What motivates someone wanting to become their own boss?  Well, what if you discovered you were being paid 6 figures LESS a year than your less experienced counterparts?  That’s exactly what happened with Dr. Lanna Cheuck, a board certified urological surgeon.  

But now she has the last laugh launching 3 successful ventures, acting as the CEO of Lanna Aesthetics, the CEO of FACE Training Center, and the CEO of FACE Med Store.  You will discover how she grew her med spa during the pandemic., as well as launched a company training other physicians on procedures to help grow their aesthetic practice, all while taking care of a child with special needs. 

Become inspired on how she overcame an unfair gender pay gap, to now owning and operating multiple 7 figure businesses!

Dr. Lanna Cheuck’s LinkTree
https://linktr.ee/doctorlanna

Transcript:

Dr. Mike: Hey guys, this is Dr. Mike. Woo-Ming! Welcome to another edition of Bootstrap MD. Recently, I have been interviewing a lot of the med spa owners, the influencers in this industry. And even if you’re not in this industry, maybe you’re looking into private practice or setting up doing cash based practice.

What I’ve been hearing from my listeners is that really getting a lot out of it. And I think this interview you could definitely will benefit as well. I’ve known her off and on for the last few years we’ve texted, but this is the first time I’m actually gonna be meaning her face to face.

She currently owns and operates LC Medical, which is her own med spa located in the heart of Midtown Manhattan. She runs face med spa training in her Manhattan location for professionals, medical professionals who wanna learn more. Facial aesthetic injections. She’s a co-founder of Face Medical Supply, which is an online medical store, specializing in distribution of select equipment and supplies for medical facilities.

I know I’ve ordered from them. She produces content through various online platforms, YouTube and Instagram. She’s a board certified uro urologic surgeon, fellow of the American college of surgeon with a holistic approach whose principles intertwined with the body healing itself. She’s affiliated with NYC health and the hospital system.

She’s got a lot of academics, a lot of credentials, but what I’ve known, just been texting he’s really cool. And I wanted to get her insight about this kind of crazy world about the medical spot industry so Lanna, thank you for joining us on the call

Lanna Cheuck: Absolutely. Mike, I’m so excited to meet you, like you said, face to face virtually because we’ve known of each other and you always have these great business pearls. And we have this big Facebook group, for physicians that are interested in aesthetics. So it’s really nice to see your face and be on your podcast.

Dr. Mike: Yeah. I really enjoy enjoyed that Facebook group. And it’s also good to vent sometimes when you’re dealing with that one patient or just to get some some inspiration about what are some things that we could do, different treatments that we perform, et cetera. So let’s talk about your journey. You went to medical school and you graduated as a urologic surgeon. Yeah. Did you start off saying this is the route you wanna go to? How did it all work for

Lanna Cheuck: yeah, so great question. So I. Always wanna be a urologic surgeon. And I went to med school to become a urologist and not a lot of people, know about your, what urology is, but I was exposed to it early on.

And so I said, you know what, this is what I wanna do. It’s super cool. We’re able to diagnose all of these cancers and all these scopes and then robotics came about. S, it’s like, cutting edge technology. And and that’s what I wanted to do. I went to I’m a do I went to school at NYCOM, which is New York College of Osteopathic Medicine.

And then I got into Brownright university, which is typically not do friendly, but I got into brown. For my urology residence, C and then I did five years there and then I did a, an extra hair fellowship in robotics. And so you’re like, you’re thinking, “okay. So this person is like super highly trained and like robotic and advanced lap endo urology. How does she get into aesthetics?” And I gotta tell you it’s like a torturous road that I’ve been down. I feel like everything in medicine and Mike, I’m sure you. Relate as well. You find your passion and then it’s okay. Later on in life to find another passion. And so specifically, my story is such that, and I started to realize that I was not being valued as my male counterparts in my program, I’m an academic urologist. I work in a huge hospital system. And what I realized was that I wasn’t valued. And how do I realize that?

So the admin pay obviously was a big discrepancy. I was paid six figures less than my male cohorts. I trained in urology, or I helped train in urology for robotics. He was offered.$75,000 more than what I was getting paid as a starting salary, and then I spoke to my chairman. And I in the administration, I said, “I’ve been here for five years. I work really hard. And let me tell you, when I say I work really hard, I never took a vacation. Never took a vacation in five years. Anytime I thought I would take a vacation, I would stay home.”

And then there was a patient that needed to be operated on emergency, and guess what? I would come in and operate on that patient. Cause I thought that’s what, this is all of that. And you give up your life for your work and to be a physician and especially to be a surgical subspecialist in a male dominated field, like urology.

I went to my chairman and I said, I would like a raise. I’ve been here for however long. And I work really hard and I’m like probably the top three producers. Because obviously you gotta show them the money, top three producers in my practice, that procedures. Yep. And residents love me.

I love teaching. And he said to me “if you can show me that another institution is willing to pay you more, then maybe I’ll match them.” Okay. A few weeks later, I got an offer from another academic institution asking me to be their program director for urology. And that’s very big in academics as yeah, sure. And and they were willing to pay me about 175,000 more than when I was getting paid there. And I don’t like talking about money, but just to, have people understand we’re not just talking about, a couple of dollars here. Listen we’re altruistic. We don’t technically care about money, but we need to make a living and we’re all in a lot of debt.

And to hear somebody else who you’ve helped train is coming in with more money than what you’re being valued at. It makes you feel a certain type of way. So I showed him, my offer letter. And, you know what he said. He said, you know what? I don’t think I can ever match that.

You should just go, you should just go and get a job there. And that’s when I realized I was not valued. Yeah. At the same time, I had a child and she was born prematurely, cuz I was operating so much. I was told to go on bed with, but as physicians who were terrible patients, I said, and so I said “let me just keep working through this. I think I’m okay.” But at 30 weeks I, I delivered through an emergency section and oh, I bled and everything. And I was I was out for a while. I was out for about six months, and then coming back into it.

I think my perspective changed, and so when you have a child with special needs, cuz that’s what my daughter has. She was born blind and she’s autistic and she was born a preemie. I think you figure out in life, things that you need to prioritize and things change.

And so I said to myself, if I was ever to be there for my daughter and build, something sustainable for her and be financially independent, it’s not gonna be working, at the hospital getting paid, and starting salary basically after five years. And there’s really nothing to leap behind us, like a legacy.

And that’s when I started thinking about entrepreneurship and what I could do. And so I moved into the field of aesthetics and I know it was a long, answer to what you asked, but that’s actually how I started. And I’m gonna tell you another quick thing. A little bit of juicy gossip, but I asked my chairman if I can do aesthetics on the sun.

And he said, yes, but then as I started to get bigger, and people were talking, he told me I had to stop and I didn’t want to stop. So I was actually forced to leave. I was basically forced to resign. And so basically at eight months pregnant with my second child, I was pretty much fired from the hospital.

Dr. Mike: Yeah. There’s so much to digest there, but your story is very, very similar to mine. I was in primary care at a son who’s autistic. And this is. I’m a little bit older than you, but this is like the early two thousands. When autism wasn’t that vogue, they weren’t making TV shows around, people with autism.

Lanna Cheuck: Yeah. Didn’t really know what it was and,

Dr. Mike: And I was the same thing. I was a yes, man, just said yes to everything and wanted to just reduce my patient hours or, my, my clinical time and basically was told, no, he can’t do it. I was like then I need to do something else because you don’t have my best interest. So it’s not really always about the money. It’s about, being there for your family and what are we all doing this for? So I commend you for taking a kind of taking a stand and doing that, but yeah, very similar.

Lanna Cheuck: Thank you. I didn’t realize that value.

Dr. Mike: Yeah. Yeah. Yeah. So let’s talk about the aesthetics. How did you like when you really don’t think of aesthetics when you’re in a urology practice or right. Or maybe you how did that actually connect?

Lanna Cheuck: We can’t make genitalia very pretty but it connected because my father owns a spa in the city, like a regular, non-medical spa. And I just thought how cool would it be for me to get into it? And not a lot of people know this, but I actually sold Rodan fields, which is skincare. And, it’s gotten a bad rap and whatever, but what I realized was that if I was passionate about something and I cared about something and other people were passionate and cared that I felt like I was helping people in that realm.

So I’m thinking as a physician surgeon, I’m able to actually do procedures to help people look and feel more confident. It’s all about confidence, right? We’re doing this because we wanna get to the core emotion of why people want to look and feel better. So a lot of it is confidence.

And I get a lot of people who, this too coming in after divorce, after breakup, right after a death in the family, and they just wanna feel better about themselves. They just wanna look in the mirror and say, you know what? I wanna remember what I looked like before all this stress and all this, all this sadness.

So I think that, you know what we do, we offer people a lot of that confidence building and make them feel really good and special when they come to see us. And it’s really. All about that. It’s you’re being your own entrepreneur. I love talking to people. I love making people happy probably to my detriment.

‘ We’re like people pleasers I’m sure. And that’s what makes us really good, with our patient care because they trust us and they trust us to help them look the best possible. So it was really just to like a roundabout way of me saying, what. Let me get into this a little bit, because I did the skincare part of it.

But I wanted something more because I’m a surgeon. So I like doing things. I like using my hands and I’m very artistic and this was the only way that for me, I could still be artistic, give value to patients and and to make a living and to be my own CEO. That was.

The most, the best part was like, Ooh, I can make my own hours. Little did I know that being your own CEO and having your own business means that you’re working 24 hours a day. That’s right, and you’re like, wait, I didn’t understand this. That’s, but’s different. It’s different when you work for yourself than when you’re working constantly for somebody else, right?

Dr. Mike: Yeah. Yeah. And. And you can still love and hate your boss too. I do that on a regular basis too. Exactly. I love hearing I always like hearing the stories about like how you started up your practice. For like myself, I self-funded my clinic and my first practice.

I had it where it was over a garage that when it opened, it was such a creaky garage. We would have to wait to take vitals because it was so loud, but rent was cheap and I was trying to self fund everything. Do you have any kind of like, how did you get started with your first practice? Was everything smooth sailing at the beginning? Or did you have some growing pain?

Lanna Cheuck: I feel like no matter where you are at the stage of entrepreneurship, you’re always struggling. There’s always like ups and downs. I started out with a very small almost like a closet size room and I had bought a cool sculpting machine. So big mistake, number one, to buy big equipment. Without even knowing if you’re gonna have people come through the door. Luckily, I was in an environment of a spa people come, they get their massages, they get, their facials and things like that. I thought that it would be an easy sell. I don’t even need to be there. I’ll just put a cool sculpting machine in and my estheticians will see the patients and bring them in.

Dr. Mike: No, maybe that’s the rep said, I think the rep said that to you.

Lanna Cheuck: Yes, for sure. Oh, you just need a hundred thousand patients and you’ll be fine, and, oh, that’s easy. No, it’s five years later. We just finished paying off the machine. Five years. So yeah, for sure. I, worked, I remember one time it was like nine o’clock at night. I had one patient to see me. I got there, I had my children and I left the nanny there and I drove all the way downtown, in New York City. And I was living at Harlem at the time and I just sat there waiting for this patient and just literally about to cry. Like, why am I here? Waiting for this patient and the patient didn’t show up by the way. So like my one patient. And let me tell you, when I had five patients a week, I was like, I made it.

I’m like amazing. Like I have five patients this week. I’m like so big, in my mind I was like, this is what it takes. And in my mind, like having five patients to me was a success, which, was like a low barometer, but… That’s when I knew things were gonna grow, but the real honest truth is, and then I worked at a gym here’s the gym and here’s a room for me.

And it was just me and one other person. And we kept really small. Didn’t do any advertising, no marketing, nothing, all word of mouth. That was it, all word of mouth. And then I grew, I grew slowly and then pandemic. I don’t know how it was for you, Mike, but when pandemic hit I took a chance.

I had a gamble because I’m in New York City, the hub of COVID and death, I’m in a hospital system where there were four trucks for, the corpse there, were, we had no place to put them. So I had a lot of content that I never got out there because I also train. Okay.

So I trained five years ago. So you may think, okay, let me get this straight. You opened up five years ago and you started training five years ago as a surgeon. That’s what we do. You learn one, you do one and you teach one.

And I taught anatomy in, in medical school and got a full scholarship. So like I knew my anatomy and I’m very confident in the procedurals and using my hands. So yeah, so that’s when pandemic, hit, it was like, all right, everyone shut down in New York, we were mandated to shut down.

These are elective procedures. I’m sorry, I can’t do your Botox. People are dying in the hospital, but I took a gamble and I started posting Mike. I posted on my Instagram. Three times a day for the whole three months, plus that we were mandated to close. And like the height of COVID where nobody knows what was going on and everyone thought they were gonna die.

I posted three times a day and I posted all my aesthetic procedures. And you would think that’s a gamble because people are dying and they’re gonna look at you and you’re posting about Botox and fillers. And what are you doing? People are gonna be upset with you because you’re being so insensitive. But actually it was the opposite. No people wanted to see something else that made them happy.

They needed. They needed distraction. And the other thing too, was they, everybody was on zoom, everybody. On, started to go on social media more and they wanted to look good.

Filters started to come into play. Everyone’s they’re trying to meet, their mate, like through the Instagram or through these, apps because, they were lonely and they were quarantining and whatnot. And so they wanted to look their best. When COVID happened and we had to shut down, I actually had a list like a three to four month wait list of patients that wanted to book with me.

And these are new patients have never seen me before wanted something for themselves and was begging me to open. And I didn’t, I did not open. But when I opened, that was the start of the floodgates and that’s how I grew during pandemic.

Dr. Mike: That’s great. That’s great. I like how you did it. Just other owners were saying, Hey, woe is me. Why did all this happen? But you directed yourself to like saying, “Hey, what can I do right now?” That might have an impact. And if it doesn’t then, so what then that’s it. But you decided to do it. And you found out, Hey, gradually, through social media, I’m gonna start getting a following.

Awesome. Awesome that you’re able to do that. Now, someone listening to this, we’ve got a few people who I hear from them. They wanna start a med spa. They’re tired, work in the hospital, or wanna do something else. And, a Botox somewhere in around the world, someone is teaching Botox this weekend, right?

Lanna Cheuck: Everyone is teaching Botox. everybody is, I’m glad I got into it like five years ago. And it was just really, getting off the ground. But yeah.

Dr. Mike: What is it like that, what do you think are the the biggest, how long? How will, how long have you had your med spa now?

Lanna Cheuck: It’s been… I started out in 2018, so about five years.

But I was part-time until last year

Dr. Mike: Parttime until last year. Yes. Yes. Very full time, right? Yes. With staff and everything. What are, what is maybe the two or three biggest lessons that you’ve learned since you’ve had it?

I’m sure there’s a lot of lessons, but what stand out to you?

Lanna Cheuck: So the three things I know you asked about three things number one is get good mentorship and good. Here’s the thing. When people are getting into it, they don’t know all the dangers. That can happen with this medical procedure. They think it’s just fun and gains, but it’s not. That’s why it’s great to go to a physician who, has taken all these courses, anatomy and really knows how to keep people safe.

It’s the Cowboys that are cowgirl Cowboys or people that don’t, they don’t understand all the danger that can happen with like occlusions and things like that, that come in. Number one, you gotta get good mentorship and good training. Okay. I didn’t, I did not get good training. To be honest, I took one of those like high volume and low.

Low barrier of entry to get in is basically a cheaper course, right? Where you don’t even get to touch a patient, you don’t really get to learn much. You learn some basics, which is fine. That’s great, but you’re not gonna get some hands on. You’re not really gonna learn. And to really learn, you gotta need to have, a prolonged program and have a mentor to go through everything.

So that’s number one, you gotta have good mentorship and you gotta have good training. Which is why we put together not only hands on training, but also, cadaver like an anatomical dissection course, along with the business that goes. I think number two is don’t go buy a big machine.

That’s like $250,000. You need to start slow,

Dr. Mike: Which have a high cost of disposable steel.

Lanna Cheuck: Exactly which you’re basically working for the company, it’s like you become employee of the company, just keep working for the company. But yeah. Keep your overhead low. You don’t need that much.

Number three, I would say, would be, marketing now. I haven’t paid for marketing until recently when I grew my team, but I grew my team from a one person show, which is me. And then I had on another person and now I have a team of 20 people. It’s much bigger team.

But with bigger teams comes more headaches, but that’s. That’s how it is when you scale. So I think those are the three take home questions. And then for somebody who’s already, someone listening to your podcast, Mike, who’s already in it, who’s already doing it.

What kind of advice can I give them? So the one thing that I would say for those kind of, entrepreneurs would be, if you think like a solo, small business entrepreneur, right there, there’s a glass ceiling. And you can make good money, but you are always gonna be limited.

Because you are one provider and everything’s artistic and everybody wants to come to you. So if you wanna scale and you wanna build, you gotta number one, build a, a good brand, because brand is what made Kim Kardashians so big. You gotta build your brand. And then, going, moving forward, think about ways of how you can scale to big business, and de and not having the founder. Of the business really be the main operator of the business, meaning the injector, right? You gotta get a team of people that are amazing. So you gotta get good staff and you gotta get your patients to trust your staff so that you can actually run the show. And you can scale whether it’s joint ventures, franchising, licensing, whatever you do you gotta get everything in order.

Have a good centralized system. You gotta have your systems in place before you.

Dr. Mike: Yeah. One hundred percent. I’m talking with you right now because I have injectors working for me right now. And, SOPs are so important at the end of the day. It’s all about systematizing.

If you’re spending all the time training. You’re the one actually training, we know how tough hiring is and firing can be yeah. Get things in place. Have the nurse create videos of what she does for the day. And so you don’t have to do that. And now you’ve got some procedures in place, so that’s just gonna make everything a lot easier.

It’s not in all, roses every day as we know, but the more that you systematize, it actually will be more attractive to you when you actually. Whether you’re gonna sell your business, whatever you want to do, expand, it’s giving you so much easier when you’re building your next location.

So what is the plan for you at LC Medical?

Lanna Cheuck: Yeah. So right now what I’ve been doing is I’ve been really focused on training. For 20, 23. And the reason is because I really love to train. And I, our team, we, so I have a nurse practitioner, a PA, RN, and they all train with me and it’s fun.

It’s like breaking up the monotony of injecting every day to meet other. Like-minded injectors who are flying in from all over, just to see your techniques and just to shadow you. One of the things that my, you know, injectors and I’ve trained, probably like over a thousand people by now, but I’ve trained so many people in the last five years.

The question always becomes, Hey, is there a mentorship program? S there like a business course? Can I, how can I just shadow you so I can learn the business? How you do your consultation, how do get people through the door, how do you make them trust you?

How do you build credibility and authority, in, in your injections? So that’s why we came up with our business course with our anatomical dissection course, because as as someone who was an anatomist, in medical school, I do think it’s really important for everybody to understand, all the potential complications that you can have just by not knowing your anatomy. And that also gives you more confidence to know that you’re doing really well. So we have, this celebrity, like dermatologist who created this huge program called the aesthetic Institute a skin Institute from.

Australia, we’re flying him in to come and do the cadaver course. He runs cadaver courses all over Europe, Asia, India, everywhere that you can think of. He’s like the guy and he like teaches all plastic surgeons and dermatologists. We’re getting him to come. We’ve got facial plastic surgeons, microvascular surgeons.

We’ve got myself, we’ve got Dr. Hardik, Sony. So we’ve got, this great team of people to come to talk to, to teach about all the anatomy that you need to know. We now have these amazing digital courses everything that you need to know. Mike, I love to show you some of it because it is, it’s really amazing.

There really is nothing like these digital courses that I’ve seen before, because it not only integrates like all the didactic stuff, but it shows you models, diagrams. It shows you cadaver live dissection, live injections, everything. In one place and all the potential complications, listing them out, showing you what to do and all these protocols and also with dissections as well.

So you can see if you’re injecting nasal lab folds. What are, where’s the paraform aperture, like all these things that you don’t see on any other digital platform it’s there. So digital platform training programs, business cadaver, and then also expansion, right? So we have local expansion we’ve already expanded into New Jersey.

So I think the next step is just to really build our teams in regional and other places.

Dr. Mike: All right. All right. And come to west coast too.

Lanna Cheuck: Sometime we gotta meet in San Diego. So yeah, we gotta meet. I think LA is probably like where most of my people are always asking like, Hey, when you come to LA. Yeah. But love San Diego.

Dr. Mike: Yeah. For sure. So where can they go and find out this information where, and also, where can they go and contact you? If people are interested.

Lanna Cheuck: Yeah. So www doctorlanna.com Spelled out D O C T O R L A N N A Dr. Lana spelled out is also my Instagram handle so that you can see a lot of like my before and afters.

So yeah, that’s really the two main places. I’m also on TikTok. Do you do TikTok Mike?

Dr. Mike: Reluctantly.

Lanna Cheuck: I do not know about TikTok yes. Yes. Here’s what I found interesting about TikTok. And I’ll just say this really quick. I’ve hired two like gen Z, like in their young twenties. Really brilliant.

Girls who work with me on my social media team, my PR team, and they’re putting my Tiktoks together. And I don’t even understand the language. Like they’re telling me these words and I’m like, what does this even mean? They’re like, Just go with it, just go with it. So there are these cute little, like videos that we put together.

And, honestly, what I would say is more people look and view my procedures than they do with the cutey things that I do. So it just goes to show you, be authentic, be I’m not like the cutey TikTok gen Z, like much older. I show good results, and so I think I’m gonna stick to that for now. Yeah. Yeah. But it is a traffic source, especially when, the gen Zs of the world, they may be introduced to something cutey, but then as they’re scrolling down, They’re gonna be, some of the things that, that you can learn, you can actually learn things on TikTok.

Dr. Mike: If you actually have the filters correctly and seen with others, so you never know who comes in, they might, they might start with a kind of cute sea dance and then he ends up with a cadaver that’s true.

Lanna Cheuck: And I always thought it was the younger generation for TAC Mike, but today I actually operated today at the hospital. They had asked me to come in, but my my older, like 60 something year old colleague urologist knew about me from TikTok. And he was like, I saw you on TikTok. My child’s therapist that I had a meeting with today was like, I saw you. I’m like, I’m not even, ONAC really, I’m like, but it’s getting there and it’s not just the gen Z.

It’s my child’s therapist. It’s the 60 year old surgeon who like, doesn’t even know how to open a phone, like it’s amazing.

Dr. Mike: Yeah. Awesome. This has been amazing. I know you’re busy any last minute thoughts before we end the call today?

Lanna Cheuck: I would just say, from a standpoint of those going to aesthetics has really boomed in the last 10, 20 years, there’s no slowing down of the aesthetic field.

It’s unfortunate that people are burning out of traditional medicine and trying to find other ways. This is just one avenue, right? But we offer coaching. We offer mentorship, we offer hands on training. Online training business and we wanna create a community. So I’m happy Mike to have come on your podcast and, one day I’ll have you come on my podcast when I really start to grow up my podcast.

Just because I really love talking to other like-minded individuals and you’ve always been an inspiration because you’re so business minded and I have a lot to learn from you too.

Dr. Mike: Oh, yeah, we can do it. I probably won’t join you ONAC but you never know. Dr. Lanna. Thank you so much. Thank you for your inspiration and your wisdom.

And it’s always guys, life will give you ups and downs, but at the end of the day, it maybe it’s just about posting three times a day on social media to get you started. It’s all about keep moving forward. Absolutely.

We are continuing our series of successful entrepreneurial medical practice owners.  Meet Dr. Carol Clinton, ER physician, who founded Timeless Skin Solutions, an aesthetic practice, after 15 years of practicing medicine in a complex, high-pressure environment. After a few years it became extremely successful, becoming one of the true pioneers in the industry. And then at 42, she was diagnosed with ovarian cancer.  

But she refused to let this disease affect her from achieving her dream, growing and successfully selling her practice for 5X EBITDA in 2020.  The co-author of the Amazon Best Seller, Med Spa Confidential, and podcaster of I’ve Got Skin in the Game, experience her inspiring journey from busy physician entrepreneur to cancer survivor.

Med Spa Confidential: Lessons Learned from Starting, Growing, and Selling 100+ MedSpas

https://www.amazon.com/Medspa-Confidential-Dr-Carol-Clinton/dp/B09ZJ281TR

Dr. Carol Clinton’s website:
http://carolclintonmd.com

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Transcript:

Mike Woo-Ming: After nearly 20 years of being a business consultant. And just over the last 10 years, working specifically with physician entrepreneurs, I’ve heard just about every excuse of why someone isn’t able to, or don’t feel compelled to start a business. “I’m too old or I’m too young, or I don’t have enough money or money’s tight, or my fear. is I just don’t have enough time.” And we have a term for this as consultants. And it’s not the nicest terms, but they’re called entrepreneurs cuz they wanna be an entrepreneur, but something, some obstacle, whether it’s perceived or real is stopping them from actually doing it. And I don’t think you’ll have many excuses after you listen to this woman’s story.

She was a busy emergency room doctor that got introduced to the aesthetics community. Started up her own practice was really one of the pioneers in Botox when Botox wasn’t even a commonplace word after a few years built a successful practice. And then she was diagnosed with ovarian cancer at 42 years old.

And what you learn in the interview is how she was able to deal with it, how she was able to run the business, actually using one of the main principles I talked about in my book, the position physician that you can’t do everything. If you’re the. A physician and the practice owner, seeing all the patients, ruining all the patients entering on the phone calls, you’re never gonna grow in scale.

You have to be able to delegate and be able to take yourself out of practice if you want that business to thrive. And she would not only thrive in her clinic. In 2020, she was actually able to sell that for five times EBITDA, which basically is the indicator for their business performance. So that’s that statistic is a lot higher than it is in this industry.

Usually it’s like one, 1.5 profits that you’re gonna make on the business. So I really hope you, you have a chance to actually listen to, or watch this interview with this amazing physician entrepreneur, my interview with Dr. Carol Clinton on this episode of Bootstrap MD.

Hey guys, this is Dr. Mike Woo-Ming. Welcome to another edition of Bootstrap MD, the podcast for physician entrepreneurs. We’re continuing our series talking about the innovators in the cash pack, cash practices. And this week we’re talking about med spas and on the call today, we truly have one of the groundbreaking physicians in this industry.

She was the founder and director of Timeless Skin Solutions, which is a physician directed skincare practice. Dedicated to help men and women and teens look their best. How I learned about her was she had a book that came out earlier this year called med spa confidential talks about her experiences, starting up a med spas and all the trials and tribulation she did to become successful. She’s graduated cum laude from Ohio State University College of Medicine. I was born in Columbus, as we mentioned, she’s also an ovarian cancer survivor. Wife and busy moment three will get into that as well. She’s lectured internationally as an expert on lasers.

And was talking about Botox when no one else was talking about Botox. So we truly have one of the pioneers in this industry. And we’re gonna find out more about which how she got started her entrepreneurial journey and what she’s doing now. So want to welcome to the program Dr. Carol Clinton, Carol, how are you doing?

Carol Clinton MD: I am doing great, Mike, and thank you for inviting me on your podcast.

Mike Woo-Ming: This is great. I talked to you just prior to starting up the interview. I picked up your book. I thought I knew a lot about med spas the wealth of information that you get got in the book.

It’s really amazing. You guys should really pick it up. If you’re getting into this industry, it’s called Med Spa Confidential. Carol, I buy a lot of business books just like yourself and sometimes they’re great. Maybe some motivation. But a lot of times there’s a lot of fluff and your book certainly did not have any fluff. It was content. I was taking voracious notes on it. So congratulations on coming out with a very successful book.

Carol Clinton MD: Thank You! Sarah and I, Sarah, as an attorney and myself as a physician, both wanted to do this industry proud in terms of making sure that we gave advice that was worthwhile and also from very different viewpoints.

The way that I went to business and decided to do this was to do a really high touch. Sort of approach and Sarah’s was a high volume and getting a lot of people to do procedures. I, don’t think there’s any right way or wrong way to do this business other than to do it with the approach that you’re actually taking care of humans.

Be respectful of the fact you’ve been given that privilege and then make sure you do it within the legal parameters of the way that laws are written in different states on, how to approach this. But I think our book also, if you wanna scale up any business, we go through the whole process of what are the systems that you need to get in order to be able to scale up.

Yeah. So you can, as a physician who wants to be an entrepreneur, this book could help you outside of the med spa arena as well. If there’s something else you’re wanting to do.

Mike Woo-Ming: Truly. And, that’s an important word “systematize,” especially when it comes time to actually selling your, practice.

And you actually do a really good job of actually contrasting those two different styles of med spas. But I wanna talk about your personal journey into the med spa industry you got started with. Not a lot of people even knew what the word med spa was. So yeah, let’s talk about it

Carol Clinton MD: I I called

my practice a medical practice.

So I actually never used the word med spa to go along. But I know that’s the kind of the vernacular that’s out there right now. So that’s why we used it with the book yet and some somewhere around 2002, I had a good friend who was a plastic surgeon and she called me and said “Hey, do you want some Botox.” And so I went over and I got Botox for the first time for myself. And she was just honest. She said “I’m a surgeon. I need to be in the operating room. When this hits the mainstream, it’s gonna be more work than I’m able to do.” So she actually started me thinking about the whole process of, do I wanna be an entrepreneur?

I had put my name forward for several of the leadership positions in the large emergency medicine group that I was in. And. Never got voted into anything or and I knew that I wanted to be a leader. And so that’s how I started my entrepreneur journey in 2004 when the year started. I just thought I don’t want it to be 2014.

And me saying, I wish back in 2004, I had done something. So by 2000, between 2002 and 2004, I had done different trainings, felt pretty comfortable. And remember this was early days. So there was one filler at that time that I felt comfortable using it was a collagen base, but that’s, you know what first wives club showed was the crazy lips.

So you had allergic reaction. There was Botox and there were lasers, but they weren’t nearly as. As they are now and light sources. And then there wasn’t all the other electrical based machines that are out there that take a whole lot of time to learn everything that all of these different Procedures could do.

So when I started it. I don’t wanna say simple, but it was much simpler times than it is currently. When you’re having to go and pick a lot of what filler do you want, which neurotoxin do you want? What skincare line do you want? It was much easier in 2004, or I would say fewer choices. So that made it easier to, do the investigation.

Yeah.

Mike Woo-Ming: There’s a multitude of choices. . Now, Sarah talks about how she got started with a one room. Practice. How, did it work for you also? Were you working your ER shifts at the time or did you leave it and then decide to go? How did you, make it work? And, more importantly, how did you make the finances work?

Carol Clinton MD: Yeah I went to halftime and in the emergency room and then started and I did two days a week. One of ’em was in a spa that was closed on Monday. So they had room that I could take over on Mondays and then they weren’t there. So it was, just me, but that did allow me. I’m not a dermatologist. I’m not a plastic surgeon. I’m not a family practice doctor. So I didn’t have an existing patient base that would come to me. So that gave me a patient base. The second one was a physician who was a radiologist who had done a women’s only practice. So she did ultrasound and breast stitching. And I was in her office where she had extras, dedicated to other professionals that wanted to come in and help women.

And I, was in her office on Wednesday. So one of those was in Dublin. One of ’em was in downtown Columbus and after about six months, I had replaced my income in the emergency room and decided. This was a business and that I was going to be okay. Began to build out my own space, which took me about six months to do it was a year from the time I had just begun to inject Botox fillers. I had a qera laser at that time, which had a 10 64 on it and different IPL hand pieces. At the end of the year, I had my space that I opened and I had an existing patient base that I just grew from that point on.

That’s great. Now I’m sure you’ve heard the statistics. I know you talked about the book in the book. You read a lot of business books yourself at 80, or maybe give you 90% of businesses fail. The first year you were successful within the first six months. Did you have any entrepreneurial training? Did you go to business school? What kind of business?

acumen I had zero and that was really intimidating. And a a couple of good things that happened to me along the way. Number one, I’m born into a very large family with multiple siblings. One of my siblings is the CFO and had been of MGM casinos.

So as he says to me all the time, the difference between my business and yours is just the number of zeros. The principles are still the same. So he came out and really helped me set up my QuickBooks and how I did my accounting and that sort of thing, which was incredibly helpful. Then I had a patient come in one day and say to me, you do understand that you’re running a business.

You’re not just a doctor anymore. And she invited me into entrepreneurs organization, which gave me a training and background that I needed. Because I had no MBA or formal business training and took one accounting course as an undergrad. So the, those two things were extremely helpful. The third thing that was helpful is watching both that physician who had decided to just take care of women, her risk, and then the spa and how they interacted the spa had clients.

they, There was no doctor. My business was separate than them, the way they treated their clients. And I watched the way that her staff, the physician staff had systematized things to make it easier for patients because back in 2004, not a whole lot of people were worried about the patient experience.

And she was as was the spa. So they gave me some marketing and sales training that I didn’t even know I did either just watching them and observing them how they went about taking care of people. So I felt like I got really great business advice from entrepreneurs, organization, marketing and sales from other professionals around me.

And then finally, my brother really helped me with that initial step of how how I did the financial piece. And then what if I felt. And this is a, tool that I know I’ve read other people do. I feel like I interviewed people all the time, but it wasn’t necessarily a formal interview. If I would sit down and be at a meeting in school, I’d be curious about the people who were sitting around me.

What did they do? A lot of stay at home moms actually were fairly powerful executives or professionals before they left the workforce. And, to get that power from them from 10:00 AM to 2:00 PM every day, because they wanna get out and work, but otherwise they wanna be around for their kids. Was really helpful.

So I used a lot of women who helped me build my business, who were, had been stay at home moms who brought their skill set to Timeless. For however many hours, they were able to dedicate during the week. But most of them not full time. And I got the best of the best doing it that way.

Mike Woo-Ming: So when

you first started How many employees did you have and how, did it grow?

Carol Clinton MD: It was just me. And then within the first year I hired a physician’s assistant and then. On the day that I opened my medical office, myself, my medical spa a year later was the day that my doctor called me to tell me that I had ovarian cancer and we’d be going to the operating room the next Friday.

That kind of slowed the growth. I had to take care of my health. So while I opened and I went back to work after major surgery, two weeks later, I really was probably slow for a good three years. That six months I had chemotherapy, but then after that, you just don’t bounce back and are your normal self.

And because we did have three young children at home, I really had to balance where my energy was going between growing the business and managing a family as well. And when I say growing the business, I also had to stay abreast of what was happening in the field, because there were so many advancements coming so quickly from 2004 on.

So there was a lot of education that. In the medical arena as well as in the business arena. So I would say by 2008, 2009, I felt pretty good about getting ready to grow the business. And then we had that big recession and it was scary. I actually grew during that time, but I wasn’t confident that I was going to, so I didn’t fail number one, but I didn’t push for aggressive.

Which I could have at the time, but I, didn’t. And then just slowly grew organically and opened my second medical office and then scaled up the, our back office. So we could do three more offices and fairly rapid succession here in central Ohio. And then my ovarian cancer recurred. Oh. Back in 2018.

So at that point I knew that I wasn’t gonna put my energy towards. adding those additional medical spas that I needed to do something in order to allow the business to continue to grow. But do it without me and my energy. And I had a great team by that time. There were 30 employees and, they know how to run the business.

Most of them in their own league, maybe better than I did depending upon what their role was.

Mike Woo-Ming: First off. How is your health now?

Carol Clinton MD: I have my hat on because I have very little hair and it looks a little crazy, so I didn’t wanna distract anybody if they were looking at the video.

Mike Woo-Ming: I’m used to that , used to no hair,

Carol Clinton MD: so it’s OK. plus I love the Dublin Irish festival and I live in Dublin, Ohio. So I had to wear that my health. Good now in the sense that I’m stable and I haven’t had any advancement of my disease probably in the last three years. So that feels really good for a disease that kills most people within the first five years after their diagnosis.

Also, if you look behind me here, if any of you are watching on video, I have my own podcast co I’ve got skin in the game, and one of the things I do with that. We did the last one that we produced by the way was about the book. But most of the time, what I’m talking about there is unexpected life changes that maybe when you get ’em are unwanted.

And how do you shift your mindset to be able to gosh, I still enjoy my life and I have chemotherapy every week. I’ve had somebody come over last summer and say, oh, I thought you were gonna be lonely. And there were six cars in my driveway and friends all around. So I don’t, I’m not lonely. I have plenty to do.

And I have a couple more books in me, not necessarily about med spas, but just looking forward to the things and our kids are adults now. So while there’s things that I do with them I do a lot less for them and, just get to be with them, which is

Mike Woo-Ming: wonder. That’s great to hear and great, outlook on life.

So you you were able to sell your businesses, right?

Carol Clinton MD: Correct. Yes. I had many people reach out over the years if I ever wanted to sell, let them know. And so when it came time that it was obvious. This disease was not going away. I just went ahead and reached out to several people individually reached out to me and then went ahead and reached out to people who I knew were purchasing in the space as well. So that I had enough people bid on the practice that it made sense. I, as I call it as a process, we did, we ran a process and found the right buyer. And at the end of 2020 my goals, everybody has different goals when they go to sell.

My goals were to be able to have the time for me. So I wanted to be a hundred percent out. Not everybody wants to be a hundred percent. That was what I had written down ahead of time as to how I would like to exit the business. And I felt like my team was ready to, perform without me.

They did not need me in the business and kind of proven that over the two years prior with you, me having been sick and, not working during that period of time.

Mike Woo-Ming: Obviously when you get hit with such a devastating diagnosis, the tendency would’ve been to just close your practice. Most doctors who would do that would’ve closed it. Did you ever. Do that or consider doing that. And what prevented you?

Carol Clinton MD: I didn’t consider doing that except for one day. And I would say that day was somewhere between March 16th and March 20th. Back in 2020 when no one knew what was happening with Covid. I called my brother and I said, that’s it.

By the way I didn’t have to declare bankruptcy. I was dramatizing. I said, “I’m just declaring bankruptcy today. I’m done. I’m closing up.” And my brother said, “Carol, no, you’re. Every day, you get new data points. You do not have enough data points to make any decision today.” And that was really the most helpful advice from there until I didn’t own the business anymore.

You, make the decision on any day that you can make based upon the data that you have and never did my data say. “Time to close shop.” It said, find someone who can run this organization and, you don’t have to do that anymore. You don’t have to have the responsibility of it anymore.

Mike Woo-Ming: What it sounds like is you learned early on that many doctors where, why I see where they get in trouble when they have their own practice is they are, if they are not available, they’re not making any revenue.

They are their own practice. They’re not able to… i, know many people and doctors who are like a one man or one woman show. They’re the medical assistant. They’re the nurse, they’re the marketing. They’re the janitor . Sounds like you already had some loyal people in place that allow you to help you recover while they’re work in the business.

Carol Clinton MD: Correct. I, did. And I wanna say that this was intentionally done. Every Wednesday we ran with the Physicians assistants, the nurse practitioners, the other one, aesthetician RNs. We all came together for an hour and a half. The office was shut. We were all together. And during that period of time, we went over expected and unexpected outcomes. So we had people who had unexpected outcomes that were better than we predicted and obviously unexpected outcomes that we didn’t like and how we went about fixing them. So every week I ran, what, not that there’s any morbidity or mortality. That’s like our true M and M board, but I tried to run something like that.

So it was a learning experience. Every week on top of there was six months training and onboarding when anybody came into the practice. So in terms of my medical and nursing professionals that I worked alongside of, they had training all of the time. And so it wa none of them were just. Let loose to be the nurse practitioner who’s running the practice, they were all there.

And then they supported each other as well. So I was so proud of that. And so yes, it was intentionally done, but I had been what you said. Very early on. Like I was the marketing team for a while. I was the the person who did QuickBooks and exhausting myself on top of doing the medical procedures and probably somewhere around 2012.

I decided it’s time for me to do less of the medical procedures in this practice to be less dependent on me and me to educate and train more so that I know that the people who are doing these are doing a great job all of the time.

Mike Woo-Ming: Yeah. It’s an important point to, to elucidate because I do think as doctors, we do tend to be control freaks and we do want everything done and it’s can be difficult to let go, but if you want to scale and grow your, practice to 5 or 10 or whatever you wanna do, you gotta be able to delegate and to be able to trust the people that, that you hire.

Carol Clinton MD: Yeah, you absolutely do. And, but I think we all have to be careful in this day and age where there’s many, states who have independent practice for nurse practitioners, the PAs want to have independent practice. Now they do not have the training that a physician has. And it’s really important.

There are so many things that come up even in the medical spa space, where people have a medical issue and either you need to address it and let them know they need to see their doctor because it’s a problem or you at least need to know that they have it so that you can adjust whatever you’re doing to what their medical diagnosis allows you to do to them.

So I think it’s really important that you stay involved as a physician and you’re not just some own or somewhere far away and don’t have any input whatsoever as to what’s going on.

Mike Woo-Ming: Oh yeah. I see that. I I,got a call last week. Same thing. A doctor said “I’m invited to become a medical director and should they do it?”

And I go” do you have any experience?” “No.” Then do not do it! So, where we talk about the med spa industry, and I think that’ll get us into the book. So first off, how did you and Sarah meet and when did, who came up with the idea of having a book and why?

Carol Clinton MD: I think we both had the idea of a book, so I had made an outline way back in 2014 and then just never executed on it.

Sarah and I actually practice in the city with her ex-husband and we had never met in person. So in a Facebook group, she saw that I was in the Facebook group of medical aesthetic owners. And she reached out to me and just said you’re somebody that I’ve wanted to meet. And I said I wanted to meet you too.

So we… It was during the pandemic. We gave each other a call. She said she wanted to write a book. My reason for writing a book, not that it was gone, but I’m never going to use it to be a public speaker or whatever. I’ve done that before. I really have enjoyed that. I thought maybe I would do it again as I phased out of being an owner.

But now with my health, it’s just not something that I can depend on my health saying I would be able to speak at an event. So not what I’m gonna do, but Sarah wanted to do it. And it seemed for the reasons that I wanted to do it was to make sure that people who were entering this space had the right advice.

So when she said that’s what she wanted to do, I told her I was all in. I thought it was great that an attorney and an MD would collaborate like this on a book. And we had, let me tell you a good bit of fun doing it. And, Sarah, you think physicians are control freaks, Sarah is an amazing editor and has a grasp of language far better than I do.

And it was great working with her. Yeah.

Mike Woo-Ming: The book reads very well and it was really enjoyable seeing both perspectives. I’m gonna ask you the question that I also asked Sarah most practice owners. They have the one clinic. Whatever they do. They, don’t want to grow. I guess hinted systemization was very important.

What else was a big game changer? Like this was the one or two things that we did that really escalated my success.

Carol Clinton MD: Yeah. I, think two things. One of them was really paying attention to the patient experience. So from beginning to end, we knew what that was like from the time they looked at our website to the time they may have interacted with one of the recordings we did or shows that we did, cuz we still have a weekly show on one of the news stations.

That whole experience was curated all the way to the moment they walked in the door and then a whole new team would start with what the experience was like once you had the person in front of you in person, and then what was it like when they left? What, did that feel like? Did they feel like they were just one and done or did they feel like they had a plan that would take them?

And for us developing a plan with the patient was the most important thing and figuring out where they wanted to go, how long they wanted it to take. And then the second thing was just really all of the time trying to be in tune with the staff and what did they need and what did we need to do to make it work for them?

Occasionally we couldn’t, but if they would come to us and say, okay, I need to now work. Monday Tuesday, Wednesday, instead of Monday, Wednesday, Friday, whatever, it was, figure out how we could make that happen. Number one, they needed to come like this is how I see it working for the business. This is how it’s gonna work for me.

This is how it’s gonna work for the business. And if they would come with that, most of the time, we would be able to figure out how to make that work for them. So then I had longevity of staff

Mike Woo-Ming: That’s great. That’s great. I, know we just a few minutes of time I know you’re out of the industry, but you still, it sounds like you still keep abreast about what’s going on. Where do you see where this med spa industry is going? Are you optimistic? What where do you, stand on?

Carol Clinton MD: I’m very optimistic in terms of there’s lots of still potential for growth. I do see consolidation. It’s just, it’s very expensive to run a med spa and then to have a team know how to maximize.

Everything so that the patients are getting the best experience, the best price point you can offer that your med spa is getting the best price for products and your vendor relationships, all of that is really a lot to manage. So I see over probably the next 10 years, these continuing to consolidate, and there’ll be probably a couple big players. And then you’ll always have the person who is an MD, a do who, says I wanna do this, I’m gonna do it on my own run, a small boutique shop. And, that will always be there. People, like that experience as well as the bigger experiences as well.

Mike Woo-Ming: Carol. This has been a great conversation. The book is called med spa confidential. You can find it on, Amazon. Get it. If you’re even thinking about getting in, into this industry and also you have your podcast called the skin in the game and we’ll we’ll leave a link of that also here in the show notes. Just, my final question. What advice would you have someone who’s thinking about? Maybe I’m gonna take a Botox course and maybe this is something that I want to do. What, kind of advice would you wanna give to that person?

Carol Clinton MD: I would say it’s a lot more than a Botox course. And especially now with there’s being so many different electrical based devices like I said, neurotoxins, as well as the fillers, you really have a lot of work to do before you can do your opening day. And way back in, like I said, it took me 2002 to 2004 to just even get everything that needed to get in order. I don’t know that it needs to take you that long, but definitely it’s more than just a course. You’ll, need to learn some business things and you’ll need to have a plan on how you’re gonna stay educated because it, this industry does change quickly in terms of new devices that are out.

And you’ll need to know when you not just want, but you need a new device.

Mike Woo-Ming: And like I said, it changes almost on a daily or weekly basis too I’m having fine. I, yeah. And it’s definitely, there’s definitely is for those who want to become their own boss. I I don’t think there’s anything else better than I think being an entrepreneur, but that’s my personal bias.

Carol Clinton MD: I agree with you. And I think the thing that you said they’re have fun with it, see humor in just about anything that you can see humor in. It’ll take you a long way and you’ll enjoy it. And you’ll last a lot longer. If you can laugh at yourself,

Mike Woo-Ming: The book is called Med Spa Confidential, go and pick it up. Skin In The Game is the podcast. Carol, thank you again for your time today. It’s been very enjoyable and very illuminating. Thank you. And

I’ll watch you as you scale.

And everybody, and as always keep moving forward.

Grow and Scale – That’s the mantra we have at BootstrapMD. Today you’ll meet an attorney (don’t worry, she’s cool!) that I first heard about when I read her book Med Spa Confidential, now an Amazon Best Seller.

Sara Shikhman is an Ivy-League trained corporate attorney and entrepreneur with over 14 years of experience. She has managed the sales, marketing, and legal teams for two high-growth medical aesthetic businesses. You’ll learn her exciting journey how she stumbled into the med spa industry, and using her marketing knowledge and business savvy, grew her practice into 12 locations with over $13 million in annual revenue. Discover her key strategies on building a million dollar practice!

Med Spa Confidential: Lessons Learned from Starting, Growing, and Selling 100+ MedSpas

https://www.amazon.com/Medspa-Confidential-Dr-Carol-Clinton/dp/B09ZJ281TR

Lengea Law – Sara Shikhman’s Law Practice

https://lengealaw.com/

Transcript:

Mike Woo-Ming: This year marks 10 years of being a medical cash practice owner. I own, or co-owned several of them, this is our latest we’re building a med spa up here and on the program is someone who took a single location and then turned it into 12 locations. 12 multi-state locations that generate 1+ million dollars annually You get to hear her story, how she started from e-commerce beginnings, took her knowledge of marketing and then got into the brick and mortar businesses and is now an attorney. And she helps other healthcare, individuals, doctors, nurse, practitioners see their vision and. I learned about her when I purchased her book med spa confidential, which is a Amazon bestseller.

I think you’ll really enjoy hearing her story. My interview with Sarah Shipman on this episode of Bootstrap MD.

Hey guys, this is Dr. Michael Woo-Ming welcome to another edition of Bootstrap MD. And we’re starting a series about talking about how you can get started in private practice cash paid practices. And I got a lot of questions about this as being a cash practice owner. And a med spa owner. I’m a med spa owner opening up a second one medical director for a couple of ’em.

And I thought I knew everything there was to, to med spas until I got a hold of this author’s book. And her story is pretty amazing. She’s an attorney. Don’t get me started on attorneys. I’ve got too many attorneys in my life, but she’s a cool one, an e-commerce expert. And she’s the co-author of the med spot confidential, which is a number one best to learn Amazon in Dermatology.

She specializes in the healthcare tech and beauty industries as a president of an e-commerce company, she achieved 12 plus million dollars in revenue in just under two years after launch she now is a direct general counsel and director of a sales of a multis spa medical practice growing from a single room location to 12 locations in over 13 million in annual revenue.

Actually, I didn’t know her until I was actually looking for a book on med spas on Amazon. I had one that I was gonna pick and then her book came out. I downloaded it on my Kindle, got on the plane, read half of the book on the plane trip and then took more notes when I got home. So I reached out to them and this is just one of the authors who can be joining us.

So here, introducing on the show today is share Sarah Shipman. Sarah, how you doing?

Sarah Shikhman: I’m doing well. Thanks so much, Dr. Mike, it’s nice to be on this podcast with you and thank you so much for the opportunity. And I’m excited to share some of the pearls from the book and my experience with your audience.

Mike Woo-Ming: First off you talk about your story in the book, as well as your, co-authors story. And you started from an eCommerce background and I’ve also have my origins and eCommerce, although. Your eCommerce company is probably one of the strangest names of eCommerce that, I heard. Tell us exactly what, they do.

So, talk about that. And, what you learned from, being involved in that company?

Sarah Shikhman: Sure. Yeah. Long ago when I was working as a corporate attorney at Deutch bank, a couple of my friends approached me and they said, Hey, we wanna start a online startup selling furniture and we want you to be the CEO.

And I said, oh, that’s great. I don’t know anything about furniture or about being a CEO. I just know about being an attorney. And they were like you are one of the smartest people we know. We wanna hire you anyway. And I said I really don’t love the corporate law life. And so let me try this.

And so we started the business from the ground up, literally from zero where we had a small investment and the, one of the first questions was what should we name our company? And this was like back in, I don’t know, 2008. And. We were not very creative. And we were like, okay, but what are we gonna be selling?

And we were like, we’re gonna be selling bedroom furniture at a discount. So we called our company at the website Bedroom Furniture Discounts. It has its advantages because when people would Google bedroom furniture discount, it would come up organically at the same time being known as the discount player forever was not so great.

But it was a fun learning experience.

Mike Woo-Ming: So you, did that, you exited out of that. And I you you, talk about your, story, how you, ended up in this med spa world. So if you could share it with the audience you’re an attorney, you’re not a medical doctor.

So how did you, end up being in this profession?

Sarah Shikhman: I knew nothing about this industry. And I, by that time I knew about running a company.I had scaled that furniture business to be a couple of million dollars a year in sales. I guess about 14 million in revenue and my husband at the time said, “Hey, I’m a dermatology resident, I’ve always wanted to have a side project and open a dermatology clinic doing Botox. Can you help me run the business side of it?”

And I was like what is Botox like who, who is who’s doing that? It’s only plastic surgeons seem to do that. And how are we gonna get started? It seems like you need a lot of money. But in actuality, after doing some research about it and how the special way that these procedures make people feel and how repeatable they are and how trainable they are I realized that it’s an amazing segment of the market.

And we again started the business from the ground up from one room in a old decrepit building to a 12 location, medical spa across several states.

Mike Woo-Ming: That, that’s amazing. What did you learn from cuz I, as I said, I’ve been in the online background as well. What did you learn? When you decided to open up your brick and mortar clinic? Just a little bit of background in my story. I was in the online space and then I was naive and thought I’m smart in marketing. I can do it. And then almost lost my shirt the first two years. How did you succeed?

Sarah Shikhman: I think that I didn’t even decide that. The space was in its infancy and I didn’t really have to listen to how everybody else was doing it. And for example, in the beginning we were told, okay, Instagram this was a long time ago. Instagram people are like real doctors don’t post on Instagram, don’t post on Instagram.

Like we would get advice like that. And we would just ignore that advice because it didn’t… I hadn’t tried it for myself. So I, how could I say for sure that it’s not gonna work? And so we would try a lot of unconventional things or back then Google would give you like a free Google specialist to, to help you set up your Google AdWords account so you could run keywords.

And the Google specialist would say things like you guys are selling Botox, but maybe you should, your keywords that people should search for. Maybe you should bid on plastic surgery. And we were like that doesn’t seem right. We’re not gonna do plastic surgery here. We’re gonna do Botox here.

So we would ignore some of the advice that people would give us. And we would try do trial and error. We had months where we would spend a thousand on marketing and get zero clients. We would have months where we would spend 20,000 in marketing and have 200,000 clients. So it was a big learning experience for sure.

And we were thankful that we were able to place some of those online ad spends on our credit cards, because otherwise I think we wouldn’t have been able to pay the bills.

Mike Woo-Ming: That sounds very familiar. So I wanna take you back to that, first clinic. I just wanna kind of experience that how many employees did you hire, maybe talk about maybe some of the challenges that you faced in that first year?

Sarah Shikhman: Yeah, I think in the, in this business, in the medical wellness concierge medicine, med spa space. One of the hardest parts is employees. And, when I say employees not, just employees in the strictest sense of the word, but your staff, contractors, your medical director, your vendors, just people.

Relationships is the hardest part because at the end of the day, what you’re selling is not the Botox. What you’re selling is a service provided by a person. And what happened in the early days was we didn’t really know that. And we learned that lesson, the very very, hard way. One of the first employees was an aesthetician that we hired.

And I had never hired an aesthetician before. I didn’t even know what aestheticians did. I had to really look at, look up the scope of practice and talk to the board of cosmetology. And, so this aesthetician would come to work and she would do facials and other treatments and she was teaching us, literally teaching us how facials are supposed to be done so we could write the protocols of how they should be done. But what we didn’t realize is how dependent you become on your employees, because if the esthetician would call out sick, like I can’t fill in for her. Or if the esthetician decided to quit and give us one hour notice, which happens in this business, you can’t fill in for her.

You have to cancel everyone. So it’s a very delicate balance of how you have to be to your staff. So one of the first things that happened was the esthetician called out. And she had legitimate reasons for doing so, but in any normal corporate environment, that environment I came from a person has a few, a call out, no show, whatever, they get terminated.

In the aesthetics world, you have to have more flexibility because you are so dependent on the person and the client relationships. And so in the beginning we were very inflexible and we had a lot of turnover. But from that, I learned that. You have to be a little bit more flexible in this particular area.

You could have really great contracts, which we do now, but you still have to sometimes make reasonable exceptions. So your business can function.

Mike Woo-Ming: Got, it. What kind of services were you offering in those beginning days.

Sarah Shikhman: We were offering a very simple menu. I think simple menu was key for any business really starting in this area.

So we were offering Botox, fillers, microneedling, and facials. And that’s pretty much it like just those. No devices.

No. Nothing. Nothing too complicated. That’s it.

Mike Woo-Ming: And that’s usually where I see one of the biggest issues of someone trying to break into this field.

you’re,

they say, you know How can you get a laser sales person to stop bothering you is to buy the laser, right? And the, buy the the $100,000, $200,000. They start off on day one by buying some Cool Sculpting or whatever it is. You didn’t do that. And I didn’t do that as well. And I think that was a big thing that kind of saved me. What, do you have to say to that?

Sarah Shikhman: Yeah, I think the machines are not gonna bring in the customers. That is a, fallacy. I don’t know where they were originated. But I think buying machines ahead of having a client base is not the right strategy for most people. I think if you are extremely well capitalized and you already know and have done the research and you know exactly what machines you need to, accomplish your business goals.

That’s one thing, but if you’re like most people starting in this business, you have no business making the machine. The first thing you get the first thing you should probably get is something that has a cheaper cost, like to start like Botox or Fillers or a Microneedling pen. But yeah, I think machines and the machine contracts are often what brings a business down where the contracts are not easy to get out of their personally guaranteed.

The interest rates are very high and a lot of them have this term in it where even if you pay off your equipment early, you still owe the same amount of money. So if you decide, oh, I wanna pay off my loan for my cool sculpting early. I have enough money for the, let’s say a hundred thousand I own, but my equipment contract says that I still owe 200,000 of payments.

Unlike your mortgage, which if you paid early, you save a hundred thousand, your equipment loan, the way it’s worded, 95% of the time, you still have to owe the 200,000. Bad things can happen if you sign those contracts and they’re not reviewed by a lawyer or somebody who knows those types of arrangements.

Mike Woo-Ming: Yeah. And, it’s funny with these with each of these lasers or the, these energy devices they are, quick to say, Hey, we can provide the financing to you.

A funny story, although really not too funny. When you think about it is they said had. I had someone come in, looked at this device, it was like 150,000.

And they say, oh we do our financing. We just need three months of your previous bank accounts. And I said, okay. And then I forgot about it. And then I never turned anything in. And the next day, oh, you’re approved. I didn’t do anything. But you find out the reason they do it is cuz the rates are really predatory.

And a lot of the examples that you you, talked about. So for someone who is starting up they want to do a med spa, what kind of advice would you give them? Let’s say they’ve got a limited amount of budget that they can start with and their physician.

Sarah Shikhman: I would say thank God or whatever you believe in. Thank goodness that you have a limited budget because that’s that limits the number of mistakes you could make. I would say number one, when starting a business, think about who you actually need to start the business with. A lot of times physicians and other people come to us and they say I wanna start this business with such and such partner.

They’re gonna give me $10,000 or, $100,000 or $2 million, whatever. And I, we always say, is that really the best thing? So first. Think about whether you could really start the business on your own without too many partners, you could always make people partners later, but first maybe you wanna bring ’em on as a contractor or as a consultant to see if you guys get along in business.

Number one is simplify your ownership to be mostly about you. And number two, simplify your menu of services initially, to be things that you truly know how to do. And you think that you’re good at, and number three, you are gonna need to spend money on marketing before you have clients not, oh, once I have clients I’m gonna market.

No, you need to market and then you’re gonna have clients and let’s say you wanna make a million dollars in revenue, be ready to spend a hundred thousand in marketing at least, or more to get to that million. I would say that’s my top advice. You have to be ready to have a simple menu of services. Be the only owner and spend on marketing.

Mike Woo-Ming: Yeah. And one thing too, that I, liked in the book is see how we call it our USP or your unique selling proposition. And you mentioned the book actually scan around your local area. See what you can offer that they’re not offering being as simple as maybe they’re not open on Saturday and you can be open on Saturday, or maybe you provide a service that, that they’re not providing.

What were the, let’s say, game changer for you when you said, “Hey, I wanna go from one location to a second location.” What do you think were, the things that led you to say, oh, I can do this. That really made a difference.

Sarah Shikhman: Yeah. I think we felt like. We had enough processes in place and they were written down to be repeatable.

I think that’s the key to scaling from one to two occasions is processes. So having a written inventory process, having a process of how the phones are gonna be answered, having a process of how every consult is done to using technology in your practice to do online appointment bookings online.

Payments online purchases referral programs that are run through the internet. So making everything as automated as possible. And then opening a second location. I think that a lot of people think that it’s okay to, let’s say you have one location and there’s one injector. And then you’re like, okay, should I add a second injector to location one?

Or should I open location two? It is so much cheaper and better and less headache and everything to just add a second injector to your first location, maybe it looks less cool cause you have one location, but it’s better. Most of the time unless you’ve achieved 100% market penetration, you could always add one more person there and get them busy cuz on the second location…

Someone has to answer the phone, someone to clean the space, someone to count the inventory, someone to see the clients someone to call if the toilets is broken all these things. So it’s much simpler to have big location with lots of people. And we have some clients who literally do five to 10 million revenue from one location per year.

It’s definitely possible, even in a small town. Not a town with 20,000 people, but a town with let’s say 500,000 to a million population. I, know people who do 5 million in revenue, single location, office, no surgery.

Mike Woo-Ming: That’s great. Great. That’s great. Non-surgical services. I wanna talk a little bit about employment, cuz this is a, this is something that I’ve seen experienced as well as some of my, colleagues as is they, find someone, they hire someone or they either like I’ve had it where I’ve basically trained the nurse practitioner.

And I know exactly what’s going on. And then I’ve had one where they’re already like five years out and they’ve already experienced on one place. But when then it, it comes down to one thing that happened in California, nurse practitioners are gonna be more independent and they’re worried about if I just train my competition.

What are some things that you can either avoid? Or maybe some things that maybe you can screen before you hire the hire them? Where, do you in terms of that.

Sarah Shikhman: Yeah. In a lot of states, non-compete agreements are becoming non enforceable. So including New York, California, and some other places.

So what do you do? You can screen for the right person, like you were saying, and what, the way we would do it is there are these online tools that measure people’s personalities actually to see what kind of person they are. So one company that we would use is called predictive index. That literally first you would have somebody who you think would be like your model employee, take the test.

And let’s say the predictive index would say that their personality type is called operator. And you’re like, okay. So for this kind of PO position, what I need is an operator. I don’t need a entrepreneur, for example. So, one, you would screen their personality. Two, you would have a multi-step interview process where you would have them do some zoom interviews.

You would have them to meet you in person. And then for half a day you would do shadowing. So you would really get to know the person and see are they gonna be on their phone all day? Are they gonna come on time? Are they on posting on Instagram every second? And really ask them like, what is their long term vision to see if it aligns with you?

And one of the main reasons I see people leaving is because they don’t see an opportunity for advancement in the current practice. So they’re like, okay, this person’s making all the money off of me. I, there’s no way for me to grow. Maybe you could tell them after you work here for five years, you could buy into the company or become part of a profit sharing program.

If that’s allowed in your state. And three, the legal ways you have ’em sign a pretty tight non-solicitation agreement of your clients, which is still enforceable. In most states, you would do a non-disparagement agreement and a confidentiality agreement with those three things. You could really protect yourself, but at the end of the day the clients may still go with the person. So the other way to protect yourself is also encouraging clients to see not just one injector or provider or one doctor, but everybody in your practice. So making the scheduling such that it almost like rotates. So when clients are booking, they’re booking Botox, not Botox with Amy necessarily, or having a promotion. Oh, you tried Botox with Amy. That’s wonderful. We have a special targeted to you try filler with Matt.

Mike Woo-Ming: Yeah. That’s great. That’s great. Great, advice. I know we’ve got limited time. But one of. Kind of the phrases that I loved in the book is to not think of yourself as just having a med spa clinic, but think of yourself as more of a technology company that happens to do med spas.

At least it turns when it becomes time to selling. And when I’ve always talk about you should always build a business with selling in mind. And I think… did that help? It sounded like that’s really what helped your valuation is because you had the technology and you had all of that at a, like central location.

Sarah Shikhman: It, sounds like everything from outsourcing you’re on the phone and, such is, that correct?

Yeah I think definitely a technology company or a technology powered company gets much higher valuations. 10 times let’s say net income versus an aesthetics company that could get, let’s say three to six times net income.

And the way to do that is to invest money into technology and outsourcing and automating processes. I’m not saying you have to become Google, but you have to say, okay, we have our own proprietary way of doing a patient consult. Okay. Here it is. We have a 10 step document and maybe we also have a video of how it should be done and maybe parts of it after you’ve have written them out, you could hire a programmer to automate so the cus, so the client does part of their self consult at home.

They send you some sort of picture using a template or whatever, so it doesn’t have to be like… Super complex, but I think definitely automation and technology will get you a higher valuation and also allow you to scale. So if all you have are processes on paper or no or, in your head, it’s gonna be very hard to open a second location or sell your business. The technology is really key in this business for sure.

Mike Woo-Ming: Yeah. Yeah. And it’s in the 10 years that I’ve, been in the business, it’s still amazes to me all that technology we’ve already incorporated from just online booking and, getting on the app where most of us are in an industry where. ..Let’s face it, they’re still using fax machines. So I think that’s one of the benefits of being your own boss and embracing that technology. Where do you see the industry? What, is your, thoughts on where the med spa industry is going? Is, this a, still a forward growing industry or are there some things we need to, watch out?

Sarah Shikhman: Absolutely. I think the med spa industry is definitely still in the prime growth phase. It there’s new entrant entering it all the time. I think that a lot of doctors I’m seeing even straight out of medical school are going to this industry specifically not pursuing more traditional paths.

People are skipping the hospital part. I see a lot of consolidation in the industry in buyers. Practices are being bought. So small practices are being bought by bigger practices. And I think in the future, there’ll be right now… There are very few big dominant players.

Mike Woo-Ming: We have, There’s

no Starbucks yet.

Sarah Shikhman: There, there a few in mind, but yeah, there is no

Starbucks. Yeah. The Ideal Image, the LaserAways, there’s a few, but there’s no real big dominant player that everybody knows. And I think that’s gonna change. But, and I think that player or those players will be all based on technology, not so much on oh, we have the greatest provider Amy, no, we have a fully automated process for everything that we do except the actual injections.

I think that’s gonna be the future because. Even the, companies themselves are moving, the vendors are moving toward having pre-filled syringes and making the treatments easier for clients to understand and do so there’s gonna be a future where. I think somebody’s gonna be able to administer their own Botox.

So your, company is gonna have to provide some other kind of service. That’s not a person coming in. This is my, opinion. Of course. I don’t know for sure, but I think that’s what we’re moving toward, like Botox cream or whatever are you put on a mask on your face and you press it in certain parts and then it makes the Botox go under your skin. So I think in that world of the future, we’re gonna need to compete based on something else. And that’s something else’s technology.

Mike Woo-Ming: Yeah, I think half my audience just groaned when you said that, but I definitely it, it’s a word of warning. You can either be part of it or you can actually see it go by you can actually see, it go by and I’m, more inclined to embrace kind of the technology and, what’s.

What’s there.Sarah, Sarah, this has been a wonderful conversation. Tell us about your, services that you offer to either a beginning or maybe an experienced me spa owner that, you currently do in terms of your, legal.

Sarah Shikhman: Sure. Yeah. So we represent lots of med spa owners. We also represent lots of medical directors of med spas and wellness centers and all kinds of different medical businesses where we help people get legally set up or restructure their business or stay compliant. Or if there’s a board investigation, we represent people. And then if people are selling their business or buying a business, we represent the buyer or the seller.

Sometimes both but rarely. And we just help people grow in a legally compliant way. So we don’t really do too much business consulting. Most of our work is legal. Our website is called lengealaw.com it’s a mouthful. I’m sure it’ll be somewhere in this presentation, but We love helping people and being very business friendly in our lawyerly advice.

But at the same time, keeping people safe and helping people grow and take their business from one location to two. Or we have clients who started with us as well, single room business, and now have 10 locations. So that’s awesome.

Mike Woo-Ming: That’s amazing, Sarah, thank you. For, joining us again, lengealaw.com is where you can go and get more information, check out the website. If you need to get contracts, if you need to get legal device, what you do in this field you need it’s, really important that you get the right counsel. Thank you again, Sarah. And thank you for joining us today.

Sarah Shikhman: Thank you so much, Dr. Mike, have a good rest of your day.

Mike Woo-Ming: Thanks everybody. And it’s always this can be very exciting business have follow the people who’ve already been there have already had success and that’s the way that you’re gonna keep moving forward.