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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Negotiating Work Contracts As An Aesthetic Physician

We receive requests information or advice from physicians, many of them looking to partner with other doctors or businesses in some way. 

Here's one we received this week that has also been posted in the medspa forums:

I am in talks with a fellow physician to be hired as an employee of (an existing aesthetic) practice. He is going to spend time training me (in addition to the training I already did with American Academy of Aesthetic Medicine) for a period that they say can be from anywhere between 3-6 months. Is that considered to be a long time to be trained? After they were comfortable with me doing different procedures I would then be seeing patients on my own.

Although they were advertising this job they keep asking me how much I want to be payed for both the training period and then after. I'm not even sure what would even be considered appropriate. Hourly? Salary? Percentage of revenue? They also are asking me to sign a 3-5 year contract.  Is this reasonable? This job is in (withheld) to give you any needed geographic references. I would appreciate any help that you guys could offer...

There is always a lot of confusion about this but most questions can really be divided into tow camps:

  • What is the fairest method or structure for compensation? (The business question) or
  • What is the best legal structure for medical oversight or liability? (The medical/legal question.)

The legal structure is always going to depend upon location since every state or country is different. In some states you can provide medical oversight legally even if you're not on-site, in others you have to physicially be at the location when any treatment is performed that you're extending your medical oversight to, and there are some states where a physician has to actually perform the same treatments that estheticians' are allowed to perform pretty much on their own. Countries differ even more with some treatments (laser hair removal is one example) being classified as medical treaments in some countries and not others. That being said, it's pretty easy to find out what your requirements are based on whatever location you're operating in.

The compensation issue is much less straightforward and can actually be impacted by some of the legal strictures that your location imposes. A couple of issues that might be of concern for you:

  • Direct referrals from other physicians may be seen as fee-splitting. (Fee-splitting is designed to prevent physicians from getting kick-backs for sending patients to other physicians.)
  • Non-physicians can not employ physicians in the US. (There are corporate relationships that are used effectively to get around this.)
  • Who is providing the medical liscence and oversight?
  • Who is providing malpractice insurance and has the legal liability?
  • Where/how is revenue being generated?

You can see that these issues all compound and none of them are trivial, but these business decisions and negotiations are much more clearly defined since every business deals with them. They're basically defined by the market and what it will bear. I'll post some thoughts later on all of these questions one by one and we'll work through the list.


Your Medical Spa's Front Desk

It's easy find sub-par front desk staff in medical spas.

I got this complaint (I'm not sure why it was even sent to me) of someone who ended up leaving a clinic less than impressed...

Here's the comment:

If you're a cosmetic surgeon, a cosmetic dermatologist or even a cosmetic dentist, the gals at the front should somehow represent your practice. Your's have much to be desired.

I recently had an appointment at your clinic I was able to make the following observations.

  1. She had blackheads
  2. Too little makeup (which made the blackheads visible)
  3. Chewing gum
  4. Her hair in a ponytail in a way that looks like a rat's nest thingy
  5. Wearing some kind of jammy looking top.
  6. Could have used a more supportive brassiere.

I left very disappointed...These things should never be seen in any medical spa.

The front desk should be the bus drivers! It means they are the first person you'll see when you enter the bus and the most likely person to cause an accident. Do you understand? If you don't like the sight of the girls you see out front, then there's something wrong about the "Aesthetic" services you're providing.

Now, look at your girls out in front. If they look anything like what I observed, then you should talk to them. Perhaps you need a dress code. Maybe you should provide them the product and treatments that your office is offering. Pamper your staff a little. Besides, it will be easier for them to sell your services since they have first hand experience.

However, one should not be to brash in saying these things since people can be very sensitive, especially women. Consider it from a perspective of a prospective client when they walk through your door. Will they wonder, "why doesn't the front desk person look anything like the product they're offering?" and "what's she doing in a place like this? She doesn't seem to belong".

While the email is obviously not actually for me since I no longer own any clinics, the sentiments represented are spot on. I don't know what clinic gave rise to this email but you'll want to make sure that your medical spa's front desk represents you the way you'd want it to.

German Plastic Surgeon, Dr. Simone Hellmann of the H-Practice

Surprisingly, plastic surgery in Germany is a taboo. Physicians strive to achieve a natural, un-operated look for their patients.Germany Board Certified Plastic Surgeon Dr. Simone Hellmann

Name: Dr. Simone Hellmann
Location: Cologne, Germany
Clinic: The H-Practice

Can you tell us what is it like practicing cosmetic surgery in Germany?

In Germany, cosmetic surgery is not highly accepted – unlike in Brazil for example. Most patients –at least in my practice - are female and they are not very open to talk about that topic with their friends and family. They mainly gather their information on the internet and we are all aware that not every written word is true and that one should hardly trust all of those reports, forums or blogs. Therefore, you have to be very discreet as a doctor and you really have to thoroughly inform and educate your potential patients. Only if you are consistently showing excellent results and offer highly qualified services you are able to build up a pool of loyal patients who will refer you to their best friends. At this level you can create a solid patient base, but it will take you quite a while.

Cosmetic surgery patients in Germany are very much afraid of what they see in magazines and on tv – celebrities with unnatural looking faces or breasts. So it is my assignment to convince those patients that these looks are avoidable and once they will trust you and your skills, German people can be very decisive for ‘getting it all done’.

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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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Nurse Practitioner Pay In New "Medical" Spas

Nurse Practitioner Medical Spa Pay

What's a good Nurse Practitioner pay in a new 'medical spa' that wants to offer Botox?

I get lots of individual emails looking for information about pay for PAs, NPs and MDs who are being recruited by a local medical spa. Some of these are just entering aesthetics and others are old hands.

Here's an example email that's typical from a NP who's being solicited by a day spa who's wanting to offer Botox and fillers:

Hello, I am a Nurse Practitioner from Wyoming and I am going to start doing some medical aesthetics for an established spa that up to this point has offered everything except medical aesthetics. The owner of the spa and I are having trouble figuring out a fair pay for me. The products are being ordered under my license and I will also be doing all the injections. Right now we are just starting out with Botox and Fillers. She pays her staff an hourly wage plus commission, but I have also talked with other spas that pay straight commission. Both of us are new to this and we are having a hard time finding out what other medical spas pay. Any insight on this would be helpful.



Ok, so here's where we're going to drop some knowledge-bombs on you. (For this post I'm not going to go too deep on whether these types of setups are good ideas on their own.)

First, think about what you're asking and how you're thinking about this new business. You're counting your eggs a little before you've got any eggs.

The fact that you're asking how much you should be paid reveals a number of problems with your understaning of how this is going to work and who's going to be responsible. (This isn't uncommon at all and we're going to disucss business models at lenght in future posts.) Since you're the clinician, you're going to be responsible for everthing to do with this business with the probable exceptions of: #1, paying for stuff and #2 supplying the 'patients'.  So let's look at what you're going to be responsible for:

Since you're going to be practicing medicine, the fulcrum in this relationship is you as the clinician. It's going to be your reputation, medical licence, malpractice insurance, and your ass on the line.

I'm reminded from a line from the science fiction novel Dune in which goes something like, "He who has the ability to destroy a thing, controls that thing." Meaning, that this is effectively going to be your business, not the spas. (Note, I'm not denying that the spa could probably find someone else to do this same deal, just that it's never going to be the spas business.)

The spa will invariably take the tact that this will be an add-on to their existing business and that the 'patients' are their customers etc. This is both wrong in practice and illegal. This will be the practice of medicine and that's pretty cut and dried. You're still going to regulated, HIPPA compliant, etc. and that's it.

You're also going to need to set this up legally in your state. In most states you can't become an employee of or partner directly with a non-physician. (Not sure about how this applies to NPs so if anyone knows, please leave a comment.)

The patients are going to be yours, the responsiblity will be yours, the insurance will be yours etc., and you can't just be paid for performing medical treatments by a non-physician. All that being said, there are ways that this can be done if you're smart, and the spa owner is reasonable.

  1. Set up a legal entity for yourself. (Have a real lawyer do this who has knowledge with clinicians.)
  2. Make sure that the spa has a legal entity. (Different lawyer there.)
  3. The agreement will be between these two entities. (There are different ways to set this up depending on state. In some cases it might be the NP's entity that is 'renting' space from the spa but there are other options. Read through the forum threads on this site for those.) The agreement should also clearly define scopes and responsibilities and what will happen if the business fails. In cases like this, the spa is often 'paid' for rent and/or 'marketing' expenses, not fee splits or referrals. A technicality maybe but an important one.

People always try to overlook the 'business fails' part of the equation but it's a necessity to outline this up front since this business will end at some point in the future, even if both parties are happy.

Since it's illegal in most states to be a clinician who is an employee of a non-physician, that becomes somewhat problematic since you can't be 'paid' in the normal way. I would also suggest that all monies go though your legal entity before being distributed. In effect, you take all payments, not the spa. Headache yes but medicine in the US is the most highly regulated and litigious market there is. Don't sit around on your thumbs with this.

If you look at what you're going to be required to do, the conversation with the spa should be much clearer and should help the negotiations. If the spa owner refuses to understand how this should be set up, don't do any deal. You can't negotiate in good faith with someone who is willing to put you at risk right at the start.

About your Pay?

The real question is, "how much money are you going to make?". 

Business 'partners' always run into personal conflict when; they don't make any money, or.. they make a lot of money. I would suggest that you make sure that you go into this with your eyes open and the spa owner does the same. If you can't resolve the above issues then the money won't matter.

Comments welcome.

Dr. Tahl N. Humes: Vitahl Medical Aesthetics In Denver

With two physicians, 30 years of combined aesthetics experience, and inclusion in the top 1% of Botox injectors in the US, Dr. Tahl Humes is rocking it at Vitahl Medical Aesthetics in Denver.

Dr. Tahl N. Humes Vitahl medical Aesthetics Medical Director Denver, Colorado

Name: Tahl N. Humes, MD
Clinic: Vitahl Medical Aesthetics
Location: Denver, CO

That's interesting: Dr. Tahl Humes is a Laser Trainer and Spokesperson for Cutera Lasers. She is in the top 1% of Botox injectors and the top 5% of Juvederm injectors in the country. 

In addition to serving as Medical Director for VITAHL Medical Aesthetics, Dr. Humes practices Internal Medicine at Saint Joseph Hospital in downtown Denver. 

You're an Internal Medicine Attending at a hospital in Denver. How (and why) did you end up making a move into cosmetic medicine?

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Top 5 Medical Spa Treatments In 2011

The top nonsurgical treatments in 2011?

  1. Botox: 5.7 million treatments (up 5% from 2010)
  2. Filler Injections (Juvederm, Restylane, Perlane, etc) 1.9 million treatments (up 5% from 2010)
  3. Laser Hair Removal: 1.1 million (up 15% from 2010)
  4. Chemical Peels: 1.1 million (down 3% from 2010)
  5. Microderm: 900,000 (up 9% from 2010)
Source: American Society of Plastic Surgeons

Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

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:

Improving Your Laser Clinics Marketing Funnel

Web users are, for the most part, used to giving out personal information online, especially in exchange for content they want. But certain kinds of information are more sensitive than others.

If you're capturing leads for your laser clinic or medical spa, here's some info from Hubspot that show how asking for certain type of information can reduce the number of contacts or leads that you're able to capture.

Here are some of the findings.

Forms asking for any type of geographic location have lower converstion rates than forms that do not, but mailing addresses seem to be much more sensitive since the perception is that visitors filling out the form will receive mail.

Asking for a telephone number has much the same impact as asking for a mailing address... a decrease in the number of completed forms.

Oddly, at least to me, it seems that asking a visitors age is also sensitive enough to prevent form completions.

So what should you do?

First, don't try to swallow the entire apple, just take a bite and begin to add value. Remember that they're filling out your form in order to receive value from you. If you don't provide any value at all and just spam them with offers, your relationship will sour quickly.

The New Medical Spa MD Podcast

Medical Spa MD now has its own podcast for physicians and medical spas and the first couple of episodes are now live.

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 Photographs & Testimonials: Keeping it Legal

Medical Spa ads are often peppered with photos (highlighting “real” patients and models) and glowing testimonials.   

Images of more than ideal treatment results from Botox, laser hair removal, fillers, chemical peels, photofacials grace local rags to targeted online ad placements…okay, you get the picture. 

A recent article stated that there are now more medical spas in the US than Starbucks!  Now, that makes for a very competitive market. 

As you strategically, aggressively advertise your Medical Spa – are you aware of the legal guidelines & do you know how to keep your advertising legal? 

The ever increasing number of State and Federal laws that can pertain to the use of photographs of patients has triggered a lot of questions from the medical community.  Below are some frequently asked questions and answers from Michael Sacopulos, General Counsel for Medical Justice Services.  Note these are general answers and are not State specific.  You should consult local licensed counsel to address laws, regulations and prohibitions specific to the State in which you practice.

Question #1:

When do I need to use the label “MODEL” on a photograph?


The term “model” should be used when the photograph is displaying the results of a procedure or procedures not performed by the physician or practice (displaying the photograph).  Here the term “model” is being used in a general representative fashion and is not being used to display a specific practice or physician’s professional services/results. 

Physicians should secure a written release from any individual, patient, or model before using a photograph of that individual, patient, or model in any way.  The release should be specific to the photographs being used.   The release should also specify the way or ways that the photographs may be used.  For example, a release “for educational purposes”, will not cover internet marketing.  Do not attempt to get a release signed that covers “any and all future images, photographs or depictions…”  Courts have ruled that releases can go stale.  Finally, it is best for the release to specify the conditions and manner by which an individual may revoke the release at a later date.  

Question #2:

I hear the use of testimonials has regulations. Please explain.


There are several sources of regulations over the use of patient testimonials.  Some state licensing boards greatly restrict or prohibit testimonials.  Each state has different standards; some flexible, some very restrictive.  The Federal Trade Commission also has rules that apply to the posting of testimonials.  In general, a physician should make sure that the testimonial is accurate (what the patient really said and not paraphrased).

Question #3:

What does HIPAA have to say in its marketing regulations about the use of “before and after” photographs and testimonials?


HIPAA in general protects patient privacy.  Although the act does many things, it would prohibit the use of before/after photographs without a patient’s permission.  However there is nothing in the act that would prevent the use of accurate before and after photographs with a patient’s prior approval.  As always, this approval should be documented.  Finally, it should be made clear that a patient can withdraw his or her approval to use the photographs at a later date and that the physician must comply with this subsequent withdrawal of approval.

Question #4:

What is this I am hearing about The Federal Trade Commission in regards to “results not typical” and endorsements?


Earlier this year, The Federal Trade Commission set forth new guidelines for the use of testimonials and advertising that apply to many areas including healthcare.  In the past, The Federal Trade Commission has taken action against certain weight loss products when these products were advertised by an individual claiming extreme weight loss.  The FTC’s position was that it is a deceptive trade practice to show an individual has lost 100 lbs. when this result is not at all representative of a typical patient’s outcome.  In this situation, the term “results not typical,” would need to be used.  Under the new regulations, we should expect that the FTC will take a similar approach.  My discussions with FTC officials have led me to believe that the Commission acknowledges that health care results vary.  The Commission’s goal is to see that potential consumers are not misled by advertising.  It is not advisable to select a statistical outlier to be representative and then try to protect it by adding the term” results may vary.”  Under the new FTC rules, you must also disclose the fact if an individual has received compensation (of any amount) or discounted services in exchange for providing a testimonial or endorsement. 

Mr. Sacopulos is a practicing attorney in Indiana.  This article reflects his opinions and perspectives on advertising and legal issues set forth in this article. 

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Medical Tourism: $100B and growing

Smartlipo in Mexico, a nose job in the Philippines or a kidney transplant in India.....

Medical tourism is generally defined as leaving home for care. It can be inbound, (someone from Mexico coming to the US), outbound (leaving the home country to go to another country) or domestic. There are local, regional, national and international medical tourism clusters developing throughout the United States and around the world.

It is estimated that global medical tourism is a $100B global industry expected to grow significantly over the next few years. While no one can know for certain the effects of the recent US healthcare reform bill, rising costs, lack of supply of physicians and the demand for technologies and treatments continue to expand and fuel the growth of the industry.

There are several ways for physicians to get involved in medical tourism. The first is as a provider, either in their home location or in a remote site doing surgery. Second, physician entrepreneurs are creating service companies like medical tourism facilitators or aggregators. Other potential business opportunities exist in supporting the medical tourism supply chain by providing insurance products, healthIT infrastructure, real estate projects, quality ratings agencies, accreditation and marketing arms and other consultation services. In addition, more and more payors and employers are offering voluntary medical tourism benefits to their employees and insureds, driving the demand for talent who can do medical tourism quality improvement and utilization review.

The most common procedures sought by patients considering medical tourism are cosmetic surgery and dentistry, bariatric surgery, IVF and short stay procedures in urology, orthopedics, ENT and ophthalmology. That said, because of the onerous costs of some procedures in the US, patients are seeking life saving cardiac surgery in India, proton beam irradiation in South Korea and living donor liver transplants in Asia.

A recent report from the Center for Medical Tourism Research in San Antonio, Texas called medical tourism "arguably one of the fastest growing industries in the US"  Maybe it's time for you to take a look.

Arlen Meyers, MD, MBA is Cofounder, President and Chief Medical Officer for  He will be a speaker at the Medical Fusion Conference in November.

The Medical Spa MD Micro-loan Fund

Join Medical Spa MD and our Members to do some good around the world.

If you've never heard of Kiva, it's a micro-lending organization that provides working capital in amounts as small as $25 or $100 to entrepreneurs in third world countries.

My daughter has had a tiny, $100 'micro-lending' fund that we started when she was ten. So far, that single $100 investment has helped 24 small businesses around the world. (It's a loan so they pay it back and it can be re-lent to others.)

We've been doing this for a few years as a family and it's been a real learning experience for my daughter. After all, this is real money and these are real people. If you lend to one person, it means that you're not lending to another. Who is more deserving? Who's riskier? We've had some very deep discussions and it's been great.

Which brings me to the Medical Spa MD Micro-lending Team.

I want to recruit you to join the Medical Spa MD Micro-lending Team on Kiva.

Kiva is a non-profit website that allows you to lend as little as $25 to a specific low-income entrepreneur across the globe. You choose who to lend to - whether a baker in Afghanistan, a goat herder in Uganda, a farmer in Peru, a restaurateur in Cambodia, or a tailor in Iraq - and as they repay the loan, you get your money back.

If you join Medspa MD's team, we can work together to alleviate poverty. Once you're a part of the team, you can choose to have a future loan on Kiva "count" towards our team's impact. The loan is still yours, and repayments still come to you - but you can also choose to have the loan show up in our team's collective portfolio, so our team's overall impact will grow!

If you're part of a medical spa, laser clinic, plastic surgery center or dermatologists office and you're willing to put in $100 or more to Kiva loans and join our lending team, I'll publish your clinic or medspa on a special page that I'll build (Hey, I just thought of this. It's not done yet.) and give you a badge to display on your website. You'll also be doing some good in the world.

Please take a look at Kiva. It's a fantastically run organization. I've been lending through them for the last six years and I have never had a momemets regret. It's easily the best $100 that I every put to use.

Let me know what you think about this in the comments. (As soon as we have a couple of members I'll build a lenders page that will link directly to supporting clinics and sites.)

Create an account and join the Medical Spa MD Lending Team!