Making the Case for Low-Dose Hyaluronidase Treatment for Nodules

Hyaluronidase has been used to reverse adverse effects in dermal fillers (e.g. necrosis, nodules, granuloma). In some way, the dosage of the enzyme could also affect the treatment of adverse effects. High-dose hyaluronidase has been the practice by many clinicians in reversing dermal filler adverse effects. Alam et al. (2018) argues that a low-dose would be as effective and could make corrections when necessary. So what then should be protocol?

Alam et al. argued that one of the advantages of applying low-dose hyaluronidase was the possibility of correcting the volume of the dermal filler. In their study, the fillers used were Juvederm XC and Restylane-L, and applied the low-dose method on nodules.

However, since the dose of hyaluronidase is low, treatment is done in weekly intervals, and there was a 4-month follow-up. The researchers reported no adverse effects. Clinicians may need to use more hyaluronidase when dealing with Juvederm XC due to concentration and cross-linking.

Findings:

• Nodules were less noticeable over time

• 9.0 units of hyaluronidase worked best for Restylane-L, while 1.5 units worked for Juvederm XC -- as per physician perception

• As for participant perception, the effects of 9 Units seemed much better for both dermal fillers

In another research, Menon et al. (2010) used a low dosage of hyaluronidase to treat over corrections. This study is one of the first to examine low-dose of hyaluronidase. Other than this and Alam et al.’s work, there are no more research on the efficacy of the low-dose method.

Literature on reversing hyaluronic acid focus more on the usage of high-dose hyaluronidase. Researchers recommend high-dose hyaluronidase to treat necrosis (Cohen et al., 2015) or ischemia (Hwang, 2016).

Immediate treatment is also needed for ischemia and scarring (Hwang, 2016). In the case of necrosis, immediate high-dose hyaluronidase is imperative (Cavallini et al., 2016).

Such is the case, hyaluronidase could lead to an allergic reaction (Kim et al., 2015) as well. Thus, it is best to conduct allergy testing may be necessary.

While the topic is not prevalent in literature, low-dose hyaluronidase could exhibit efficacy in the long run. Alam and his team could prompt new investigations in applying lower doses of hyaluronidase to prevent allergies and to treat other adverse effects with hyaluronidase with lower doses. The study could open new avenues to examine low-dose hyaluronidase with other dermal fillers and for other adverse effects.

References:

Artzi, O., Loizides, C., Verner, I., & Landau, M. (2016). Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel. Dermatologic Surgery, 42(1), 31-37. doi:10.1097/DSS.0000000000000562

Cavallini, M., Trocchi, G., & Gazzola, R. (2016). The use of Hyaluronidases in Aesthetic Medicine: Indications, technique and complications. Aesthetic Medicine, 2(4), 31-35. Retrieved from http://www.lamedicinaestetica.it/images/files/files-portale/AE_4_2016.pdf#page=31

Chesnut, C. (2017). Restoration of Visual Loss With Retrobulbar Hyaluronidase Injection After Hyaluronic Acid Filler. Dermatologic Surgery, 44(3). doi:10.1097/dss.0000000000001237

Cohen, J. L., Biesman, B. S., Dayan, S. H., Delorenzi, C., Lambros, V. S., Nestor, M. S., . . . Sykes, J. (2015). Treatment of Hyaluronic Acid Filler–Induced Impending Necrosis With Hyaluronidase: Consensus Recommendations. Aesthetic Surgery Journal, 35(7), 844-849. doi:10.1093/asj/sjv018

Hwang, C. (2016). Periorbital injectables: Understanding and avoiding complications. Journal of Cutaneous and Aesthetic Surgery, 9(2), 73. doi:10.4103/0974-2077.184049

Khan, T. T., Colon-Acevedo, B., Mettu, P., Delorenzi, C., & Woodward, J. A. (2016). An Anatomical Analysis of the Supratrochlear Artery: Considerations in Facial Filler Injections and Preventing Vision Loss. Aesthetic Surgery Journal, 37(2), 203-208. doi:10.1093/asj/sjw132

Landau, M. (2015). Hyaluronidase Caveats in Treating Filler Complications. Dermatologic Surgery, 41. doi:10.1097/dss.0000000000000555

Loh, K. T., Phoon, Y. S., Phua, V., & Kapoor, K. M. (2018). Successfully Managing Impending Skin Necrosis following Hyaluronic Acid Filler Injection, using High-Dose Pulsed Hyaluronidase. Plastic and Reconstructive Surgery - Global Open, 6(2), E1639. doi:10.1097/gox.0000000000001639

Waiting room videos can educate, inform, and sell.

There's always space in your waiting room to educate patients about your services.

Here’s an example of a marketing video created by Workhorse (a design agency) that shows how compelling it can be to have a looping video of your services.

Most clinics will have information from distributors and sales reps, which is fine - but they’re interested in branding themselves and increasing their mind share, not yours.

To have a video created like the one above should take roughly a week and cost you between $500 and $1k depending on the level of complexity and work involved. If you do it correctly, it will pay for itself the first day.

The Subscription Business Model: Patient churn is killing your clinic’s profitability.

The single most important determining your success and profitability is how well you do one thing; create value for your patients.

Most providers don’t actually understand that sentence very well. They see ‘value’ as the effort they put in to provide good medical advice – but that’s just a tiny part.

When you don’t provide value and build relationships in the ways that your patients want – especially in cosmetic medicine – they’ll drift off for greener pastures – and that loss (patient churn) destroys the long term value of your business.

Here are the numbers.

The gap is just as wide in cosmetic medicine as in other areas because it’s competitive. The fact that your staff is friendly and offer free sparkling water is no longer enough to set you apart. It’s expected, and discounted as a basic requirement.

So what can you do to set your clinic apart in what’s become a hyper-competitive marketplace.

That’s actually simple to understand, but difficult to work through – you need to do the things that patients want AND that your competitors are unable or unwilling to do.

That is NOT EASY, because the top 3 things patients want demand TIME – and you don’t have any.

Here’s what patients want:

And you can’t deliver what patients want because you can’t simply work more hours and spend more time without impacting your practice and profitability.

There’s a reason that you’re working 70 hours a week but only spending 27% of that time working at the top of your licence.

Fortunately, there are now technologies that are coming into the market that let you automate much of the time-sucking, redundant manual tasks that keep you doing everything manually.

First, telehealth came along. That was good but all of the first telehealth solutions were built around insurance reimbursements. That meant that they were manual too, and didn’t save you any time as a provider. Patient’s no longer had to drive to your clinic and sit in your waiting room, but they didn’t really save you time as a provider – you were just trading 15 minutes in a treatment room for that same 15 minutes on a video call.

You added during Covid but you’re probably using a free telehealth service like Skype or Zoom, or a slightly upgraded version like Doxy, and none of these solve the base problem; there’s only 1 of you and you can’t be in 10 places at once.

Fortunately, technology doesn’t sit still.

The newest telehealth platforms integrate both your in-clinic care with on-demand access that allow you to automate almost all of the myriad of things you’re doing that are completely redundant and manual.

These new technologies were built for large health systems and clinical trials, but have become available to smaller clinics and individual providers, and they solve exactly the problems you need solved; How do I replace the low-level redundant tasks with automation in the ways that patients love.

Read that last sentence again because it’s important. The technology has to be loved by the patients, not just be another hoop to jump through.

These new technologies were designed outside of the insurance reimbursement ecosystem. They were designed for clinical trials and drug discover where it’s critical for patients to be engaged and love interacting with caregivers. The average cost of 1 patient in a clinical trial is now $3,600! There’s no way you can afford to lose patients in these ecosystems or you’re dead in the water.

And that’s exactly the problem you have.

These new platforms allow you to create ‘care pathways’ that automate any use case; new patient onboarding, triage, treatment, followup.. whatever you want. Best of all, your patients don’t differentiate between interactions on these new systems and live interactions. You can build these care pathways, and you can charge for them.

That means that you really can be in 100 places and once.

And because you can built it once and charge for it over and over, it opens up entirely new revenue streams and business models that allow you to scale your practice and business in ways that haven’t ever been available before.

Here’s what this looks like as recurring or subscription revenue over time.

If you’re interested in creating subscription or recurring revenue for your cosmetic practice or medical spa, you can learn more here.

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Links if you want to dive in further:

Advisory Board. (2018, February 12). Your staff is underperforming. Now what? Retrieved from https://www.advisory.com/daily-briefing/2018/02/12/c-performers

Bailey, D. (2017, June 27). Unicom Teleservices, Inc. Retrieved from https://www.unicomcorp.com/blog/tips-to-increase-medical-practice-profits/

Brinker, B. (2017, November 26). 10 Warning Signs of a Disengaged Employee. Retrieved from https://www.aventr.com/blog/10-warning-signs-disengaged-employee

Carter, A. (2012, March 20). Front Desk Profits. Retrieved from https://empoweringyouconsulting.com/2012/03/20/front-desk-profits/

Easy Pay. (2014, October 16). Patient Payments Blog. Retrieved from http://www.easypaycollect.com/blog/5-front-office-staff-best-practices

Gooch, K. (2016, April 26). Patients' No. 1 complaint? Front-desk staff. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/patients-no-1-complaint-front-desk-staff.html

Hamilton, K. (2017, November 18). 7 Surprising Reasons Why Your Medical Staff is Unhappy. Retrieved from https://getreferralmd.com/2013/09/medical-staff-employment-tips/

Nijjer, R. (2018, August 29). How Negative Reviews Impact SEO. Retrieved from https://www.searchenginejournal.com/how-negative-reviews-impact-seo/265991/

Quora. (2018, April 26). Why Soft Skills Are So Important For Medical Professionals. Retrieved from https://www.forbes.com/sites/quora/2018/04/26/why-soft-skills-are-so-important-for-medical-professionals/

Russell, P. (2016, October 13). Do Receptionists Keep Some Patients From Medical Care? Retrieved from https://www.medscape.com/viewarticle/870272

Sinsky, C. (2008, October 01). 10 Big Ideas That Could Make Your Practice Better. Retrieved from https://www.aafp.org/fpm/2008/0900/p33.html

Thomas, C. (2017, August 11). 11 Tips to Create a Profitable Front Desk at Your Salon Spa. Retrieved from https://www.linkedin.com/pulse/11-tips-create-profitable-front-desk-your-salon-spa-chris-thomas/

Vanguard Communications. (2017, November 10). Online Doctor Complaints Primarily About Customer Service | Vanguard. Retrieved from https://vanguardcommunications.net/patient-complaints/

Wiggins, K. (2017, March 16). How employers 'manage out' unwanted staff. Retrieved from https://www.ft.com/content/356ea48c-e6cf-11e6-967b-c88452263daf

Jobs To Be Done + Your Medical Spa

It’s not about the client. Jobs To Be Done is a new methodology that forces you to look at your products and services the way that your patients and clients do.

What is “Jobs To Be Done” and how can it help your medical practice?

Harvard Business School professor Clayton Christensen is the author of The Innovators Dilemma and a well regarded business thought leader. He described “Jobs To Be Done” in this paper he wrote with one of the best tech entrepreneurs and product marketers of all-time, Scott Cook of Intuit.

The theory simply asks, “What job is your product or service hired to do?”.

The answers might not be exactly what you might usually think. For example; if you ask most people directly why they bought a lawnmower they would probably say to “cut the grass,” but if a lawnmower company examines the higher purpose of cutting the grass, say, “keep the grass low, neat and beautiful at all times,” as a business looking at what job needs to be done, it might switch from investing in better, more capable lawnmowers to develop genetically engineered grass seed that grows to an exact height.

The example that Clayton Christensen uses most is that of McDonalds milkshakes and what the “job” is that causes people to buy a milkshake. Here’s a video. The results are pretty surprising but led to a 300% increase in the number of milkshakes that McDonalds sells and a conclusion that the size of the market is 7X what they thought it was. You should watch this.

This is the power of the JTBD concept and technique: It helps a business understand that customers don’t buy products and services; they hire various solutions at various times to get a wide array of jobs done.

So what is the best way to define the customer’s job-to-be-done? Keep in mind that the reason the jobs-to-be-done theory is so powerful is because it allows companies to analyze the job like it would analyze a business process, providing a new and effective method for uncovering and prioritizing customer needs. Consequently, the job must be defined as a process; an activity that consists of a series of steps that customers take to complete a task or achieve a goal or objective. This means that the job-to-be-done is always a functional job; not an emotional job.

Over the years we have developed a set of rules that we follow to define the job correctly. Here are three of the dozen or so rules we use to get it right along with some jobs-to-be-done examples:

1. We think about the job from the customer’s perspective, not the company’s. For example, a company that supplies herbicides to farmers may conclude that growers (the job executors) are trying to “kill weeds”, while the growers might say the job-to-be-done is to “prevent weeds from impacting crop yields”. To avoid this mistake, don’t ask “what job are people hiring my product for”, rather ask, “what job is the customer trying to get done”. Because customers often cobble together many solutions to try and get the entire job done, the answers to these two questions are often very different. We see many jobs-to-be-done examples in the blogosphere that get this wrong.

2. We think big; to encompass the entire job, not just a piece of it. A narrow focus will hurt a company because customers are looking for products and services that help them get the entire job done better. For example, a company could focus on helping a grower “prevent weeds from impacting crop yields”, but they may want to consider helping them get the entire job done, which is to “grow a crop”. Customers do not want to have to cobble lots of incompatible solutions together to try and get the entire job done. They prefer to get the entire job done on a single platform.

3. We define a market around a functional job, not the emotional goals that accompany it. A company that offers a product that “prevents people from getting lost when driving” would do themselves a disservice to conclude that their customers are hiring their product to “achieve peace of mind”. A focus on “peace of mind” will not deliver the insight that’s needed to better prevent people from getting lost. Knowing the customers’ accompanying emotional jobs is helpful, of course, but only when it comes to positioning and messaging, not innovation. Once again, we see many jobs-to-be-done examples offered in the blogosphere that miss this point.

People buy products and services to get jobs done; and while products come and go, the underlying job-to-be-done does not go away. This notion is at the heart of jobs-to-be-done theory.

If you remember anything about jobs to be done, remember this: they are completely neutral of the solutions you create (your products and services). While a customer JTBD remains fairly stable over time, your products and services should change at strategic intervals as you strive to provide ever increasing value.

As Christenson says, “at a fundamental level, the things that people want to accomplish in their lives don’t change quickly.”

Additional reading:

• The JTBD Framework: https://strategyn.com/customer-centered-innovation-map/

• Harvard Business Review: https://hbr.org/2016/09/know-your-customers-jobs-to-be-done

• Clayton Christensen Video: https://www.youtube.com/watch?v=Zn6-KksdOgE

The money is made in the consultation room.

The single most important determining your success and profitability is how well you do one thing; consultations. The 10X Consultation Playbook is a proven, step-by-step system that teaches you and your entire team exactly how to conduct consultations that convert in precise detail. It shows you exactly what to do every step of the way to guide each patient along a journey that they already want to take.

Dr. Shehla Ebrahim - After Glow Skincare and Ambleside Dermedics, Vancouver

Name: Dr Shehla Ebrahim
Locations: Vancouver, BC
Website: www.afterglowskincare.ca, www.amblesidedermedics.com

Bio: I am a family physician with a special interest in dermatology. I am the owner and founder of 2 award inning medi-spas on the North shore in Vancouver, BC. As a graduate of the University of BC, I began a career in family medicine in 1992.I am a certificant and a fellow of the college of family Physicians of Canada. Responding to the urgent need for dermatological care in my community, I pursued a diploma in Dermatology through Cardiff University. I have a flourishing focused dermatology practice which has enabled me to reduce wait times for the patients in my community.

What made you pursue cosmetic medicine?

Having practised Family medicine from 1992-2005, I started feeling unfulfilled in my current profession. Pharmaceutical based medicine was disenchanting, patients were never satisfied, and the energy was wearing me down. I also realized that I possessed creative and artistic qualities and it would be a winning combination to merge art and creativity, with science and technology of the emerging aesthetic medicine industry. I recognised that I wanted to be in control of my own destiny and the only way to do that would be to be in business for myself. In 2005, I took a leap of faith and opened my first location in North Vancouver.

Kindly give us a background of your clinic.

I am the medical director of 2 award winning medi-spas on the North Shore, in beautiful British Columbia. I have a full service medi-spa and my patient population comprises mainly of women between 45-70 who have a disposable income of 60,000 or more. Most of my clients are women who are interested in positive aging. Wanting to be the best version of themselves and wanting to look the best for their age. Both the clinics offer a complete menu of medical aesthetic services covering the face to the body.

How do you manage your staff members?

I always used to tell my staff that customers come first. Now I tell my customers that my staff comes first. We all know that finding and keeping good staff can make or break your business. I have a successful business model that has enabled me to keep the same staff for 14 years and that business model is to have:
1)    humility in leadership.
2)    To respect and appreciate my staffs need to have work life balance.Most of these women are young,have children and unlike the baby boomers like myself who make work our number one priority,,these individuals have priorities other than work which needs to be balanced.
3)    To run the business like a family owned business.
4)    To respect and value who they are and making a daily effort to thank them for their service.
5)    Build a team that buys into my vision of providing exceptional and high quality service with integrity and authenticily.

My staff is paid hourly plus commission. Generally, between 20 to 27$ per hour depending upon their seniority. Commission is fixed for some treatments at 125$ and others as a percentage of the treatments sold. Varying from 5%-20%.

I hire staff based on my intuition and their personality. Technology can be taught but personality cannot.

It has been my experience that people leave your business because of who they are and not because they were not valued as we are taught in business and HR management seminars.

Which light based or laser devices are currently in use in your practice?

I use a number of laser and light and energy-based devices in my practice. IPL, fractional, fully ablative, microneedling, ultherapy and coolsculpting. My favourite is IPL and Micro needling with RF and total resurfacing. Over the years, it has been my opinion that many devices are overpriced and underperform and do not meet the expectations that sales people promise.
I now look at buying second hand devices esp. for hair removal. There are a number of companies in Canada and USA that sell second hand devices which will then allow you to pay them off quickly.

What marketing strategies do you employ?

Marketing is the most difficult yet the most exciting part of my business.

Because the industry is very competitive, it is important to find creative strategies that will set you apart from the other clinics. Other the usual website that use SEO and SEM strategies, the best way to now market your business is through social media. This would include Facebook, Facebook live, Instagram, paid google adwords, blogs, newsletters, videos and you tube. Having your own video channel and regularly posting videos is a very effective and inexpensive way to market one’s business.

Which treatments and procedures are usually done in your practice?

The most profitable treatments are injectables and constitute 60% of my business. These would include, botox, and fillers.

Over the years I have dropped treatments that no longer serve me or my patients. These include laser treatment of veins ,nonablative fractional and some chemical peels. I have added other treatments such as PRP for hair loss and vampire facial. I have recently invested in female rejuvenation treatments and threads.

Please tell us any anecdotes you can share.

Aesthetic medicine is a fascinating and everchanging industry.

The most exciting thing about this industry is how rapidly things change and all the different treatment options available to our clients. Clients are generally opting for little or no downtime treatments that get them back to work faster and are willing to pay a premium for these treatments. From treatments that slow down the aging process to treatments that may reverse aging, such as recent advances in regenerative medicine. Harnessing the power of blood to improve the quality of one’s skin to using stem cells for tissue regeneration and minimally invasive treatments such as threads to lift the skin.

What pearls can you share to fellow physicians in the field?

Having passion is the number one criterion if you want to be successful in this industry.
Everything else will happen effortlessly and money will come wherever it is supposed to come from as long as you are first happy without it. Treat your employees with respect. Honour and always thank them for their efforts in helping your business grow.

Reducing Patient Churn in Your Medical Spa

Customer churn or attrition happens to all businesses and your medical spa is not immune to it. It can’t be helped, there are patients switching to other providers for reasons. However, you can reduce the incidence of patient churn.

Know why patients leave your medical spa, and how you could reduce patient churn or attrition. It is a common occurrence, but some medical spas fail to realize is that you do not keep track of patients who never return. According to Solutionreach, most patients leave due to indifference. This is caused by poor customer service, so it is imperative to improve your service.

Running the numbers on churn rate would help give you an idea how many patients you are losing. HubSpot argues you should measure customer satisfaction so you can know who are the unhappy patients. In turn, if you do not account for those who never return (and if there are more who churn), then it is likely your medical spa will fail.

Here is a simple calculation that businesses use, that could be applied to your medical spa, on how to measure churn rate:

Annual Churn Rate = (Number of Patients at the Start of the Year - Number of Patients at the End of the Year) / Number of Patients at the Start of the Year

For example, you have 3000 at the start and 2000 at the end.

3000-2000 = 1000/3000 = 33%

As for the monthly churn rate, just change year to month.

As for an ideal churn rate, it seems there is none, but according to some experts, it is less than the example we demonstrated. However, these numbers should only serve as a guide while it does cost a lot to acquire a new patient, it still is good for business to acquire so long as you are measuring your numbers often.

What Actions You Can Do to Reduce Patient Churn?

Prioritize Communication in the Patient Journey

Aside from these metrics, communication is a huge factor in reducing churn. Patients appreciate it if you communicate with them in every step of their journey. They need to feel valuable to avoid being seen as “indifferent”.

Always ask for feedback from patients, regularly send them personalized emails, and remain transparent with them. Do not forget to thank them also.

Learn how to build high-touch patient journeys >

Emphasize Value

The reason patients could be returning to your medical spa is because of the value you provide. According to Sam Suthar, you could show testimonials to your patients to prove to the others about why patients keep coming back to your medical spa.

Not only the value of your services, but you should value your relationship with your patients. Engage with your patients, and strategize how you can retain your current patient base. Offer incentives or make sure they are getting their value for money in your medical spa.

Strengthen Customer Service

In NGData’s article and in other blogs, customer service is vital in reducing churn. Your staff has a huge role in making sure patients return. One of the things your staff can do while patients are in your medical spa is to be attentive and responsive. Make sure they treat patients nicely as well.

Birkett, A. (n.d.). Customer Satisfaction: The Ultimate Guide. Retrieved from https://www.hubspot.com/customer-satisfaction

Bulygo, Z. (2018, July 13). 6 Ways You Can Improve Churn Rate and Increase Revenue. Retrieved from https://neilpatel.com/blog/improve-churn-rate/

Edgar, H. (2017, May 31). Importance of Patient Retention: 8 Benefits That Every Practice Loves. Retrieved from https://www.practicebuilders.com/blog/importance-of-patient-retention-8-benefits-that-every-practice-loves/

Gandolf, S. (2014, July 11). 9 Essentials of Improving Patient Retention. Retrieved from https://www.healthcaresuccess.com/blog/medical-marketing-advertising/the-9-essentials-of-improving-patient-retention.html

Hicks, P. (2017, March 2). Effective Strategies To Reduce Customer Churn. Retrieved from https://www.salesforce.com/blog/2017/03/effective-strategies-to-reduce-customer-churn.html

Law, R. (2017, February 3). Churn Rate: How High is Too High? A Meta-Analysis of Churn Studies. Retrieved from https://www.cobloom.com/blog/churn-rate-how-high-is-too-high

Plaksij, Z. (2018, May 16). Customer Churn: 12 Growth Strategies to Stop Churn Right Now! Retrieved from https://www.superoffice.com/blog/reduce-customer-churn/

Referal Saasquatch. (2018, March 15). Calculating Churn Rate and 12 Customer Churn Statistics. Retrieved from https://www.referralsaasquatch.com/calculating-churn-rate-12-customer-churn-statistics/

Shewan, D. (2017, March 27). How to Calculate (And Lower!) Your Customer Churn Rate. Retrieved from https://www.wordstream.com/blog/ws/2014/05/12/customer-churn

Smart Insights. (2016, July 20). 17 unbeatable ideas to reduce churn rate. Retrieved from https://www.smartinsights.com/traffic-building-strategy/integrated-marketing-communications/17-unbeatable-ideas-reduce-churn-rate/

Solutionreach. (n.d.). 6 Ways to retain your patients | Infographic | Solutionreach. Retrieved from https://www.solutionreach.com/infographics/6-ways-to-retain-your-patients

Stringfellow, A. (2018, June 28). How to Reduce Customer Churn: Tips from 32 Gurus – NGDATA. Retrieved from https://www.ngdata.com/strategies-to-reduce-customer-churn/

Suthar, S. (2018, June 25). 11 Proven Strategies to Reduce Customer Churn Rate Proved By Experts. Retrieved from https://acquire.io/blog/reduce-customer-churn-rate/

Vardhan, H. (2017, December 13). Reducing customer churn: A complete guide | Hiver blog. Retrieved from https://hiverhq.com/blog/reducing-customer-churn/

5 Critical Areas Of Staff Training We've Learned From 17 Years Building Clinics

If you're not continuously training your staff and yourself, you're losing patients, profits, and devaluaing your business.

A while back we sent a survey to 472 physicians asking about efficiency and productivity in their clinic or practice. You may be able to fit your own clinic into these responses:

• Over 9/10 of physicians said that their clinic operated at less than 80% efficiency, and 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%).

Yep.

The most common reason that physicians give for not doing anything? They don't know what to do...

And, if you are doing anything it's usually something like "Hey everyone... <insert-patient-name-here> told me that she didn't know that we're now offering _____ and that she had to wait 40 minutes today. From now on everyone should tell every patient about ______ and don't keep patients waiting without asking me."

I may have not got it exactly but every clinic member recognizes this type of direction.

You've also seen the results; piss-poor execution, patients slipping through the gaps, poor morale and feckless leadership... and worst of all; shooting your own business in the foot.

There's a better way, but it's not as simple as spouting a 'directive'. It involves some effort.

Where should you begin? 

I'd suggest that you begin with the Ultimate Clinic Operations Blueprint, our course on implementing systems in your clinic, but here are some general rules to get you started. (Also, watch the video all the way through at the top of the post for a better understanding of this.)

The 5 critical areas of staff training:

1. Patient interactions
2. Sales
3. Safety and compliance
4. Accountability
5. Decision-making

A blog post is too thin a medium to detail everything needed in these areas (which is why we built the operations course), but here's a little preliminary guidance.

Employer Rule No. 1: Give employees ownership of real deliverables. In a clinic this often needs some preliminary work to implement measurements. I'm guessing that you don't know your average wait times or how many word-of-mouth patient referrals you're receiving each month.

 Depending on the kind of manager you are, you’ll either shy away from this because: a) you can do it better, or b) you don’t want to overload your direct reports. Either is a mistake. In my experience, most complaints I’ve had with any of my past employers have related to having too little to do, rather than insufficient salary/title/etc. Give your employees meaningful work, and they will rise to the challenge.

Insist on personal accountability. Yes, it’s scary to have people counting on you. It’s much easier to coast along behind the scenes. But admit it: it’s not very satisfying. Sloth never is. It’s much better to be king of an infinitesimal pond than a nobody in a massive ocean. Go for the responsibility, not the title. (I’ve made this mistake on several occasions, and each time I’ve regretted it.)

Employer Rule No. 2: Less is more. You really don’t need 10 people for two jobs. You need one. I’ve become a big believer in slow, organic growth in organizations. It’s much better to hire one person and stretch them thin than it is to hire 10 people and have them struggling to find sufficient work to keep them occupied.

 More is less. You don’t need more. You just need to work with what you have. The less you have, the more resourceful you’ll become — this makes us think like a real customer, who has to stretch a budget. Speaking of which….

Employer Rule No. 3: Every employee should be revenue-additive. This is the most important of them all. Marten Mickos, CEO of MySQL, once told me that he thinks business development is something every employee should do, all of the time. I didn’t believe him then, but I do now. Every employee should understand how she contributes to the company’s top and bottom lines, and should be held accountable for how she measures up. Everyone should be selling, developing product, marketing it, etc. No exceptions.

Employee Corollary No. 3: If you’re not making money for your employer, you’re a waste of money. If you don’t understand how you fit into the Circle of Life for your employer, find out. Or figure it out. But don’t just collect a paycheck. You owe it to your employer and to yourself to help defray the cost of your paycheck, as well as that of others’. The more revenue-driven we become, the more effective and the better our chances of improved future employment.

There is 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. Take a look at the Ultimate Clinic Operations Blueprint.

As with any business, staff and personnel may have to undergo training to further enhance their skills and to give them an opportunity to learn new ones in the process. Medical practices should also partake in training, as it also helps grow your medical spa.

Customer Service

One of the best training you can provide to your staff is customer service. In many reviews given by patients, it seems that patients notice the service provided by the staff particularly rude behavior. Customer service training is also vital as this is one of the first things patients write about in reviews. 

Learn how to use patient reviews to grow your profitability.

Sometimes the case is untrue, but still, it would be best to train your staff with telephoning, emailing, dealing with patients as well. Your non-medical staff, especially front desk and reception personnel are your first line of defense, and the way they transact with your patients is a reflection or representation of your medical spa. You could be losing patients if your staff is untrained, so give them better training in that area.

Procedures

Every procedure in your clinic needs to be standardized. Patients compare every interaction and if there's an identifiable difference between treatment sessions or interactions then patients will tag one as "worse" than the other and make the patient feel that you're less reliable. The result is greater patient churn, less income, more resistance to buying and less revenue.

Marketing and Reputation Management

Marketing is not just going on social media and promoting your medical spa. There are several aspects of marketing you must remember for healthcare. There have been instances where medical staff and providers forget to abide by HIPAA regulations, and that could put your medical spa at risk. In that light, you will need to learn how to strategize marketing around HIPAA or Health Information Regulations.

Social media is your best bet in marketing your medical spa especially it gives you exposure. You could invest in SEO for your medical spa, as part of your marketing strategy as well. Reputation management could be considered a branch of marketing as it deals with your reputation online and social media as well. Make sure that you have the right software to manage your reputation.

Operations and Management

This is mostly applicable for medical owners and physician owners of the medical spa. Managing your team should be a priority, by delegating tasks, setting meetings, overseeing without micromanaging, aside from seeing patients. It could become taxing, but it is doable with training. You will need to enhance your skills in operating your medical spa or aesthetic practice smoothly.

Not only would training make them more engaged but your staff can be more productive in work. You can motivate your employees with training, and it will most certainly help them become more engaged in your medical spa.

You can find some of our training courses on our website.

When Your Marketing Goes Too Far: How One Dermatologist Got Suspended for Dancing and Rapping during Procedures

Don't get yourself in trouble by failing to think through what you're doing and how it can damage your clinic and your reputation if something goes wrong.

You may have seen something about the recent case of  dermatologist Windell Davis-Boutté The “Dancing Doctor” who has been suspended for "negligence" after posting videos of herself dancing and rapping while performing surgeries. The physician used the videos to market her practice, where she was seen rapping and dancing, that it ended up having her patients file lawsuits against her with some of them claiming to be severely injured. (CBS article)

To get real for a second, this was a stupid thing to do for lots of reasons. Anyone who has been around for a while knows that it's not if you get sued, it's when you get sued since your patients have been pretty well conditioned to expect perfect results based on their own criteria.

The result: Dr. Davis-Boutté was sued by 7 of her patients and was forced to agree to a 2.5 year suspension of her medical license.

According to Gutierrez and Johnson (2018), there have been other instances like Davis-Boutté’s where physicians are singing and dancing while doing procedures. It causes immediate alarms to go off for patients, as physicians are expected to be focused exclusively on their care and the procedure. 

So what did Dr. Davis-Boutté get so wrong?

1. She wasn't focused exclusively on providing the best care: Patients expect perfection from their treatment and if they're unhappy with the outcome in any way they're going to be looking to the doctor for answers. Any indication that the physician wasn't focused exclusively on providing the best care is immediately going to be the peg on which they're able to hang blame.
2. She turned her patients into props: No patient really likes to be filmed when they're unconscious on the operating table.
3. She made it public: Of course that was the whole idea. These were 'marketing' videos and they were produced and posted online in order to increase visibility for her practice.

While this went completely off the rails from the beginning for Dr. Davis-Boutté, there are some lessons to be learned. Here are a few things Dr. Davis-Boutté could have done to meet her goals without dropping a bomb on her dermatology practice.

1. Use patients only for live testimonials: The social proof of happy patients is probably the best general marketing you can use, but they need to be aware of what they're doing and how it's going to be used. I'd suggest that if you're shooting live videos for promotion that you let patients "sign-off" on the final product before you actually release it. Make sure that patients 
2. It's not about you: Patients want to be treated by a physician who's nonthreatening, caring and personable, and who puts them at ease, but they don't far beyond that because they're focused on themselves. Your efforts need to be focused on them as well. 
3. Focus on what's actually important: There's only one thing that you're looking to have patients think about you if you're performing cosmetic treatments; that is that you're "the best" at what you do. Marketing campaigns that promote you as being the funniest, hippest, or best looking have no place beyond getting some initial interest. Successful clinics focus on outcomes for their patients and strive to earn new patients primarily by word-of-mouth.
4. Think it through: All of this could have been avoided with a few simple "what if" questions were asked 

Below are a number of resources around the ethics of marketing physicians and procedures. In some cases it's a little head-in-the-clouds but remember that cosmetic medicine has really caused headaches for the medical ethics community.

Read more

Continuous Care. (2018, March 15). Ethics of healthcare marketing for physicians and medical practices. Retrieved from https://www.continuouscare.io/blog/healthcare-marketing-ethics-for-physicians-medical-practices/

Cătoiu, I., Geangu, I. P., & Gârdan, D. A. (2013). Applying Marketing Principles in the Field of Medical Services – An Ethical Challenge? Procedia Economics and Finance, 6, 449-456. doi:10.1016/s2212-5671(13)00162-7

Gandolf, S. (2014, July 22). 7 Dangerous Legal Issues to Avoid in Doctor Advertising. Retrieved from https://www.healthcaresuccess.com/blog/doctor-marketing/dangerous-legal-issues.html

Gutierrez, P. L., & Johnson, D. J. (2018). Can Plastic Surgeons Maintain Professionalism within Social Media? AMA Journal of Ethics, 20(4), 379-383. doi:10.1001/journalofethics.2018.20.4.msoc3-1804

The American College of Obstetricians and Gynecologists. (2011, November). Women's Health Care Physicians. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Ethical-Ways-for-Physicians-to-Market-a-Practice

Medical Spa Pricing Strategies To Increase Profitability

Pricing your medical services is a key factor in your clinic's success.

Your pricing strategy helps to determine how patients respond to you, and their feelings about your clinic. It's as likely that you're charging too little as it is that you're charging too much.

There are plenty of different pricing strategies; bundling, discounting, subscriptions...   let's take a look at a few and the research that can help give you a guide for what might work in your situation.

Before we start, let's settle on a point of view and the outcome we're looking for. In general, we're discussing how to maximize gross revenues. There are some strategies that you may employ with other goals in mind; for example you may want to work only 20 hours a week and so your focus may be on maximizing hourly revenue rather than focus on a total. That's an entirely justifiable goal and we'll discuss it and other areas around this in future posts.

For now  let's just begin with maximizing gross revenue.

Pricing High or Pricing Low?

In some cases physicians combine "lowest cost / cheap" with "value".

This is completely wrong.

"Value" is the primary buying criteria for every person and every purchase. The difference is that while cheap or the lowest cost is an external measurement that's easily quantifiable, "value" is completely internal and emotional. Value is personal.

Buyers who purchase high-priced services or pay more do so because they perceive the value from these purchases to be higher than cheaper alternatives. I many cases this is completely without merit but there it is.

So... economy pricing could be a hit and miss for your medical spa. With many reports of botched patients and reviews about horrible side effects and complications, medical spa may want to avoid the "cheapest" label for a number of reasons. The problem with being the lowest price is that there can be only one, and you can get stuck in a race to the bottom with competitors who are also pursuing a "lowest-cost" pricing strategy. And a patient who comes to you for price will leave you for a lower price just as quickly.

So, it may be that premium pricing is a much better option if you're able to execute. 

Break it Down or Bundle it Up?

For this specific strategy, you would need to consider different ways to implement this. Breaking it down refers to x number of treatments for this price per treatment. Example, you can price a  treatment for ___$ a session as opposed to using a “starting from” price implementation.

A bundle pricing strategy could also work for patients who need multiple treatments (e.g. laser hair removal, non-surgical fat contouring) or multiple procedures that could reduce wrinkles but if you break it down, patients could also see how much the treatment is per session as opposed to bundling it up. 

Bundling is a common strategy for treatments that require multiple treatments to see an effect and satisfy a patient.

The answer may be to do both.

Some medical spas utilize a “membership plan” method, wherein a patient is given an option to avail of similar procedures, for this certain price. This is essentially that 'concierge medical model' but it is an uncommon practice in cosmetic medicine, yet it’s something that has serious advantages.

Should it be a 5, 9, or 0?

Pricing with the ‘9s at the end is called Charm or Psychological Pricing. It’s when you dock a cent off from its perceived value. Grocery stores employ this strategy thus many customers, and many are enticed when they see an original price and see the lower priced amount.

However, it doesn’t work all the time. You simply can’t have all treatments priced $_99. 

The answer: price treatments differently.

However, consider the “psychological” aspect of the patient when they browse your price list. Round numbers like 0s work well for people who rely on emotions because seeing the number would make them “feel good”.

One of the most effective pricing implementation strategies online is a discount or "credit" on a first treatment inside a specific time window. Sumo (see below)has done their research on the matter, and found that most customers signed up after learning they could receive store credit, and that the company’s email list grew by 87%. 

Slashing off or Discounting?

The strategy works well definitely for costly treatments. Instead of offering a $4 discount for a $12/unit of Botox, better to have it as such: $150 off a $450 for a treatment of Botox. Thing is, for both examples, the price is just docked 3 times off its original cost. Patients tend to go for the $150 off as a larger perceived value.

For values lower than $100, go for an actual percentage.

You can have a side by side comparison of the old price to the current price by putting a slash on the old price, provided the old price is higher than the current one.

You can implement any of these at a time, but remember not to go overboard with it. Learn which strategy could definitely work for your medical spa, and which would be more cost-effective as well. For your medical spa to get more patients and leads, you may need to switch up your pricing or implement different ones at the same time and which ones receive the most profits.

Further Reading On Pricing

Ciotti, G. (2015, September 09). 10 Pricing Strategies That Can Drastically Improve Sales. Retrieved from https://www.entrepreneur.com/article/250289

Maguire, A. (2017, March 16). 6 Different Pricing Strategies: Which Is Right for Your Business? Retrieved from https://quickbooks.intuit.com/r/pricing-strategy/6-different-pricing-strategies-which-is-right-for-your-business/

Moreno, N. (2018, May 10). 9 Pricing Strategies to Explode Your Revenue (Backed by Psychology). Retrieved from https://sumo.com/stories/marketing-pricing-strategies

Reeves, C. (2016, August 03). 8 Pricing Strategies To Use On Your Product, Service Or Workshop (FS124). Retrieved from https://fizzle.co/sparkline/7-pricing-strategies

Von Wilpert, C. (2018, July 04). Ecommerce Store Credit Strategy (Hint: 87% Email List Growth). Retrieved from https://sumo.com/stories/ecommerce-store-credit

Learn from The Past - Prevent Embezzlement in Your Medical Spa

Embezzlement and theft news for medical practices often happen, so why is it rampant?

Whether or not your practice has been affected by a previous embezzlement or theft case, you need to be wary about the security of your finances and data.

These are some simple measures you can prevent embezzlement in your medical spa. To learn more about other cases of embezzlement and not become a victim of it, you can sign up for this free course in our Training Academy.

How to Get More Positive Reviews

Receiving one negative review can affect your medical spa marketing and sales?

Some clinicians believe that a couple of negative reviews are common and to counter that, you just need to receive more positive reviews. That’s easier said than done...

Some stats:

According to Vendasta, you get an 18% bump in sales when there are reviews that customers see. 

Based on Robert Cialdini’s research 77.3%, people are inclined to follow through with a favor when you ask them for help. Influencing your patients to leave a review will make a difference, so you should be making it a point to ask for reviews from your patients.

In an infographic by Website Builder, 84% patients submit online reviews to rate physicians. Review Trackers, on the other hand, find that most patients would leave a review after a negative review, and only 24.8% of patients will leave a positive review.

Here are the do’s and don’ts in getting more positive reviews.

Do Not: Disregard Any Review You Receive

You will need to find where most of your patients post about you, and start from there. 

Regardless if it’s positive or negative, you need to know where you receive them. As for responding, a simple thank you would suffice. Don’t get too carried away, choose your replies. Reply only to around 25-60% of reviews that are 3 stars and up.

However, if a negative review surfaces, it’s better to contact them directly offline than engage with the patient any further.

Do: Claim Your Listings

As such, wherever you have a listing, claim it. 

Facebook, Yelp, and Google are the best platforms to have reviews for business in general, and in Website Builders, ZocDoc, RateMD, and Healthgrades are the top 3 review sites for physicians. So you can have at least SIX different websites to have a listing on. Up to you then, which would be strategic on your part.

Do Not: Depend on One Review Page

If you want patients to come to your medical spa, then you will need visibility. Google is definitely your best bet to be noticed, although it would take a while, with some traction from other sites, you are on your way to acquiring new patients. 

You may need to consider Google Reviews as your primary channel for reviews. Through Google My Business, you can control the reviews that you receive from your patients. You would easily be found via Google provided you have complete information (i.e. website, schedule, contact details, and reviews).

Do: Add a Testimonials Page on your Website

Another channel where you can post reviews is on your website. These could be in a form of testimonials or reviews from other sites. Many physicians apply this strategy, and it is effective because it could also help arouse more interest in you and your medical spa. Adding a testimonials page would also add value to your website.

Do Not: Resort to Posting Fake Reviews

Posting fake reviews are definitely a no-no. You can detect fake reviews if there is no pro and con, if it uses uncommon terms, and if multiple reviews come in a short amount of time. Don’t be afraid to ask from reviews from your patients, even if they are family or friends.

Do: Automate Your Reputation Management

There are many reputation management software in the market, and if your medical spa does not have one yet, you may be missing out. Many businesses have seen an influx of reviews ever since installing a software. Not only that, you could control the reviews you receive and prompt the patient to write a review 

Medical Spa MD’s partner in Reputation Management -- Podium -- is in and has helped businesses receive more reviews. Your medical spa can benefit greatly by saving $1257 when you are a member of Medical Spa MD.

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Supporting research and reading:

Bassig, M. (2017, August 04). Patients More Likely to Review Their Doctors After a Negative Experience. Retrieved from https://www.reviewtrackers.com/patient-reviews-doctors/

Bassig, M. (2018, April 04). Did You Know? 67 Percent of All Yelp Reviews are 4 or 5-Star Reviews. Retrieved from https://www.reviewtrackers.com/know-67-percent-yelp-reviews-4-5-star-reviews/

Bloem, C. (2017, July 31). 84 Percent of People Trust Online Reviews As Much As Friends. Here's How to Manage What They See. Retrieved from https://www.inc.com/craig-bloem/84-percent-of-people-trust-online-reviews-as-much-.html

Bonelli, S. (2017, February 08). 70% of consumers will leave a review for a business when asked. Retrieved from https://searchengineland.com/70-consumers-will-leave-review-business-asked-262802

BrightLocal. (n.d.). Local Consumer Review Survey | The Impact Of Online Reviews. Retrieved from https://www.brightlocal.com/learn/local-consumer-review-survey/

Christopher, E. (2017, June 14). 5 Proven Ways to Get More Customer Reviews On Google and Facebook. Retrieved from https://www.entrepreneur.com/article/295655

DashBurst (2017, November 02). Why Positive Reviews are So Valuable to Small Businesses. Retrieved from https://smallbiztrends.com/2017/04/importance-of-online-reviews.html

Shrestha, K. (2018, February 06). 50 Important Online Reviews Stats You Need to Know [infographic]. Retrieved from https://www.vendasta.com/blog/50-stats-you-need-to-know-about-online-reviews

Walker-Ford, M. (2018, May 06). How to Make a Website that Influences People: 9 Web Design Psychology Tips [Infographic]. Retrieved from https://www.socialmediatoday.com/news/how-to-make-a-website-that-influences-people-9-web-design-psychology-tips/522884/

Websitebuilder (n.d.). [User Reviews is The King: Why Online Reviews Can Either Make Or Break Your Business] [Infographic]. Retrieved from: https://smallbiztrends.com/wp-content/uploads/2017/04/58ba1a5ea43c71e16d55cd7f.full_.jpg

Dr. Joel Kopelman - Kopelman Aesthetic Surgery, NY & NJ

Name: Joel E. Kopelman, M.D. FACS
Locations: Park Avenue, NYC & Ridgewood, NJ
Website: https://www.drkopelman.com

Brief Bio:  
I trained in oculoplastic and facial plastic surgery at UCLA in 1983. I subsequently did another fellowship in orbital surgery at Moorfields Eye Hospital, London, England. I have been the director of multiple professional courses on blepharoplasty, endoscopic brow lifting, facelifting, laser resurfacing, and rhinoplasty across the United States. My current laboratory research is on how aging affects the eyelids.   

Can you give us a background of your career in cosmetic medicine?

The training that influenced my entire career really began at U.C.L.A. thirty-plus years ago. Under my fellowship director we performed primary and secondary cosmetic and reconstructive eyelid and eyebrow surgery. Our particular focus was fixing complications from overdone cosmetic eyelid surgery and forehead/brow lifts. Subsequently, my practice evolved into primarily a cosmetic practice. I began to incorporate facelifting techniques, chemical peels ,laser resurfacing techniques, and body contouring into my practice. I never stop learning.I bring new surgical and non-surgical techniques that offer safety and lasting benefits to my patients. I don’t jump on every new product or technique because I have learned from experience that there are fads that are not safe and have precipitated problems. Like everything else in life, experience counts.

What can you tell us about your NY and NJ practices?

I currently practice on Park Avenue in Manhattan in an office I share with three cosmetic dermatologists. I also have a second clinic in Northern N.J. where I have a certified surgical facility. I have four employees who include R.N.s, surgical techs who assist me in surgery as well as a board certified anesthesiologist. My New Jersey and New York practices are similar and consist of primarily women between the ages of thirty to sixty-five and men in their thirties to fifties.  

How do you manage your staff?

I highly value my employees and generally compensate them commensurate with their training and experience. Each employee is intensely vetted prior to hiring them so I don’t usually fire anyone unless they have been dishonest or rude to the patients.

What devices do you regularly use?

I currently use IPL for diffuse skin pigmentation, acne and telangiectasia. I have erbium/YAG, pulsed CO2, and erbium-glass lasers that I use for skin resurfacing. I usually prefer my erbium lasers because there is a very rapid recovery time. I also use a non-invasive ultrasonic body contouring device called UltraShape Power. I like this device because it causes little discomfort compared to CoolSculpt.

What marketing strategies do you employ?

Word of mouth, internal marketing ”awareness”, website and Instagram. The marketing that traditionally has worked is “word of mouth” recommendations. In the past few years internet ratings and ranking has increased traffic but I have found that these patients do not always have realistic expectations.

Which treatments do you consider the most popular in your practices?

Facelifts, blepharoplasties, endoscopic brow lifts. I plan on performing more PRP for hair rejuvenation. I no longer perform rhinoplasty.

In your many years of experience, what have you learned so far?

I tell my staff “If a patient is happy when they come to see me they will be happy when they leave but if they are unhappy when they come to see me they will be unhappy when they leave”- there is nothing that I can do to change their view of the world. 

Lastly, what can you impart to fellow physicians in the field?

Do great work, be passionate, show that you care. Patients will recognize, value and trust your service, see you as their medical guardian, and appreciate you as an outstanding physician and surgeon. You don’t have to wave a flag - your actions will speak louder than words.

Online Presence Matters - Learn How to Make It So for Your Medical Spa

It is necessary to be known by your patients. Some of them research providers before choosing one (Kyruus, 2017).

Going digital is not just about having your own website and updating your social media accounts as often as you would like. You will need to build up your online presence, as because apparently, that is an important factor for many patients when searching for a physician. According to Doctor.com, 63% of patients choose a physician because of their online presence. 

Your medical spa may need to step up on building a digital presence if you may need to acquire more patients.

Website

Your website should be your main source of information about yourself, your medical spa, and all your other procedures. Social media on the other hand acts a supplementary resource, linking you back to your website, and vice versa, your social media accounts should also be in your website.

Keywords could help you be found by potential patients. Your city and a popular procedure are some examples of using keywords for your websites. You could use Botox in New York City. That’s a bit generic, and many plastic surgery and dermatology practices could be using the keyword phrase. You can add in units, before and after, and a certain treatment.

Review Sites

Many experts emphasize the importance of claiming your listing in review sites. Those experts make a good point in doing so, as this helps Google identify you better, and in turn it will appear on Google’s search pages (it could take a while, so you will need to be patient for it). Still, if you are planning to focus on a stronger online presence, review sites are one of your good options.

Social Media

Social media is one of your best tools to build up your online presence. Many of your patients could find you on social media, and could follow your medical spa or your own Twitter. So long as you abide by privacy information regulations, you’re all set. To be noticed more by patients, you will have to update more on all your social media accounts. For example, you can post about what’s new in your medical spa or an event you’re hosting. Follow the Pareto Principle, 80% marketing, 20% about yourself or your medical spa.

Doctor.com. (n.d.). Customer experience trends in healthcare 2018 (Rep.). Retrieved https://www.doctor.com/cxtrends2018

Kyruus. (n.d.). 2017 Patient Access Journey Report (Rep.). Retrieved https://www.kyruus.com/hubfs/Whitepapers/Kyruus_2017_Patient_Access_Journey_Report.pdf?t=1527110475505

Only Work On What Brings Value To Your Customer & Your Medical Practice

If you're working on solutions without a very clear definition of the problem you're trying to solve, you're doing it wrong.

Is the solution you're working on solving a real problem? Is the problem based on your existing patients needs? If you're successful with the project you're working on, would it change anything for your patients? And in turn, would it change anything for your clinic? These are the fundamental questions you need to answer to make sure that you're investing your time and effort working on worthwhile opportunities.

If you put yourself in a position where your clinic is running on autopilot and give yourself a chance to get off of the constant production treadmill you'll have a chance to work ON your business, not just IN your business.

Process is critical here.

My guess is that you don't have any real way to prioritize what you're working on at any one time. If you're like the vast majority of clinics who are physician-owned, you're not running a business as much as you are running a communal job, where nothing's addressed until there is enough pain that you have to actually do something.

• We don't have enough patients; so I need to try and figure out how to get some. I guess I'll call that local ___ rep who was in here last week promising that she could help grow my practice. Maybe my nephew can help me out with some Facebook ads.
• We're getting a lot of returns and some negative reviews online; Oh well, what can you do. Some people will always be unhappy. Nothing really you can do about that. (If this is you, get your ass a Podium account now.)
• I know that we're over-promising on what the results are with this old IPL that I've had forever but it's still working and it's not worth much so I can't afford to upgrade. (Get a certified quote on your used laser or IPL)

I could go on forever.

Features and solutions are easy to imagine and talk about with other people, and coming up with a 'solution' is rewarding, it makes us feel like we're making progress and are figuring things out.

This is not the way that successful clinics operate.

Successful clinics have systems, and one of those systems is some kind of process to prioritize what to work on, and it's not the low hanging fruit.

It's the hard things that will kill you.

No one cares if you add a Facebook widget to you website so that patients can join up and be ignored in your I-don't-have-time-to-do-it Facebook group.

But if your staff is fighting over commissions your patients will see that and you'll have less word-of-mouth.

Who gives a shit if your using a credit card processor that charges you 5% more than someone else.

But if your consultations aren't perfect you're cutting your own throat.

You need to be working on the hard things; building systems into your business, an obsessive focus on patient satisfaction, a team that is all working in unison, and a real business.

It's the hard things that you have to get right- the foundations of your business- not the bullshit on the surface.

Here's a simple process to identify and prioritize what you should be working on. (Note: I use this but I stole it from Amazon.

Prioritizing What To Work On

Here's a simple method to ensure that you're working on problems that can actually affect your business.

Note: This is a physical process, not a thought exercise. I suggest that you use post-it notes and do this first with yourself, but then with your team. (If you're doing it with your team DO NOT hog the meeting and deliver the answer. Let your team help you with all of it.)

1. Write down the BIG problems that are facing your clinic. These are the problems that, if they're not fixed immediately, can put you out of business. 
2. Prioritize those problems according to risk, with the biggest problem at the top and the least risky one at the bottom.
3. Pick the problem right at the top. The one that poses the biggest risk to your clinic.
4. Break it apart into smaller constituent parts. For example; "We don't make enough revenue to cover our costs" can be broken down into, "We don't make enough revenue" and "our cost's are too high".
5. Keep breaking it down into smaller segments.
6. Pick a segment or a challenge. 
7. Use this technique of the 5 Why's to uncover the root cause.
8. Use these root causes to build a plan of action that you can be sure are contributing to drive value and work on your most pressing problems.

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How To Add Texting To Your Clinic And 6X Your New Patient Inquiries?

Allowing patients to use text messaging makes them 6 times as likely to reach out and communicate with you.

6X in anything is a MASSIVE increase, but especially in inbound contacts there's simply nothing else that comes even close to that.

Nobody likes to call.

Asking new patient-prospects to call your front desk is a lot to ask. It's an investment of time, it's slow, you have to call during office hours, and you know that there's social pressure that's going to be applied by the person on the other end. It's a big hurdle and has always cost you those patients who you might have had if only it had been a little less difficult.

You're missing those inquiries, patients and those sales.

But texting is easy.

Sending a text is a much lower 'ask', and that's just what you want as a business; a very easy first step. It's asynchronous so you don't have to worry about office hours or connecting, and there's much less social pressure than talking to someone on the phone.

Best of all, your front desk staff can probably handle 5 times the traffic in texting communications than in phone calls.

Here are the numbers*: (reference)

• New patients are 6 times more likely to text you than call. 
• Texting is 10X quicker than phone calls
• 81% of Americans text regularly
• 85% of people want to be able to not only receive a message from a business but also answer a message from a business.
• 98% of consumers want to use texting when communicating with a business
• 95% of texts will be read within 3 minutes of being sent
• People prefer text for most scheduling, changing appointments, or confirming reservations
• Response rates from text are 209% higher than phone calls and 200% higher than email

If you can read those stats as a clinic owner and think that you don't need a two-way texting capability to communicate with your patients and field new inquires...  well, I don't really know what I could say that could help you or your business. Please stop reading.

The simple truth is that you need to find a solution using text messages because it's the preferred method of communication for your existing patients, and it's more productive than what you're doing now.

How much time is actually wasted every week on the phone? Here are my guesstimates:

---

Common Tasks

Calling to confirm appointment

Call patients to fill a cancelation

Staff time wasted: calling, on hold,
calling back, waiting....

Phone

2-5 minutes

5-30 minutes

50-60%?

Text

40 seconds

2 minutes

0  

---

Texting is clearly a more productive and efficient system and your patients respond better to it. The only question for you is what to do about it.

How do I add texting to my clinic?

Before getting started there are a few things we suggest doing to ensure that you are successful. The first is setting up your Google My Business listing to accept text messages from mobile searchers. Check out this post for instructions on how to set up Google Click-to-Message for your business.

Next, you’ll want to find a solution that can enable your landline to accept text messages. This will help you maintain continuity and consistency with your contact information, which is an important factor in where your business ranks in local search.

Once your landline is set up to accept text messages, you’ll want to publish that number wherever your contact information is displayed with instructions to “call or text us.” Some places to include it are on your website, on all of your business directory listings, and even in your email signature.

Finally, you’ll want to implement a customer interaction platform to help you manage all of your text message conversations.

More help on that a little later.

Best practices: What would I use text messaging for?

I understand your reluctance to start texting your patients and prospects. Its new and you don’t really know where to start or how to do it. but let's identify a few moments during your patient journey where it makes perfect sense to be using text messaging.

1. SET APPOINTMENTS AND SEND APPOINTMENT REMINDERS One of the biggest frustrations is when patients no-show, but you can eliminate a large number of no-shows by texting out appointment reminders and setting appointments with your customers. It's much less intrusive and time-consuming than having your staff call out and remind customers about upcoming appointments.

There are automated systems that you pay for that do this automatically, but that's all they do. You want a a system that does this and the other things on the list too.

2. BE A RESOURCE TO SOLVE PROBLEMS Not all of the questions your customers have will warrant a phone call. Some are simple and can often be answered with a very short text. Because texting is more visual than a phone call, it allows your patients to use testing in ways that phone calls just don't handle well, like sending a photo. This can eliminate a lot of confusion that might arise if they were to try and describe the problem verbally.

3. LOOK FOR OPPORTUNITIES TO UPSELL Having a texting relationship with your customers will also give you the opportunity to upsell them from time-to-time. This will provide your business with incremental increases in revenue that will not only improve customer satisfaction but also boost your bottom line.

4. ASK FOR FEEDBACK A number of our customers have started to replace traditional customer satisfaction surveys with a text message-based survey. These customers see a higher open and response rate because text messaging is more conversational and less intrusive than a survey. A simple "let us know if we can help in any way" as a text is another touch point of care that patients appreciate and cost's you nothing.

5. CLOSE BUSINESS This might sound crazy to you, but it’s not uncommon for people to make a sale in a text message conversation – even for big-ticket purchases. Just send a special offer to your best clients, or followup on a consultation in a non-intrusive way.

7. COLLECT REVIEWS Finally, you should invite all of your customers to review your business via text message. Building up your online reputation is important because it makes it easy for consumers to find your business via online searches, while also helping to influence purchase decisions.

8. LET PATIENTS TEXT YOU AS A FIRST CONTACT This is a big one... make it easier for patients to take the first step towards your clinic by allowing them to text you as a first contact.

What does all of this?

We started looking at providing a solution for our Members that solves these problems. The company that we chose to partner with is a best-in-class software solution called Podium. 

We contacted them and they agreed to partner with us and put together a special offer for Members. You can see that offer here: https://medicalspamd.com/podium

Here's a little info about how it works to make it easier for prospects to connect with you, to communicate and interact with them, and to get them to help you grow you reputation and business.

Here's a video showing how new patients can use Podium to text you directly from your own website or from other pages like your Google business page. Now, instead of just being able to call, they can now text, connecting them to your front desk and allowing your staff to respond right from their computer.

1. User finds you on the web, often on a mobile device or smart phone.
2. They text you.
3. You text them back.

It's asynchronous so it doesn't impact calls and no one has to wait, you can send images if you want (like a price list or before and after photos), it's efficient so your teams productivity increases, and it's what your patients want.

And here's a video that shows how Podum's new webchat feature works for brick and mortar businesses like your clinic.

"Podium Messenger makes texting with customers a breeze. 90% of consumers want to use messaging to talk to businesses. With Podium Messenger, stay connected with your customers and answer questions in real-time via text message – all from one centralized dashboard"

So that's really it. This is something that you actually need, that your patients want, and that you're never going to get a better deal on since it's only our Members that get it.

To learn more about how you can take advantage of this Members only deal, just find it - along with other deals and offers - in the Marketplace.

Oh.... and in addition to Members getting better pricing forever for this, you'll also get free training for your entire team online.

Done.

The New Member Forums: Cosmetic Lasers, Legal, Marketing + More

The new Medical Spa MD Member Forums are now open.

The old forums were becoming difficult to navigate to the information you might have been looking for. We've simplified them and put them entirely in their own section.

Now, there's one link in the main header above that says "Member Forums" instead of a drop down. That link takes you over to the forums and we've simplified the navigation there as well, removing all of the links above and replacing them with the various categories; clinical exchange, legal, marketing, and cosmetic lasers, IPL, and RF technologies.

There are something like 30,000+ comments. This should make it much easier to use the forums again to find answers and express opinions that both you and others can learn from.

As always:

• You must be a Member to post a new comment or ask a question
• You can identify yourself or remain anonymous
• We regularly (daily) sweep the forums for spam and remove junk links and threads

The forums are an incredibly resource if you use them correctly. For example; ask very specific questions, not general "what should I do" fluff that no one could possibly answer. There are some threads that have more than 400 responses, and others that clinics use to deep-dive into very specific questions.

Take a look and ask your most pressing question. There are thousands of readers and members who just may have the answer to your question.

Take a second and ask the experts.