Medical Spa MD: Physician community of skin clinics, laser centers, plastic surgeons, dermatologists and aesthetic doctors practicing nonsurgical cosmetic medicine.
In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).
I'll begin with a personal story...
When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique. My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent. Simple, huh?
I spent months thinking about how to do this as a physician. I searched websites and blogs. I spoke with mentors and colleagues. I read the literature, all to no avail. There seemed to be no conversation about a career like this in medicine. I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.
With all the concern over the economy and the changes in health care, I thought it would be a good idea to write just a quick post about financial assets.
Most physicians do not understand the concept of financial assets and wonder why they feel like they are working harder and faster for less and less reward.
Now, I want to be clear, I am not a financial expert or a wealth manager. However, I have found a few principles that have really helped me personally, so I though I would pass them along to the readers of Freelance MD.
First, it needs to be said loudly and clearly that when a physician first graduates from his or her residency program, they have not "made it" in the financial sense. Yes, graduating from residency is a great achievement and does signify the completion of a long, difficult training period. It also usually is accompanied by a significant increase in salary and the ability to live better and spend more.
However, in the financial sense, a newly minted physician is in a horrible financial place.
Most physicians finish residency with significant debt, debt that is made worse due to the young physician's new salary, a salary that places the physician in a tax bracket that precludes the interest on student loans from being tax deductible.
Next, most physicians have little financial training so they immediately "reward" themselves for all the years of focus and discipline with a "few" nice things. I clearly remember many resident friends of mine who bought expensive luxury cars and nice homes immediately after graduation. Since few residents have significant savings, these new physicians simply added to their significant student loans even more debt in the form of car loans and large mortgages.
The problem with all this is that the new physician is suddenly saddled with enormous overhead. His or her lifestyle looks nice, but at the end of each month very little money goes to savings or retirement or investing in other financial assets that could help increase their overall net worth. Even those physicians who are aggressive about paying down debt and funding retirement often do not rise as high as they could financially because they make the mistake of pouring their disposable income into items that they believe are assets but actually are liabilities.
Robert Kiyosaki, author of Rich Dad Poor Dad, has produced a couple of very short informational videos (around 2 minutes each) that summarize the issue of assets. The true definition of an asset is something that makes you money. While this seems obvious, it is often misunderstood. For instance, many physicians consider their homes and their cars "assets." Strictly speaking, these items are not assets since for the most part they take money out of your pocket.
Here's a short video of Robert defining true assets, and how to differentiate them from your liabilities:
Make sense?
For an item to be a true asset it needs to produce cash for you.
Physicians work very hard and make a good salary, but most take their disposable income and instead of using it to buy assets, they pour it into items that actually increase the outflow of money from their pockets. If the physician hits a snag in his/her career-- illness, salary decrease, burnout-- they suddenly realize how fragile their financial world really is. Without true assets putting money each month back into their pockets, these physicians realize they are simply highly-paid hourly workers who are forced to exchange time for money indefinitely if they are to survive. This realization is a very depressing concept, and one that I believe significantly contributes to the frustration of many physicians today.
To break out of this cycle, a physician absolutely must understand the principle of investing in true assets with their disposable income so that they begin to slowly wean themselves off of the dependence of their physician salaries. In the end, a wise physician will have lived frugally, paid down debt, placed money in retirement, and instead of buying "toys" with their disposable income, instead slowly built up a collection of assets that put money back into their pocket and made their physician salary superfluous. Ideally, a physician will eventually reach a point where their living expenses are covered by the income from their assets and their salary as a physician becomes simply the "icing on the cake" so to speak. Perfectly executed, this freedom from the time-money continuum allows a physician to see their careers as something they choose to do for whatever reason-- desire, interest, altruism, curiosity, etc...-- not something they are forced to do to continue surviving. It truly is a life-empowering shift in perspective.
So what are some examples of assets?
Here again, Robert Kiyosaki succinctly describes the three broad categories of assets in the following video:
I hope this all makes sense and you're beginning to get a vision about how you can begin breaking free from the time-money grind through the purchasing and development of true financial assets.
I've been looking to start a podcast for Medical Spa MD for a while now, and we've finally launched.
With each new episode, we'll talk about cosmetic medicine, plastic surgery, cosmetic lasers, clinic operations, management, marketing, sales, treaments, cost controls and everything else you'll want to know. We'll be asking (and hopefully answering) the tough questions. How do different cosmetic lasers compare? Which IPL company provides the best service? How should you compensate and motivate your staff? How to market your clinic? Where to spend your advertising budget? How to get started. How to grow. How to compete. Finally, what does that mean for your business and lifestyle?
To start, we're interviewing physicians who discuss their own concept of personal brand and how they've managed their careers outside of clinical medicine.
In the first episode we talk to Dr. Greg Bledsoe about the Medical Fusion Conference and his desire to help physicians control more of their career. Greg's speaking from experience here. He's a leader in expedition medicine and organizes his other businesses to facilitate the lifestyle and income that he wants.
In episode 2 we're talking with Dr. Elliot Justin of Swift MD about telemedicine and the efficient delivery of medical services remotely. Elliot talks candidly about Swift MD and how company got started and functions operationally. He's also got some views on the state of US healthcare that resonate with almost every other physician I know.
We've already got another few episodes being edited and a long list of physicians and others who are scheduled to appear. My goal is to get out at least one every other week for the foreseeable future.
This new podcast will focus on providing relevant information for physicians, with a special emphasis on cosmetic practices, techniques, marketing, operations and just about everything you'll want to be aware of the field of nonsurgical cosmetic medicine. While we'll have plenty of physician interviews, we'll also be talking to technology companies, marketing gurus, and others about what it takes to run a successful medical practice, and exactly how to use these tactics and operations inside your own clinic. We'll be providing broad overviews as well as delving down into specific treatments and 'how tos'.
The Medical Spa MD Podcast is a permenant addition. You can find it by clicking on the link in the main navigation at the top the page. You'll also be able to subscribe to the RSS feed directly or subscribe via iTunes as soon as they index the feed.
Please leave a comment and let me know what you think. What topics would you like us to cover in the future? What guests would you like us to interview?
Medical Spa MD
Physicians, plastic surgeons, and dermatologists practicing nonsurgical cosmetic medicine in medical spas, laser clinics and aesthetic practices.
This Embezzlement & Employee Theft Scams training course gives you a practical roadmap to protect your clinic, your patients, your reputation, and your bank account.
Taking cash payments in the treatment room, stealing Botox and fillers to inject their own patients, ordering fraud, trading extra services for large tips, or stealing your client database to sell or use... This new course on beating embezzlement and employee theft schemes uncovers the hidden tactics behind how these scams work, and how to discover them before they kill your clinic.
The insiders guide to buying used cosmetic lasers.
Take advantage of these insider secrets about buying (and selling) used cosmetic lases to make more informed buying decisions. Enter your name and best email below to make sure you don’t get burned.
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Have you ever paid a commission for Botox and laser treatments? Although it’s very common ... it’s also very illegal.
During the past several years, a very troubling trend has developed in the medical spa industry. Nurses, nurse practitioners, physician assistants and laser technicians are being paid by commission in order to incentivize them to bring new business into the spa. This is very lucrative for both the spa and the individual, but unfortunately, in most states, it is illegal.
However, by accepting commissions for Botox treatments, she was engaging in illegal fee-splitting. Not only could she face significant monetary sanctions if she continued to do so, but both she and her supervising physician risked immediate suspension or revocation of their licenses if the state learned she was taking commissions.Fee-splitting refers to dividing or sharing fees from medical services between a physician and a nonphysician. In most states, all fees generated for medical treatments must be paid directly to a physician or physician-owned corporation. No one other than the physician—including nurses, physician assistants or any nonphysician medical practitioners—may receive any share of a medical fee.
Although the prohibition against fee-splitting has been on the books in most states for years, the practice of paying commissions has become quite prevalent in the medical spa community. This is probably because, in medical spas, most medical directors do not want to spend time firing lasers or injecting since other services can be more lucrative. As a result, injections and laser treatments are delegated to other medical professionals, who, in turn, develop a large client base. An easy way to compensate those professionals is to pay commission.But the consequences for fee-splitting are severe. In most states, the state licensing board has the power to revoke, suspend or refuse to renew licenses in response to fee-splitting allegations. Accordingly, regardless of the monetary incentives, it is always advised to avoid paying or receiving commissions. A safe alternative to fee-splitting is to use a pre-set bonus structure—the nonphysician can still be rewarded for performance, but the bonus is not related to the number of treatments performed.
Recently, a client called me with an urgent concern. This client, a registered nurse in Chicago, worked in a medical spa as an injector and laser technician. She was well-compensated: In addition to an hourly salary, she was also given a commission—a percentage of net revenue—for every Botox and laser treatment she performed. And boy did this nurse perform—during the past 12 months, she personally had generated more than $350,000 in revenue for the spa.
Her concern arose from a conference she had recently attended where she learned that most states have laws prohibiting fee-splitting. She was informed that taking commissions on Botox and laser treatments might land her in hot water with the state nursing board. She explained that this didn’t make sense, given that she had been receiving commissions for years, and that the physicians who paid her surely wouldn’t risk their licenses by doing something illegal.
It is imperative for any medical spa professional to seek legal counsel immediately if being paid a commission for medical treatments. The laws of each state vary and are often difficult to find, but as is often the case, ignorance of the law is never an excuse.
Thoughs on the Ideal silicone / saline breast implant.
The 2 main types of breast implants available for decades have been the saline filled an silicone gel filled breast implants. Each has its pros and cons.
Silicone gel implants have a more natural feel and look. Unlike silicone gel, implants containing only saline do not blend well with surrounding tissues at the edges of the implants. This is due to the chemical properties of salt water which is chemically charged as positive and negative charges that attract each other as opposed to silicone gel which does not carry a charge. Thus saline is more cohesive than silicone. What this means in clinical terms is that saline implant margins are more visible than silicone gel implant margins, especially when the soft tissue (breast gland and fat) between the outside world and the implant is thinner. Thus, in those patients with smaller breasts (less glandular tissue and/or fat) it is preferable to place saline implants under the chest muscle.
Saline implants may look very good when lying flat on a table. However, when upright the upper portion of the implant collapses (wrinkles or ripples) as the cohesive saline falls
There is an element of a gamble inherent in the medical tourism industry as it currently exists.
An interesting thing happened to me at work the other day. It was Friday afternoon, and I received a call from a primary care doctor. The phone call began with, “I’m really sorry about this, but I have a surgeon’s nightmare in my office.”
This is not a good way to begin a conversation.
He began to tell me about the patient. This particular woman had a Lap Band placed several years ago. For one reason or another, she decided that she would like this converted to a different procedure. She drove by my hospital to get to the airport, hopped on a plane and flew over hundreds of other well-qualified bariatric surgeons in order to reach a surgeon in Mexico where she had her Lap Band removed. She then returned 6 months later and had a sleeve gastrectomy. This is where things go bad.
While hesitant to try yet another Social Media platform, I have left thousands of Facebook fans behind for Google + (and so should you...)!
Guest post by Craig Koniver MD
I know, I know, another social media platform is about all you need to read about these days. From Facebook to Twitter to Pinterest to Instagram to Foursquare, it always seems as if there is another "latest" and "greatest" social media platform to pay attention to. But, trust me when I say this, I think Google + is THE one to pay attention to. And here are some reasons why...
In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).
I'll begin with a personal story...
When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique. My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent. Simple, huh?
I spent months thinking about how to do this as a physician. I searched websites and blogs. I spoke with mentors and colleagues. I read the literature, all to no avail. There seemed to be no conversation about a career like this in medicine. I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.
With the spreading of social media into nearly every aspects of our lives, it is worth pausing and reflecting upon their value.
Are you tweeting yet? Posting to your Facebook wall? How about connecting through LinkedIn? How big is your cirlce in Google+? With the onslaught of social media, there is mounting pressure to join each network, manage conections and monetize these various social media outlets. It seems as if social media has become the dominant measuring stick for how well you are doing as a business and how well you are connecting with others.
And while I think social media is something to be embraced, I do not think every outlet is for every person. Nor do I believe that social media serves as any type of barometer in your life (professional and personal). In fact, I think the more you are selective about where you garnish your social media energy and attention, the better you can use social media to your advantage.
Before I get to the specifics of the most popular social media outlets, I want you to come away from this article with one main point: social media presence does NOT equate to success. There is a lot of advice coming at us telling us to join all of the social media networks, trying to convince us that the only way to grow our business and connect with people is by creating these various outposts/hubs to connect with others.
The truth remains, however, that most of the time you can spend a lot of time and energy creating and maintaining these various social media outlets without actually realizing much results. And so while we embrace social media in medicine and beyond, we need to be cognizant as to the actual role of each social media outlet is providing for us. I think a better perspective is "what can I do for social media" not "what can social media do for me".
Let's review the major social media outlets. For each I will give you my personal experience and opinion:
By Greg Bledsoe MD MPH
Protect your clinic and profits in 24 hours.
This Embezzlement & Employee Theft Scams training course gives you a practical roadmap to protect your clinic, your patients, your reputation, and your bank account.
Taking cash payments in the treatment room, stealing Botox and fillers to inject their own patients, ordering fraud, trading extra services for large tips, or stealing your client database to sell or use... This new course on beating embezzlement and employee theft schemes uncovers the hidden tactics behind how these scams work, and how to discover them before they kill your clinic.
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