Hey Doc,
Ten mistakes in the report below. I made most of them.
New tech and new protocols get the attention. There are a thousand posts a week on them. The hard work happening on the ground is less clickable. The sweat, the tears, the wins nobody sees. Foundations, reputation, team.
Part of why it stays quiet is that the conversation is hard. It takes humility, self-awareness, and a willingness to say what you got wrong with your name attached.
So I asked. Twenty-six doctors answered, in the open. I compiled it into a field report below. It is a work in progress, and that is the point. If we want a standard for longevity medicine, we have to put this out and let others build on it.
Our certification learners also told us they wanted to study alongside their own specialty. So we are opening the first CLD cohort for dermatologists. Just reply to this email if that is you.
As always, Happy Sunday.
Dr. David Luu,
Founder, longevitydocs™
PS. Built the technology. Built a complex product. Built a multi-offering. Built a place. Maybe I should not have. I learned from all of them. We were building something that did not exist yet. Happy to give back now.
Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life. For my full perspective sign up for my weekly newsletter and follow on substack. Read the full issue on Substack.
Mistakes to Avoid When Building a Longevity Practice
Longevity medicine has a growing clinical literature and no operational one. Physicians opening practices have no published standards, no pricing benchmarks, no model comparisons, no software evaluations, and no account of what the first eighteen months actually cost.
So we collected one. Over the course of a week we put a series of questions to physicians in the member chat on longevitydocs.ai and let them answer each other in the open. Twenty-six responded on the record, from two months in practice to twenty-three years.
Ten mistakes came back often enough to treat as the operating reality of the field rather than one person's bad luck. Insurance does not pay for this work. Most physicians underprice at launch. The payment model decides how you practice, not just how you get paid. Capital gets spent before demand exists. Service lines get added before any of them are good. Paid marketing loses to the physician's own voice. Income tied to time caps the practice. Access given without terms is the most common boundary failure. No software does the job, so everyone runs workarounds. And systems get built only after something breaks.
1. Expecting insurance to pay for longevity testing
Steven Murphy named it as his first error in exactly those words. Every respondent who addressed insurance had made the same one.
"Don't expect to be able to spend this much time with a patient and have insurance pay for your time." — Steven Murphy
Jijoe Joseph found the more dangerous version, which is partial coverage.
"I got insurance wrong by assuming that 'usually covered' was good enough. About 1 in 8 patients could still get a surprise $4,000 to $5,000 bill." — Jijoe Joseph
Partial coverage is worse than none. It moves unpredictable risk onto the patient, and the surprise lands on your relationship.
2. Underpricing at launch
Near-universal. The regret is not the number. It is that the number is hard to change later.
"I should have started pricing higher. Most of my colleagues would chastise me for how little I charge. And that's harder to walk back now." — Melissa Loseke
"You'll be surprised how many stay after the price increase." — Jijoe Joseph
Set the price you intend to sustain, from patient one. Raising it later is harder than starting there. Fewer patients leave than you fear.
3. Letting your payment model decide your medicine
The most consequential finding came from a physician who changed her model to fix her medicine.
"I was nervous to ask people to come back (and pay money), so instead I would see them, do some testing, give them some supplements, and then they would feel lost for next steps. I moved to concierge to ensure consistent follow up, so people felt like we were moving the needle." — KeriLyn Bollmann
Fee for service made her reluctant to ask patients to return. That reluctance removed follow-up. Without follow-up, testing produces confusion instead of care. She changed the payment structure to restore the clinical loop.
"Membership was slow for almost two years. Fee for service kept the lights on." — Jijoe Joseph
Not a payment decision, it decides how you practice. Membership funds continuity and follow-up. Fee for service optimizes the encounter. Pick the one that fits the medicine you want to deliver.
4. Spending on space and equipment too early
"Make money first, assess patient needs and then buy one thing at a time. That stung when a patient told me she loved me but got more at another practice, but good business is not reacting to every sting with bad economic decisions." — Steven Murphy
"If I could go back I would literally just open a PLLC, rent a desk somewhere, and do some light organic marketing and social content." — Shah Ahmed
Start lean, buy one thing at a time, after demand is proven. Hire the person before the device. Shiny object syndrome is expensive.
5. Building every service line at once
"Every vertical adds equipment, staff, training, marketing, and management complexities before demand is proven. That's my number one mistake." — Jijoe Joseph
Narrow the offering to what you are good at. Listen to your patients, measure traction before adding. Start with solvable cases that get results quickly.
6. Spending on paid marketing instead of your own voice
"Word of mouth and just doing a great job with patients is all you need." — Melissa Loseke
"I spent $20,000 on local ads. My social account reached 17,000 followers despite zero formal strategy and completely erratic posts. Now imagine if I took that 20k and put it into a real social team instead." — Shah Ahmed
Your voice outperforms paid ads and costs nothing. Patients choose a physician, not a clinic. Raw beats polished content.
7. Tying your income to your time
"Don't tie your income to your time. Put systems in place early so that other people in your practice are doing the heavy lifting." — Jonathan Stegall
"I wouldn't be so afraid to spend the money on quality staff. They are everything to a successful practice." — Katie Rybak
If you only earn when you are in the room, you are the ceiling. Ask for help and take it. Delegate before you are drowning, not after. Hire good staff early, train them, keep them.
8. Giving away your access without boundaries
"People are paying to sit down and talk to me. The value is the physician. I changed my cell number because of this. Most had little respect for my time." — Melissa Loseke & Ladi Ilkhani
"Set clearer boundaries and trust more slowly. I blurred the lines between being a boss, mentor, friend, and business partner, and I was too generous with trust, titles, and credit." — Sarah Lacarrubba
You are the asset. Protect the time and the access. Set expectations at visit one, not after they slip. Give out a practice line, not your cell.
9. Waiting for the perfect EMR
"Essentially, I'm looking for the unicorn: SimplePractice ease plus a more robust longevity-medicine EMR. I've tried Charm, Practice Better, OptiMantra, Elation. I'm evaluating Ultralight Health and SigmaMD." — Tatiana Zeballos
"What is missing is a truly integrated longevity platform that brings together labs, imaging, wearables, lifestyle data and longitudinal trends. Measurement is solved. The challenge is turning all that data into better clinical decisions." — Maloes Zadeh
No fully integrated EMR is built for this field yet. Choose for patient communication and documentation first. Expect to migrate, so keep your data portable. Measurement is solved; turning data into clinical decisions is not.
10. Waiting to build systems until you need them
"Businesses last when they have repeatable processes. The goal is building a business that can keep working even when the founder takes a step back." — Jijoe Joseph
"Put systems in place early so that other people in your practice are doing the heavy lifting. If the practice stops when you step away, you built a job." — Jonathan Stegall
Build the process before you need it, not after it breaks. Write down anything an app or nurse could run without you. Repeatable beats heroic.
What does the longevity field still have to build?
This field is early. Nobody in this report had a map when they opened, and it shows in what they got wrong.
What closes the gap is not more protocol content. It is benchmarks, so a physician knows what to charge without guessing for two years. It is systems, so the first eighteen months are inherited instead of reconstructed. It is technology built for this work rather than borrowed from another specialty. And it is continuous learning between physicians, because judgment and strategy do not come from a document. They come from watching a colleague make the call and say how it went.
That last part is the one we can do immediately, and it is what this report is. Twenty-six physicians answered a question in the open so the next physician does not pay for the same lesson alone.
Thank you to the longevitydocs members who answered
Shah Ahmed, Janaan Arfeen, Katy Bernstein, KeriLyn Bollmann, Bismarck Cadet, Shoma Datta-Thomas, Brenda Dintiman, Julie Doyle, Mark Dukshtein, Ladi Ilkhani, Jijoe Joseph, Daniel Kessler, Sarah Lacarrubba, Melissa Loseke, Salomé Masghati, Lisa Menuet, Haleem Mohammed, Steven Murphy, Mohan Muvvala, Jontel Pierce, Laura Preece, Katie Rybak, Jonathan Stegall, Christine Watson, Maloes Zadeh, Tatiana Zeballos.
Frequently Asked Questions
How do I sign up for Dr. David Luu's weekly newsletter?
You can subscribe to Weekly Longevity Medicine Intelligence, Dr. David Luu's newsletter, at newsletter.longevitydocs.org. It publishes every Sunday for licensed physicians and healthcare professionals, and covers a new cover story, a LongevityDocs Lexicon deep-dive, and a roundup of the week's longevity medicine news.
Why are doctors leaving traditional practice for longevity medicine?
Standard visits do not leave enough time to prevent disease, personalize a protocol, or follow a patient long enough to see it work. Physicians moving into longevity medicine get paid for outcomes rather than volume, and they get to practice the medicine they trained for. Read last week's deep-dive here.
What is longevitydocs?
longevitydocs™ is the world's leading vetted physician network, offering physician-only access to evidence, peers, events, and true infrastructure for growth. Also home to the Certified longevitydocs (CLD) longevity medicine certification, built by physicians for physicians. The community is designed for those committed to advancing evidence-based longevity care and uniting the best specialties across functional medicine, cardiology, hormone health, and regenerative medicine. Learn more at longevitydocs.org
Do I need to already be practicing longevity medicine to be part of the longevitydocs community?
No. The longevitydocs member community spans 1,200+ doctors across 68+ countries from all different areas of expertise. Nearly half of all Certified Longevitydocs alumni come from primary care, emergency medicine, and internal medicine—not everyone is from concierge or boutique backgrounds.
What is the Certified Longevitydocs (CLD)?
The Certified longevitydocs™ (CLD) is the world's first longevity medicine certification for physicians: 100+ hours of curriculum across 10 modules, from Biology of Aging and Testing and Diagnostics to Specialty Integrations and Practice Leadership, self-paced over 6 to 9 months alongside a full clinical schedule. Graduates earn the Certified Longevitydocs™ credential and join a working network of 1,200+ physicians across 68+ countries.
How do I transition to longevity medicine?
Transitioning to longevity medicine requires clarity on your practice model, pricing, payment structure, and operational systems. The Certified Longevitydocs program guides physicians through business strategy, clinical protocols, and community connection. Explore transition pathways here and learn from physicians who have made the move.
What is the ROI of a longevity practice?
ROI depends on your practice model, pricing, and operational efficiency. Physicians report that membership models fund continuity, fee-for-service optimizes encounters, and proper systems allow practices to scale without trading time for money. Learn how to build a sustainable model and determine ROI through the CLD and by exploring real physician case studies.
About Dr. David Luu, MD
Dr. David Luu, MD is the Founder of longevitydocs™. He is a trained pediatric cardiac surgeon, longevity tech entrepreneur, and philanthropist who helps physicians, organizations, and leaders build the global infrastructure of longevity medicine.
About longevitydocs™
longevitydocs™ is a physician-led longevity medicine community and certification platform. We train doctors in the science and business of longevity medicine, connect them with peers worldwide, and provide the operational benchmarks, infrastructure, and clinical protocols this emerging field needs. Our 1,200+ vetted member physicians span 68+ countries.
Editorial Disclaimer
This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.
All content is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.
By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.
If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.
Mistakes to Avoid When Building a Longevity Practice
NEWSLETTER
Mistakes to Avoid When Building a Longevity Practice
Part 2 of 4: Operational mistakes longevity physicians make when building longevity practices shared by 26 doctors across specialties from anestheisiology, cardiology, dermatology, emergency medicine, internal medicine, primary care and more. A community-sourced field report on pricing, insurance, payment models, hiring, systems, and EMR.Hey Doc,
Ten mistakes in the report below. I made most of them.
New tech and new protocols get the attention. There are a thousand posts a week on them. The hard work happening on the ground is less clickable. The sweat, the tears, the wins nobody sees. Foundations, reputation, team.
Part of why it stays quiet is that the conversation is hard. It takes humility, self-awareness, and a willingness to say what you got wrong with your name attached.
So I asked. Twenty-six doctors answered, in the open. I compiled it into a field report below. It is a work in progress, and that is the point. If we want a standard for longevity medicine, we have to put this out and let others build on it.
Our certification learners also told us they wanted to study alongside their own specialty. So we are opening the first CLD cohort for dermatologists. Just reply to this email if that is you.
As always, Happy Sunday.
Dr. David Luu,
Founder, longevitydocs™
PS. Built the technology. Built a complex product. Built a multi-offering. Built a place. Maybe I should not have. I learned from all of them. We were building something that did not exist yet. Happy to give back now.
Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life. For my full perspective sign up for my weekly newsletter and follow on substack. Read the full issue on Substack.
Mistakes to Avoid When Building a Longevity Practice
Longevity medicine has a growing clinical literature and no operational one. Physicians opening practices have no published standards, no pricing benchmarks, no model comparisons, no software evaluations, and no account of what the first eighteen months actually cost.
So we collected one. Over the course of a week we put a series of questions to physicians in the member chat on longevitydocs.ai and let them answer each other in the open. Twenty-six responded on the record, from two months in practice to twenty-three years.
Ten mistakes came back often enough to treat as the operating reality of the field rather than one person's bad luck. Insurance does not pay for this work. Most physicians underprice at launch. The payment model decides how you practice, not just how you get paid. Capital gets spent before demand exists. Service lines get added before any of them are good. Paid marketing loses to the physician's own voice. Income tied to time caps the practice. Access given without terms is the most common boundary failure. No software does the job, so everyone runs workarounds. And systems get built only after something breaks.
1. Expecting insurance to pay for longevity testing
Steven Murphy named it as his first error in exactly those words. Every respondent who addressed insurance had made the same one.
Jijoe Joseph found the more dangerous version, which is partial coverage.
Partial coverage is worse than none. It moves unpredictable risk onto the patient, and the surprise lands on your relationship.
2. Underpricing at launch
Near-universal. The regret is not the number. It is that the number is hard to change later.
Set the price you intend to sustain, from patient one. Raising it later is harder than starting there. Fewer patients leave than you fear.
3. Letting your payment model decide your medicine
The most consequential finding came from a physician who changed her model to fix her medicine.
Fee for service made her reluctant to ask patients to return. That reluctance removed follow-up. Without follow-up, testing produces confusion instead of care. She changed the payment structure to restore the clinical loop.
Not a payment decision, it decides how you practice. Membership funds continuity and follow-up. Fee for service optimizes the encounter. Pick the one that fits the medicine you want to deliver.
4. Spending on space and equipment too early
Start lean, buy one thing at a time, after demand is proven. Hire the person before the device. Shiny object syndrome is expensive.
5. Building every service line at once
Narrow the offering to what you are good at. Listen to your patients, measure traction before adding. Start with solvable cases that get results quickly.
6. Spending on paid marketing instead of your own voice
Your voice outperforms paid ads and costs nothing. Patients choose a physician, not a clinic. Raw beats polished content.
7. Tying your income to your time
If you only earn when you are in the room, you are the ceiling. Ask for help and take it. Delegate before you are drowning, not after. Hire good staff early, train them, keep them.
8. Giving away your access without boundaries
You are the asset. Protect the time and the access. Set expectations at visit one, not after they slip. Give out a practice line, not your cell.
9. Waiting for the perfect EMR
No fully integrated EMR is built for this field yet. Choose for patient communication and documentation first. Expect to migrate, so keep your data portable. Measurement is solved; turning data into clinical decisions is not.
10. Waiting to build systems until you need them
Build the process before you need it, not after it breaks. Write down anything an app or nurse could run without you. Repeatable beats heroic.
What does the longevity field still have to build?
This field is early. Nobody in this report had a map when they opened, and it shows in what they got wrong.
What closes the gap is not more protocol content. It is benchmarks, so a physician knows what to charge without guessing for two years. It is systems, so the first eighteen months are inherited instead of reconstructed. It is technology built for this work rather than borrowed from another specialty. And it is continuous learning between physicians, because judgment and strategy do not come from a document. They come from watching a colleague make the call and say how it went.
That last part is the one we can do immediately, and it is what this report is. Twenty-six physicians answered a question in the open so the next physician does not pay for the same lesson alone.
Thank you to the longevitydocs members who answered
Shah Ahmed, Janaan Arfeen, Katy Bernstein, KeriLyn Bollmann, Bismarck Cadet, Shoma Datta-Thomas, Brenda Dintiman, Julie Doyle, Mark Dukshtein, Ladi Ilkhani, Jijoe Joseph, Daniel Kessler, Sarah Lacarrubba, Melissa Loseke, Salomé Masghati, Lisa Menuet, Haleem Mohammed, Steven Murphy, Mohan Muvvala, Jontel Pierce, Laura Preece, Katie Rybak, Jonathan Stegall, Christine Watson, Maloes Zadeh, Tatiana Zeballos.
Frequently Asked Questions
How do I sign up for Dr. David Luu's weekly newsletter?
You can subscribe to Weekly Longevity Medicine Intelligence, Dr. David Luu's newsletter, at newsletter.longevitydocs.org. It publishes every Sunday for licensed physicians and healthcare professionals, and covers a new cover story, a LongevityDocs Lexicon deep-dive, and a roundup of the week's longevity medicine news.
Why are doctors leaving traditional practice for longevity medicine?
Standard visits do not leave enough time to prevent disease, personalize a protocol, or follow a patient long enough to see it work. Physicians moving into longevity medicine get paid for outcomes rather than volume, and they get to practice the medicine they trained for. Read last week's deep-dive here.
What is longevitydocs?
longevitydocs™ is the world's leading vetted physician network, offering physician-only access to evidence, peers, events, and true infrastructure for growth. Also home to the Certified longevitydocs (CLD) longevity medicine certification, built by physicians for physicians. The community is designed for those committed to advancing evidence-based longevity care and uniting the best specialties across functional medicine, cardiology, hormone health, and regenerative medicine. Learn more at longevitydocs.org
Do I need to already be practicing longevity medicine to be part of the longevitydocs community?
No. The longevitydocs member community spans 1,200+ doctors across 68+ countries from all different areas of expertise. Nearly half of all Certified Longevitydocs alumni come from primary care, emergency medicine, and internal medicine—not everyone is from concierge or boutique backgrounds.
What is the Certified Longevitydocs (CLD)?
The Certified longevitydocs™ (CLD) is the world's first longevity medicine certification for physicians: 100+ hours of curriculum across 10 modules, from Biology of Aging and Testing and Diagnostics to Specialty Integrations and Practice Leadership, self-paced over 6 to 9 months alongside a full clinical schedule. Graduates earn the Certified Longevitydocs™ credential and join a working network of 1,200+ physicians across 68+ countries.
How do I transition to longevity medicine?
Transitioning to longevity medicine requires clarity on your practice model, pricing, payment structure, and operational systems. The Certified Longevitydocs program guides physicians through business strategy, clinical protocols, and community connection. Explore transition pathways here and learn from physicians who have made the move.
What is the ROI of a longevity practice?
ROI depends on your practice model, pricing, and operational efficiency. Physicians report that membership models fund continuity, fee-for-service optimizes encounters, and proper systems allow practices to scale without trading time for money. Learn how to build a sustainable model and determine ROI through the CLD and by exploring real physician case studies.
Dr. David Luu, MD is the Founder of longevitydocs™. He is a trained pediatric cardiac surgeon, longevity tech entrepreneur, and philanthropist who helps physicians, organizations, and leaders build the global infrastructure of longevity medicine.
About longevitydocs™longevitydocs™ is a physician-led longevity medicine community and certification platform. We train doctors in the science and business of longevity medicine, connect them with peers worldwide, and provide the operational benchmarks, infrastructure, and clinical protocols this emerging field needs. Our 1,200+ vetted member physicians span 68+ countries.
This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.
All content is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.
By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.
If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.