Business is the Best Medicine’s Medical Entrepreneur Interview Series is designed to highlight our fellow healthcare entrepreneurs.  We believe that everyone benefits when entrepreneurs share their business successes and failures.  

Today’s interview is with Dr. Derek Guirand, founder, and medical director of sculpMD Aesthetics & Performance Clinic, located in Ardmore, PA.  A former Marine, Dr. Guirand blazed his own trail to Medicine and entrepreneurship.  After more than a decade in surgical services, he is now focused on making his side hustle a full-time career.  

Join us as Dr. Guirand discusses the benefits and challenges of running his own clinic.  

Part 1:  Getting Started

1. Introduce yourself and your background.  What did you do before Medicine?

My name is Derek M. Guirand, MD.  I was born in Boston and grew up in Palo Alto, California, in the San Francisco Bay Area near Stanford.  

Sculp MD owner

I took a circuitous route to the medical field.  I left college at 21 mainly because I was unsure what I wanted to study and enlisted in the US Marine Corps, reporting to Boot Camp in the summer of 1989.  I served with the 3rd Air Naval Gunfire Liaison Company (ANGLICO) and later with Marine Air Group 46 as an Intelligence Analyst and a Reservist while attending UC San Diego, where I studied Biochemistry and Cell Biology.  

Little known facts about me: I’m the oldest of 4 and the only one who doesn’t play an instrument.  My favorite job of all time was being a roadie for a mobile DJ company in San Diego.

2. Introduce your business.  What is it?  When did you start?  How have you grown?

I’m the founder and medical director of sculpMD Aesthetics & Performance Clinic in Ardmore, PA.  We specialize in non-invasive aesthetic procedures (Botox, filler, RF microneedling, EMSCUPLT NEO, laser, and esthetician services) and performance and lifestyle medicine services.  Our mission is to help people live a healthier, more fulfilled life.  

Our philosophy is based on the Finnish concept of hyötyliikunta or getting exercise from regular daily activities.  We encourage small acts of everyday life as exercise, such as walking, taking the stairs, and riding a bike instead of driving.  In addition, we promote better sleep, eating, and stress reduction.

Sculp MD

3. How did you become interested in entrepreneurship?  What was your very first business venture or idea?

Interestingly, I had my first experience with business while in medical school.  A classmate and I started an international medical student clinical exchange program called GlobalMedEx, coordinating clinical clerkship experiences in hospitals worldwide.  

Later, along with a plastic surgeon colleague from residency, I founded a tech startup around an app like “Tinder for plastic surgery marketing”— users would swipe multiple anonymized before & after photos from local plastic surgeons to match with a surgeon who shared their aesthetic.  This was a fun project to work on.  It was completely outside of my comfort zone.  My background was in the biological sciences and medicine, and I knew next to nothing about designing an app, user interface/experience, or computer science in general.  But I learned and gained valuable insight in the tech startup world.  We found the HBO comedy “Silicon Valley” was quite helpful.  

One main issue was trying to conquer the two-sided marketplace.  Users needed to see a large variety of content from their local area on the app (plastic surgery before and after photos) or we would have too much turn over-downloading then deleting the app.  Content providers (plastic surgeons) needed to see a significant number of users on the platform before committing their most valuable asset (before and after photos).  

Unfortunately, we were unable to solve this problem and decided to shelve the project in Autumn of 2020.  Interestingly the pandemic provided an opportunity for innovation.  In the Spring of 2020, my CTO was able to design one of the first HIPAA compliant video consultation platforms at a time many physicians were using FaceTime or Zoom before it had a HIPAA compliant option. 

4. Do you have any formal business education?  What do you wish would be taught in school?

I do not have a formal business education.  I’ve mainly learned from my wife’s MBA textbooks, trial and error, and speaking to more experienced business professionals.

I wish we were taught entrepreneurship, organizational leadership, negotiation, evaluating risk, finance, medical billing, and other skills required to open a private medical practice. 

medical entrepreneur

5. What factors led you to start your own business?

Mainly a desire to take charge of my medical career and move away from the constraints of hospital/insurance-based medicine.  I wanted more control over my time and to truly help patients.  I trained in general surgery and completed an ECMO-Critical Care fellowship.  I have always been employed by a hospital system.  I founded my tech start up business four years after beginning my hospital job. 

6. What were your fears when you started?  How did you overcome them?

That I was not only going to fail, but I’d be too stubborn to fail fast enough and lose money I should have saved for retirement.  

I’m not sure I HAVE overcome them!  However, I was able to pivot from my original idea (mobile-based aesthetic practice using a converted Mercedes Sprinter) to a more traditional storefront-based clinical practice.  I brought in more experienced staff with expertise where I needed to improve (practice management, human resources, etc.).  I also pivoted by adding preventive/lifestyle medicine to my practice.

I also had a nagging fear that I wouldn’t be able to maintain my ethics and have a financially successful practice.  I’ve seen a number of practices that are more sales than Medicine.

7. How does your current workload compare to a typical job in your field?

That’s a difficult question to answer.  I don’t think I’ve ever had a typical job in my field.  I started working 12-15 hours a day in the Marine Corps, then spent much of my career in the surgical services.  The long hours spent building a practice just seem like the norm.

My schedule is more manageable now. I’ve learned to be much more efficient with my time and to better delegate.  My typical day begins around 6:30am with a workout 1-2 hours depending on where I am in my decathlon training schedule.  I try to work on graduate coursework for my Master of Public Health until 10:30am, and usually get to the clinic by 11:00am.  I typically finish clinical work by 4pm, but as a business owner there is always something to do around the clinic, so I usually get home around 6pm.  I still work at the hospital part-time 3-4 nights a week, but mostly weekends. 

8.Did you include your spouse/significant other in the business?  Either way, how has that decision affected your relationship?

Yes, my wife is the business manager.  She has an MBA in healthcare management and is integral to keeping the business running so I can focus more on the clinical and marketing side.  It had a negative impact initially until we made strict work-hour rules.

9. What do you do for fun?

I compete in Masters Track and Field, specifically the Decathlon, and sometimes the open 110m High Hurdles.  The Decathlon is ten events over two days.  Day 1: 100m, Long Jump, Shot put, High Jump, and 400m.  Day 2: 100m hurdles, Discus, Pole Vault, Javelin, and 1500m.  Over the years, I always “scratched” on the pole vault, fearing that I’d injure my wrist and be unable to work.  Last year, at 55, I took up formal pole vault training and hope to clear 11 feet by August. 

I compete for USA Track and Field’s “Masters Team USA.”  I competed in Lyon, France, in 2015 and Perth, Australia, in 2016 (where I took 10th in my age group out of 30 countries).  I unfortunately missed Malaga, Spain, in 2018 due to injury.  Due to the COVID-19 pandemic, the World Championships were paused for the last few years.  I am currently training for the World Masters Athletics (Track and Field) Championships in Gothenburg, Sweden, in August 2024.  

Part 2:  Business Development

10. How did you fund your business?  Did you take on any debt?

The structure of the practice is a PLLC (Professional Limited Liability Company), and I am the only member.  We initially funded the practice with some debt via small business loans and personal savings.  At the moment, I am still working part-time at a local hospital in a surgical nocturnist staff position.  I’m slowly winding down at the hospital as the practice grows.

11. Do you have any partners?  If so, how did you divide roles?

The PLLC prohibits non-physician partners.  A few physicians have approached me, but I haven’t found the right fit yet.  I have a staff including a business manager, a laser esthetician with 15 years of practice management history, and an aesthetic nurse injector with fantastic social media experience.

12. If you have a physical location, do you own or rent?

We started our business in September 2020 as a mobile-only practice, then quickly pivoted to a hybrid model (mobile and office).  We sublet space in a 7,000-square-foot medical office formerly owned by a podiatrist but currently occupied by an IV infusion business.  I rented 4 of the 8 rooms covering about 1,000 sq ft.  However, despite the incredible office, the location was not amenable for an aesthetic clinic.  The local demographics weren’t the right mix, the area was not walkable, which limited drop-ins, and the signage was too small for the speed limit.  

One year into the lease, a drug rehab center opened below us (in a GORGEOUS space!).  Despite assurances from the director, the clients congregated around the outside entrance, smoking, and physically blocking the door…which ran off many clients.  We found and leased a 1,585 sq ft space in November 2022 in a very young, affluent area in the Philadelphia Main Line suburb of Ardmore.  Our clinic is a 2-minute walk from two luxury apartment complexes (more being constructed), a 5-minute walk to regional rail, and a local high-end shopping mall near cocktail bars, Ardmore Music Hall, etc.  

I personally completed 98% of the minor construction over the first five months, including installing a “Murphy door” to complete our Nordic-Speakeasy aesthetic.

medical business

13. Do you have employees?  If so, what has been the biggest challenge in dealing with them? 

Yes, I have a receptionist (who is applying to medical school), two new aesthetic nurse injectors and a fantastic laser esthetician with over a decade of experience, who is more of a practice manager.  But finding the right fit took a while.  

The greatest challenge was finding staff who understood that we were a growing clinic.  Nurses enter aesthetics for several reasons: to have a more balanced lifestyle, supplement their income, or as a first step into entrepreneurship.  Many just want to leave the physically demanding and relatively poorly compensated hospital-based nursing and becoming an aesthetic injector is an attractive option.  But success in this industry takes more time than many anticipate before they can make it their primary source of income.  It also takes self-promotion, and they must learn to build their own brand.  It’s important they understand that this is a “side hustle” until it’s and not, and to not quit their day job immediately.  We had several applicants who only wanted to punch a clock, and I understand and appreciate that mindset, but that isn’t the type of staff we needed.

To be successful in the aesthetics industry requires staff to understand the cyclical nature of the business.  They must also be able to critically evaluate new aesthetic trends for safety and efficacy and have the ability to counsel their patients appropriately. 

14. What is your advertising or marketing strategy?  Anything that has worked surprisingly well?  Anything that hasn’t worked as well as you expected? 

Marketing has been one of THE greatest challenges, and I would encourage any business owner to invest in professional marketing early.  The idea of just putting up a website or social media page and hoping for the best in 2024 is naïve.  Social proof in marketing is imperative.  When people decide to have someone stick their face with needles containing botulinum toxin or hyaluronic acid, nobody wants to be first.  This is difficult for a new practice with new injectors.  

We went through a few DIY strategies but finally bit the bullet and paid a marketing company to build us a new website and SEO plan.  I basically went to the website of a well-known plastic surgeon and contacted his marketing company.  LOL.  We are a few months into this engagement and haven’t implemented paid ads yet, but we have had the best 1st Quarter in the company’s history. 

From my previous tech startup, I knew that aesthetics marketing is estimated to be a $1 billion+ industry and that the average practice spends between 7 and 9% of their gross income on marketing.  There are several marketing funnels with questionable ROI (think Best Doctors in X specialty magazine advertisements). 

laser room

15. What is your relationship with social media?

Love/hate, but mostly hate.  My generation isn’t native to social media.  However, most of our patients are.  It’s necessary, in some ways more necessary than a website, to have a social media presence.  For the moment, Instagram seems to be the sweet spot, as Facebook has become older, and TikTok is for a much younger (and meaner!!) crowd.  Podcasting seems to be gaining more influence.  

The trick is to be able to distill your message to between 15 and 20 seconds and have longer form content available for more in-depth information.  I’ve found that Instagram Reels where I speak get the most engagement, so I should probably do more posts. 

16. Where do you see yourself and your business in 5 years?  10?

In 5 years, I think we will be well established in the area.  I see the practice expanding aesthetic and performance services but still primarily based in Ardmore.  I’d prefer to venture into expanding concierge-type services rather than open a second brick-and-mortar location, although I’m not against it under the right circumstances.  

In 10 years, I don’t see myself performing day-to-day management of the aesthetics side of the practice.  However, I see potential in expanding telehealth options for the business’s performance/preventive medicine side.  I plan to be boarded in Preventive Medicine and Obesity Medicine in the next two years.  I’ve also been speaking with one of my former medical school classmates, who is a leading voice in telemedicine, so there’s potential for expanding into that area. 

17. Would you ever sell?

For the right opportunity, of course!

18. Did/Do you have any mentors?

Not really.  I do have trusted people on whom I can bounce ideas.

19. Any business tips, tricks, or hacks that have made your life easier?

HAHA!  Yes, since I’ve stepped on almost every business landmine possible, I have a few tips. 

  • If you are going to fail…fail fast before you spend all your retirement savings and have your spouse glaring at you!
  • Don’t be wedded to the original idea – Pivot early and as needed. 
  • Have a flexible mindset.  In the Marines, it was Improvise.  Adapt.  Win.  Repeat. 
  • Move fast, but don’t rush.
  • Be honest but not timid.
  • Have a plan, but realize that, as we say in the Marines, No plan survives contact with the enemy (or if you are an Iron Mike Tyson fan: “Everybody has a plan until they get punched in the mouth”)
  • DO NOT BUY DEVICES YOUR FIRST YEAR* (unless you’ll have exclusivity and have a solid marketing plan).  If you cannot convince the public that it’s a useful product, it won’t matter if the science is solid.
  • Hire slow, fire fast. 
  • Make friends with your neighbor businesses even if they are competitors or have nothing to do with your type of business. 
  • Do not listen to device/sales reps…YOU WILL NOT pay for the machine in 6 months. 
  • Be honest.  Put the patient’s needs first.  Don’t be greedy.
  • Quote the price of the service, then stop talking. Do not rush to give a discount out of desperation.

20. Any business software that you’ve used that has helped you?  Any that wasn’t worth the investment?

The Good:

Square.  It’s not the best, but it’s never failed us.  TouchMD is great for before and after photos, in-office and in-app marketing, video consultation, and more.  Go High-Level CRM (offered as part of the Influx Marketing package) has been very helpful.  Instead of physical business cards, I use Linq Card, and our practice uses Unicode (formerly Beaconstac) for customized and dynamic QR codes.

The Not so Good:

I’d rather not say…but feel free to contact me by email or Instagram, and I’ll tell you.  LOL

21. How do you handle your retirement savings?  Health insurance?

I have a financial planner who built out a nice retirement vehicle for me.  We currently purchasing our own private insurance, as the hospital-based plan at my part-time employer wasn’t adequate for our needs.

Part 3:  Reflections

22. What is the biggest barrier that medical professionals face when starting a business?

Training

Most physicians have little business acumen.  We spend all our time learning about the human body and pathophysiology.  By the time we finish education and training, many of us are too burned out to learn anything else.  I think instead of doing very little during the 4th year of medical school, we should have formal training on entrepreneurship, business management, healthcare economics, etc.   Leaving medical school with an MBA or MPH is feasible if you are motivated.

Imagination

Lack of innovative mindset. 

23. What motivates you?  Is this the same motivation as when you started, or has it changed?

I’m honestly not sure if I can put into words what motivates me.  I like to try new things, and I want to challenge stale thinking.  And, of course, if I’m told I can’t do something, it motivates me even more (see Marines and Medical School).  I’ve always liked the quote attributed to Hannibal as he tried to cross the Alps with African battle elephants: “Aut inveniam viam aut faciam.”  I will either find a way or make one.  

I think many physicians lack imagination and fear breaking the rules, leading them to follow policy rather than kick in a locked door…but I can’t blame them.  I get it.  Getting a medical degree is a HUGE investment in time, money, and putting off living life, so not wanting to upset the status quo is a reasonable response.

injector room

24. How do you manage your work-life balance?

For most of my career, I’ve managed it poorly.  But that’s a personal flaw of mine I’ve had to work on.  It took a health scare to get me to REALLY make a significant change.  Part of the reason I opened my clinic was so I could (eventually) work four days a week, 10-3 pm, and have weekends off.  I’m getting there.  

Right now, I’m working on creating a more structured daily routine.  I’ve been concentrating on better sleep hygiene, eating, and exercise habits…and monitoring my screen time.  Mobile phones are the worst thing you can use before bedtime.  Taking long weekends, regardless of what’s going on at work, at least once per month with friends and family is something that has been working. 

25. What has been the hardest aspect of business ownership?

The occasional crippling fear of knowing the odds of success are against you since most businesses fail but attempting the venture anyway without a safety net.

26. What has been the most rewarding aspect of being a medical entrepreneur?

The knowledge that I built something. 

27. What advice do you have for medical professionals considering starting their own business?

  • Make sure you have the stomach for failure and the ability to bounce back.
  • Engage a good attorney first.  Make sure he/she understands your vision so any major legal issues with the idea can be addressed before committing money to the venture.
  • Finding the right team is paramount.  A spouse-led team may sound fun at first, but it causes many difficulties, and the lines between business and personal relationships can be blurred.  Staff turnover is one of the most expensive parts of doing business.
  • Establish a “bailout” trigger, a red line that tells you it’s time to dissolve the business.

28. What do you wish you had known before starting your business?

I wish I’d known how long it would take to build.

29. Has your relationship with your patients changed as a result of you being the owner?

Not really.  I have always liked to take my time with every patient.  I don’t and have never believed in the idea of “VIP Medicine”, because it suggests I was not giving all my patients my best care.  But I have made it a practice not to personally schedule or take payment from the patient.  I think it’s important to maintain the physician-patient relationship. 

30. Would you do it again?

Yes.  Without a doubt.

31. What’s next for your business?

Marketing, marketing, marketing to establish us as the go-to aesthetics clinic in the area.

32. Do you have any side businesses or other ventures?

Not now, but at some point, I’d be interested in getting back into the tech startup world.

Part 4:  Final Thoughts

33. What do you want potential patients or customers to know about your business?

We want them to know that the staff at sculpMD puts patients above profits (I know, weird for a for-profit business).  We want to establish a reputation as the most honest and ethical aesthetics clinic in the area.  We want long-term patients who will recommend our practice for years to come.

medical business 2

34. Do you have any business book recommendations?

Economics for Healthcare Managers by Robert H. Lee 5th Ed (incredibly boring, but very useful information that applies to public and private practice).  Any good basic textbooks on business leadership, human resources, management, and marketing.

35. If you could change one thing about the current US medical system, what would it be?

Increase access to comprehensive PREVENTIVE care.  This might include decreasing patient load and/or increasing reimbursement for smoking cessation, lifestyle change, nutrition, and exercise programs.

36. How can people find you and your business?  

74 Rittenhouse Place, Ardmore, PA 19003

On Instagram @drguirand and @sculpmd

Website www.sculpmd.com

Phone: (610) 632-5773

Email: info@sculpmd.com