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Medical Spa MDs: What's your problem?

OK,  since 90% of poll takers responded that they'd like something enough to pay at least something, it looks like I'll write something on medical spas. Of course if Dermacare starts voting that number might drop.

questionmark.gifSo I thought I'd ask for input as to what, if any, information the 10k monthly readers of this site would like to know more about (yes... increasing new patient flow will be in there automatically) 

Operations? Hiring? Technology? Finaincing? Where to buy a whetstone to sharpen your Botox needles so you can resue them? How to compensate your minions? How to keep get out of a medical spa franchise? Non-compete agreements?.... whatever. 

I'd just like some imput and interaction that can help provide some guidence about what you'd like to know the most so I don't waste as much time as I might.

Just leave a comment or send me an email.

Reader Comments (39)

I'd like to know how to compete better against plastic surgeons and dermatologists. I've been performing aesthetic treatments, Botox, Restylane, and IPL, (I got rid of my Cooltouch laser after a year). I've run into some nasty interactions with derms and plastic surgeons in my location. They've been actively telling patients, (some of them mine) that I have no training and that I'm practicing outside my scope of practice. (The hint is that I'm skirting the law.) So I'd like to know how to address this type of situation. Thanks.
03.18 | Unregistered Commenterflanks MD
Yeah, I'd like to find some logical, systematized way of determining which technologies are the best. A tall order I know but perhaps some type of matrix that includes cost, and physician satisfaction. Anyway, just a thought. Thanks for the offer to take input.
I know that in your post you discussed covering advertising and 'new patient flow' but I'd like to put in my 2 cents to try to make sure that that's covered... BTW, just like LS or CT or whoever, I'm addicted... not other site quite like this on the web.
03.18 | Unregistered CommenterDermGal
flanks MD:

What you've come up against sounds like bullying and harassment to me. You're not practicing outside your scope of practice if you hold an unrestricted license. It is 100% legal and ethical. You do have legal recourse. I would suggest talking with a lawyer. I don't care if the PS you're speaking about is chief of plastics at you're university. He/She has no right to harass you like that. And you have every right to defend yourself. Obviously, the PS and derms have fears of loosing their patient base.
And if I may add. This is a good case for developing our own specialty of cosmetic medicine.
03.18 | Unregistered Commenterbotoxdoc
Thanks for the support. I'd agree that a line's been crossed but of course it's just that, an theoretical line. Of course it's my patients that have let me in on what's really going on. I'll just deal. To be honest it's slightly fulfilling to have them worried about me and stiffened my resolve. Certainly I just bite my lip. I can't see how any patient could react positively to one physician back-stabbing another. Thanks again.
03.18 | Unregistered Commenterflanks MD
You're welcome. But, remember no line has been crossed. I'm not a lawyer, but I do know that if you hold an unrestrictred medical license in the US, you have the legal authority to practice medicine and surgery, including invasive surgery. However, you are also legally responsible for the outcome. So if you are going to do an appendectomy, for example, you better know what you're doing. But, you're injecting Botox and Botox isn't surgery by any stretch of the imagination. No line has been crossed.
03.18 | Unregistered Commenterbotoxdoc
Sorry I wasn't clear. I was referring to a line that others crossed. Back on topic now.
03.19 | Unregistered CommenterFlanks MD
I'd like a list of suppliers. I know there are docs saving a lot more than I am by buying in bulk, knowing where to buy from, etc. Give me that and I'm a happy doc.
03.19 | Unregistered CommenterChicago MD

Sorry my mistake. I misunderstood. You're right....they crossed the line of profesionalism and business ethics.
03.20 | Unregistered Commenterbotoxdoc
Flanks MD and DermacarelessMD,

Where is your aesthetic practice? If you have another practice internal marketing is the least expensive.

I have had some of the same problems. I have had some of the derms take pot shots at me in the same way. Patients will tell me this and keep coming back to me for aesthetic procedures. All you can really do is do your job and do it well. Excellence is the only way you will survive in this market.

I agree that we need to compile all of the data on the different technologies. At this time it is best to talk to others that already are using the technologies you are looking at. I searched the internet to see clinics using the technology and found that most were more than happy to talk about their technologies. Remember, talk to a lot of different people not just the sales rep. You are spending a lot of money and it is well worth your time to do some research.

I recently was looking for a good IPL and talked to many people and it came down to the Sciton BBL and the Palomar Starlux. I was leaning toward the Palomar but decided on the BBL when I talked to others and they did not likethe cost of the multiple heads and replacing the heads on the Starlux. This adds up in the long hall and acts just like having consumables.

We should form a purchasing group to buy in quantity.
03.20 | Unregistered CommenterLH
Hmmm..... A buying consortium.....

Perhaps this site could be used in some way to organize something like that, an group of physicians who have buying power. What do you think Jeff? Could Surface organize some type of affiliate group and/or use your site to offer this as some form of service to other physicians?
LH and DermacarelessMD have something there. Whatdaya think Jeff?
03.20 | Unregistered CommenterDermGal
You would have to accept that their will be the appearance of bias once you make your decision on the particular equipment. And you would have to come to a unanimous decision, which could be troublesome as you get more decision makers. I have seen a GPO work but the members of the GPO basically have deferred to the physician running the GPO that he "knows best". In this case, he actually does, but usually it's rare. Conceptually it is a good idea, but it has its pitfalls.
03.20 | Unregistered CommenterDexter
I'm aware that there are discounts to be had for bulk orders. Is there a way to bulk order Botox, Restylane, or other consumables? Perhaps there are vendors out there that would offer a discount or percentage off to readers of this site? Who's running this show anyway?
03.20 | Unregistered CommenterSumaMD
I agree it would be very difficult to organize the purchase of larger equipment such as lasers, IPL etc as we all have diferent needs in our respective settings.

I do think it may work to purchase radiesse, restylane and botox through joint efforts. Could even purchase hard goods such as 4X4's syringes etc. The only issue I can think of is making sure you are distributing to qualified individuals and you would not get dircet support from the manufacturers.
03.20 | Unregistered CommenterLH
How much support do you need for a 4x4? If Jeff were willing to organize it I'd show my picture ID.
You do not need anything for 4X4's or baseline goods but you must have licensure to purchase Botox, restylane etc. Of course, those are where you are going to save the most money.
03.21 | Unregistered CommenterLH
I'll check into this a little. If there any physicians who have some thoughts about how this type of system might work or what they have as needs, comment here or email me directly.

My first thoughts are bulk orders and split shipping for things like fillers, and technology consumables; Thermage cryogen canisters etc. Only for licensed physicians of course so there would be some checking to ensure that. I'd check with my lawyers too.

I'd like to gauge the acceptance of something like this so comments and thoughts would be appreciated.
One easy thing to do is to let everyone know if you have a less expensive supplier for any of these things. I currently get refurbished Fraxel tips that save me about half the cost on each tip and I have not noticed any difference in performance.

I can not believe that nobody is refilling the candela, thermage canisters.

By the way the AACS has a buying consortium. I have not used it and know very little about it. You must be a member of the AACS.
03.23 | Unregistered CommenterLH
They least the Thermage consumables. And they are terrible (unreliable, etc). Wouldn't recommend it.
03.25 | Unregistered CommenterAnnonymous
I'd sue the PS and Derm for Libel ... or at least send a "cease and desist" notice from a lawyer stating you'll file suit if it continues. That will make them STFU about your practice since most likely they have no business acumen.
03.26 | Unregistered CommenterLawDoc
How can we, as a group, fight for a specialty to be started for non-invasive procedures? I think this would be an amazing milestone and a good fight since it is in the name of consumer advocacy. I think a 6month - 1 year course/residency type program would be ideal for both physicians and consumers(patients) because we all know anybody can get into this field. And although we're happy we (non derm/plastic surgeon) physicians appreciate the fact we can have a piece of this action, it would be much more lucrative if we were to cut out a lot of the providers or add to our credentials as "Board Certified Aesthetic Medicine" physicians... please see if we can start a group of physicians to fight for this specialty. I think cosmetic surgery just because it's own american board specialty this year.
03.26 | Unregistered CommenterL.A. D.O.
L.A. D.O.

You are absolutely 100% correct. If you've looked at my posts I've been calling for an independant specialty board for some time. There is power in numbers.Its the only way were going to get the derms and PS off our back. (although they will be eligible for membership...) A medical board in "Aethetic Medicine" is exactly what we need. It is very possible to do. There are several steps that need to be followed to be recognized by the AMA and eventually by the ABMS. The board must be in existance for a minimum of 5 years to be recognized by the AMA and also have 1000 AMA members. But, I think there are enough of us practicing Aesthetic Medicine that we can hit those numbers. I recommend going to the AMA web site. There you will find a list of criteria that needs to be fulfilled. If you are interested please respond. I think if we can get 10 Docs to form a governance board we'll be on our way. I have already thought about this issue and I have developed a working model for a set of rules and regulations. But, its way too time consuming and expensive for one person. I think a group of 10 docs can do it with relatively little time and money commitment. It would be a chance to form a governing board, but also a chance to educate the public about who can perform cosmetic medicine. Many people still think you need to be a dermatologist which of course as we all know isn't true. Let me know if you're interested.
03.26 | Unregistered Commenterbotoxdoc
By the way, The founders of the board will automatically get fellowship status and get the designation of Fellow of the American College of Aesthetic Medicine (our what ever name we decide to call it.) ie. MD/DO, FACAM. Therefore, Its probably best not to call it the Universal College of Esthetic Medicine. as a fellow would then be MD/DO, FUC EM. Kidding aside, let me know if you're interested.
03.26 | Unregistered Commenterbotoxdoc

I wish I could say that board was already available but it is not. the American Academy of Cosmetic Surgery is doing exactly this. They were just recognized as a board in California after a long legal battle.

The only issue I have with them is that they will allow us Non-core trained docs to be associate members but we can never be fellows or board certified by them.

They have done a lot of the legal battles already. Maybe we "non-core" docs should start putting pressure on the AACS to be more inclusive of us. If enough of us were members and attended the national meetings we might be able to change things to our advantage.

We need to have one voice and the AACS says they want to be inclusive but are not inclusive enough. They will take our money to train us but do not want to truely include us.

03.26 | Unregistered CommenterLH
I'm absolutely interested in getting a process started. It would take a lot of teamwork, effort and motivation all of which we all most likely possess or have potential to possess. Feel free to email me to discuss this further. I think we can do this correctly and we should focus on becoming recognized by the ABMS and not another "Society" or "Academy" we see all over the place for a fee. The hardest part will be organizing courses and such and it's probably best to have a lawyer on board which will own a piece of this "company" because there are a lot of legalities and paperwork and that will alone make us broke.
03.26 | Unregistered CommenterL.A. D.O.
Thanks for your comments and support. I guess there is two ways to do this. One would be to pressure AACS into accepting those of us who are not boarded in a surgical specialty. since the AACS is a private organization, they can pretty much make their own rules. ironically, some of the original members and fellows do not have formal surgical training. But when any College just starts out, the few founders usually don't have residency training either, simply because the residency has not been established yet. Emergency Medicine was that way 20 years ago. The first ER docs were IM's and FPs as an ER residency had not yet been established. Over time the academic community accepted the specialty and now the ABMS. But, it was a long and hard fought battle.
In order to develope a specialty there needs to be a non-profit corporation established first. So those of us who are interested can forget about making money from it. It will definitely require legal counsel as well. It could be very expensive initially. We also need to set up a charter of rules and regulations as well as a board of governance. there needs to be in place a College, and also a Board. The board of the college would have the responsibility of certification. But, there is also the stipulation if you read the AMA charter, that board certification must be available to members AND non-members. There needs to be a residency or the option of residency training within the field. And the AMA won't ratify a board if one already exists. Unfortunately, the ABMS has already recognized procedural dermatology as a board. So our field would have to be different from theirs in some way. We also need to have a center of operations. That means an office somewhere with full-time staff dedicated to running the College.
Anyway, all of this is doable. It will take a time commitment and probably a financial commitment as well. But, eventually the financial commitment would be off-set by membership dues.
I'm certainly willing to contribute my time, as well as some money if others are willing as well.
Anyway, the way I see it, A College of Aesthetic (or Cosmetic) Medicine and Surgery dedicated to non and minimally invasive cosmetic procedures is going to happen sooner or later. Either by us or another group. Its just a matter of time.
To not include non-surgeons into their academy is really limiting to the AACS as most of us who are running med-spas aren't surgeons. Anyway, just some thoughts. I'm hesitant to leave my contact info on an open website like this. So let me know how to get in contact with you.
03.27 | Unregistered Commenterbotoxdoc
Botoxdoc et al:

If you'd like to contact or be contacted, I'll be happy to arrange it. Send me you're screen name and email using the contact email link at the top right of this site.

If someone wants to contact someone from this site they can submit their contact info and the person they're trying to reach by the same email. I'll forward those contact requests and the person contacted can decide to reply or not. This should provide enough security.

botoxdoc, it sounds like a great plan and I agree that somebody will definately do this eventually. Especially when derms and PS are fighting to keep other physicians out of this business (you see what happened in Florida). You can email me by clicking on my name at the end of this signature and clicking on Send Email. Jeff, I don't know how to contact you to give my info. Speak to you soon.
03.27 | Unregistered CommenterL.A. D.O.
It's easy as ABCD or else, FUC EM... :-) American Board of Cosmetic Dermatology? It really is a specialty of its own because it's not in a Dermatology Residency's objectives to teach these procedures, In Florida, a law took effect in July saying that only dermatologists and plastic surgeons can supervise a medical spa. And now in California, where I am - these type of regulations are being reviewed. This is a fight the Derm/PS put up and they are winning it. With no merit in my opinion.
03.27 | Unregistered CommenterL.A. D.O.
Since that membership link went up on this site today, perhaps we could use this site to generate interest and create a core group?
03.28 | Unregistered CommenterRaincityMD
Thanks LA DO and RaincityMD. I will be contacting you in a few days. Hopefully we'll generate enough interest to make this viable. I think we can start with MedspaMD, but we will need to generate a website of our own as well. I think this will be a wonderful opportunity for us to develope our own specialty society and board certification. I have already incorporated as the American College of Cosmetic Physicians and the American Board of Cosmetic Medicine and Surgery. If you like that designation, then we can go with that. Its incorporated in the state of Florida. But at this point its a for-profit entity. It will need to be changed to a non-profit corp. I will need to look into that. If you're interested, and you agree we can stay with that name otherwise, we can change it to something else. I think it would be best not to use the title "dermatology" as this may cause some raised eyebrows and perhaps litigation from the AAD. I beleive its better to stay with the designation "cosmetic or aesthetic physisian." My other concern is that dermatology residency does have rotations in cosmetics now. According to CT who has posted here, dermatology residency now includes about 1000 hours of cosmetics.
However, for the ABCMS (American Board of Cosmetic Medicine and Surgery) we can develope a "fellowship" program leading to board certification.
Of course the nice thing about starting a board is that the founders will automatically receive board certification status.
I certainly hope we can generate enough interest in this as it would be to our best interest to have a unique specialty, certification, as well as political clout. I do have some connections in Washington DC. So if we get to the point of needing a lobbyist, that can be done too. But, we need to start with the basics. ie, non-profit corp. a charter and mission statement, and web-site as well as a mechanism for implimenting membership. All this will be very expensive. Some of it I have done already. But if we can get 10-20 physicians together who are willing to donate some time and money, like i said it can be done. Of course the more interest we have and the more "founders" we have the less expensive it will be for each doc. Anyway, keep me posted as to you're level of interest and I'll send you an E-mail probably early next week with more info.
03.28 | Unregistered CommenterBotoxdoc
I think this sounds very interesting. I like ABCMS. We want to avoid the pissing match from the derms/plastics. We want to be inclusive as long as you have the training or time in service. The ABCMS is more inclusive no matter what your core training was in.
03.29 | Unregistered CommenterLH
I agree with ABCMS being best... I look forward to moving forward with this process.
03.29 | Unregistered CommenterL.A. D.O.
Since we would be trying to avoid raising eyebrows as much as possible, we should take into consideration how close "American Board of Cosmetic Medicine and Surgery" is to the "American Board of Cosmetic Surgery" that is in existence.
03.29 | Unregistered CommenterL.A. D.O.
I think you'd be better off going with American Board of Aesthetic Medicine
03.30 | Unregistered CommenterMichMD
Maybe you could have an area on this board for employment opportunities? I'm an esty, that would love to get into a medical setting. I'm in Scottsdale, Az. I think if you had a specific area on this board for that type of thing. It would be great. thx

Thanks for the support. I'd agree that a line's been crossed but of course it's just that, an theoretical line. Of course it's my patients that have let me in on what's really going on. I'll just deal. To be honest it's slightly fulfilling to have them worried about me and stiffened my resolve

Wow, I never knew about buy and bail. I think this procedure would take time and compromise but it can be done. That’s pretty interesting…Thanks for sharing it

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