← Med Spa Success Strategies
Med Spa Success Strategies
Why Med Spas Lose Their Best Providers (And How to Stop It!) - Interview w/ Mary Beth Hagen
01:00:31
Loading summary
Transcript67 lines
- [00:02]
Ricky Shockley
Hi everyone. I'm your host, Ricky shockley, owner of MedSpa Magic Marketing. And welcome to the Med Spa Success strategies podcast where MedSpa and aesthetics practice owners come to discover strategies and tactics that help them better market and manage their practices so they can grow, improve profitability and have greater impact for their teams and their patients. This is a full circle episode. I'm super excited to be joined by Mary Beth Hagan. Mary Beth was the first ever guest on our podcast couple years back and it's very timely that we have her back. I think this this topic today is a major area of need for many practices, so we're excited to dig into it. But Mary Beth founded Titan Aesthetic to support great injectors and great practices providing great patient outcomes. Working in aesthetics since 2005, Marybeth developed a strong knowledge base within the specialty while working at both Medicis Now Galderma and Allergan. As the Botox cosmetic product manager, she supported the launch of the Crow's Feet lines indication and created marketing programs like Boto for Friends bff. She also worked closely with the FDA to protect the supply chain from importers and to protect providers that do business with strong ethics. As the National Account Directory, she worked with corporately directed organizations in aesthetics and understands the clinical and business side of aesthetic injectables. Top injectors combine art and medicine to provide the best patient outcomes. So Mary Beth developed the Titan Aesthetic Screening Protocol to to identify potential injectors with innate aesthetic aptitudes and strong communication skills. Patient safety and natural results should always be at top of mind for aesthetic providers. And Mary Beth hopes that bringing new injectors into the market with the right foundational training and good peer education can help support great patient outcomes for years to come. I think this topic that we're going to be covering today is a massive area of emphasis for so many practices. We know that that provider retention is critical to the success of your med spa, and today we're going to talk about how to retain, recruit and develop quality talent for your med spa. Marybeth, we're so excited to have you back. I think this episode is long overdue. For those of you who don't know, Mary Beth was our first guest on the podcast, so this is full circle for us. I know this is a topic of need for so many people that I talk to in the space, and today we're going to be diving into team retention. Really? Like, how do we. How do we make sure that what we're doing is setting us up for Long term success with maintaining teams that are healthy, a good culture, people that want to be here. So with that said, we're going to jump right in here to some questions. Mary Beth, one of the things that you talked about leading up to our interview was that this is a time of year where a lot of people are facing attrition. Why is that kind of, just to start off, why does this seem to be the time of year when people are facing attrition issues?
- [02:45]
Mary Beth Hagan
Great question, Ricky. You know, when we're looking at early in the year, really three things happen. Number one, all of a sudden, everybody who had come in for treatments, how busy everything was in October, November, December, it kind of falls off a cliff. And so practices who work in aesthetic medicine all of a sudden are feeling like, oh, my gosh, nobody's coming in, we're not busy. Then they start looking at, okay, I've got to get my taxes ready. And they start looking at their P and E, I mean, their P and L. And they start looking at how much money did I spend versus how much money did. And I think a lot of people would be really, really shocked to know how tiny the margins are in aesthetic medicine. The third thing is, is that people a lot of times over the holidays, that's time when they stop and they think and they kind of reassess, what do I want with my career? What do I want with my life? Where do I want to be five years, ten years from now? And so you have a lot of providers or a lot of staff members making personal decisions to seek different goals. So those three reasons, I think, really kind of lead to kind of this perfect storm of attrition in Q1 every year.
- [03:49]
Ricky Shockley
Yeah, makes sense. So. So with that said, whether you're starting a med spa or you're in this situation where you're dealing with attrition issues, and we're going to go deep on a lot of that, how to prevent that. One of the things we wanted to add up front was just when we're talking about how do we find people? If you're listening to this episode, you need a new injector. You need, you need to fill some spots on the team. What does that process generally look like? What do you recommend?
- [04:10]
Mary Beth Hagan
First of all, as anybody who's done this knows, it is not easy. And that's why I giggle a little bit when we have what I call med spa entrepreneurs who will call me and say, oh, I see this med spa space is growing and it's really great. And, you know, I'VE got everything done. I've got my space and I've got my marketing. I've got my everything decorated. Now I'm going to open in like six weeks, and I just need you to find me an injector who's been practicing for like five years and is going to bring their book of business to my practice. I'm like, no, that's not what I do. And we have to understand a couple things. First of all, if you are a provider to looking to transition into aesthetic medicine, or if you are a business owner or a practice owner and you want to find new staff, the number one thing everybody has to remember is this is a medical specialty. This is not easy. This is not something you can learn overnight. You're basically asking providers to stick the most potent toxin in the world into people's face. And they're doing it because they're paying cash and it's an elective procedure. And almost everybody from a patient standpoint who comes to an aesthetic practice needs education. People know the marketing. You guys do a good job with helping people understand the words and the phrases. But there's a whole difference in terms of how does it apply specifically to me as a patient. So when you are looking to transition into the specialty or whether you're looking to hire someone in, there are three things that you're going to need to look for. Number one, does this person have the right innate aptitudes to do aesthetic medicine? This is the hardest part of medicine because there's no right, there's no wrong. Everybody has a different idea about what they want to look like. And so you have to really be able to listen to the patient and be able to do a variety of treatments to help meet their needs. Number two, everything changes in aesthetic medicine very, very, very often. So you need to have somebody who is willing to be a self directed learner, who is willing to consistently learn, and who is willing to put their own money into training in conjunction with resources from the practice themselves. The third thing that I think makes this very important is this is really a medical specialty that blends art and science. So you have to be a great provider. You have to be able to get the product in the exact right muscle and the exact right plane of the skin. But you also have to be able to talk to the patient about what their goals and expectations are. So you're really saying, okay, I want to be a good provider, but I also need to be an artist to help match the vision that I have with the vision the patient has. So that the end result meets patient expectations. So it's very hard to transition into finally because it's cash medicine. And what I tell a lot of people is if you want to transition into aesthetic medicine, you need to make sure you save up about six months worth of living expenses. Because in aesthetic medicine everything is cash. And if you're not bringing any revenue with treating patients and doing procedures, then there's no money to pay you. So that's what I want, you know, people to really understand is that if you're looking to transition into this specialty as an RN and NP or a pa, you really are going to have to put the work in first to create a strong foundation of knowledge both clinically and in terms of how to understand what happens. I'm always kind of surprised when people say, oh my gosh, it's my dream. I just love everything about beauty. And I'm like, tell me about your experience as an aesthetic patient. Oh, well, I'm too young, I don't need treated yet. I just want to do this. And I think a lot of people think that they're going to get a job in aesthetic medicine and they're just going to stand in a room and inject Botox all day long or they're going to get a job in aesthetic medicine and they're just going to get all kinds of free product and take selfies and become insta famous. And neither one of those are the job. So that's what I would say you really want to think about. Do you have the right aptitudes, do you have the right self motivation and are you willing to take the time to develop a patient base and to develop your skills so that you can bring relevant skills to a practice. That's why we do the titan aesthetic screening process to kind of help look at some of those things before practices, hire an injector or, or even hire somebody for the front desk or a marketing manager or something like that. Because you have to make sure that the person you're hiring is going to meet your needs as an employer. But the employer also needs to make sure that they can provide the environment and meet the needs of the person they're hiring so that they really can grow, develop and be happy staying with that practice for a long time.
- [08:50]
Ricky Shockley
So the first thing. No, that's great. So the first thing as a practice owner, like you're going to need a screening system in place so that you know the people are checking certain boxes, right? You need, you need to figure out how to screen people properly so that's where like, like what you said. And we'll make sure that's in the show. Note links for anybody that's interested also. But so you need some sort of screening process is kind of step one in terms of job posting boards, is there, are there certain places you recommend posting the job as you're looking for applicants?
- [09:19]
Mary Beth Hagan
I'm going to be quite honest, there are. It depends on what it is you're looking for. If you are someone who is saying I am only going to hire somebody who has experience, you can start on indeed, you can start by asking your reps. You can start by posting something like on job Snobs job board. You can start by just reaching out, going to other events and looking for an experience injector. I will tell you that is going to be the hardest way to fill your open spot because I found two things. Number one, great experience injectors have a list 10 practices long of people that want them to come work for them if they ever should decide to leave where they are. But more importantly, so many injectors are finding out that they can just start their own practice. And I know a lot of the practice owners are nodding their head right now going, yep, I lost a provider because they left and started their own practice. So you have to think, if you're looking for someone, be willing to think about finding that person who is the right cultural fit for your practice and for your team. Someone who has those right aptitudes and characteristics that would make them a good provider and someone who has the self initiative and drive to train and to come in as a new hire. And my experience in the last eight years having Titan aesthetic is that if you're looking to bring in a new provider, you are going to have significantly better retention if you hire and train the right person for your culture and your practice rather than trying to hire someone to come into your practice. Because if you hire that experienced person, unless they're moving across the country and they're, you know, kind of just changing their life and looking for a new place to practice, a lot of times they're bringing their brand to your practice and they want to build their brand in your practice. And then you know what, if they're willing to leave somebody else to come work for you, there's always the chance they're willing to leave you to go work for someone else. So I do a lot of work trying to create win win scenarios so that the providers who work for practice know I'm getting an opportunity to go work here. At a practice that's willing to hire a developing injector. But because they're giving me that chance, I'm giving you my guarantee or my word that I'm going to stay here for at least two to five years. Now, I want people to stay for longer than that. And that's a lot of what we do with our performance planning and our development coaching, because too many people don't check in with their injectors and they don't have those conversations. And that really, that communication strength, that's what helps retain patients and retain providers within a practice for the long term.
- [11:59]
Ricky Shockley
Yeah, that's so critical. We always talk about you and I talked about in our preliminary conversation before this. So many people are thinking that these other things like marketing or advertising are going to solve their problems. And this is, I, I think this might be the biggest problem that practice owners face. And if you can't get this thing right, nothing else you do really matters.
- [12:18]
Mary Beth Hagan
Yeah.
- [12:19]
Ricky Shockley
Like, because this, this lends itself to patient retention, to good reviews. Like all the things you need to build a successful med spa, like, they're really dependent on your people. So you mentioned it's really hard to hire somebody that already has a book of business that's established and that's maybe a misnomer. People think that they're just going to go hire the person that's been doing this for five years. I guess two questions on that. You said your preferred method would be to build the person. Right. Get somebody that's kind of on the ground floor. How do you get that person work serving patients so that you're able to monetize their services early if they don't have the experience and you have to build them from kind of from zero.
- [12:54]
Mary Beth Hagan
Yeah. Well, and that's such a good question, Ricky, because you think about it, if you hire somebody for your marketing agency, you know, you've got somebody that's been hot shot someplace else and then you bring them in. Well, I know how to do this. This is what I did before. Here's what I'm going to do. And they. There always is kind of that it's wonderful to have the experienced person. But if they don't blend in with your culture, then it sometimes can be a tough integration. But if you hire somebody and say, here's what we want you to do, here's the development plan we have for you. We're going to start out here and you're going to start copywriting, then we're going to have you work here and we're going to have you be, you know, a junior associate to be able to work with this client and you work your way up. And it's the exact same thing within aesthetic medicine, right? You want to find somebody that has the right aptitudes, that is willing to put the work in, that is willing to take a little bit less. I mean, that's the hard thing is that a lot of people who come from other areas of medicine make a lot of money in the hospital or they, you know, have. It's interesting because they want to make the same money they made in the hospital, but then they want the more convenient schedule that they have in aesthetic medicine. They think, without thinking about the fact that if you're not working and bringing in revenue, there's no revenue to pay you. You're probably going to be on call because you end up giving your phone number to a lot of patients to be able to say, call me if anything goes wrong. There's a lot to be said there with all that. So what we really want people to do is think about what are the needs of your practice. I'm very fond, when I do my coaching and my consulting of asking people to sit down and say, what are your goals? What do you already have to achieve your goals? And then what are your gaps? And then focus on filling those gaps. So many people focus on what they already have and it becomes a to do list. And then they never achieve the goals because they're never filling the gaps. So, like, when you're trying to hire somebody and you want to develop them, it's the same thing. You have to have them say, okay, what are your goals as a provider working here in the practice? And then you have to be very clear with them. Okay, my goals for you are that the first six months you're here, you're going to spend three months training, shadowing, and basically acting as an ma. The next three months, we're going to start you on simple procedures. Maybe we're going to do some very foundational laser device procedures. We're going to start doing some neurotoxin injections. We're going to start doing some things where you can be possibly even assisting with one of the more experienced providers. And then you move your way up as your skills are going and you can add to the schedule and you can fill the schedule. So by six to eight months to a year into it now, they really have the opportunity to be able to say, I feel good about my skills. I've really developed a patient base. Hopefully the People that they've seen have referred that provider to other people. So they have filled the books with friends of theirs. And that's the other reason why I also encourage employers to, say, create a sliding pay scale for that developmental year. Because those first three months when they're training, you know, pay them like an MA if that's what they're doing. For the first three months, they're really getting paid to learn on the job, but they're learning your culture, they're learning your systems, your protocols, they're learning your customer service expectations. So it's a very, very important three months. Those next three months when they're really starting to do procedures. It's even more importantly, because now you're seeing, are they encouraging? Do they have the processes in place when they walk the patient up to the desk? It was so great to have you with us today. I loved being able to be your provider, and I hope that we maybe can see each other again in about three to four months. We talked about you coming back for another neurotoxin treatment in October. Then we also talked about the possibility of maybe looking at doing some laser skin resurfacing so that you can take care of some of those areas that you express concern about. I really think we can build a really strong relationship with helping you meet your needs with the good communication we started. So I'm going to go ahead. I'm going to leave you here with Joan here at the front desk, and she'll get you set up for another three to four months. And, oh, by the way, we also have a great loyalty program that I'm excited to have you look at so that when you come back, you're not just coming to see me and let me know what's going on with your life, but, you know, get a little bit something for you as well. Can't wait to see you again. Take care, you know, and those are the experiences that they need to be learning and developing in those second three months, then the next six months, it really is, am I good at what I do? Do I have confidence what I do? Am I doing ongoing training? And that's what really needs to become a partnership between the injector. You've got to reach out and you've got to find your tribe, your community, and other injectors in your market, whether you're following them on Instagram, whether you're going to meetings with any of the vendors or manufacturers. Every single time you're there, go introduce yourself to everybody and say, what was it like? For you, from the first six months to a year, what do you remember? What do you wish you had known? It's really great to learn from the people who are doing the same thing you aspire to do, because they're going to tell you everything went well and everything that didn't go so well either. Right.
- [17:57]
Ricky Shockley
Yeah.
- [17:57]
Mary Beth Hagan
We all learn from mistakes.
- [17:59]
Ricky Shockley
So. So it sounds like that gold standard is be thinking ahead to build your bench. Right. Like you. You want to develop people, be building the bench so that six months, a year from now, you're developing talent and people that can step into those roles. What about, though, the practice that maybe is smaller? They have one injector, two injectors, and one of those injectors. January comes, they decide, I'm putting in my two weeks, and now you have to fill that gap immediately. Is. Is there a version of getting somebody that's maybe less experienced, just kind of on the job and doing the injections and things early on? Or in that case, do you have to go to hiring an experienced injector? And if so, those practices that are like, I gotta find somebody that can come in right away and be able to do the job. Is there a path there? And what do you recommend they do as maybe a next step? Because I feel like I've talked to a lot of people that are in that situation specifically.
- [18:49]
Mary Beth Hagan
Well, and they're usually in that situation because they haven't developed an ongoing relationship with their providers and they don't know what the provider's thinking. So we'll talk about that in a minute. But when you're in that situation and you need somebody, like today, I. I'm going to be quite honest, Ricky, you have a better chance of finding someone who has the right aptitudes and the right cultural fit and training them, Then you have a finding and experience injector right away.
- [19:18]
Ricky Shockley
Good to know. Yeah. You need to find someone that's got.
- [19:20]
Mary Beth Hagan
Yeah. You have to always be recruiting. You can't ever say, I have a great injector. I don't need anybody else. You can.
- [19:28]
Ricky Shockley
Hey there. Wanted to briefly interrupt the episode to make a quick ask. If you're a podcast listener, it would mean the world to us if you leave a review for the podcast, whether that's on itunes or Spotify. It's something I hadn't really remembered or thought of asking for, but it does help us show up more frequently so that we can reach more people with the information that we're providing. So it mean the world to us. If you leave a Review on itunes or Spotify if you're listening on audio. If you're watching on YouTube, make sure to hit the subscribe button. So you're in the loop for future videos and you don't miss any of the content that we're putting out. So this kind of goes to like being growth minded I think is probably important if that's the case because as, as you're growing, you have more margin and you can get a step ahead with recruitment and talent. If you're kind of in survival mode and you're always super small, there's a lot of risk there. Like if you're, if you're a practice with one injector and the injector is not the owner. Right. The owner is somebody who's not not the injector. There's a lot of risk there. And it's basically what you're saying is it's really hard to fill that gap fast.
- [20:30]
Mary Beth Hagan
Well, and that's why honestly when I am talking to clients who say I want to come, you know, I've been successful in other businesses and now I really want to open a med spa, I'm like, the best advice I can give you is go back to school and learn to be a provider and then open practice. Because it is your chances of success at this point in the market of being a non provider owner are maybe 10% or less. And everybody thinks, oh, I'm going to go open this chain of med spots and I'm going to find all these providers and I'm going to sell my business and I'm going to make millions. No you're not. Because it just doesn't work that way. So I always encourage people to really think about if this is the right specialty, the right business model for you if you're not a medical provider. You know, it's very interesting that in America we have a lot of corporate practice of medicine laws and I'm not an attorney and don't Play 1 on TV, so please just take this as a observation and not as advice or guidance or anything. But we have a lot of places where we have MSOs or we have different corporations that are, or business people who are trying to come in and think that it's very easy. And most everybody who's been in this specialty for a while will tell you it is not easy if you're not a medical provider. So that's why, yeah, I would really think hard if you're not a medical provider and you want to open a medicine.
- [21:58]
Ricky Shockley
I think that's a phenomenal disclaimer for people listening to this podcast. And I. I will back that from every conversation I've had with. With practice owners who are not the practice owners that we see that are most successful. They're providers.
- [22:11]
Mary Beth Hagan
Absolutely.
- [22:12]
Ricky Shockley
And they're providing services and they're. And they're building with that foundation.
- [22:15]
Mary Beth Hagan
Yeah.
- [22:16]
Ricky Shockley
And it is much harder to do it another way. There's a lot of risk because ultimately people are. I always say people are not loyal to the shell that is the business. In most cases, they're really loyal to the provider. And if you're not a provider at all and you're just coming in as a business person, you're going to have to either, like you said, develop that talent and be really strategic about it, or you're gonna have to get really creative, it sounds like, to get somebody that already knows what they're doing and is willing to make the switch. And I'm assuming a lot of that creativity comes on the financial side. So, like, if you are in the situation. I know I can't keep coming back to this question, but I'm just looking for that solution for the. For the owner that maybe isn't this. Let's say. Let's say you're the MD maybe, and you've got an injector, and that ended up being a lot of your business. The injector leaves, and that's where a lot of your business is. And you do need someone to fill that gap. We talked about getting ahead of it so this doesn't happen again. Ideally, are there creative ways to incentivize a provider to. To switch gears, like. Like profit sharing, ownership, like, it sounds like you're gonna have to really stretch to get that person. So you're gonna have to give up a lot more than just putting the person on payroll.
- [23:23]
Mary Beth Hagan
Yeah.
- [23:23]
Ricky Shockley
So I don't know if that's a good segue into the next part of the conversation, but going into comp structures for new team members or just injectors in general, since they are such a pivotal part of the business. What. What are you usually looking at in terms of compensation structures? I think we talked about that a couple of years ago, but I would love to revisit that conversation just in terms of some guidance.
- [23:42]
Mary Beth Hagan
It's one. I never meant to become an expert in compensation, but the first year that I opened Titan, back in 2017, I think 50% of the questions we got were, how much should I be making as an injector? Or how much should I be paying my Injector. And it was funny because it made me realize that that really is kind of a huge gap of knowledge. And so we started the Titan compensation survey in 2000. The first one was for. In 2018, for the 2017 calendar year. And at that point, what we found was the average injector made about $149,000 a year. And what we realized at the end of that survey was we didn't ask them how much revenue they brought in. And so the second year, when we ran the survey, we found that the average injector brings in just a little bit over $150,000 a year on about $700,000 worth of patient revenue. And what was interesting is we've gone through, and we're getting ready now to do the seventh one. We're going to. Literally, that's what I have to do when I get off the call with you is finalize the survey for this year. We've had a lot of questions. We've added a lot of market dynamics, and what we know now, as of last year, in the 2023 calendar year, the average injector made just under $200,000 a year, about 199,000 DOL, $1.2 million in patient revenue. And so when you start looking at compensation, I think a lot of people think, ooh, this is a really lucrative field as an injector. But you have to remember that those injectors who make $200,000 a year or so, they are working between 39 and 45 hours a week. They are seeing, you know, more than 45 patients, 47 patients a week. They are doing not only injectables, but they're also doing ancillary services for additional revenue. They are incredibly tenured in the field. They've been doing it for, on average, seven to 12 years. And they are people who, in oftentimes, are trainers as well. So what we've got to realize is this is a real developing market. And so when you're looking at compensation. Sorry, I'm give you a lot of.
- [25:56]
Ricky Shockley
This is good. I love the back. I'm like, I want to make sure we share this survey. If this is a public thing, is this something you publish publicly, or is it.
- [26:03]
Mary Beth Hagan
We. We don't. What we do is we basically send out the link to as many people as we can get. We ask every RNMP or PA in the United States who does aesthetics more than 50% of the time to be able to complete the survey. And then everybody who completes the survey, we provide A complimentary copy of the survey report and the Insights guide. I partner with Gordian Solutions Group to do this survey. They are also the same marketing agency or market research agency that does AMSPAs state of the Industry report. And what we do, I never see any of the results. I have no idea who takes the survey. They always email me and go, hey, Mary Beth. I'm like, I don't know. I don't have this. I have to send it to Gordian Solutions Group. I don't see any of the individual responses. I just see everything in aggregate, just like they see when we publish the report. But what we do is we really try to also write an Insights guide that puts everything in perspective. And the sentence that I think I write about 15 times is, this is not what you should be making. This is aggregate of what people are making around the country. Please look at individual, you know, situations for years. So we do look at people who have five years of experience or less. We even break down some of the information by people that have been in it one to two years. So, you know, if you're making $75,000 in that first year or two, you're probably doing pretty well. That's pretty average. So I always say, I know we don't have a picture here, but if you think about an. On a graph and, you know, the bottom of the graph is, how many years have you been doing it? And then they, the Y axis, I always forget which one's which. But the, the up part then is, you know, how much revenue do you bring? And you're always going to see that when you start out, you're going to not bring in a lot of revenue because you haven't been doing it very long. And what we find is that, that X kind of, you know, as you continue to go up, you're going to find that you bring in more money when you've been doing it longer and you're seeing more patients. But the other thing is that you really are much more valuable to an employer when you've been there longer and you bring in more revenue and you see more patients and you have more of established practice. So we have to realize that in the beginning, when an injector first starts working for a practice, the practice is more important than you are. And I don't mean that personally, it's just that they're giving you a place to practice. They're probably giving you a medical director to work under if you need one. They are probably helping you with buying product and Helping you decide which products you're going to use. They're probably providing you with some additional training. They're probably providing with some marketing. They're definitely providing you with, you know, a sharps container and a bed and, you know, gauze and things like that. So what you've got to realize is those things cost a lot. And if you're not bringing in revenue to help offset the cost of those things, the employer is just either not breaking even or not making very much money off of you those first couple of years. So you want to be appreciative, but the employer also wants to be investing in that developing injector at the same time. Because then when you get to the point where the practice is not as important because you've been there for a while, you've developed a patient base, you as the injector at this point, that's the point where a profit sharing or an equity stake in the business can be a really good motivating factor for helping somebody come into a practice. And I always joke with these because a lot of people get very. Physicians especially, you know, it wouldn't even blink twice at having a $2 million surgical partner. But if they have a nurse that's bringing in $2 million of revenue, they still just think about it as just an employee. And I really encourage, especially physician owners, if you have an AM aesthetic provider, an RN and MP or PA that's been with you for a while and is such a part of that total continuum of care. Exactly like you said, Ricky, give them profit sharing. Give them an equity stake in the business. I have seen more than one deal fall apart because somebody who owned a business was going to sell their practice and they included the injector revenue as part of the ebitda. And then when it came right down to it, the injector quit and the deal falls apart. So you really want to look at where does your revenue come from in a practice and reward that person accordingly. That's kind of how I look at that.
- [30:24]
Ricky Shockley
Do you have any general guidance on, like, let's just say profit sharing? Like, is there, like. I think a lot of people that hear that term? I know, you know, there's a lot of people in this. In this business that maybe don't have a business background. Right? There's a lot of people that have the medical background and they're trying to figure out the business part. So when you say profit sharing, I know there's people listening that are going to have no idea what that even means.
- [30:41]
Mary Beth Hagan
Like and there's somebody ways to describe it too.
- [30:45]
Ricky Shockley
Yeah. And if you say if you had to give like a really simple explanation of maybe like a ballpark range of what is, what does a realistic profit sharing plan maybe look like?
- [30:54]
Mary Beth Hagan
Okay, full disclosure. These are the things I'm very, very good about saying, here's what I'm good at, here's what I'm not good at. So I have a colleague that I refer people out to, Dana Jacoby with Vector Medical, that when you're looking at profit sharing plans, she can be a much better guide for you than I can on that. The different types, you can have phantom equity plans where you get a piece of the profit, but you don't own a piece of the business. You can have a profit sharing plan that is like an esop, like an employee saving opportunity where you know, we're going to set aside this much of the revenue that is our, our net at the end of the year and we're going to divide it up among the employees. There are some people that will get a profit sharing based on their individual revenue production. There are others working on one opportunity right now where a very experienced injector is going to join an established practice, but they're opening a new satellite location for her. And so she's going to have equity in that particular location, but not in the overall business. And so that gives her almost the best of both worlds. She has the opportunity to be able to really help determine how things go in that particular location. And the business owner knows that they're going to. She has something invested in staying there, so she's probably not going to just up and leave. There's another great organization out in the east coast where they have people come into their practice and then they say, you know what, if you want your own practice, we will give you a significant discount off of the franchise fee for opening one of our locations and being within our group. And you get all of the benefits of being part of our group, but you own this location. So there's a lot of different ways that that can happen. So I always say I'm a good one for coaching and consulting to help people know about the ideas and then tell me what works and I can refer people out.
- [32:50]
Ricky Shockley
I think that's a good answer though, because the bottom line is if you're an owner watching this, you're going to have to be pretty thoughtful about this. Like you're going to have to figure out a comp structure. And I think this is probably true for whether you're trying to get an injector with some experience or you're bringing someone new in that you want to make sure after they're building up a patient database that they're staying. Like, you need to make the financial incentives and the risk incentives align so that it doesn't make sense for that person ideally to leave and start their own thing.
- [33:16]
Mary Beth Hagan
And they have to know that up front, Ricky. That's what's so funny. This is not some big secret that should come out only after somebody comes in and threatens to leave. This should be part of the plan, Right?
- [33:27]
Ricky Shockley
Yep. So, yeah, I don't think there's a lot of people that have thought about this is the. Is the perception that I have from talking to people. And it is so important, which kills.
- [33:37]
Mary Beth Hagan
Me because that's all I think about all day long.
- [33:39]
Ricky Shockley
Yeah. And again, I think people are just. There's something right in front of their face that feels more pressing. But when this becomes an issue and those of you listening who are in this situation, you know, it's more impactful than pretty much any other problem that you're going to face. So figuring out how to make sure that you're retaining your injectors and your staff is just so important. And figuring out a comp structure that, let's be honest, like so many people, like, there's things in culture, there's things in their work schedule, their risk analysis that are going to make them sticky to some extent, but a lot of it's going to come down to financial implications. And you have to make the math make sense for your team to make. Make it feel like they're giving up maybe a little bit of what they could have if they tried to go out on their own. But they're also gaining, you know, a consistent paycheck, reliable, not having to deal with all the other stuff that you mentioned that comes with own a business.
- [34:29]
Mary Beth Hagan
But, you know, what's so important about everything you just said, Ricky, is you have to find out what's important to each particular person. And, you know, after years, I mean, I started in aesthetic medicine back in 2005 with Medicis. Yes, I'm really old, but it's been so fun watching the development of this specialty through the years and how things work in the practices and the communication processes that happened. And so that's a lot of. When I've looked the last couple of years post Covid especially, what I realized was so many people were getting blindsided either and, you know, providers were getting blindsided because the practice was being Sold. And they didn't know anything about it. And they were like. I mean, it's. It's instant fear of the unknown, right? Or the practice is blindsided because the provider all of a sudden comes in and goes, thank you so much. I've loved working here, but I'm leaving Starman in practice. And they're like, oh, my God, why is this person not loyal to me? And both of these situations. You mentioned something earlier when you and I were chatting about transparency and the importance of that. And I was talking to one of my clients this morning, and it was funny because she said, you just seem to get this. And I said, no, what I get is that information is power. And some people feel like if you keep all the information, you have all the power. But if you have all the power, what's the other person have? So I've always kind of subscribed to the belief that information is power. And the more information that's relevant to each of us that we all have, the more power we all have together. And so what I've tried to do with the coaching and the consulting that we do at Titan is to really set up really good communication plans. Years ago, when I first started, we. I did a talk called how to have the compensation conversation. Because, let's be honest. Do you like talking about money?
- [36:24]
Ricky Shockley
No.
- [36:25]
Mary Beth Hagan
Do you like talking about money? Yeah. Do your employees like talking about money? Everybody is. I mean, maybe Bill Ackman, maybe Bill Gates, maybe Elon Musk, maybe some of those guys that have so much money that it's not, you know, even real money at this point, like talking about money. But the average person, we've grown up with this fear of talking about money, but we all need it. That's. I mean, it's great if you can do your job because you love it. We all want to have a job we love, but the end of the day, very few of us can do our job without making any money. And so we need to kind of demystify this compensation conversation. Because I used to joke and say that, you know, every single employer thinks that all of their employees are lazy and greedy or lazy and entitled. And every single employer thinks that all of their. Or every single employee thinks that all of their employers. I'm saying this completely backwards.
- [37:20]
Ricky Shockley
I totally agree.
- [37:21]
Mary Beth Hagan
Bottom line is everybody has a misperception about what the other thinks. So what I've tried to do is basically create a platform for practices and employees to have that communication conversation in a little bit easier way. And so we. I literally created an entire performance management packet specifically for aesthetic medicine, and it only costs $750. It's all the pieces that you need to sit down and create a performance management process and development process within your practice. You know, one of the biggest things, like you just said, what does everybody want? When we do the Titan compensation survey, one of the questions we ask is, have you ever thought about leaving a practice or switched to practice? If you left, what was the most important component in you leaving? And I think a lot of employers think it's money. Do you know what the number one thing that people noted as why they were going to leave a practice? Work life balance. And then we asked the same question. If you've stayed with your practice, what's the reason you've stayed? What was the number one thing? Work life balance. And so I think, you know, we had kind of the 80s and 90s where, I mean, it's. When I grew up working in those, I mean, it was a badge of honor to just work yourself to death. And we've got a new generation of people who said, no, I want to enjoy my life and enjoy my job. And so we need to ask people, what does good work life balance mean to you? For some people, it's, I don't care, I don't need to make more money, but please don't make me work on the weekend. For some people, it's, I love my job. I don't need any more money, but can I please have, you know, I'll work Saturdays, but can I please have, you know, Sunday, Monday as my weekend, or three, can I work four days instead of five days? And so what we have to do is we have to ask people what they want. Some people, I'm okay, I don't need more money, but do you have a 401k plan that I can invest in? I need to think about, or I need insurance, or I need different benefits or you know what? I'm killing myself. Most injectors that I talk to that are really good injectors spend 10 to $20,000 a year out of their own pocket on continuing education. So when we write organization, offer letters, and try to guide people on how do you make a job attractive to a potential employee? We tell them, put in a healthy CME stipend, make education important. Some people just want to, you know, let me go and do training and pay me for the time I'm training. So I talked to one physician at a several years ago, and I'm like, why haven't you sat down with these two injectors because they both left to go start their own practice. You know, why did they do it? He goes, I don't know. I go, why weren't they happy here? I don't know. I'm like, when's the last time you sat down and talked with them? Well, I say hi to him in the morning. I'm like, you don't do like yearly performance management or any sort of development? He's like, well, no, I don't want to meet with them and talk about things because I'm afraid they're going to ask for more money. So did they ask for more money? No, they just left.
- [40:31]
Ricky Shockley
So that's the choice you're facing. This episode is brought to you by Med Spa Magic Marketing, my agency. We help Med spas and aesthetics practices grow with more effective marketing strategies. And I know that's a vague phrase, right? That's a vague claim. So I have an offer for you. I offer this to any new prospects if you're interested in exploring any of them. Another marketing option, a new agency, or just getting into Facebook, Instagram, Google Ads for the first time. I'd love to show you why we're different, what we're doing for clients. And we can do that via a one and a half hour planning session where I'll outline a specific marketing plan and I'll give you all of the blueprints that we would implement if we were to do business together. Now you can take that, use that on your own, hire someone else to help you execute it or work with us. We really don't hold anything back on that strategy call. And I think you'll have a lot of confidence in how you manage your marketing investment moving forward. Understanding some of the nuances that can help you implement more effective marketing strategies for your business. So if you want to do that, you can go to medspamagicmarketing.com so basically like to kind of, to kind of boil that part down is like you, you need communication with your team and you need to make sure you have an alignment in a growth and a vision that, yeah, makes both parties happy. Right. What, what does this business need to look like for my provider so that they're excited to be here long term? What do I need to do to make that happen and what, what is a bargain that I think is fair? And you need to come to some sort of agreement and that might be different for different people.
- [41:54]
Mary Beth Hagan
Exactly. And it's even. So I tell every, every business owner, every Med Spa or aesthetic Practice manager and owner. Number one thing you have to do is you have to know what your goals are for the year. Number two, you have to communicate that to your employees. If you're not communicating what your goals are, it could be, we bought this new machine and so we need to use it at least this many times per week to be able to make our lease payment on it. It could be, we've got this new space. So you guys, we need one more provider to make the space manageable from a rent standpoint. I would love it if you guys would help me look to find somebody else to come join us in our amazing culture that we have here. Involve them in what your needs are, and then have them say, okay, this is what I need you to do to meet the needs of the practice so we can stay strong, we can continue to grow. We can be, you know, a productive, beneficial practice here. What do you need for your career and what can I do to help support you so that you're happy working here and your developmental needs are met? So we have a, you know, we have a how I want to be managed for them. So we ask them, what motivates you? What are you looking for? What. How do you like to be spoken with? You know, are you someone that likes public praise? Are you someone that wants quiet praise? I screwed that one up one time, you know, because I thought, oh, why doesn't everyone?
- [43:15]
Ricky Shockley
I think we talked about that on the first episode. Now that I remember.
- [43:17]
Mary Beth Hagan
Oh, my God, that was like. So I talk about a learning moment for me. Yeah. And so that's something you have to understand. How do they want to be managed? And that because somebody could literally leave because you're too nice to them or you're too public with praising them, it's like, what? But then you also want to find out, where do they see themselves in their career? Where are they now? How are they spending their time? Where do they want to be, and how do they want to be spending their time? And then what is going to have to happen to help them get there? And so then we have goal planning charts, and it literally is, you're here, you want to be here. Hew right in here. And let's work together to figure out what are the steps you're going to take to get there. So if somebody comes in and says, I love working here, but I need to have. I need to make more money, can you raise my hourly or can you raise my commission or my bonus? And what you say is, you know what? Here's what you're bringing in right now to make what you made this year, if you can bring in X amount more, then that will give the total budget that we have for employee compensation or for your employee compensation this much more. And then you can set a goal of saying you're here if you get here, if you get here, this is what's going to happen from a compensation standpoint. All of a sudden then the injector or the provider has control over whether or not they're going to get a raise. And it's not a matter of are you a nice employer or are you a mean employer. You put the dollars and cents into a spreadsheet to say, if you do this, I can give you this because it makes financial sense. Because the last thing you want to do is have a provider that like demands so much money and then the practice goes out of business because they can't make ends meet. Because this is really, really, really expensive to run a med spot or an aesthetic practice of any kind.
- [45:06]
Ricky Shockley
Yeah, I love that. So mistake it sounds like to avoid here is this is maybe an uncomfortable conversation. So I'm going to avoid it because inevitably what that's going to lead to is first of all, yeah, you're gonna have, you're gonna have the attrition issue. So maybe the North Star of this entire thing is like you have to communicate with your team and you have to have a system for doing that. Yeah, I had a follow up question. I'm just going back to my sheet here. I'm sorry, on that front. No, no, they were tied to that. So is there a cadence for how often you should be doing those check ins you mentioned? Once a year. Is there like a quarterly, monthly. How often should you be having those conversations with your team? That's question one. And then I have one other follow up that ties back into what you're talking about.
- [45:48]
Mary Beth Hagan
That's an easy one because with the Titan Performance management kit that you get, it actually has a calendar that comes with it and it's color coded for here's what the employer should be doing every month of the 12 months of the year and here's what the employee should be doing. And literally you've got a whole calendar of in January or February, you should be sitting down and you should be setting goals for the year. The provider should know what do they want to do from a developmental standpoint. The business owner should know what are their goals for the practice. Then you sit down and you create. Okay, what are we going to do throughout this year to achieve those goals. Then you sit down and you go, okay, are all the job descriptions written out appropriately? Is the job description, is the job you were hired for still the job you're doing? You want us to have their step goals that these step charts that we have where they're always going in and checking how am I coming toward achieving my goal? Then you want to make sure you have mid year performance reviews. And I know this is. It sounds so corporate when I talk about this, but it's just common sense. It's not really anything that's weird. And it doesn't have to be some weird formalized process. It's just, hey, bring me your goals. Let's sit down and talk about it. What do you need from me? What do I need from you? Where are we going on this? Are we trending to the right place? Are we both on track to achieve the goals that we want to hit by the end of the year? And if not, figure out what you need and if so, let's celebrate. That's fantastic. How do we keep it up? And then you want to get toward the end of the year, there's wonderful opportunity for all your employees to do a self assessment. I always laugh about self assessments because I found through the years that your absolute best employees will rank themselves lower because, you know, say the pie is, you know, the size of a dinner plate and they are doing the size of a, you know, serving of a teacup baked potato. Yeah. You know, they see how much more there is to be done. So they see themselves as not being exceeding expectations or not being super great because they know how much more there is. Whereas your average employee is going to say, oh, I'm doing the dinner size plate, I'm doing everything there is to be done. Because they don't see how much more. They don't have that vision and that self awareness of seeing beyond what they're doing today. So that's where a good manager can really help them by saying, here's where you are, here's where we need you to be, here's what we need you to do to get there. So then nobody's blindsided at the end of the year, when you're sitting down in December or January and saying, okay, we're going to have that year end performance review conversation, you know, you said you were going to do this, you did this and more. Great, here's your reward. And it's all predetermined, so it's easy.
- [48:28]
Ricky Shockley
Yeah.
- [48:28]
Mary Beth Hagan
And if they didn't get there, it's not your fault as an employer. You know, you guys have shared ownership and responsibility.
- [48:34]
Ricky Shockley
So. So when you're going into that financial conversation and you mentioned, here's how much you brought in, here's how much you made. If you bring in this much, here's how much we can pay you. Obviously that requires a lot of transparency in that conversation, because I think without full transparency of the numbers, there's. There's a risk probably to the injector going, oh, I didn't even really think about it. I'm bringing in this much money, and I'm only getting this small piece of the piece. How do you recommend people deal with that conversation? And to make sure that there's not any confusion there, you know, there was.
- [49:04]
Mary Beth Hagan
Actually a post on one of the med spa owner, I don't know what group, or one of the Facebook groups, and somebody said, how transparent are you with your staff? And half the people said, very transparent. They have to know. The other one said, I don't tell them anything. It's none of their business. And it was so fascinating to me. I will bet you the ones who say, I don't tell them anything, you know, they probably are struggling a little bit more than the ones who have transparency. There was a great professional named Bruce Maller who started BSM Consulting. Many of you who've been in the aesthetic space for a while will know of bsn. They're fantastic consulting organization. And Bruce is the one who basically said, look, every single year, I sit down with my entire company and I go through our financials and I tell them, here's what we brought in. Here's what our expenses were. Here's, you know, where we were in good shape. Here's where we weren't in good shape. Because I want them to understand I'm not just sitting here raking in the money that we're all doing a piece of making this business successful. So he said, it does two things. It gives them education and it gives them ownership, and it gives them transparency. And so then they come back and they are much more willing to work toward what we need to do to be successful because they understand. Now, I'm not saying you have to tell everybody exactly how many dollars go into every pool, but it's absolutely easy to say, okay, in 2024, you know, here's the whole pie of money that came in. And you think about it, where's money come into the practice? You know, it comes into the practice through products sold and services provided. There's no magic pot of money coming in from, you know, insurance reimbursement or gosh knows where else. It's like it's product sold and it is services provided. And then you think about what has to get paid for out of that pot and that's where you start breaking up your pie and say, okay, this much went to employee compensation. This much went to rent or lease. This much went to sharps container removal. This much went to buying new equipment. This much went to cost of goods. You know, you start looking at how much a neurotoxin costs or how much a filler costs or how much consumable for a laser or an energy device costs. And I think a lot of people don't realize how much goes out the door in cost of goods. You know, how much does a piece of gauze cost? How much does syringes cost? So there's, there's a lot of expenses that I think a lot of people don't think about. You know, insurance. And, you know, there's business insurance, there's malpractice insurance, there is, you know, how much, if you're getting paid vacation, it's a double hit on the business owner because you're not there providing revenue and they're paying you. So it's a double hit anytime you get paid vacation and you appreciate it. But I want you to understand it also, you know, if they're getting 401k, do you know how much the average business pays in taxes? You just ask anybody who is a 1099 contractor. The taxes are insane. So I tell most of the people that I work with on a consulting basis who are looking at a compensation plan from an employee's perspective, you've got to realize that if you get healthcare benefits and they pay your taxes and they pay, you know, you basically have to bring in three times the amount of patient revenue of what you get paid. So if you make a hundred thousand dollars a year, you basically have to bring in $300,000 in patient revenue for that employer to even think about breaking even on having you there as an employee. And so when you understand, you know, those ratios and those perspectives, I think it makes it a lot easier for that transparency to help lead to everybody working together.
- [52:48]
Ricky Shockley
Yeah. So more transparency the better. Right. We're in an industry where it's not like the margin is 60%, so they're not going to uncover something and go, oh my gosh, they're making a million dollars off my back. Like it's, it's probably going to give them more appreciation for the risk you take on as the owner of the business and how you can fit in this puzzle together to work toward a common goal.
- [53:06]
Mary Beth Hagan
Well, that's why I say you're better off being a provider if you want to be in this specialty. Because if you're an owner and you can't bring in revenue.
- [53:16]
Ricky Shockley
Yeah.
- [53:17]
Mary Beth Hagan
You're a cost center, not a profit center.
- [53:19]
Ricky Shockley
Yeah, exactly. Other than communication and aligning on in terms of a common vision of how you're both going to win in the business, are there any other common components of culture that you see businesses doing right or wrong that lead to attrition and retention issues?
- [53:37]
Mary Beth Hagan
Trust communication. This is going to sound crazy, but even employing, it's amazing how many times when somebody brings on a new provider and they don't involve the existing staff. There's just an automatic distrust in many cases. But a lot of that all starts with the owner. So I think the biggest thing is I just saw something the other day that says culture is not an HR function. It stops at the top, starts at the top. And so the culture has to come from the practice owner. And it's not from the office manager. It comes from the practice owner or the physician that owns the practice or the nurse practitioner that owns practice or the pa, whoever owns. They have to set the culture. And then the communication with the culture is just as important. But communication with culture is not just saying it. We've all been in places where they say one thing and they live a completely different one. Right. And so that's why I always encourage people, before you hire somebody, have them come in and spend a day in your practice. Do you, do the people get together and talk at lunchtime? Does everybody just go out on their own at lunch? Is it, you know, and some people are fine. Some people are like, you know what? I work so hard to talk to patients all day. When I have my lunch break, I just want to sit in silence for just a few minutes. It's okay. You want to be in a practice, though, where that culture is okay. You don't want to be in the practice where you're done seeing patients and now everybody gets together and has a party every day at lunch. That's not going to fit. So that's why, you know, assessing the cultural fit before you hire somebody is so important to that employee's long term happiness.
- [55:20]
Ricky Shockley
That's the second time that's come up in the last three episodes. This idea of kind of having a trial day or even trial few days like, like you got to Be comfortable with each other. You both have to see that this is going to be a fit. Ricky, all those things I hope sticks.
- [55:35]
Mary Beth Hagan
It's not a. I'm an employer. I'm hiring you to do what I need. And then now you are subservient to the employer. It is. You need employees to provide specific tasks or responsibilities or care within a practice and they need you to provide certain things, you know, in terms of running the business successfully. And if you're not both doing it, if you're not creating that win, win, then everything's going to fail.
- [56:03]
Ricky Shockley
And this idea that culture comes from the top, I've heard that come up a lot recently, even in huge organizations. That true? That's true. I think Mark Zuckerberg maybe said recently something, something along these lines of like you can't really outsource that component. Yeah. And the person at the top has to take the lead on those things. And I think so many business owners, especially the non nurse owners in the space, they just think that like they see it as a financial interaction and they just kind of open the doors and leave things be. And they don't really hone that skill of leadership and developing culture. And especially if you're not the primary provider that starts the business, it's probably even more important to have that dialed in. Otherwise your chances of success go from 10% like you mentioned to 5.
- [56:48]
Mary Beth Hagan
So there is an amazing practice owner who is a non provider who is down in Bel Air Bluffs, Florida. You know who you are and she is the best cultural leader and she tells them, look, I'm not a provider, I'm a business owner. I'm going to run the business. I'm going to let you know where we are. But I need you guys to tell me what do you need in order to make this a successful medical practice? And they work so well together. And she, her, her injectors have been with her for like 17 years. It's amazing. But they have built loyalty that is based on mutual respect and understanding of which each provides. And you know, we've all worked for people where the owner doesn't make themselves available or doesn't isn't part of the business. And it's just not as much fun because you want to feel like you're going somewhere together in most cases.
- [57:45]
Ricky Shockley
Yeah. I really think this is one of the most important episodes we've done. I really hope list people listen to this from start to finish. Mary Beth, where can people learn more about you if they want to work with you? You Mentioned some things here you've got frameworks and all these things to make this kind of a cheat sheet implementation for getting better with a lot of the things that we talked about today. So where can people learn more about you and take the next step to potentially working with you and your team?
- [58:09]
Mary Beth Hagan
Thank you. We're in the process of redoing our website, but you can still find me@titan aesthetic.com my email is mbhagen h a g E N. Just like Haagen Dazs ice cream@titanesthetic.com you can find us on Instagram at Titan. Underscore Aesthetic. Underscore. MB Hagen. You can find us on Facebook at Titan Aesthetic. I think we're still Titan Aesthetic Recruiting. They're trying to get rid of the recruiting because it's really. I mean, we do consulting, we do screening, we provide resources through our consulting work. We provide coaching for people looking to come into the space. This is such a hard specialty to transition into. If you're a provider and you want to do this, there aren't any schools, there aren't any academic training institutions. You can go. And so there's a lot of ways to spend a lot of money that might not necessarily help you achieve your goals. And let's be honest, I'm from the Midwest. I am incredibly cheap. All of my people and friends that will tell me, Mary Beth, your prices are all too low. But I just want to help people achieve their goals so that we can keep this a very strong, very safe, very ethical specialty. I mean, this is medicine. This is not pr. This is not entertainment. This is not looking at fame or fortune. This is giving patients great outcomes in a safe environment.
- [59:30]
Ricky Shockley
Yeah, I love it. I'm going to make sure we have all that in the show notes. I really encourage you, if you're listening to this and you found this episode valuable, probably means you're in need of Mary Beth services and her team. So I would really plug into those resources. It's. It's. I do this for our agency. I buy versions of what you're talking about. Of, hey, I know this is important. I need to figure this out. Let me go to somebody that's already figured it out and let me implement that system as opposed to trying to figure it out from scratch. Like, this is the cheat sheet. Many of you need to get this part of your business right. So really encourage you all to check out the show notes. Mary Beth, thank you so much for being on. We look forward to hopefully having you on again sometime soon.
- [60:06]
Mary Beth Hagan
My pleasure.
- [60:07]
Ricky Shockley
Thanks everyone for tuning in. This podcast is a production of medspa Magic Marketing. If your med spa or aesthetic practice is in need of digital marketing services, help with advertising on Facebook, Instagram, Google lead generation and booking more appointments, please visit Medspamagicmarketing.com.