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The Cost of Opening a Longevity Practice
NEWSLETTER • ISSUE 114
The Cost of Opening a Longevity Practice
Depending on the model, opening runs from under $10,000 to more than $1 million. Most of that difference is real estate and equipment.
Hey Doc,
I just came back from ASDS in San Diego, the American Society for Dermatologic Surgery meeting. More and more specialists want to add longevity care to their practice to support the specialty they already have, from dermatology to cardiology to internal medicine. I think we are seeing a shift.
Today’s story is part 2 of The Business of Longevity Practices: what it costs to open a practice. Stay tuned for part 3 next Sunday: the equipment for your longevity practice.
Then, What’s New at longevitydocs™: we are introducing Courses, to learn the latest in longevity medicine. In Research, I am excited about Vadim Gladyshev’s Simply Aging perspective. And in News, Anthropic bought Mithril, a one-person biotech company.
Happy Sunday!
Dr. David Luu, Founder, longevitydocs™
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, read the full issue on Substack.
THE BUSINESS OF LONGEVITY PRACTICES · PART 2 OF 4The Cost of Opening a Longevity Practice
You do not have to mortgage your house to start a longevity practice.
Or take out another loan. It can be simple and fast. There are still several steps, and we all went through them when we opened our own practices. Here they are, summarized, so you do not have to do the work.
Depending on the model, opening runs from under $10,000 to more than $1 million. Most of that difference is real estate and equipment. Most physicians underestimate a second number: the cash it takes to keep the practice running until the panel fills. Below: four levels, the ramp, three ways to open for less, and a two-page checklist so you do not miss a line.
If you are a health system or a larger investor planning a longevity clinic, stay tuned. Next week’s issue covers equipment, and you can adapt the thinking in this one to your clinic as well.
This is not a final playbook. The figures are planning estimates for a major US metro, where most of our US readers practice. Adjust them to your own practice and region, and get quotes before you commit.
Level 0: the lean start, under $10,000
A longevity practice can open for less than $10,000.
For the solo physician moving into longevity medicine. Start virtual and cash-pay. Keep it simple:
A license in one state
No MSO, no physical space, no DEA
One review with a healthcare attorney: member agreement and state rules
EMR, AI scribe, telehealth: monthly software, nothing upfront
Marketing: AI agents and LLMs
Branding and networking: mostly your time
You can move to Level 1 as soon as you get some revenue.
Level 1: virtual practice, $30,000 to $75,000
No lease. No build-out. The money goes to:
A professional corporation, and an MSO if you plan to grow
A healthcare attorney
Licenses in every state where your patients live
Malpractice
An EMR with telehealth and an AI scribe
A website and a brand
Labs come from at-home kits or mobile phlebotomy. Fixed overhead stays near $175,000 a year. The trade-off: no physical exam, no on-site testing, and less of the trust that comes with a room.
Level 2: in-person practice, $175,000 to $450,000
One or two exam rooms in about 1,200 sq ft. Imaging sent out. The biggest line is the space.
Build-out: second-generation medical space, already plumbed and wired, costs 30 to 50% less than a shell. Roughly $100 to $260 per sq ft nationally, 20 to 30% more in coastal metros.
Exam furniture, ECG, body composition, blood draw station: $30,000 to $60,000
Legal, technology and brand: $25,000 to $50,000
A lease deposit
If you want a room, start here.
Level 3: state-of-the-art clinic, $1 million to $2.5 million
2,500 to 4,000 sq ft. DEXA, VO2 max, ultrasound and recovery rooms on site, built from a shell.
Build-out: about $240 to $365 per sq ft in coastal metros. 3,000 sq ft costs $720,000 to $1.1 million before equipment.
Body-composition DEXA: $30,000 to $45,000 refurbished, more new
Metabolic cart with treadmill: $40,000 to $80,000
Design, furniture, IT and pre-opening hires: the rest
Level 3 can climb fast. It depends on the equipment you pick:
MRI: up to a 7T scanner
CT: the latest generation
VO2 max: from a simple mask device to a full gas-exchange metabolic cart
This model makes sense once a brand and a waitlist already exist. Next Sunday, part 3 goes through the equipment machine by machine.
The number most physicians miss: the ramp
Opening costs end on day one. Overhead does not.
Overhead in last week’s metro example: about $38,000 a month
At 8 to 10 new members a month paying $10,000 a year, revenue covers overhead after about 7 months, and your target pay after 12 to 15
The gap until then: about $130,000 for overhead alone, closer to $500,000 if you pay yourself
Budget for it before you sign the lease.
The most important investment is trust and knowledge.
Dr. David Luu, MD · Founder, longevitydocs™Ways to open for less
1. Go virtual. Build the panel online. Add a room when you have the members to fill it.
Skip the lab room. Mobile phlebotomy and at-home kits do the draws.
Send imaging out. An outside DEXA stays cheaper until you run several hundred scans a year.
When you buy, buy refurbished or lease. A GE iDXA rents from about $1,200 a month.
2. Partner. Someone else already has the space, the equipment or the patients.
Hotels and members’ clubs. They want longevity on the premises. They bring the space and the clientele. Negotiate a revenue share instead of rent.
Gyms. Run VO2 max and strength testing where the equipment, and your future patients, already are.
Other physicians. Sublease an exam room by the day. Or split the suite, the front desk and the nurse with a colleague whose patients complement yours.
Landlords. Take second-generation medical space. Negotiate a tenant improvement allowance and free months.
Health systems. Become their longevity service line. They have the rooms, staff and patients. You bring the program.
3. Go niche. Pick one clinical lane and equip only for it.
Menopause and bone: a lab partner and a DEXA referral.
Cardiometabolic: labs, CGM and an ECG. Send the calcium score out.
Skin longevity: the dermatology room you already have.
Brain health: cognitive testing software and a lab partner.
One mistake to avoid
Do not build your model on a margin from labs or treatments like HRT and peptides. They are becoming commodities. Patients can already order a 100+ biomarker panel online for $199, and prices keep falling. There is almost no margin left to make on them.
The most important investment is trust and knowledge.
Build your brand, stay educated and keep growing your mindset.
Before you sign anything, go through the opening checklist. Two pages, one for a virtual practice and one for a brick and mortar practice, with every line to budget on each: one-time costs on the left, monthly costs on the right, each marked must-have or nice-to-have.
Outside the US. Rent, build-out and equipment prices vary more by country than anything else in this story. Run the same levels with local quotes. In many markets, a hospitality or private hospital partner is the fastest way to an in-person room.
Planning your opening? Club members have already done it, and can tell you what they would not buy again. Apply to the Club →
Next Sunday, part 3: how to equip a longevity practice, and what Humanaut, Atria, Biograph and Neko put on site. Part 4, the following week: who to hire first.
Keep reading
-
How to Build a $1M Longevity Clinic
Three clinic models, the metrics that matter and the checklist to run before your first patient. -
What It Really Takes to Build a Longevity Practice
The Cannes Summit panel on launching and scaling a longevity practice. -
longevitydocs™ Launches The Club
The private physician membership for peers building longevity practices, with 100 seats in the 2026 cohort.
Frequently Asked Questions
How much does it cost to open a longevity practice?
Dr. David Luu puts opening costs between under $10,000 and more than $1 million, depending on the model. A lean virtual start runs under $10,000, a full virtual practice $30,000 to $75,000, an in-person practice with one or two exam rooms $175,000 to $450,000, and a state-of-the-art clinic $1 million to $2.5 million. The figures are planning estimates for a major US metro.
Can a physician start a longevity practice for under $10,000?
Yes, as a virtual, cash-pay solo practice. That means a license in one state, no MSO, no physical space and no DEA registration, one review with a healthcare attorney for the member agreement and state rules, and monthly software for the EMR, AI scribe and telehealth. The physician can move to a fuller virtual setup once revenue comes in.
What does a virtual longevity practice cost to set up?
About $30,000 to $75,000, with no lease or build-out. The money covers a professional corporation (and an MSO for growth), a healthcare attorney, licenses in every state where patients live, malpractice, an EMR with telehealth and an AI scribe, and a website and brand. Fixed overhead stays near $175,000 a year, at the cost of physical exams and on-site testing.
How much does the build-out of a longevity clinic cost per square foot?
Second-generation medical space, already plumbed and wired, costs 30 to 50% less than a shell, roughly $100 to $260 per sq ft nationally and 20 to 30% more in coastal metros. A flagship clinic built from a shell runs about $240 to $365 per sq ft in coastal metros, so 3,000 sq ft costs $720,000 to $1.1 million before equipment.
How long before a new longevity practice covers its overhead?
In Dr. David Luu's metro example, overhead is about $38,000 a month. Adding 8 to 10 members a month at $10,000 a year, revenue covers overhead after about 7 months and the physician's target pay after 12 to 15. The gap to fund is about $130,000 for overhead alone, or closer to $500,000 if the physician draws a salary.
How can a physician open a longevity practice for less?
Go virtual first and send labs and imaging out, partner with hotels, gyms, other physicians, landlords or health systems that already have space and patients, or pick one clinical lane such as menopause and bone and equip only for it. Dr. David Luu also warns against building the model on lab or HRT and peptide margins, which are becoming commodities.
What is longevitydocs™?
longevitydocs™ is the intelligence network for longevity medicine. A vetted network of 1,000+ licensed physicians in 68+ countries, founded by pediatric cardiac surgeon Dr. David Luu, that trains, certifies, connects, and conducts research with doctors practicing longevity medicine. The network runs the Lexicon, the Directory, the Masterminds, the annual Summit and the Certified longevitydocs™ (CLD) credential.
How do I apply for longevitydocs™ membership?
Apply on the membership page at longevitydocs.org/pages/apply-membership. Membership is open to licensed MD, DO and MBBS holders, and every application is reviewed manually to confirm credentials.
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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 the intelligence network for longevity medicine. A vetted network of 1,000+ licensed physicians in 68+ countries, founded by pediatric cardiac surgeon Dr. David Luu, that trains, certifies, connects, and conducts research with doctors practicing longevity medicine.
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