In 2022, Dr. Rami Hosein bought malpractice insurance, secured a business license, underwent specialized training and transformed a corner of his apartment into a de facto medical aesthetics practice.

He started seeing patients – mostly friends and family – under the bright lights he installed. His handful of patients sat in a special treatment chair and underwent one of the few procedures he offered, which included Botox and microneedling.

In just a matter of months, exclusively through word-of-mouth marketing, his patient list grew to over 80. He was still working full-time as a per diem hospitalist, but saw a different path forward in aesthetics.

So along with his sister Ellen, he started planning to launch Elinea, a med spa in San Francisco. Now, about two years in, he has built out an office so elegant it was featured in Architectural Digest, and his business now generates over 7-figures of revenue on an annual basis.

So, how did he do it?

In this Side Gig Story, Rami shares his journey within medicine, his entrepreneurial leanings, and what he has learned through the process of launching his med spa business including how to achieve a work-life balance and career he is proud of. He also outlines what other physicians can do to build an alternative career in medicine themselves.

Rami's Med Spa Is His Second Business

During residency, Rami's sister Ellen gifted him a float session, which involves spending time in a sensory deprivation tank filled with saline water which allows for easy floating. The darkness and lack of stimulation are calming, and can be beneficial for some people for a range of ailments including trouble sleeping, anxiety and even physical pain .

The grueling residency schedule was disruptive to his sleep, and floating became a major source of relief. "After floating, I had the best sleep of my life and I was like, whoa, there could be something to this," he said.

His positive personal experience was also cultural. Rami and his sister are of Jordanian descent, and having been to the Dead Sea several times, the floating experience felt especially meaningful. So the two opened up a float spa in Sacramento.

This experience was foundational and set the stage for his med spa venture.

He learned the process of understanding the market, identifying your niche within a broader market, clearly articulating your business's exact and distinguished offering. He learned the process of building a business plan and what it takes to set up a brick-and-mortar, shop especially one involving complex mechanics and plumbing operations.

"I knew what I was getting myself into operationally, so the second time around was a lot smoother," he said.

Pay Attention to What Interests You Most in Clinic and Lean Into It

After graduating from UC Davis School of Medicine and completing his residency in internal medicine at Kaiser Permanente Oakland Medical Center, Rami worked as a hospitalist within the Kaiser system in the Bay Area. He was drawn to both OB/GYN and internal medicine during his rotations, particularly enjoying procedures while avoiding the long hours of surgery.

"I love doing procedures," Rami said. “Whether that’s putting in a central line, doing a thoracentesis, a paracentesis … I didn't do them on a daily basis, but when I did, they were really satisfying.”

But it was during his time working in the emergency department and ICU that actually piqued his interest in dermatology. “I was super fascinated, working as a hospitalist in the emergency department, by seeing how patients recovered from their wounds. It was really the interest in tissue regeneration that got me interested [in aesthetics],” he said.

Complete Research and Due Diligence

Rami identified medical aesthetics as an opportunity for entrepreneurship, but ahead of going full steam ahead, raising capital and making a major upfront investment to launch a new practice, he approached this venture methodically.

Industry and Legal Research

First, Rami conducted extensive research on the aesthetics field and what it takes to open a med spa. This process took him and his sister Ellen 1.5 years to complete their due diligence.

“Do the research and be prepared to spend maybe 10, 20, 30 thousand dollars investing in just trying to understand the field and whether or not you're going to pursue it. And if the answer is yes, let's do it, then go for it. If after that time, it doesn't feel right, then just be prepared to let that go and there should be no sunk costs or emotional costs tied to that,” he said.

As an internal medicine physician not specialized in plastic surgery or dermatology, Rami pursued specialized training for the various procedures and services he offers. He secured a business license, malpractice insurance, and works fully within the scope of his medical license.

Clientele Research

Rami was intentional about being extremely clear with their offering to intended customers:

"Understanding what the market is, understanding what you're offering, understanding who your client base is and having a name for that person or people. Like what's the demographic? What do they do for work? What are their likes? What are their dislikes? Connect with them emotionally and just try to understand what it is that you're selling. It's okay that there are others around who are doing what you're doing, but you need to figure out how you're going to stand out," he said.

Starting too big or broad could lead to inefficiencies, overextension and non-strategic use of resources.

Start Small and Build Gradually Ahead of Going All-In

Rami began offering just Botox and microneedling in his apartment to friends and family. This was a small financial investment to test his products/offerings and to ensure there was demand for them. Eventually as his client base grew to over 80 patients, he gained confidence and assurance that his business had legs.

During this time, he maintained his work as a per diem physician. He did not sign a contract with Kaiser, in order to maintain flexibility and avoid complications due to non-compete clauses. This flexibility allowed him to build his aesthetics practice while still working as a hospitalist, providing some financial security while honing his aesthetics skills.

Confer with Consultants

Ahead of launching his business, Rami and his sister met with consultants who would offer projections and feedback on their growth plan. Given the huge initial investment it takes to set up a brick and mortar med spa, he wanted to be sure his forecasts for the business were sound.

“It's just a huge initial investment and you have to be prepared to continue putting money into [the business] two, three years down the line. Now, if your forecasts are not profitable after that, it's probably not worthwhile, whatever business, you're contemplating. But if there is profitability there and you're talking to the consultants who do this day in and day out, and they look at your numbers and they say they're realistic numbers [then it’s worthwhile].”

Rami reflected that he tended to be more optimistic than the consultants. “I needed to just dial that back before we opened our doors just to set realistic expectations. And now that we're meeting those conservative estimates, that's good.”

Secure Funding and Build Your Team

Both financially and operationally, family played a crucial role in Rami’s entrepreneurial journey. His sister, a non-medical professional, manages the administrative side of the business, handling everything from permitting to payroll. In Rami’s case, his business is funded through a combination of personal and family investment, a 0% interest loan from a San Francisco nonprofit that went towards the purchase of a laser for his practice, and higher interest loans that enabled him to secure additional equipment including microneedling and other laser devices.

His monthly operating costs are high — over $100,000 — so continuing to hone his business strategy while expanding the full-time and part-time team continues to be a top priority.

“I have so many people on retainer. It's really important to get experienced people to help you,” Rami said. “We have a bookkeeper, a financial advisor, a marketing team, we have a social media person, and we have a branding team. So all of these different people are on retainer and the amount of money we put into advertising is a lot.”

His business is now turning a profit, and Rami has plans to continue to grow the business by hiring another provider and expanding the amount of services he’s able to offer.

“I would say I'm probably now making about just as much, maybe a little bit more than I was as a hospitalist working full time, which is good. But what matters most is control over your time, flexibility, and the ability to be with friends and family.”

The Journey is Meaningful, But Not Easy

Has it been worth it? Both financially and in terms of his own career satisfaction, Rami feels his alternative career journey has been worth it – in spite of the inevitable ups and downs of entrepreneurship.

"We talk about all of the highlights, we post something on social media, and people really just see the outcome of all of our efforts without seeing the effort that's actually been put in to all of this. And let me say, it's a lot like you'll have to sacrifice," he said.

He has seen less of his friends and family since before launching Elinea, but recognizes that this is part of the sacrifice of immersing yourself in a meaningful venture. And Rami is confident that working full-time on Elinea versus splitting his time between his business and the hospital is the right move.

"I was working in the hospital three to four days a week, and the other three days of the week, I was working on creating the business plan, getting funding and figuring out the business," he said. "A year into it, things are good."

Bottom Line

For doctors considering a similar path, Rami offers four pieces of advice:

• Pay attention to your passions: Lean into areas you care about and are drawn to.
• Start small: "Start super, super small - as small as you can - and go from there."
• Do your due diligence: Spend time (a year or more) researching before fully jumping in.
• Invest in expertise: "It's really important to get experienced people to help you."

If you're a physician who's starting a business of your own, or you are pursuing a side gig and non-traditional career path in medicine, get in touch! We want to hear your story and feature it as part of our My Side Gig Journey series. Reach out to sarah@offcall.com with My Side Gig Story in the subject line.