Since the beginning, the health care industry has practiced a self-imposed moratorium on doing business and physicians have been encouraged to not address the business side of the delivery of their Oath. And yet if today’s physicians aren’t attentive to the business aspect of their practice, it’s a sure thing they won’t be practicing for long. And then who loses?The concept for this book began several years ago during my residency training. In no uncertain terms, I was specifically instructed to not think of medicine as a business. As a surgical resident, I was surrounded by mentors whose appointment was to teach surgical technique. And while they stressed the importance of proper credentialing, the subject of money was avoided at all cost, not unlike the uncomfortable feeling in a restaurant when the waitress announces that the lobster served that evening is “market price.” If you had to ask, then maybe you were in the wrong restaurant; so you just didn’t ask. You just sweated the amount (particularly on an intern’s pay) until the check was presented. The message implied to us was that someone else would manage the money-a practice manager, for example. And so when patients asked what a treatment would cost, we were instructed to defer that detail to someone in accounting.So after years of hard work, long hours and endless studying, I was unceremoniously dropped into private practice where I found out that even though I had to assume risk for the business, my staff all had to be paid first leaving me to be the last one to get any money. The fact remained that there were no guarantees I’d even paid for my services, or anything, for that matter. To even open the doors of a practice you have to commit to paying full-time reception help, nursing, and space costs before you know when your first paying patient will arrive. Even then, there are no guarantees that payment due from those first patients will be on time for you to pay your staff, your office space lease, and or your basic living expenses.Like many young associates, I began by casting a wide net seeking to fill my appointment book. I didn’t turn away patients whether treating them would be a profitable use of my time or not. In observing my peers, it did not take very long for me to recognize that some aimed to make the most of their training and career; others were just filling time in between graduation and retirement. Those who were enthusiastic and excited about the work they were able to do were rewarded well financially for it. Sadly, the majority of physicians embraced the “Field of Dreams” mentality-hanging a shingle and waiting and hoping clients would come. As you can imagine, results were highly inconsistent and in most cases very poor. The defining characteristic of the successful practice seemed to be a combination of strategic planning, marketing execution and recognition that no doctor has an infinite earning capacity because no matter what we do, there are only 24 hours in a day.Doctors who make the most of their time choose first to do things for clients that make the best medical sense. But they also consider what make the best financial sense for both the patient and themselves. In training, we were always taught to do what is right for the client and never taught to concern ourselves with profitability. But one of the most difficult early steps in your practice is knowing when to say no and when to say yes based on the profitability of your answer. This insight is cultivated as you gain experience and unfortunately can cause many early missteps that may result in the loss of both time and revenue.I did not start my practice with a business manual like this in hand. I suffered along with the rest of my peers until I learned that the successful practitioner did not cast fate to the wind but instead proactively charted a carefully designed course engineered for success. Operating without a strategic endpoint in mind is like trying to drive somewhere without actually knowing where you want to go having never been there and expecting to arrive on time, without frustration. Typical business environments would have you assigned to a mentor but in the world of cosmetic medicine all the mentors who could potentially help you are probably your competition.Over the last decade, I have consumed every marketing and practice building resource available. I spent nights in the library researching business strategies and essentially creating my own mission statement. I learned everything I could about how to build a business that would survive any market condition and then how to sustain and grow that business. I also learned how to manage my time so that I can add capacity to my business, and fill that capacity the way I want to keep client satisfaction and my financial results both in mind. Most of my colleagues laughed at my new ideas until, years later, when my practice had grown from a fledgling entry level endeavor into a highly successful cash-only elective enterprise. In eight short years, I’ve built a career that now allows me to do exactly what I want: not accept insurance and actually enjoy what I do. I have patients who are thrilled with what they get when they come to my practice. On a daily basis, I literally change people’s lives by the work I do. For some, the results restore lost confidence while for others it simply grants them confidence they never had. In many cases they come into my office with their heads down not wanting to be seen. But when they leave, they smile, hold their head high, and proceed to talk to everyone with a new dose of confidence.We all have the choice between thriving and surviving. I choose to thrive. If that is your goal, it will require a paradigm shift to reach a state of what I call “thrival”. Simply stated, a state of thrival is a position where your practice is not only surviving, it is thriving. I don’t want to peak once and fall back or have peaks and valleys. The best case scenario for me is a practice that never stops growing in the areas of client satisfaction and profitability. But to achieve this will require you as a practitioner to adopt new methodologies and embrace an entirely new way of thinking.