MD Starting a solo cash-only private practice after internship year

Whale

7+ Year Member
Apr 2, 2010
50
6
Status
There’s a group locally in my town run entirely by NPs and they have a strong social media presence and are doing incredible business. There’s a huge market, the good products work well...
Do you know how big the market is for minimally invasive aesthetic procedures? Business revenue/profit? Only in big cities I suppose?
 

KeikoTanaka

2+ Year Member
Aug 11, 2017
621
364
Status
Medical Student
FootFetish,

Just my 2 cents. I'm not business-savvy and I'm only a 2nd year student, so literally I only have 2 cents to offer.

If you fail to make it into a Derm residency, I really think you should consider a rural/unopposed Family Medicine residency and just finish the whole thing.

You mentioned above that you would be interested in not only providing beauty and cosmetic modalities to your practice, but also would like to take care of the occasional Hypertensive patient, diabetic, etc. etc.

You won't be limiting yourself at all in the beauty world since you can do it without a board certification in a specialty, but having a broad specialty like FM be your board certification, it can just be an additional tool you have in your toolbox when assessing patients with beauty complaints/needs.

You can always go to Turkey anyhow and learn hair transplant and what not, but I just think that having a couple extra years in residency will make you more confident treating a wide array of patients, and at the end of the day, will not hinder your capacity to do beauty work down the road. I mentioned a rural FM residency because I heard that in rural areas FMs do a lot more dermatologic procedures like biopsies and stuff. You could get a lot more practice in that realm doing this.

Good luck with whatever you choose.
 
  • Like
Reactions: Dr. Doctor MD

operaman

7+ Year Member
Jun 7, 2010
1,936
4,508
Status
Resident [Any Field]
Do you know how big the market is for minimally invasive aesthetic procedures? Business revenue/profit? Only in big cities I suppose?
Well I haven’t opened such a business myself but from the number of them I see popping up there is clearly a demand for it. I think it extends well beyond the bigger cities too.

The Established products Just work and are priced similarly to other High end health and beauty products. Take a standard 50U vial of cosmetic Botox - about $600-700 cost to patient and that’s enough to do a solid treatment. Many of these people are dropping hundreds every month on creams and serums that don’t do much at all, so 600 for something that truly works and lasts 3-4 months is pretty awesome.

I’m also amazed at the range of services and products available. Botox, fillers, kybella, peels, hydra, cryo - lots of high demand things that have relatively low materials cost. You can add lasers pretty easily too just by renting them and passing costs on to your affluent cash paying customers.

From a cash flow standpoint it seems very doable. Easy to scale to demand as well by hiring ancillary staff to administer products for you. I’ve even heard of people doing the food truck model too where they have a mobile injection center and go to all these high end gyms and coffee shops and whatnot or do Botox and filler parties for private groups.
 

nimbus

Member
10+ Year Member
Jan 14, 2006
4,767
5,014
Status
Yep. Just need a license. Many clinics have nurses and aestheticians who do the actual procedures while a doc “supervises” them. There’s a group locally in my town run entirely by NPs and they have a strong social media presence and are doing incredible business. There’s a huge market, the good products work well and are fairly easy to use, the crappy ones still seem to convince rich aging people to pay for them, and if you’re careful you really have minimal risks to deal with so I’m sure Med-mal coverage is probably reasonable too.
Yep one of my former partners left anesthesia to do Botox full time. I asked him how he got interested in it and he replied that he was tired of paying so much for his wife’s Botox so he decided to go to an allergan course and learn to do it himself. He now has become one of the top injectors by volume in our city and hired another MD and a NP. He’s got hundreds of 5 star yelp reviews, 2 offices, a boat, and an Aston.
 
Last edited:

hallowmann

Lifetime Donor
7+ Year Member
Mar 13, 2012
5,565
5,193
Status
Resident [Any Field]
Yeah ironically enough the lack of training may be somewhat protective from a medicolegal standpoint. Standard of care is defined in terms of what someone with similar background and training would do. This protects NPs and well as undertrained MDs. We have an OBGYN here banging out cosmetic facial procedures he has no formal training in. Not the same as GP but same idea.
As far as I understand it, medicolegally physicians aren't necessarily judged on standard of care based on their same background of training, they're judged on standard of care for the individual procedure or medical treatment that they offer, which is often defined by the specialty organization known for such a procedure. An FM delivering a baby for example is typically judged by the standard of care of physicians delivering babies, not say nurse midwives. They ultimately are judged on ACOG or similar standards.


The vast majority do allow it however, including NY and CA, which surprised me. IDK why for some states that require 2 years for MD only require 1 for osteo.
CA has changed its law to make it 3 yrs. Also, its because we already have 200 hrs of practice in bone wizardry, so obviously that's worth a year of GME compared to our MD counterparts.
 
  • Like
Reactions: nimbus

You shall know the Truth

2+ Year Member
Dec 3, 2016
339
299
Status
Medical Student (Accepted)
Yep one of my former partners left anesthesia to do Botox full time. I asked him how he got interested in it and he replied that he was tired of paying so much for his wife’s Botox so he decided to go to an allergan course and learn to do it himself. He now has become one of the top injectors by volume in our city and hired another MD and a NP. He’s got hundreds of 5 star yelp reviews, 2 offices, a boat, and an Aston.
So your saying I should forgo a surgical residency and just do Botox all day everyday?
 
Jun 24, 2019
148
91
Status
Medical Student
I’m sure you need some amount of cash to really get a good business started. finishing your residency, saving some money then starting up a med spa doesn’t seem that hard to do if you have some extra moola in your bank account. I would hesitate to do it fresh out of school or residency because of the risk.
 

LoGo

MD PhD
2+ Year Member
Aug 13, 2016
148
347
Status
Resident [Any Field]
On what planet are FM docs "handling lupus with ease"? Rheum is almost always involved in the care of lupus patients.

Choosing to leave residency for solo practice is ridiculously stupid, in my opinion.
You may not know, but the theme of this thread and consensus among those who will never step foot in a derm/plastics clinic is that “you can be anything”, and that regardless of your training (or lack there of), everyone is a dermatologist/plastic surgeon.... I presume the same terrifying assumption is there for rheum....