Integrating Aesthetics in Your Practice

Non-surgical cosmetic procedures continue to rise steadily, and it is expected to so in the coming years. The market, however saturated, is still competitive with the increasing demand of patients seeking these procedures. Thus, many physicians venture to aesthetics either through ancillary services or as the focus of their practice.

Admittedly, adding aesthetic treatments and procedures is more profitable and bring in more patients in the practice. Based on the statistics published by the American Society for Aesthetic Plastic Surgery (ASAPS), non-surgical procedures have steadily every year with statistics only limited to plastic surgeons, what more for dermatologists and general practice physicians. Many expect the number of procedures to...

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5 Ways To Turn Negative Reviews Of Your Medical Spa Around

If you're a dermatologist, plastic surgeon or medspa you've probably and you've been in business for a while, you've probably had some comments or reviews posted about you online that are less than flattering.

Cosmetic medicine seems to suffer from 'perfection expectations' more than other practices and with the advent of the internet and patients increasingly savvy use of it, it's easy for a less than perfect outcome or lapse in customer service to become a public event that's driving away new patients and tarnishing your online reputation. 

It's important to remember that even when 20% of all medical spa reviews are fake, that these are actually opportunities that you can use to both expand your reach and come across as a real person (which can actually help you considerably), but before you start penning a groveling apology let's take a look at how we can do some comment-judo and see if we can't turn these hurtful words to our advantage.

Here are 7 things that you can do turn around negative reviews of your clinic or medspa.

1. If the criticism has merit, apologize fast and accept responsibility.

We've all dropped the ball in some way. The more 'real person' and human you seem the more forgiving others are. Respond quickly and mean it, then outline what you're going to do to fix it now and in the future. Getting this right will position you as a clinician who cares rather than a defensive and patronizing jerk.

Had to wait too long to see someone? Wouldn't match the other local medspa's pricing? Couldn't use a Groupon after the expiration date? Admitting a negative has a strong psychological association with the truth, and you can use a small admission to actually increase your trustworthiness. Just be sure to do it fast, completely, and without that hint of sarcasm or patronizing tone that can often creep in.

2: Use it as real feedback and an opportunity to improve.

The worst reviews are the middling reviews of three thats that don't illicit enough emoitional response to even let you know where you're falling short. At least a one star review and an outpouring of profanity lets you know that you have a real problem that you can address rather than a festering wound that goes unnoticed but is continually costing you patients and damaging your reputation. So, if you get lampooned, take it as an opportunity to track down the real issue.

From Shmula: Henry David Thoreau said “There are a thousand hacking at the branches of evil for every one striking at the root.”  His statement was a commentary on the human condition but, I believe, describes quite well the state of most companies: companies launch initiatives that don’t actually attack root causes of business problems, instead their aim is on the branches — we need to pay Taiichi Ohno’s 5-Why’s a visit and remember that surgically attacking statistically validated root causes is the only way to solve problems, improve the customer experience, and improve the enterprise.

Taiichi Ohno is known to have said that “having no problems is the biggest problem of all.”  He viewed problems not as a negative but as a “Kaizen opportunity in disguise.”  Whenever problems arose, he encouraged his staff to investigate the problem at the source and to as “ask ‘why’ five times about every matter. Here's one of his favorite examples:

1. “Why did the robot stop?”
The circuit has overloaded, causing a fuse to blow.
2. “Why is the circuit overloaded?”
There was insufficient lubrication on the bearings, so they locked up.
3. “Why was there insufficient lubrication on the bearings?”
The oil pump on the robot is not circulating sufficient oil.
4. “Why is the pump not circulating sufficient oil?”
The pump intake is clogged with metal shavings.
5. “Why is the intake clogged with metal shavings?”
Because there is no filter on the pump.

The purpose here is to follow through and discover what's going wrong with your processes that can be fixed or improved. in many cases it's easy and relatively simple.

1. “Why did this patient feel the need to post a negative review?”
She was upset that she couldn't book her regular appointment for Botox.
2. “Why couldn't she book her regular Botox appointment?”
The front desk couldn't schedule her treatment at the time she requested.
3. “Why couldn't the treament be scheduled?”
The front desk software showed that there were no available appointments.
4. “Why were there no avialable appointments?”
The software won't make appointments of less than 15 minutes and won't allow double-booking.
5. “Why can't we double-book in the software?”
Because we haven't taken the time to change the settings in the software.

Perhaps that example doesn't fit you but the idea is clear. Track your issues back to the root with purpose and take care of them.

3: Overcompensate with your response.

Going overboard in your response can position you as someone who will do almost anything to please your patients. If you do it right you'll come across as one of the good guys who, even in the face of a disgruntled or angry patient, can respond with level-headed care. Using Twitter or Facebook to reach out to a (justifiably) disgruntled patient and offering them a free product, service or treatment (or more) is worth far less than it would cost for all the free advertising and congratulatory press you can get. Remember to be reasonable and don't pinch pennies or go so far overboard that it feels contrived.

If you are successful with this tactic you can reuse it across the board. Publish photos of this patient being treated in your medspa along with a few sentances and perhaps a testimonial (if you can win them back).

4: Humor always wins if it's done well.

Humor is the great equalizer that can take the sting out of any attack, especially if the attackers go overboard. Take a look at this video published by Bodyform in response to criticism on Facebook about periods being over-hyped with beauty shots.

In 2012, Bodyform received a well written complaint on their Facebook page lamenting how tampon adverts always presented an idyllic lifestyle rather than the less pleasant experience of real life... and his post was racking up likes. Instead of taking it lying down, Bodyform responded with a well-produced sarcastic apology that generated over five million views and received an overwhelmingly positive response.

5: Never leave it alone.

Any of the tactics above can work depending upon the circumstances, but the primary thing you want to do is make sure that you respond appropriately as soon as you're aware there's an issue. Any response is better than no response at all.

More reading:

Reputation Management Part 1: Understanding What Not To Do

Physician Reputation ManagementPart 1: What is your reputation online and what can you do that will burn it to the ground?

As a physician or clinic, managing your reputation online can be a tricky task. Online review sites like Rate MD, blogs and social sites like Twitter and Facebook give patients a much louder voice and longer reach than they used to have. Worse, a couple of individuals who really don't like you can have a disproportionately large voice since - unlike your generally happy patients - they're the ones who are really motivated to talk about you. 

There are ways that you can manage and control your reputation successfully, and then there are the most common responses that do much more harm than good. By way of example, here's is an example of exactly what you don't want to do and why people do it anyway.

Case study: IMD Lasers In Toronto

A few months ago, IMD Lasers in Toronto was named in an online discussion thread on Medical Spa MD with patients calling it a "horror" and saying it should be shut down... Not what you want people to be saying but, as those who are literate in the ways of the internet know, to be expected at some point if you're treating hundreds or thousands of patients a year. The problem wasn't really that IMD had some harsh comments posted about them, it was that they were unprepared, unrealistic, and unprofessional in their response to...

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Medical Spa MD: Online Defamation FAQ For Physicians

Understanding what is libel or defamation and what is protected speech.

Your medical spa, plastic surgery practice, or professional reputation are are open to criticism and 'reveiws' online. Here's what you need to know about what's protected free speech, and what might cross the line into Libel.

Here are some links about these kinds of CyberSlapp suits and where the law comes down on free speech and other issues around this:

Chilling Effects Clearinghouse: A joint project of the Electronic Frontier Foundation and Harvard, Stanford, Berkeley, University of San Francisco, University of Maine, George Washington School of Law, and Santa Clara University School of Law clinics.

DefamationThe law of defamation balances two important, and sometimes competing, rights: the right to engage in free speech and the right to be free from untrue attacks on reputation. In practice, the filing or even the threat to file a lawsuit for defamation has sometimes been used as a tool to shut down legitimate comment and free speech on the Internet.

John Doe AnonymityDo you post to a public message boards or discussion areas on websites such as Yahoo, AOL or Raging Bull? Do you use a pseudonym, fake name or a "handle"? Has someone asked the host of the discussion or your ISP to turn over information about you or your identity? If so, then the John Doe/Anonymity section may answer some of your questions. 

Protest, Parody and Criticism SitesThe Internet, which offers inexpensive access to a worldwide audience, provides an unparalleled opportunity for individuals to criticize, protest and parody.

The following is long but you'll come away with a much better understanding of what this all means and what speech is protected in the U.S.

Need to protect your reputation? Check out Frontdesk's Reputation Protection for Physicians

Online Defamation FAQ

Question: What are the elements of a defamation claim?

Answer: The party making a defamation claim (plaintiff) must ordinarily prove all four elements:

  1. a publication to one other than the person defamed;
  2. a false statement of fact;
  3. that is understood as
        a. being of and concerning the plaintif; and
        b. tending to harm the reputation of the plaintiff. 
  4. If the plaintiff is a public figure, he or she must also prove actual malice.

Question: What defenses may be available to someone who is sued for defamation?

Answer: There are ordinarily 6 possible defenses available to a defendant who is sued for libel (published defamatory communication.)
1. Truth. This is a complete defense, but may be difficult to prove.
2. Fair comment on a matter of public interest. This defense applies to "opinion" only, as compared to a statement of fact. The defendant usually needs to prove that the opinion is honestly held and the comments were not motivated by actual "malice." ( Malice means knowledge of falsity or reckless disregard for the truth of falsity of the defamatory statement.)
3. Privilege. The privilege may be absolute or qualified. Privilege generally exists where the speaker or writer has a duty to communicate to a specific person or persons on a given occasion. In some cases the privilege is qualified and may be lost if the publication is unnecessarily wide or made with malice.
4. Consent. This is rarely available, as plaintiffs will not ordinarily agree to the publication of statements that they find offensive.
5. Innocent dissemination. In some cases a party who has no knowledge of the content of a defamatory statement may use this defense. For example, a mailman who delivers a sealed envelope containing a defamatory statement, is not legally liable for any damages that come about from the statement.
6. Plaintiff's poor reputation. Defendant can mitigate (lessen) damages for a defamatory statement by proving that the plaintiff did not have a good reputation to begin with. Defendant ordinarily can prove plaintiff's poor reputation by calling witnesses with knowledge of the plaintiff's prior reputation relating to the defamatory content.

Question: Can an opinion be defamatory?

Answer: No — but merely labeling a statement as your "opinion" does not make it so. Courts look at whether a reasonable reader or listener could understand the statement as asserting a statement of verifiable fact. (A verifiable fact is one capable of being proven true or false.) This is determined in light of the context of the statement. A few courts have said that statements made in the context of an Internet bulletin board or chat room are highly likely to be opinions or hyperbole, but they do look at the remark in context to see if it's likely to be seen as a true, even if controversial, opinion rather than an assertion of fact dressed up as an opinion.

Question: Is there a difference between reporting on public and private figures?

Answer: Yes. A private figure claiming defamation — your neighbor, your roommate, the guy who walks his dog by your favorite coffee shop — only has to prove you acted negligently, which is to say that a "reasonable person" would not have published the defamatory statement.

A public figure must show "actual malice" — that you published with either knowledge of falsity or in reckless disregard for the truth. This is a difficult standard for a plaintiff to meet and especially if you're running a business that engages in any marketing or advertising that effectively makes your business 'public'.

Question: Who is a public figure?

Answer: A public figure is someone who has actively sought, in a given matter of public interest, to influence the resolution of the matter. In addition to the obvious public figures — a government employee, a senator, a presidential candidate — someone may be a limited-purpose public figure. A limited-purpose public figure is one who (a) voluntarily participates in a discussion about a public controversy, and (b) has access to the media to get his or her own view across. One can also be an involuntary limited-purpose public figure — for example, an air traffic controller on duty at time of fatal crash was held to be an involuntary, limited-purpose public figure, due to his role in a major public occurrence. 

Examples of public figures:

  • An attorney for a corporation organized to recall members of city counsel
  • A psychologist who conducted "nude marathon" group therapy
  • A land developer seeking public approval for housing near a toxic chemical plant
  • Members of an activist group who spoke with reporters at public events
  • Your medical spa or clinic...

Corporations are not always public figures. They are judged by the same standards as individuals.

Question: May someone other than the person who originally made the defamatory statement be legally liable in defamation?

Answer: One who "publishes" a defamatory statement may be liable. However, 47 U.S.C. sec. 230 says that online service providers are not publishers of content posted by their users. Section 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law. 

Question: Can an ISP or the host of the message board or chat room be held liable for
defamatory of libelous statements made by others on the message board?

Answer: No. Not in the United States.

Under 47 U.S.C. sec. 230(c)(1) (CDA Sec. 230): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection against defamation or libel claims made against an ISP, message board, blog comments or cummunity forums where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer: 47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law. 

CyberSLAPP & John Doe Lawsuits

Question: How is Internet anonymity affected by John Doe lawsuits?

Answer: Often called "CyberSLAPP" suits, these lawsuits typically involve a person who has posted anonymous criticisms of a corporation or public figure on the Internet. The target of the criticism then files a lawsuit so they can issue a subpoena to the Web site or Internet Service Provider (ISP) involved and thereby discover the identity of their anonymous critic. The concern is that this discovery of their identity will intimidate or silence online speakers even though they were engaging in protected expression under the First Amendment.

Question: Why is anonymous speech important?

Answer: There are a wide variety of reasons why people choose to speak anonymously. Many use anonymity to make criticisms that are difficult to state openly - to their boss, for example, or the principal of their children's school. The Internet has become a place where persons who might otherwise be stigmatized or embarrassed can gather and share information and support - victims of violence, cancer patients, AIDS sufferers, child abuse and spousal abuse survivors, for example. They use newsgroups, Web sites, chat rooms, message boards, and other services to share sensitive and personal information anonymously without fear of embarrassment or harm. Some police departments run phone services that allow anonymous reporting of crimes; it is only a matter of time before such services are available on the Internet. Anonymity also allows "whistleblowers" reporting on government or company abuses to bring important safety issues to light without fear of stigma or retaliation. And human rights workers and citizens of repressive regimes around the world who want to share information or just tell their stories frequently depend on staying anonymous – sometimes for their very lives.

Question: Is anonymous speech a right?

Answer: Yes. Anonymous speech is presumptively protected by the First Amendment to the Constitution. Anonymous pamphleteering played an important role for the Founding Fathers, including James Madison, Alexander Hamilton, and John Jay, whose Federalist Papers were first published anonymously.

And the Supreme Court has consistently backed up that tradition. The key U.S. Supreme Court case is McIntyre v. Ohio Elections Commission. http://www.eff.org/Legal/Cases/mcintyre_v_ohio.decision

Question: What are the typical claims behind a CyberSLAPP suit?

Answer: The most common complaints by CyberSLAPP plaintiffs are defamation, trademark or copyright infringement, and breach of contract. Speech that involves a public figure - such as your medical spa or practice - is only defamatory if it is false and said with "actual malice." It also must be promoted as being factual rather than an expression of opinion. In the US, because of our strong free speech protections, it is almost impossible to prove defamation against a public figure.

Trademark and copyright complaints typically claim that defendants have violated intellectual property rights by using the name of a corporation or its products, or by quoting from some of their copyrighted materials such as an annual report. In reality, the First Amendment includes a clear right to criticize and discuss corporations and their products, and the law includes clear exceptions for the "fair use" of protected material for those purposes.

Breach of contract suits often involve a claim that anonymous speakers might be employees who have violated a contract by releasing confidential information. Of course, the right to anonymous speech is meaningless if a corporation can unmask your identity at will because you might be an employee breaking a promise of confidentiality.

Question: What other resources are available?

Answer: Web sites dealing with this issue include:

www.aclu.org
www.citizen.org
www.johndoes.org
www.casp.net
www.cybersecuritieslaw.com,
cyber.findlaw.com/expression/censorship.html

Question: What are the key federal decisions involving anonymous speech?

Answer: 1. Buckley v. American Constitutional Law Foundation (1999) 525 U.S. 182, 197-200;

2. McIntyre v. Ohio Elections Commission (1995) 514 U.S. 334. In that case, on page 357, the Supreme Court said:

"[A]n author is generally free to decide whether or not to disclose his or her true identity. The decision in favor of anonymity may be motivated by fear of economic or official retaliation, by concern about social ostracism, or merely by a desire to preserve as much of one’s privacy as possible. Whatever the motivation may be, . . . the interest in having anonymous works enter the marketplace of ideas unquestionably outweighs any public interest in requiring disclosure as a condition of entry. Accordingly, an author’s decision to remain anonymous, like other decisions concerning omissions or additions to the content Amendment.
* * *
Under our Constitution, anonymous pamphleteering is not a pernicious, fraudulent practice, but an honorable tradition of advocacy and dissent.

3. Talley v. California (1960) 362 U.S. 60. (holding unconstitutional a state ordinance prohibiting the distribution of anonymous handbills)

4. Lamont v. Postmaster General (1965) 381 U.S. 301, 307 (finding unconstitutional a requirement that recipients of Communist literature notify the post office that they wish to receive it, thereby losing their anonymity);

5. ACLU of Georgia v. Miller (N.D. Ga. 1997) 977 F. Supp. 1228 (striking down a Georgia statute that would have made it a crime for Internet users to “falsely identify” themselves online).

Question: Aren’t people required to explain why they’re subpoenaing my identity and other information?

Answer: Not with the initial request. The reasons for the subpena are only provided if the subpena is challenged, through a motion to quash. In opposing the motion to quash, the person seeking the information must demonstrate, at a minimum, that it is likely to lead to the discovery of information that would be useful in a lawsuit.

Question: I signed a confidentiality/privacy agreement with my ISP that provides that they will not release my information. Doesn’t that protect me?

Answer: No. Most privacy agreements state that information will be turned over in response to legal requests, and a subpena is such a request. Even if the agreement does not say so, a legally issued subpoena overrides such agreements as a matter of public policy. Each ISP has a different policy about notifying users when their information has been subpoenaed, but they cannot simply ignore a subpoena under the law without risking legal santion themselves.

Question: What does "respond" to the subpena mean?

Answer: Usually, it means that the ISP will give the requested information to the requesting person. In some cases, ISPs have resisted requests for information on behalf of their customers, but this is not the norm. Unless specifically told differently by your ISP, you should assume that your ISP will turn over your information as part of its response.

Question: Can an ISP or the host of the message board or chat room be held liable for defamatory of libelous statements made by others on the message board?

Answer: No. Under 47 U.S.C. sec. 230(c)(1): "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This provision has been uniformly interpreted by the Courts to provide complete protection
against defamation or libel claims made against an ISP, message board or chat room where the statements are made by third parties. Note that this immunity does not extend to claims made under intellectual property laws.

Question: Can my ISP or the host of a message board be held liable for defamatory statements I make on the grounds that they are a "publisher" or "republisher" of the information?

Answer: No. Federal law provides: "No provider or user of an interactive computer service shall be treated as the publisher or speaker of any information provided by another information content provider." This has been interpreted to protect hosts of discussions between other people against defamation and libel claims as a "republisher" of the information. Note that this protection does not extend to claims under intellectual property laws.

Question: Must an ISP or message board host delete postings that someone tells him/her are defamatory? Can the ISP or message board delete postings in response to a request from a third party?

Answer47 U.S.C. sec. 230 gives most ISPs and message board hosts the discretion to keep postings or delete them, whichever they prefer, in response to claims by others that a posting is defamatory or libelous. Most ISPs and message board hosts also post terms of service that give them the right to delete or not delete messages as they see fit and such terms have generally been held to be enforceable under law.

Question: My ISP tells me it's been asked to turn over my name as part of a lawsuit against hundreds of "John Does" in a faraway state. What can I do?

Answer: You should probably contact a lawyer, and suggest that the lawyer take a look at arguments raised by the EFF, ACLU, and Public Citizen in one of these suits (e.g.,http://www.eff.org/IP/P2P/RIAA_v_ThePeople/JohnDoe/20040202_UMG_Amicus_Memo.pdf)

Need to protect your reputation? Check out Frontdesk's Reputation Protection for Physicians

The Use Of Strategic Vendors

Price isn't the only thing that you should be looking at when choosing a technology or product vendor.

So what is a strategic vendor?  I’ll get to that a bit later…   I’ve been in the business world now over 30 years with the last 8 in the medical aesthetics field.    In those 8 years, I’ve been mystified why so few vendors in this sector understand the importance of staying close to the customer.  How so few  really take the time to understand my business which although is similar to many others is uniquely mine with its own challenges.

Most vendors only come around when they have a new product, service, promotion or are on a ride along exercise with their boss and need some place to go…  Most vendors never care to ask what my goals are and very few know what I’m planning for my business this year and next 5 years.  Most only care about making the sale today and then move on to the next buyer.

Most vendors also carry with them a planned obsolesce strategy for the equipment they sell.

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Interview: Brian K. Sidella, Founder Of Forever Young Medspa In South Florida

Brian K. Sidella, Owner and President Forever Young Medspa

Surviving and thriving in the cut-throat cosmetic industry of South Florida.

Brian Sidella, founder of Forever Young Medspa sat down with us to discuss how a non-physician running a medical spa competes with a host of physician run clinics in South Florida.

Name: Brian K. Sidella
Location: Cooper City, FL
Website: foreveryoungmedspa.us

Having now been in this business for almost 7 years, I’m still amazed at how this industry operates. Most of the players have a planned obsolescence strategy of about a 4 year life cycle and then most force you into a fork lift upgrade. As an example you could have begun 2004 with a Palomar Medilux, bought a Starlux 300 in 2005, a Starlux 500 in 2009 and now an Icon in 2012. Each of these systems represents a six figure investment. Whoever brings to market a field upgradable platform that will last a decade is going to dominate… as for the technology itself we have a pretty extensive suite from Palomar, Cynosure, Syneron, Edge & BTL. We use Palomar for IPL services and 1540 Fractional, Syneron for the Matrix, Cynosure for laser hair removal, Edge for HydraFacial M.D., Syneron for VelaShape & BTL for the Exilis...

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The Medical Spa Physician Report: Learn From Experienced Operators

The Medical Spa Physician Report is critical information compiled from the answers of experienced doctors in cosmetic medicine.

Each Medical Spa Physician Report includes a survey of cosmetic clinics around the worlds physician interviews and case studies. We reach out to not only our member base, but also other prominent doctors in cosmetic medicine to find out what doctors are really thinking about technology, marketing, staffing and clinic operations.

And this is an experienced group.

Look at this graph from the last Physician Report and you'll see that 58% of physicians indicating that they've been practicing full time cosmetic medicine for 6 years or more.

You can always find the latest Medical Spa Report (as wells as previous issues) free to download in the Medical Spa MD Free Deals for Members... and if you're not a Member yet, you can join the thousand of other physician members and access all of the free deals right now.

Medical Spas + Student Doctors

Preparing for a future in cosmetic medicine as a medstudent or resident.

Here's a question I received from Josh:

I'm a medical student, and will be graduating med school in 5 weeks. I'm planning on doing a residency in Family Medicine, and I am curious as to what type of training is applicable to medspa's? What procedures should I try and focus on during residency? What can I do to learn more about building a practice after I finish my residency?

First, I'd suggest that any medschool student or resident check out the new community at Uncommon Student MD. We're building Uncommon as a sister site to Freelance MD by to address the specifics of how to control your medical career and lifestyle early on.

Second, I'd suggest that you take advantage of the the community here at Medical Spa MD. You may find a mentor and you can certainly find a lot of information and make some connections with physicians how have been around the cosmetic block.

Does anyone else have some advice for Josh or other medstudents who are looking at cosmetic medicine? Leave your thoughts in the comments below.

The New Medical Spa Physician Report

The New Medical Spa MD Physician Report is (finally) out!

download

And we thought that our first medical spa report was huge...

We've had to juggle a huge number of launches in the last month and, unfortunately, the launch date for the report got pushed back a little. We're sorry that we weren't on time, but once you take a look at the report we think you'll find it work the wait.

We integrated a lot of your feedback from the first report in this one, cutting back on the 'situational' questions (although we still have some) and moving in to areas that we know you want answers about.

Here are some of the questions that are answered in this report:

  • What percentage of your clinic's revenue is spent on marketing and advertising?
  • How is your clinic staff compensated?
  • What do you think of paying commission for medical treatments?
  • What is the total income of your clinic or medical spa per month?
  • What percentage of your clinic's revenue is spent on payroll?
  • If you pay commission, how is it structured?
  • What are your patients requesting most that you don't currently offer?
  • How much is a new patient worth you you as a clinic in the first month?
  • How many new patients does an average client refer to you in a year?
  • What do you consider to be the most important way to generate sales for your clinic?
  • What is your most effective marketing tactic?
  • What marketing have you tried that you would never recommend?
  • If you could add one cosmetic medical technology by manufacturer and model, what would it be?
  • Which treatments generate the most revenue for your clinic?
  • What generates the most profit?
  • Which technology manufacturer do you think has the best reputation for efficacy among physicians?
  • Who has the best reputation for customer service? Who has the worst?

Whew.... and that's just a partial list of what we cover. There is also a great interview with plastic surgeon Dr. Enrique Etxeberria from Spain and some great info about waiting room marketing videos from this reports business sponsor, Frontdesk.

Download the report here.

 

Thank You To All Of The Contributing Physicians & Clinics

The following is a partial list of the physicians and clinics that contributed to this report and gave us permission to identify and link to them. Sign up to contribute to the next report here.

Note: We do not identify individual physicians or clinics with specific answers to make sure that all respondents can be completely candid in their answers. (Our surveys are done through our online software and provide confidentiality and anonymity and they take about 10 minutes to complete.)

Clinica Etxeberria

BCLaserAndSkinCare.com

ForeverYoungMedspa.us

WinchesterLaserCosmetic.com

RenovoMD.com

Reveal.com

VisageMedArt.com

ScienceMedispa.com

OmniHealthPro.com

Clinica-Luxury.ro

Our contributing physician list is growing fast. Thank you to the physicians and clinics who have contributed to this report. If you're a physician and would like to contribute to the next report, please let us know by entering you information in the form below.

 

Become a Contributing Physician Member

Complete this form to contribute to the next report.

Licensed Clinicians Only: If you're a licensed clinician practicing cosmetic medicine and would like to be included as a Contributing Member in the next report, please fill out this form. You will then be added to our Contributing Members and receive a monthly questionnaire that only takes about 10 minutes to complete. (If you're a business that would like to sponsor a report, please contact us.)

The Medical Spa MD Physician Report Out! Download It Here.

The FREE Medical Spa MD Physician Report is now available. Whew.

download

Our entire report team has been busting their ass collecting answers from physicians and clinics for the last month and compiling them into the only report of it's kind that deep-dives into aesthetic medicine and gives you information you can't find anywhere else. (Thank you Dar, Apple, Marco, and Laurie!)

We've taken on a herculean task in compiling this report and we're pretty happy with the result.

The Medical Spa MD Physician Report researches and tracks all aspects of what's working in cosmetic medicine (and what's not), not only in the U.S. and Canada but across the world.

These reports are published to give our entire physician and clinician community access to the information, statistics, and inspiration to improve their medical (and business) results.

Do you want to know how other clinics are choosing technology, attracting new patients, marketing to their existing clients and compensating their staff? Would you like to discover what's the most effective uses for that new fractional laser, or what other clinicians think of it? Could you use more info about how successful medical spas are expanding their business, saving money, or deciding on what new treatments to add or get rid of?

Answer yes to any of the above you will love, love, love this new report.

Download the report here.

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The Medical Spa MD Physician Report

With the power and knowledge of our growing membership, our goal is to bring together all the valuable information, successes and failures; giving you an insider’s point-of-view to improve your business and your bottom line. Which products sell best? Which treatments are most profitable? Which equipment manufacturers are recommended and which are not? Our reports deep-dive into the various areas, such as “Growing your business”, “Advertising and marketing”, and “Staffing and training”.

The reports generally include a survey of cosmetic clinics around the world, an interview or case study, and an area for sponsors or select partners who wish to get in front of our Members and readers with their products and services. To begin, we reached out to not only our member base, but also other prominent doctors in our field. The response was overwhelming. About 80% of our respondents practice in the US, but the other 20% come from all over the world, including South America, Europe, the Middle East and Russia. About 92% are physicians, with the other 8% working as RNs or PAs in cosmetic clinics and medical spas.

Another way to contribute to our Physicians’ Report is to participate in our monthly interview. We choose and office or medical spa each month to get their unique perspective on running their business. The interviews add insight into working medical spas and cosmetic practices, what works, what doesn’t work, successes, failures and anything else you want to share with your peers.

A special thanks to our growing group of physicians and clinics for participating in this month's report. If you would like to join our panel, please sign up to contribute to the next report here. The more participation we get, the greater the value for the group. (Sign up to contribute to the next report here.)

Do you have a suggestion to improve our services or an idea for as research project you think we should be doing? Would you like to be interviewed, or sponsor a report? Please contact us.

Warmly,

Medical Spa MD Report

Founder, Medical Spa MD

P.S. Please feel free to distribute, email, link to, tweet, post or send this report to anyone who may be interested as long as you do not modify or change the report in any way.

 

Contributing Physicians & Clinics

The following is a partial list of the physicians and clinics that contributed to this report and gave us permission to identify and link to them. Sign up to contribute to the next report here.

Note: We do not identify individual physicians or clinics with specific answers to make sure that all respondents can be completely candid in their answers. (Our surveys are done through our online software and provide confidentiality and anonymity and they take about 10 minutes to complete.)

paceslaserMd.com

cos-medica.com

JaneAesthetics.com

naturophoria.com

delajeness.ru

koe-aesthetics.de

centrosbys.com

dermavogue.net

smacboca.com

plasticsurgerysandiego.com

rhamawy.com

LaserCosMedix.com

wimedispa.com

landecker.com.br

jdvmedspa.com

chirurgiefaciala.ro

RomoPlasticSurgery.com

NewportWellessBoutique.com

drminniti.com

dryveshebert.ca

doctorhoefflin.com

monarchbaylaser.com

thenyac.com

mandalaclinic.pl

plasticsurgeryoftheface.com

Our contributing physician list is growing fast. Thank you to the physicians and clinics who have contributed to this report.

If You're Not Getting Paid What You're Worth, There Are Only Two Possible Reasons...

Are you getting paid what you're worth?

In reading through the comments on my post  "Are Groupon Deals Killing Your Medical Spa?" it's obvious that there are some very strong feelings about pricing, Groupon, and the prices that some clinics are able to charge, or not.

Then there's any number of discussion forums on Medspa MD where you'll find a common thread around dissatisfaction with what someone's making as an employee, from the physician owner to the staff.

At the core, it's really around the perception of value on the part of the buyer, whether the buyer is a patient looking for Botox, or an employer that's staffing a clinic.

Here's what technologist Seth Godin has to say about value and what you're worth:

If you’re not getting paid what you’re worth, there are only two possible reasons:
1. People don’t know what you’re worth, or
2. You’re not (currently) worth as much as you believe

The first situation can’t happen unless you permit it to. If you’re undervalued, then you have a communication problem, one that you can solve by telling accurate stories that resonate.

Far more likely, though, is the second problem. If there are reasonable substitutes for your work, and those substitutes are seen as cheaper, then you’re not going to get the work. 'Worth' in this case means, "what does it cost to get something like that if something like that is what I want?"

A cheaper substitute might mean buying nothing. Personal coaches, for example, usually sell against this alternative. It’s not a matter of finding a cheaper coach, it’s more about having no coach at all. Same with live music. People don't go to cheaper concerts, they just don't value the concert enough to go at all.

And so we often find ourselves stuck, matching the other guy's price, or worse, racing to the bottom to be cheaper. Cheaper is the last refuge of the marketer unable to invent a better product and tell a better story.

The goal, no matter what you sell, is to be seen as irreplaceable, essential and priceless. If you are all three, then you have pricing power. When the price charged is up to you, when you have the power to set the price, there is a line out the door and you can use pricing as a signaling mechanism, not merely a way to make a living.

Of course, the realization of what it takes to create value might break your heart, because it means you have to specialize, take risks, create art, leave a positive impact and adopt generosity in all you do. It means you have to develop extraordinary expertise and that you are almost always hanging way out of the boat, about to fall out.

The pricing power position in the market is coveted and valuable... The ability to have the power to set a price is at the heart of what it means to do business profitably, so of course there is a never-ending competition for pricing power.

The curse of the internet is that it provides competitive information, which makes pricing power ever more difficult to exercise. On the other hand, the benefit of the internet is that once you have it, the list of people who want to pay for your irreplaceable, essential and priceless contribution will get even longer.

So the real question to ask yourself is if you're really irreplacable and essential as a business or as an employee.

For medical spas or clinics this means that your offering is not comoditized and that you're offering is not /can't be replicated.

Unfortunately, most clinics seem to tag along with a t me-too idiology that seeks to find what others are doing that makes money, and then offer the same thing at a reduced rate. (The Groupon rush is just one indication of that.)

Making your services irreplacable and unique will go a long way to giveing you pricing power.

Related Posts

Groupon: Are Groupon Deals Killing Your Medical Spa?
Pricing: Pricing, Cognative Dissonance & How To Charge More

Are Groupon Deals Killing Your Medical Spa?

There's a deluge of Groupon offers from Medical Spas who are using cheap laser hair removal treatments to gain new patients... Is it working?

This Groupon tactic is used by skin clinics who are desperately trying to get new clients and don't know how to market effectively or drive perceived value.

Let's take a look at some of these offers and run some numbers on how effective, or ineffective, this will be for your medical spa or laser clinic.

Here's the first of the offers for laser hair removal that I've received from a local laser clinic in the last two weeks. (I think I've received five or six.)

This Groupon offer is from Enlighten Laser Cosmetics of Bountiful, UT.

Enlighten Laser Clinics Bountiful UT

Okay, so let's take a look. Enlighten is offering an 84% discount on laser hair removal from a starting price of $617 for a savings of $518.

The starting price seems about right for what the average cost of most 6 series laser hair removal treatments are in the area so that appears about right. Since they've sold 700 treatments the can't be unhappy about that since it appears that they're getting swarmed with new clients. Let's dig a little deeper.

The selling price is $99. Groupon takes 50% so Enlighten is taking $49.50 for each sale. They may have sold many more than 700 but let's go with that number. So, with 700 sales at $49.50, Enlighten is bringing in a respectable $34,650 from Groupon...

So let's break down that number and see what we find.

With 700 sales at an average of 6 treatments we see that that gross number of $34,650 comes in at a mere $8.25 per treatment. ($34,650 / 700 = $99 / 6 treatments = $8.25 per treatment)

Not so good.

That's $8.25 before any labor, rent, treatment tips, appointment scheduling or anything else. It also ties up around 4,000 or treatment room time that this laser clinic won't be able to use for other treatments. They'll also have to deal with all of the support issues; phone calls, appointment setting, consultations, equipment depreciation and the inevitable complaints and patient issues that arise any time you're treating a patient population of 700 individuals.

If you've ever sold gift certificates you know what I mean. You sell a boat-load in December for the holidays and then starve in January and February as your rooms are booked delivering the services and no money's coming in.

So, what is the most likely scenario?

Enlighten laser clinic is going to skimp on treatment time.

Instead of performing a complete treatment, the staff is going to be under a lot of pressure to get these patients in and out. One likely scenario? They'll cut a 45 minute treatment to 30minutes. They'll perform skip treatments where they're not covering the entire area but treating every other one. They'll have a waiting room stacked six high or schedule patients only on off hours... All of these can lead to exactly the opposite result that Enlighten is looking for, happy repeat clients.

I'll also note that as I've spoken at length about before, the people buying these Groupon deals are coming for price, and they'll leave it just as quickly... Not the patients you're looking for.

Here's another laser hair removal offer from Lisse Laser & Aesthetics Medical Spa in SLC, UT.

Lisse Laser Clinic & Medical Spa SLC UT

This offer arrived in my inbox early this morning so it just started. They have 101 sold deals now but it doesn't end for 24 hours so they'll probably sell many more. (Note: While I wrote this post their sales have climbed to 371 in about 40 minutes.)

Lisse Laser & Aesthetics Medical Spa is taking a much sneakier approach. They're listing their value at $2000 in value.

Here's Lisse's Groupon offer:

...for $145, you get six laser hair-removal treatments on the lower or upper legs (a $1,000 value for women, $1,400 value for men), lower or upper arms (a $700 value), or Brazilian bikini area (a $1,000 value for women, $2,000 value for men)

So again, six treatments but at least they're making an extra $23 per patient. Let's do the math again.

$145 per sale / 6 treatments = $24.16 per treatment.

Lisse is going to have all of the same issues and problems with scheduling, service, appointment setting and the rest as well.

(I'd be interested to hear how those medspas that are using commission (which I personally hate) to pay their staff feel that this kind of discount effects both the level of service and the commission structure. If you have a thought on this please comment.)

And there's another problem.

Selling your services at this type of discount positions you in the marketplace as the cheap player in town. You'll never be able to control your pricing. You'll never be able to create steady, repeat buyers that pay a premium for your services. You'll never be able to bring in the bigger treatments and you'll always have cash flow issues.

Instead, you'll always be scraping along at the bottom of the barrel... if you can survive this type of cut throat slash-and-burn price war.

I can see that Groupon is doing a great job of selling their deal to laser clinics just by the endless stream of deals.

For Groupon this is great. They just made $34,650 from Enlighten by sending out an email... but Enlighten is the one who's stuck delivering all of the services, making all of the appointments, dealing with the customers, and putting their reputation and business on the line, including the potential of any issues that hit their malpractice insurance or medical licensure. (I'm not saying this will happen, just that the risk is entirely on Enlighten and the physician, not Groupon.)

Undoubtedly, there are some occasional successes and I've heard from clinics that claim that they love Groupon, but I've never heard from a physician who was paying the bills that this worked well. It's often the staff that like this since the clinic is now busy, but the physician owner is the one that's not making any money and still paying out.

Here's a quote from a business that ran a Groupon offer.

After three months of Groupons coming through the door, I started to see the results really hurting us financially. There came a time when we literally could not make payroll because at that point in time we had lost nearly $8,000 with our Groupon campaign. We literally had to take $8,000 out of our personal savings to cover payroll and rent that month. It was sickening, especially after our sales had been rising. So the experience jaded me, and the interactions with the few bad Groupon customers we had jaded our staff. After all of this, I find myself not even willing to buy Groupons because I know how it could hurt a business...

This business owner goes on to tell of her experience that the Groupon clients also lambasted her business on Yelp and other review sites with negative reviews.

If you have an opinion on this or experience with Groupon, please leave a comment.

Additional posts on Groupon:

Why Medical Spas Fail Reason # 9: Buying the Laser Before You Have a Business Plan

In the film, Field of Dreams with Kevin Costner, the ghost would whisper, “Build it and they will come.” Meaning all Kevin Costner needed to do was build the baseball stadium and the ghostly baseball players would come to play ball and people from all over would visit his farm and pay to watch them play. Doctors often have the same mentality when it comes to buying laser equipment. The idea, “Buy it and they will come,” is derivative of the Field of Dreams concept, that all you need to do is buy the laser and patients will ask for the treatment and you will make a lot of money with this device.

The reason most doctors don’t think about this is because they have not had to traditionally.  Most practices receive the great majority of their revenue from insurance companies, not from advertising their services.  The idea that they would need to spend a lot of money on advertising to bring patients through their door is a foreign concept in most cases for a lot of medical specialties.  This all changes when trying to generate aesthetic revenue because these procedures are not covered by insurance and the doctor needs to spend money on advertising to bring cosmetic clients through their door.

The smooth talking, good-looking, laser sales rep will show you some impressive numbers about the revenue you can generate with his/her laser, however they fail to mention exactly how you will get your telephone to ring, how your receptionist will effectively book those aesthetic consultations, and how you will close your consultations and sell thousands of dollars worth of aesthetic treatments.

The successful operation of an aesthetic practice does not happen by chance.  It requires careful planning, marketing, training and resource allocation.  Quite frankly, it requires a lot more work than most doctors are willing to put forth if they only knew of the work involved before they began the process.

Careful thought needs to be taken in creating a basic business plan and a realistic cash flow proforma of the first 12 months of operation.  You should project ultra-conservative numbers and determine if your investment will pay you the Return on Investment that you are expecting.  After you have done this, the LAST step in setting up an aesthetic practice is buying the laser equipment.

Unsure what to purchase? Check out the Lumenis Lightsheer and some other brands in our ad page here.

3 Comments

Vin Wells

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

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

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

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

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

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

Why Medical Spas Fail Reason #8: Lack of Cash Flow Planning

One common pitfall for medical spa owners is the failure to properly account for prepaid services, such as discounted packages of laser or light-based facial treatments.  If you sell a package of treatments up-front, you can have obligations against those treatments for up to 8 months out (e.g. Laser Hair or IPL).

If you spend all of the money from those packages now, then you will have future expenses against revenue that has been long-spent.  This places you in a negative cash position which requires that you play catch-up, although it is difficult to ever catch up if you manage your cash flow in this manner.  The only potential solution is to offer higher revenue, single treatment procedures such as laser lipolysis or fractional CO2 resurfacing so that you can obtain significant revenue from single, one-time treatments that will offset the money spent in commodity-based treatment packages (Laser Hair & IPL).

The best solution is to never get into this situation and maintain an adequate cash reserve at all times.  You can help keep track of outstanding liabilities by using an accrual-based accounting versus a cash-based method.  By doing so, you will quickly realize all of the up-front money received from laser packages has liabilities against it for up to 8 to 9 months out.

Maintaining business liquidity is extremely important because you will have months in which you are offering promotions and selling packages, and follow-up months in which you are fulfilling the packages that have already been purchased from months prior.  You need adequate cash to offset the expenses you will face down the road when it comes time to deliver the services clients have paid for in advance.

1 Comment

Vin Wells

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

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

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

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

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

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