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Want a Smooth-Running Practice? (Ep.144)

Hello and welcome to Beauty and the Biz where we talk about the business side of cosmetic surgery and how you want a smooth-running practice.

If you’re working too hard and want to streamline your practice so it runs like a well-oiled machine…so you can unplug, relax, and have a system in place that does the work FOR you so you can spend more time with your family WHILE you get excellent results from your patients….this podcast is for you.

The most successful, profitable smooth-running practice doesn’t  happen by accident.

The surgeons running the best smooth-running practices have learned the core success principles that are MANDATORY for you to build a practice you are proud of and enjoy going to every day.

Otherwise, what’s the point of working so hard?

⬇️ Click below to hear “Want a smooth-running practice?”

This week’s Beauty and the Biz podcast episode, “Want a Smooth-Running Practice?” lays out what it takes to build an enviable practice you can enjoy until you drop or you can sell for a profitable exit….it’s your choice!


P.S. I’m practically giving away the “The MBA for Plastic Surgeons Course” this week in honor of St. Patrick’s Day. Since I’m super Irish, I want to give you the “Luck of the Irish” so you create a “pot of gold” when you have your own smooth-running practice.

Click Here to Grab the Course for this never-before offered low price.


Want a Smooth-Running Practice? 

The (4) Core Success Principles Needed

After working with surgeons for more than 22 years, I understand how difficult it can be for you to juggle staff, patients, family, and overhead as well as grow your practice at the same time so I feel your pain and do what I can to simplify things for you.

The objective is to set up your cosmetic surgical practice as a business so it’s more profitable, more enjoyable to go to every day, smooth-running, and it frees up your valuable time so you have more of it to spend doing what you like to do with the people you most enjoy being with.

So in this podcast, you’ll get:

  • Clarity as to how to run your practice like a business and that will give you peace of Mind and
  • More Free time to enjoy your life, hobbies, family, special interests and
  • That means you’ll be more productive without working harder but you’ll be achieving better results.
  • Turn your business into a smooth-running practice.

So, we’ll be covering topics including mindset, team-building, leadership, marketing and systems strategies you need for leverage to think bigger, do better and earn more… all while enjoying the process.

Because as Ralph Waldo Emerson said:

“Unless you try to do something beyond what you have already mastered, you will never grow”.

You already mastered surgery so now let’s master the business and marketing side of surgery.

THAT is what catapults you to success and a more certain future.

So Let’s Start with Mindset to create a smooth-running practice.

As a surgeon, you were programmed to think in a certain fixed way.

You had to think that way to become a great surgeon.

However, that thinking is the opposite of how a businessperson has to think.

For example,

You most likely put more value on YOU as a surgeon vs. growing your staff and your systems and you work IN your practice rather than work ON your practice

Michael Gerber explains it well in his excellent book the “EMyth, Why Most Small Businesses don’t work and What to do About it”.

Basically, he says to run a successful business, you need (3) key players:

The Entrepreneur to come up with new ideas to keep up with the times;

The Manager to set up the processes and people so things run smoothly; and

The Technician to actually do the key work that makes a profit.

So, in a cosmetic practice, you, the surgeon, are the technician but you’re also juggling the jobs of the entrepreneur and the manager and that takes different skill sets to make it a smooth-running practice.

That’s not a good use of your time and it will not get you to your financial goals.

So, we’re going to change that up for you because when you set up systems, you and your staff get clarity. And when you remove the complexity, results happen because “Money is Made in the Processes”.

Here’s the first big mindset shift:

“Operate your practice like it’s for sale”.

In other words, regularly ask yourself,

“If I wanted to sell my practice tomorrow, what would I need to improve to get the most value for it?”         


“If I wanted to buy an existing practice, what would ”I” be looking for and be willing to invest in?

It’s smart to figure this out now on how to create a smooth-running practice rather than wait until it’s too late.

Because the goal is to have an asset to sell, or at least to enjoy, for the rest of your career.

Because the alternative is you don’t do anything to improve but then you must know, you’ve only created a job for yourself. That’s not a bad thing if that’s what you want. But the goal is to be sure you’re clear what you’re working towards so you’re satisfied with the outcome.

Ok, enough said. Let’s get on with it.

Here are the (4) Core Success Principles Needed to Grow a Sellable Cosmetic Practice:

  • Building a Team of Rock Stars
  • Strategic Marketing and Planning
  • Setting Standards so You Don’t Compete on Price and that includes Differentiating Yourself from Your Competitors and
  • Setting Yourself Up to Grow and/or Exit when you’re Ready (and that includes Leadership Skills and Managing Metrics)

Success Principle #1:

Build a Team of Rock Stars

Hiring the right team for your practice will be your biggest challenge but also your greatest asset. Because it’s all about the WHO.

Jim Collins, Author of Good to Great) says:

“The most important decisions that business people make are not
“what” decisions, but “who” decisions.

 What typically happens is surgeons want a smooth-running practice and to fix the staffing problem quickly, so when a staff person leaves, you have a tendency to hire fast to fill the position but then you have to deal with bad hires who don’t fit your values or your culture.

And, you know all-too-well what bad hires cost you:

  • You can’t rely on them;
  • They are adding stress to your day and maybe even your nights when you’re trying to sleep;
  • They have a negative impact on you, your other staff and your bottom line; and
  • And did you know a bad hire costs at least 15X their salary in lost productivity?

By the way, there are usually warning signs when staff goes “bad”:

  • They become moody
  • Treat other members badly
  • Don’t care anymore
  • Bad attitude
  • Excessive time off
  • Come in late and/or leave early
  • Don’t participate or contribute

That is a problem that is not going away so do everyone a favor and take care of it sooner rather than later.

So your new motto is…..  Hire Slow – Fire Fast

The point is to take more time at the beginning to choose the right team players so you save a lot of time and grief at the end trying to deal with a toxic staff person who is just not cutting it and help your practice in running smoothly.

And, be sure you have the right people doing the right jobs.

There is a saying in business,

“Get the right people on the bus and then get them in the right seats”

For example, certain staff should be on the front lines because they have excellent people skills and other staff have analytical skills and are better suited behind the scenes.

And here’s another mind shift change….

View staff as an asset vs. a liability.

The team supporting you IS your secret practice-building weapon when it comes to patient-relations since they spend more time with your patients than you do.

Staff can make or break your cosmetic practice so be sure you have the right people representing you. 

They are your leverage.

You can’t do it all alone, nor should you want to.

When you hire the right people, give them the right tools and hold them accountable, they handle the majority of the practice so you don’t have to.

And that leads us to ……

Where do you Find Rock Stars?

Start with people your staff knows. Your staff knows you and the practice and they know who would fit well with the rest of the staff and they also know they have to vouch for and work with this person so they will be careful to choose someone who will make them look good for a smooth-running practice.

But here’s the pearl – offer a bounty but spread it out.

That will motivate them even more to be sure they bring you the best talent and that they succeed.

Then if you’ve exhausted your staff’s contacts, put the word out on social media to your followers. They can cast a wide net by sharing your “help wanted” post.

Then ask your vendors since they are “feet on the street” and they know which practices are closing, moving, and so on.

Then look to your own service providers like the receptionist who works at the high-end hair salon you get your hair cut or the friendly sales staff who help you pick out new clothes.

And keep your eyes open when you are at 5-star restaurants or your country club. Those employees already have the customer-service mindset and could be a great fit for your practice.

Lastly, cast a wider net by Advertising on, Indeed, and

You’re doing this to prove to yourself that there is no shortage of talent out there so you don’t have to take just anyone. Be selective.

When interviewing, use a list of questions to help you determine how articulate, confidant and assertive they are as well as where they see themselves going in life.  

You’ll also use their answers to see how consistent they are when you talk with them in person……..should they get that far.

As a side note, you want to Google them to check out their social media to see how they represent themselves online.

If they do well on the phone interview, do a 2nd interview via Facetime and ask more questions. You are checking out their demeanor, how articulate they are, if they show up on time, etc.

If all goes well, have them come in for a live interview. You want to follow up with questions that start with “What” and “How” and “Tell Me More”.

For example, if they have experience in our industry, ask:

  • What did you do to help promote the practice?
  • How did you grow patient retention?
  • Tell me more about whatever else they bragged about doing at their last job.

By the way, here are some red flags to watch for when you’re interviewing someone:

  1. They blame, criticize and make excuses for their failures
  2. Cannot explain job moves
  3. Speaks badly of past bosses

So, if you are feeling good about them, have them spend time with your staff so you can then compare notes since you will all have different perspectives.

Then sleep on it. And if you believe this is your new a-player, then have them come back again and preferably at lunch hour with you and your team so you can see how they act in a more relaxed atmosphere. Either go out to lunch and see how they act towards the wait staff, or have lunch brought in and see how they act in general.

Success Principle #2:

Strategic Marketing & Planning

Now we’ll move on to Strategic Marketing & Planning where you will discover…

  • What the most successful smooth-running practices focus on to gain market share;
  • How to increase your revenues by up to 33%;
  • How to set up a SYSTEM for creating a powerful 12-month marketing plan to Predictably and Reliably keep a steady stream of patients coming to you;
  • Increase your average patient’s lifetime value so that EVERY patient is worth more to you…today, tomorrow and far into the future; and
  • Generate more referrals for your smooth-running practice without hoping, guessing or waiting for your patients to “mention your name” because you’ll have a system to make referrals happen like clockwork.

You are painfully aware of how the relentless competition is making it more difficult for you to succeed so you need to approach patient attraction more strategically.

You stop for a minute and think this through before you keep throwing money at the problem because here’s a quote that says it all:

“The key to success is not doing more it’s doing more of what works”

Please don’t take that lightly. I watch so many non-smooth-running practices go from one shiny object to the next, hoping that will solve their problems. They throw money at all sorts of Internet, advertising and marketing companies who promise them the world but then don’t deliver and now they don’t trust anybody and are skeptical.

Let me give you another easier way to figure this out…

Be strategic by focusing on increasing the 5 Key Metrics that grow a cosmetic practice and those are:

  • # of Leads
  • # of Appointments
  • # of Consultations
  • # of Conversions
  • # of Retention

Here’s the point… You may be focused on the wrong thing, such as more new leads.

Please remember – leads are only 1 part of it.

That means a lead is just a lead until you get them through your processes to a YES. Otherwise it’s a dead lead going nowhere. Which means you are just burning money on lead generation and NOT conversion and retention.

Before you invest in any more new patient-attraction shiny objects, plug up the holes in your systems that are costing you a silent fortune. That’s where you’ll see new profits more quickly and easily.

It’s quality over quantity, which means you do less but get a better result because you slow down and go deeper into the numbers that are telling you the truth.

So, Let’s go over each metric and start with the one you like the most… the # of Leads.

I know you want more patients so that means you need to increase the # of leads coming to your practice so the question becomes…..

Where are the new patients?

The answer is they are everywhere and nowhere.

Prospective cosmetic patients are clicking around like crazy so you have a nano second to catch their attention long enough for them to stop – notice and click on your website.

Here are some suggestions….

For the foreseeable future, Google rules the world so do what they like and you’ll have a better chance of get ranked over your competitors.

In a nutshell, Google likes fresh new content, before/after photos and lots and lots of reviews particularly on Google.

Google also want you to “pay to play” you’re found in the search rankings, but the downside is Google Adwords  can cost you a fortune so you need to work with someone who knows what they’re doing.

So here’s my advice: I would have a new rule anytime you are considering any kind of advertising or marketing effort and that is:

If you can’t track it, don’t invest in it.

It’s too expensive and it’s too easy with today’s technology to track so you no longer have to guess at your marketing’s effectiveness.

Here’s another easier and faster approach to growing your practice:

Follow your successes.  

This is so obvious; it’s easily missed. It’s also a more positive way to look at your practice because this is where all of your hard work paid off and where patients chose you and gave you money so you want more of them.

As Peter Drucker, the guru of business said quite succinctly:

“The Purpose of Business is To Create AND Keep a customer”

Here’s an exercise to help you identify your successes:

Go through your schedule and note at least the last 40 surgeries or big-ticket procedures you performed.

You want to know how they heard about you.

  • Did they find you on the Internet randomly?
  • Were they referred to you by a friend?
  • Or were they a current patient coming back for more?

You also want to note the procedure they had as well as the demographics such as age and zip code because you will see trends that you’ll want to capitalize on and budget proportionately to those successes.

Once you decide who your preferred patients are, you map out a Marketing Mix plan to reach new Internet stranger patients as well as a plan to encourage your current patients to return for more and refer more of their friends.

You do this with a marketing mix plan:

You set up a system to get found on the internet by stranger patients using SEO & content, before/after photos and patient reviews AND you also set up a system for your current patients to return and refer their friends using text, email, social media and word-of-mouth referrals.

#2 metrics is the # of Appointments

You can get leads all day but can your receptionist convert them to a scheduled appointment with you?

In a nutshell, here are the 5 phone fixes that make all the difference in your receptionist being able to book a caller to an appointment:

  • Answer the phone within 2 rings with a friendly, warm voice & greeting
  • Ask How They Heard About You
  • Promote you, the Surgeon, as the best choice
  • ASK for the Appointment
  • Collect Contact Info

Please be sure you have the right person representing you on the phones and check out my Phone Club if they need training.

Then #3 metric is the # of Consultations

How many of the prospective patients who book an appointment actually shows up?

You and your patient coordinator block time for a consultation, and if your prospective patients are not showing up for their appointments, your valuable time is wasted not to mention the wasted time and money because now your staff is standing around.

So, here’s what you do. First, you establish a cancellation policy and then live by it. For example, you get their credit card upfront and either a charge a consultation fee or at least charge a reservation fee that is charged ONLY if they do not cancel or reschedule within 48 hours.

You also have your patient coordinator conduct a pre-consult call to introduce herself and to prepare the patient to show up ready to say yes.

This pre-consult call will help you get to a yes at the consult and eliminate no-shows.  

#4 metric is # of Converted Consultations

How well do you and your patient coordinator convert consultations into procedures? Everything that happened until this point is just “pre-marketing”.

You don’t get paid for consultations. You only get paid if you can successfully convert a consultation into a paid procedure. Therefore, THIS step has the biggest impact on your bottom line. The better you convert consultations into procedures, the more revenues you’ll make for your practice.

Here are strategies to help you convert:

Use video to give yourself celebrity status. Psychologically, your image is enhanced when prospective patients see you on a screen no matter what size.

Shoot a “welcome to my practice” video as well as procedural videos and testimonial videos so patients get a feel for your expertise and are more comfortable with you and see you as the expert and best choice.

And then your patient coordinator must be trained to convert a consultation which is an entirely separate training but I will say the #1 skill I see coordinators are lacking in is in asking for the decision so please get them the scripts & structure they need and watch your conversions increase immediately. Check out my Converting Club at

#5 metric is Patient Retention

It’s 7X more expensive to attract a new patient than to keep a current patient so please take this metric as seriously as you do new leads.

Because if your patients are NOT returning and referring their friends, something is wrong. They are still getting aesthetic rejuvenation. They are just not getting it FROM YOU anymore so it would behoove you to figure this out.

You cater to a very hungry audience with endless needs. The patients who care about how they look and feel have all sorts of concerns you can address NOW AND for years to come thanks to the relentless aging process.

Cosmetic Patients enter your practice through many doors. That means a patient who came in for Botox will often work their way up the ladder to surgery or other big-ticket procedures and those who came in for surgery are much more likely to now be open to your non-surgical procedures and skin care treatments to stay looking good and feeling great.

You have so much leverage here because you already did the hard part, which was spending time, money, and effort attracting this patient to you. Now it takes only minimal effort to keep them coming back.

Now here’s Success Principle #3:

Set Standards so You Don’t Compete on Price

In this section, you’ll discover:

  • How to set standards so you are NOT competing on price
  • What you can do to be different and stand out from your competitors
  • How to get the patient to see you as the BEST choice

Here’s a popular question I get from surgeons:

Q:  “I am losing consultations to lower-priced competitors even though I have more skill and expertise than they do. I’ve even “repaired” their work. How should I be pricing my services to compete?  I don’t want to lower my prices because I know I’m good but I also don’t want to miss out on new patients.”

 One of the reasons this happens is because if the cosmetic patient truly believes there is no difference between other physicians and surgeons, all they have to go on is price as their determining factor. But we know there’s way more to it.

If aesthetic rejuvenation was based solely on price, this would always be about the lowest price and that would turn into a race to the bottom and then nobody wins.

It’s only about price until YOU add in other determining factors to help the prospective patient consider the VALUE they get.

Patients Weigh Their Options

When a cosmetic patient questions your price, they are really doing a cost-benefit analysis in their heads and asking:

“What am I getting from you that I’m NOT getting from your competitor for that higher price?”

Patients select their surgeon based on the perception they are getting “better”. Better really equals more benefits, less risks and/or less hassle and that equals peace of mind, certainty and reassurance.

Actually, contrary to popular belief, the majority of cosmetic patients rarely decide based on price alone. Affordability – yes but price alone – rarely.

Pricing Starts with Your Own Mindset

Get very clear about your value and what you stand for.

Have conviction and believe in yourself and your prices.

If you believe you deserve top dollar because you do great work, then price your services for your “preferred” patients. Those are the patients who see you as a skilled, reputable plastic surgeon and they are glad to pay more for your expertise so they can be confident they’ll get a great result and then brag about you to their friends and family.

You determine what’s most important to those preferred patients and give it to them. For example, is it price, procedures, technology, innovation, expertise, credibility, status, convenience, quality and/or 5-star customer service?

And consistency is key. Your patients learn to trust your brand and expect the same experience and result – every time.

Focus on Preferred Patients

Once you have clarity about your preferred patients, you attract more of them and deter everyone else. Now you and your staff have more time and energy to focus on the serious prospective patients who are looking for quality and service more than saving a few dollars.

How To Differentiate Yourself in a Competitive Marketplace

It’s your responsibility to educate prospective patients so they see you as the BEST CHOICE at a FAIR price. That takes creativity. Here is a list of specific differentiators to consider:

  • Specialist in one procedure
  • Advanced/uncommon technology
  • Extensive experience
  • You are Board Certified
  • Attended top medical schools
  • Affiliated with top hospitals
  • Authored studies, white papers and clinical trials
  • You have performed thousands of procedures
  • You offer computer imaging when your competitors don’t
  • Exceptional facility with views
  • Superior results
  • Caring personality
  • WOW experience
  • You are the first to offer a new procedure
  • You are a media favorite
  • Your office setting is unique (Villa with views)
  • Convenience or accessibility
  • You personally call patients night of treatment/procedure
  • You make house calls
  • Waiting times are short
  • You remember patient names and details like they were family
  • Exceptionally friendly, professional and courteous staff
  • You ensure a pain-free treatment or procedure
  • You are well known around your community
  • You are an author of aesthetic book
  • You speak at medical conferences
  • You train other physicians
  • Vendors make you an elite top tiered practice
  • You sit on vendor boards
  • You are well known in social media with a huge following
  • You are from the town you practice in
  • You have special credentials
  • You belong to many professional membership societies
  • You offer easy pay plans
  • You include post-op care in your fees
  • You have longer hours
  • More patient online reviews
  • More before/after photos
  • You offer virtual consulting

Come up with your own list and be sure your unique points are integrated into every aspect of the patient experience including your in-house signage, patient welcome package, advertising, public relations, on-hold messaging and new patient calls scripting.

This exercise will not only help YOU get clear about your value, but it will also give your prospective patients clarity about why you charge what you charge.  They now understand your value and are more than willing to pay for it.

Success Principle #4:


You know you’re doing a good job leading when your practice is running smoothly and your staff is working well together. You have peace of mind it’s running like a well-oiled machine with or without you there.

However, if you feel frustrated like you have to do everything yourself or you feel the need to micro-manage to ensure what you think is getting done is actually getting done, that’s a red flag.

Because if you feel like nobody cares about your practice like you do, that could mean you did NOT:

  • Hire the right people
  • Give them the right tools they need to succeed
  • And/or you’re not holding them accountable

The reality is you simply cannot build a successful practice by yourself. 

You’ve got to have a team supporting you.

Leadership Concepts

This is a big topic so here are the basics and then I urge you to become a student of leadership.

A leader is not born. Like anything else in life, you become a great leader from learning and doing and practicing and getting good at it (just like you did to become a great surgeon).

So, to begin, a good leader is clear about their vision.

Decide now what your vision is. Know thyself.  

Are you building an empire or a lifestyle?

You need to know that because it will affect every decision you make.

Then be sure the staff knows your vision so they perform at a high level because they have clarity and know the end result you’re striving for.

For example:

“You are in the business to make money helping patients look and feel great about themselves.  This allows you to pay your staff well so they continue to enjoy their own lives.”

You may even consider adding a bigger vision. For example, you give a % of your revenues to a philanthropic cause you feel strongly about.

That way, you have a bigger “why” which helps when determining the How and the What to do to grow your practice.  Because staff works harder, longer and more seriously when they have a bigger Why.

It’s also nice to give back to the less fortunate and do good in the world.

Now you need a mission statement that acts as your “Rules of Conduct”.

A really good exercise for your team is to develop a new mission statement you all can get behind and live by. For example:

“We strive to add joy to our patients’ lives through genuine caring,
generosity of spirit, and the quality of our work.”

A good leader also takes good care of his team so they take great care of the patients.

That means you are genuinely interested in them as people first, then as staff.

Show interest in their lives and families and what’s important to them. Catch them doing things right and thank them often.

A good leader communicates the culture of the practice. For example:

“We are in business to make money and we do that by taking care of our team so our team takes care of our patients.

We do not say no to patients who give us money – we make time for them because that’s how we get paid.

We treat every patient the same with kindness and respect. Always with a smile – no matter how many patients or how crazy it is at times.

We acknowledge every referral with a heart-felt thank you and so on…”

And a good leader makes sure the entire group plans as a team, wins as a team and celebrates as a team.

They also give credit for their success to their team knowing it would not have been possible without them.

A good leader gives the staff solid goals they can work towards and have something to strive for that is concrete.

A good leader meets with the team, listens and gets feedback from the team, and lets them brainstorm how they will meet the goals. 

A good leader then holds them accountable without micromanaging.

And, team meetings are a must when you run your practice like a business.  Hold your meetings on the same day and time so nobody can say they didn’t know about it. It’s always on the calendar and stick to it for consistency.

This is true team-building and keeps everybody engaged and interacting with the success of the practice.

The agenda of the meeting should be structured and fast-paced with everyone participating by reporting on the numbers they are in charge of. For example:

  • # Calls
  • # Email Requests
  • # Appointments
  • # No-Shows
  • # Consultations
  • # Procedures
  • # Post-Op Appointments  
  • # Referrals
  • # Returns

Because you want to know at a glance, if you’re healthy or hurting and that’s easy to do when you regularly review your numbers.

Bonuses Based on Productivity

We can’t talk about goals without also talking about Perks. There are countless scenarios but here’s one that makes sense and keeps everyone working together as a team:

Break up staff into teams for each revenue stream such as:

Revenues Stream #1:  Surgery

Revenues Stream #2:  Lasers & Injectables

Revenues Stream #3:  Skin Care + Retail

Assign revenue goals or % of Increase over last year

Perks get bigger for everyone when each revenue stream reaches their goal. The teams will help each other out to reach their goals since the prize gets better; i.e.,

  • 1 team hits their goal   = lunch brought in for everyone
  • 2 teams hit their goals = spa day for everyone
  • 3 teams hit their goals = lunch out + shopping $ for everyone

And/or another Bonus Structure that works well is:

Gross Sales

  • COGS
  • O/H U

=    Profits of which % goes into a bonus pool and is distributed evenly among the team and/or based on part-time or full-time status.

So, you see how knowing your numbers gives all of you clarity and direction?

It makes it so much easier to identify what you are doing right to create a smooth-running practice and what else you could be doing when you have the numbers giving you an accurate story.

It’s also so much more motivating to staff when they know what they are striving for and why. 

Please spend some time customizing your own metrics and perks plan that would work best in your particular practice.


A good smooth-running practice business leader is always planning their exit to build a legacy and get their equity out so let’s talk about Profit Centers.

To recap, you’re doing it right when…

You have specific metrics in place so you are generating predictable and smooth-running income rather than checking your bank balance to see if there’s enough to pay the bills.

That means you have a reliable and smooth-running marketing plan as well as processes and systems in place so your smooth-running practice runs like a well-oiled machine and your staff knows exactly what to do whether you’re in the office or in surgery or on vacation.

The secret is to keep it simple so you and your staff will actually do it!


The reality is you can’t do it alone and you probably don’t want to be a 1-man show where you are the only revenue-generator for your smooth-running practice. That’s stressful!

When you smoothly run your practice like a business, the goal is to get to no more than 30% of your income coming from your own hands.

That’s how you set yourself up to grow and it allows for “life’s surprises”.

For example, I used to run a surgeon’s coaching club with an 8-figure surgeon and he got a phone call at 4:45 pm in the afternoon saying his house was on fire. By the time he got there, it was gone. Nobody got hurt but because he has his practice running so smoothly, it was a distraction rather than devastation.

Here is a simple exercise to get you thinking:

What is Your Per Hour Rate when you are in surgery? $800 – $1,000

What is an RN’s Per Hour Rate? $350 –  $500

And what is an aesthetician? $50 –  $150

+ Cost of Materials

+ Amount of time to do procedure/tie up room

Here’s a thought:  Would it make more sense to network with aestheticians in the community who could refer to you vs. having in-house aestheticians tying up an exam room for $100/hour when getting another nurse injector could be more profitable?

And here are other questions to ask yourself:

  • What are the opportunity costs of you doing everything?
  • What COULD you be doing to make more hourly?

(Perhaps spending more time with high-revenue patients, following up personally, networking, answering questions on RealSelf, etc.)

Because sometimes, one of the smartest questions you can ask yourself is:

What are you going to stop DOING that is costing you time, money, effort & hassle?

However, there are 2 thoughts processes here when it comes to keeping or delegating injectables:

  • You like doing the injectables to bond with your patients or
  • You delegate them so you have more time to spend with the higher-revenue patients

There is no right answer. There is just a right answer for you so please think about what makes most sense for you.

Here is what I have seen work best in a solo practice:

Since surgery is the most profitable revenue stream,

You set up your other profit centers to feed the surgery.

The most popular revenue generators are:

Nurse injectors, laser technicians and aestheticians that can also perform high-ticket procedures and sell retail; however, they too need:

  • Goals
  • Tools
  • Accountability

For example, their goals are:

  • to take great care of patients
  • to give them the best result possible
  • to refer them to you, the surgeon, whenever an opportunity comes up to do so

Then give them tools to do just that.  For example,

  • Their treatment rooms should show off your excellent surgical work using signage and digital photo frames so the visiting patients ask about surgery.
  • Now your staff can hand them a VIP surgical comp card and set up a surgical consultation with you.
  • This provides the paper trail for accountability you need.

And you know for a fact, which staff members are promoting you or not.

  • However, they must know “what’s in if for them” to promote you because they don’t want to lose their patients to you especially if you have given them a revenue goal to hit, nor do you want to get into fee-splitting issues so what do you do?
  • You could increase their hourly fee when they prove to be a good referral source or give them a night out on the town or add more to their bonus.

The objective to make your practice smooth-running is to acknowledge and thank your revenue-generators for their commitment to the betterment of the entire practice – not just their piece of the practice.

What about Additional Profit Centers like Adding:

  • – Veins
  • – Hair Restoration
  • – Anti-Aging
  • – Dermatologist and so on?

TIP:  Hire SLOWLY because you can lose a ton of time and money on this.

Here are the criteria to help you determine if it’s a go/no-go:

  • Do they fit your culture and have the same values?
  • Is their profitability at least 10-15%?
  • Do they act as a feeder to your ultimate goal, which is surgery?
  • Do you have to buy equipment and, if so, does it pay for itself within 2 years because technology will NOT drive your practice – people do?
  • How much of YOUR time is going to be involved?
  • Can you systemize it?
  • What’s the competition like?
  • How much is it going to cost for you to promote this new service in your marketplace?
  • Is this a distraction taking away from more profitable revenue generators?
  • Do you like the “Business Side” of practicing; i.e., meeting with accountants, lawyers and consultants?
  • Are you bringing them on as a partner or will you be the benevolent dictator until they buy in to succeed you?
  • Do you enjoy solving problems to make a smooth-running practice?
  • Do you enjoy managing people and maximizing human potential?

If not, bigger is not always better.

But if you decide to move forward, you need accurate cost accounting for each revenue stream so your books MUST BE in order.

Otherwise, you will never truly know if it’s profitable or if it should be dropped.


You can never be 100% sure that you are foolproof but here are tips to help:

  • Sloppy systems open you up to trouble.
  • Don’t tempt anyone.
  • Tighten up your processes so they know you are on your game and watching.

To keep track of non-surgical monies, use a control document Day Sheet that is multi-carbon pages and numbered.

  • Staff makes out the day sheet the night before so all of the patients’ names are on there already;
  • I sheet goes into a 1-way box that night so staff can’t take a cash-patient’s name off of it;
  • 1 goes into the box with the cash and 2 people have to sign the envelope;
  • and 1 is given to the patient.

You also:

  • Keep a laser logbook to know how many pulses were used
  • Keep a Botox log for how many units were used and for whom
  • Keep a skin care retail products inventory log
  • And outsource all insurance billing

The easiest thing you can do to avoid problems is for you, the surgeon, to personally open all bank and credit card statements to review all debits and checks issued to be sure they make sense.

You then use a red pen and circle questions you have for your bookkeeper so they know you are watching closely.

And, always match disbursements with checks and transfers. Then put the statement back into the envelope, write reviewed by with your initials and off it goes to your bookkeeper.

This takes 10 minutes and can avoid massive grief down the road.


It has been said the only reason to have a business/practice is to grow and sell it.

So, the question is… What is my practice worth? 

This is tricky because you want to get paid for the risk and effort it took for you to build a name for yourself and your smooth-running practice. For the blood, sweat, tears and goodwill that went into building your practice as well as your reputation.

But that’s intangible which makes it difficult to put a price on it.

So, you turn to tangible and financial assets such as the office building if you bought it, the equipment, the furniture, inventory, A/R if any MINUS the liabilities such as payroll taxes, loans, and retirement plan contributions.

There’s a lot more that goes into this but I’ll leave that for the lawyers and accountants.

Here’s a more practical way to look at it from a business point of view:

“You, the seller has a ready-made income stream to sell. The buyer is looking for a ready-made income stream to buy. In business, that is what value is all about.”

But here’s the reality when it’s all said and done…

The bottom line is your practice is worth whatever someone else is willing to pay for it.

So, think about it. What would YOU be willing to pay for if YOU were going to buy someone else’s practice?

That brings us back to the assets I mentioned early on:

  • The Profit
  • People
  • Processes
  • Tools
  • Patient List
  • P&L Statements
  • Vendor Agreements are all of value BUT in order to present these assets to a potential buyer,

You have to have your act together.

The buyer is looking for an asset’s ability to generate cash with a degree of certainty and limited risk so you need to show a prospective buyer how you have built a cash cow.

You do that with a Cosmetic Patient Blueprint so they see how you keep a steady stream of patients and revenue coming in.

And you show them your systems and processes that keep your office running smoothly and your staff on their game.

And you show them your constant review of your smooth-running metrics to show the health of your well-oiled machine.

Then you show them your clean and organized books and that includes not overextending yourself with too much debt since there is a big difference between income and actual profits of your smooth-running practice.

And there you have it.

The 4 Core Success Principles for running your practice like a business:

  • Build a Team of Rock Stars
  • Strategic Marketing and Planning
  • Setting Standards so You Don’t Compete on Price and that includes Differentiating Yourself from Your Competitors and
  • Setting Yourself Up to Grow and/or Exit when you’re Ready
    (and that includes Leadership Skills and Managing Metrics)

I covered a lot here and there is much more to each principle but you have plenty to start with.

Of course, please call or text me if you need clarity

Catherine Maley, MBA • Author, Your Aesthetic Practice • Cosmetic Patient Attraction AND Conversion Specialist

[email protected]

Cell/Text:  (415) 377-8700

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Picture of Catherine Maley

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.


Beauty and the Biz is for Plastic Surgeons who know they don’t know everything and are open to discovering the pearls to grow and scale a sellable asset when they’re ready to exit.

Listen in as Catherine interviews surgeons who talk about the business and marketing side of plastic surgery and listen to Catherine’s pearls from consulting with plastic surgeons since Year 2000.



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