Surface Clinics in the South East: Gettin our groove on.

Midwest sent me an email calling out these other Surface clinics in Nashville who are opening clinics in the South East. Turns out that they are us and we are them. If you're a physician and think that you'd like to work in/on/with Surface in the new SE clinics, drop me an email. But be warned, if you're a doc just looking for a job don't bother. The docs we're looking for are smart and motivated. This is not a franchise.

Getting the Wrinkle Out...Of the Business Plan

 

Maren Scoggins is the vice president of strategic development at Surface Skin and Facial Rejuvenation, a new medical clinic in Nashville specializing in non-surgical cosmetic procedures.

Founded in November 2006, the facility functions as Surface's beta site where the business plan can be modified to accommodate an aggressive expansion plan that calls for five to 10 new sites to be developed throughout the Southeast within the next five years. Plans are already underway to acquire real estate in Naples, Fla., with further expansion planned in Orlando, Fla., Atlanta and Charlotte, N.C.

While this may seem like an ambitious business plan, the market for Surface's products and procedures is expanding rapidly, especially as a result of an entire generation of aging Baby Boomers that wants to continue to feel - and look - young.

Improvements in technology are also helping to draw customers who might otherwise be intimidated by invasive surgical procedures that usually involve a lengthy recovery period.

"People are going for things that are minimally invasive and more natural," says Scoggins. "The products in aesthetic medicine are growing very fast. Aesthetic procedures have grown by about 500 percent in the last five years."

Scoggins estimates the initial investment necessary to start a clinic at around $1 million, adding Surface hopes to balance its budget in its first fiscal year. The beta site in Nashville has 10 employees, but future facilities will be staffed with about half a dozen - including physicians, aestheticians and administrative personnel.

"Most medical spas don't have physicians on site," explains Scoggins, "We differentiate ourselves by offering services that other spas don't have."

The services include Botox, Thermage, facials, chemical peels, Intense Pulsed Light (IPL) photo facials and hair removal and the Natural Lift, a nonsurgical face lift that is reversible, involves only local anesthetics and leaves no visible scarring.

Pricing for the procedures varies from a few hundred to a few thousand dollars - no single procedure offered by Surface is listed at more than $5,000 - with financing options available. Costs are kept to a minimum by avoiding expensive hospital stays and anesthesia.

"Youth is hard to hang on to, but beauty you can have at any age," says Dr. Deborah Kondis, a Surface physician. "What we're after here are natural looking results."

Surface's office at 2020 21st Ave. S. appears and even smells more like a day spa than a state-of-the-art medical facility. A scented candle burns while soothing music plays from a flat-screen TV with ambient lighting. The walls are painted in gentle pastels meant to create a calm and inviting atmosphere.

The staff and the environment are not the only features meant to distinguish Surface from the competition. To educate and attract customers, the facility maintains a detailed Web site with frequently asked questions and comprehensive information about each procedure.

The site's goal - along with e-mail updates, educational seminars and free consultations - is to keep clients informed. Surface also offers gift certificates, which are helping to develop new business trends.

"In fact, a lot of people do this together," Scoggins says. "They want to stay young together. That's becoming more popular."

Scoggins, who developed the operational plan for Surface, was formerly senior operations analyst at BH1 - Private Equity Healthcare, Surface's parent company. Aside from Surface, BH1 owns and operates Baptist Women's Treatment Centers and Middle Tennessee Medical Center, located in Nashville and Murfreesboro respectively.

Aside from being a graduate of the Owen Graduate School of Management at Vanderbilt University, Scoggins studied in the pharmacology research graduate program at the University of Virginia, has an undergraduate degree in engineering from Vanderbilt and was previously a professional golfer.

In addition to marketing, advertising and staffing Surface, Scoggins is responsible for the real estate acquisitions for the planned out-of-state locations and for fine tuning the business plan as problems arise at the beta site.

"She impresses me every day," says Theresa Fletcher, a Surface aesthetician. "She's on top of it. I think she hardly sleeps."

Comments

[MaineDoc]

Jeeze, I'll just cross my fingers that Surface fares better than Dermacare has on this site.

[Dexter]

Jeff,

What is that you do with your clinics (Surface) that you think separates you from other franchise models?

[plasticized]

What most of us have learned is that the success of any cosmetic endeavor is highly correlated to the personality and skill of the particular on-site physician. And a physician can not be franchised like a business model or a name or a procedure.

[plasticized]

also, in your before and after photos as an example above, the first is not taken in the standard frankfort plane, and the second is even futher from this standard. it is frustrating when this is seen in cosmetic marketing.

[Medical Spa MD]

Dexter,
Where do I begin.

All surface clinics are completely company owned and built around our own physicians who only practice non-surgical cosmetic medicine. Most of our physicians are employees who are incented and completely committed to Surface's success.

We have a lot of advertising and marketing savvy.

We have developed our own proprietary treatments (Point Lift)

Since we own and run the clinics, its not a sell and forget situation like franchises can be.

We have more resources than many other competitors.

The people running the clinics are the ones making the decisions. IE We're focused on servicing our patients, not telling other physicians how to run a business that we're not really running.

I could go on. In fact, this whole site talks about how we differ from the franchises.

As to plasticized's comment: Sorry you're frustrated. As I said above, we're not focused on selling to physicians. In general, we compete most directly against plastic surgeons by offering alternatives to surgery. Our success is built on happy patients who want the best medical care. There's no way that smoke and mirrors builds successful businesses.

As to the comment on physicians not being able to be replicated: That's exactly what we're doing. Making the delivery of the highest quality medical care scalable and replicatable. Medicine is switching from 'knowledge and skill' based to a technology based. It's what the market demands.

[plasticized]

i disagree with your last statement. the technology means nothing without knowledge and skill. if you shift your reliance to technology its clearly a mistake. look at the contour threads. they are dying because they didn't deliver. you have to decide which patients need surgery to meet their needs and which don't. that takes a good deal of experience. from our experience, non-surgical practices are reluctant to send patients out for surgery (when some of them clearly require it to acheive what they want). how can they succeed otherwise? what i'm saying is that there needs to be a balance.

[Dermgal]

I think what Jeff's saying (and I agree with him) is that technology is replacing the knife. Where surgery used to be the only treatment available, there are now a host of technologies that perform far outside the parameters of what surgery can do. In twenty years I don't know where we'll be, but it will be a technology that takes us there.

[Midwest]

My gut reaction:

My first reaction upon finding the article about 'Surface's' Southeast expansion was 'HEY!..these guys can't take Surface's name and franchise it!!! (I found the article on Monday in medspapress.com) I feel loyalty to this site, believe it has provided a wonderful service to those in the field. So, I contacted Mr. Barson to make him aware that there may be some trademark/copyright infringement upon 'Surface's' name.

Well, did I feel like a big dork when I found out that it's actually the same company. Der...lol... Which makes me feel a little strange.

1. Why was this business expansion not posted on this blog months ago? Or was it and I just missed it?

2. If it wasn't, something just feels wierd about all of this. Were we all being used as a giant market research experiment?! LOL! All this talk of the pitfalls of franchising and then...BAM...is 'Surface' heading that way too? It possesses that odd feeling of confiding in a good friend about your relationship and having them turn around to use the info to woo your partner into bed...lol.

3. Alright, I'm done with my goofy conspiracy theories. I am sure there are damn good reasons for the blog not being made privy to 'Surface's' expansion. They are a solid and reputable business and can do whatever the hell they want..lol.

4. When you read the article and Mr. Barson's explanation, the infostructrue doesn't really seem like a franchise operation either. So basically, I'll unruffle my feathers and stop being such a big baby about it...lol.

[MichMD]

One question I have Jeff is are there physician partners in Surface? I thought a nonphysician employing physicians was a no no?

[LH]

I think they are doing it the right way. Look at what is happening to the franchises. The biggest reason is you have too many personalities in the ownership of the other companies. When it is a physicians money on the line they are likely much more problematic to deal with (likely they feel everything is owed to them). I used to be in charge of about 30 physicians and it was always very difficult to get them on board with changes that needed to be made. In other words it was a pain in the butt and a lot like trying to herd cats.

If I decide to expand, I will hire other physicians. These days most physicians work for someone else. In my area the large "health systems" employ about 95% or more of the physicians. It is only the rare physician like many of us that have the balls to open our own clinics. Most physicians these days just want the stability and the consistent paycheck. As we know, the vast majority of Americans are employees not owners.

I also agree that the physician is one of the most important "technologies" at the spa but not the most important. If the physician has the bedside manner of a rock then that site will not go far. It is Jeff's job to put the right face in the right place. But we as operators of medspas must also understand that it is a business. We can not base our decisions on the emotions of being physicians.

If you remember, Jeff and I were discussing this on previous posts. I was on the side that the medispas industry can not take the physician out of the equation. I have had time to think about it and feel Jeff is mostly correct. If the medispa is structured the right way, the staff, facility and technology can become more important than the physician. If people feel they can walk in to the facility and get the exact same results no matter which aesthitician, midlevel or physician they see, then the medispa will survive even if there is a change in physicians.

Retail medicine is growing in the US and business people are jumping in. Look at all of these little minute clinics openeing up. Walmart is now going into that business and wants to open thousands of them in the US. If we as physicians do not learn to think like business owners we will ALL be doomed to become employees.

Also, I would not expect Jeff to post all of his business decisions here. I guarantee his competition is reading this site. I have stayed anonymous because I do not want my competition to know who I am and what my plans are.

[Midwest]

Point taken LH. I agree, and am frankly happy for the whole Surface team. If anyone can make a business expansion like this work, it's definately them. It will be interesting to watch the progression. Best of luck guys!

[Medical Spa MD]

Didn't really expect many comments on this post but thanks. To answer some questions:

"One question I have Jeff is are there physician partners in Surface? I thought a nonphysician employing physicians was a no no?"

Quite right. Non-physicians may not partner or employ physicians. Needless to say, we're very aware of this. However, there are ways where physicians and non-physicians can work together. Some of this has to do with entities. Our structures are carefully built to avoid any legal compromises.

Midwest: Here's a category of previous posts about Nashville.http://www.medicalspamd.com/display/ShowJournal?moduleId=182618&categoryId=67369 Certainly all the Surface sites have this info and if you use the search function on this site to look for "Surface Nashville" you'll find it referenced at least 14 times. You'll also notice the big green "Surface is hiring physicians" button that's been on this site for a few months and links to this page: http://www.medicalspamd.com/surface-physician-hiring/

Sorry if someone's in bed with me who doesn't want to be.

LH, we're building Surface specifically around physicians. And not the kind that are looking for a job. The single most important decision that's made at any Surface clinic is who the physician is. Then we give them the tools. We're only looking for exceptional physicians that are smart and motivated. (I'll do a post on this later.)

I've worked with fantastic physicians and real assholes. I try to work with the former.

PS: No one needs to reference me as "Mr. Barson", that's my dad.

[MD]

I Dido that on physicians who are real assholes, way more than are fantastic.

[Vexed MD]

I'm with Jeff and MD. I think I may be an asshole.

[LH]

Jeff,

That makes my point that the physician plays a key role for you but can be replaced. I am guessing that the physician has to show you a lot before you decide to work with them. I definitely not want to put a million dollar venture in the hands of one of those "assholes". I hope things continue to go well for you. Again, I think you are a step ahead of the franchisers. If I choose to expand, I will likely follow your lead. Your business plan makes the most since and is the most likely to suceed.

[Aesthetic MD]

I think "plasticized" is right that when doctors are in competition with each other, they rarely refer to one another. I perform only minimally invasive or non-invasive procedures that patients elect to have done either as a complement to plastic surgery, or as an alternative. But for those who select it as an alternative, they need to understand that they will not necessarily get to the same endpoint. When patients expect a "face-lift" result from a non-face-lift procedure, then everyone gets disappointed. So I routinely refer patients out for surgery, ablative procedures that can't be safely performed in our office, etc. And most of the plastic/oculoplastic surgeons I refer to aren't really in competition with me. They don't want to be doing the things that I do...they might have a PA or RN doing some of it. But most of them prefer to be in the OR and see what I offer as a compliment to their work. It doesn't need to be "us vs. them" all the time.