No matter how firmly established the practice, new investments must be made continuously to remain profitable. Every decision, from hiring staff, to purchasing devices, to selecting products to dispense, has immediate and long-term effects on the bottom line. How those decisions are reached—whether through tedious analysis or quick gut reaction—depends on the doctors involved and the issue. It's all part of the process of adapting to the pressures and realities of managing a practice. Since physicians generally receive no formal training in business matters, the new practitioner often jumps into a ‘trial by fire' situation. But even the experienced physician may not know if a given action was the right one until months or years later.

A medical practice has many moving parts. It is almost impossible to completely separate medical and business decisions. As physicians, we must focus on the needs of the individual patient; what will maximize both their outcome and experience? But running a business means looking at the big picture to identify ways of improving operational flow for everyone. It may require complex restructuring of finances or reorganization of people in order to improve the underlying infrastructure. Or it may be as simple as picking the contractor or vendor with the best price and reputation. But what about the gray area in the middle, i.e. the investments that are harder to quantify? Giant corporations hire other corporations to predict and then confirm the impact of their branding and marketing campaigns. Do physicians now need to invest in consultants to determine the success of other investments?

Especially frustrating is being poised to make an investment that seems ‘rate limiting' of the practice but not being able to move forward. For instance, you may define a new staff position and devote the resources toward advertising and interviewing, only to find that the appropriate candidate may not present. Another prime example is selecting a larger office space: The lease or purchase agreement can be signed and architectural plans produced but construction stalled by an unexpected blockade from a zoning or co-op board. It isn't surprising that we sometimes feel like prisoners to powers beyond our control. Market and media forces can also make us feel powerless; you can spend on the latest hot device to be the first in town, but if the company's planned PR launch is knocked out of the media spotlight by world events—or worse by a competing device—your high-cost investment may never reap the expected returns.

Investing in our practices must be approached in the same way we make decisions for our homes and personal finances. It is a balancing act of the adages: ‘no reward without risk' and ‘always look before you leap.' In other words, do your homework but don't get so caught up in it that you don't move forward. When managing the complexities of an aesthetic medical practice, be willing to ask difficult questions, make tough calls, and even be wrong at times. Learn from your mistakes and successes and those of your colleagues to build a practice that can flourish into the future.

Co-Chief Editors Heidi Waldorf, MD, FAAD, and Steven Dayan, MD, FACS