Most practice-opening advice comes from people whose practice worked. That makes it survivorship-shaped: you hear what the winners did, not what the thing actually costs when it goes wrong.
Tatiana Sarmiento, a board-certified aesthetic nurse practitioner in Florida and Empire faculty, opened a practice, ran it, and closed the doors. She talks about it without embarrassment, and her account contains the single most useful sentence a prospective owner can hear.
“I Bought Myself a Job, But I Didn't Have a Business”
That is the whole diagnosis in one line, and it describes an enormous number of clinics that are still open.
“I'm proud of every single step that I've done,” she says. “I think I opened my practice before I was ready for it.”
What went wrong was not clinical. She could inject. What she could not yet do was run the thing around the injecting: “I didn't close the company. I just closed the door. Why? Because I wasn't ready for that administration portion. I didn't know what KPI it was.”
Then the detail that tells you how granular the gap really was: “I didn't know that I have to take in consideration if I use alcohol pads or the alcohol bottle — it makes change in the prices. It's unbelievable.”
Alcohol pads versus a bottle sounds trivial. It is exactly the level at which margin is actually decided, and it is the level nobody teaches in a clinical course.
The Difference Between a Job and a Business
The distinction underneath her sentence is the one every owner eventually meets.
A job pays you for your own hours. If you stop injecting, the income stops. Your ceiling is how many patients you can personally treat in a week, minus everything the premises cost.
A business produces a return beyond your personal treating time — through other providers, through systems, through pricing and retention that work whether or not you are in the room.
Opening premises converts a job into a job with overhead. It does not, by itself, produce a business. That transformation requires the administrative layer Sarmiento names: knowing your numbers, knowing your costs to the level of consumables, knowing what a KPI is and which ones matter.
A clinician who opens without that layer has typically taken a pay cut and added risk, while working longer. It is possible to run that way for years without noticing, because revenue looks healthy and the shortfall shows up as exhaustion rather than as a number.
What She Did Instead, and Why It Was the Right Move
The interesting part is not that she closed. It is what she did next.
“So I went to work for three different practices,” she says. “I work for three different practices at the same time. I was learning the administration part, the hiring process — being an injector nurse that you have a boss and you have a schedule.”
She deliberately took employed roles to acquire the thing she was missing, and she is explicit about what the experiment was for: “That taught me about if I really wanted to be an injector or a business owner.”
That is a genuinely unusual move. The instinct after closing is to treat it as a failure and retreat, or to open again quickly to prove it was bad luck. She treated it as a diagnosis and went to get the missing training — from inside other people's businesses, on their payroll.
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She now runs her own practice again and also works for a large practice, training the providers it hires. She describes having “the good and the bad” of both sides deliberately.
The Question Behind It
Her experience answers a question most people never actually ask themselves before signing a lease: do I want to inject, or do I want to own a business?
They are different jobs. Owning pulls you out of the chair — and out of the income that comes with being in it. As she puts it, the administration “takes you out of the injection side, because you have to block your schedule in order to do the administration part.”
Maritza Mejia FNP puts the same caution more bluntly: “A lot of people want to be their own boss, or they want to build their own business. But the business is not for everyone.”
Neither answer is the better one. The failure mode is not knowing which you wanted until you have signed for premises. We cover the choice itself in not everyone should own a practice.
What to Learn Before You Open
Drawn directly from what she says she was missing:
- Your KPIs. Which numbers tell you the practice is healthy, and how often you will look at them.
- Your true cost per treatment, to the level of consumables. Pads versus bottles is not a joke — it is where margin lives.
- Fixed versus variable cost, and how many treatments a week cover the fixed side. See the med spa business plan.
- Hiring and managing people, including what you will do when someone leaves.
- Pricing, deliberately, before you open — covered in med spa pricing.
- How much of your week the administration will consume, and what that does to your treating income.
Empire teaches this layer in the 3-Day Business Bootcamp, Med Spa Pricing & Financial Planning and Blueprint for Success. If you would rather build the patient base before the overhead, starting a practice while still working covers that route.
Closing Is Not the End of the Career
Worth stating plainly, because the fear of it keeps people in practices that are quietly costing them money.
Sarmiento closed her doors, went and learned the missing half, and came back to own a practice and teach other providers. The closure was a correction, not a verdict. She describes being proud of every step — including that one.
The costly version is not closing. It is staying open for a decade in a business you bought yourself as a job, and never running the numbers that would have told you.
Frequently Asked Questions
What does “I bought myself a job” mean?
It describes a practice that pays the owner only for their own treating hours, with premises and overhead attached. Income stops when the owner stops injecting, and the business produces no return beyond their personal labor. Opening premises does not by itself create a business.
Why do aesthetic practices close?
Frequently not for clinical reasons. In this account the gap was administrative — not knowing KPIs, not knowing true cost per treatment to the level of consumables, and not anticipating how much treating time the administration would consume.
Should I work for someone else before opening my own practice?
It is an underrated route. Employed roles let you learn hiring, scheduling and the administrative layer on someone else's payroll, and they answer the more important question of whether you want to own a business or simply want to inject.
Is closing a practice a career failure?
Not necessarily. The faculty member in this article closed her first practice, took employed roles to acquire the missing skills, and now owns a practice again while training providers for a larger group.
Disclaimer
This article is educational and is not legal, financial or tax advice. Ownership eligibility, scope of practice and supervision rules vary by state. Confirm your position with your state board and with a healthcare attorney and accountant licensed in your state before opening or closing a practice.
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