: full-time hospital medicine → part-time → PRN → walking away from PRN entirely, over the course of a few years.

Looking back, I don’t think there was ever a perfect time to leave hospital medicine. There were only a series of slightly less risky decisions made one after another. If I did it again, I’d probably make the same choice — just a little more slowly, and with a much better understanding of how seasonal this business really is.

And if you’re in the thick of that decision right now, the uncertainty isn’t a sign you’re doing it wrong — it’s probably just what this looks like from the inside.

This article is intended for medical providers interested in career and practice-building in aesthetic medicine. It is not medical, legal, or licensing advice. Always follow the licensing and scope-of-practice requirements in your own state and practice setting.

Everybody loves to talk about the machines they bought. I want to talk about the ones I almost bought — and didn’t. Every device in this article is one I looked at closely, demoed, or was close to signing for. Had I signed every contract I seriously considered, I would have spent well over $1 million on aesthetic devices. Walking away from each one taught me more about building a practice than most of the machines I actually own. In this business, a six-figure device that doesn’t fit drains capital you won’t get back — and can put patients through treatments you don’t fully stand behind. Deciding where not to spend is a skill in itself.

What surprised me most was that I rarely walked away because a device “didn’t work.” Most worked quite well. I walked away because they didn’t fit my patients, my practice, or the physician I wanted to become.

Up front: this is my thought process, not a verdict on any company. A few of the names will look familiar — Morpheus8, EMSculpt NEO, Clear + Brilliant, and Ellacor among them — alongside several that fly more under the radar. Here’s the full list, and the reasoning behind each pass.

Morpheus8 (InMode)

Technology: Bipolar radiofrequency microneedling with adjustable needle depths (up to 7 mm on the body) that delivers RF into the dermis and subcutaneous tissue to stimulate collagen remodeling, tighten skin, and, at deeper settings, remodel subcutaneous fat.

Why I considered it: Morpheus8 was probably the most talked-about device in aesthetics, so it warranted a serious look. I want to be clear that my reservations are specific to this device, not to radiofrequency microneedling as a category — I think the technology is genuinely valuable. There are RF microneedling platforms that combine monopolar and bipolar energy, run more adjustable, and treat more gently than Morpheus tends to, and those can be excellent tools. Morpheus itself is a great machine, too.

Why I passed: Unfortunately, I’ve personally treated patients who came to me after experiencing facial fat loss following aggressive RF microneedling — the kind of loss that often takes multiple modalities to reverse. A lot of that comes down to who I treat: most of my patients are in their mid-thirties or older, already starting to lose fat in the face, without a lot of reserve to tolerate the more aggressive Morpheus settings. My hesitation really comes down to two things — it’s highly provider-dependent, and I don’t think most patients actually need settings that aggressive. That aggressive end just doesn’t align with the aesthetic outcomes I want to create. Any six-figure device comes with an enthusiastic pitch, so I try to make these calls on my own read of the technology and my patients — and with Morpheus, that read kept telling me to hold off.

triLift (Lumenis)

Technology: Combines Dynamic Muscle Stimulation (electrical muscle stimulation) with TriPollar®, Lumenis’ proprietary multi-electrode radiofrequency technology designed to create more uniform dermal heating for collagen remodeling and skin tightening. An optional RF microneedling module (triFX) can also be added to address skin texture and resurfacing.

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The average med spa in this country does about $1.4 million a year in revenue. I’ll do around $750K. And I still haven’t paid myself a dime. Let me tell you why neither of those facts means what Instagram thinks it means.

Because on Instagram, seven figures is the finish line. It’s the Birkin, the “first-year millionaire” caption, the reveal video. Somewhere a provider is sitting in a small treatment room with a stack of payables on the desk, watching that reel, and quietly deciding she’s a failure.

I want to talk her out of it.

According to the American Med Spa Association's most recent State of the Industry report, the average med spa does about $1.4 million a year in revenue. Read that word again—average. It blends practices of every age and size: brand-new solo clinics right alongside mature businesses with multiple providers and years of momentum behind them. So the seven-figure number the reels treat as a first-year miracle is really just where the whole industry, established practices included, tends to land. It was never a benchmark for a one-provider practice in year one. If you're nowhere near it yet, you're not behind—you're early.

And revenue is not what lands in your account. Even at that average, the owner is not pocketing anything close to the top-line number—and newer owners take home far less. Some of us take home nothing, on purpose.

Six figures had always been a big number to me, so when I crossed six-figure revenue that first year, I assumed I’d finally have something in the bank to show for it. Instead, at year’s end, I could barely cover the machine payments. The revenue was real. The money in my pocket was not.

Let me show you where the money actually goes, because “revenue isn’t profit” is easy to ignore until you see it laid out.

Machines. Every serious device in this space is a major purchase. The cheapest thing I own—a facial machine—ran about $50K, and the priciest is near $200K. I bought mine early, in year one, and I pay them down on a three-to-five-year plan. Added up, my machine payments alone are around ten thousand dollars a month, before I’ve paid a single person or kept the lights on.

Maintenance and warranties. Owning the machine is only the start of paying for it. Each one—especially the lasers—needs annual servicing and a warranty plan, and that runs roughly $7–10K a year per machine. Multiply that across a treatment menu and it’s a line item all its own.

Payroll. I have staff, and staff means their pay plus the employer side of payroll taxes. That comes off the top every cycle.

Insurance. Malpractice coverage, general liability, and unemployment insurance for my team. In this field, being properly covered isn’t optional—it’s part of doing right by the patients who walk in the door.

Overhead. The unglamorous machinery of a real business—a payroll service like ADP, a good CPA to keep everything clean and compliant, and the rent and utilities that come due every single month. None of it is exciting. All of it is non-negotiable.

Reserves. I want the business holding two to three months of operating cash—call it $50–70K—so a slow month or a machine that goes down is an inconvenience, not a crisis.

Reinvestment. At the end of this year, I’m hoping to add a 401(k) match for my team. That’s money I’m choosing to put into the people who built this with me.

Add it all up and the picture is simple: the money that comes in has a lot of good places to go before it gets to me. That’s not failure. That’s a practice being built to last.

There’s one number I could shrink to pay myself more—how I pay my team—and I won’t. Many practices in this field pay their providers on commission. Depending on the state and how it’s set up, commission-based pay for medical services can raise fee-splitting concerns—or even run afoul of state law. I chose a different path. My team is paid hourly, with productivity bonuses. Honestly, the hours my staff put in—and the grind of building a client base from nothing—are worth more than I can pay them right now, and paying them a reliable wage they can count on, not one that swings with the schedule, is the least I can do to honor that. Could I take home a little more with a different compensation model? Probably. But building a stable team matters more to me than maximizing my own paycheck. I’ve never regretted that choice.

My own path, honestly: my first year I was still mostly part-time, working as a hospitalist on the side, and I basically sat idle for the first six months. I still ended year one in six figures. Year two I nearly tripled it. Year three I doubled again. This is my fourth year—but my first all-in—and I’ll land around $750K. Almost all of that revenue came from my own hands and my own patients. My staff only joined about six months ago, so this year’s number reflects essentially a single-provider practice, not a multi-provider team.

I also bet big, early. My first six-figure machine arrived while I was still working hospital shifts, and honestly the logic behind buying it was a tangle.

Part of it was that I wanted the treatments for myself—a little silly, I know.

Part of it was a safety net in reverse: as long as I was still at the hospital, I figured I could pick up extra shifts to cover the payments if the practice couldn’t yet.

The textbook-smart move? Probably not. I’ve written before about why I’d tell a newer version of myself to build the injectable side of the business first—it carries much lower overhead, it grows your client base and your cash flow, and it doesn’t chain you to a six-figure loan before you’ve proven the demand. I still believe that. I’ll admit I had a small panic attack the day that first machine came through the door—the full weight of what I’d just signed for landing all at once. It worked out, and those machines are part of the practice now. But if you’re early on this road, build your base before you buy the big equipment.

If I’d measured those early years against the first-year-millionaire posts, I’d probably have quit somewhere around month six. I’m grateful I didn’t hold myself to that yardstick.

If that provider in the small treatment room is you—if you’re earlier on this road than I am—here’s what I want you to hear. You were told that simply breaking even in your first year is a win, and it’s true. Choosing not to pay yourself for a year or two while you pay down equipment and build a reserve isn’t a red flag. It’s often the smartest, most boring, most durable thing you can do. I fully intend to pay myself well down the line. That day is coming. It just wasn’t day one—and it doesn’t have to be yours either.

And let me be honest about one thing, because it matters: I can take home nothing right now partly because I don’t have to. I’m fortunate to have a husband whose income can carry our life without mine. Not everyone has that cushion—and if you don’t, paying yourself sooner isn’t weakness, it’s survival, and it’s completely valid. Putting the money back in for a year or two, if you can afford to, is a strategy—not a scarlet letter.

If you’re at the start of your own practice, please don’t mistake a slow, careful beginning for failure—more often than not, that’s exactly how the ones that last get built. I’ll do about $750,000 this year, and I still haven’t paid myself a dime. That’s not because the business isn’t working. It’s because, for now, I’m choosing to build something that will.

This article is intended for medical providers interested in career and practice-building in aesthetic medicine. It is not medical, legal, or licensing advice. Always follow the licensing and scope-of-practice requirements in your own state and practice setting.

Start with margin, not markup

Before we touch a single number, get one distinction straight, because it causes more confusion in this business than almost anything else: margin and markup are not the same thing.

• Margin is your profit as a percentage of the price the patient pays.

• Markup is your profit as a percentage of what the product cost you.

Most injectables in this industry get priced at a margin somewhere between 30% and 60%, depending on location. I’ve seen margins pushed as high as 75–80%, which I think is a little too high — but it exists out there. Just know that when someone tells you they run “80%,” you should ask whether they mean margin or markup, because an 80% markup and an 80% margin are wildly different prices. Throughout this article, when I quote a percentage, I mean margin on revenue unless I say otherwise.

The worked example: neurotoxin (Botox)

I’m going to build all of the math in this article around a typical Botox order, because it’s the product almost everyone starts with and the numbers are easy to follow. Prices here assume you’re a new clinic with no discount and no membership benefit — which is exactly where you’ll be when you open your doors. These numbers reflect my own purchasing and pricing at the time of writing; manufacturer pricing, rebates, and package configurations vary.

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Everyone wants to talk about the “aesthetic of the aesthetics business” — the branding, the room design, the Instagram grid. Almost nobody gives you the real numbers. So let’s answer the question people actually lie awake over: “How much money do I actually need to open my first practice?”

That’s what this post is: my actual budget, line by line, from when I opened.

I’m going to break it into two paths, because they are genuinely different businesses with different risk profiles:

1. Injectable-only — the lean way in, and where I strongly suggest most people start.

2. Adding a machine — where the costs climb fast, and where you need to know what you’re doing before you sign anything.

My honest advice: if I were starting over today, I’d stay on the injectable side until I truly understood my patient flow, my margins, and my own hands. Then, and only then, would I think about carrying a device. Let me show you why with the math.

Path One: The Injectable-Only Clinic

When I first started out, I rented a small room in the back of a hair salon. That’s it. No storefront, no build-out, no signage budget.

The room was about 150 square feet, windowless, and just big enough to fit my treatment chair, a small cabinet, and a chair for me (the provider). There wasn’t really room for an extra desk — and I didn’t need one. Rent ran me about $1,400 a month.

If you can find an arrangement like this, take it. Your overhead in the early days is the thing most likely to sink you, and a back-of-salon room keeps it tiny.

My first room

• 150 sq ft

• $1,400/month

• No windows

• No signage

• Five patients in my first three months

That tiny room eventually became the practice that allowed me to expand into a much larger space.

Setting up the room

Here’s the beautiful part of going injectable-only: the room was essentially already set up. My real one-time costs were short.

• Treatment chair — the single biggest room expense. Expect $2,000–$4,000 depending on how nice you go.

• Pharmacy-grade, temperature-controlled refrigerator — a dedicated medical refrigerator that reliably maintains manufacturer-recommended storage temperatures is something I consider non-negotiable for storing your product correctly. These range from about $500 to $2,000 depending on size and build quality.

• Towel warmer — around $200, and worth it. For a long time I prepped patients with a simple alcohol swab, and that’s perfectly fine. But if you take the time to learn a few basic facial skills and actually wash and prep the face properly, it noticeably elevates the experience. Patients rarely remember whether your treatment chair cost $2,000 or $4,000. They do remember how you made them feel.

And that was basically it for the space itself. No expensive equipment, no plumbing, no construction.

Two things worth calling out when you’re picking your room:

Find a room with a sink. Mine already had one, and it makes a real difference for hand hygiene, cleanup, and general workflow. A sink sounds trivial until you spend a day walking down the hallway every time you need to wash your hands. Retrofitting plumbing is exactly the kind of expense you’re trying to avoid at this stage, so make an existing sink part of your search criteria.

Understand the licensing situation for the space. In Pennsylvania, you generally can’t simply co-share space that’s licensed as a cosmetology establishment without addressing the licensing status first. In my case, the room had previously been occupied by a cosmetology provider, and it could be released — made “unlicensed” from the cosmetology board — so that I could use it for my medical practice. That distinction matters, and it’s the kind of thing you want to sort out before you sign a lease, not after.

A disclaimer: this was my experience in Pennsylvania, and licensing frameworks vary substantially from state to state. Always verify your own state’s rules before signing a lease.

Stocking your injectables

This is where new injectors overthink it. You do not need to walk in with a full menu. My guidance: buy conservatively and add as you go. Do not place large bulk orders of toxin or filler in the beginning — you’ll be tying up cash in product that may expire before you use it, and you won’t have the volume yet to justify it.

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I don’t regret shadowing. I just realized afterward that I was solving the wrong problem. I thought I needed to learn how to inject better and do a better consultation. What I actually needed was to learn how to build a clinic.

Before I opened, I wanted to get as much shadowing and preceptorship experience as I could. In full honesty, I didn’t get very much — and I think a lot of physicians run into the same wall I did.

Here’s the awkward part nobody says out loud: we’re providers who can open a med spa on our own license. That makes us competition. So it’s not always easy to find another provider who’s genuinely happy to let you shadow them. Before I ran a business myself, I didn’t appreciate how hard it is to let someone shadow you either. But people ask me about this constantly, so here’s exactly how I did it — and whether I found it worth it.

My first experience

This happened right after I finished my Botox training. As soon as I got my first certification, I reached out to the local doctor I’d been receiving treatment from and asked if she needed another provider to help her out. She said yes — she wanted someone to cover the Saturdays she wasn’t in.

So it was technically shadowing, but not in the formal sense. Nobody walked me through the steps one by one; it was mostly up to me to figure things out as I went. I’m sure that’s useful in its own way, but it’s not the structured “watch and learn” experience most people picture. I was looking for something more “traditional,” so I didn’t pursue it after the first day.

That was the mistake. I didn’t understand yet how rare that offer was. Someone was offering me a paid job in a real clinic — real patients, every Saturday — while I figured out the business on my own time, and I turned it down because it didn’t look like the thing I thought I was supposed to want.

My second experience

The second time, I paid for it. And honestly — after the one I was dumb enough to turn down, I never got another chance to shadow anyone without paying.

This one was in the UK, in the Manchester area, as part of a Level 7 mastery program. It included shadowing two clinicians for full clinic days, so you could see how they ran consultations, delivered treatments, and assessed each patient’s face. Because it was UK-based, some of the nuances and logistics didn’t fully translate to how things work here. But medicine is medicine, and it did give me a real sense of how you carry yourself and move through a full day of clinic.

I personally think seeing it once or twice is generally more than sufficient, if what you want is to see how a clinic day flows. It’s a good day to figure out not only how to inject Botox and filler, but which supplies you’d actually need to buy to create a smooth experience for your patient.

My third experience

The third was with Dr. Tim Pearce. I watched him run his consultations and deliver treatments.

What I liked was that it was split into two days — one near the beginning of my training journey, one near the end. The second day was the one that mattered. By then I’d been injecting constantly, and you’d be surprised how much more your eye picks up once your hands already know the work. Same room, same clinician, completely different day. Watching only teaches you what you’re ready to see.

And that’s genuinely the extent of my shadowing experience.

Is paid shadowing worth it?

There are a lot of paid opportunities out there — online and in person — where you can shadow a specific provider, often somewhere in the range of $3,000 to $10,000 for a half day. Here’s the part that won’t make me popular: a lot of these shadowing days are promoted to new injectors who haven’t opened yet. And I honestly don’t know how practical they are before you run the business. Once you’re open, I think they get more useful — you finally have the context to know what you’re looking at.

On the clinical side, sure — you may argue you’ll pick up technique, and that it’s genuinely useful to see how someone runs a consult. But isn’t that what the training day was for?

A lot of these days also promise to teach you how to convert — how to turn a consult into a booked treatment. There’s no magic there. Patients can tell the difference between someone who’s listening and someone who’s closing.

What I’d remind myself if I did this again

1. The advanced technique was never my bottleneck.

When you first open, you won’t have the volume to offer it as a service in the first place. I learned things I wouldn’t get to use for a year — and by then I’d have to learn them again.

2. Watching was never repetition.

Your injection skill is built on hundreds of your own treatments, not on another observation day. No amount of standing in someone else's room speeds that up.

3. The business was the hard part, and nobody was shadowing me through it.

Injecting turned out to be the small(er) piece. The things that actually determined whether my clinic succeeded were inventory I over-ordered, pricing I guessed at, and cash I watched leave faster than it came in.

4. When someone offers you paid work, take it.

The Saturday job wasn’t shadowing, and that’s exactly why I said no. But it was patients, it was income, and it was a year of learning the business while someone else carried the overhead. The rare thing isn’t the observation day you can buy. It’s the person who’ll let you work.

5. I was buying certainty, not preparation.

I almost paid £8k to have my treatment menu redesigned to attract more clients. I’m glad I didn’t. You’d be surprised how many people reach out offering services you’d never thought about needing. I still get some version of a PowerPoint deck in my inbox every day, promising to improve this or that in my business.

Spending another £8k felt productive because it made me feel like I was getting ready. But preparation you don’t need is just spending.

When shadowing is worth it

I do think it’s worthwhile if you’re an NP, PA, or RN who wants to work at a particular clinic, and that clinic offers a shadowing experience as part of getting you in the door. That’s a clear, practical reason to do it.

It’s harder for a physician to ask another physician — especially a local one. I don’t know how a provider feels about you shadowing at their place and then opening a med spa two miles away, and that’s a big part of why so many of us can’t find shadowing close to home.

What would actually help more

If someone offered a shadowing experience focused on the parts that actually make or break a new clinic — how to set things up, how to place your orders, how to run the operational side — I think that would be far more useful than another day watching someone inject.

Until someone sells that day, keep the $3,000-10,000. Put it toward the first three months of rent you haven’t figured out how to cover yet.

Next up: the startup budget I wish someone had handed me before I signed anything.

The series so far:

✓ Why I left hospital medicine

✓ Every training I took (and what it cost)

✓ Opening ROA: finding my first office and surviving the first three months

✓ If I opened my practice again: what I’d never pay for twice

✓ Shadowing Showed Me the Clinic I Wanted. It Didn’t Show Me How to Build One. (you’re here)

⏳ The Clinic Startup Budget I Wish Someone Had Given Me

This newsletter is intended for medical providers interested in career and practice-building in aesthetic medicine. It is not medical, legal, or licensing advice. Always follow the licensing and scope-of-practice requirements in your own state and practice setting.

I once spent $31,600 to bring in maybe fifteen clients.

If you read my last article, you know my first three months in private practice weren’t glamorous. Five patients. A phone that barely rang. Plenty of moments where I quietly wondered whether I’d made the biggest mistake of my career.

Today, roughly five people join our waitlist every day. My nurse practitioner is growing quickly enough that, at her current pace, she’ll likely have a waitlist of her own within the next year.

That certainly wasn’t how it started.

Medical school taught me how to diagnose disease.

Residency taught me how to manage critically ill patients.

Aesthetic training taught me how to evaluate and treat faces.

But we’re never taught how to build a business. Being good at what I do and being able to fill a schedule are two completely different skills. Nobody teaches you the second one in medical training.

Eventually I stopped thinking like a physician who happened to own a business and started thinking like a business owner who happened to practice medicine.

That shift changed everything.

So if I woke up tomorrow in a brand-new city—with no reputation, no referrals, an empty schedule, and the exact same budget—I already know exactly where I’d spend my marketing dollars.

More importantly, I know exactly where I wouldn’t.

Before we start, I want to tell you something that took me years to learn.

Money is money. Business is business.

If the numbers don’t work, you cut it.

Even if you liked it.

Even if the sales representative was genuinely lovely.

Even if it made you feel like you were “doing something.”

Business doesn’t care how something feels.

It only cares whether it works.

That mindset didn’t come naturally to me. Like many physicians, I was uncomfortable charging people—especially once the number had a comma in it. If that’s you, I genuinely recommend Get Rich, Lucky Bitch! by Denise Duffield-Thomas. It’s funny, surprisingly practical, and probably contains more F-bombs than any business book I’ve ever read. Somewhere along the way it helped me stop apologizing for charging what my work was worth.

Because you can’t build a sustainable business if you flinch every time someone pays you.

With that out of the way, let’s start with the expensive lessons - the ones that, all told, cost me well over $50,000. Some of that was clean, itemizable spend, like the magazine you’re about to see. A lot of it wasn’t: ad budgets that bought almost nothing, and free treatments for influencers who never posted. That kind of waste never lands neatly on a spreadsheet — but it’s real money all the same.

What I wouldn’t do again

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If you walked past it, you’d never have guessed a medical practice was inside.

It was a back room in a salon suite, the kind of place where a bunch of different professionals share space. I was mostly surrounded by hair stylists. About 100 square feet. No window. No sign on the door with my name on it.

I almost didn’t rent it.

It took my husband half-forcing, half-encouraging me to sign that little lease. On my own, I probably would’ve kept waiting for the right time: one more course, one more certification, one more sign.

Looking back, I wasn’t waiting to be ready. I was waiting to stop being scared.

But I signed. And once I had the key, I wasn’t sure I belonged there. So I tried to make it mine. I called the contractor to take the blow dryer holder off the wall. I framed the painting by Talou Galanou that my husband had ordered for my birthday and hung it where the holder used to be. The painting was supposed to live above my desk at home. When we ordered it three months earlier, I wasn’t even thinking about opening this place.

So this is what those first three months actually looked like. Not the version you see on Instagram. The real one.

Finding the room

I didn’t find a dream space. I found what I could afford to lose.

The room was tiny, inexpensive, and low risk. At the time, low-risk was the only kind of risk I could stomach. It was close enough to home that I could still pick my daughter up from school, and small enough that the rent didn’t make me panic.

If I’m honest, part of me didn’t even know what I should be looking for.

But the real reason I said yes was quieter than any of that. I needed to find out whether this was a fake dream, or a real one I could actually afford to follow.

There was no grand opening. No ribbon, no champagne, no line out the door. Part of me was ashamed the space was so small no one would ever notice me there. Part of me was scared. And a small, stubborn part of me was excited. This windowless little room was finally a project that was mine to build.

I’d told myself building a business takes time. I knew that. I’d read it a hundred times.

But knowing something and living it are two completely different things.

Five.

By the end of month three, I’d seen five clients.

Five.

Meanwhile, I was still working my hospital job. Picking up extra shifts. Trying to run a practice on the side. Three jobs, basically. And the newest one was the one losing money.

Here’s the honest money picture, because it matters more than the dramatic version. My savings funded the startup: training, setup, everything you pay for before a single patient walks in. But the month-to-month losses got absorbed by my hospital salary. That’s the quiet upside of starting small: the room was inexpensive enough, and the bleed slow enough, that my paycheck could cover it.

Starting small never once made me feel successful. But it’s the entire reason a brutal three months didn’t end the whole thing.

So the money part was survivable. The mental part was not.

It was never really about the dollars.

It was the shame of being a fully grown, fully trained physician with nearly ten years of experience, and still needing help with something this small. A quiet voice kept whispering that maybe I just wasn’t built to build this.

And the comparisons made it worse. I would put on a podcast and there would always be someone, cheerful, effortless, talking about the seven figures they’d done in their first year in aesthetic medicine. And I’d spiral: If I could just get their secret. They must have known someone. They must have had a following before they ever opened the doors. God, somebody please tell me I’m not failing already.

And underneath that was something I can only name now. The whole time, I kept quietly telling myself I could let it go. Walk back into the hospital full-time and pretend none of this had happened. I thought having a plan B was protecting me. It wasn’t. It was keeping me from ever fully showing up. A business can feel it when you’ve got one foot out the door. I could feel it.

Most nights I was awake at 3am, running the math, regretting everything. I’ll be honest, because I think someone reading needs to hear it: the self-doubt got dark. It just quietly convinces you that you were stupid to try, that everyone was too polite to tell you, that you should go back to the safe thing and never speak of this again.

If that’s where you are right now: it is a season, not a verdict. It felt permanent to me too. It wasn’t.

The pride that cost me months

Here’s the part I’m least proud of.

Good friends, more than one, told me what I needed to do. Market yourself. Run some ads. Put your name where people can actually see it. They weren’t wrong. They were completely right.

And I didn’t listen. Not because I disagreed. Because I was too proud, and too ashamed, to admit I needed to. Marketing felt like begging. It felt like admitting the work alone wasn’t enough, that I wasn’t enough.

I lost real time to that pride. Weeks. Months.

I had to stop being a professional doctor and start being a business owner.

In medicine, there’s so much shame built around being business-savvy. Wanting to be paid well, marketing yourself, treating your practice like the business it actually is: somehow all of that is supposed to be beneath you.

I had to unlearn every bit of it.

Fast.

What I did next was throw everything at the wall: 100 emails to local businesses, partnerships, a magazine ad, a Google ad, a YouTube channel I started on a whim, random posts on a local website. Some of it worked. Most of it flopped.

That’s the next post. Because how I got my first real patients had almost nothing to do with the random ads I kept throwing at the wall, and even less to do with sitting back and waiting for word of mouth. The biggest lesson hiding inside all that flailing was one nobody warned me about: marketing only works when you aim it at the right people. Figuring out who those people actually were turned out to be its own whole learning curve, and I made every wrong turn on it so you won’t have to.

If you’re in your own version of month three

If you’re sitting in a too-small room, watching your savings drop, lying awake doing math at 3am, and wondering if you made a terrible mistake: I see you. I was you.

The slow, scary, am-I-crazy beginning is normal. It is not proof you failed.

And the thing that finally moved me forward wasn’t more training, more polish, or more waiting to feel ready. It was deciding to run this like the business it always was.

You’ve got this. 🧡

Next up: how I actually got my first patients, and it wasn’t the Google ad.

The series so far:

• ✓ Why I left hospital medicine

• ✓ Every training I took (and what it cost)

• ✓ Opening ROA: finding my first office and surviving the first three months (you’re here)

• ⏳ How I got my first patients (hint: it wasn’t the Google ad)

• ⏳ The five mistakes that cost me $$$

• ⏳ Every machine I almost bought, and the ones I actually did

This newsletter is intended for medical providers interested in career and practice-building in aesthetic medicine. It is not medical, legal, or licensing advice. Always follow the licensing and scope-of-practice requirements in your own state and practice setting.

“How did you get started?”

“What courses did you take?”

“Is it worth it?”

I love these messages. I was the person sending them once — scrolling through injectors’ pages at midnight, trying to reverse-engineer a career from captions and clinic tags. So I want to do the thing I wish someone had done for me back then: lay it all out. No gatekeeping. The real path, the real numbers, and the parts the receipts don’t show.

Here’s exactly how I trained, what each step cost, and what it actually gave me.

One thing before we start: this is the training question. It is not the same as the can-I-legally-do-this question. Scope of practice, collaborating-physician rules, medical director requirements, and who’s even allowed to own an aesthetics practice all vary by your state and your license. That piece matters more than which weekend course you pick, and I’ll cover it in its own post. For today, I would assume you’ve checked your state’s rules first.

The breakdown

One more thing to keep in mind before you read the numbers: I started this journey more than five years ago, so these are the prices I paid back then. Course fees tend to creep up over time, so assume most of these have gone up since. Treat them as a ballpark for the scale of the investment, not a current quote.

🩺 Dr. Kay’s Anatomy Course (online) · $1,200

This is where it started, and honestly where I think it should start for most people.

Dr. Kay is based in Pasadena, but the course itself is online, so you can complete it from home before you ever travel anywhere or pick up a needle.

Before you touch a needle, you need to understand what’s underneath the skin: the vessels, the danger zones, and the tissue planes you’re working through.

Anatomy isn’t the glamorous part, but it’s the part that keeps your patients safe.

I didn’t rush it, either. After the course, I spent roughly six months reviewing anatomy and studying on my own before I ever started injecting.

I still think about that anatomy every single day I inject.

💉 Rana Kennelly Full-Day Course · Chicago · $2,500

A full-day introductory course, and a great starting point.

The toxin training covered full-face treatment in a way that was genuinely actionable: clear, simple steps you could actually walk out and use rather than theory you had to translate yourself.

They also covered the fundamentals of filler for cheeks, lips, and smile lines, so I left with a real foundation in both toxin and filler.

There’s a massive gap between understanding something in theory and feeling it in your own hands, and this is where that gap started to close for me. Watching an experienced injector work in person — their pacing, their decision-making, the tiny adjustments they make in real time — taught me things no slide deck ever could.

📚 Dr. Tim Pearce Mastery Program · Manchester, UK · ~£10,000 (≈ $14,000 USD)

This was my biggest investment.

And I’ll be honest, it’s no longer offered since SkinViva joined the Harley Academy, so this is more about why I did it than a recommendation to go find it. I took it because I’m someone who wanted the complete map before I started injecting: the full picture of risk, complications, and judgment, top to bottom. If that’s how your brain works too, you can likely find a comparable comprehensive program here in the States.

But I’ll also say this, because I wish someone had said it to me: sometimes the best way to learn is as you go. You don’t need to absorb the entire field before you begin.

Learn cheek filler.

Treat cheeks.

Repeat.

Then move on.

If you learn a technique and then don’t use it for months, you’ll forget it — and you’ll end up paying for a refresher anyway. Learning in the order you’ll actually use it tends to stick.

If I were starting over today, I’d build my education in the same order my practice was growing.

🌍 Dr. Choi 1:1 Training · Piena Clinic, South Korea · ~$2,500

South Korea is operating on another level, and I wanted to learn directly from a market that has influenced aesthetic medicine around the world

.One-on-one time with Dr. Choi was worth every hour of the flight.

If you’re interested in refining your mid-face cannula technique, he’s exceptional.

More importantly, training abroad stretched my eye.

Different faces, different aesthetic goals, different philosophies — it reminded me that there isn’t only one correct way to inject.

⚡ Annual conferences, company trainings & ongoing 1:1 mentorships · $250–$5,000+

This is the part people underestimate. The learning never ends.

New products, new techniques, new research, refreshers on the things you think you already know. I budget for this every single year.

One honest caveat, though.

During your first year as an injector, before you’ve started doing more advanced work, a lot of this won’t land. The pace is fast and the material is pitched at people already practicing, so it can fly right over your head.

By year two, once you’re actually injecting, it transforms — you can watch a technique, pick up the small things, absorb the planning and the decision-making, and walk away with something you can use. Those are the things that elevate an injector over time.

📱 Swift Beauty by Dr. Swift · $500/month

An ongoing education subscription I used for a stretch, and I'm not subscribed anymore — but it earned its place on this list. Where it really helped me was early in year two as an injector, that window where conferences still hadn't quite started to make sense yet. Because it's home video you can watch and re-watch on your own time, I could go back over a technique as many times as I needed until it actually clicked — something you just can't do with a live training that moves on without you. Once you've got real reps behind you, that kind of rewatchable, go-at-your-own-pace resource is what keeps you learning continuously instead of in scattered bursts.

One thing about filler training nobody tells you

Almost every filler course you’ll find is built on hyaluronic acid (HA) — your Juvederm, Restylane, RHA, that whole family. That’s a very good place to start. But HA isn’t the whole story.

The non-HA fillers — Sculptra, Radiesse, Renuva — behave differently in the tissue and call for their own technique, so they’re not something a general HA course really prepares you for. You need designated training for each. The good news: by the time you’re ready for them, you’ll already have a handful of HA injections under your belt, and a lot of what you’ve learned will carry over.

Here’s how I’d approach the education for these, because it’s worked well for me:

1. Start with the free company training. Most of the brands run their own trainings, and many are free. Take them. They’re a no-risk way to learn the product straight from the source.

2. Then book a 1:1 with a separate provider. A different teacher means a different technique — and the goal is to see more than one approach so you can decide which one actually becomes yours.

For both Sculptra and Radiesse, that’s exactly what I did: one company training, then one in-person 1:1. Two perspectives on each, and the room to build my own style from there.

If you add up the course fees alone, it’s already a serious number. But the price tags above are only the price tags. They don’t include the flights to Chicago, Manchester, and Seoul. The hotels. The meals eaten alone in a city where I knew no one. The income I didn’t earn during every day I spent in a classroom instead of a clinic. The weekends, the jet lag, the time away from people I love.

This took 5+ years across multiple countries. It was not a course you finish and a certificate you frame. It was a slow, expensive, sometimes exhausting accumulation — and I’m still in it.

If you’re just starting

I want to be really clear about something: this is my path, not the path.

There are excellent injectors who trained completely differently from me, for a fraction of the cost, in a fraction of the time. The specific names and price tags above aren’t a checklist you have to replicate. They’re just an honest look at the road I happened to take, and the way it shaped how I practice today.

What I would pass on as actual advice:

• Start with anatomy. Always. It’s the foundation everything else sits on.

• Go slow. This work rewards patience and punishes ego. The injectors who rush are the ones who get into trouble.

• Keep investing in your education long after you feel “qualified.” The day you think you’ve learned enough is the day you become dangerous.

Botox is harder than it looks. The good ones make it look effortless precisely because they put in years where it was anything but.

If you’re standing at the start of this, staring at the cost and the timeline and wondering whether it’s worth it — I see you. I was you. And I hope this gives you a clearer, more honest map than the one I had.

You’ve got this. 🧡

In the next post, I’m taking you behind the scenes of opening ROA.

I’ll share how I found my very first office, why I chose that location, what opening day actually looked like, and what the first three months were really like — financially, emotionally, and professionally.

Spoiler: it looked nothing like the polished “grand opening” social media usually shows.

If you’ve ever dreamed of building your own aesthetic practice — or you’re simply curious what it really takes to start from scratch — I hope you’ll come along for the journey.

Coming up in this series:

• ✓ Why I left hospital medicine

• ✓ Every training I took (and what it cost)

• ⏳ Opening ROA: finding my first office and surviving the first three months

• ⏳ How I got my first patients (hint: it wasn’t word of mouth)

• ⏳ The five mistakes that cost me $$$

• ⏳ Every machine I almost bought — and the ones I actually did

Got a question about getting started that I didn’t cover here? Reply to this email or drop it in the comments — I read every one, and your question might become the next post.

This newsletter is intended for medical providers interested in career and practice-building in aesthetic medicine. It is not medical, legal, or licensing advice. Always follow the licensing and scope-of-practice requirements in your own state and practice setting.

A few years ago, I was a hospitalist with a full rounding list and a two-year-old at home.

Don’t get me wrong, I still love medicine. But hospital medicine is not forgiving to a mom, and it's really not forgiving to a toddler mom. I spent my days fighting guilt from every direction. I worked 7-to-7 shifts, which meant most days I wasn’t there for her. Snow days and sick days gave me actual heart palpitations.

Who’s covering? Who’s watching her? How can I be in two places at once?

We’d just moved to a new city for my husband’s job, and I didn’t know a single person. I flew our nanny in from Chicago out of pure desperation. On the truly impossible days, I flew my mother-in-law in just to save us.

I knew something had to change.

I just didn’t know it could look like this.

If you’re quietly wondering whether you could make the same transition, this is for you.

Why aesthetics

I’d always loved aesthetic medicine, but as a consumer first.

For years I’d quietly thought, I don’t just want to receive this work, I want to do it.

Then COVID hit, and I couldn't fly to Korea for my annual "maintenance." So I tried to get it done here, and… let's just say I lived through a pretty horrible laser and Ultherapy experience. (We won't even talk about the lip filler.)

Sitting there with results I wasn't happy with, something clicked.

That was the moment "someday" started turning into "why not me."

The trap I fell into

Here’s the part I’m a little embarrassed to admit, because I see so many of you doing the exact same thing.

While I was pregnant, I started taking trainings. Good ones.

But nobody ever told me what to actually do with them, or how to go from “I have a certificate” to “I have a patient in my chair.”

So I did what felt safe.

I assumed I wasn’t ready yet, and I signed up for more training. And then more.

Training became my procrastination.

Every new course felt like progress, but really I was just collecting certifications so I’d never have to take the actual scary step. When it finally came time to open, I froze, because I genuinely didn’t know where to go or what to do first.

So I delayed.

And delayed.

If I could go back and tell myself one thing: you are more ready than you think, and no amount of additional training will fix a confidence problem. The next course is not the missing piece. Starting is.

Year 1: brutal

It honestly took my husband half-forcing, half-encouraging me to rent a back room in a salon suite.

And then reality hit.

By month three, I’d seen five clients.

Five.

I was working my hospital job, picking up extra shifts, and trying to run a practice at the same time.

Basically three jobs.

Most nights I was awake at 3am regretting everything. I drained my savings. And the shame of depending on my husband to help cover the rent nearly broke me.

Then it hit me.

I had to stop being a “professional doctor.” And start being a business owner.

So I sent 100 emails to local businesses asking for partnerships. In medicine, there’s so much shame around being business-savvy, like wanting to be paid well or market yourself is somehow beneath you.

I had to unlearn all of it.

Fast.

Year 2: the expensive lesson

Year two started strong. For a few months, I thought I’d figured it out.

I hadn’t.

I expanded my office far too early. I was still working full-time at the hospital and didn't need the extra space.

That’s when I learned what seasonality actually means. One great month means almost nothing. The slow months came. The bigger overhead didn’t care. And suddenly I was underwater again. I sold every luxury bag I owned on The RealReal because I flat-out refused to ask my husband for more help.

Looking back, I wasn’t expanding because the business was ready.

I was expanding because I wanted proof that I was succeeding.

Those are two very different things.

Year 3: stable, finally?

Three years after that little back room, the practice is stable.

We’re growing.

I run a medical spa here in Lancaster, PA, with two incredible women seeing clients alongside me, plus a small location near Chicago. I train for tox. And I’ve closed my personal client list so I can focus fully on the patients who trusted me from the very beginning.

I still can’t quite believe it when I write it out.

What no one tells you

People ask me whether leaving hospital medicine fixed burnout. Not exactly.

It just replaced one kind of stress with another.

Now it’s payroll.

Cash flow.

Hiring.

Slow months.

Wondering whether I made the right decision.

Is it easier than the hospital? Hell no.

Is it worth it? I’m a Korean-American woman who was raised on 20-step skincare routines and a deep love of aesthetics. In a way, I was born to do this. So yes, but not because it’s easy.

Entrepreneurship is not the escape everyone thinks it is. It’s just a different kind of hard. The difference is, this one’s the hard I chose. And I get to pick up my daughter from school and be there when she needs me.

Why I’m writing this

When I started posting my journey on Instagram, my DMs filled up with providers, physicians, NPs, and PAs, asking the exact questions I’d been too scared to ask out loud a few years ago.

How did you start?

What training?

Do I need another degree?

Where do I even begin?

How long did it take?

So many of you want to walk this path. And there’s a frustrating amount of gatekeeping around how it’s actually done.

I’m going to do the opposite. I’m putting the real path here: the training routes, the credentialing, the business struggles, the marketing, the mistakes that cost me time and money.

Everything I wish someone had handed me years ago.

If you’ve had the 3 a.m. regrets, the financial fear, or quietly wondered whether you could build something of your own, you’re exactly who I’m writing this for. Let’s stop pretending it’s easy and start supporting each other for real.

New posts go out every other week. Next week I’ll walk you through every training I took, what each one cost, what I’d recommend today, and what I’d skip if I were starting over.

I’d love to have you along.

This is career and practice-building education for medical providers, not medical or legal advice. Always follow the licensing and scope-of-practice rules in your own state and setting.