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Ep.07: Patient Flow from Start to Finish

Ep.07: Patient Flow from Start to Finish

Learn Catherine’s pro-tips from her 40+ years as marketing and business guru for top aesthetic practices around the world.

In this Episode of Beauty and the Biz:

  • Learn how to get your consults into the door without any bad surprises!
  • Glean only the best consults from your pool of prospects!
  • Get them to say yes!
  • How to capitalize on existing patients while profiting from new ones!

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FREE advice call with Catherine


Hello and welcome to “Beauty and the Biz” where we talk about the business and marketing side of the cosmetic practice. I’m your host Catherine Maley, author of “Your Aesthetic Practice – What Your Patients are Saying” as well as consultant to cosmetic practices to get them more patients and more profits.

Today’s episode is called “Patient flow.” It’s about the patient experience from start to finish. Because here’s what I know for sure: the most successful practices focus on certain things that help them beat the competition and be the market leader in their area because when you focus on these fundamentals you’re gonna get more patients, more procedures, more revenues, and with minimal time and effort.

So here’s a mantra that I live by and I hope you do too. The key to success is not doing more, it’s doing more of what works. I have watched practices over and over spend an absolute fortune on focusing on only one thing and that is new patients. That’s all they want. “I want new patients from the internet,” everyone who calls me says. “I need more patients,” and that’s all they want to talk about. But quite frankly that’s where the lost profits are; every day, every month, every year, because here’s what happens when your focus is only on new patients: you end up spending a fortune redesigning your website again (and I’m not saying you shouldn’t, I mean you can’t look like old school anymore you’ll look outdated but also do you really need a $50 000 website? I don’t know maybe you do). So you throw a bunch of months and money into that, redesigning it and then you’ve got to have a hosting service and that’s another whatever it is, a thousand or two a month. Then you’ve got to have somebody doing your SEO for organic search and that, it hasn’t died but it’s definitely not the thing going on but you still need to do that, and that’s another couple thousand a month, and then you’ve got to have somebody writing this content. Either you’re spending your own valuable time writing content or you’ve got to pay someone else to do it, and same thing with social media. You either have to spend your valuable time doing that yourself, or you’ve got to pay somebody to do it.

So here’s what happens – you’re throwing all this money at new leads and you’re saying, “Oh my God this place is gonna be great, I’m gonna be so busy, it’s gonna be packed.” And I know that’s what you want – you want a nice busy reception area with the phones ringing, and you want to be running from exam room to exam room, and I know that makes you feel good, it makes all of us feel good, the issue is just because you’re busy doesn’t mean you’re profitable.

So then what happens is oftentimes it’s not working, or it’s not working like you wanted it to, so now you’re frustrated and you’re cynical. Now you say all this stuff doesn’t work and then oftentimes you just give up, but you have to go somewhere in between. Doing everything all the time and not doing anything at all, because here’s the truth: the prospective patient leads that you get, they need help. Can you imagine being a consumer today looking for a solution? Let’s just take the example like a tummy tuck. A lot of us have a tummy and sometimes it’s just a little pooch, sometimes there were a bunch of kids involved so they have fat hanging over, you know it’s not just fat, it’s also skin and on and on. Can you imagine trying to decide how to choose first of all the procedure that you need, and then who’s gonna do that procedure? It’s a really big deal. So they’ve been thinking about this forever, but now when you start really looking at and doing the research, you get more confused because there are so many opposing views about what to do for each procedure. Should it be surgical? Should it be non-surgical? And it goes on and on that they truly need a professionally trained staff guiding them through their journey to a yes.

So with that I’d like to look at the five-step flow of the leads that come in. So we’ll start with the leads that are coming from let’s say the prospective patient is on your website. So they fill out that I’m ready for a consultation, or maybe you have an opt-in box that says “ask a question”, so they fill that out, or maybe they see you on social media and they direct message you. Well what happens then because here’s what the stats have shown, when it comes to following up, 48% of practices never even follow up, and then the average first follow up is 72 hours later. In today’s crazy world where everything is instant, 72 hours is a lifetime in social media and on the Internet. So if you’re gonna do this, you have got to be on your game.

So that’s another issue – how do you stay responsive to these leads coming in? Well oftentimes you need a practice cell phone and it’s notifying you the minute somebody reaches out to you. But then what happens to the cell phone after hours? Is somebody taking it home? What happens on the weekends? And on and on. You have to figure that out because there’s nothing simple about that. But let’s say the prospective patient actually picked up the phone and called you. That is a super big deal. I would call that a hot prospect because they’re the most qualified, especially because of technology. They didn’t have to call you, they could have just text you or emailed you but instead they’re serious enough where they stopped what they were doing, and picked up the phone to call you. So when that happens, hopefully your goal is to answer the phone within three rings with a human being, otherwise if it’s not, guess what happens?

We do a ton of mystery shopping and we get answering services which are horrendous, by the way, so many of you still use the old antiquated medical answering services and they’re awful. They’ve never heard the words “customer service.” There are so many new friendly receptionist services that you can use. Please, if you’re gonna do it, please use a good one or they immediately put you on hold. Or maybe the prospective patient hears the phone tree from hell. Those are awful. Those are for your convenience, not for the patients, and if your phones are that busy you better figure out how to triage those calls and I have a lot of options for that, but it’s not we’re not gonna go into here. You have to think about a patient with a credit card. They’re not gonna put up with shoddy service. If you’re asking them for cash, you know they expect service. And when they do have a conversation with your receptionist, you have to really understand like did they get what they wanted from that, because your staff must be trained to handle the phones. They’re never gonna get to you if they can’t get past that phone call with your receptionist.

And here’s what ends up happening: bad phones are costing you a fortune and most people don’t realize it because you’re not calling your office and you don’t know, but trust me I’ve heard thousands of calls all my years of doing this and you’re losing at least a patient a day. And if you are, trust me it’s probably a lot more than that, but if you’re only losing a patient a day and they’re worth $2,000 because I don’t need to over emphasize this I’m not even talking about surgical patients you’re losing I’m just talking about like a minimally invasive patient spending $2,000. If you multiply that out by 22 working days per month and then twelve months per year, you realize that’s $528,000 in lost revenues per year! So fix your phones and give yourselves a half-a-million dollar raise.

So here are the skills your receptionists need: they have to know how to bond with the caller. It starts right that second – you have to have the right voice, the right tone, and the right words to say to bond fast. They have to qualify them, but in a strategic way. And you’re not doing a mini-consult, you’re just qualifying a little. And then she’s got to credential you as the best choice. There’s a good chance she’s calling all over the place on the internet because she sees you and everybody else on there, so there’s a good chance she’s just going right down the line calling everybody and the receptionist has to control the call; if she doesn’t, the caller controls the call and that’s never good.

And then your receptionist has got to be skilled, to ask for an appointment, so here’s step number two: let’s say she gets past the phone, she books an appointment, does this prospective patient show up or not? And that’s a really big deal in today’s world with everyone clicking around and being flaky there’s a really good chance you have a no-show issue. Now a lot of you are afraid to charge for a consult because your competitors don’t. You just have to decide how you’re gonna play this because there’s a chance you’re doing a free consult but if so many of them are not showing up and they’re wreaking havoc with your schedule, that’s not helpful. Or they are showing up but they’re not even serious about this, they’re just kind of looking around and they’re not sure about any of this. Do you want a qualified consult or not? You have to decide.

Some of you would rather just do the numbers game and you’re confident you’re closing so go for it, but otherwise for most of you this is a real problem, this no show thing. So here’s what I would suggest: I would suggest charging a small no-show fee. It could be $50 or $75 depending on what area you’re in, but you know some of the bigger areas they’re charging $200-$300 for a consult fee because they’ve had enough of a problem with it and they’re trying to weed out those who aren’t serious.

But here’s the pearl – you always want to add value before you say the price because if you’re just charging a consult fee and you just blurt it out, they’re gonna say, “no I’m not gonna pay that.” Instead you have your receptionist pre-frame that price. For example, she can say, “Oh Sara let me just tell you what our process is. First you’re gonna see Lisa and she’s our skin care esthetician and she’s just wonderful, and she’s gonna do up a facial and do a skin care analysis and give you some recommendations to keep your skin looking great. And then you’re gonna meet with Amanda and she’s our coordinator and she’s gonna meet with you first and get to know you a little bit better and give you a tour of the practice. And she’s gonna talk a bit more about the doctor and then she’s also going to do a computer imaging session with you. You can communicate what it is you want, and then she’s going to have Dr. Great come in and he’s gonna check out what you two have come up with regarding what it is you’re looking for and he’ll give you his clinical response on what he can do to get you to the result you want, so together you’re both satisfied. And then you’ll go back to Amanda and she’ll go over the quote and over the surgical dates. Now we do all of that in about an hour and we do have a $75 consult fee, so let me just see what days we have for you.” And then you just move on and you start booking so you don’t say “oh and we charge $75” with a question mark because that leaves it open for the caller when you, quite frankly what I teach the receptionist is you must use your voice and your confidence to keep it going, so the caller just follows you. That’s the point.

Now let’s say you’re still scared to charge a consult fee. Just at least do this: offer a reservation fee. What I mean by that is it’s a hybrid between not charging anything and having a no-show issue. So here’s what I say: “Connie, since Dr. Great’s in high demand, I’m gonna need a credit card to hold your reservation. All I ask is that you give me 48 hours notice if you need to change your appointment to avoid a $75 no-show fee. Did you want to use your Visa, MasterCard or Amex?” Now what I like about this is you’re saying that Dr. Great is in high demand, and quite frankly you’re always in high demand so that’s a good reason – there’s a book on this. If you give somebody a reason for why you’re doing what you’re doing it makes more sense to them and they just follow you. And also a little tip, you do want to run their card on zero because they will give you all these pretend credit cards. You really have to figure this out, do you want to weed out the riffraff or do you want to spend your day with them? You have to decide.

Now for step number three: that’s the prospective patients consultation with you and the coordinator. I realize you all have different ways of doing this; some of you meet with the patient first and then they just meet with the coordinator for numbers, some of you do it the other way where they meet with the coordinator first then they meet with you, then they meet with the coordinator. You have to decide what works for you. I will have podcasts on this down the road explaining how I would do it, but in the meantime they’ve got to have a good consultation.

So here are a couple pearls: For one, you’re trying to take people from 0 to 60 in about an hour. They’re supposed to meet you, learn all about you, go through your consultation, and say yes, and that’s just not how most people are wired. They need to get more comfortable with you. So I actually have lots of training on how you get them more comfortable. Before they show up, one thing I would suggest is having your coordinator pre-frame you before they meet you. Your coordinators gotta be your big cheerleader and she’s got to be bragging about you, about how brilliant you are, how much your patients love you, what a great father you are, whatever it is, somebody’s gotta brag about you and it can’t be you.

Now I do highly recommend the coordinator make a pre-consultation call because it’s getting so important that you convert these now rather than later. So a pre-consult call – one of the objectives, the main objective, is to answer their objections now so you don’t hear them at the end after you’ve spent an hour with them. So here’s an example that I would do for a pre-consult call. Your coordinator would say, “Hello Sarah, it’s Amanda from Dr. Great’s office and I’m gonna be your coordinator and I’ll be assisting you through your journey with us so I wanted to prep you for your consultation with us to help make it a good experience for you so just a couple things. Number one, please allow about an hour with us (go through your process) and I want to make sure we have enough time to answer your questions. And then I’d like you to bring your schedule because Dr. Great is in high demand and he does book out quickly so I want to make sure we can accommodate your schedule so should you decide to move forward we’ll get some dates for you. And then number three, you know there’s always the issue of financing (because these are not cheap services so just so you know I’m here to help you get what you want so I don’t want financing to get in the way, we do great affordable pay plans and I’ll go over those with you at the time of your consultation) and then lastly is anybody gonna be helping you make this decision? Maybe it’s your husband or girlfriend or a sister, just bring them along with you because I’d like to be able to answer their questions as well so we save time. How’s that?”

So now you’ve pretty much pre-framed them to not say at the end “I don’t have the money, I don’t have the time, I have to check my schedule, I have to talk to my husband.” We all hear those so the point is to not hear that by pre -framing them ahead of time so they give you the real reason why they’re not saying yes. And then you also want to educate the patient before they meet you. Not a lot of you are getting very good at educating and if they don’t get educated from you, they’re getting it from your competitors. Some of these guys are spending a lot of time on Instagram and so you have to decide if you’re gonna do that or are you gonna let somebody else educate your patient? But then you say something when they get there and they say “well that’s not what I saw on the Internet” so I personally would somehow educate your patients beforehand on your philosophies and how you handle certain situations and then with your coordinator I would give them presentation visuals.

Here’s an example that comes up a lot: the prospective patient was thinking about lipo but now they keep hearing so much about let’s say CoolSculpting and now they’re confused should I do surgery or should I do not surgical? And that’s a big deal, so if they’re still mulling that over you need to learn that now before you just keep pushing lipo when they’re actually not sure yet if it’s lipo. So I would somehow have some visuals where the coordinator can go through the differences of CoolSculpting versus lipo and then they’re closer to making a decision and then you can do the same thing but then once she’s decided that, now you can move on with your consultation because she’s not still in that first phase of surgical versus non-surgical.

And then your coordinator has got to professionally do the thing that nobody, most don’t even bother doing, and that’s ask for a decision. Nothing counts until that prospective patient hands you a credit card, period. Everything you’ve done to this point doesn’t count until you wrap it up and get to a yes and get the credit card. So yeah, it takes some training. I will say just a little blurb about me; I do offer to train your staff, your coordinators to promote you and to close because you’ve got to have a really good converting person there to get to the bottom line. If you need help with that you can just go to my website,, or you can go to This can’t be taken lightly because this is where all of the rubber meets the road at this stage.

But let’s say you got that your coordinator, she’s not great. Now we have to do step number four. She’s got to professionally follow up after the consultation because she didn’t get it done, didn’t have my training yet. So you have to have a really good process called “fix your follow-up.” You really have to fix your follow-up. Most coordinators I have learned only make like one phone call, or they’ll just send one email and then they drop it and they move on, and that’s not what a professional does. Let’s face it, the reality of life is things get in the way. Life is really complicated and the prospective patient is juggling an awful lot of stuff, so there’s a chance she didn’t say no, she just said not yet, or not now. Or maybe she’s confused about something. But I’ll tell you what happens most of the time it’s just one more thing on her to-do list. She wants to do it but it takes a little pressure for somebody to finally make a decision rather than continue to procrastinate. Isn’t that the truth? To get somebody off the couch and do something like take action is a monumental task, so the professional coordinator who follows up makes that happen. They say with urgency and there’s a way to do this (and again I have training on this) but she’s got to have the right protocol. The right proven scripts. And she’s got to use different communication channels to help that patient get to a yes because here’s what always happens: the coordinator says, “I don’t want to be pushy.” Well here’s the thing, if you don’t want to be pushy then you might as well say goodbye to the patient because you’re not gonna even follow up with them so what’s the point? Like why did you just go to all that trouble if you’re not gonna follow up? However if you follow up and you do it in a way that I would show you in my club, I’ll tell you what, they end up respecting you. The prospective patient realizes you really are professional, you take this seriously and you care about me because you keep connecting with me. Most don’t. That’s where your leverage is, that’s how you can dominate your marketplace; build relationships with people so they feel like you care about them, and then they’ll care about giving you their credit card.

So here’s the point: incoming leads is serious business and you just can’t be mediocre or average about it, you really need skilled professionals to make that happen. So now I can say now that that happened, everybody was on their game, this patient became a real patient, they had surgery or they had things done, and they’re just ecstatic.

Well here’s step number five: hang on to them. How big would your practice be if you didn’t lose any patients? I don’t understand this, but most of you just move on to the next patient. It’s a one-and-done kind of mentality, and you just can’t be like that in today’s world. Current patients who already know, like and trust you, they’re a given, those are your laydowns because they already gave you money once and they’ll give you money again. If you just nurture those relationships they’ll also give you great reviews because the ones who are unhappy will give you a terrible review so the ones that are happy you want to make sure they’re giving you the good. And they’re also the ones who are gonna give you the word-of-mouth referrals because isn’t it a lot easier to convert the word-of-mouth referrals than it is that stranger patient who doesn’t know you?

I mean you would like to spend all day I’m sure you do it now, you spend all day with Internet patients. They’re frowning at you because they’re squirming, they don’t know you, they’re uncomfortable already with something about themselves and now they have to get to know you, get to know your staff that’s so awkward. So it’s not easy. How would you like to have a whole day of patients who are word-of-mouth referrals who came in from your current patients who have raved about you and they’re already open, they’re smiling at you, they’re listening to what you say and they’re also not as price sensitive, and you know why? Because your patients have pre-framed you as the best choice. So now it’s not all about price, it’s about you’re the best and what’s great about that, they’ve already seen your results face to face, they’re standing in front of their friend or their girlfriend or their whatever their sisters or colleague, they see the result they got, how happy they are, and now they want the same thing. And we all know it’s a whole lot cheaper to keep a patient than it is to go find a new one.

Now if you’re not sure about this where this fits into your practice I highly recommend you do this exercise and it’s very simple. As soon as you get off this podcast, have your staff pull up the surgery schedule and look at the last 40 to 100 surgeries you did and just have them jot down what was the name of the patient, what procedure did they have, what was the referral source, and then just little notes like if they were female or male, their zip code and their age. What you will find, because I’ve done this all over the United States for years, here’s what you’ll find: depending on the age of your practice, typically let’s say it’s a practice that’s been around like five to ten years, then there’s a practice that’s like 10 to 20 and then 20 plus. Most of them will be the internet but the majority will still be word-of-mouth. If you’ve been around at all the majority will always be word-of-mouth when you’re brand new because that’s how you build the darn thing. Now some of you say, “no no I do a great job on social.” Well okay so you can do that, but then those will become word-of-mouth for you.

Then the other group, the ones who have been in practice for a while, the majority of those should be like fifty percent word-of-mouth and then the ones who have been around for 20 plus years the majority or the ratio should be about 70 word-of-mouth. If it’s not, that means you’re working too hard. That means you are ignoring the patients who like you and you are spending all of your time money and effort going after the new patients. I don’t know why because it’s a shiny object?

I don’t know why I but that’s the harder way to do this so here’s the mantra: retention is the new patient attraction strategy. It really is a lot cheaper to hang on to your patients then go find new ones. I can’t say it enough. So then you say, “well how do I do that?” Well you’ve got a huge email list, and hopefully you’ve been collecting cell phones (if you haven’t, please collect cell phones because texting is gonna take over the world if it hasn’t already) so you want to communicate regularly with your patients via email. You can also start a VIP Club for your favorite patients or you could just start a loyalty program (I have one of my own and it works beautifully) and then you can also do patient appreciation events. I always say face time is the absolute best marketing strategy in the world because they might see people on the internet and see them on YouTube even if they saw them on social media, but nothing compares to meeting somebody face-to-face where you can see, smell, touch and hear them, so patient appreciation events are brilliant.

So to wrap this up, as a team I would get together and fine-tune each step in your prospective patient flow and the experience they have with you so you know what happens when they call, when somebody opts in, when they DM you, do they show or no show, how can we avoid the no-shows, how was their consultation with you? Like really go through each of the steps and figure out is your consultation process as good as it can be or are you running them all over the place? Is it complicated? Also, if they didn’t book, what’s our follow-up after the consultation, do we have a protocol in place? And then of course you want to retain that patient because here’s the bottom line: the patient flow experience when you get good at that, that’s what takes the patient from a new patient to a raving fan and that’s what you build your practice on – raving fans who return, refer, review, buy your retail stuff, and stay with you.

So that is it. I hope you enjoyed that and please subscribe to “Beauty and the Biz” and of course I really would appreciate you sharing this with your staff and your colleagues because I sure would like to grow this. I have a lot more coming up and then if you’d follow me on Instagram that’d be nice, it’s CatherineMaleyMBA. Thanks so much, we hope you found valuable insight on this episode. For more episodes, tools, and Catherine’s free book, visit

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Catherine Maley

Catherine is a business/marketing consultant to plastic surgeons. She speaks at medical conferences all over the world on practice building, marketing and the business side of plastic surgery. Get a Free Copy of her popular book, Your Aesthetic Practice: What Your Patients Are Saying View Author Profile.


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