Proctology Medical Spa. Is this branding?
/Medical spa started by proctologist has record breaking attendance at grand opening. Some people have questionable taste.
Medical Spa MD: Subscribe to the 'comments' RSS feed.
/Medical Spa MD has some interesting discussions going on.
If you've been reading any of the 120 comments on the Dermacare Medspa and Carl Mudd post you've been witness to a slew of comments from Dermacare insiders, some of whom are less than enthusiastic about what's going on in Arizona.
You'll find the most commented on posts in the Medspa Top 10 here.
Medspa MD has more than 1000 subscriber to the main RSS feed. But there's also a feed for comments that will allow you to keep track of what everyone on the site is saying. You can access both feeds below. (More about medspa MD's RSS feeds.) You can also subscribe to the main medspa feed by email.
Medspa MD RSS feeds:
So if you're interested in more than just my prattling, subscribe to the comments feed as well. You never know what someone out there is going to say. And be sure to join Medical Spa MD while you're at it.
Sorry Cosmetic Doctors & Lawyers.
/Customer service vs. CMA (cover my ass) defensive medicine.
Aesthetic MD has commented that saying you're sorry to a patient prevents a large number of problems and can preempt the loss of a patient or possible litigation.
But the majority of doctors have a problem saying 'sorry'.
"Dr. Michael Migliori had the delicate task of telling the woman she needed a third operation. He began with two words that could make a defense attorney's head explode: I'm sorry.
"In this state," Migliori said in a recent interview, "that can be used essentially as an admission of guilt" if a patient files a malpractice suit...
...The surgeon said that he realizes an apology could come back to haunt him but that he considers saying "I'm sorry" essential to preserving the bond of trust between doctor and patient.
Otherwise, "patients think I'm hiding something, I must have done something wrong," he said.
Apology laws vary by state. In Arizona, Connecticut, Idaho, Maine and 11 other states, doctors can safely apologize to or commiserate with patients or their families about an undesirable or unexpected outcome, according to the AMA.
Personally, I think expressing concern and regret for unwanted outcomes is entirely appropriate.
HGH: Bioidentical Hormone Balancing in your medspa?
/CNN.com has a story on Human Growth Hormone's rising use.
Human growth hormone used since 1950s to help children with growth problems- 1990 study found HGH reduced fat, boosted lean muscle mass in men
- HGH among the drugs found in Anna Nicole Smith's body after she died
- HGH use for anti-aging is prohibited by law
From the story: "Growth hormone levels drop with age, and I'm just bringing them up to a normal physiologic level," explains Dr. Mark Gordon, a Los Angeles, California, physician who says he aims to give patients the hormone levels of a young adult. "In the course of that return, we see improvement in a whole array of medical conditions." He trained as an orthopedic surgeon but says he started practicing what he calls "interventional endocrinology" after seeing HGH injections speed recovery after orthopedic injuries.
...Despite the dire warnings, only a handful of doctors have gotten intro trouble for prescribing growth hormone. One of them, though, was Jackie Springer.
In 2004, the Kansas medical board stripped her of her license, saying she prescribed growth hormone, as well as various diet treatments, without performing diagnostic tests. Springer insists she did perform the tests.
After Springer lost her license, the Lothamers say they found another doctor to continue their treatment. "It's not for everybody, but we think it works, so we do it," says Ed Lothamer.
Perls isn't convinced. "When [clinicians] indicate they're not seeing any side effects, I simply do not trust them. They're running a business." He sighs deeply. "Everyone should stop, because there really is, I think, significant risk of big problems down the road."
I've been following the HGH debate for some time. There are certainly promoters and detractors. I'm wondering where the physician community here stands and if any of you are performing this treatment?
Free Medical & Spa Journals
/Free Medical Journals
Over the next few years, many important medical journals will be available online, free and in full-text. The unrestricted access to scientific knowledge will have a major impact on medical practice. Open access medical textbooks will soon become the standard in medical publishing.
The American Academy of Anti-Aging Medicine (A4M)
/
CNN.com has an article on the American Academy of Antiaging Medicine (The A4M). It's general journalism and, while not too flattering, isn't a complete hatchet job. Since there's been a number of comments on this site about forming a recognized body of some sort, I thought I'd link to the CNN article and see what everyone thinks.
The American Medical Association does not consider anti-aging an official specialty. Unlike Casas, who is board-certified in internal medicine and was an assistant professor at Dartmouth Medical School, many anti-aging practitioners are not certified in traditional fields. Robert Goldman and Ronald Klatz, the co-founders of A4M, are osteopathic physicians who were once ordered by the state of Illinois to stop identifying themselves as MDs.
Some observers say the whole field is an expensive hoax. "There is no such thing as anti-aging medicine," huffs Jay Olshansky, a sociologist at the University of Illinois who studies medicine and longevity. "As long as humans have existed, we have always desired to live longer. Every society, every religion, every culture. Of course, they all failed at dramatic life extension." Olshansky was slapped with a $120 million dollar defamation lawsuit by A4M after he accused the organization of promoting quackery. He counter sued and both sides eventually agreed to drop their cases.
Thermage sales guy vs. Botox sales guy.
/I see a lot of sales guys. I refer to them sometimes as the charts and smiles crowd.
(I have two very hard rules in my clinics. One, that there has to be a ready supply of Diet Coke, and two, that no one can give out my cell number to sales guys.)
A good sales guy is great, a poor sales guy is a liability. Chris Oordt is my Thermage rep in UT and he's on the good side (Hi Chris). He makes himself available when needed and is generally fairly attuned to my wants. The Botox guy's not in the same league.
Chris came into my Park City Surface location about three weeks ago and presented the clinic with the only Thermage's Pinnacle Award account in Utah or Idaho. Of course it's a made up award that Thermage gives to their larger accounts (I think $500k or more but I'm not sure.) and is based on how many of those $650 tips you buy a year, but it's still a feel good way to show a little appreciation. Chris and I talk and I get the feeling that he'd at least piss on me if I were on fire. I like Chris and people do business with people they lilke. (I'm guessing that I won't have a lot of business with DermaCare, American Laser Clinics, Sona, or Radiance Medspas.)
Contrast that with my Botox guy. (I won't mention his name.) Botox guy made an appearance after a few months absence and proceeded to complain to my staff that I didn't like him and that's why he hadn't been around. He wen't on at some length evidently, (I wasn't there) about how I'd laughed him out of the clinic when he presented me with his ideas about how to grow our business. Certainly I don't remember being that negative but occasionally I can be.... sarcastic. I guess Botox guy thinks I have it in for him which I don't. What I'd like is for something besides an appearance and useless information, not to mention less bitching to my staff about how I've oppressed him. I had to laugh at that. Jeeze Alergan, give me an award or something. Just the Park City clinic does 15k worth of Botox a month. Where's the love? At least Thermage gave me a big plastic thing-a-ma-jig to wow patients with.
And it's all about feeling good. Currently I feel good about Thermage since they shipped me ten pounds of award, and Chris now feels good that I mentioned him by name in a positive post and he can print it out for his quarterly performance review. How many other Thermage reps have gotten such positive press for their company?
Of course Chris and I have discussed Thermage or other technology vendors posting to and taking questions from this site. I've yet to hear how that has gone. If he gets it done, maybe I'll send him a statue.
A couple links of medspa interest.
/Will the number ever live up to the hype? Building a better vagina
Well, when you look at the reimbursement patterns, this is no surprise:
the primary selling points being enhanced sexual gratification for the women and aesthetically pleasing results. Starting at $4,500, a woman can have a labioplasty, in which her inner labia are cut and reshaped if she thinks they’re too large or asymmetrical. Or a woman can become “revirginized” and have an approximation of her hymen restored.
“Typically, people will spend between $300 and $1,000 for a Botox treatment,” says Resneck, all of which is paid for by the patient (given it’s for cosmetic reasons), usually at the time of service. By comparison, a skin checkup might net a dermatologist an eventual insurance payment of anywhere from $30 to $100.Long wait times have become customary for dermatology practices over the last few years, but now even patients with urgent problems complain they are being told to take a number and stand in line.
So a pair of California researchers decided to put these complaints to the test. Posing as patients concerned about a “changing mole” (aka skin cancer central), they called 851 dermatologists across the country to make appointments and reported the results in a 2006 study in the Journal of the American Academy of Dermatology.
The average wait time given them was 38 days, with doctors’ offices in some cities taking much longer: 47 days in Syracuse, N.Y., 48 days in Phoenix and a whopping 73 days in Boston.
Via Kevin MD
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?
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?
Medspa Nightmare: Erbium Laser Resurfacing by Non-Physicians.
/I had lunch today with a NP who had left a medspa chain a few months ago. (I won't identify him or the medspa chain since I didn't speak to him about posting this.)
During our conversation we discussed why he had left the medspa he was with after only eight months. He reeled off a list of things that caused him to feel that he wasn't a good fit but there was one thing that took me by complete surprise. He told me that the 'estheticians were performing erbium laser resurfacing'.
I thought that I must have misunderstood, but no, this medspa chain has a erbium laser and the technicians are the ones performing the treatments. Not docs, not NP's not PA's... just estheticians on their own.
Errrr..... that's not good and I said so. In fact, as far as I know, it's illegal on any number of fronts.
I'm wondering what everyones reaction is to this?
Join Medical Spa MD: Membership has its privileges?
/
Ok, here it is. After numerous emails and comments, I've bitten the bullet and created a Medical Spa MD Membership. I've had discussions with a technology and service providers as well as existing member who would like to be able to distribute information, offers, and the like to the readers of this site.
Medical Spa MD will receive periodic offers and the occasional update. I'm not exactly sure how much value will be derived by members buy, hey, it's 60 seconds and an email address. (You can always hit the spam filter later.)
Who's searching for Medical Spa MD?
/Tonight I took a look at what readers are searching for that come to this blog. I've posted a screen shot of the searches from the last few days. The searches change but the screenshot shows how people are typically searching for information.
It looks like the long strings of comments on the Dermacare posts have given this site a rather large footpring for people searching for Dermacare.
Thermage is usually in the top two or three searches so it's no suprise to see 'Thermage reviews' and 'Titan vs. Thermage' and 'does Thermage work' among the top searches.
It's much more of a suprise to see 'dermadoc' as generating a number of searches.
Of course the list is much longer. I've just posted what fit on my screen.
How to Terminate a Medical Spa Franchise: Letters of woe.
/It seems that I'm being type cast as a medical spa vigalante and I'm being sent all kinds of medspa franchise stuff.
There's been more than a few questions about how to terminate a medical spa franchise. Since people have sent me info, I've uploaded some scans of letters which franchisees have terminated their franchise agreements with.
Both of these letters were sent ot Radiance Medspa Franshise Group. I've been told that neither letter received any kind of response. That seems to speak volumes.
Successful franchisors make their money from royalties. The 'franchise fee' to a large extent is for training and startup. It's telling that in these instances at least, the franchisor let the franchise go without so much as a phone call. (Of course no one got their $80k back.) I'm curious about what other Radiance owners think?
So, for whoever requested this type of info.... here they are.
The follwing links will take you to the scans of the letters. All identities have been removed from the letters.
Medical Spa Franchise Termination Letter 1
Medical Spa MDs: What's your problem?
/OK, since 90% of poll takers responded that they'd like something enough to pay at least something, it looks like I'll write something on medical spas. Of course if Dermacare starts voting that number might drop.
So I thought I'd ask for input as to what, if any, information the 10k monthly readers of this site would like to know more about (yes... increasing new patient flow will be in there automatically)
Operations? Hiring? Technology? Finaincing? Where to buy a whetstone to sharpen your Botox needles so you can resue them? How to compensate your minions? How to keep get out of a medical spa franchise? Non-compete agreements?.... whatever.
I'd just like some imput and interaction that can help provide some guidence about what you'd like to know the most so I don't waste as much time as I might.
Just leave a comment or send me an email.
Thermage: Do plastic surgeons hate everything non-surgical?
/First, I'll state that I like Thermage.
But plasticized raises the questions that have been haunting Thermage since the early days.
Thermage is a radiofrequency device that is meant to create skin tightening and collagen remodeling. It takes multiple treatments to acheive desired results, and is somewhat uncomfortable.
There seems to be a growing consensus among surgeons that Thermage is not everything they hoped it would be. When looking at a presentation by the medical device company that sells Thermage, it is at times difficult to distinguish between the before and after images. We have to strain our eyes to tell the difference (see here). Also, issues with fat atrophy and scarring have surfaced.
The issues story about Thermage fat atropy and scarring that plasticized points to:.
"I was shocked and dismayed over the scars that resulted from this reportedly safe and non-invasive procedure,” said thermage patient, Laurie.
Thanks to White, Laurie doesn't appear to be disfigured. At first glance, you can't tell she suffered second-degree burns to her neck. It's taken her two years of reconstructive procedures, but today she hopes White can hide her last remaining scars.
Of course my account rep Chris addressed these questions with me just last week. I've invited Chris to submit some posts and rise up to defend Thermage's name. He's said that he'll check with corporate to see if they'll let him.
Update on 2007-05-12 15:35 by Medical Spa MD
Thermage Corporation has responded to this post here: Thermage Safety - The Whole Story
American Laser Clinics Part 1: Armed guards & threats.
/This series of posts details how it came to be that American Laser Clinics hired an armed guard to stand in a physicians waiting room and prevent him from seeing his own patients.
While this took place years ago, there are still lessons to be learned.
In November of 2005 I was contacted by Dr. Vaugn Moody, the medical director of an American Laser Center in Draper, Utah. (Yep. The same ALC that's running the laser hair removal infomercials.) Dr. Moody had been the medical director for ALC and had built out a new clinic in Draper. ALC had moved with him and were renting 4 treatment rooms and a front desk area. ALC had a staff of about six young women (early 20's) who were generally autonomous. About medical spa franchises.
Dr. Moody called and asked to meet and discuss the possibility of leaving American Laser Clinics and associating in some way with Surface.
According to Dr. Moody, American Laser Clinics was constantly late paying him for overseeing their operations and operating far outside the acceptable norms of ethics and acceptable medical standards. He was unhappy with a long laundry list.
- American Laser Clinics was initiating IPL fotofacials without adequate or proper training for their staff.
- The ALC technicians were being hired, given an hour or so of training from the other technicians and then performing treatments.
- Dr Moody, the medical director, was entirely removed from any interaction with patients. The staff gossip was that the ALC staff had been told never to referr a patient to Dr. Moody's clinic since he'd try to 'steal them'.
- Patients were being diagnosed and treated without being seen by anyone other than a technician with no medical licensure or training.
Dr. Moody twas being sued by a patient who had been burned from a bikini line hair removal. The most interesting thing about this was not the fact that they had burned someone but that the burns showed the treatment pattern and that it was obvious that they had intentionally not treated the entire area but were 'skipping' ever other pulse. During later conversations with staff members they represented to me that they were actually trained to do that to save time.
The patient suing Dr. Moody (and American Laser Clinics) had been treated by a new hire who, without any supervison, had used the IPL Fotofacial head rather than the hair removal. Additonally she'd turned the device up. The result was a perfectly detailed burn that ran from her navel down to her pubis and resembling a zipper with that skipped pattern. The patient, who was supposedly a swim suit model heading for Las Vegas, was not happy. And rightly so.
Dr. Moody also told me that ALC staff treated a number of patients after he told them specifically not to because the laser was not resetting itself correctly and needed to be serviced. The result. Burns again.
This litany of horrors went on and on. The staffs of both clinics were almost openly hostile. The situation was unmanagable and getting more so.
I should insert here that Dr. Moody went to medical school with one of our physicians and there was some pressure from that quarter to help him out. There was also the idea of converting his entire clinic to a Surface clinic which was Dr. Moodys positon from the start.
I ended up having a number of meetings with Dr. Moody. The situation was bleek but after a few weeks of dinners and a number of long conversations I agreed to convert his clinic to a Surface locaton after he disentangled himself from American Laser Clinics.
Of course there were a few problems. First, Dr. Moody claimed that he was afraid that ALC would not only retaliate by suing him, but that he might be in physical danger from them. He constantly spoke of ALC being run by 'mobsters'. At first I thought this was kind of funny.
Dr. Moody sent a letter to ALC that basically said that he would not sign a lease at that location and that they had 30 days to find another location. I saw and read the letter before it was sent and there were some other notes in there about late payment and such but that was the gist of it. (There was a letter of intent at the time but no lease so Dr. Moody was fine there.)
ALC did not go quietly into the night.
Rick Frisk, who I think is a vice-president, was one of the founders of American Laser Clinics and had know Dr. Moody for a long time, called. Dr. Moody described the call to me as a lot of yelling and threats. Now I'm aware that people often exaggerate to make a point. But in this case I was there during a number of the calls and could hear the speaker on the other end. (Dr. Moody also recorded at least one of these calls and possibly more with a little recording device he'd bought at Radio Shack.) I could hear some of what was said and listened to the recorded converstaton that Dr. Moody provided to me. I've never heard or seen anything quite as nasty. Rick's boss, the President of American Laser Clinics (I forget his name as I write this) threatened to spend his last cent to 'break' Dr. Moody among a long list of profanity. There were any number of these calls. The one's I was privy to were at least ten minutes long.
What had really upset Rick and the ALC gang was that Dr. Moody had spent long hours at night copying all of their patient records. Now as the medical director he actually had a right to access these records but ALC was not happy with having their entire database of clients copied by someone who was kicking them out and obviously had designs on their business. Dr. Moody now had copies of every patient contact sheet that ALC had at the clinic. I can't remember exactly how many there were but it was an entire wall full and had taken at least 30 hours of work at night to copy.
Then the shit really hit the fan.
American Laser Clinics hired an armed guard to protect themselves, their records, and their patients, from Dr. Moody.
The picture at the top of this post is of that guard standing in the front of Dr. Moodys clinic. I took the photo. It's difficult to see but the guard actually had a gun on his hip. It was crazy. The guard had been informed that Dr. Moody was a threat to the patients and staff and he took his posting seriously. Any time that Dr. Moody would walk towards his office (where I was standing and where the picture was taken from) the guard would run down the hall and confront him to prevent him from whatever.
All the while American Laser Clinics is treating patients. That woman in the photo is a patient filling out paperwork.
Let me reiterate:
- American Laser Clinics is performing medical treatments on patients while an armed guard prevents the physician responsible for their care from seeing them.
I thought I'd seen it all but I guess not. The ALC staff members had been instructed to have no contact with any of other clinic staff and they were telling patients that the guy with the gun was just waiting for someone to get of work or some such nonsense. I would certainly love to have been privy to what the patients were thinking. There were a lot of angry looks from the ALC girls.
By the second day even I'd had enough.
I called a few contacts I have at the local news and had a camera crew sent out. At the same time Dr. Moody called Utah's Department of Licensure and complained to them about these 'illegal' treatments going on inside his clinic while the guards were there. (They hadn't heard of this before either.)
It was priceless watching the film crew show up. Dr. Moody, who used to be an Elvis impersonator, escorted the camera right up front and started interviewing the guard and the ALC staff. I guess he felt safe enought that the guard wouldn't shoot him in front of the TV camera. The guard went all shades of red. It was somewhat funny but I felt really bad for the entire ALC crew. They were scrambling for cell phones like they were drowning and their cell phones were reserve air tanks. The poor security guard was obviously asking his boss for directions. He didn't know if he should plug'em all or run.
Dr. Moody spent 20 minutes interviewing the ALC staff asking them who their medical director, who's clinic it is, and why there's a guy with a gun there.
Then the inspector from DOPL showed up. (I have photos of this entire phase.)
The inspector was really a take charge kind of guy. The TV cameras didn't even phase him.
Then two police cars and the security guards company owner show up.
Let me set the stage again: We have an Elvis impersonator with a TV crew, the State, the Cops, Dr. Moodys staff, and the ALC staff.... and patients coming in for laser hair removal.
I have to say that the State inspector and the cops were really good. The first thing that the cops did was run the security guards off the property as soon as they determined who owned it. They left in a hurry. ALC was not as fortunate.
The State shut them down on the spot.
They reopened the next day and treated a number of patient without any medical supervison (Dr. Moody took photos of all of this) but the State was on to them and they closed for a few more days while they scrambled. They ended up hiring a PA to literally sit in the waiting area all day. They met the deadline and moved back to their previous location.
But the saga is not yet over.
The patient who was burned sued ALC and Dr. Moody making them co-defendants.
ALC sued Dr. Moody for breech of contract claiming that they had a lease (which they did not).
During these procedures Dr. Moody was ordered to turn over all the American Laser Centers patient records that he had copied. He turned over a few few hundred but the vast majority were never turned over. I don't know specifically what the order stated but every single ALC record was copied and then entered into the front desk computer database with emails and contact info.
So, that's how it happened. Any thoughts?
