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Saturday
Jul262014

Negotiating Work Contracts As An Aesthetic Physician

We receive requests information or advice from physicians, many of them looking to partner with other doctors or businesses in some way. 

Here's one we received this week that has also been posted in the medspa forums:

I am in talks with a fellow physician to be hired as an employee of (an existing aesthetic) practice. He is going to spend time training me (in addition to the training I already did with American Academy of Aesthetic Medicine) for a period that they say can be from anywhere between 3-6 months. Is that considered to be a long time to be trained? After they were comfortable with me doing different procedures I would then be seeing patients on my own.

Although they were advertising this job they keep asking me how much I want to be payed for both the training period and then after. I'm not even sure what would even be considered appropriate. Hourly? Salary? Percentage of revenue? They also are asking me to sign a 3-5 year contract.  Is this reasonable? This job is in (withheld) to give you any needed geographic references. I would appreciate any help that you guys could offer...

There is always a lot of confusion about this but most questions can really be divided into tow camps:

  • What is the fairest method or structure for compensation? (The business question) or
  • What is the best legal structure for medical oversight or liability? (The medical/legal question.)

The legal structure is always going to depend upon location since every state or country is different. In some states you can provide medical oversight legally even if you're not on-site, in others you have to physicially be at the location when any treatment is performed that you're extending your medical oversight to, and there are some states where a physician has to actually perform the same treatments that estheticians' are allowed to perform pretty much on their own. Countries differ even more with some treatments (laser hair removal is one example) being classified as medical treaments in some countries and not others. That being said, it's pretty easy to find out what your requirements are based on whatever location you're operating in.

The compensation issue is much less straightforward and can actually be impacted by some of the legal strictures that your location imposes. A couple of issues that might be of concern for you:

  • Direct referrals from other physicians may be seen as fee-splitting. (Fee-splitting is designed to prevent physicians from getting kick-backs for sending patients to other physicians.)
  • Non-physicians can not employ physicians in the US. (There are corporate relationships that are used effectively to get around this.)
  • Who is providing the medical liscence and oversight?
  • Who is providing malpractice insurance and has the legal liability?
  • Where/how is revenue being generated?

You can see that these issues all compound and none of them are trivial, but these business decisions and negotiations are much more clearly defined since every business deals with them. They're basically defined by the market and what it will bear. I'll post some thoughts later on all of these questions one by one and we'll work through the list.

 

Monday
Jul072014

How Your Competitors Might Be Destroying Your Medical Spa Business Using Google Maps

Almost anyone can damage your medical practice business or reputation by turning Google against you.. and it's not very hard.

medical spa google maps

Here's an example from Wired Magazine detailing how a restaurant's business was destroyed: Read the article.

It began in early 2012, when he experienced a sudden 75 percent drop off in customers on the weekend, the time he normally did most of his business. The slump continued for months, for no apparent reason. Bertagna’s profits plummeted, he was forced to lay off some of his staff, and he struggled to understand what was happening. Only later did Bertagna come to suspect that he was the victim of a gaping vulnerability that made his Google listings open to manipulation.

He was alerted to that possibility when one of his regulars phoned the restaurant. “A customer called me and said, ‘Why are you closed on Saturday, Sunday and Monday? What’s going on?’” Bertagna says.

It turned out that Google Places, the search giant’s vast business directory, was misreporting the Serbian Crown’s hours. Anyone Googling Serbian Crown, or plugging it into Google Maps, was told incorrectly that the restaurant was closed on the weekends, Bertagna says. For a destination restaurant with no walk-in traffic, that was a fatal problem.

In the case above the business owner is actually trying to sue Google, claiming that a competitor manipulated the restaurants business and that Google didin't do anything about it.

He's not going to get anywhere with that, but it serves to highlight just how vulnerable a local business can be if you're not keeping abreast of what's going on.

Beneath its slick interface and crystal clear GPS-enabled vision of the world, Google Maps roils with local rivalries, score-settling, and deception. Maps are dotted with thousands of spam business listings for nonexistent locksmiths and plumbers. Legitimate businesses sometimes see their listings hijacked by competitors or cloned into a duplicate with a different phone number or website...

Small businesses are the usual targets. In a typical case in 2010, Buffalo-based Barbara Oliver & Co Jewelry saw its Google Maps listing changed to “permanently closed” at the exact same time that it was flooded with fake and highly unfavorable customer reviews.

“We narrowed it down as to who it was. It was another jeweler who had tampered with it,” says Barbara Oliver, the owner. “The bottom line was the jeweler put five-star reviews on his Google reviews, and he slammed me and three other local jewelers, all within a couple of days.”

The first thing you should do is go to Google, Yelp, Yahoo, and Bing and search for your business in different ways using your street address, name, zip code and your name (with misspellings if that's possible) and see what the returned results are. That should give you a sense of whether or not you might have an issue. All of the search engines have a method for creating a local business listing and changing it once you have it.

Not addressing new technology is really just whistling past the grave yard. Your business and reputation are vulnerable and makeing sure that you have clean information online is the first step.

Thursday
Jun262014

TruClinc Finally Brings A Real Telemedicine Solution For Concierge & Cosmetic Clinics

Telemedicine for small (cosmetic and concierge clinics) is finally getting off of the ground with TruClinic.

Very different from the doc-in-a-box model of other telemedicine players, TruClinic is the first truly embedded technology that closely fits how providers already work, and increases the ability of both physicians and physician-extenders to see more patients.

TruClinic has been built into a full telemedicine platform with a knack for tackling hard integrations, bottom-up user growth, and jaw-dropping uses. TruClinic’s cloud-based portal gives providders and patients access to each other from anywhere. All they need is a computing device, Internet connection, and a webcam, smart phone or tablet. From remotely wiring every home on the Goshute Reservation to facilitating interactions between a mother and her newborn child in an ICU to hosting surgical followup appointments, the uses of an always on, instantly connected telemedicine platform are only starting to be realized.

TruClinic is already being used actively by both small individual physician clinics, and larger hospital and clinic chains like the University of Utah Health Care that serves 5 surroundings states in a referral area encompassing more than 10 percent of the continental US and where TruClinc helps the U to reach their clients better, particularly in fields that mostly require communication, like mental health or post-surgery follow-up.

The University of Utah Health Care System is a thought leader in telemedicine. Here's a video:

One of the places that this is likely to be addopted first by individual physicians is around concierge or cosmetic medicine, where a very high-touch interaction at a distance can really have an effect on an ability to scale and interact with more patients in the same amount of time drives real revenue.

You can request a demo of TruClinic here.

Monday
Jun022014

Just When You Thought You'd Seen It All.

Bagel heads? What the hell?

National Geographic's new television series Taboo has shed light on the bizarre Japanese trend for “bagel heads”. Japan is the locus of weird. Especially in places like Tokyo, where you're compacted in with millions of other people, if you want to look like an individual the standards are HIGH.

Supposedly, the increasingly popular procedure is done by injecting saline into the forehead, then pressing in the center of the swollen area with a thumb. It’s temporary, so your “bagel” absorbs into your body after 6 to 24 hours, and that’s a good thing – no bagel-headed grandmas will be walking around in 50 years.

I can't see that you need to run out and sign up for any training on how to do this...

Thursday
May222014

Dr. Hung William Song - Omni Aesthetics in Oakland, New Jersey

Oakland, New Jersey Cosmetic Physician Dr. Hung William

Name: Hung William Song, MD
Clinic: Omni Aesthetics
Location: Oakland, NJ
Website: omniaesthetics.com

Can you tell us a little bit of your background and how did you get to where you are now? 

I am board certified in internal medicine I practiced internal medicine for 15 years but switched to a 100% cosmetic practice in 2008. I had about a two year transition period when I did both, but eventually turned over all my medical patients to a colleague and started concentrating full time on my cosmetic practice.

Do you have any procedures that you like better than others? Have you dropped any treatments? If so, why?

My favorite treatments are dermal fillers and fat transfers. I stopped marketing acne treatment because acne is more of a medical problem rather than cosmetic, I now refer these clients to a dermatologist.

You offer treatments with fat transfer. Where have you seen the most success with this treatment? What have you learned about getting the most benefit from this? Do you have any special techniques or 'tricks' that you use? 

I offer a full face fat transfer. I like to fill the whole face starting from the hair line and temples to cheeks, nasal labial folds and pre-jowel sulcus. I use the Viafill system and mix platelet rich plasma with the fat for better viability.

Can you share your experience with fat transfer? How would you describe the efficacy and results? Where have been the most successful improvements in keeping the fat alive after transfer?

By using a disposable coated cannula to harvest and inject the fat and mixing the fat with PRP, I have been able to get good uniform fat retention. The fat is centrifuged using the Viafill system.

What are your thoughts about the technologies you’re using now such as Smart Lipo and Ulthera? 

Smartlipo is a good system because it is a very recognized name, but the machine is very expensive with high disposable costs. If I was to do it again, I would have bought the Vaser for half the price.

Ulthera was a moneymaker for me the first two years but now, I am having a difficult time with competition undercutting me on price. Everyone seems to have one these days including the gym across the street. The consumable cost on the Ulthera is also very very high.

I recently purchased the THermiRF system. This one was a home run because the price of the device is very reasonable and the consumable cost is very low. I use this device for stand alone skin tightening and in conjunction with doing liposuction on small areas like face, neck and arms. It is a very versatile machine but it does require some minor surgical skills which his good for me because I don’t think they will be offering this at the gym across the street.

Click to read more ...

Wednesday
May212014

Limiting Options Can Boost Your Medical Spas Sales

When you're trying to be everything to every one, too many options will actually cost you.

We make choices daily, may it be major or minor. We desire choices which we can differentiate and evaluate. But presenting individuals an abundance of choices do not necessarily equate to happier consumers. Consequentially, if you happen to be providing your medical spas clients or patients with too much choices, it will almost always hurt your conversion rates.

Choices have repercussions on the brain. As a matter of fact, some studies revealed that having to come up with a lot of decisions can leave people exhausted, mentally drained and more dissatisfied with their decisions. On top of that, it leads people to commit poorer choices -- sometimes at a time when the choice is crucial. Even if we choose well, we are often less content because, with so many choices, consumers are certain that somewhere out there was something much better. We experience doubt and uncertainty about the alternatives and we ponder about missed opportunities.

The same is applicable to your clinic. Your lits of services and pricing should be simple, straightforward and uncomplicated. If you want to increase form conversions, you must think about eliminating the number of options, not continually increase them. An easy experience shows users that you have enough options to choose from, and allows them to make comparisons that are relatively easy.

In fact, offering fewer options quickly lead to many more profits:

 

  • You're able to spend your patient markeing budget on fewer items.
  • Your staff can spend less time trying to talk about everything you can do, and talk about the benefits of the things that you already do.
  • You probably don't have to buy more technology.
  • Your patients can make clearer choices, and feel better about their decisions.
  • You sound more credibile and 'expert' in the area.

 

Limiting your menu of services and focusin your offering on a few key offerings gives you many benefits, and few drawbacks. If you offer everything you'll never be seen as being an expert in anything.

Saturday
May102014

Awesome Plastic Surgery Commercial?

Rhett & Link make local commercials (and they've turned their attention to plastic surgery).

These guys have millions of views on their YouTube channel. In these videos they show a 'behind the scenes' making of and then the actual videos.
You have to give it to Dr. Timothy Kelley there... that's not what you normally see, but the proofs in the 621k+ views... something's working there.
Sunday
Apr272014

Right Size Your Medspa Info & Pricing

Next time you're in the consultation room... remember this graphic.

Monday
Apr212014

Question: Are Female Doctors Better Than Male Ones?

A new study from the University of Montreal finds that there may be real differences between the care provided between female and male doctors, and that women outperformed men on certain metrics of patient care.

Valérie Martel, a masters candidate in the school’s department of health administration, Régis Blais, a professor in the department, and Roxanne Borges Da Silva, a professor of nursing, recruited 870 Quebec-based physicians—half men, half women—treating people with diabetes. To compare if a doctor’s gender affected patient behavior, the researchers evaluated  physicians on three parts of standard diabetes treatment: prescribing periodic eye exams, scheduling frequent physical check-ups and keeping their patients on some mix of three different medications, such as statins to control cholesterol. On all of the metrics, the female doctors beat the males. Other research has found that female doctors tend to show greater empathy are perceived as being better listeners.

The men tended to spend less time with their patients, as evidenced by the fact that the male physicians performed, on average, 1,000 more basic treatment procedures per year than their female counterparts.

The Montreal investigators plan to broaden their findings, looking at three other manageable conditions next: hypertension, asthma and chronic obstructive pulmonary disease (COPD), to see if the gender-based difference applies to other conditions as well.

Male doctors shouldn't pack up their doctor kits just yet. The younger the doctors in their study were, the narrower the divide between the sexes, suggesting that hurry-up male doctors are aging out of the system, being replaced by a newer, gentler generation of male clinicians.

Question: Will new patient ratings and outcome reimbursment triggers affect this?

Saturday
Apr122014

Dr. Daniela Dadurian - MD BeautyLabs Medical Spa In West Palm Beach Florida  

Dr. Daniela Dadurian, MD Beauty Labs Medical Spa, West Palm Beach Florida

Daniela Dadurian, M.D. specializes in Anti-Aging medicine, Laser treatment and Cosmetic Medicine. At MD Beauty Labs, Dadurian practices a whole-body approach. She evaluates everything from anti-aging to preventative, nutritional and emotional wellbeing.

Name: Daniela Dadurian, M.D.
Clinic: MD BeautyLabs Medical Spa
Location: West Palm Beach, Florida        
Website: mdbeautylabs.com

What's your training and experience like and how did you get to where you are? 

I started my practice specializing in internal medicine. My patients started asking me why I don’t offer Botox in my practice and if I did they would prefer to come to me. So I started educating myself on Botox injections and it all started from there. I then brought in lasers and microdermabrasion and over the years the practice has evolved into a full service medical spa.

What has certainly been your inspiration to start a medspa? What was the greatest obstacle you encountered?

My driving force to open a medical spa was to combine wellness and aesthetic medicine and focus more on preventative medicine rather than fixing problems that are already there

My biggest road block was the overwhelming doubt from other physicians that I wasn’t a real physician anymore. Patients trust their doctors opinion when choosing procedures and many of the times the same colleagues that referred to me for years, now discredited my ability because I was changing my direction to aesthetics. 

MD BeautyLabs Medical Spa, Dr. Daniela Dadurian, West Palm Beach. Florida

What treatments/services do you offer?

I offer a number of different services, however the treatment that consistently generates the most revenue are fillers. I have dropped services in the past. I have dropped services because the market had decreased their value (example Groupon, Living Social), and I have also dropped service because I found a new technology that I feel is superior.

Have you ever had any encounters with technologies that you felt were oversold, either to the physician or to the patient? Are there any specific technologies that you would endorse to physicians to be wary of, either for medical or business reasons? 

I feel like cold lasers have very unpredictable treatment outcomes usually ending with dissastified patients. There is nothing specific that I would say to stay away from, my only advice is to focus on being good at a few things not everything unless you are properly staffed.

Click to read more ...

Tuesday
Apr012014

Dr. Janet Turkle, (Turkle & Associates) Phases Skin Care & Laser Center In Indianapolis, Indiana

Some problems are better handled with less invasive treatment and there are products and treatments that can delay the need for surgery or prolong and protect one’s investment in surgical procedures.

Indiana Board Certified Plastic Surgeon Dr. Janet Turkle

Name: Dr. Janet K. Turkle
Clinic: Turkle & Associates
           Phases Skin Care and Laser Center
Location: Indianapolis (Carmel), Indiana
Website: turklemd.com  phasesskincare.com

That's interesting: Dr. Janet K. Turkle was involved in the clinical trials for the silicone gel implants and provided extensive data to the researchers.

Please tell us briefly about your qualifications and how did you get to where you are?

I have been in Indiana as a plastic surgeon since I completed my residency at Indiana University Medical Center in 1993 and entered private practice.

Are you convinced that being female creates opportunities in attracting prospective clients?

I think it has advantages and disadvantages. As a female, I can relate to my female patients but I hopefully relate to my male patients as well. Some women may feel more comfortable telling you things or showing you things that they would not if you possessed the Y chromosome but it doesn't always work that way.

If you weren't a medical professional, is there anything you'd rather be spending time on?

I truly cannot think of what that would be. I am doing exactly what I want to do.

Janet Turkle MD, Indiana Cosmetic Plastic Surgeon

Aside from a plastic surgery practice, you also have a Skin care and Laser Center. What difficulties did you tackle when you began your practice? 

When we started then skin care portion of the practice it was fairly rare to combine that with a plastic surgery practice. I think that the biggest challenges have been to make people aware of how important lasers and skin care can be in terms of their total improvement. When we do surgery, we can make improvements in structure but we cannot improve things like texture and discoloration. A combined effort of laser treatments, products and other therapies will improve the outcome, regardless of the type of surgery.

Click to read more ...

Wednesday
Mar122014

Dr. James Wharton - Louisville Dermatology Clinic In Kentucky

Dr. James Wharton uncovers insights that could lead to better business decisions.

Dr. James Wharton - Louisville Dermatology Clinic In Kentucky

Name: James R. Wharton, MD
Clinic: The Aesthetics Center of Louisville/ Louisville  Dermatology Clinic
Location: Louisville, KY
Website: aestheticscenter.org and louisvilledermatology.org

Tell us about your clinic? What treatments do you provide?

We have separated our practice into two clinics. The Louisville Dermatology Clinic is a full service general dermatology practice. We evaluate and treat patients with any skin disease or condition. We treat adult and pediatric patients. We perform surgical procedures such as biopsies, excisions and more complicated cases requiring Mohs micrographic surgery. We have a full dermatopathology lab that can provide analysis and examination of specimens on site.

The Aesthetics Center of Louisville is located in the same building but is a separate practice. We separated our practices for the benefit of our patients. We feel this ethically is the best representation we can provide to our patients. We have a state of the art full service aesthetics practice that offers: peels, microdermabrasion, make-up application, waxing, lash/brow tinting, dermaplaining, IPL, laser hair removal, laser resurfacing, leg vein treatments, various radiofrequency procedures, Ultherapy, tattoo removal, Acleara treatments for acne, MiraDry, injectable toxins, dermal fillers, and concierge VIP dermatology.

You possess active medical licenses in Kentucky, Arkansas, Texas, Hawaii, Missouri, and Florida. Are there any specific distinctions regarding how you can practice medicine on each state?

I have active medical licenses in multiple states. While I currently  only practice medicine in Kentucky, it is important that physicians familiarize themselves with all the regulatory requirements for their state. There is a great deal of variation in the laws regarding which procedures can be delegated and the requirements of each state can significantly affect a business and what services they are able to offer.

Click to read more ...

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