5 Lessons We've Learned About Building A Successful Cosmetic Practice

Patient Experience

John D. Rockefeller's quote of "I would rather earn 1% of 100 people's efforts than 100% of my own" is exactly right. So how do you get your patients to help you out just 1% and turn your dribble of patient referrals into a torrent?

The smartest clinic owners know that getting your patients to work for you just that 1% is the path to easy, repeated sales, makes life difficult for your competitors, and isn't forcing you to work 80 hours a week to keep your head above water. Savvy clinicians intuitively work towards each of these goals, but they often don't think of them as part of a whole. In this series of posts we're going to pull these topics apart and detail why and how they all fit together to build a machine that perpetuates and grows your clinic's income. 

I'm going to break down 5 critical areas that you need to spend effort on improving if you're going to move past the average medical practice income and reputation and get into the VIP section of top performers. Leave any one of these out and you're hamstringing your business. 

  1. Mastering patient consultations
  2. Replacing yourself with systems
  3. Delivering the remarkable
  4. Aligning your staff's perceived best-interests
  5. Waging asymmetrical warfare against the competition

Note what's NOT on the list - anything about patient outcomes. (We'll take it for granted that you're not burning patients with your IPL or they're getting ptosis from your Botox.) Outcomes are really what patients "perceive", not the actual clinical result. Improving these 5 areas will readily increase patients perception of the value you're delivering, and their outcomes. What else is not on the list? Price. (More about this below.)

Here's why these 5 areas are of critical importance to your clinic, and what you can do to start improving them.

Mastering Patient Consultations 

Top performers know how to sell. Average performers hope you'll buy.

On a scale of 1 to 10, where would you rank your consultations? How good do you think you are? It's probably that you think that your consults are somewhere above average.  After all, you're getting patients and you're busy so what's the problem? Isn't being busy the goal?

Actually, no. Everyone is busy. That part's easy. Being successful and profitable is the goal. (Having a work/life balance and a 36 hour work week may be part of that too.) and if you're not delivering perfect consultations you're stepping on your own success. 

It's most likely that your consultations - like most - are completely average.

94% of college professors believe that their teaching skills are above average, a statistical impossibility, but there's nothing special in this regard about academics, clinicians also think they're above average in every self-assessment of skills.

We sent a survey to thousands of clinicians and asked them to rank their consults on a scale of 1 to 10. The results of that survey fit right in line with the college professors, every response rated their consultative skills between 5 and 9. So, if you answered the question above and ranked your consultations as a 7 or 8, you're right at the top of the bell curve and you can bet that your consultations are solidly average. Sorry.

Why is that important?

Poor consultations destroy your reputation and waste every dollar you spend on bringing new patients in to your clinic. Poor consults will put you out of business.

Average consultations generate some sales and leave you almost (but not quite) satisfied with your business - where you can't quite figure out what's missing and your clinic is just grinding along. 

Great consultations are the secret of incredibly profitable clinics. They almost print money. Great consultations fill your schedule and treatment rooms and create fanatically loyal patients and they boost your revenue faster and easier than anything else.  Best of all, mastering patient consultations is a skill set you can learn.

What to do: You need to improve your consultations. To that end, we're about to launch the 10X Consultation Playbook in the Training Academy in order to teach you and your entire staff how to master consultations. This masterclass teaches you everything you need to know to put your consultations at the very top of the heap. Oh, and it's 100% satisfaction guaranteed.

Replacing Yourself With Systems

Top performers use systems. Average performers don't.

 Stop working IN your clinic, and start working ON your clinic.

Systems are what every clinic uses in order to stop micro-managing, stop flailing, stop losing patients, and stop losing revenue. They're a way of replacing yourself. Systems help you pre-decide what’s important to you — ONCE — and then force you to stay focused. Instead of your clinic staff wondering what they should do… or making it up on the fly… you’ll have a clear system to follow that is both structured, and flexible, so you’re not constantly “trying harder” to “catch up.”

Once you integrate real systems into your clinic, you’ll feel the freedom of not being crushed by the necessity to be involved in everything (I'm talking to you, micro-manager) because you know that everything is getting done, and it's getting done right.

Think of the simplest system you use — where you put your keys. Maybe it’s by the door, or in the kitchen. Yet it’s become a habit and you never think about it. You don’t have to “try harder” to put the keys where they should be… it just works. It’s mindless. And it does what it needs to do.

You may be thinking that you already have systems. You have a manual, you have some "policies", everyone knows pretty much what to do and when.

Eh... I'm skeptical.

A few weeks ago, I sent a survey to 472 physicians asking about their clinic's efficiency and productivity. Perhaps you're not surprised by some of the results. You might even recognize your own clinic.

  • Over 9/10 of physicians said that their clinic operated at less than 80% efficiency
  • 4 out of 10 said that their clinic efficiency was below 60%!
  • Physicians reported this "productivity gap" costs their clinic between $5k and $40k in lost revenue every month.
  • When I asked them what doesn't work, the most common responses: "lack of systems" (44%), "wasted time and effort" (50%), and "micro-management" (40%).

There's a better way that can pull you out of the micro-managing, hair-on-fire, unproductive daily grind and put you in a position where you're working ON your business, not IN your business.

You're smart. You're tired of sloppy training, loose accountability, and variable patient care and you want some control of your business and your lifestyle. You're tired of putting out fires, answer the same questions, micro-managing everything, and running legal, clinical, and business risks.

Get real systems and put them to work for you.

Being Remarkable

Top performers are remarkable. Average performers are nondescript.

Please don't be beige.

Hard I know, but beige sucks. Beige is mediocre. Beige is completely forgettable. Unfortunately, most clinics aspire to beige... do what everyone else does. It's safe. They're thinking, "I should be able to make go of it... I can do what others are doing...  at least I won't make any costly mistakes that cost me."

Not so.

Working to be average is among the most costly mistakes clinics make, and the most common. Playing it safe leaves stillborn everything you might do that could cause a patient to 'remark' about your clinic. It leaves your patients in limbo and forces you to carry all the water yourself. 

To get your patients to tell others you need to do two things; first, you need to be worthy of being remarked upon and second, you need to make it easy.

Example of being remarkable: One of my clinics was located near a big U.S. Air Force base with about 20,000 military personnel and staff. When operation Iraqi Freedom was launched in 2002 many of those military members were about to be deployed to Turkey for a year. Just before this deployment were some politics going on in the UN and France vetoed a resolution which was unpopular at the base.

I took the opportunity to launch a tongue-in-cheek PR campaign to "Veto French Armpits" and we gave away free underarm laser hair removal treatments to every female military member as well as any wives or girlfriends of military personnel. It was open-ended and completely free series of 7 treatments, a complete package. We didn't tie it to other offers, and yes, we did get some patients who took advantage of it completely but that was what elevated it and made it remarkable. 

The result? We donated more than $40,000 in treatments which made us a lot of friends and brought in a massive surge of new patients, we got national media attention and a deluge of local coverage, and we took a massive chunk of the market that continues to this day. That investment in being remarkable produced about a million dollars in revenue over the years, dwarfing our investment.

If you're open to seizing opportunity, you can do remarkable work with just about any situation. We secured a massive patient population not by doing something that was simple, but by doing something that was remarkable.

Do something, anything, that makes you worth talking about.

Second; you need to make it easy for your patients to help you. If you don't,  you're missing out on all of the goodwill and positive thoughts you're generating.

How many times have you asked patients to share a Like on your Facebook page, or leave a review on Google, or just hoped that they would see how incredible you are and tell everyone?

Hope is not a strategy.

You need to make it easy for them, and that means facilitating the action you're asking them to take - Keep a stack of postcards at the front desk and give them $10 off if they'll write a friends address and a short note when they check out. Give a free package for local business owners or their spouse. Start a corporate program. 

The key is that you want to build these out as part of your standard processes and make it drop-dead easy.

Take a look at the special offer from Podium, the leader in patient review marketing. It's a paid application that allows you to capture reviews from you happy patients right at your front desk when your patients are most likely to take the time to help you out.

Aligning Your Staff's Best-Interests With Your Clinic's Needs

Top performers are leaders. Average performers just pay.

If you think that anyone works for you, well, news flash -  they don't. They all work for themselves, just like you do.

Your job, as a business owner, is to align what they perceive to be in their own best interest with your business goals. This will always include money, but there are other areas where you can have a drastic impact. Workload, environment, professional and personal satisfaction, advancement and training, reputation... your goal is to make your staff believe that making your clinic excel is the most closely aligned with their desired path forward. Do this, and you're going to have a motivated team.

If you can't do this, you're going to have constant turnover and you'll lose income. Your staff may comply with your demands, but they're working for a paycheck, and it only takes a single arched eyebrow or eye-roll to cost you a $4,500 package sale or destroy a reputation with a patient. Multiply that by every patient interaction and you'll see a significant problem.

What's the difference?

Leaders understand that everyone works for themselves. They understand that leadership is given by those willing to follow from the bottom up. Leaders have to live up to very high standards to be worthy of being followed, and they work at it constantly.

Average performers think that their staff works for them. They have 'authority' that flows from the top down, but they're not leaders because they're not worth following. People work simply for a paycheck and will leave as soon as something better comes along. 

What can you do?

  • Work hard to be be someone that others are willing to follow. It's not easy and there are challenges. You'll occasionally be taken advantage of but much less so if you just take the authority route. 
  • Implement systems in your clinic that get your head above the ground and allow you to focus on bigger picture goals.
  • Constantly talk to all of your staff members. Be aware of changing attitudes that may signal a problem. Ask them how aligned they think they are with the clinic. Most people will be very open if they sense that you're interest is genuine.
  • Empower them to make decisions, and use policies to make sure that everyone knows which types of decisions they can make.
  • Get better at interviewing people and asking the right questions.
  • Fire faster. Firing is difficult and most people wait until there's real damage being done.
  • Make sure you understand common embezzlement and employee scams. Forewarned is forearmed

When you've aligned your team you'll feel like you're running downhill. Everything is just easier.

Destroying Competitors With Asymmetrical Competition

Top performers make it happen. Average performers hope, and hope is not a strategy.

Like it or not, cosmetic medicine is a business, and that means that it's going to be increasingly competitive as treatments and services become commoditized and prices drop leading to increased competition.

Asymmetrical Competition is finding and exploiting game-changing opportunities that your competitors can't easily match or compete against. 

When we began opening clinics in new locations we devastated the existing clinics run by clinicians who were taking their patient populations for granted. These physicians (mostly plastic surgeons and dermatologists at the time) expected that they would simply inherit all new cosmetic treatments as part of their current fiefdom of "aesthetics". 

They couldn't respond or adapt to the playing field we created.

Rather than position ourselves as competitors to existing practices we redefined the market and positioned ourselves as the experts in nonsurgical cosmetic technologies. We positioned the existing plastics and derm clinics as experts in surgery and dermatology, and we took everything else. The competition didn't have an easy answer since what we were doing was a fundamental change that they couldn't respond to or reproduce.

We focused with absolute madness on keeping appointments on time, on incredible patient services, and on giving power to our patients. We built systems that put our clinics on autopilot and allowed us to easily scale. We empowered our staff to make any decision, as long as they could explain that it was in the best interests of the clinic. We initiated corporate programs, free educational seminars and consults, incredible comfort and atmosphere, and we took all design and marketing seriously. We trained our staff to perform consultations based on sales and service that crushed our goals while turning our patients into raving zealots. We embraced social media and email. We answered questions and posted our pricing right on our website. In short, we did everything that they couldn't do. 

Of course they adapted and started trying to copy us, but they couldn't actually compete. They didn't have the systems, or the desire.

Asymmetrical Competition is available to you as well. You just need to look at what your capabilities are and match those to the market's need. Most clinics don't have the ability to change. They're essentially locked in place and that always presents you with opportunities to exploit areas that they can't adapt to.

As a Medical Spa MD Member you have assess to a wealth of information and know-how about building your clinic. Special offers from partners when you're buying your next laser or IPL, group-buy wholesale pricing on fillers and injectables, software deals, design & marketing services

Be smart and take advantage of it all.

Note What's Not On This List

The cosmetic medical market has matured in the last 15 years, but 5 areas above are not entirely tied to medicine, they're really business strategies. You won't find "improving patient outcomes" here because those are simply table stakes. 

Patient Outcomes - You can't build a business marketing better patient outcomes.

Outcomes are what the patient says they are. You can have a perfect outcome but if the patient expectations are unrealistic, the 'outcome' from the patients point of view can still be negative. Trying to build your clinic and reputation only through your technical prowess is essentially a dead end because it's beyond your control.

(Now I'm not saying that this is not a priority and shouldn't be your focus, but I am telling you that trying to convince your patient population that you're 'better' than the competition makes you seem small and petty and is only a part of what a successful strategy looks like.)

Technology - Not a determining factor in your success

There are successful clinics using every platform.

Choosing the right technology is important, and can save you money, but the lasers and IPLs that you put in your clinic are all producing the same light waves. There are differences; customer service, cost, consumables, and usability, but none of those will either put your clinic out of business, or make you more money on their own. It's reasonable to let laser companies help pay for some of your marketing, but don't make the mistake that they're going to really help you much. patients don't buy based on which IPL you're using, they buy from someone they know, like, and trust.

If you're looking to save money and find a reputable vendor of used devices, contact anyone in our used cosmetic lasers classifieds who is a member of our Certified Partners program and you'll get a great deal. (And if you have a complaint you can contact us directly as a Member and we'll intercede on your behalf.)

Price - The death spiral of lowest-pricing.

Do not hitch your wagon to being the low-cost provider unless you love being on the verge of bankruptcy at all times. There can only be one lowest price in any market, and everyone who will come to you because of price will leave you just as fast. If you can't justify higher pricing then put the work in to build a clinic that does. 


In future posts we're going to dive into these areas in detail and help you take actions to improve them.

Have some thoughts on this or anything to add? Leave a comment. I read them all.

References For This Post:

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  2. Kruger, J. & Dunning, D. Journal of Personality and Social Psychology 77, 1121–34 (1999).
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  5. Alicke, M. D. & Govorun, O. in The Self in Social Judgment (eds Alicke, M. D., Dunning, D. A. & Krueger, J. I.) 85–106 (Psychology, 2005).
  6. Cross, P. New Directions for Higher Education 17, 1–15 (1977).
  7. Taylor, S. E. & Brown, J. D. Psychological Bulletin 103, 193S210 (1988).
  8. Shedler, J. et al. American Psychologist 48, 1117–1131 (1993).
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  10. Sharot, T. The Optimism Bias: A Tour of the Irrationally Positive Brain, New York: Pantheon Books (2011).
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  12. Trivers, R. Deceit and SelfDDeception: Fooling Yourself the Better to Fool Others. (Allen Lane, London, 2011).
  13. Barber, B. M. & Odean T. Quarterly Journal of Economics 116, 261–292 (2001)
  14. Johnson, D.D.P. 2004. Overconfidence and War: The Havoc and Glory of Positive Illusions. Cambridge: Harvard University Press (2004).
  15. Enquist, M. & Leimar, O. J theor Biol 127, 187S205 (1987)

How Good Are Your Patient Consultations? ... About Average.

patient survey results

A while ago we surveyed some of our members to tell us a little about how they perform cosmetic patient consults.

If you were surveyed and responded. Thank you. (We're still collecting responses so if you haven't taken the survey you can do so through the button below.)

We had a pretty good response, and we're looking on putting together a report to present all of the findings, but there were a few surprises. One of them was the results we received about how clinics thought that were already performing. 

How well do you think that your clinic performs patient consultations?

survey results

As you can see the bulk of the answers registered were between 5 and 9 with a few 4's thrown in. There were no 10's and nothing bleow 4.

Part of that is that we used 0 as "our consults are usless". Our bad. A consult that bad is pretty hard to actually perform, so let's look at this as though 4 - the very bottom answers- are actually the lowest. If we do that then we're left with a couple of impressions:

  • If you ask yourself how well you perform patient consults and your anything less than a 9, you're probably about average. That's not great since we know that consult training can increase a clinic's profitability anywhere between 25 - 100%. You're leaving money on the table, or in the consult room.
  • If you answered 9, you're probably pretty good at consults.
  • If you answered 6 or below. You're going to need some help.

We're going to publish all of the results once we stop collecting them. If you'd still like to contribute and add your thoughts, you can still take the survey below.

What Should You Do If A Patient Wants To Record A Consultation?

patients recording a medical consultation

Patients are now equipted with the technology to record their consultation, whether you know it or not.

With the proliferation of smartphones, many patients now have the ability to record a consultation at their fingertips by installing a simple, and free, app. Recording a consultation has some advantages for doctors and patients. It can help the patient to retain information for example, but when a patient covertly records a consultation, it can cause the doctor to question why.  

One study suggested that patients immediately forget between 40 and 80% of the medical information provided by their doctor and almost half the information they do recall is incorrect.  

Some patients come in with notepads, ready to write down everything they hear. The problem is that when patients are busy writing things down, they may not be completely focused on everything that’s being said. Bottom line, they still don’t get all the info they wanted.

Physicians are split on the subject.

Christopher Eden, consultant urologist at the Royal Surrey Count Hospital, Guildford, explains why he approves. 

The other day, a chap came to see me to discuss his surgical options following a recent diagnosis of prostate cancer. I fully expected he’d have a lot of questions, but the first one lobbed my way wasn’t quite what I’d anticipated.

Clearing his throat, he said: ‘Do you mind if I film you, doctor?

It’s not the first time a patient has asked if they could tape our consultation. But usually they mean an audio recording. Appearing on the small screen - or at the very least his smartphone - was altogether different.

But I didn’t have any objection. Research has shown that patients pick up only a third of what a doctor tells them.

The other side of the coin.

A U.S. cancer specialist recently wrote in a leading journal that he felt taping a consultation disrupted the lines of communication and trust between doctor and patient - particularly if it’s done surreptitiously.

Why, he asked, was there a need to record the conversation at all?

Obviously, I’d prefer to be told if it’s going to happen: if a patient trusts me to save his life, he should feel comfortable enough to tell me he wants to tape our discussion.

So what should you do if a patient asks to record a consultation with you? It is common courtesy that somebody wishing to make a recording should ask permission. If you feel uncomfortable at the prospect then you should express that discomfort and tell the patient that they would prefer the consultation not to be recorded.

If the consultation is recorded, it would be sensible to ask for a copy so that it can be placed in the patient’s notes to form a permanent record.

The content of the recording is confidential to the patient, not the doctor... so the patient can do what they wish with it. This could include disclosing it to third parties, or even mounting the recording on the internet. So what does this mean for doctors?

Doctors should always behave in a responsible and professional manner in consultations. Consequently, any recording will provide concrete evidence of that.

Technological advances will undoubtedly bring further changes and it may well be that in 20 years’ time, recording of consultations, with copies being held by both doctor and patient, will be commonplace.

Does anyone here have experience with this?

Yes, I Sometimes Google Patients. Is That Weird?

There's no doubt about it. Typing your name (or your clinics name) into Google or Yahoo and seeing what pops up is something that the majority of your patients are now doing. So, we ask the question, is it fair to do the same?

Humans are curious creatures. Our curiosity has us doing utterly unproductive things like reading news about people we will never meet, learning topics we will never have use for, or exploring places we will never come back to. As social beings we're programmed to be interested in other people. It’s part of what makes us tick. (And let's face it, social media encourages us to become voyeuristic.)

Have any of you Googled a patient you found to be particuarly interesting? A patient you found to be behaving oddly? A famous patient? According to recently published articles, it appears that most M.D.’s answer that questions with a resounding “yes.”

In a New York Times column published online yesterday, Haider Javed Warraich, M.D. discusses whether or not that’s OK.

“Doctors do ‘Google’ their patients,’ he writes. “In fact, the vast majority of physicians I know have done so. “I remember when I first looked up a patient on Google. It was my last day on the bone marrow transplant unit, back when I was an intern. As I stood before the patient, taking her history, she told me she had been a painter and suggested I look up her work on the Internet. I did, and I found her paintings fascinating. Even though our paths crossed fleetingly, she is one of the few patients I vividly remember from that time. “But it surprises me that more physicians don’t pause and think about what it means for the patient-doctor relationship. What if one finds something that is not warm and fuzzy?” I recently read about a case in which a 26-year-old woman went to a surgeon wanting to have a prophylactic double mastectomy, citing an extensive history of cancer in her family. However, she was not willing to undergo any work-up, and her medical team noted several inconsistencies in her story. When they searched online, it turned out she had set up multiple Facebook accounts soliciting donations for malignancies she never had. One page showed her with her head shaved, as if she had already undergone chemotherapy. The surgeons immediately decided to halt her care.

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to. Maintaining trust in the doctor–patient relationship is very important. Can a patient trust a doctor who presents information that has not been offered within the confines of the consultation?

Searching for information about patients online is ethical as long as the doctor is seeking information that helps treatment, Dr Warraich believes. “But if the only reason a doctor searches online is to gather personal information that patients don’t want to share with their physicians, then it is absolutely the wrong thing to do,” he concludes.

Thoughts? Is this a black and white, right/wrong issue? Please share. (We promise not to Google you.)