Its door was wide open, and anyone on staff could simply walk in and take what they wanted off the shelves. When products weren’t there, they were written on a sticky note—or simply remembered by staff—and orders worth tens of thousands of dollars were made on that basis.

I sat down with the owner and asked her: How much have you sold over the last three months? She said she had no idea: current stock wasn’t written down, and if she wanted to do an audit, staff had to go through paper receipts. Later, in the corner of a supply room, I found a box of expired filler worth $50,000 retail. It had never even been opened.

I come from four generations of doctors: My great-grandfather ran a hospital, my grandfather ran a radiology department, and both my parents are physicians—I am the first in the line not to go to medical school. Instead, I did a master’s in public health at Columbia, and after graduating joined a family office in New York.

In 2023, we started looking at rolling up med spas, buying small practices and building them into something bigger. We’d looked at 50 to 60 health care verticals and decided that aesthetics and wellness was the best bet. It had grown massively, from a couple of thousand practices countrywide to close to 20,000 in less than a decade.

But then I started visiting them.

It is standard practice when investing to ask to look at the books, but in many cases there were none. The more practices I visited, the more I realized that this wasn’t a couple of bad apples—this was the industry at large. It is, for the most part, run by clinicians or first-time entrepreneurs with little business background: they weren’t willfully negligent, they had simply never been given the tools.

In a med spa, inventory is the single largest expense, even bigger than payroll.

A vial of Botox, for example, costs several hundred dollars—and it is small enough to fit into a jacket pocket. It would have been easy for me to walk out of any one of those med spas with three vials—worth $2,000—with very little effort. Given the razor-thin margins of many practices in the U.S., that can be the difference between a profit-making month and a loss.

And then there was the safety aspect. God forbid that a state pharmacy board inspector had dropped in at any point because many of these spas could not have produced documentation.

I still visit clinics where there is no Hylenex (a drug used to dissolve hyaluronic acid when a filler injection goes wrong) on the shelf, a serious issue. If filler is accidentally injected into a blood vessel, a patient can suffer permanent tissue damage: Hylenex is the standard emergency treatment, and needs to be on the shelf. I saw clinics that were using unauthorized numbing creams: one bad reaction and a practice would be finished.

So that day in New York, I went back to the family office and told them I didn’t want to help them buy med spas—I wanted to fix them. Their answer was: good luck. If it works, we’ll invest.

I went back on the road, knocking on doors across New York and persuading med spas to let me take over their purchasing: I visited 40 or 50 outlets and came away with seven yeses. Then we signed our first enterprise client and word started to spread. Today we work with the largest med spa groups in the U.S., serving more than 1,500 locations in all.

All that has taught me a lot, but the best lesson I ever received about building a product was from my mother, a physician. When I first described the company to her, everything ordered automatically, no phone calls, no fuss, she said: “I would never use you.”

She said that her sales reps weren’t a nuisance that could be automated away, they were how she learned what was new, what worked and what to watch for.

So we pivoted: instead of trying to replace human reps, we started streamlining the paperwork around them. The vendors noticed their best-run customers were growing and buying more, and started sending new practices our way.

Three years in, I am convinced that the messy supply closet is a microcosm of a much bigger story: wellness businesses are two decades behind the technological curve and it is the simplest problems that are holding them back. Insurance reform and new drugs will play a seismic role in American health care reform, for sure. But equally important are the simplest issues—procurement, purchasing, admin—that help businesses keep the lights on.

Transforming health care doesn’t always start in the operating room or the lab. Sometimes it starts in the supply closet.

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