Adding Another Injector Won’t Fix Your Margins – The CFO Framework That Determines If You Should Scale at All

Don Adeesha: Most med spas fail because they grow faster than their finances can handle. Welcome back to the Business of Aesthetics podcast. I’m your host, Don Adeesha. And to help us rethink how financial systems actually drive successful expansion, we’re joined by Chelsea Zainea.

Chelsea is a virtual CFO and medical spa profitability expert who works with growing practices to build structure, clarity, and strategy into their financial decisions. She specializes in helping owners move beyond basic bookkeeping and build the financial infrastructure required to scale with confidence.

Today, we are going to be discussing financial infrastructure. We are talking about profitability and how to make smarter scaling decisions without putting your business at risk. This episode is brought to you by Ekwa Marketing, the digital growth partner behind this podcast and a trusted resource for aesthetic practices looking to dominate their local markets. With that being said, Chelsea, welcome to the Business of Aesthetics podcast.

Chelsea Zainea: Thank you so much for having me, Don. Happy to be here.

Don Adeesha: Happy to have you here. Now, Chelsea, when you step into a med spa that looks successful on the surface, what is the first financial signal you look at to determine if the business is actually healthy or quietly struggling?

Chelsea Zainea: Yeah, and this is so important because there are so many med spas or wellness practices that look really healthy from the surface. Their revenues look great and they may even be profitable. What I’m looking for is cash flow.

So I will start by looking at their cash flow for the last three months and in the past 12 months. And what I’m looking for is, are they generating enough revenues that they’re covering their operational expenses or are they using debt to supplement? And then from there, I want to know how long that’s been going on. Because for me, that’s telling me, okay, is this more of an operational problem? Is there a deeper level here? Or are we just a little bit disorganized and need some financial systems in place?

Don Adeesha: Okay. Now tell me a little bit more about that. How much of a ratio is good when it comes to the cash flow, when it comes to covering the operational expenses? What’s the healthy ratio you’re looking for?

Chelsea Zainea: It’s not so much a ratio as far as, if we’re bringing in net profit, I don’t want any more than 50% of your net profit going toward debt payments. So that’s one of the key indicators that I’m looking for.

And are we building cash every single month, or are we running out of money and then turning around and using debt to supplement to make sure that we can cover our operations?

Don Adeesha: So when it comes to vanity metrics, are there any specific ones that owners often brag about that actually hide deep financial trouble?

Chelsea Zainea: Obviously revenues. And that’s one of those things. The faster that practice scale, usually the worse it actually is.

For example, at the beginning of the year, we had a big cleanup for somebody who was wanting to exit. They wanted their finances to look really good. Well, when we looked at that, the revenues looked great. Over the past year, they doubled in revenues, and they were even showing an operating profit.

But then when we flipped over to the balance sheet, they were very low on cash, the proportion of cash to sales. If you’re looking for a healthy ratio of cash reserves, I always want to see at least 10% of gross revenues in cash reserves. That tells me that a client has enough money that one slow month isn’t going to do anything to them. They’re able to support themselves. They’re not going to end up in a bunch of debt.

But when we look at that balance sheet, if we see low cash and then we see a bunch of debt, we know there’s a problem there, that their operations aren’t truly profitable. They’re using debt to purchase things. And that may be assets, because a lot of them, when they’re expanding in the beginning, are buying a bunch of devices, medical equipment, or doing a bunch of leasehold improvements. You don’t see that on the profit and loss statement. That’s over on the balance sheet.

So that’s what I’m looking for. Are we sustaining the practice with cash, or are we using a bunch of debt to get there?

Don Adeesha: How often should an owner be checking their cash flow? Is it daily, weekly, monthly to catch this downward trend before it’s too late?

Chelsea Zainea: I train my clients weekly because they’re busy. They’re managing a practice. Oftentimes, they’re a provider in the practice, so they don’t have a ton of time to be monitoring this.

And it takes your mental bandwidth. It’s anxiety-inducing when you’re constantly watching your bank account. So I train my clients to do it in 30 minutes or less once a week. What we’re looking for is to build that cash flow up enough that we’ve got enough of a safety net in there that nothing’s going to bounce, and we don’t need to be worrying about it on a daily basis.

Don Adeesha: Okay. And now how do you practically build a forecasting system inside a growing practice that allows an owner to make confident hiring or expansion decisions instead of relying on gut instinct?

Chelsea Zainea: Yeah, and this is so important because if you think of a forecast like GPS, for example, if I got in my car today, I’m in central Ohio. Let’s say I get in my car today and I want to drive to California. Knowing me, I won’t even make it without a GPS. I have no sense of direction.

So your forecast is like your GPS, right? We need to put numbers to all of your plans. A good starting place when you’re first building a monthly forecast, your bird’s-eye view for the year, is building it out monthly. What’s going to happen for the next 12 months?

We’re probably going to start with historical numbers. What did last year look like? We’ll start there. But then it is so important to build on that because we’re forecasting. This is all future-focused. We’re planning here.

So what is it that you want to do this year? Do you want to hire somebody? Is that on your radar? Are you wanting to possibly purchase a new device? Are you wanting to move to a second location? What are these big things that you want to do?

Then let’s put numbers to all of these plans and see if they’re going to work out, because ultimately we want to know what has to happen in order for a practice owner to do what they want to do, and how that affects cash flow at the end of the day. It always comes back to those cash balances.

How much cash are we going to have left at the end of the 12 months when we get through this? Are we going to have more than we had last year at this time? Are we going to have less? Do we have enough for the business? At any point in time during the year, are we going to be in a cash crunch? That’s what we’re looking for with a forecast.

Practically, that leads me into a 13-week, more granular cash flow forecast. That is so much more important for a practice owner. That big bird’s-eye view is great to look at, especially with someone like a fractional CFO, to make sure that all of your plans for the year look good from that level.

But things change on a day-to-day basis. So always having a more detailed cash flow forecast 13 weeks out, we call that our weekly CEO planner, is what we use. That’s the true decision-making tool, the everyday decision-making tool that practice owners need to have in place to help them make the best decisions for their business.

That 13 weeks is much more granular and we’re changing. If you get in your car and your GPS has you on a route, and the road’s closed and you turn off, it’s going to reroute for you. That’s what a forecast is all about. It’s not static like a budget. This is changing. So we want to be updating those actual numbers and seeing, okay, this changed, so what does the map look like now?

Don Adeesha: Okay. That’s very interesting. Can you give us an example where we’re looking at the 13-week forecast and trying to make decisions based off of that? Like you mentioned, there might be a roadblock or maybe there might be a surplus. How are you addressing that? And how has that actually shown up?

Chelsea Zainea: Yeah. So let’s say I have a business owner and they’re wanting to hire a new employee. We made our plan for the year back in October. I like to do it three months before the start of the year.

We thought about March, we would be hiring somebody. Well, we’re going to be watching that. Maybe we realize at the beginning of the year, something happened and we had a really slow month. Now we don’t have that cash that we thought we were going to have.

So when we put those numbers in there, we’re now in a place we don’t want to be. Our cash balance goes too low. That’s going to allow us in the moment to decide, okay, let’s wait till April or May. Let’s just postpone this decision until the investment makes sense.

The other way is, I have a client with us right now where we’re seeing, and it’s wonderful, she’s up much more than we had originally forecasted she would be at this time. So then we’re looking at, okay, now we’ve got extra cash in the business. What does that look like for you?

If you don’t need to hire anyone and everything’s going great, that’s extra money for the practice owner to take out. They can take an owner’s distribution. You’ve got that extra cash, or you can invest it. Whatever you want to do, you know how much extra you have, and then you’re able to make that decision of what looks best for your practice.

Don Adeesha: Okay, so your recommendation is to create a 13-week forecast, or is it like the yearly forecast?

Chelsea Zainea: The 13-week is always. So you’re always forecasting at least 13 weeks out. Once a week, you’re getting into your forecast, updating your actuals, and looking out at what the next three months look like.

That allows us to see, okay, we’re going to have a problem in two weeks here or two months here. We need to either make sure that we generate enough revenues to cover that, get ahead of that problem with some marketing, or figure out otherwise how we’re going to fix that cash flow crunch.

Don Adeesha: At the beginning of the year, are you not forecasting for the whole year then?

Chelsea Zainea: Yes, you’re forecasting for the whole year. That’s a higher-level forecast. That’s on a monthly basis. This is what we think January is going to look like. This is what we think February is going to look like. This is what we think March is going to look like.

But that’s at a monthly level. Throughout the month, especially for newer practice owners who don’t have as much cash built up, that cash may not be what it is at the end of the month. Things happen throughout the month.

So on a much more granular level, we want to be forecasting weekly, day-to-day in our business. That’s what actually helps us make decisions on the day-to-day.

Don Adeesha: Amazing. So we’re first looking at the historicals, then we’re looking at our own goals and figuring out the numbers on how to get to those goals while having this overarching map for the whole year. But at the same time, having a much more granular look with this 13-week forecast, which I assume is much more dynamic compared to the whole-year version.

Chelsea Zainea: Exactly. The weekly is much more dynamic. You’re updating that every week. For our clients, we use a software called Reach Reporting, so we’re still updating the annual forecast at a monthly level every single month. But we don’t want to wait till we get to the end of the month to realize that we need to course correct. We want to be getting that done on a weekly basis throughout the month.

Don Adeesha: What is the exact process you identify whether adding another injector will increase profit or actually dilute the margins?

Chelsea Zainea: Yeah. So for me, I like to start out by looking at utilization. Are we fully utilizing the employees we’ve already got? And then I also like to take a look at revenue capacity based on the number of providers they have, because that can be indicative of some problems too.

I want to know, based on the number of providers we have and their available hours and our average revenue per hour, this is what it looks like we should be able to generate in revenue. And then what are we actually generating?

Because if those two numbers are far off, we need to investigate that first. Do we have employees that aren’t as effective as other employees? Check into that first. Make sure that we can’t accomplish our goals with what we’ve already got before we decide to hire.

Then if we realize, okay, our utilization is good, it’s at that 80% or higher, and our revenue capacity is right there, we’re on the verge of capacity, then it’s too late to hire because you’re wait-listing patients and overtaxing your staff.

We want to hire in time so that we’re not stressing our system too much, but we don’t want to hire if it’s unnecessary because then we will see that negative impact on our margins. Before we make that decision, again, going back to the forecast, we’re going to put those numbers into our forecast.

Even if your pipeline is flowing and you’ve got plenty of new patients coming in, it’s going to take a minute before that new employee is completely trained, onboarded, and their books are full. So do we have enough cash to cover their salary in the meantime? What does that look like? How is that going to affect our numbers?

Don Adeesha: When you are stress testing the system, how do you determine if we are stressing the system too much? What is the revenue capacity that you feel is a good ratio to really consider hiring a new employee?

Chelsea Zainea: I think that 80% is a good ratio, but you’re not only going to have to look at the numbers for that. You’re going to hear about it from your employees because they’re going to be stressed out. They’re going to be running from room to room and patient to patient. You’re going to know that it’s time to hire from that.

We just want to make sure that it’s not a scheduling problem, or that we have one employee who’s not performing. All of those issues need to be worked out before we then decide to make that decision. Then we map out the numbers and make sure that’s all going to work as well.

Don Adeesha: If the data shows that a current injector might be diluting the margins, what are probably the first three levers an owner should pull to fix it?

Chelsea Zainea: I encourage sharing numbers with your employees. For my clients, we set up scorecards.

I want a weekly scorecard for the business as a whole. I also want a weekly scorecard for our providers. You are communicating their numbers to them on a weekly basis.

Again, we’re doing it weekly because we want to get ahead of it. We don’t want to wait until it’s already happened and then go back and have to have these really awkward conversations. Having the numbers and having this hard tool that we can use as a conversation piece is really helpful in addressing those issues.

The first four metrics that I start everybody out on are number of new clients, the sales that they’re bringing in, their average invoice value, and their utilization.

I also want you looking at retention for employees because that would be the key indicator. You might be funneling patients to them, so their new client list is growing and they’re constantly booked, but they’re always booked with new patients. They’re not retaining their clients.

If their clients aren’t asking to come back to them or rebooking with them, that’s usually an indication of a performance problem. The average invoice value is also an indication that they might be uncomfortable with the sales process. Clinicians are clinicians, and I’m an accountant. We don’t always feel comfortable with marketing and sales, but every day, you have to be able to sell things.

We want the best outcomes for our patients, so you need to be willing to have those conversations. You can see from that average invoice value, if theirs is lower than everybody else’s, they may be uncomfortable with that. We need to get them the training that they need to fix that.

When you’re looking at their numbers with them every single week, you’re able to say, okay, how can I support you here? What do you need from me to help you reach your goals?

Don Adeesha: What is a good retention ratio, do you think, on average?

Chelsea Zainea: Usually more 60% to 70%. That can be really hard to see in softwares. It’s usually on the dashboard somewhere, but you really need to have an understanding of how that works in yours.

It’s the same with utilization in your specific software, because sometimes it pulls things in that aren’t exactly accurate. You want to know where that number is coming from and what you’re seeing. Sometimes it’s rebooking; there’s just a rebooking number, and that can be really beneficial versus looking at retention if that looks off to you or if it’s taking into account other things or not pulling in what you feel is accurate.

Don Adeesha: Ensuring that you’re checking your provider utilization as well as your revenue capacity and seeing the difference between that is important. Also looking to identify earlier on if your team is under pressure. And if they aren’t doing that great, sharing the numbers seems to help drive the conversation in a much more productive manner.

Chelsea Zainea: It does. It helps drive the conversation. And you’re also communicating and showing appreciation for your employees that are hitting their numbers and doing well.

It brings you back to having those conversations, whereas sometimes we get busy in the practice and our employees feel like we’re taking them for granted. We’re not. It’s just not on our mind all the time. So having a designated time and a designated tool to help you is really beneficial in both rewarding employees that are doing well and helping course correct those employees that need further training or whatever the case may be.

Don Adeesha: Now, before we continue, a quick word from our sponsor, Ekwa Marketing.

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Now let’s get back into our conversation.

Don Adeesha: Chelsea, how should an owner structure their cash flow management so that growth doesn’t create constant financial pressure or instability?

Chelsea Zainea: Yeah. Some business owners come to me and they have a super overcomplicated system. We want to keep this simple and manageable. We need to be able to stay on top of it.

You don’t need five accounts. You don’t need to be transferring money around every day. Usually practice owners are too busy for that, and it ends up in some sort of cash flow disaster.

I like three accounts, and I would like you to transfer money there just once a month. I want them to have an operating account, and that’s where everything’s coming in and everything’s going out. That’s where all of our operating expenses are coming out.

Then a tax reserve. That’s exactly what it sounds like. I want you to save tax money for taxes every single month based on your net profit and what your tax advisor has told you is a good percentage allocation for that.

We want to do that just once a month. Look at last month’s numbers. What was net income? Okay, let’s move that over once a month and set it and forget it. That way, at the end of the quarter or the end of the year, however often you’re paying in, you’ve already got the money. You don’t think about it.

I do want that tax account separate from your other savings because there is an emotional attachment that comes with it when it’s bundled in with your other savings. If it’s in its own separate account, you don’t even think of it as yours. It’s not a concern.

The last account is your cash reserves account. That account is really important for relieving that financial pressure because if we’ve got some extra cushion there, we’re able to confidently invest in the business and scale without worrying about having a slow month and not being able to make payroll.

We want to have a nice cash reserve there. Again, 10% of gross revenues is a good minimum. I like to use percentages of revenue. You can also say, okay, I want three months’ worth of operating expenses as a minimum. Usually, one or the other number comes out very similarly.

It’s just whatever works in your mind. I like to say at least 10% of your last 12 months of gross revenue. That will really serve as that safety net so that you can confidently invest in hiring or maybe expanding to a new location, whatever it is, and know that if we have a slow month or something happens, we’ve got it. No problem.

Don Adeesha: How do you separate lifestyle spending from business reinvestment so the owner gets paid well without starving the practice?

Chelsea Zainea: Most are S-Corps at this point. So if they’re an S-Corp, they’re taking a regular salary, and that needs to be reasonable according to the IRS, which is a super gray area.

Basically, I tell my practice owners it’s what you would pay somebody else to do the same job. If you have managerial duties, you need to take that into account.

So we have our regular consistent salary that we’re bringing in. Then I like the owner’s distributions. That extra money that you get as a benefit of being the owner of a practice, you went out and did all this hard work to build this thing. The benefit of that is the owner distribution on top.

I like that to be on a quarterly cadence because that 13 weeks, that three-month period of time, gives you enough time to see if the money is actually extra. Then we know we don’t need that in the practice to support it. We can go ahead and take that extra quarterly distribution like a little bonus.

Then that’s what we can do when we want to build our lifestyle, or I really encourage you to invest in a retirement plan. We’re maxing out those tax-sheltered retirement plans, all of that.

At the same time, we want to not stifle our growth either. So it’s a balance of, okay, that’s what we’re looking at annually. What are our plans for the year, and how much cash flow are we going to need to generate to make those happen? We know that in advance, so we’re not taking any extra cash out of the business that we’re going to need. We already know what those numbers are, and we’ll have those goals set.

Don Adeesha: Now, I’m just curious, is there ever a time when it’s okay to touch the tax account without it being tax season?

Chelsea Zainea: If you get to the end of the year, yes. I always encourage you to wait till the end of the year because even if you’re making quarterly deposits, this year might not look like last year.

So if you get to the end of the year and your tax advisor gives you your number and it’s much less, and you’ve got a bunch of extra money sitting there, great. That’s a bonus for you. Yes, absolutely. Take it out then. But at least you have that sitting in your bank account, accruing interest, versus overpaying the IRS and then they’re making money on your money.

Don Adeesha: That’s great. Now, what does a complete financial operating system look like inside a high-performing aesthetic practice before they open a second location or even expand their services?

Chelsea Zainea: Yeah. They really need a proven business model from all aspects: operations, finance, and marketing.

I like to compare this to a recipe. If I’m going to a family party, I have a signature dish that I always make and I’ve made it a hundred times. I know it works for me. It’s cheesy potatoes. My nieces love them. I know they’re going to be a hit.

What I’m not going to do is try a batch of cookies at home. If I find this Pinterest recipe, make a small batch of cookies, and they’re terrible, I’m not going to double down on that. I’m not going to then double my batch of cookies and take them to a family reunion.

If your family is anything like my family, you’re going to get razzed over that. That’s not what we want to do. We want to make sure that our recipe is perfected before we double down.

From a financial perspective, and I’ll speak to the financial side of that, but also operationally, you need to have systems and protocols in place for your providers so that you are consistent and repeatable. Everything’s got to be repeatable.

The same with your marketing. Your marketing needs to be working, and we want to be able to repeat exactly what we’re doing.

From the financial side, what that looks like is making sure that we’ve got a profitable business model. First of all, are we making a profit at that first location? Are we hitting our margins? Do we have a good pricing system in place? Do we know how to price things and how to get those margins?

Then we want to make sure, of course, that we’ve got enough cash. I can’t talk enough about cash because if you’re struggling with cash flow in the first practice, you’re going to be really struggling once you open a second one. That really opens you up to a cash flow crisis generally.

We want to make sure all of that’s going well. Then we want to have our everyday systems in place. Do we have that 13-week decision-making tool in place? Are we able to make confident, data-informed decisions? That’s the key.

On a weekly basis, do we have our scorecards in place that we can then take? We know how to manage our employees with them. We know how to manage our practice with them. We have those benchmarks.

There are always industry benchmarks, but then there are our benchmarks. Let’s say your average invoice value for the med spa industry is $500, but yours is $700. Then we’ve got that benchmark from our first location to use in the second location. We already know what those numbers should be.

We want to have those scorecards set up, the forecasting, and the future-focused accounting. Most everybody has bookkeeping and financial statements. Usually at this point, people have hired a bookkeeper, and that’s great.

But what they’re missing is that fractional CFO piece. The things that we set up are forecasting, planning, and future-focused accounting. All of that needs to be in place, whether that’s something you handle yourself or you hire somebody like me to do it.

It’s so important to have that structure in place. An experienced practice owner making multi-millions in revenues or a brand new practice owner, they need to have that future-focused accounting and those systems and processes in place from start to finish.

Don Adeesha: Is it possible for you to give us your worst example that you have actually seen of a med spa?

Chelsea Zainea: Yeah, the worst ones are the ones I can’t help. They’ve gotten in too deep.

I will just warn everybody. I don’t know if you’ve heard of an MCA, but it’s basically a merchant cash advance. It’s the equivalent of a business payday loan, and they’ve really infiltrated the med spa industry.

It’s easy money. They’re reaching out to practice owners and saying, hey, do you want financing? Here you go. But they’re not truly loans, so they don’t have to follow traditional lending practices. They are really unsavory, with really high financing fees associated with them.

What will happen is a practice owner gets in a crunch, and then they see this easy money come into their life. They say, yeah, give me that MCA, give me that cash advance. Then they have this gigantic automatic draft coming out of their bank account every week because that’s what they’ll do.

The next week rolls around and they have to start making these payments, and then they’re in an even worse situation. So then they reach out to somebody else and get another one.

I’ve seen where their full balance sheet, the liability section, is just a bunch of merchant cash advances. That’s a tight spot to get in. Once you get in that cycle of borrowing Peter to pay Paul, that’s so hard for me to get you out of. I can’t do it at that point.

Once you’ve done multiple merchant cash advances, you have to basically find a bank that’s willing to refinance all of that. That’s your only way out.

Don Adeesha: Let’s hope that our listeners do not get into that.

Chelsea Zainea: That’s my PSA. Do not do a merchant cash advance. There are so many better loans you can get. They’re harder to get. You’ve got to go have a relationship with your banker, but do that versus taking the easy money. If somebody’s seeking you out, trying to lend you money, it’s usually the first indication it’s a bad deal.

Don Adeesha: Now, for our listeners tuned in, they have an idea of the ratios that they should be looking for when it comes to cash flow. But if they’re not hitting those numbers and they are going toward a bit of a downward spiral, what would you tell them? What is the first step they can take to course correct?

Chelsea Zainea: First of all, I will say, don’t be discouraged because those percentages and the ratios that I’ve thrown out there are goals. Every client that comes to me, they aren’t there yet. That’s what we’re working toward. That’s our goal.

But if you are in that negative spiral and your revenues are dropping, I want you to get to the bottom of that. Why are your revenues dropping? Is it a marketing problem? Is it an operational problem? Do you have a performance problem? Are you getting bad patient outcomes?

We need to get to the bottom of what’s causing that first before we worry about anything else. I can show you how to manage your cash flow on a weekly basis, and that is one of the first things I would do because then you’re going to make better decisions and minimize the trouble that you’re getting in.

But at the end of the day, we have to fix that underlying problem of why that revenue is decreasing. Maybe that’s operational, maybe it’s marketing, but you’ve got to get to the bottom of it fast.

That’s why it’s so important to look at your numbers on a weekly basis versus waiting till the end of the month, or worse, the end of the quarter or the end of the year. Weekly, we are looking at everything and making sure we’re on the up and up. And if we’re not, what do we need to do to course correct?

Don Adeesha: Chelsea, we are here at the end of the podcast. I would love for you to give our listeners one last key takeaway, perhaps the golden nugget of our conversation.

Chelsea Zainea: The golden nugget is planning is key. Planning out your cash flow. You want to know how every decision you make is going to affect cash flow. And that’s going to be your North Star.

Don Adeesha: That was a powerful look at the financial reality behind growth with Chelsea Zainea. If you’ve been struggling with strong revenue but inconsistent profitability, we hope that this conversation gave you the framework to rethink how you’re making decisions inside your business.

Mastering your financial infrastructure isn’t just about clean books. It’s the ultimate driver of sustainable, confident growth. If Chelsea’s approach to financial strategy resonated with you, I highly recommend connecting with her and exploring her work, where she acts as a strategic financial partner for owners who are ready to scale without the guesswork.

Chelsea, where can our listeners find you?

Chelsea Zainea: They can find me on Instagram at Chelsea Zainea. We also have YouTube, and that’s Peak Financial Wellness.

Don Adeesha: Amazing. And before we wrap up, one final reminder from our sponsor, Ekwa Marketing.

If you want a clear plan for attracting more high-value patients, they’re offering Business of Aesthetics listeners a complimentary marketing strategy session. Their team will review your current online presence, identify missed growth opportunities, and give you a tailored action plan for your practice.

You can reserve your session at www.businessofaesthetics.org/msm. I’m Don Adeesha, Business of Aesthetics podcast. Thanks for listening. Keep on leading.