Heather Levites, MD, took what she calls “a long road” to plastic surgery. It ran through MIT, Citi Smith Barney and Duke University before landing her in Raleigh, N.C., where she now runs Levity Lifts, a cash-pay cosmetic surgery practice in the Research Triangle.
Most physicians arrive at private practice after years inside hospital systems. Dr. Levites arrived with something most of them do not have: three years managing private wealth before she enrolled in medical school.
“I was not one to sit at a desk for any extended period of time,” she said. “I wanted something a little more creative, something a little bit more public-facing, where I get to interact with different people and meet new people.”
The pivot from finance to medicine was not a rejection of the first career so much as a recognition that it was the wrong version of the right instincts. Economics and finance at MIT gave her a fluency with data and financial modeling that she now applies directly to running a practice.
“I think familiarity with numbers and data manipulation was probably the couple of things that I took out of that time that I use now,” she said. “Do I like, am I doing pivot tables in Excel? No, but I think just having that sort of financial mindset when I look at everything is definitely helpful.”
According to a 2022 study in the National Library of Medicine, 79% of medical trainees reported below-average understanding of personal finance, despite nearly all agreeing that this education should be an integrated part of their training. However, incoming physicians are increasingly seeking to close that gap. According to a 2025 report from the Association of American Medical Colleges, 9% of medical students are pursuing dual degrees, with institutions reporting rising enrollment in MD/MBA and MD/MPH programs.
Physician leaders have also told Becker’s that business skills are necessary for physicians looking to step into executive or leadership roles at healthcare organizations, but are rarely taught in traditional medical school environments.
“Getting an MD alone is practically worthless in today’s [leadership] environment,” Regis DeSilva, MD, a cardiologist and associate professor of medicine at Harvard Medical School in Boston, told Becker’s. “The reason for that is that it’s been taken over by MBAs and business people, and they don’t pay any attention to garden-variety MDs.”
Dr. Levites completed her residency at Duke University Health System, where she remains on clinical faculty today. That affiliation is not incidental to the practice she has built. Raleigh’s Research Triangle is anchored by three major academic medical centers — Duke, UNC Health and WakeMed — and Dr. Levites said that institutional ecosystem gives Levity Lifts credibility with patients who fly in from outside the region specifically to be treated near those institutions, even though her practice operates entirely outside the insurance system.
“Levity Lifts is a private practice, and we don’t take insurance — we’re cash pay, all aesthetic surgery, all cosmetic procedures,” she said.
The model is deliberately distinct from the health system practices around her. Duke, UNC Health and WakeMed offer some aesthetic procedures, but Dr. Levites described them as primarily insurance-based and reconstructive-focused. The gap she identified was not in procedure availability but in the experience surrounding it.
“There’s definitely this niche of being able to come to a private practice like mine, where it’s very concierge — you’re well taken care of from beginning to end by a small team,” she said.
That model carries financial risk that employed physicians do not face. Without insurance reimbursement to smooth revenue, a cash-pay practice lives and dies on patient volume, pricing transparency and the strength of the patient relationship from first consultation through recovery.
From 2018 to 2023, the number of direct primary care and concierge practice sites grew by 83.1%, and the number of clinicians participating in them by 78.4%, according to a 2025 article in Health Affairs.
As insurers struggle to keep pace with rapid advances in biologics, diagnostics and AI-enabled care navigation, more physicians may turn to cash-pay models, according to Joshua Siegel, MD, director of orthopaedic sports medicine at Exeter, N.H.-based Access Sports Medicine and Orthopaedics, who told Becker’s he expects more patients to seek cash-pay services.
Nationally, roughly 1% of U.S. physicians have opted out of Medicare entirely, according to 2025 KFF data — a figure that understates the broader cash-pay and direct-pay movement, which includes physicians who accept Medicare for some services while operating cash-pay for others, as Dr. Levites does in aesthetic surgery.
Duke residents still train in her office, an arrangement that keeps her connected to academic medicine while she operates a fundamentally entrepreneurial practice.
“It’s a long road to get here,” she said.
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