Burnout vs. Misalignment, The Hormonal Cost of Scaling, and Executing a Strategic Downsize

(0:00:11) We are often taught that scaling a medical practice requires relentless hustle. We are told that exhaustion is just a price of admission for success. But what happens when the pursuit of growth actually destroys the biology of the provider running the business?

(0:00:30) Welcome back to the Business of Aesthetics podcast. I'm your host, Don Adesha. To help us navigate the intersection of executive performance and clinical entrepreneurship, we are joined today by Bertha Osorio-Campbell, known affectionately as Miss B.

(0:00:48) she is a dual board certified family and psychiatric mental health nurse practitioner and the founder of optimal weight loss institute she is unique in our space because she approaches entrepreneurship through a fully integrated medical lens she has successfully navigated the highs and lows of ownership including restructuring her own practice to prioritize profit sustainability and

(0:01:15) nervous system regulation. Today we are discussing the biology of burnout. We are going to be talking about how to execute a strategic downsize, the hormonal impact of decision fatigue, and how to stop letting sunk costs dictate your future.

(0:01:34) This episode is brought to you by Echo Marketing, the digital growth partner behind this podcast and a trusted resource for aesthetic practices looking to dominate their local markets. That being said, Bertha, welcome to the show. Thank you, Don. Absolutely. Let's get right into it.

(0:01:56) So, high-achieving practice owners often normalize chronic stress and mistake it for the necessary cost of scaling. From a clinical and operational standpoint, how can a CEO determine if they are experiencing true physiological burnout versus simply running a business model that is fundamentally misaligned with their values? So, Dawn, in the aesthetics and wellness model,

(0:02:26) industry, specialty, stress is usually or often worn like a badge of honor.

(0:02:34) Back-to-back injectables, right? Launching GLP-1 programs, adding peptides, onboarding exosomes, managing staff turnover. And all the while, we're telling ourselves that this is what growth feels like. But if we look at it from a clinical standpoint, it's actually measurable. Like physiological burnout is actually something that we can measure. What does that look like?

(0:03:01) So sleep fragmentation, like that cortisol spike between 2 and 4 a.m. So if you're wondering why you wake up at 3 a.m. every single night, that's a reason, right? And you're looking at your email or you're reading something or you're thinking of, you know, like, did I mess up the Botox? Is the eye going to drop, right? Increase visceral fat despite stable diet, nothing changed.

(0:03:26) For my women, irregular menses or worse than PMS, thyroid issues, brain fog is a huge one, reduced working memory and irritability or emotional blunting. Those are some of the things that you'll see physiologically, right? So that's what we call HPA access dysregulation. Chronic sympathetic activation keeps our cortisol level elevated.

(0:03:54) Over time, that's gonna suppress progesterone, it's gonna alter insulin sensitivity, it's gonna increase central adiposity, and impair our prefrontal cortex. So this right here, our prefrontal cortex, I like to call this the CEO of our body, right? That's the big gun. And that right there is actually responsible for things like, let's say,

(0:04:24) it would be executive functioning. It would be decision-making. It would be all of those things, right? That is the prefrontal cortex. Now, in contrast...

(0:04:47) misalignment is a little bit different. It's more structural. So for example, you built a high volume Botox membership model because it scales. But what you actually love doing is metabolic consults and hormone optimization, right?

(0:05:04) You're not physically exhausted. You're like energetically contracted. Or you added the latest thing that came out, right? Salmon, PRP, exosomes, or whatever, you know? Peptides, IVs, because the so-called industry said that you should. Now you're managing inventory, compliance, and staff training, and all of this is draining you, right? Right?

(0:05:29) So the clinical question that a CEO should ask themselves is, if this same revenue came from a different structure, would my body still feel inflamed, exhausted, or dysregulated? If you answer yes, it's physiological burnout. If you answer no, then your model is misaligned. And sometimes it can be both.

(0:05:54) So burnout shows up in biomarkers and misalignment shows up in resentment. Okay. Now, sometimes it can be both. That's what I was wondering about. Is it usually the both where misalignment leads into the more physiological burnout? And I do think that they go side by side.

(0:06:16) I do think more than often it is both of them. Misalignment, doing things that you don't love, then leading to the burnout, leading to the biomarkers, the physiological burnout, and all of those symptoms that I described. Okay. So even if you are aligned, you could be having these physiological burnout symptoms, is it? Yes, absolutely. Even if you're aligned, you can. And that's because...

(0:06:47) we're constantly on the go. Like our, especially CEOs, entrepreneurs, their cortisol levels are spiked up. That sympathetic nervous system, it's going, going, going, going, going to the point of the body has to be able to rest. You need sleep, you know? That's when we make serotonin, melatonin. These are things that our body needs. Our neurotransmitters, they need rest. So you could be aligned, like love what you're doing, but you're overdoing it.

(0:07:18) There we go. Now, you talk about the hidden hormonal and mental health impacts of entrepreneurship, specifically cortisol and decision fatigue. When an owner ignores their own nervous system regulation, what is the specific biological breakdown that occurs in their executive functioning and leadership ability?

(0:07:40) So this is what I was talking about when it comes to that prefrontal cortex. Right. So entrepreneurship is sustained executive demand. Like you're always on the goal. You're always on like a med spa owner is going to make 100 cognitive decisions daily. Pricing filler packages.

(0:08:01) managing injector conflict, reviewing labs for GLP-1 patients, handling adverse events, negotiating device contracts, monitoring marketing metrics, just to name a few, right? Each of these decisions burns glucose in our prefrontal cortex. So when cortisol remains elevated from chronic stress, our prefrontal cortex, which is executive planning, becomes less efficient.

(0:08:28) The amygdala, which is, you know, that's like our alarm system in our body. It's our alarm system. It goes off and it detects threat. So it becomes more reactive. So now you're more irritable. You're more aggressive. Your anxiety has risen. And the hippocampus, which is memory and learning, becomes impaired as well. So that's where you see that brain fog that we were talking about earlier. Okay.

(0:08:53) So biologically, you're shifting from strategic leadership to survival mode. And a lot of entrepreneurs are in survival mode. So biologically, I mean, operationally, that looks like this.

(0:09:09) impulsivity. And that goes back to the prefrontal cortex because your prefrontal cortex deals with impulse control. So if it's dysregulated, now you have impulsivity. So now you could be buying $150,000 device, right? You could be adding necessary, you avoid necessary staff terminations. You know that this person has to go, they're changing the culture of the environment, they're changing that, you know, it's an infection, but

(0:09:36) you're not doing it. Launching new services before you even stabilize current ones. Discounting reactively when bookings dip. Micromanaging because you feel loss of control. So in women specifically, chronic cortisol suppresses progesterone, affects thyroid conversion, worsens insulin resistance, and it fragments their sleep like we discussed earlier. So basically what you're

(0:10:00) to do is you're trying to lead from a neurological compromised state and that's just never a good thing so so just to conclude chronic cortisol doesn't just change your waistline it changes your judgment

(0:10:16) Okay. Now, we often hear it's lonely at the top. From a psychiatric perspective, how does that isolation exaggerate the hormonal stress response? And how can we chemically counteract that without medication?

(0:10:32) So yes, lonely at the top, right? Because you can't be friends with your employees. You have to have boundaries. So you're making all of these decisions, decision fatigue. And so yes, it's lonely at the top.

(0:10:48) What's really, really important is self-care. What's really, really important is understanding and being attuned with your body. So if you're attuned with your body, you know when your anxiety level begins to go up and you know, okay, wait a second, my amygdala, that fire alarm is going off. So this means that right now my capacity is full. I can't take on anything more. Mental health days are great.

(0:11:16) You know, clear my schedule. I'm taking a mental health day. And we need to normalize that conversation. You know, mental health day. Yes, we need to normalize it.

(0:11:27) our neurotransmitters, our neuronal pathways, all of that right there, if you do not change the way that you're governing your body and listening to what your body is telling you, because our body speaks to us, it literally tells us what it needs. So if we're not listening to it, then we are, in essence, building these neuronal pathways that are defective. And that's just going to lead to more

(0:11:53) more, more of whatever they're feeling. So self-care days, you know, I feel like every entrepreneur should have a therapist. There's just so much that goes on, you know, on a daily basis saying no, no is a complete sentence.

(0:12:11) Setting boundaries. These are all things that they can do that don't require any type of medication. Sleep hygiene. That's one of the most important ones. If you're scrolling on your phone at night, you know, your nervous system doesn't think that it's time to go to sleep. So your cortisol levels are going to stay spiked up.

(0:12:29) So all of that right there are things that they can do. Walking outside, drinking water, eating a good balanced meal, taking vacations without your laptop, which is probably very hard for most people. But those are some ways that they can definitely manage chronic stress and actually get to a more regulated state.

(0:12:52) Do you think it's possible that some of this toxic culture we see in aesthetic practices is actually just a trickle down effect of the owner's unregulated nervous system?

(0:13:02) 100%. So remember what I said when our bodies speak to us? So trauma lives in our body. So if we have unresolved trauma from our childhood, unresolved trauma from a marriage that we left, unresolved trauma from something that caused us to have PTSD and we didn't deal with it, that absolutely has a trickle-down effect.

(0:13:26) you know into the things that we do the decisions that we make because you're coming from a dysregulated state and i tell people if you notice yourself snapping because somebody said something and going like this you kind of have to ask yourself where is this coming from because it's coming from somewhere you want to find that root cause of it and you because of neuroplasticity which i love we can't change those neuronal pathways

(0:13:52) So we can actually feed it the good stuff so that we don't become dysregulated and we're more regulated. We increase our window of tolerance, you know, so that means that we don't snap as easily because we're practicing these things that are helping our body just become better mentally, physically, emotionally, spiritually, all of that.

(0:14:16) Absolutely. Now, Miss B, many owners are terrified to pivot or even let go of failing service line because of the time and the money that's already invested. What is the physiological framework a provider must adopt to release those sunk costs and execute a downsize without viewing it as a failure?

(0:14:41) So this is what I did, right? This is like a personal story for me. So I had a functional medicine and aesthetics practice. I had the big office, multiple rooms, you know, hired, bought the two lasers way before I was supposed to buy them, you know, hired staff, had, so that was me. And at one point,

(0:15:08) I sat back and I asked myself the question of,

(0:15:13) what is it that you really want? Not what's trending, not what you see everyone else doing, not what you think is going to make money or yield a high ROI. It's what is it that your heart truly loves? And when I began to answer that question, it was hands down that holistic approach, like that functional medicine aspect and weight loss. Like that's my niche because I

(0:15:41) I have a personal story with weight loss. You know, my heaviest, I was 298. So that's something that resonates with me. And whenever you have something that's personalized to you, you're going to love it even more. And so you're going to do it with passion and it's not going to dysregulate you.

(0:15:57) But what happens in aesthetics is that people invest in all of these certifications, right? Okay. This came out. Let me do this certification. Exosome inventory, peptide training. Oh, wow. Let's get a second location, another device because, you know, the three that we have right now are not doing it or we can make more money with that one because now that's the trend, right?

(0:16:21) But what happens is your margins are thin, staff is overwhelmed, and you're exhausted, especially keeping up with all of these things. So here's the clinical reality. Chronic stress is going to narrow cognitive flexibility. Elevated cortisol biases the brain toward loss aversion, and the amygdala, our alarm system, overactivates around perceived threats. So it may not even be a real threat, but it perceives it that way because your stress levels are chronically elevated. So that can include financial loss.

(0:16:51) So holding onto a failing service line isn't just emotional, it's neurobiological, right? So the psychological shift must be this. Was that investment just tuition, right?

(0:17:05) Or you wanna ask yourself, if I were opening up this practice today with the knowledge and data that I now have, would I add this service? Would I add this device? Would I go to this training? Would I hire this person, right? And if the answer is no to any of the questions that you ask,

(0:17:27) then keeping it is identity attachment. It's not strategy. Downsizing is going to reduce your cognitive load. It's going to decrease sympathetic activation, improve sleep, and restore executive function. And that's not failure. And that's what a lot of people think, right? What are they going to think of me? You know, I'm downsizing or I'm getting rid of these services. They're going to question things. But that's not really the question. What you want is nervous system stabilization, right?

(0:17:54) So letting go of a service line can lower cortisol faster than any supplement. And so that right there is what I would say for an entrepreneur and a CEO to really look into. You know, do you feel joy? I know some people I've heard speaking where they'll see their name on the schedule and it's for a procedure, let's say hair removal.

(0:18:20) And their whole entire body just like, you know, just like activates because they hate doing laser hair removal. But yet that's a service that's on there. That's a device that you bought. So that right or they get fidgety or anxiety for PDO thread comes in because you're like, oh, my goodness, PDO thread, you know, and it's like.

(0:18:43) If you don't like doing it, if you don't enjoy doing it, and your body speaks to you, it tells you. It tells you exactly what it feels. Listen to it. I'm curious, Ms. B. Now, all this internal work. In your example, let's take that. You were at a point of high stress, I would imagine. Yes. How were you able to...

(0:19:13) you know, ground yourself really to ask these questions, you know, by yourself and not have it go the other way. Whether if it's, you know, an impulse buy or something like that, but rather, you know, really take the time to deep dive and reflect. Hmm. I...

(0:19:36) Well, I had just had a baby. I know that, right? And so she was young. And one of the reasons why I had her was to be present. And I wasn't present with her. And I was like, what is it that I really want? Remember that question that I told you I asked myself? What is that I really want? What I really want is to be with my baby girl. What I really want is to travel the world with her. So what are the things

(0:20:00) that are going to enable me to get to this goal. And I had to sit back and really think about that. And the minute that I understood what I wanted, everything that did not align with that goal, I got rid of instantaneously.

(0:20:16) You know, I believe in therapy. That's something that's huge for me. So working with a therapist, talking about this, right, talking about how I feel, because I went through it as well. I'm downsizing, you know, the failure, that, but just dealing with the emotions, learning to regulate, understanding that

(0:20:40) This is for the greater good. And also, I don't answer to anybody else. What's most important to me, right? I don't care what people say about me or think about me or what's on social media or what they view. That's you show people what you want to show people on social media. But for me, it was...

(0:20:58) my heart posture you know i had to be in a place where i felt good about everything that i was doing and that i was present with my family but also most importantly present for myself right where now i don't have this anxiety or this depression that may come because

(0:21:20) Numbers are up and down or I'm doing procedures that I don't like or feel aligned with or I don't feel like I'm very well trained in it the way that I want to be because I haven't done this many years, but I'm still doing it. Those are all things that really helped me to just go back inward into myself.

(0:21:41) and work on myself, like work on me, work on my nervous system regulation, work on things that make Bertha happy, safe, feel secure and regulated. Amazing. Thank you very much for sharing that with us. Now, before we continue, a quick message from our sponsor.

(0:22:07) Our sponsor, Echo Marketing, they are offering our listeners a complimentary 60-minute digital strategy session. This is a one-on-one consultation with the senior strategist to help you map your 12-month high-value patient acquisition roadmap.

(0:22:22) You will get a personal diagnosis of your online presence and patient funnel, uncover untapped growth levers across SEO and social, and walk away with a clear, actionable plan tailored just for your practice. You can check the availability and reserve your spot in under two minutes at businessofaesthetics.org forward slash MSM. That's businessofaesthetics.org forward slash MSM. Now let's get back to the conversation.

(0:22:53) Miss B, you mentioned the necessity of investing in your own regulation before leading others. Practically speaking, what is the first step a busy practice owner must take to begin regulating their nervous system while actively managing staff, seeing patients and running a high volume business?

(0:23:16) So they have to look at it the same way that they look at their business, right? Regulation must become operational. So step number one, create a daily non-negotiable downshift window before clinic hours. Even five minutes of slow nasal breathing can increase your vagal tone and reduce your sympathetic dominance, right? Tapping, EFT, I love that. Emotional freedom technique helps to reduce our nervous system overload and help to regulate us. The more you do those things,

(0:23:45) the faster your nervous system goes, oh, okay, this is what we're doing. We're going into a relaxed state and they go much quicker. Clinically, that's going to improve your heart rate variability, which correlates with better emotional regulation and cognitive performance.

(0:24:01) Step number two, you want to reduce decision density, right? So for example, standardized GLP-1 dosing protocols, template consult workflows, delegate, delegate, delegate, very important, you know, inventory management or anything else that can be delegated, and stop checking marketing metrics at night. Blue light, like I said, that phone, that's a cortisol spike, right?

(0:24:28) You're not going to sleep well. You're not going to create the serotonin that your body needs to regulate. Step number three is you want to seek containment. So like I said, I'm a huge proponent for therapy. Or even if you don't want that exact coaching, you know, all of that is going to reduce emotional load.

(0:24:46) CEOs absorb staff trauma, patient dissatisfaction, financial stress, and regulatory pressure. So without processing all of those things, they're going to accumulate, right? And that accumulates as somatic tension and chronic hypervigilance. So it's going to live in our body.

(0:25:09) That's going to live in our body. And how many times have they done that for how many years? So how many, how dysregulated could they be? Right? So regulation isn't spa days. It's neurological efficiency. You want to feed your brain the right things to be able to perform and to be able to be the best version of yourself. Because if your nervous system is chaotic, then your leadership is going to be inconsistent. Right?

(0:25:38) And does that also translate, you know, into patient feeling that dysregulation? Absolutely. Because energy, right? We're made up of energy.

(0:25:50) People call it like my spirit doesn't take it or energy, whatever you call it. We co-regulate each other. And someone that is dysregulated is going to dysregulate someone else quicker than that person could regulate them. The negative is what's going to overpower it, not the positive.

(0:26:13) And so that you don't know, but that aura could be coming from you, right? Your staff can feel it. Your patients can feel it. It may not look like you're saying anything or doing anything that could cause it, but it could be talk. Your body could be speaking it. Absolutely.

(0:26:35) Now, Ms. B, ultimately, you advocate for designing a practice that supports freedom, motherhood and longevity rather than just chasing industry trends. What is the fundamental operational shift an owner needs to make to build a business that serves their life rather than a business that consumes it?

(0:27:00) So I think that the shift has to be from revenue-first design to physiology-informed design. Instead of asking, how do I scale to seven figures, ask what level of operational complexity can my nervous system sustainably carry, right? So in med spa terms, that could mean fewer service lines with higher profit margins, right?

(0:27:25) Eliminating low-performing add-ons, choosing depth, so like metabolic programs, hormone optimization over constant trend adoption. So like that fee-for-service model that really burns out entrepreneurs and CEOs. Protecting one to two no-clinic days per week.

(0:27:45) and hiring from a standpoint of emotional maturity, not just technical skill. So when your complexity exceeds your capacity, that's when cortisol rises. And when cortisol rises, chronically, like we learned, the prefrontal cortex, which is our insight and our judgment, that's going to decline. If your judgment declines, the business destabilizes.

(0:28:12) So longevity requires physiological sustainability. So a business built without regard for your biology will eventually cost you your biology.

(0:28:28) I'm curious, perhaps a lot of the practice owners, well, although it not may be their primary objective in starting a business in aesthetics, but it's definitely one of the primary concerns is, you know, increasing revenue, increasing the profit margin. Isn't that, you know, physiologically speaking, isn't that also a goal?

(0:28:57) Absolutely. We go into business to make money. So that's why I said, so I'll give you an example. I'm part of different Facebook groups, right? I don't think there's one day that I don't see somebody put out a post and say something that, guys, it's a slow month. What are you doing? Like this, or I feel like this and I'm doing this and I'm stressed and I'm this and I'm that.

(0:29:25) i see it constantly constantly constantly right because we're chasing this this high you know our dopamine that's our reward system so we get a good day right and we're like yes dopamine rush right but then we also have to understand that they're also this is a business there's ups and downs there's seasons

(0:29:47) And so we have to find a model that's going to be good for making money and also keeping us regulated because we don't want this high anxiety all the time.

(0:30:00) Program packages, investing in a business coach, someone that you see that's actually doing what you're doing, that actually doing something that you want to do. You want to get to that point, right? Somebody that knows more than you.

(0:30:17) Not trying to do everything on your own. You know, these are all things that are very important that come before making money. But if you if you feel that way, then you're going to be losing revenue anyways, because you're not going to know if someone's stealing from you.

(0:30:36) You're not going to know if an employee needs to be let go because they're just bad energy. You're not going to know that this device that you just bought is not going to give you the revenue that the rep said it's going to give you. So these are all things that decisions that you may make that eventually is going to just make you fall short anyways. So if we operate from the standpoint of

(0:30:59) what I want and what I can build from, then you'll do way better. And your growth will be exponential. It's not that money is hard to make. You know, it's not money is hard to make. It's our bodies living in chronic stress, nervous system dysregulation is not going to allow ourselves to even enjoy the seven figures if you even get there.

(0:31:27) Because you're always constantly on the goal. So what is the goal? I would say, ask yourself, what is the goal? What is the goal? What is it that you want in life? What is it that you want your legacy to be? What do you want to leave for your children if you have children? You know, what do you want to do for retirement? Where do you want to be five, 10, 15 years from now? So those are some questions that you can just delve into and ask yourself to really see, like, am I doing what I really love to do?

(0:31:57) Absolutely. Now, if you could go back to the start of your practice with the knowledge you have, what is the one operational boundary you would have set on day one? One. So it would be not to follow trends.

(0:32:27) not to follow trends. And I think that encompasses a lot, right? So if there's a new device, if there's a new service, if there's a class, a new certification, a new modality, a new filler line, you know, that does X, Y, and Z better than this one,

(0:32:45) Don't be so quick to jump on that bandwagon because I think that's going to increase profit or do this or just make decisions impulsively. Come from a point of really looking at it and seeing like, is this really going to be for the benefit of myself and setting those boundaries? And I wouldn't start out so big the way that I did. I would start out small and grow myself that.

(0:33:17) Thank you. Well, that was really a profound conversation on sustainable leadership with Bertha Osorio Campbell. Now, before we sign off, a quick reminder, Echo Marketing is offering a complimentary 60-minute digital strategy session. This is one-on-one consultation to help you map your 12-month growth roadmap. You can check the availability and reserve your spot in under two minutes at businessofaesthetics.org forward slash MSM.

(0:33:47) I'm Dan Adisha and this has been the Business of Aesthetics podcast. Thanks for listening and keep on leading.