How much it costs to open an aesthetic medicine clinic in Spain: the eight budget items

Why the investment varies so much from one clinic to another

The investment required to open a clinic in Spain varies considerably from one project to another, and so does the time from the start of the project to the first patient seen. We have worked with that variation since 1999, exclusively in this sector.

Between the most modest project and the most ambitious one, the gap is wide. Faced with a difference of that size, the first conclusion is that an average figure says little of use.

That range, however, holds precise information: the difference reflects decisions, not uncertainty. There are four specific decisions, and all of them are made before the first contract is signed. If you know them, you decide how much your project invests instead of discovering it along the way.

This analysis answers three questions: what those four decisions are, which eight items must be budgeted before you commit a single euro, and which item is most often left out. That last item is also the one that determines how stable the first months are.

The final budget depends on each project’s figures; by the end, you will know what to ask and in what order to build yours on solid ground.

The four decisions that set a clinic’s investment

Two projects match in floor area, city and street, and the question is which of the two requires more investment.

The first variable is which sector the center works in: a beauty center and a clinic with an operating room are very different inside. Dentistry needs an X-ray installation, and plastic surgery needs an operating room authorization, the slowest permit of all. A beauty center operates, in most cases, with a municipal activity license (licencia de actividad). Each requirement translates into works, equipment and schedule, and this variable alone already accounts for tens of thousands of euros.

If both projects are in the same sector, the difference moves to another variable.

The project that starts from premises in worse condition invests more. Premises that were already a clinic keep their installations, their layout and, often, the air conditioning. A former clothing store requires a full build-out: partition walls, plumbing to the treatment rooms, electrical capacity and ventilation. Fitting out the same floor area can cost three times more in one case than in the other.

With the same sector and premises in the same condition, the third variable comes into play.

That variable is the equipment: the project that buys its devices instead of financing them, and that opens with six instead of two, invests more. It is the decision that ties up the most capital on opening day and the one that leaves the most room to maneuver. A device can be added in month eight, once the schedule justifies it.

If the equipment also matches, one last variable sets them apart.

That variable is the schedule: every month with the premises leased and no revenue means cash going out on rent, utilities and, often, payroll. A project that takes twice as long to open costs substantially more than another, with the same works and the same equipment.

Sector, condition of the premises, equipment and schedule: those four decisions set your project’s investment, and all of them can be analyzed before you sign.

The eight items in an opening budget

A realistic opening budget is made up of eight items, all of them necessary; what varies between projects is the weight of each one.

1. Premises. Security deposit, rent paid in advance and, often, a bank guarantee: payments made before the clinic exists.
2. Works and fit-out. Partition walls, floors, ceilings, paint, carpentry and accessibility.
3. Technical installations. Electrical supply and capacity, air conditioning, ventilation, plumbing and drainage in the treatment rooms. This is the item that grows the most when the premises need a full fit-out.
4. Equipment and clinical fittings. Bought, financed or leased: the payment method changes the initial cash position, not the total cost.
5. Furniture, IT and practice management software. This includes the scheduling and medical records software, which is contracted before opening and paid from the first month.
6. Technical projects, fees and licenses. Fees for the technicians who sign the projects, municipal fees and those charged by the region (comunidad autónoma).
7. Brand, website and launch communication. This starts before opening: a clinic that opens with demand already generated reaches its planned schedule occupancy sooner, and that eases the pressure on the next item.
8. Working capital. The funds needed to operate until the clinic is sustained by its own revenue.

The item that carries the first months, and how to calculate it

Of the eight items, the one missing from most of the budgets we analyze is the eighth: working capital. It is left out because it is not perceived as an investment: it is not works, a device or a license. It is the money to pay payroll, rent, utilities and suppliers while the schedule reaches its planned occupancy.

Working capital is one more budget item, as necessary as the works or the equipment. It determines the project’s solvency up to month twelve, and it is simple to calculate. Here is how: the center’s fixed monthly cost multiplied by the number of months it will take to cover that cost with its revenue.

Both terms of that product tend to be underestimated at the same time, which widens the gap. The fixed cost is calculated without the months staff take to ramp up, and the time frame is estimated on the optimistic scenario. If your plan needs the clinic to reach its steady pace by month three, it is worth reviewing. Run the same calculation with month eight and check that the plan holds up in that scenario.

On top of that calculation comes a factor outside any promoter’s control. Of the entire opening schedule, the phase that depends on the authorities is the least predictable part of the project. A prudent budget works with the long time frame, because the short one depends on the only factor beyond your control.

Six steps to build your clinic’s budget

With everything analyzed above, the opening budget is built in this order:

1. Set your sector and your clinical scope before visiting premises. They determine requirements, works and permits and, therefore, the minimum amount of your budget.
2. Assess the premises by their fit-out cost, not by the rent. Low-rent premises that need new installations end up costing more than high-rent premises that are already prepared.
3. Separate the equipment you open with from the equipment for growth. Decide which devices you open with and which you add once the schedule justifies them. That separation frees up a significant share of the initial investment.
4. Budget all eight items with three quotes each. The third quote is the one that shows whether the first was competitively priced.
5. Calculate working capital on the slow scenario and include it as a budget item, not as an optional reserve.
6. Assign a date to the permits and allow for it to change. Each month of delay has an exact cost: the fixed monthly cost you have already calculated.

With these six steps you will have a figure of your own, with its assumptions stated, instead of a sector average. You will also know which levers to adjust to fit that figure to your investment capacity.

Your opening budget, built item by item on your project

The eight items in this article have a different amount in each project: they depend on the sector, the condition of the premises, the equipment and the schedule.

In our Opening service line, our team of consultants builds your clinic’s business plan and financial model, and directs the opening up to the first patient appointment.

We have worked only with clinics and beauty centers since 1999, with more than 1,050 projects across Spain.