How to become a Heroic Physician in the eyes of your patients.

Ready to add more to your bottom line from word of mouth patient referrals?

What you need is a hero.

You likely already know that effective marketing is not about blatant self-promotion. (If you don't, well, you should.) Your focus should be building your authority and credibility  that provides true value to your patients. Over the long term, this snowball building strategy will easily convert a good percentage of your patients into active zealots (patients who actively promote your practice).

 It's medical practices with an active zelot-building strategy that are healthy, growing, and profitable.

But there's a catch. (There's always a catch.)

The only really effective way to build this kind of proactive patient population is not through a frontal assault, but with a carefully organized strategy of soft, outside promotion.

Is it ever okay to do some “hard selling”? Absolutely, but your best bet is to do it in a way that doesn't come across as selling. The good news is that the technique you can use is one of the most potent forms of selling around.

Confused? Let’s take a closer look at the bad, better and best approaches.

Bad: Blatant Self-Promotion

See: Physicians get the consultants they deserve. Marketing that focuses on telling people how wonderful you are is bound to be a flop. If it comes across as self aggrandizement, you're shooting yourself in the foot. No one wants to go in and have a consultation of buy something who thinks he's God's gift to mankind. (Note: If you think that you might actually be Gods gift to mankind, there's no need to continue reading this since it obviously won't help.)

All great marketing focuses on the prospect, and all great medical marketing focuses on the patient. You’re wasting your time telling people how great you are, because odds are no one will care enough to decide whether to believe you.

Better: Customer Testimonials and Media Blurbs

As I’ve said a couple times before, what other people say about you is more important than what you say about yourself. This is the foundational aspect of testimonials and third party endorsements. Board certification is a perfect example of this. Plastic surgeons show that they're board certified so that patients will feel a sense of security knowing that this third party has said that this doctor isn't a complete sham.

Testimonials and media mentions are important because of the concept of social proof. We all, to vary degrees, look to others for indications of what to do and how to behave. Social proof is the basis of buzz, word-of-mouth marketing and fashion trends, but it’s also an important aspect of our day-to-day lives. We avoid sensory and information overload by looking to social indicators for judgmental heuristics that help us make decisions.

When patients pull up to your clinic, they don't want to see you driving up and getting out of a beat up VW bug. The fact that you have a BMW, Rolex, a good haircut, and staff wearing jackets with their name are all forms of social proof that show that you've got money because a whole bunch of other patients choose you. So, a patient can fee that they're not stupid choosing a doc who so many others have chosen before.

However, outside of a focused attempt to get someone to take immediate action (like order a product or call you), testimonials are not very compelling. Simply regurgitating what someone has said about you is not nearly as interesting as it is when it’s read somewhere else. In short, testimonials do not make 'great' sales fodder.

Can we do better?

Best: Hero Stories

What’s a hero story?

A hero story is similar to a testimonial, except that it transcends praise and becomes a compelling, engaging narrative that your patients can directly relate to. Instead of you or your business being the center of attention, your patient or client is the “hero” who solves a problem utilizing your solution. Bingo.

Here are some key characteristics of the hero story:

• The story is not about you or your company
• The story is about your customer and how they solved their problem
• First, introduce the hero
• Next, introduce the problem
• How did the hero solve the problem?
• What did the hero learn along the way?
• What specific results did the hero achieve?

Woven into the story, of course, is you and your solution. But you’re really just an “extra” who supports the hero. You want the hero to speak to your readers and prospective customers in terms they can relate to. Or in other words, a hero makes you look good in ways that are difficult for you to achieve yourself. People will tune out your own horn-blowing, but they’ll love a good story with a protagonist who conquers challenges that are similar to their own.

A Hero Story is Simply a Good Story

The key, of course, is a good story, and a good hero story is just like any good story—it contains drama, obstacles, conflict and resolution. And the key to writing a good hero story is to be engaging in your presentation.

I could use multiple examples but I'll relate one that I've coached some of our physicians to use during consultation training.

We have a before and after picture of a patient we treated who had with a large port wine stain along the right side of her face. The mark, the size of an outstretched hand, covered her from above her hairline, over her ear, down her cheek and neck and to her clavicle. Since she was born, this huge and obvious mark had ruled her interactions with people. Her teen and dating years were marked by peril at what boys and others might think or say.

As a result, she always wore turtlenecks and covered her mark with hairstyle and makeup. It was an onerous, deeply threatening condition that in many ways ruled her life. At her wedding she had had no photographer and had forbidden pictures to be taken.

She became a Surface patient shortly after she was married. During her lifetime there had never been a technology that could treat her condition and when we came on the scene, one of our other patients who was a close friend, recommended that she come in for a consult. 

It took six treatments, but we were able to remove the entire mark to a level that you would never be able to tell that a port wine stain had ever existed. For her, it was a miracle.

For the first time in her life, she dropped the turtlenecks and wore her hair back. In fact, she went further and assembled her entire wedding party and had her wedding pictures taken in her wedding gown. It took her six months to adjust to the new way that people speaking to her looked at her eyes and didn't constantly look at her mark. She loved it.

We were happy to be a part of it. 

Heroes? Sometimes. 

4 Tips for preparing your patients for price increases.

How to Prepare Your Medspa Patients for Price Changes

When Allergan increased the price of Botox, I was not happy. (Not that Allergan and my Botox rep think I'm happy with them anyway.)

You never want your patients to be surprised by a price increase for something that they're already used to (Botox or Restylane being prime examples.) Pleasantly surprise them all you want with price decreases for packages on hair removal, but when you’re increasing the prices, up-front communication is key to preventing a rebellion at your front desk.

If your business costs are rising, you’ll eventually have to pass that on to the consumer. Here are some tips to make this increase as complaint free as possible.

1: Explain Why

When you put yourself in the position of delivering bad news (increasing your prices) with the reasoning behind it (Allergan or Thermage is screwing you again, etc.) your patients are more likely to accept the increase as inevitable and reasonable. The apparent absence of reason of  will annoy your patient and she will assume you’re just trying to squeeze more money out of your relationship. (Even if you aren't.)

How to: I've used a front desk sign with an explanation. The sign mitigates the heat that the front desk has to suffer from patients who were expecting the price they already know. We're also sure to alert any patient who may be in that position. When we increased our Botox pricing, we made sure for months that every confirmation call included a reference to the new price to avoid any unpleasant front desk scenes. 

2: Provide Advance Notice

Don’t pull a price increase out of thin air. Give your customers an advanced warning that changes are coming. Include the timeline of when changes will happen.

How to: Again with the confirmation calls. If I think I'm aiming for a price increase I'll often use the 'for a limited time' around advertised pricing.

3: Grandfather Your Previous Pricing

A price increase is a great opportunity to give your current (and hopefully loyal) customers a sweet deal. Give your existing patients the opportunity to maintain their current pricing by paying for services in advance.

How to: Say you're increasing your Thermage or Obagi Blue Peel pricing. (Something that might be a recurring treatment.) Offer you patient the option of pre-paying for any number of treatments they'd like at the current pricing. This is especially effective since the patient is now included in the decision making and you're in the position of receiving payment up front for treatments you haven't delivered yet.

4: Open Communication Equals Retention

Once you notify your patients of a price change, some may start shopping your competition. There's nothing you can do about that and those are not the patients you really want anyway. (Someone who comes to your medspa for price will leave you for price just as fast... And there can be only one lowest price.) You should know that increasing your prices will lose you a few potential patients but your revenue per patient or treatment will be higher. If you end up with more revenue it was a good decision.

When you surprise your patients with a price hike, even your loyal patients will start to shop around. Why? They’re mad.

Keep them informed and keep your patients.

Med Spa vs Laser Clinic: Analyzing your medical spa competiton.

Get to know the laser clinic and med spa competition.

Contrary to what some may say, growing your clinic or medical spa isn't a single event.

Successful clinics and medspas look for 'incremental wins' that compound over time. The key to winning market share is to differentiate your company by providing products, services or solutions that your best prospects will find more desirable than what's offered by your competitors.

Experienced marketers know it's easier to fill an existing need than to create one. Someone who is already using the type of product or service you offer is a great prospect because he or she has a clearly defined need and is looking for a solution.

The job of convincing qualified prospects to buy from you instead of your competitors' is where the real work begins. One of the first steps is knowing what the other clinics, day spas, medical spas, and others who might be competing are up to in your market.

1. Do some detective work. Ok, this is a little spy like, but don't think all of your competitors aren't doing it to you and it's just good business sense. Start by gathering your competitors' marketing tools and advertising materials. Read their web site, print and broadcast advertising, and articles in which they've been featured. Request their brochures, price lists and any collateral materials. You may also be able to do some mystery shopping, which will allow you to experience what these medical spas are offering and how their positioning themselves. You'll want to send your staff rather than visiting yourself if you want to avoid embarrassing situations. (Surface has had more than 45 plastic surgeons, dermatologists and other physicians attend our seminars over the last five years in this type of sneaky capacity. They're not hard to spot and often they're 'outed' by women in the audience. They're the guys (mostly) who are sitting in the back scribbling furiously while their estheticians sit up front and ask telling questions like, "Now types of sutures do you use?".)

2. Evaluate your "slant" competitors. Chances are, you have a lot more competitors than you think. In addition to real competitors, evaluate the marketing tools and materials of any businesses your prospects perceive as offering a similar set of products or services. It's very common for day spas to attempt to compete with medical practices by offering a few medical services from a NP or PA. Microderm is often touted as some sort of medical type treatment. OBGYN's, FP's, pretty much whoever is in the market or wanting to get in. Know who's saying what about you.

3. Focus on the message. Once you've gathered the materials, the next step is to analyze what's being communicated and how. Identify the key promises made by your broad field of competitors. And don't be surprised if you see a lot of "me too" marketing. There's so much out there that's mediocre or worse, you may find the majority of your competitors have similar messaging, with only a few front-runners showing anything approaching real positioning. (This probably refers to you but we'll work on that.)

After assessing the most effective messaging, look at the actual tools and materials themselves. What formats seem to work best overall? At this point, your competitive analysis will reveal whether your company is lacking any standard tools that prospects expect everyone in your industry to offer.

4. Find a unique spin. So now comes the 'look in the mirror' moment. You've gathered all the materials and have learned the key message points of your real and perceived competitors. It all boils down to this: How does your clinic meet its patients' needs in a way that is both unique and compelling?

To find the answer, consider not only the products or services you sell, but also how you operate, including any company-specific characteristics, such as a higher level of customer service or uniquely specific positioning. If you can't find a selling point based on your current service offering that will help you stand out from your competitors, use what you've learned in this competitive analysis to retool what you sell and how you sell it.

If you can't see any difference between yourself and your competitors, why should you think any patient would choose you? 

Retail Medicine: The Sopranos & the expectation paradox.

Seth Godin (Yeah, I know you don't know who he is) posted about the final episode of the Sopranos and the expectation paradox.

The expectation paradox

So, people are upset because of the non-ending of the Sopranos. People are always upset when a TV show ends with a big finale, because it never meets the hype, never meets the expectations. If HBO had been quiet about it, hadn't done the full page ads and the radio shows and the newspaper articles, it would have been fine. Expanded expectations led to big disappointment.

The paradox: if expectations hadn't been raised, fewer viewers would have tuned in.

...In each case, the paradox is at work. On one hand, you want to raise expectations, because without doing that, you diminish trial. On the other hand, you want to exceed expectations, because that's what generates word of mouth.

As word of mouth becomes an ever more important component of marketing, the scales are tipping. Undersell, overdeliver. It's the strategy that works in the long run.

Every marketer has a choice... to make the first interaction the best of the experience, or the worst (least best).

Managing patient expectations is a constant challenge for many docs. It's easy to oversell and overpromise... don't. It leads to unsatisfied patients who feel 'sold'.

I had a long talk with a doc in FL today about this very subject. He's hired a 'marketing' person who will be incented to close sells and increase patient flow. Here's the potential problem: It's easy to overpromise in this situation leading to an unsatisfied patient and creating a situation where you're constantly having to feed new patients into your clinic. As the wise man said, "That ain't good." 

Read more about paradox in relation to medspas: The paradox of unlimited choice 

Non Compete Agreements: Keeping your Medspa staff from killing you.

Are Non compete Agreements Valid?

It's common for physicians to ask about how to prevent nurses, estheticians, or even other physicians from leaving to work for a competitor?

Many physicians ask their staff to enter into broad non compete agreements or employment contracts with non compete provisions to prohibit departing employees from working for a competitor or from using information they acquired while working for you. Or perhaps you just want to specify how soon an employee can begin working in a similar business.

There are problems with many non compete agreements valid and if overly broad they're not legally enforceable?

As a general rule, non compete agreements--often referred to as agreements or covenants not to compete--aren't valid or are not readily enforcible. In most states, there's a longstanding, strong public policy against such agreements since they're often so one-sided and impinge upon an individuals ability to make a living which is frowned upon by legislatures. The rationale for this policy is to ensure that employees have the right to pursue any lawful employment of their choice. (The California Legislature has enacted a law that declares void every contract that prevents someone from engaging in a lawful profession, trade or business of any kind.) Of course, as with most laws, there are exceptions provided in the law and created by the courts. In most states, the courts have carved out an exception to the general rule that covenants not to compete are void. They're typically permitted when deemed necessary to protect valid trade secrets of the employer. When former employees engage in unfair competition through the unauthorized use of trade secrets or confidential information, the courts will generally enforce proper non compete agreements.

A non-compete agreement which prohibits someone from working anywhere is far less likely to be valid than one which prohibits someone from working within 10 miles of the former employer’s business but this will depend on the kind of work. Your medical spa may have an interest in keeping an esthetician you trained from competing across the street, but if the non-compete agreement says nowhere in the state, it becomes less reasonable. If the esthetician can find a job in the state 50 miles away, most of the clients will not travel that distance for the service, but will stay with your medspa. On the other hand, this non-compete could force the esthetician to move to look for work or otherwise to travel hundreds of miles.

A non-compete must also be for a limited and specified time. If the esthetician is gone for a year, the medical spa can expect that the vast majority of the customers will have stayed and the estheticians departure will likely do little harm to the business. Thus, keeping the esthetician out of work for three years does little to help the business, but seriously harms the esthetician .

Depending on the circumstances and the language used, agreements not to compete signed by employees when starting a new job can prevent them from legally using secret formulas, recipes, certain protected customer lists and other trade secrets. Of course, merely labeling information as a trade secret or as confidential doesn't make it so. Disputes as to whether certain information is truly secret or confidential are decided by the courts on a case-by-case basis.

A similar issue arises when an employment agreement attempts to prevent a departing employee from taking other employees with them to a competitor. Such non-interference agreements aim to prohibit employees from soliciting other staff members to leave the employer. It's clearly improper for a departing employee to induce fellow employees to breach their employment contracts. On the other hand, if there's not an employment contract, nothing prohibits employees from deciding to join a colleague at a new employer.

In the end, to be valid a non-compete agreement must be narrowly tailored to meet the needs of the employer which will be balanced against those of the employee. If you are preparing a non-compete agreement, you need an experienced lawyer to draft it in a way that it will not be held invalid. If you are dealing with a non-compete agreement as an employee, there are lots of ways to attack it.

However, there are ways to accomplish what you're trying to do without having to rely on non-compete agreements exclusively. The key is that any agreement must be made by knowledgeable and informed parties and can't limit an individuals ability to make a living. 

When Surface was first formed I had all of our staff sign non-competes since they were constantly being poached by both competitors and schools who wanted to boast that "the instructors worked at Surface". I found that my energies were better spent elsewhere. My staffs will often receive boastful offers from competitors. Interestingly, they're almost never accepted. (The last one was years ago.) Why? I'm transparent with my staff to an extent that they know they can trust me. (Another post on this later.) 

We do prevent our physicians from competing directly with us, but it's not through non-competes.

Of course, as with any legal matter, you are always advised to consult an employment law attorney when considering anything legal. If you do something stupid, it's your fault.

Seth Godin & Your Med Spa or Skin Clinic

In sitting down to write this post I was struck with the width of the topic. Not Seth Godin, but cosmetic medicine (laser clinics, med spas, skin clinics) and how successful medical practices are built and run. It's no easy task. Which brings up Seth Godin.

Seth has a job. He describes it as being Seth Godin, noticing things that don't have an existing vocabulary and giving words to people so that they can talk about concepts that didn't have words before. Seth's quite good at this as, since there's a scarcity of Seth Godin's in the world and he's the only one.

Scarcity. Superstars. Best in the world. Remarkability. Mantra.

All things I've blogged about but not really focused on in a coherent pattern.

In effect, I've missed the forest for the trees. I'm going to try to talk about a few of those trees. They're the ones you're using to build your business.

There are now many smart docs reading this site. Some comment, most do not. It's a statistical fact that only about 1% of any interaction you have (including blogging) elicits a response from the people you're interacting with. I'll guess that many come and scan the list of recent comments along the left side of the page rather than read what I'm writing about. That's good, fine, and by design. Decentralized but organized systems win every time.

Seth is used to talking about markets and retail. This site is for physicians in retail medicine (It say's so right at the top.) so I'm going to use some of Seth's words and some of my own. I think they're good ones.

Doctors in retail medicine have been operating at a disadvantage. Due to certain idiosyncrasies of the medical marketplace they've not had access to the resources that other retailers take for granted. The medical spa franchises are a first studdering step to bring systems to the marketplace. My own feelings are that the current crop are doomed to fail because they don't fulfill what is needed to succeed. Scarcity? Remarkability? Best in the world? No. If you've sat through any of the medspa franchise discovery days what you hear is this: Turn key operations. Low hanging fruit. Uniformity. Those are not the words that build successful businesses. These are the words that build commiditzed, mediocre, average, and struggling businesses.

The good news? There's also a scarcity of superstars. There's room at the top. Medicore's where the crowd is.

Physician Consultations: The paradox of unlimited choices.

While not the best dressed presentation, Barry Schwartz's presentation on choice is worth watching for anyone designing an offering or performing consultations.

 
Via Presentation Zen:

Happiness, decisions, & the paradox of unlimited choices

 If some choice is better than no choice, and more choice is even better than that, then how can still even more choice — a seemingly unlimited array of choices in fact — not be a kind of decision-making nirvana where people make both better decisions and are happier about those decisions? Do not more choices and a greater number of options lead to better decisions? And if so, why then are people unhappy with their decisions even when a decision is a good one? Why do people feel regret even when they choose well?...

Learning to love constraints
 At the end of the book Schwartz ends with 11 ways we can end the crippling effect of too much choice or  “the tyranny of small decisions.” The last one in the list is simply this: “Learn to love constraints.” I recommend the book, but you can save your money and get a pretty good feel for the book’s content by watching this 2005 presentation by Barry Schwartz at TED (below). This is a good presentation, though you will surely have some tips to offer him on both slide design and on the issue of making appropriate fashion choices on the day of your presentation.

“Imagine finding yourself lost on the open road. You finally see a lone gas station up ahead, you’re hungry to discover the route back to the freeway. You ask the attendant for directions, and he begins to offer plan A and plan B and plan C, each with varying degrees of specific detail. Rather than finding the clear, simple, and concise directions you were seeking, your brain is now swimming in a sea of even greater confusion. Clear, simple, and concise directions are all that you want.”

We've all had a similar feeling while using a poorly-designed website, application, or even a cell phone that did everything under the sun except make calls that didn't drop halfway through a conversation.

Simple, clear, concise
As daily life becomes even more complex, and the options and choices continue to mount, making designs which are clear, simple, and concise becomes all the more important. Clarity and simplicity — often this is all people want or need, yet it’s increasingly rare (and all the more appreciated when it’s discovered). You want to surprise people? You want to exceed their expectations? Then consider making it beautiful, simple, clear…and great. The “greatness” may just be found in what was left out, not in what was left in.

Medspas: Disagree & Commit

I love that Stanford University Entrepreneurial Thought Leaders Podcast. Listen to just one and you'll quickly see why it's the most popular iTunes podcast on technology startups and entrepreneurship.

Greg Ballard, CEO of Glu Mobile, was one I've listened to more than once in the last month. Greg touched on a number of topics of interest and there was this gem on 'disagree and commit'.

Disagree & Commit

Medical clinics and service businesses are a stressful place for interpersonal relationships. The stree and  long hours are hopefully made up for by your ability to have input and make a difference. Arguments and disagreements are just part of the deal. Hopefully there is a process where a decision is finally made and everyone gets on board. (It's been referred to as totalitarianism with input.)

There is an important element in any management situation, the ability to disagree but commit. 

The failure to be able to disagree and commit is possibly the most corrosive and common situation that any business faces internally. Someone who can not commit to a course he doesn't agree with becomes a leper, infecting your business and management team. Greg describes what he sees as the highest quality as anyone in business can have as the ability to 'disagree but commit'.

I've been in any number of situations where I've seen this failure to disagree and commit in action. Advertising agency's are rife with creatives who love to gripe about account reps and clients. Doctors staffs discuss stupid patients, but are just as likely to criticize the physician they're working with or for. It's a lot easier to give lip service to agreement or get overruled and stand your ground. Hey, when it doesn't work out you can give them the old 'I know that wasn't going to work'.

If you can build a team in which disagreements can be frank, even harsh, but where once a decision is made the team can get behind it and implement without reservation, then you actually have a team.

If you can't you have a typical doctors office. 

How much can a Medical Spa make?

 Dermadoc got me thinking with a comment he left on this Dermacare Franchise post:

"I will say that Dermacare offered no help whatsoever with suggestions in setting up the business or tax structure, HR for the folks we hired ( other than to force them to sign a non-disclosure agreement), or even how to address the competition locally (apparently 'We are Dermacare, tremble before our might!' was supposed to send the competition scurrying.)

'MedSpas' can be a fun business - I have a great time with the patients. It can also cost a fortune to get up and running if you don't do your homework, and franchisors truly only have some of the answers. I don't think I will ever make a million dollars with my little slice of heaven here, but it's mine and that's the important thing for me."

In general I don't like to comment on how much Surface makes. Certainly it depends on the clinic and other conditions, but I'm supprised a bit by DermaDocs comment that he feels that he won't every make a million dollars. Now while you may not take home a million dollars, a million in gross sales is very possible... if you know what you're doing.

Dermadocs comment that Dermacare offered no help or suggestions with business structure, taxes, HR leaves me absolutly dumbfounded. What the hell are you paying for DermaDoc?

We need to talk. 

I talk to somewhere between 5 and 10 physicians a week. Most are looking to try to enter or start a 'medical spa' but a fair number are already open or looking for training.  For many if not most physicians in this area, they're making a few thousand extra dollars a month and they're good with that. Of course if you're running an actual business, that just won't cut it. I'm curious about what everyone thinks is attainable or what you're goals are?

Would you buy a Medical Spa MD book?

Hmmm.... In the last month I've received six unsolicited emails inquiring about or suggesting that I write a guide or ebook about opening a medical spa and/or medspa operations.

When I started Medical Spa MD (at the time it was Medical Spas Online), my intent was to educate physicians who I saw making the same mistakes over and over and had no real sense of what was happening outside their own clinic. I thought I'd make a site and share some of the things I've learned in running and growing Surface. This site will pass 10,000 unique readers from around the world this month and the community is educated and informed.

So, here's a question with the two poll on the right. Would you buy a book from this site?

Easy. Let's do some market research here. This is completely informal of course and I'm just trying to get a sense of if it's worth the effort.

Medspa Mentor: Your patients don't feel average

It might be obvious but I've had a number of conversations on this basic topic lately about 'average medical spa patients'.

From my buddy Shmula who designs systems. 

Most organizations collect and report on metrics that are not descriptive of their processes. Some of you may have noticed that most metrics that are reported are the “average” or the “median”. Most people do not understand elementary statistics and their application to business. Here is the truth of the matter: Your customers do not feel the average — they feel the variation.Make

sure that your metrics reflect what your customers are feeling. The “average” is an inadequate measure and is not descriptive of what the customer is feeling. There are other measures that basic business statistics makes available to us that will help us (1) understand the customer better, (2) understand better where we can improve (3) identify ways in which we can further delight the customer.

Pete's exactly right and worth repeating.

Where Pete is talking about 'deviation from the average' as outside what the patient has come to expect, I'm using that term to highlight how a medical spa or physician looks at and services it's patients. There are any number of times when I've heard physicians or staff discuss 'average' patients.

When you first open your doors you are thinking of 'the sale', if you begin to achieve some level of success this quickly morphs into 'sales' and generalities begin to set in. You begin to use things like average sales, average consultations, average everything.

In and of itself that's not a terrible thing, except when it bleeds into patient interactions. If your 'average' patient spends $250 on Botox, a patient who's spending $150 might be thought of, and possibly treated in some subtle way as "below average". Are they? No. The average is an abstract construction that should remain in the realm of accounting. Don't let it migrate into your customer service. It's poison.

Your patients do not feel average.

Medspa Q&A: Planning ahead for your medical spa.

This post is part of Medspa Q&A, questions that I receive from physicians. If you have a question you'd like me to answer, you can email it to me here.

Hello Jeff,
Thank you for your reply.

I graduated medical school in the summer of 2003, in Denmark, Copenhagen, and have since completed my internship (11/2 years) and worked temporarily in a general practice in Norway. I am currently on maternity leave and will be starting a PhD program in the summer of 2007.

I’ve always wanted to be a plastic surgeon. Plastic surgery seemed like the natural choice for me as I’ve always been very creative and love the combination of aesthetics and surgery. I love the challenge of correcting disfigurements and doing cosmetic enhancements.

I’ve had several opportunities to shadow other plastic surgeons and found their work exciting, but also somewhat crude and that’s why I really like the idea of non-surgical cosmetic medicine.

I have had plans for a long time of running my own clinic someday. My sister is a cosmetologist/spa manager and she introduced me to your website. We have often talked about working together and incorporating our different, but very complementary skills into a health enhancing, cosmetic business.

Until I read your website, I had no idea that medical spas existed. It seems like the perfect model for us. We have already committed to opening a medical spa.

I was hoping that I could get some information from you on how to start up such a practice, what I’d need and where I could be taught how to use fillers (e.g. Restylane, Botox, Liposolve, laser, point lift and other anti-aging techniques. I plan to learn as many techniques as possible at the same time as I’m doing my PhD. A bit of a mouthful, I know. I hope to start up the medical spa shortly after the end of my PhD program, which is roughly going to last 3 years. It will probably take longer than I anticipate and I’m also ready for that.

I’d be happy for any advice or information you could provide.
Sincerely,
Dr. E B...

Ask a question, get an answer. Here goes...

It’s certain that I know a lot about my own company Surface. I’ve opened a few clinics myself and consulted more than a few doctors opening medical spas. You’ll have to decide if what I’m about to write makes any sense for your situation.

Decide how much money you’ll need to make: Since you’re at the beginning of your career, you’re in a much different situation than the many physicians I deal with who are looking to change their practice or add to an existing clinic. One of the benefits is that your overhead is probably as low as it’s going to be for a while. (Existing practices offer different challenges.) So ask yourself; How much money do you need to make.

Many doctors make the mistake of opening a new medical spa and only after they’re in business do they figure out that they’re not able to make the money they need to take home and keep the business afloat. When you’re thinking about your startup and recurring costs, keep in mind that you’re going to have to eat. Can you live on the cheap for a while? There’s a distinct possibility with any business. Don’t think that you’re going to be taking home 20k the first month, or any month during the first year.

Decide what kind of medical spa you want to start: Perhaps the most common problem that doctors get into is the leaping before you look strategy of business. Here’s a tip: Day spas do not make any money. As a rule, the average margins for day spas in the US is 6%. Medical practices generally lie in the 50-60% margins. Physicians hear day spa and start thinking this is great. The day spa will bring in all these patients and my hard working staff will kick them upstairs for face lifts and boob jobs. Sorry. It doesn’t work that way.

So, decide very carefully about the medical spa you’re starting. The answer to this question will largely depend on what your own background is and where you have connections. What is your current situation? How is it structured? What’s the legal and liability issues? Who owns what? What’s the offering and pricing? Who’s responsible for the advertising? Who’s running the operations? Get the picture? Not easy to know in advance but there it is. This is Retail Medicine and it’s significantly different from the mainstream.

Find someone who knows more than you: This is not a recommendation buy a medspa franchise or hire a spa consultant. The truth is; The only people I recommend that you really talk to are already running successful medical spas of the type you’d like to emulate. Salesmen, professional trainers and spa consultants are in the business of retailing their services to you. (Read: Inside a Sona medspa franchise series.)

You’re probably going to research training, seminars, and conventions on the net. You’ll find lots of people telling you that they know the secret. I once actually sat in a training session at the NY Medspa Expo with the title: Make $200,000 per treatment room. Right Now! The expert advice to turn each room into a gold mine? Never let a patient leave without rescheduling a future appointment and buying at least $100 in retail. Utter tripe and a good way to kill your own reputation. I could go on ad nauseam but you get the idea. Find someone who’s in the business of running medical spas. Not a doctor who already does Botox, they can’t teach you what you need to know.

OK, so that said, what does it take to start a medical spa? Well, here are a few principal ways I’ve seen physicians start cosmetic practices.

Start with a lot of money: Get $500,000, hire the best people you can find, and then count on not making much money for the first 6-12 months until you’re able to build a client base and some sort of reputation. Of course you might make any number of mistakes in hiring, advertising, or choosing the wrong technology.

Medical Spa as a sideline: Build your aesthetic practice alongside your existing one. This is probably the most common route. It seems the easiest and probably has the least risk. But it still has challenges. When you hire full time employees your burn rate can skyrocket quickly.

(There’s often the esthetician who has ‘hundreds of clients’ that they’re willing to bring in exchange for a regular paycheck. Sorry. Any aesthetician who has hundreds of clients is not looking for a job. I can’t tell you the number of time I’ve heard variations on the ‘the aesthetician was supposed to bring the clients in’ theme.)

The advice here would be to start slowly and learn fast. If you’re going it alone, spend as little as possible until you have to. Never buy redundant technologies. Get professional help from a reputable advertising agency with medial spa experience.

Get lucky: I know a few good luck stories when it comes to starting a medical spa but not many and It’s not the kind of odds you’d like to bet on.

Hope this helps.

Wall Stree Journal Article on Medical Spa Franchises: Medspa boom is a bust for some

Via Wall Stree Journal. Read the entire article here.

Read the Medical Spa MD series: Inside a medical spa franchise.

Medspa Boom Has Become a Bust for Some

By RHONDA L. RUNDLE
November 21, 2006

...Medspa ownership turnover generally reflects business stumbles rather than safety issues. Ms. Leavy says many of the troubled spas are affiliated with franchise chains with flawed business models, such as those requiring too much of a franchisee's revenue to go for marketing. (She estimates that about 10% of medspas are franchises, although other industry experts put the percentage at 30% or higher.)

Several Sona franchisees, though not Mr. Nebot, are in private arbitration over problems that include misrepresenting a complicated business as a turnkey operation and failing to provide needed support. Sona officials declined to comment.

Several franchisees of Radiance MedSpa Franchise Group PLLC, a franchiser in Scottsdale, Ariz., say the company's financial projections overestimated revenue and underestimated initial start-up costs, including working capital.

The president of Radiance, Charles L. Engelmann, recently said: "There are currently 32 open stores and we will have 47 or 49 open by the end of the year. None of the stores have closed." He also acknowledged that some franchisees are attempting to get their money back.

One common pitfall for medspa operators is the failure to properly account for prepaid services, such as discounted packages of laser or light-based facial treatments. At Mr. Nebot's shop, for instance, clients would routinely pay $1,000 in advance for a package of laser hair-removal treatments to be delivered over a year or more. The shop's rooms were then filled with nurses treating customers who had paid months earlier. Finding new customers with fresh cash was a constant struggle.

Mr. Nebot says he felt like a cartoon character, "running faster all the time but falling further behind." He used radio advertising to draw more clients, moved to a larger space and extended his operating hours. To avoid alienating customers, he gave away free treatments to those who complained that their hair kept growing back after they finished the five-treatment regimen they purchased.

In the wake of the recent legal changes in Florida, some medical-spa owners there must shell out an extra $60,000 a year or so to a dermatologist or plastic surgeon to oversee operations.

"I can't be my own medical director any more, which is an added expense I can't afford," says one Florida physician who is not a dermatologist. He says he is "facing personal bankruptcy and trying my best to get out while there is something left for my family" after miscalculating what it would take to market, advertise and build his business. Indeed, many medspa owners are doctors who hope to make easy cash at a time when income is shrinking from their traditional medical practices.

Some franchisers have run afoul of state regulators by violating laws against the corporate practice of medicine. In February 2005, California denied a franchise application from HealthWest Inc., a Los Angeles firm that had more than a score of Inaara MedSpas around the country. California ruled that HealthWest had "falsely represented" to owners that they could legally own a medspa without a medical background. HealthWest has gone out of business, but some Inaara shops broke away from the founders and still are operating as independent, stand-alone shops. (Note: The former owners of HeathWest are now 'licensing' medspas under the name Solana.)

Another bust was Skin Nuvo International LLC, which filed for bankruptcy and sold its 37 stores to a private equity firm that in turn sold them to Pure MedSpa, a Toronto company.

Sleek MedSpa, a closely held chain in Boca Raton, Fla., recently acquired SkinKlinic's Fifth Avenue flagship in Manhattan, but SkinKlinic's two other stores, one in Las Vegas and the other in Greenwich, Conn., have closed. SkinKlinic's founder, Kathy Dwyer, is a former senior executive of cosmetics giant Revlon Inc. Attempts to reach her for comment were unsuccessful...

Medspa Training: The Paradox of Choice.

Too many options create unsatisfied patients.

While the comments below were made regarding web site development, they are equally applicable to any offering. Novice businesses often want to include the 'we do it all' statements in their advertising  and consultations, in effect, putting the decision making problems back in the lap of the patient.

The patient wants and needs to feel secure in their decision. Creating a menu of too many choices creates a petrie dish of patient dissatisfaction. 

From the patients point of view, too many choices puts them at risk of choosing something other that the optimal. While you may not want to extend yourself to 'telling a patient what to choose', that's exactly what the patient wants you to do. Great salesmen know this and often employ a 'shark fin' approach by narrowing the offering to three choices; an exceptionally expensive choice, a minimal baseline choice, and the one they're really selling, the 'as good as premium but without the bells and whistles choice'.

The patient wants to be sold. That does not mean the the patient wants to be pressured, it means that they want you to lay out their options, risks, and rewards, and make a recommendation in their best interest.

Luke Wroblewski - The Paradox of Choice:

When people have no choice, life is miserable. As you start adding options, you increase wellbeing. However, you reach a point where the curve flattens out and there are diminishing marginal effects. At a point in the curve, satisfaction drops and you are worse off than when you were neutral.

Are all these choices a good thing? Yes. Having choices is good but we have always thought it was only good. There is a dark side as well:

• Paralysis: so many options that you end up not making a choice. A grocery store alternated allowing customers to sample 24 different flavors of jam & 6 different flavors of jam. With 24, more people came to the table but 1/10th as many people bought jam. In Speed dating, you are more likely to select a match with 6 dates vs. 10. For every 10 mutual funds made available, rate of participation in 401(k) investing goes down 2%
• Decision Quality: when presented with too many options, we do not use difficult criteria to decide but choose on the basis of what is most simple. For 401(k)’s the simplest choice is the worst choice: putting money in a money market account. In retail brand and price are the simplest choices.
• Decision Satisfaction: Even when people have chosen well, they are dissatisfied with their results. When you give people lots of options, they will get a better result. But they will feel worse due to regret and anticipated regret. If you did not examine ALL options, you assume one or more might have been better. This reflects opportunity costs: the reduction of value through comparison to other options.
• Escalation of expectations: the availability of many choices increases expectations. When things were worse (less choices): it was easier to exceed expectations (now as high as possible). There are no pleasant surprises left.
• Maximizer Impact: too many choices is an issue for people whose aim in life is to get the best (maximizers). How do you know if you got the best? You actually need to look at every possibility by making an exhaustive search. There is virtually no area where maximizing makes sense.
• Leakage: the conditions present when people are making a choice do not stop exerting influence after a choice has been made. People are less satisfied due to regret or missed opportunities and this dissatisfaction extends after the choice to the actual experience.

Sona Medspas: Inside a medial spa franchise.

Medical Spa MD Series: Inside a Sona Medspa Franchise

Q&A from former Sona Franchise owner Ron Berglund.

Ron posted a number of thoughtful comments regarding the problems with medspa franchises.

After exchanging emails, Ron's agreed to answer a number of questions about his experiences with Sona including the good, bad, and ugly. Why he chose Sona? What he was told? What really happended? What went wrong?

As far as I'm aware, Ron is the first medical spa franchisee who's been willing to come forward and tell his side of the story in a comprehensive way.

Want to make REAL money?

Cosmetic medicine may not be the answer.

 
People both in and out of the medical field often comment on how much fun I must have at work.  And I actually do have a lot of fun.  I enjoy my job and I enjoy this field of medicine.  But it's still work.  And there are still problems as there are problems in any line of work.  But I always get a chuckle when people assume that since the office looks like a day spa and since our patients pay out of pocket, that any physician who works in cosmetic medicine must be rolling in the money.  I even hear that from other physicians.  My own ob/gyn is soon going to add cosmetic services to her practice so she "can finally get out of debt."  And while I think there are a few clinics out there that do exceptionally well.  For the most part adding cosmetic services to your current practice is like starting any new business.  For every Microsoft, there must be 5,000 others that fail.  Those odds of success and failure definitely apply to the field of cosmetic medicine.

Course most people think that all doctors are rolling in money.  I think most physicians earn a decent living, but when you take into account all the years in school, tuition, and the residency "stipend" that works out to be about minimum wage....well, I think there are a lot of easier ways to make that same amount of money.  Which is why I'm happy that I enjoy my work.  If I had entered medicine just to make money, then I might be disappointed that I didn't decide to become a plumber.  My plumber makes between $200 - $300 / hr and doesn't have to spend thousands on malpractice.  And he's so busy that his voicemail says don't even bother leaving a message if you are a new client.  He's already got all the work he needs.  And then he takes off to Mexico for 3 months out of the year.  Not that I'd want to muck around in some of the stuff he does.  But if you are only interested in money, then perhaps medicine isn't the right calling for you.  And if you are really interested in money, then cosmetic medicine may not be the pot of gold at the end of the rainbow that you think it is.

In fact, perhaps you should head straight onto Wall Street.  Monday's (November 27,2006 Lure of Great Wealth Affects Career Choices) New York Times had a front page article about a hematology/oncology physician who was making about $150,000/year in clinical medicine.  But then he straddled over to Wall Street and is now earning over $1-2+ million a year.  He launched from "decent" money to "insane" money.  

We often hear about Drs. X, Y, and Z entering this field from all different types of specialties.  And I'm sure they are lured by the predictable hours and lack of insurance wrangling.  But if they are drawn by the ideas of wealth and grandeur, they might be sadly disappointed.