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LH: Comments on Medspa Franchises & Doctors in Business.

 LH thinks that most doctors suck at business. Is he right?

bad_business.jpg"I have been reading these as well. Thank God I am not involved with a franchise. I think what you are seeing is that there is more business involved in these franchises than medicine. The focus is completely upon making money for the franchise and they seem to care less about the franchisees.

The franchises think of it as a business and the docs/nurses think of it as medicine. They are not meeting in the middle and the franchises are trying to make it a 100% business model which may work short term but will not work long term. This will do nothing but piss off the medical personnel and they will continue to have high turnover rates and pissed off docs complaining about them on sites like this one.

The other side of the coin is that the docs/nurses want it to be 100% medicine. In medicine, they have the old addage that build it and they will come. We need to understand, that when they are elective procedures with expendable cash, patients have a choice. So business must play more of a role in this situation than in a normal medical practice.

In a normal medical practice most visits are not based on "wanting" to be seen but upon "needing" to be seen. So in this situation the patients will come to you out of "need". The business side of aesthetic practices must focus on the "wanting" to be seen. You must create the "want" for patients to come to you. This is where the business side steps in.

All of these enterprises are going to fail, if the business people do not understand that this is still medicine and if the medical people do not understand that this is a business. These franchises that are failing is because of their lack of understanding the difference between medicine and business. They are trying to take medicine completely out of the equation.

I have watched some of what Jeff is doing and feel he is at least moving in the right direction with Surface (although I do not have inside knowledge of his contracts with physicians/nurses). Surface seems to understand that the physicians must play a key role in both the medical and business side of the MediSpa.

We as medical personnel must understand that most of us suck at business. This is why most physicians are no longer in private practices and work for some large health system like Keiser or others. So we as physicians must learn the business side or our aesthetic businesses will disappear."

I'll thank LH for his nice comment on Surface. We do build our clinics around physicians. there are a number of reasons for this but I'll list three here:

  • One: It's a competitive advantage. Every potential patient want's to be seen and treated by a physician rather than a 'technician'. 
  • Two: It means that we're always in complete compliance with any state or federal regs. It won't matter at all if the laws change or scope of practice varies. Surface is built around physicians.
  • Three: It allows us to offer complete but focused services. "Low hanging fruit" is a favorite term I hear from franchisors. It's a code word that means 'no barriers to competition'. Anyone can get the low hanging fruit and abbreviating your offering puts you in a position of competing with everyone else. You become the 'K-mart' of medicine. Not a good place to be. Physicians allow us to get all the fruit.
    I like fruit.

Reader Comments (2)

I'm sure LH is "kinda" right, the common thought w/ chains seems to be 'get a couple hundred grand and start doing treatments.' But I've seen it dozens of times where people just want to see "their doc"--he(she) knows all the history etc and they feel like they have a relationship. Sometimes I've seen, when all else is equal, patients (clients) will go to the closest, convenient place. Its up to us to show them the difference in our own ways. As to "sucking" at business, Michael Gerber has a great book "The E-Myth"that , in a nutshell, says that the common assumption is that people think that because they can do the (doctor) job they can run the (doctor) business. Many Docs are happy just being the technician and doing the consults and treatments...and not worrying about the rent or light bill. In a discretionary "cash" business skill, personality and relationships count; in a commodity-type sick-visit clinical setting there may be economies of scale to be had w/ a big group like Kaiser.

06.24 | Unregistered CommenterDermaRogue

I hope not everyone on this site thinks I was talking about them. I look forward to your input. Those of us that have been around for a while are the exception to the rule. Most docs just want to go to work go home and get a paycheck. They do not want to think or deal with the business side of things or administration.they are otherwise nothing more than a "technician" as DermaRogue puts it.

I agree that many think they can run the business because they can do the job. Go look at all the used aesthetic equipment on the secondary market. Many of these people (not all are docs) thought they could do it just because they were an MD or RN and in some scarey cases estheticians.

I do not want to generalize but I stand by my statement most of us suck at business. I have worked in multiple administrative positions in health systems and I am amazed at how many docs think they know how to run a business and work with staff. Many times they could not fight their way out of a wet paperbag (in a business since). I have seen them screw up just about everything that is outside the realm of medicine.


You were right on the money when you talked about relationship with patients. Franchises do not develop the relationships. They just want to great'em, treat'em and street'em. Relationships are what we as physicians do best. We forge a relationship with the clients. I have clients contact me to see which plastic surgeon for breast augmentation or which derm to have a suspicious mole removed. This entire ballgame is about relationships. We all know what it cost to get a new client in vs. treating an established client. I want return clients built upon trust and relationship.

Relationships are where the franchises fail. They have high turnover for staff. The clients see a different tech each time and so on.

06.24 | Unregistered CommenterLH

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