Business is the Best Medicine is proud to present the first in a series of interviews with medical entrepreneurs, where we can learn from their varied experiences.
For our inaugural post, we are pleased to interview Kevin Salas, FNP-C, a serial entrepreneur who owns four businesses. Kevin’s primary business is Courtyard Family Practice, a single-provider clinic in Midland, Texas. Over the past six years, Kevin has grown Courtyard from 30 to 50 patients daily and now includes an adjacent medical spa.
Kevin is the married father of two high school-age daughters and an adult son. He also has two young grandchildren. His wife is a Pediatric Nurse Practitioner.
Part 1: Getting Started
1. How did you become interested in entrepreneurship? What was your very first business venture or idea?
I have wanted to own my own business since I was a kid. My first business venture was when I was 20 years old, and I bought a bunch of equipment and began DJing at local restaurants and clubs. I enjoyed it at the time since I was young and could stay up late. As I got older and started school, I discovered the nightlife lifestyle was not going to work out for me.
I wanted to open my practice as soon as I received my license as an FNP-C. I wanted to build a legacy for my children, not by giving them money but by leaving a concrete example of work ethic. The other motivator for me was the desire to challenge myself to build a practice that I and the community of Midland would be proud of.
Before I started Courtyard Family Practice, I was a co-owner of Permian Occupational Medicine. We specialized in workers comp patients, DOT physicals, and pre-employment physicals for oil field companies. The practice was successful until the oil bust in 2015-2016 caused us to close and search for other opportunities.
2. Do you have any formal business education? If not, how did you learn?
I do not have a formal business degree. One thing I wish I was taught in school, especially in our FNP program, is a section about setting up a business, paying taxes, setting up credentialing, etc.
I learned about business while working at Gateway Computers from 1999-2003. I worked my way from part-time sales to being awarded operations manager of the year. The following year, I was promoted to area general manager over stores in West Texas and Eastern New Mexico. The training Gateway offered its managers was outstanding. I learned a lot and received several management certifications.
After getting into nursing and graduating with my bachelor’s degree from Texas Tech, I became unit director of the ER at Medical Center Hospital in Odessa. This was, by far, one of my favorite jobs. I always felt like the ER team was my family and loved everything about the experience. We made it through good and bad times together. That job will always mean so much to me, and I will never forget the leadership skills it taught me and the purpose we possess in healthcare.
3. What were your fears when you started? How did you overcome them?
Upon opening the practice, my biggest fear was that patients would not show up and it would not work because people would feel more comfortable with an MD than a nurse practitioner. I hold a healthy fear in my heart every day that I come to work so I do not become complacent and make errors that could affect my patients. I learned from my EMS and ER days to balance fear with the confidence that I have been well-trained and that resources and colleagues are available to me should I not know what to do.
4. How does your current workload compare to a typical job in your field?
My workload is slightly higher than the average family practice. I see an average of 45-50 patients daily, whereas most providers will see 25-30 patients daily. One of the reasons I see more patients is due to demand from the public; I see, on average, 30 to 40 new patients per week, with a current wait list of 2 months. The increased load does not affect the time I spend with my patients. We have made this successful through communication between our staff and patients and a scribe to help me keep the flow.
During COVID, I hired an outstanding young NP to help with the increased patient load. I believed we could grow the practice enough to cover the costs of a second provider. Unfortunately, all the established patients wanted to see me since I knew their history, which caused a lot of unproductive time for the new provider. As time passed, he was able to build a following, but we also had to increase staffing levels. Therefore, the operational expenses did not exceed what he produced. I eventually made the difficult decision to go back to solo practice. Although this placed more work on my staff and me, we understood this would make the business more profitable and translate into raises for them and sustainability for the practice.
5. Did you include your spouse/significant other in the business? Either way, how has that decision affected your relationship?
My wife is a pediatric nurse practitioner who is not directly involved in my practice. She convinced me to start the business and wouldn’t let up until I did. But I don’t think anyone truly knows what the commitment will be like until you get into it 100%. Did it cause a strain in our marriage? Yes. Did it distance me from my family at times? Yes. Owning a business is not a job you clock in and out of. It is 24 hours a day and sometimes pulls you thin, but nothing successful in life is easy.
Your family must understand that the initial start-up will be difficult and time-consuming, but eventually, it will balance itself out. Once it does, you will be able to spend more time with them. Also, hire the right staff who cares about you, your family, and your business, and they will help you find that balance.
Part 2: Business Development
6. How did you fund your business? Did you take on any debt?
My funding was provided by two silent partners who took a huge chance on me and believed in me. I did take on some personal debt related to a change in salary structure, but it was recouped within one year.
7. Do you have employees? If so, what has been the biggest challenge in dealing with them?
I have five employees, and I can honestly say I do not have many challenges with them. They are very close, and they all know what they are supposed to do and get it done. One of the biggest challenges has been keeping employees for a long time. I believe this is mainly related to personal growth or family changes. Some graduate from school and move, others get married or have kids and stop working.
8. How did you develop your brand? What is your advertising or marketing strategy?
The biggest way I developed my brand for my Family Practice was through social media (Facebook & Instagram) and word of mouth. My wife used to laugh at me because everywhere I went, I would tell people, “If you need anything healthcare-related, let me know; here is my card.” It was like a walking advertisement. We also did billboards and radio commercials, which helped as well.
9. Where do you see yourself and your business in 5 years?
I will be fifty in five years, and my kids will be out of high school and in college. At that time, I would like to invest more into adding a second provider and slowing down personally to enjoy life. I have spent 20 years in the medical field, and much of that has been 7a-7p Monday through Friday and on the phone day and night responding to texts and phone calls. I would like to take a deep breath and listen, just listen to nothing at all.
10. Did/Do you have any mentors?
Yes, I have had three mentors who mean the world to me. One made me who I am and gave me life. He always told me nothing in life is unattainable and the only person that can hold me back is myself. He also instilled confidence in me that he would always be there to lift me up whether I failed or succeeded.
The second was old-school medicine, a doctor who took me under his wing when I graduated from NP school. He taught me that life is precious, and you have to enjoy yourself as well as help others. I remember asking him, “You are in your eighties; why are you still working?” He always said, “The mission is not over, son; people still need me.”
The last one is new-school medicine and business; I continue to learn so much from him. He has taught me the importance of making decisions for yourself and suffering the consequences of your actions. He has never micro-managed me and always has had faith in me to make good decisions, even when it impacts us both. This is a true leader and mentor. The lessons I learned from him benefit my business and have directly impacted my life for the good.
I’ll throw in a bonus mentor. I had a district manager in my Gateway era who had a major impact on my life in management. He was very intimidating. I once asked him when I was promoted, “Why me?” I was 21 years old and felt too young for the role. He said, “Okay, then I am going to take it back because I didn’t realize I was so bad at my job and couldn’t pick potential, and the whole time, I was supposed to pick older people.” I laughed and apologized. He often said that life is not about how much you believe in yourself but how much others believe in you.
11. How do you handle your retirement savings, health insurance, and investments as a business owner?
I have a 401(k) and health insurance set up through the business. My silent partners are investors in other medical practices, which allows us to collectively provide health insurance and a retirement account to the employees and me. The 401(k) matches 3% if I contribute 5% of my salary.
I have another 401(k) from a previous job and an annuity, and I also have money invested in stocks. My investments are all handled through a financial advisor.
Part 3: Reflections
12. What is the biggest barrier that medical professionals face when starting a business?
The biggest barriers are capital to start the business and getting and maintaining credentialing with insurance companies.
13. What motivates you? Is this the same motivation as when you started, or has it changed?
Patient perception is what motivates me. I want Courtyard to be known as one of the best healthcare options available in our community. This has not changed since we opened, and I don’t think it ever will.
14. Do you own any other businesses or side hustles? How do you manage your work-life balance?
I also own Black Widows Softball Organization, Black Widows Oilfield Services, and E&A Cleaning. Black Widows Softball currently has six teams in Texas and New Mexico, with 80 girls aged 10 – 16. We practice two times a week and travel every weekend to play in tournaments in Texas, New Mexico, Oklahoma, and Florida.
Managing work-life balance is difficult, but I always tell myself that I can only do one thing at a time. Coaching doesn’t feel like another business; it’s the best hobby I have! Being with my two daughters and the other girls is amazing. They can make me smile no matter what, even if I’m dead tired after work. Since my family is involved in the organization, it is something we all do together. No matter what, my family will always be my priority.
15. What has been the most challenging aspect of business ownership? What has been most rewarding?
The hardest part is the constant worry, the sleepless nights wondering if you are doing enough. The most rewarding thing has been the validation of watching the clinic grow over the years and winning the local newspaper’s Gold Award six years in a row as the best Family Practice in Midland, Texas.
16. What advice do you have for medical professionals considering starting their own business?
When you start a medical practice, there is no balance – the clinical aspect must be done while the patient is in the clinic, and the business aspect can be done after hours. So, that just means that sometimes you have to stay late if you fall behind. Make sure you are ready for the commitment this step takes in your life, and make sure everyone you love in your life knows what to expect. There will be nights when you come home frustrated and nights when you come home happy, mad, and sad. It’s an emotional rollercoaster.
17. Would you do it again? What is next for your business?
Absolutely. Hopefully, years and years of success.
Part 4: Final Thoughts
18. What do you want potential patients or customers to know about your business?
I want them to know that they are not just patients to me; they are family, and I want them always to feel that way, inside and outside of Courtyard Family Practice.
19. Do you have any business book recommendations?
The Hard Things About Hard Things by Ben Horwitz, Zero to One by Peter Thiel, and Think and Grow Rich by Napoleon Hill.
The Hard Things About Hard Things, by Ben Horwitz, taught me that failure is an inevitable part of life, and I must use failure as fuel to learn and make myself better. It is like when Permian Occupational did not pan out; I could have accepted it was over, but instead, I took what I learned and tried again. What I learned was that my services needed to be diversified. Occupational Medicine can come and go with the local labor market, but adding Family Practice adds stability. We also now offer Biote Pellets for hormone replacement, DOT physicals, slim shots, B12 shots, IV therapy, Peptide Therapy, and even Semaglutide injections for weight loss. This diversity of services has helped Courtyard weather economic downturns.
Going from Zero to One by Peter Thiel helped me understand there is a first step in creating any business. You have to go from zero to the creation and build from there. You must accept that the creation will be hard and bumpy but will eventually lead you to 100. Starting my team from nothing to a productive office staff was the outcome of zero to one.
The book Think and Grow Rich by Napoleon Hill was recommended to me by my son, Jared Salas, a motivational speaker. He was always telling me, “Dad, it is so amazing how positive thoughts can impact your life.” He would always tell me that if you believe you can, you will. Therefore, when I read Think and Grow Rich, I realized it was about teaching myself to attain wealth and success through positive thinking, persistence, and a focused desire for success.
20. If you could change one thing about the current US medical system, what would it be?
The one thing I would change about the US medical system is a move to a more value-based system in which providers are paid based on capitation and healthcare outcomes. The fee for service does not address prevention and health outcomes, ultimately driving up healthcare costs. Patients who are treated with a better understanding of their health status, including proper prevention, increase positive outcomes and limit unwarranted repeat visits. I would certainly like to spend more time with each of my patients to discuss their healthcare needs and the changes they need to make to improve their health.
21. How can people find you and your business?
Patients can find my business on Google, Yelp, Facebook, Instagram, etc. Our website is Courtyard Family Practice, Midland, Texas.