Why is this even a question? I mean the first chapter makes it abundantly clear, as in literally clear, that after he failed to keep up with the highly competitive struggle for a position in the countries top hospital he opened his own practice which failed and left him saddled with a huge debt. His aim now is to run a high scale surgical beautician where he can deal with less stress and still earn a huge amount of money. By the way the starting salary for a specialist in dermatology is ~$325K, the median salary in 2015 was ~$425K. Whereas the average surgeons salary in 2018 was ~$322K. So there certainly is some ignorance of the real world at hand but I'm not sure if its really the authors.