What's Killing Your Cosmetic Practice Profits?

If you haven't watched this video, do it now and learn what top performing cosmetic practices are doing that you're not.

Hint: It's your internal systems.

A few weeks ago we sent a survey to 472 physicians asking about efficiency and productivity in their clinic or practice. Here's just a little of what we found out:

  • Over 9/10 of physicians said that their clinic operated at less than 80% efficiency, and 4 out of 10 said that their clinic efficiency was below 60%!
  • Physicians reported this "productivity gap" costs their clinic between $5k and $40k in lost revenue every month.
  • When I asked them what doesn't work, the most common responses: "lack of systems" (44%), "wasted time and effort" (50%), and "micro-management" (40%).

There is a better way that can pull you out of the micro-managing, hair-on-fire, unproductive daily grind and put you in a position where you're working ON your business, not IN your business. Take a look at the Ultimate Clinic Operations Blueprint.

Why Medical Spas Fail Reason #7: Lack of Systems in Your Practice

In the book, “The E-Myth Physician”, Michael Gerber teaches us that unless your practice can be duplicated, it will never run without you.  According to Gerber, if you don’t have systems, then your aesthetic business will ultimately fail because you as the owner must keep all of the plates spinning in order to keep everything functioning.  Unless you train your employees to operate your clinic without you always having to be looking over their shoulder, you and your business will suffer from burn-out.  Systems and procedures are necessary for the long-term success of any business.

Perhaps the hardest area for doctors to address in their aesthetic practices is daily operations.  In each practice there are hundreds of daily routines and processes that take place. These processes are the methods in which things get done by our team members (support staff, laser technicians and consultants). This includes how the phone is answered, how consultations are scheduled, who is responsible for what services, how payments are collected, what paperwork clients fill out, how clients are greeted when entering the office, how clients are placed into the treatment room, how aesthetic treatments are performed, how consultations are conducted and measured, how charts are pulled and organized, and who is ultimately responsible for what.

Each of these areas can have a significant effect on the experience a patient has in your clinic and the profitability of your practice.  The importance of these areas should not be under -estimated.  If you find yourself working longer hours, getting paid less, feeling less in control and not having fun, then you need to develop an E-Myth practice.

Below is a list of the areas that should be systemized within your aesthetic practice:

Operational Procedures

A. Pre-Opening Procedures
Business Opening Checklist & Timeline
Establishment of Business Guidelines
Securing a Location
Building Out Your Site
Setting Up Bank Accounts
Getting Insurance
Meeting Your Tax Obligations
Required List of Equipment
Initial Inventory
Conducting a Grand Opening

B. Human Resources
EEOC Guidelines
Laws Regarding Harassment
Immigration Reform Act
Wage & Labor Laws
Job Descriptions
Employee Profile
Recruitment
The Employment Application
The Interview Process
Introductory Period
Developing Personnel Policies
Employee Orientation
Training
Time Reporting
Compensating Staff
Uniform / Dress Code
Performance Evaluations

C. Office Procedures
Suggested Office Hours
Customer Service
Client Retention
Daily Activities
Confirming Appointments
Checking Out First Time Clients
Checking Out Regular Clients
Accepting Payment
Processing Auto Debit Payments
Merchandising Retail Products
Inventory Management
Generating Business Reports
Maintaining the Office
Safety and Security

D. Sales
Scheduling New Client Appointments
Established Client Appointments
Greeting Clients
Conducting Consultations

D. Clinical Procedures
Clinical Certification
Treatment Programs
Greeting Regular Clients
Taking Clinical Photographs
Clinical Chart Documentation
Clinical Follow Up Calls
Laser Safety
Clinical Equipment Maintenance

F. Advertising
Calculating Advertising ROI
Internal Advertising Strategies
External Advertising Strategies
Required Advertising Expenditures
Public Relations
Community Involvement
Obtaining Advertising Approval

Written Medical
Treatment Protocols

Step by Step Clinical Treatment Protocols & Procedures
Laser Hair Reduction
NdYAG 1064
Photo Facial
Fractional Resurfacing
Spot Testing
Set-up & Operation of Soprano
Set-up & Operation of IPL
Care & Maintenance of Lasers
Infection Control
Exclusionary List
ST Handpiece
Eye Protection
Laser Safety Precautions
Laser Committe
Q Switch
Laser eyewear inspections
LSO Responsibilities
Laser Safety Index
Sclerotherapy
Restylane and Juvederm
Levulan
Jessner Peel
Botox
Cosmelan
DermaSweep
Tooth Whitening
Other Tx Index
Accent
Portrait PSR 3

Home Care Instructions

Thermage
Fractional
Photofacial
Portrait
Hair Removal
Restylane and Juvederm
Jessner Peel
Tattoo Removal
Microderm
Botox
Cosmelan
Levulan
Laser Vein
Accent Home Care
Lipolysis
Sclerotherapy
Teeth Whitening

Consent Forms

Arbitration Agreement
Thermage
Fractional
Photofacial
Portrait
Hair Removal
Restylane and Juvederm
Jessner Peel
Tattoo Removal
Microderm
Botox
Cosmelan
Levulan
Laser Vein
Accent Home Care
Lipolysis
Sclerotherapy
Tooth Whitening

Medspa Build Out
Design
Full Color Floor Plan
Interior Elevations
Storefront Elevation
Interior Finish & Color Board
Interior Finish Schedule
Interior Finish Listing
Door & Frame Schedule
Glass & Glazing Products
Storefront Sign Panel
Lighting Fixture & Ceiling Information
Retail Display Elevations
Furniture Information & Prices
Cost Reduction Options
Vendor List

Clinical Chart
Documentation

Chart Organization Guide
Master Chart Checklist
History & Physical Exam
Sclerotherapy Progress Notes
Microderm & Peels Progress
Laser Hair Progress Notes
Cosmetic Filler Progress Notes
Tattoo Removal Progress Notes
IPLProgress Notes
Portrait Follow-Up logs
Technician Daily Checklist
Fillers Flowsheet
Body Contouring Analysis
Hair Removal Flowsheet
IPL Flowsheet
Nd Yag Flowsheet
Accent Flowsheet
Fractional Flowsheet
Client Intake Profile
Portrait Treatment Log
Tattoo Removal Progress Notes

Administrative &
Employee Forms

Spreadsheet Cashflow ProForma
Automatic Payment Form
Package Treatment Plan
Treatment by Treatment Plan
Master Price Book
Front Desk Operations
Front Desk Certification Manual
Refund Policy
Opening Receptionist Checklist
Closing Receptionist Checklist
Employee Forms
Uniform Specifications
Employee Evaluation
Employee Warning Notice
Employee Status Change Form
Reference Check
Interview Report
Interview Questions
Application for Employment
Office Policy Manual
Orientation Checklist
Form I-9
Time Sheet
Vacation Request
Corrective At Will Action Notice
Employee Policies Handbook
Employee Accident Report

Medspa
Business Plan

Executive Summary
Strategic Objectives
Mission Statement
Products and Services
Clinics in Operation
Consolidated Profit/Loss
Market Analysis Summary
Market Segmentation
Buying Patterns
Competition
Competitive Advantages
Physician Recruitment
Staff Recruitment
Staff Training
Marketing Strategy
Sales Strategy
Implementation Strategy
Management Team
Liability Protection
Funding Request & Overview
36 Month Pro Forma P&L
36 Month Expansion Pro Forma
Corporate Support Expenses
Cash Flow Per Clinic
Per Clinic Start Up Cost

This business plan successfully funded the build out of multliple aesthetic practices. It can also give your existing practice new ideas on how to improve and enhance your operational performance.

Automate your systems, get better results. Check out the Ultimate Clinic Operations Blueprint and find out more.

Comment

Vin Wells

Vin Wells, MHSA,  is the President and Founder of RockBottomLasers.com and has over 11 years experience in the aesthetic laser industry. Mr. Wells started his own chain of aesthetic clinics under the brand name Skinovative and opened his first medical spa in Boise, Idaho in February 2001. Mr. Wells continued to grow and operate aesthetic clinics for over 8 years.  Since 2008, Mr. Wells has focused on selling used aesthetic equipment to physicians and medical spas.

Mr. Wells received a masters degree in Health Services Administration from Arizona State University (1995) and has extensive practice management experience, working with a number of different hospital and outpatient care systems.

Mr. Wells has developed a number of business operations systems that help aesthetic clinics to maximize their profitability, including: Aesthetic Consultation Training, Medspa Management Training, Medspa Business Plans, Medspa Operations Manuals, and Front Desk Operations Training.  These products can be found at: SkinSalesTools.com

Mr. Wells completed received his bachelors of Science degree at Brigham Young University in 1991 and continued his education at Arizona State University, in Tempe, Arizona, receiving a Masters in Health Services Administration in 1994.  He has worked for a number of different health care organizations including as a Program Director for group of primary care clinics (Arizona Association of Community Health Centers), a Health Care Manager for a hospital network group (Arizona Healthcare Federation), and as Associate Director for the Arizona Council for Graduate Medical Education.

Mr. Wells has devoted considerable time in research the latest cosmetic trends and treatment modalities. He stays current on the cutting edge of such research and uses this information to make strategic decisions for the company.  He has a broad understanding of lasers and has been certified in laser biophysics and theory.

Mr. Wells was successful in developing a Laser Certification Program that was approved by the Arizona Radiation Regulatory Agency, the agency that oversees the use of medical lasers in Arizona. The program involves 40 hours of laser didactic curriculum as well as hands-on laser training.

New Medical Spa MD Products Coming Soon!

There are some new Medical Spa MD products under development for our Members.

I've been exchanging emails with a number of member physicians running medical spas and it has me thinking.

I'll first say that I generally don't like consulting with individual medical spas and don't generally do it. Yes, I've opened seven medspas and, yes, I have helped physicians and trained docs, but I decided long ago that the 'medical spa consultant' is most often a hack, has a terrible business model, and doesn't have any fun. That's not for me.

Many of the emails are general in nature; How can I improve my medspa's website, use patient testimonials, finance my clinic, etc... but there are a few bullet points that stand head and shoulders above the rest in terms of where a physician running a medical spa's concerns lie;

  • What technology should I avoid or buy?
  • How can I get the best training in new treatments?
  • How can I improve my business operations?
  • How can I drive new patients and increase my business?

There are a few other secondary contenders but these are the questions most often asked.

We've devoted a tremendous amount of time and effort on providing resources around some of these. You can read through thousands of insider comments in the IPL and cosmetic laser forums to see what other physicians and medical spas think of the technology they're using, or why they didn't buy something. There's also a tremendous number of posts and comments about business operations, marketing, advertising and more than a few about medical training, but I've come to believe that there are also some holes in our offering and some places to improve.

While you can use all of the information on this site to make better decisions, there are benefits to having everything put together in a logical format or product that you can use. While we've been fantastically effective in organizing our members and using our combined group buying power to get Select Partners that offer our Members discounted Botox pricing, malpractice protection, outsourced internet marketing, or postcard marketing there's a lot of insider information that's not so easily packaged up and offered broadly.

However, the feedback that I received from our Medical Spa Training Manuals has me thinking that we should be doing more to offer quality 'how to' products that physicians can actually use to address both their internal operations, and drive more patients and revenue.

The challenge has always been that it's just to much work to take the very best of this information, develop a comprehensive, quality product from it and then train an individual do on how to use it. It's just not an efficient model to deliver individually, without some sort of broader distribution to keep the cost at a manageable level for our Members.

But our growth has now put us in a position that we can scale. ; ) So, about a week ago we decided that we were going to organize and produce a number of new information products to address specific needs for our Members. (If you're not already a Member, join Medical Spa MD here.)

These products are not going to be general information, they're going to be specific 'how to' products that give you simple, plug and play directions that you can implement within days.

Medical spa products that we're working on right now:

  • The most comprehensive medical spa operations manual ever developed that details specific treatments and procedures, from how to answer the phone, to how to handle cash, to up-selling. This one product took me literally 16 months to write (when you see it you'll know why) and I used it in every one of my clinics every day. This isnt' some crappy 'template' that you'll get from a 'consultant' who couldn't make any money with thier own medspa and now wants to tell you how to run yours. This one product will change your medical spa into a real business that gives your staff the tools they need to perform at peak efficiency.
  • The Medical Spa Blueprint. A complete blueprint that speaks to physicians running medical spas or cosmetic clinics. The Medical Spa Blueprint will be a free strategic and tactial overview of the key points you'll be addressing in your clinic.
  • How to drive an extra $120,000 in revenue in one month. Yep. You read that correctly. I'm going to offer a product that's the single most effective revenue producing system I'm aware of. I've used it in every medical spa or cosmetic practice I've been a part of to drive revenue and it's NEVER failed to deliver spectacular results. I've used it to increase monthly revenue at a single clinic by up to $120k without canibalizing existing business. It is BY FAR the single best thing you can do to increase sales. The best thing about this system is that you can use it over and over to actually increase your profit margin with full-price treatments that don't erode your business.
  • Outsourcing for your medical spa. I started outsourcing a number of business functions years ago and have been running businesses with full-time outsourced team for the last five years. Most people give up outsourcing because they spend just as much time managing their team as they did when they were doing everything themselves. But if you do it correctly, outsourcing can free you to work on your business rather than just work inside it.
  • New site for Medical Spa Classifieds so that you can buy and sell your cosmetic lasers and IPLs.
  • New site for Medical Spa Jobs.

These products are going to take some time but as soon as we launch we'll make some general notifications. As always there will be no pressure to buy. If we're offering a product that's not for you, then it's not for you. We'll also be offering Members some introductory offers and additional free downloads that well be available in our Members Only area.

If you've never purchased anything from us (you're not alone), consider looking though the offerings of our Select Partners and making a test purchase. See what your experience is like and compare it with going it alone. We're confident that you'll not only have a better experience that you're having with your existing solutions, you'll be getting a better price.

Your Medical Spa + Groupon

Does it make sense to promote your medical spa with Groupon?

Groupon is a “daily coupon” website. It’s basically an email list that charges advertisers to send out their “coupons” called Groupons.

Many small businesses I’d likely never hear about otherwise send me their coupons this way. I receive them mainly to see what’s up… because the city I receive them from is 2 hours away, I don’t expect to take advantage of them.

I've noticed that for the most part, these are not large mainstream businesses. They are small businesses – spas, bakeries, etc. that likely don’t have large advertising budgets and think that Groupon is a great way to drive traffic without spending marketing dollars.

At Groupon, they have an email list of over ten million people and if you contact Groupon to be included on their “deal-of-the-day”, you can get the word out about your medical spa to thousands of people you would otherwise never be able to reach.

There are usually huge discounts involved (50% or more) to incentivize buyers and the general idea is that by offering a big discount on your products or services, people will try out your offerings and keep coming back for more. On the surface, it sounds like a great way to market your business and I was really excited about the idea until I thought about it some more and did some analysis. While Groupon might work for a small subset of local businesses, here’s why I don’t think Groupon is a good fit for the majority of medical spas out there.

Using Groupon will cost your medical spa an arm and a Leg... and another arm.

You might have read some Groupon horror stories already, but the reality is that Groupon is extremely expensive for a business. If you look at their faq, they give off the impression that running a Groupon campaign is free. They collect the money online from prospective customers, send you a check and mail out the coupons automatically.

What is not explicitly spelled out is that they take 50% of your revenue as a fee for using their service. So given that most Groupon campaigns offer the end customer around 50% off, let’s run some numbers here. Say your product retails for $100. By giving a 50% discount to customers, you will only make $50. After Groupon’s 50% cut, you only get $25 for something you normally would charge $100 for. Depending on what your markup is, it better be more than 400% otherwise you could potentially lose money on every transaction!

What’s attractive about Groupon is that they run the campaign for you and simply send you a check. It’s not until later when you have to fulfill orders with these ridiculous discounts do you realize how much money you are potentially losing out on. Most medical spas that are using Groupon—and there are many of them—tend to try to limit their 'deals' to services like laser hair removal and IPL treatments rather than Botox or cosmetic surgery to limit their exposure to services with high fixed costs. But whatever you're offering, it's questionable that taking a huge loss on hundreds of services will prove beneficial to your clinic's bottom line in the long term.

While I'm not absolutley against using Groupon in any way, there are some issus that you want to be aware of around how using Groupon will actually hurt your medical spa or cosmetic clinic.

Groupons don’t make your medical spa memorable.

I’ve got some experience using Groupon a few times as a consumer and you know what? Every time I've purchased through Groupon, what stands out in my mind after my purchase was not the business itself but how great of a deal I got on the product or service. In fact, I remember talking to friends about what a killer deal I got through Groupon. Not once did I mention any details about the business that I was actually purchasing from. I was too excited about the bargain itself.

Using a Groupon takes the spotlight away from your business. After all, it was Groupon that provided your customer with the coupon and the unbeatable deal. It was Groupon that made your customers’ purchase exciting and fun. As a result, customers are far more likely to brag about Groupon and not your clinic.

Groupon deteriorates the perceived value of your medical spa.

Whenever a store offers an incredible deal or discount, there is this perception that the markup was already ridiculously high. If company X can offer a 50% discount and still make a good profit, then they must be jacking up their prices. Once a customer receives a large discount, it trains them to wait for later coupons and deteriorates the value of your products and services. This is especially true with medical spas since Groupon is saturated with them.

There is this dining card I sign up for almost every year called “The Passport” card which entitles the card holder to a free entree at select restaurants when another entree is purchased. The card lasts exactly one year until it expires and you have to pay to reactivate it. One year, we decided to let the card expire and you know what? We refused to dine at “Passport” sponsored restaurants during this period because it didn’t seem worth it without the card. We were so used to getting a free entree that we didn’t want to pay full price again.

While this principle applies to coupons in general, the price erosion caused by a Groupon are infinitely worse because the discounts are so steep.

You can bet that the majority of the new clients you attract through Groupon will be visiting your competition next month. You've just invited all of these new users to price shop you.

Groupon hurts your loyal clients.

Don’t you hate it when you are a loyal customer of a product or service only to find out that the company started issuing huge discounts for new customers only? This happens all the time with cell phone carriers and it really pisses me off. Using Groupon has a similar effect on your regulars and your loyal customer base.

By taking a loss using Groupon to obtain new clients and patients, you are essentially forcing your loyal clients to make up for your losses. And this is counter-intuitive to the way you should be doing business. Your regulars should be the one rewarded with discounts and perks.

There are 2 possible outcomes when a regular customer sees one of your Groupons and both are bad. In one case, your loyal customer could get pissed off and consider shopping with a competitor. But more likely, your regular customer could buy a S@$% load of Groupons and only pay a fraction of the price for what they normally would spend at your store. In effect, you would be losing out on future business with this customer because you would be taking a loss or breaking even on what could have been a 4X profit!

I've had experience with this first hand through another service. Some of our most loyal—and profitable—clients found out about some discounts and switched to them. All we could do was smile since there was no way that we wanted to make waves with our existing clients. We just quietly folded our program and smartened up.

Conclusion

Outside of the issues I’ve already covered, the main problem with Groupon is that the longer term effects are extremely hard to measure. It might be possible to measure repeat business somewhat but it’s almost impossible to measure the word of mouth effect.

To sum it up, I think of Groupon as a shortcut with major consequences. The attraction is that you’ll get a lot of customers upfront, but once everything is said and done, you’ve lost a lot of money and the long term benefits are questionable.

My general philosophy in business is to focus on the long term. Instead of trying to get a one time flood of customers, why not put forth your efforts on making your business stand out? Be the store that everyone wants to shop at because you are awesome and not because of a coupon. Be the medical spa that offers the best customer service. Be the clinic that gives customers the best experience. Giving a one time discount isn’t going to win over any followers and you risk damaging your medical spas real business.

Interview With Jessica Wadley, Former COO Of Spa MD

This episode of the Medical Spa MD Podcast introduces us to Jessica Wadley, former COO of Spa MD, who brings years of Medical Spa business experience to share with our members.

In part 1 of this podcast we discuss a host of issues around medical spa operations, sales, marketing, startup costs and staffing. We've got some agreement and you'll want to listen to how our thoughts (and strategies) differ around commission structures for staff and internal operations and training.

We also discuss how Spa MD went from $3m a year in revenue to over $12m in gross revenue within four years so you'll want to hear that.