Where Does Creating The WOW Factor Begin?

Have you ever been put in the bad situation of believing you need to fill an opening out of need? You post and ad and literally the first few people that respond and can walk and chew gum get the job.  How did that ever work out for you...

There is a real skill set to interviewing & selecting the "A" players that will create the WOW factor even without all the tech behind them. The question I'm most often asked is how to find them, interview them and hire them.  Here are a few tips to consider.

1.  Start with ad itself. Don't flour up the position or your establishment to make it seem like a dream job.  Instead, think of what you specifically need for the position you're trying to fill and use language that will weed out anything other than "A" players. In other words don’t talk about your wonderful environment. Talk about the demands of the position.

2.   Weed through the stacks of resumes and make piles of A & B applicants. All others can be put in a rainy day file for a possible another look. Now send an email to each of your A/B possibilities asking them to describe in specific terms what they can do for your organization. Then sit back and evaluate who you want to bring in for a face to face meeting. In order to hire a WOW employee they need to really impress you in this phase.

3.  At this point you're now meeting the applicants. Remember your job is to find the best "A" level player. Now you have to find out if they can think on their feet and react positively to pressure.  For myself I inform each applicant that regardless of what they are being hired for that every position also has three responsibilities.

   A.  Everyone is in Sales

   B.  Everyone is a Customer Advocate

   C.  Everyone is responsible for outside marketing activities and needs to bring in 5 new patient per month through those efforts.  In short they will need Evangelize how we are and what we do.

Now at this point you will begin to weed out the producers from the pretenders but for me, there is still one more test. I call it my pen test but feel free to create your own. I tell the applicant that I need them to role play for me. I tell them that I want you to sell me a pen and not just any pen. I want you to pretend that there are 3 other pen sales people in the waiting room all trying to sell me the exact same pen you're trying to sell me. I then count down from 5 and it's roll play time. 

What you're looking for is the applicant that can take the heat of the moment and find some way to shine. Funny thing is that I'd estimate that 75% of the over 1,000 people I've interviewed in my life fail this test. Some break down and cry, some stammer then shut down, some freeze and walk out and some hit it out of the park. I submit that if a candidate can't handle selling a pen how the hell are they going to sell aesthetic services?  If they can't handle the pressure of a simple role play how will they handle the irate patient we get from time to time. If that can’t sell you a pen that’s the same as 3 others how can they sell Botox & Laser treatments that are same at other practices in your area.   I’m constantly amazed at how few staff members at other organizations I meet can’t give a simple elevator pitch as to why I should buy from them vs. the competition.  If they lead or bring up price in the first sentence or two I can assure you the organization is floundering on failure.

So, seek out the "A" level players.  They exist but you need to attract them, hire them and retain them.  The last one might be another topic to discuss...

Effects of Changes in the Medicare Physician Fee System

Relatively newly practicing physicians may not know that the Medicare physician payment system changed pretty substantially in the early nineties. This was by design.

The perception of those who designed this new system was that certain services were overpaid and others underpaid. It likely had much more to do with ratcheting down the costs of health care. As physician fees constitute only 10-20% of the entire equation, the wisdom of concentrating on physician’s fees to change the system is perhaps questionable. This is what was done nevertheless.

A cornerstone philosophy of the new system was that procedure-based specialties were overpaid. The physician fee system prior to this was based on usual and customary fees. This newer one based payments on a model that paid for a service at a uniform rate regardless of who performed it. While this seems fair on the surface, it had predictable effects.

Why would a surgeon with much higher overhead remove a lump in a patient if the new payment system put the procedure in a revenue negative position? The practice of surgeons removing certain lumps gave way to family practice and dermatology physicians removing many of them. These were the only specialties that under the newer system could turn a profit doing so.

The Medicare fee schedule economically regulates procedures in medicine. It also indirectly fed the growth of cosmetic medicine and surgery as this was the escape hatch many practitioners sought as the Medicare boom feel upon us. Surgeons interested in turning a profit quickly figured on what paid adequately and more importantly on what did not. As my grandfather told me as a young child, everyone needs to make a living. It is perhaps unfortunate that doctors do not discuss these matters with patients when telling them why they cannot offer a service. Is it really ever wrong to tell your patients the truth?

How To Use CT3+V: An Equation For Creating Facial Beauty

CT3+V = A simple equation for creating or restoring facial beauty.

We all know that "Beauty" is in the eye of the beholder. When it comes to creating and restoring facial beauty, we collaborate and negotiate with our patients (and sometimes their family and friends) to optimize the result and reduce the risk by using more conservative aliqotes of different techniques and technologies. Each practitioner brings their own unique skill-set and biases to the procedure room. We (hopefully) listen to the patient requests, evaluate what the underlying structure, tolerance for downtime and discomfort, economic consequenses and duration of effect is, to be able to offer the patient a scientifically valid, safe, sensible treatment plan. Then, we present a palette of procedures, techniques and technologies to consider.

What sets successful docs with many happy patients apart from the rest of the competition is attention to detail, listening to their patients (and sifting out the unrealistic ones) and having a plan that is recreated in some form (it's never the exactly the same twice) again and again.

My equation (tool) for discussing and creating facial beauty (or re-creating a more youthful appearance) is CT3+V = Beauty... short for Color, Texture, Tone, Tightness and Volume (in proportion or re-establishing proportion)

When the patient (on request) brings pictures of their face and neck that show them in yourthful repose, it is a strong tool to build consensus of what procedures and when in the scheme of possiblities, to pursue. Compare the old photos to current digital pictures obtained in 5 views-front-quarter and side views against a solid background with decent lighting and a portrait lens. Now diagnose the changes and educate the patient on the many ways you have to enhance and revitalize the issues you uncover in a systematic manner:

Color-pigment mottling and broken blood vessels respond well to various IPL's, NdYAG's, PDL's and KTP lasers depending on the patient's heritage (Fitzpatrick or Lancer skin type);

T3 (Texture, Tone and Tightening)-decide if the issues are epidermal, dermal or sub-cutaneous and treat with chemical or laser peels, focused ultrasound or radio-frequency and remember the skin looks better when "on-stretch", so Volume and surgery fit here too.  Toxins soften the dynamic wrinkles and shape the brow, but should be delivered in a artful manner that yields a natural, rather than "done" result;

Volume-Pierre Fournier, MD (Paris) taught us that "the look of youth is full" and the current saying "size matters" comes in to play here too.  Youthful features are generally softer and rounder, age makes them more severe and hollow.  Surgery helps take the luff out of the sail or the sag out of the jowl and neck, but does not effect volume very effectively.  Volume is at least as (and maybe more) important long term.  Fat and fillers (I prefer fillers for face) are a great way to go as long as you educate the patient as to how much it will really take and offer them permanent fillers (like Artefill in the USA) that can serve them well long term, once they find the look they want to preserve.

So-with every patient: define the issues, make a mutually agreeable long term plan, track the progress with digital pictures and keep an open dialog and flexibility, so that both you and your patient achieve happiness and WOW results long term. Happy patients refer their friends. Surviving aesthetic medicine these last 15 years is no accident....it's all been done with mirrors and this equation!

Planning Ahead For Equipment Failures

It's inevitable. At some point your cosmetic laser or IPL will go on the fritz. Then what?

About half of the people I speak to every day are medical spa owners. The nature of my job pretty much implies that most people calling me are in some type of situation they would consider an emergency. Most have just one cosmetic laser or IPL, a schedule full of customers, and no time. A week of searching for a repair company or technician can put a medical spa in a very bad situation. Unexpected service expenses are not so... they should be expected, but they are ignored.

How does one prepare for such unforeseen expenses as the need for a laser cavity rebuild, a power supply repair, or laser rod resurface- all repairs that can result in at least a week of downtime? This problem can best be remedied at the time of purchase, but most of you are far beyond this point. There are few options, but there are options.

The very best option in contingency planning for unexpected repairs is to warranty your devices. This is best done when purchasing your new or used laser- new lasers should come with a minimum 12 month warranty, and you should never purchase a used laser from a company that cannot offer at least a 6 month warranty after purchase. Many dealers and third party service companies now offer warranties on a wide variety of laser makes and models, but to know who offers what you may have to ask around. Some of these third party warranties offer more for the money than the original equipment manufacturer warranty, but come with the caveat that there are parts that may not be readily available at all times.

Another option to consider, even if you have a warranty, is a backup unit or rental. If you can only afford one laser, teaming up with local colleagues is one way to alleviate this problem. If you have a Cutera Xeo, for example, you can seek out colleagues in your area who also use the Cutera Xeo and together purchase a standby unit that is only used in case of emergencies. You might also ask your warranty company if they are capable of providing loaner units while yours is in repair.

The third option to consider is leasing your unit. Under a lease, you are not directly responsible for all the maintenance. In case of emergency, the leasing company should be able to provide a loaner or temporary unit. I am not referring to a lease as in taking out a loan from a bank to pay for what will be your laser- I mean leasing the laser from an owner who will handle all the maintenance should anything go wrong. These kinds of arrangements do include clauses where you may be responsible for negligence, equipment abuse, and misuse, but most lasers fail because of normal wear and tear.

Of course, none of these options will alleviate every emergency situation. The best course of action may be a combination of these options, or all three. Even though there is no catch all, HAVING a plan, or at least being aware of the possibility of an unforeseen expense is more than ignoring the possibility in it's entirety.

Have a question? Please leave a comment.

Top 5 Cosmetic Surgery Treatments In 2011

According to the American Society of Plastic Surgeons cosmetic surgical procedures increased 2 percent, with nearly 1.6 million procedures in 2011. The top five surgical procedures were:

• Breast augmentation (307,000 procedures, up 4 percent) 
• Nose reshaping (244,000 procedures, down 3 percent)
• Liposuction (205,000 procedures, up 1 percent)
• Eyelid surgery (196,000 procedures, down 6 percent)
• Facelift (119,000 procedures, up 5 percent)