The A to Z of Starting an Aesthetic Practice Effectively

Adeesha: Welcome back to the Business of Aesthetics podcast. I’m your host, Don Adeesha. And today we are breaking down the A to Z of starting an aesthetic practice effectively. Joining us is a man who has spent over 50 years in the medical field, from being a paramedic in the 70s to managing multi-million dollar practices. He is the founder and CEO of Shorr Solutions, Jay Shorr. Jay, welcome to the show.

Jay Shorr: Thank you so much. It’s a pleasure. It’s an honor to be a guest on the podcast because I’m usually the one hosting the podcast. And now I’m even a guest on my own podcast as I’m turning it over to my crew and my team.

Adeesha: Before we dive into the business side of things, Jay, I wanted to ask you, since you started your journey in 1972 as a paramedic in Philly, looking back at those high-stakes emergency situations, how did that experience shape your no-nonsense approach to fixing medical businesses today?

Jay Shorr: When you are in an emergency trauma situation, you have better think about what you’re going to do before you get there. It is basic instinct and triage. You really don’t have time to think because you don’t have seconds to waste. As I got older, I was a corporate director of safety, health, security, fraud, and embezzlement. I ended up falling in love with a cosmetic surgeon, a dermatopathologist, Mohs surgeon. She owned a very large practice here in Fort Lauderdale, and I retired from corporate America and joined her practice as an administrator. My late wife became ill and passed very quickly from stage four cancer. Right before then, I decided to take the show on the road to teach businesses how to be a real business.

Adeesha: When someone tells you they’re about to open their first aesthetic practice, what are the biggest mistakes you already know that they’re about to make?

Jay Shorr: Most new aesthetic practices don’t fail because of the clinical skill that they have. They’ve been trained at all stages. They fail because the owners underestimated the business. The biggest mistake is they act like clinicians opening a room, not a CEO building a company. Medicine’s a business. So I usually say, when you want to open up a practice, let me give you two key takeaways. You’re not going to come in on time. And you’re not going to come in on budget. Are you prepared for that? Because you’ve got a lot of predictable mistakes ahead of you.

Adeesha: What is the hardest mindset shift for a doctor to go from being the lead provider to being a CEO?

Jay Shorr: The biggest mistake first-time aesthetic practices make when they first want to do this is they don’t have a business model. The failure to plan is the plan to fail. You assume Botox, fillers, laser equals revenue, and it doesn’t, because you don’t define your true price strategy, patient acquisition costs, or even your service mix. They don’t understand the capital requirement and the needs. And they sign terrible leases. They hire too much. They hire out of emotion. You don’t have a compliance infrastructure, policies, procedures, protocols, HIPAA, OSHA training. You need to do it within your first 10 to 30 days of opening your business or hiring somebody. You have no marketing engine, you have no social media, and you have no financial dashboard for KPIs. So what are you doing? You’re opening up a business, you don’t even know how to open it.

Adeesha: Before a single patient walks through the door, what are the non-negotiables in setting up the business properly? I’m talking about the LLCs, PLLCs. Where do most people get this wrong, and what should they be doing differently?

Jay Shorr: Most states, commonwealths, require that there’s either a PLLC or a PC. One is a professional limited liability company or a professional corporation for medical services. People form a generic LLC because it’s easy. A common best practice structure is a professional entity, a PLLC or a PC, that provides medical services, and a management company like an LLC or an MSO that handles operations, marketing, staffing, leases, and this protects liability and really simplifies partnerships later. Even solo owners need an operating agreement. Banks, investors, partners require it. And then you have to have proper malpractice coverage, cyber liability, EPLI insurance. If you form a partnership, you need other types of insurance, key man, business operating, buy-sells, because when you don’t, and you run into a nightmare situation with the death of a partner, you’re going to see how the vultures come after you.

Jay Shorr: What we do is I’ll write contracts for HR or whatever, and I’ll amend them with a disclaimer. I’m not a physician. I’m not an attorney. I’m not licensed to give medical advice. I’m not licensed to give legal advice. But here is my two cents worth. I had multiple entities. I had a separate business formation for my med spa, a separate business formation for my operating room. I had a separate business formation for all the equipment that was owned and a separate business formation for the derm plastics practice. And then I had a separate business for being the property owner, because the property owner, the landlord, me, rented to each one of my business entities. So that the liability fell on each one with its own legal structure.

Jay Shorr: We had four practices that all opened up within like 10 weeks of each other. They’re all different practices, but a business is a business. The legality behind them were basically the same, except for state and commonwealth laws. There’s no gray. If it doesn’t say I can, it means I can’t. It’s not easy, but I have a team. One part of my team handles marketing. Another part of my team handles training. I handle compliance. Another part is I handle HR and then finance. We have meetings with the client every week, twice a week, and our internal CRM tracks three things: what needs to be done, who’s going to do it, and when it needs to be done. Our team is called La Familia, because that’s what we are.

Adeesha: What should our practice owners actually be negotiating when it comes to leases? And what are the biggest red flags?

Jay Shorr: The lease is one of the most dangerous documents in your entire business, because it probably binds you for just about the longest period of time, five years, ten years. The longer the term of your lease, the better the deal that you’re going to get. There’s a thing called tenant improvement build-out, commonly known as T&I. People don’t realize that it is, but it is. It’s a commodity, and it’s negotiable. Free rent, let’s say you get a five-year lease, 60 months. Somebody’s going to give you four or five free months with a five-year lease, so you’ll get a 65-month lease with the first five free. The downside is the five free months you’re getting are months one, two, three, four, and five, when the rent is the least expensive. Then you have exclusivity clauses, assignment rights, sub-leasing. Ensure the lease allows you to sublease at the landlord’s discretion, whose acceptance shall not be reasonably denied. CAM, common area maintenance, see if you can get a cap. Plumbing, HVAC, electrical, whose responsibility is it? After-hour access, signage rights, parking, there’s a red flag in personal guarantees, because the landlord wants to know he’s protected if you can’t pay.

Jay Shorr: I ask the client, get me a schematic. I don’t want a blueprint. I need to do something like an egress sheet that shows me all the rooms and the dimensions. There’s a difference between a treatment room and an exam room, because you need more space in a treatment room. When you’re going to be operating, you want it done in an OR-type setting. Is the room big enough for what you want? That room doesn’t have 220, it only has 110, and the machine you’re buying is 220, where are you going to plug it in? Get your electric in the floor so you don’t slip, trip, and fall. Do you have enough air conditioning in each one of these rooms? Because when that laser starts firing up, the BTUs, it starts getting hot. And keep your employee break and lunch rooms away from any type of patient experience rooms.

Adeesha: Before we continue, I do have a quick message from our sponsor, Ekwa Marketing. Ekwa Marketing is offering our listeners a complimentary 60-minute digital strategy session. This is a one-on-one consultation with a senior strategist to help you map your 12-month high-value patient acquisition roadmap. You can check the availability at www.businessofaesthetics.org/msm. Now, back to our conversation.

Adeesha: Once the doors are open, things either stabilize or fall apart. Let’s talk about staffing, from hiring to training to structuring roles. What does a properly built team actually look like in those first six to twelve months?

Jay Shorr: Your most important resource in your business is that human resource. The person that answers that phone is the Director of First Impressions, they’re not your receptionist. Early teams should be lean, cross-trained, and built around revenue-producing roles. Zero to six months: owner provider, front desk and patient care coordinator, part-time marketing support, whether in-house or an agency like Ekwa, and a medical director if it’s not the physician. Six to twelve: a second provider, a dedicated practice manager. There’s a difference between a manager and an administrator. The administrator has fiscal responsibility. Then a full-time esthetician or laser specialist, and a part-time bookkeeper. In my former practice, I intentionally overstaffed once I was solid and profitable, because there’s always going to be somebody that calls out.

Jay Shorr: Where do practices go wrong? They hire too many people in the very beginning. They hire based on personality instead of capability. I take my time to hire and I fire quickly. They don’t have a written job description or KPIs or MBOs, what am I grading you on? I have to give it to you, so I never hear “that’s not my job.” In the job description, it should say “and other duties as assigned,” because your paycheck does not have what your title is, it has the name of the company you work for. They don’t have any performance management, any onboarding, any training. The training has to be clear, concise, consistent, with proper policies, procedures, and protocols, so when one team member leaves and another comes in, there’s your playbook. The first hire determines the culture, and the culture determines retention.

Jay Shorr: If you don’t measure it, you can’t fix it. And most practices measure nothing. How much do you make an hour in your exam room? How many hours are you in there, and how much revenue did you generate? Divide one into the other. What is your monthly burn rate, how long until you run out of money? I analyze clients’ P&Ls every month, against the prior month and the same month in the prior year. Many people don’t even know what a chart of accounts is. They put everything in cost of goods sold. What is your revenue per hour per provider? If a PA or NP doing a couple of syringes can’t get $1,000 in 15 to 30 minutes, you’re either talking too much or you don’t have enough business. Then there is your gross margin by service line. What is your patient acquisition cost, Mr. Wonderful’s favorite question. And do you have membership or recurring revenue? Because if you ever want to sell your business, I want to know what I’m buying. The whole conversion cascade, marketing to call, call to consult, consult to treatment, treatment to retreatment, that’s where we help our clients increase revenue and profitability.

Adeesha: What’s the first thing they can do tomorrow morning that can really change their trajectory for the better, wherever they’re at?

Jay Shorr: You don’t know how to get there unless you know where you’re going. If I invited you to my house for dinner tonight, do you have a plan how to get here? You’d type the address into navigation. That’s a plan. But if I ask an experienced business, how are you going to get from $1 million to $1.5 million to $2 million next year, they’ll tell me, well, I’m going to do some PPC. You don’t have a plan, a business plan. We create business plans for every client, zero to three, three to six, six to twelve months, one to three, and three to five years. Audit it financially, operationally, administratively. Never run your business by the seat of your pants. It’s not a field of dreams, build it and they shall come. And don’t be afraid to hire a coach. Don’t say you can’t afford to. You can’t afford not to, because I negotiate equipment and save people in one year more than they paid me. If you can name me any professional athlete that doesn’t have a coach, then they’re not a professional athlete. And if you’re a professional business, PA, NP, physician, you need a coach.

Adeesha: If our listeners want to connect with you or the team at Shorr Solutions to make sure they aren’t fighting these operational fires, where should they go?

Jay Shorr: All of our social media is @ShorrSolutions, S-H-O-R-R Solutions with an S plural, because we have more than one solution. Our website, www.shorrsolutions.com, and my phone number is 561-289-4640. Shorr Solutions won the Practice Management Company of the Year in 2018, 2019, 2021, and again in 2024 and 2025, five out of seven years. And I have the honor of being granted the Lifetime Achievement Award from Informa and The Aesthetic Show. Our company is filled with professional people who have owned practices and know the ins and outs, and we’d be more than happy to help any one of you.

Adeesha: Success in this industry isn’t just about the clinical skill, it’s truly about the structure. From how you form your business to the lease you sign, every decision compounds over time. If you’re looking for clarity on how to attract high-value patients, don’t forget to grab your 60-minute strategy session at www.businessofaesthetics.org/msm. I’m Don Adeesha, and this has been the Business of Aesthetics podcast. Thanks for listening.