Money Checkup Podcast

tips for a successful partnership in a medical practice

Episode 38: Launching a Practice with a Partner

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David Lieberman and Sachin Parikh met in residency at Stanford University and began talking early in their friendship about starting a facial reconstructive surgery practice. For nearly a decade, the pair have run a successful Palo Alto practice, growing their staff and service offerings while maintaining their relationship. 

“Don’t be afraid to have the tough conversation when you’re running a business, whether that be with your partner or your staff or anybody. If you come at it honestly and there’s a concern that you have to address, the tough conversations tend to move you forward in ways that you wouldn’t expect.” 

 The COVID-19 pandemic forced L&P Aesthetics to close its doors for several months this year, but the pair say that weathering the storm made their partnership even stronger. 


David Lieberman and Sachin Parikh are the co-founders of L&P Aesthetics, a Palo Alto-based facial reconstructive surgery practice. Both men are double board-certified, fellowship-trained surgeons who serve as co-medical directors of their practice. Their surgical services include facelift, eyelid surgery (blepharoplasty), and rhinoplasty, and their medical spa services include BOTOX® Cosmetic, dermal fillers, laser skin treatments and more. 

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  • Drs. Lieberman and Parikh met during residency at Stanford University and, after years of friendship, noticed that they had similar goals and values. They founded their practice together in Palo Alto in 2011. 
  • David says developing a good lending relationship at launch is key. Sachin believes a high-quality, polished website is worth the investment and wishes they’d identified that when they launched the practice. 
  • It took L&P Aesthetics six months to turn a profit, which is faster than average. Both Sachin and David had “side gigs” during those months that took up about half their working time, which they were able to leave within the first 12 months. 
  • Their initial startup loan was $500,000 and they only spent $56,000, which made it much easier to become profitable. 
  • L&P Aesthetics initially shared space with another surgeon’s practice, which saved them money up front, though they always had their own staff and their own phone lines. As they proved themselves, that surgeon began to refer patients to them.
  • Their first staffer was a part-time employee. When they were overwhelmed, they were increased to full-time. When they got overwhelmed again, they hired the next part-time staffer, and so on. Now, nine years in, they have about 15 employees.
  • At the start of 2020, the L&P Aesthetics leadership team sat down and reviewed their “flower beds” — each aspect of what their company does. They isolated the P&Ls for each flower bed and made a plan for each one. They also decided to dedicate one day each month to business development and to set a certain number of surgery days for the year. 
  • If you hire a bookkeeper, Sachin recommends spending a lot of time with that person to ensure that you understand your financials as well as they do. 
  • In 2018, L&P Aesthetics expanded into their own space, which included their surgery center, clinical office and medical spa. 
  • David encourages business owners to lean on their financial advisors to help inform big spending decisions. 
  • COVID-19 forced L&P Aesthetics to stop almost all of its work. Sachin and David sat down at the start of the Shelter in Place order to discuss how they could reduce their expenses as much as possible as they went into a “semi-hibernation state.” They furloughed most of the staff. Then they approached their creditors to see which bills they could put on hold. Finally, they subtracted any cash on hand that had come from clients who had not yet had procedures performed, in case they needed to give refunds. 
  • L&P Aesthetics had cash on hand because they had been saving for capital improvements, which helped them weather the storm. 


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If you loved this episode, here’s another I know you’ll enjoy too! Episode 22: Launching New Medical Practices with Debra Phairis


“Most of these relationships end in fiery divorces and crashes. The idea is to stress-test the [partnership] as much as possible before you press the go button.” 

“When you run a business, having access to cash and capital is really important, and then having as little debt is really important in terms of sleeping at night. When you have access to money, you start to use it, but it is a lot easier to spend borrowed money than it is to pay it back.” 

“It’s very hard to work on your business when you’re always working in your business.”

“Establish your [banking] relationship not just for your current needs, but for your future needs.”

“Your staff is your number-one asset. Do everything you can to train them… for us, our staff is our number-one marketing. Our patients can feel that positivity and that family-like atmosphere, and they feel like a magnet and they want to come back. It just kind of happens on its own. That vision comes from the top.” 

“If you’re inspired as a business owner by your purpose, then you end up hiring people with that same level of fire and commitment. And if you can communicate that clearly with your staff, about the vision, about expectations, about creating a system for success, and you work it every day, then you’re off to a really good start.” 

“Don’t be afraid to have the tough conversation when you’re running a business, whether that be with your partner or your staff or anybody. If you come at it honestly and there’s a concern that you have to address, the tough conversations tend to move you forward in ways that you wouldn’t expect.” 

“Make sure not to lose sight of continuing to be inspired as to why you did it in the first place. If you feel that, then it shows in the quality of what you’re doing, and the people around you — your staff, your family, your partners — also feel it.” 

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