How Aesthetic Practice Owners Make High-Stakes Decisions!

BUSINESS OF AESTHETICS | EXPERT PANEL TRANSCRIPT

Transcript

How Aesthetic Practice Owners Make High-Stakes Decisions

High-stakes decision-making for aesthetic practice owners, including ROI and financial pressure, team decision authority, operational priorities, cash flow, growth investments, multi-location consistency, benchmarking, escalation, talent retention, and confident leadership under pressure.

PARTICIPANTS

Don Adeesha (Host)

Lester

Full session transcript

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Don Adeesha (Host) 00:00:25

Everyone's joining in… welcome. Alright. Right. We can get this started. Good evening, everyone, and welcome to tonight's Executive Session from the Business of Aesthetics community. The community dedicated to ensuring that, in the world of clinical excellence, your business success matters just as much. Tonight's discussion is on how aesthetic practice owners can make high-stakes decisions. It'll tackle the weight that every owner feels making high-stakes decisions in a landscape where clinical responsibility and business growth collide in real time. I'm your host, Don Adisha, and alongside our amazing expert panelists. We are going to unpack the mental frameworks and practical systems you need to decide faster, lead better, and recover with authority when things don't go to plan. Which is usually the case. Now, a couple of housekeeping notes for you to get the best of this hour. First, yes, we are recording, so a replay link will be sent to you once the event is over, so that you can share it with your partners and also watch it. But do not let that make you passive. Make sure you engage with us throughout the session using the Q&A button down below to send me questions that I can ask the panelists on behalf of you, or else use the chat to engage with your colleagues here. I'll have my eye on both the feeds as we move along. And, ensure that, I weave in some of those questions as we go. Or else we will tackle them in a dedicated Q&A session a bit more towards the middle of the event. So, that being said… We'd also like to give a massive thank you to our Platinum sponsor and growth partner, ECO Marketing, founded by Naren Aral Raja, the very same founder of the business of aesthetics community. And for nearly 20 years, ECHO has helped aesthetic practice owners across the globe stop being the best-kept secret in their town. They believe that great care deserves great visibility, and stick around until the end, as we have a great exclusive resource just for our attendees here tonight, on behalf of ECWAP. Now, that being said, let's look at some of the main key discussion points that we have lined up for you. We are first diving into the reality of the aesthetic pressure cooker. We're going to explore what decision-making actually looks like on the clinic floor, why even the most seasoned owners still second-guess themselves, and the specific frameworks that these leaders use to decide faster and better. Our goal is to help you build a culture where your team can make great decisions without you, so that you can focus on the big picture. Let's meet the panelists who will guide us through this conversation. First, we have Kelly Jamorski. She is the VP of Aesthetics for a massive multi-site organization leading operations across 150 clinics to drive scalable, brand-driven patient experiences. Kelly, welcome to the panel.

Kelly Jamorski 00:03:52

Thank you, excited to be here.

Don Adeesha (Host) 00:03:55

Great to have you here. I think Lacey, is on her way, so once she gets here, we'll see how that goes. We are awaiting communications on her, for now. But next up is, John Bergano, founder of the Aesthetics Card. John has a unique perspective of having, grown a bootstrap practice all the way to a major acquisition by the KKR-backed Skin Spirit. John, great to have you here.

John Bergano 00:04:26

Great to be here. Thanks for having me.

Don Adeesha (Host) 00:04:29

Absolutely. And finally, we have Kevin Cassover. Kevin is an industry veteran with over 20 years of experience achieving double-digit growth for PE-backed practices, and serves as the co-chair of the Aesthetic leadership group. Kevin, great to have you on the panel.

Kevin Kassover 00:04:48

Happy to be here with my co-chair, Kelly, also, and the team.

Don Adeesha (Host) 00:04:52

Wonderful. Right then. Before we dive into the main Q&A session here, I just want to… Yeah. Let's have a quick pulse check of our attendees here tonight and see what your priorities are for this session. I'm going to launch a quick poll, alright. Here we are. So let us know, just buy, yep. So let us know, what is your biggest, barrier preventing you from making high-stakes decisions with total confidence right now? Is it the ROI slash financial fear, you know, second-guessing the financial or clinical ROI of big moves? Is it team dependency? You know, your team depends on you for every minor decision, leaving no headspace for bigger ones. Or is it lack of data? Lacking real-time data to backup Those gut feelings, or perhaps it might be priority collision. Everything just feels like an emergency. We'll just… get a real good… okay, so… ROI and financial fear is leading the charge here. So, second-guessing on the big decisions seems to be the case, with team dependency, lack of data, prior to collision, following up, equally right behind. Let's see if that has any change. This will really help us align the conversation tonight, so that we address your priorities, first. and foremost. Alright, I'm going to end the poll here and share these results with our panelists. So, ROI and financial fear. Second guessing on those big ROI moves. Let's see if we can bring some clarity towards that particular issue towards the end of this discussion, and I'm sure that you will be able to walk away with Great frameworks that'll help you understand better. Here we go. Now… Let's get into the main Q&A session here. My first question is to you, Kelly. Where does decision pressure show up most consistently across your clinics today, and when multiple priorities collide in real time?

Kelly Jamorski 00:07:18

Yeah, so thank you for the question, and I think this is very real, right? So there's a few different things that I think are most current today. So I think AI adoption and integration are probably the most current decisions across industries, including ours. But outside of that, there's some day-to-day things that I do think really impact the performance of your offices. really 3 primary pressure points, and I think I'll be able to touch on the results from the poll as well. So I think one really key thing is, as leaders, you are responsible for defining the operational priority for your team daily. And it really shouldn't be more than 3 to 4 focuses, because priorities differ by role, right? And so, the challenge is, as your leader, if you're looking to grow and move in a specific direction, really being clear on what each role and what that priority is for them on a daily basis to help lead the team holistically to your overall goal. So, being very clear about what those operational priorities are on a daily, is a really easy way to make sure you're not falling behind, and set your team up for success. Because where there's Clarity, you don't have decision fatigue. I think the next one is really lead speed and priority response, and so a lot of new offices, or really anyone, is really looking for new business, and we are in a world where patients, clients can reach out to us through many different channels. And so, who do you serve first, and do you have that outlined and prioritized for your team. So I think everyone would agree that if there's a person in front of you, you take care of that person in front of you first. But have you defined for your team what comes after? You're getting, calls in, you're getting emails, you're getting third-party reward system communications, text messages. So, have you defined what order that you would like your team to reach out to these contacts with, so you can be very consistent with that speed and support that new patient acquisition interest? And then the last one, I think, is the ROI and the financial fear. Such a great call-out, because it is… it is a very real thing, especially when you're growing your own business. Sometimes you may not have… a lot of times, you may not have the capital up front to make those investments, and so I think you've got to get very comfortable with really understanding how quickly you're going to see that return and how you're measuring it. Does that look like you're sitting down with your team and you're mapping out an actual ROI calculator? What does that timeline look like? Is that actually realistic? Are you making your ROI ROI calculator off of gross profit or net. What variables are you taking into account? If you don't have the capability to do an investment up front, especially when it comes to equipment and aesthetics, which is very expensive a lot of times. what other options do you have? And as our business has grown, there has been other options that can support your business, such as renting equipment, working with third-party rental companies, working even with some of the primary energy vendors. So there is a model shift happening on that side as well to support some of these financial fears. But I think just getting very comfortable with understanding what is it going to take to turn this investment into actual… an ROI that's profitable, and really sitting down and mapping that out.

Kevin Kassover 00:10:48

You know, I… oh, sorry, I was gonna…

Don Adeesha (Host) 00:10:50

Go ahead, Kevin.

Kevin Kassover 00:10:50

If that's okay. Kelly, I think you raised a couple of things, one in particular that I want to piggyback on around. financial fears, and for me, that's about daily measurements and KPIs. What that also translates to for me as a leader within an organization, is how do we translate What our overall goal is, our annual goal, our budget. into day-to-day activity, right? And it's… that's often where I think the disconnect is, and I think you nailed it by saying, you know, what are the two, three, or four priorities that you work on, and in what order, so that we can take our more lofty goals and make them… Approachable.

Kelly Jamorski 00:11:38

Yeah.

Don Adeesha (Host) 00:11:39

And. Kevin, I would like to ask a follow-up question right there. So, how do you decide between speed and thoroughness in that decision-making framework when revenue timing is under pressure?

Kevin Kassover 00:11:52

That's a great question, too. I'd say there's a couple of things that I'd be thinking about when I'm dealing with speed. and pressure for decision making. The first is taking a step back, and I did this in my most recent position, which is, do we have the right people in place? Can… do I trust what they're saying? Are the right people in the right roles doing the right things? Because ultimately, it's people first, because that's who we're working with, and that's who we're working through. So, I would take a step back and look at overall decision-making, because this will help us in setting up speedy decisions by having the right people. I think the second thing I'd be looking at is data. If we've established our KPIs, are we looking at context? Are we trying to compare what we're doing to year-over-year revenue and growth goals? In other words, having some data So that we can at least contextually make a decision that is somewhat informed and helpful. And then, I would also say, when in doubt, exercise caution, because when a decision is made too hastily, it affects team. culture, morale, and it affects, ultimately sales and an impression of the brand, right? And whether that's about making a decision as to whether or not you want to do a sale because you're reaching the end of the month. or whether that means, you're purchasing equipment, within a certain time frame. So, so for me, those are probably the The 3 big ones?

Don Adeesha (Host) 00:13:37

Right. How do you… figure out which one is the priority. Is it the people that is the issue? Is it data, or rather the lack of? How do you decide, or how do you figure out that is where your problem is stemming from when it comes to a decision?

Kevin Kassover 00:13:53

I think people is the background. People is the most important thing that you have in place as a framework, and I think then data.

Don Adeesha (Host) 00:14:02

Okay. Now, you mentioned… Okay, you mentioned there, the word cautious, right? To exercise caution when we're making decisions based off that data. What do you mean by that, specifically? Do you have an example you could share us?

Kevin Kassover 00:14:21

Sure, I would reference what I was just saying in making a decision that could affect your brand and your team, right? So, I think the last-minute sale is a great example, right? That, for me, is the epitome of… Of, you know, speed and decision-making in trying to make your goal. I think that's where it's really important to have a framework in place. You know, what… who are we? What do we do? Is this in line with us? Is it… Does it make sense for our business? I hope that's helpful. I throw it out to the rest of the panel, too, to elaborate if you have any thoughts.

Don Adeesha (Host) 00:15:04

Right. So, basically, even if it's a last-minute, you know, sale, or, rather. That should be thought of way well in advance, through a framework, instead of.

Kevin Kassover 00:15:17

And then, yeah.

Don Adeesha (Host) 00:15:18

gut feeling.

Kevin Kassover 00:15:19

Yeah, I think in terms of certainly last-minute sales, it's about really calendar planning, so hopefully you're not making that last-minute decision if you've actually planned things out ahead of time.

Don Adeesha (Host) 00:15:31

Right. Now, John, what patterns do you see in how growing practices handle high-stakes decisions differently than earlier stage operators under pressure?

John Bergano 00:15:43

You know, I think it depends where you're at in the business life cycle, right? You know, when it's more of a startup or, you know, an early practice, you're going to have a different set of priorities, rather than a growing or a practice that's already looking towards your exit, so I think it depends where your business life cycle is at. You know, an earlier stage practice, you know, they're trying to achieve profitability, they're trying to build a client base, you know, they want to make sure that they have all the tools in their toolbox, you know, in order to run a successful practice. Whereas those that are growing, you know, are looking to expand service lines, they might be looking at additional locations, hiring additional providers, you know, and then if they're further along enough, they're probably looking ahead to their exit strategy as well, so… You know, I think that it really depends where you're at, you know, to see how you handle, you know, high-stakes decisions. I think you also just, you learn based on experience, right? You know, sometimes when you're early on, you know, you might be, you know, pressured into, you know, opening up new accounts with new vendors, trying out products, bringing in you know, CapEx that you might not necessarily have planned for. And, you know, you… you learn from some mistakes, you know, as Kelly alluded to. you know, CapEx is not cheap. You bring in a device, and you're making a long-term invest… investment commitment, and so you've got to, you know, really map that out from the start, you know, as far as, you know, what your expected expenditures are going to be, what it's going to cost you, and what kind of ROI you're gonna get. So I think, you know, with sufficient planning, seasoned operators, they get that confidence under their belt to be able to make high-stakes decisions.

Don Adeesha (Host) 00:17:34

For our bootstrapped owner, what is perhaps the first piece of data that they should look at before making a growth bet?

John Bergano 00:17:44

You've got to look at your cash flow first and foremost, right? You've got to understand how all of your expenses are lining up. You've got to understand your P&L, you've got to understand your financials, and so, you know, if you don't have a clear path to profitability with an investment, whether that be a device, a provider, a location, you know, that you're getting yourself into with a long-term lease, if you're not making, you know, these decisions on paper first. You know, in a spreadsheet, you know, you, you could, you know, you're not really setting yourself up for success.

Kelly Jamorski 00:18:20

Yeah, John, I think that's great, great feedback, and I echo your comments. And I think another thing when you're a bootstrap and you're trying to grow, you know, one of your biggest cost factors is labor, right? And so, if you're trying to grow and you're trying to be competitive, being very thoughtful about who you onboard and, is that person the do they have an additional licensing that can give them a broader scope, so you're not necessarily having to hire multiple people? Is there a cross-training capability that you can incorporate with this new hire? And I think the other piece, too, is, you know, there are a lot of upfront costs, and you don't have to have every single thing available to be successful. In fact, it really is finding a niche or even small offerings and really growing your patient experience and reputation, and that's going to give you some of that additional financial opportunity to expand into some of the newer services. I think some clinics that kind of, they feel like they have to offer everything to have a foot in the door can find themselves in a little bit of a financial situation if they don't have that consistent patient flow. So not necessarily offering everything is the right move right out of the gate.

John Bergano 00:19:32

Yeah, and I think it's good, too, as you are growing practice, if you are bootstrapped, you've got to listen to your patients, right? When my wife and I, when we opened our practice, you know, we were in our early 30s, a lot of our patients in their early 30s, they're not coming in for CO2. You know, they want to come in for quick microneedling treatments, you know, that have little downtime, you know, they're not making, you know, big investments in their aesthetic procedures yet, and so, you know, you have to understand what your patients are looking for, what their, you know, what your demographics are, and then try to bring in services that complement what they're looking for that really, you know, are gonna fit their needs, as well as your P&L.

Don Adeesha (Host) 00:20:15

Wonderful. Ensure that you know your cash flow in and out, as well as the people that you're serving. Or our bootstrap operators here. Now, Kevin, how do you decide… oh, my apologies? Kelly. Kelly, what structure do you rely on to make consistent decisions across locations? When teams interpret situations differently, this is an interesting one.

Kelly Jamorski 00:20:41

Yes, so, as you shared, I have lots of experience across multiple locations, and it absolutely is a fun challenge, but the reality is consistency across locations is truly built through structure. And so the first step is you really have to have protocols and policies. You have to have something that defines what right is. What is right. So you do have to have something that defines that as kind of a, a backdrop to whatever you're doing. And then the second thing is, you have to have some sort of real-time access. So, if someone makes a different decision somewhere, and maybe it's not exactly what you wanted, and they need to quickly validate something, you need to have real-time access to someone who can help guide that. And that shouldn't necessarily be an email. It shouldn't necessarily, you know, phone calls are probably the best way to do about it, but in a large group. Sometimes it's something as simple as a dedicated Teams chat channel, something that is really designated just for those types of issues or specific concerns. So when someone communicates, it's like a visual flag. But it also gives input from others to make sure that, is there a policy for this? How do I approach something if I have this question? And then, you know, you really need to make sure you have closed-loop communication. So if there was a decision made that wasn't necessarily the right one, or if it was the right decision, you do need to then follow up with your team and just kind of reconfirm everybody understands the process and whatever the protocol call is when they run into this particular situation. And I really think it's important that we recognize someone who did something right in that process. So creating some sort of positive recognition will reinforce the behavior for your team to go back and reference the policy. Make sure they're doing this right whenever this situation occurs and they have to make another decision on how to navigate it. I'm a really big believer in, you know, positive reinforcement and positive peer pressure, and just really re-encouraging your team to… Do what is right, and then that… and give them a channel to communicate that easily.

Don Adeesha (Host) 00:22:56

What does that positive recognition look like?

Kelly Jamorski 00:23:00

It could be something as simple as you do an announcement to that group, or in that particular channel, just saying, I really appreciate that Kevin was able to follow the process that was outlined, or he ran into this challenge, and he executed this, which is what we wanted him to do, and he did a really great job. A good job or a great job goes incredibly far with your team, and if you're able to tie it back to a specific action that they did, you're going to get the same res… in most cases, you're going to get the same response from the balance of your team, because they recognize that positive reinforcement.

Don Adeesha (Host) 00:23:35

Check. Now, you mentioned, ensuring that The whole team is on board, on understanding what is right. How do we figure out what is right? Where do we start?

Kelly Jamorski 00:23:49

Yeah, so a lot of that really is, and at least in the aesthetic world, a lot of it's going to go back to appropriate medical policies or business decisions. So if it's a medical policy, there's going to be some literature that your medical director can lean on, or they are the ultimate authority in whatever the medical steps are. If it's a business decision, and that's a business process, that's going to be really up to the business owner, and sometimes that's the same person, right? And so, those types of decisions really sit with the person that is looking at the books, looking at the business, looking at how do I want my team to respond to these situations, whatever they may be? And the reality is that that process, that book, those decisions should continue to expand as your business expands, because the challenge you have today is going to be different from the challenge you have tomorrow. So as you get more seasoned, you're going to learn how to navigate things a little bit differently, but as you're growing your business. to keep yourself consistent, especially if you're expanding in other locations, having kind of a good policy book or a reference guide is always a great place to start, because you can always reference and go back. It can be updated as needed, but it gives your entire team kind of a threshold of what the standard is that you've set.

Kevin Kassover 00:25:06

I'd also like to add to that. I think that part of our job is to plan that mistakes and poor decisions will be made. I mean, it's inevitable. Totally agree. I agree. So I think that's part of our process. And so, when you do have a mistake or a poor decision that may be made locally, or even at the leadership level. it's important to make it a teaching moment, right? It's something that we can learn from, so we can take a negative, and as Kelly said, turn it into a positive, or make it… turn it into positive reinforcement, so that people learn from it. So I do think that there's something there, and expecting that this will happen, because that's the nature of being human and who we are.

John Bergano 00:25:53

I think also constant communication with your team. When you have a weekly meeting, it sets up opportunities to dig into what went right and what went wrong this week. You know, so we used to, you know, like to do meetings on Fridays, right? By the team lunch, you know, we're talking, you know, how did the week go, right? Were there areas of opportunity? Were there areas, you know, that we really excelled at? You know? And, you know, also get the team involved from a financial standpoint as well. You know, were we hitting our goals? you know, was everyone kind of pulling their way, you know? Did we perform really well in one area? So, I think also constant communication with your team also kind of helps set those expectations.

Kelly Jamorski 00:26:35

Yeah, agreed.

Don Adeesha (Host) 00:26:35

Oh. Wonderful. What an amazing structure. What is right? Real-time access, closed loop. Positive recognition to really, wrap things out there, and of course, planning for the unexpected, and… How are you going to find all these things out? Consistent communications. Thank you so much, everyone, for that. Now, let's see… John, when a practice is weighing a major growth decision, what moment tells you it's time to move forward versus pause?

John Bergano 00:27:09

I think as an owner, you know, when you have a pulse on your business, you know, you can trust your instincts, you… kind of start to feel, you know, when the work mandates, we need to add extra staff, you know, we need to bring in additional products, service lines, so I think, you know, when… when you give serious consideration to major decisions, particularly when it comes to capex spend, you know, you… almost have to look at these decisions as categories. You know, what's, you know, a more immediate, you know, sort of quick decision, you know, that you need to make? Is it hiring a new staff, bringing in a skincare line? I mean, it's something you can do with relative ease. You know, more significant decisions, such as, you know, bringing in a device. or hiring a new provider, that becomes… it adds an extra, you know, or additional layers of consideration, where you have to start budgeting, you know, a little bit more in depth. And then, you know, more significant decisions, such as opening an additional location or exiting a business, it takes serious consideration, and especially a lot more planning. And I think You know, when you start to gravitate towards the more serious decisions, which is opening another location. or preparing for an exit. At that point is when it's helpful to bring an outside perspective. You know, sometimes on a day-in and day out. You know, even your trusted managers, providers, they still might not have that ability to, you know, objectively look at your business from the top down, and help you decide if that major decision that you're trying to make is really the In the best interest for you and your business. You know, and I've worked with a number of, you know, practices from all sorts of phases of the business cycle. You know, startup, where I've underwritten, you know, lines of credit and financing tools for them, all the way to taking practices to exit. And so, you know, I have a unique perspective on seeing these businesses sort of struggle with different decisions along the way. You know, I've had to counsel clients on, you know, some tough choices to make. you know, taking a look at an underperforming clinic that really should be closed, because we're trying to achieve a certain profitability, a certain EBITDA, In order to get the valuation that they're after in the market. You know, having to make, you know, recommendations to cut staff, you know, to cut payroll costs. You know, so if you don't understand your benchmarks as well as you're growing and you're making these major growth decisions, you know, you're gonna… you're not really setting yourself up for success for the long term. If you're not looking at, you know, how you're benchmarking your financial performance. So, you know, at the end of the day, you know, no matter who I'm talking to, whether they're early stage, whether they're preparing for an exit, you know, it's about You know, taking a critical look at their financial picture, and understanding what the goals are, and, you know, helping them to talk through, you know, what needs to happen in order to achieve those goals.

Don Adeesha (Host) 00:30:28

John, I think you touched on a very interesting point there. You said it as in getting to the valuation of the market, if you're an underperforming, right? I'm really curious, because when it comes to the sale, and if… If it's not going great, we're going to sell at whatever price they're asking for. Especially considering the fact that now there's a lot of consolidation going on, and the fear of PE-backed ventures. So, you're telling us it's possible to get to that valuation of the market How?

John Bergano 00:31:05

You know, I mean, I take a look at practices that, you know, no matter if you're doing a million dollars or five million dollars, you know, if you're running 50% payroll, if you have an EBITDA that's in the single digits. you know, you're gonna have a tough time, you know, because fundamentally, you're not running a proper business. You're not running a company that, you know, would allow an investor to come in, you know, take over, use centralized resources to continue to cut costs and operate more efficiently. You know, it's really kind of a mess of some of its parts, you know, collective assets that really don't have have much value. You know, there's a lot of over-leveraged practices out there that I think, because they weren't operating with business fundamentals from the day they opened their doors, they got in over their heads with, you know, CapEx purchases, too much inventory, you know, not training their staff properly, you know, allowing too many red flag patients to take over their schedules. You know, there's a lot of ways that businesses can go sideways. sideways, you know, if you're not… being diligent from the… from the day you open your… even before you open your doors, you know, you have to… you have to, you know, set those business fundamentals, set those SOPs, set those KPIs, set those expectations for you and your staff, and maintain them, you know, and… You know, I think, you know, if you… you have to think about, like, what your rent goal is, you know? But what is your timeline? You know, how long do you think you're going to be running this business? How long do you want to stay involved in this business? You know, and I think, you know, unfortunately, you know, a lot of decisions are made, you know, with very short-term vision, but really, I just encourage a lot of business owners to take a long view at, you know, a lot of decisions that they're making, even if they seem like they're on on a daily basis or a monthly basis. It's just… it's so important to scrutinize the decisions that you're making.

Don Adeesha (Host) 00:33:05

Kevin, I would love to get your… oh, go ahead, Kelly, go ahead.

Kelly Jamorski 00:33:08

Sorry, Don. Apologies for interrupting, but I think John hit on a really important, really important component, is anyone in this industry should know your industry benchmarks. That's going to be almost an immediate indicator of how the health of your business is performing against the balance. Of what's out there, right? Especially as we talk about PE firms that are looking to, acquire businesses. They're doing that research, right? They… and that's what they're referencing when they're looking at your books. And so, I think, you know, knowing what those industry benchmarks are, and the benefit is we now have a lot of that data, which, you know, if you've been doing this for a long time, like, I think most of us here, for a long time, there wasn't a lot of industry data. But now we have a lot of industry data, so I do think that that benchmarking is such a great call-out. And if it's not something that you're familiar with, it's definitely going to be your gut check, your most immediate gut check right off the cuff. It's a really good point, John.

Don Adeesha (Host) 00:34:11

Kevin, I was also just wondering, from your 20 years of experience in the P&E section of things, what is your look on this? How have you… what's your experience when it comes to the sale? Are they underselling, underperforming?

Kevin Kassover 00:34:30

Can you elaborate on that question? What do you mean by…

Don Adeesha (Host) 00:34:34

No, I was just curious, okay. So, because as, John mentioned over there, you know, we could… take an underperforming clinic, get to the evaluation of the market, you know, fixing some of the fundamental business issues. Have you seen this be the case in your experience?

Kevin Kassover 00:34:53

I have. I actually agreed with what John was saying, and I do think that one of the biggest mistakes is oftentimes, especially if you have multiple locations. further investing in a location that isn't doing well, and you've tried to invest in, at a certain point becomes a sinking ship. So I think it's knowing when to cut your losses specifically so that you can make the rest of the portfolio appealing.

Kelly Jamorski 00:35:23

That's a really good point, Kevin. That's a really good point, and unfortunately, sometimes it's… it can be a little of an emotional, difficult decision, especially if you're the owner, the leading clinician, so I think that's a really… like, having as much objectivity, especially if you're the clinician as well as the business owner, you almost have to have two hats on, right? When you're in that clinician mode, you're taking care of your client, taking care of your patients, but when you're in that business owner mode, you do have to almost separate that and look at it through that lens, to Kevin's point, because you don't want to tie yourself to a sinking situation if you can avoid it.

Kevin Kassover 00:35:56

Yeah, and that applies to not just locations, but to individuals within the location and their performance, etc. I think it's… and I agree with Kelly, that's when benchmarking is vital.

Don Adeesha (Host) 00:36:11

That's the answer I was really looking for, because John had mentioned when you're making serious decisions, it's always a good idea to bring in an outsider perspective, and perhaps that objectivity is what is brought in. Is that correct, John? Am I understanding that.

John Bergano 00:36:28

Yeah, it's helpful to get another set of eyes on the business, right? You know, because again, you… you get so, you know, you're in the weeds, you're in the trenches, right? You're in the day in and day out, and sometimes you kind of lose sight of the big picture. You know, you might think that there are members of your team that are just so intrinsically valuable, when in fact, they're not producing, you know? You know, they don't have a clear-cut goal or role, and, you know, so there's a lot of different decisions to be made, and so, it's always helpful to bring in that outside perspective.

Don Adeesha (Host) 00:37:03

Absolutely. Now, Kevin, what's typically breaking down during rapid growth when decision-making isn't standardized, and who will feel that impact first?

Kevin Kassover 00:37:17

Sure, it's also a good question. This ties in with some of what I said, and I think some of what we've already discussed, but for me, there's some major categories. One is culture. You know, as, you know, what's the expression? Culture eats profits for breakfast, right? So, what will often break down is how your team feels about being there, right? So that's… for me, one of the most important… I keep talking about people being important because they're… they're who we're relying on to generate revenue and translate the brand. The other thing that breaks down is the brand. How are these decisions impacting how patients or consumers are perceiving the practice. If a decision is made too hastily, or inconsistently, it affects their experience. The team, as I mentioned, I think, you know, you're going to see everything from From… from turnover to, issues with morale, and then… and then, ultimately, it's revenue that you're going to see change or drop. So those are the… the biggest categories, I think. And if you have multiple locations, you can also see conflicts between locations that may arise.

Don Adeesha (Host) 00:38:36

Okay, and what do you do when these conflicts arise? What's the first step, Kevin?

Kevin Kassover 00:38:41

Let's take a step back and take… and ask what… what… how did this happen, and what can we do better to make things more consistent? For me, I… I am very much about the team and wanting to get their buy-in so that we can't… so that we don't make that mistake again. So, for me, it's about making sure that The team, collectively, Comes up with a process or evaluates what happened, so that they're now buying in to future solutions.

Don Adeesha (Host) 00:39:13

Check. Thank you very much for that, Kevin. Now. We've been talking about the pressure of making the right growth decisions, and one of the highest stakes decisions you'll make this year is where you spend your marketing dollars at in this age of AI. So if you're feeling that pressure, then I would like to pause here for a moment, and as a token of appreciation for registering and attending this webinar. We have a special resource for you, and I would like to invite a representative from ECO Marketing, the organization that made this event possible, to deliver it to you. Lester D. Elvis, Marketing Manager at Eco Marketing, the stage is yours. It's here? There we go. Oh.

Lester 00:40:08

Thank you so much.

Don Adeesha (Host) 00:40:09

There we go.

Lester 00:40:09

Thank you so much, Don, and thank you for, Business of Aesthetics and, everyone at the team putting together so much of an amazing event. I'm really proud to be part of this as a Platinum sponsor here. So, I just want to leave with a very quick tip, so… I know I've been listening to this conversation, and every big decision we've been talking about tonight was about growing your team, opening another location, and coming back, and everything comes back to one thing, and that is new patients. So, if new patients keep coming in, every choice gets easier. If they don't, you start without every move you make. So, here's what most practices where we, when we work with, are, struggling or losing. So today, people use Google 12 billion times a day. And when someone needs a skin doctor or a plastic surgeon, they are not on Instagram, they are on Google, and only the top 5% practices get 95% of the traffic. And, from Google, and everyone else has to pay for every new patient. So, paid ads do hurt, because, when someone clicks a social media ad, they spend 5 seconds on your website. And when they come from Google search, with no ad, they spend 90 seconds. So… So that means you need 18 ad clicks, to click… to actually equal one, real search visit. So, practices that run ads spend 10 times more money, that means, and those patients trust them less and can sell more. There is no trust factor in that. So the hidden… that is the hidden cost of not having a plan, and the top 5% follow a 6-month marketing plan. close to 6 months to 1 year, and they show up on page 1 of Google for 100 or more search terms or keywords. They get 10 or more new Google reviews every month, and they show up on ChatGPT and Gemini and all of the AI models we talk about. So. So that's basically, how marketing works. Marketing is all about getting the patients to find you and giving them a reason to choose you. So, so the… so what we want to offer you, is basically, as a token of appreciation for attending this event. Echo Marketing, in partnership with Business of Aesthetics, is offering a complimentary marketing strategy meeting with our team. We'll pull up your practice, your competition, your actual rankings. and show you exactly where the growth is hiding, and you'll walk away with a clear picture, whether you work with us or anyone else. So the link is in the chat that is, this is the faceitics.org. And, forward slash MSM, forward slash XPanels. It takes 90 seconds to book, and one last thing, tonight you heard four, leaders talk about making confident decisions under pressure, and the best decision any of us can make is knowing exactly where we stand before we decide the next move. So… Google yourself, just a small thing again, Google yourself the way a new patient would, and… sit, keep the perspective as a new patient, and think if you would book yourself. When you see yourself on Google. Well, that's the tip from us. Thank you so much, Don, and over to you.

Don Adeesha (Host) 00:43:37

Thank you very much, Lester, and to everyone, just to, reiterate. So, the marketing strategy meeting, usually valued at $900, completely complimentary for you tonight. Do check the, link in the chat for to book it under a minute or so. And, you know, it'll be time well spent. Right, let's get into one of my favorite segments here. Live Q&A. This is an open floor discussion we're going to have for the next 10 minutes, so we can answer your burning questions. So, as you get a bit comfortable, I'll just pull up one of the questions that we had gotten from our community, here at Business of Aesthetics, right? Okay, we got one from a medical director in Arizona, with regards to something along the lines of, every med spa on, my block has turned into a weight loss clinic, GLP-1s, overnight, just to pay the bills. It feels a bit desperate, I'm sticking to my high-end lasers and injectables, but revenue is flat. is staying the course the smart leadership decision right now, or am I being stubborn? I'm opening this to the whole panel, whoever wants to take a gander at it. Can go first.

John Bergano 00:45:08

I'll take a stab, because I think that, you know, kind of goes back to what I was saying earlier, and about polling your patients, you know? If you have loyal patients and, you know, they're honest with you as you're honest with them, they'll tell you what they're looking for, you know? And maybe there is something that you can do, especially being a physician, you know, maybe there's something in your skill set that you can offer your patients that they're looking for, especially so they don't go elsewhere. But, you know, we are going through an economic, you know, rough patch here, and again, we all don't know if we're headed towards a recession or not, so you do have to, you know, recession-proof your business as much as possible. So, you know, I'd look for, you know, higher margin, low-cost, you know, services that you can introduce to help keep your patients engaged.

Don Adeesha (Host) 00:45:58

Kevin Kelly, do you have anything to add on to that?

Kelly Jamorski 00:46:02

Hmm.

Kevin Kassover 00:46:02

I… I would say.

Kelly Jamorski 00:46:03

I'm sure we all do.

Don Adeesha (Host) 00:46:05

Go ahead, Kevin.

Kevin Kassover 00:46:06

I would say, what's your core business and what's your brand, right? I think it complements what John said, which is, for me, I'm all about patient satisfaction surveys or patient surveys, whether they're formal or informal. And for me, it's understanding what your med spa brand is on the block and sticking to it. I will say there has been… a lot of bleeding between what was once core aesthetics, based in dermatology practices, which is the background that Kelly and I come from, and now med spas and wellness. It is very, very blurry. One business can feed the other, but you really do need to determine what's right for your patients. I think, you know, what I'm seeing is certainly more and more med spas are getting into that space as a loss leader that feeds their other, more profitable service signs. So, I kind of lean both ways, and I kind of would want to know more about the patient base and understanding your brand.

Kelly Jamorski 00:47:21

So, I think…

Don Adeesha (Host) 00:47:21

Great place.

Kelly Jamorski 00:47:22

I think Kevin and John made excellent points, and I think that anytime you're looking at your business and you've got a lot of competition around you, you do have to figure out what is your unique selling proposition and lean into that very, very hard. If this particular clinician has a handful of lasers, and maybe his competitors don't, and knock on wood, these lasers don't have a ton of… Cost of goods to go along with them to support, you know, low cost and high ROI. There's definitely some creative packages that he could put in place, you know, really lean into, like, the side effects of GLP-1. The reality is that it is… it is a great product, and a lot of people are seeing really strong benefits from it, but they're also now noticing other things about themselves, too, and once you start, kind of, on that personal enhancement journey. you do start to plan for other enhancements, down the road. And so I think if he's not looking to necessarily jump on and join the GLP-1 bandwagon, then he needs to figure out how can he work within the competitive landscape and still be attractive. To patients utilizing the equipment that he has, or utilizing the tools that he has, and maybe that is really focusing in on the side effects of GLP-1 and what he brings to the table to support that. But again, like, you know, Kevin and John both said, if that's what his patient base is really looking for, but if his patients are demanding GLP-1, he will need to give some very serious thought to incorporating that into his business, because if they want it, and they have, you know, options down the street. There is a risk there.

Don Adeesha (Host) 00:49:05

I'll love that answer, making the problem the solution, and of course, starting there, perhaps, and seeing if you want to really include GLP-1s in your own treatment process. Now, we have another very interesting, inquiry, by one of the founders in Atlanta. My top injector just quit and is poaching patients on IG. What should I do?

Kelly Jamorski 00:49:36

Really good contracts is probably the first thing that comes to mind anytime you bring on someone. You know, you definitely want to make sure that you have some sort of, you know, non-solicitation clause, you know, non-compete detail in your hiring contracts is a great way to kind of get started. But the reality is, injectable patients or cosmetic patients tend to get very comfortable with their injector, so even if you have these clauses in your contracts, it's not uncommon that you have A little bit of a lull when that injector leaves, just because they've developed that rapport with the patient base. However, you can soften that by having some long-standing termination requirements, whether that's, you know, 60-day minimum. So it gives you a little bit of time to think about, am I going to replace this person? How am I going to absorb this business? Do I quickly hire and start aggressively marketing my new person so I can try to get new business in and retain the current business that I have? So there's a few things you can do, kind of, in the short term as you're hiring somebody. I think if you don't have someone hired in and you don't quickly replace them, you're going, you know, you need to, pretty much right away.

Kevin Kassover 00:50:54

I would… I would agree. I think… I think one of the things about being in this business is that this happens, right? So, planning for this to happen, although you don't want it to, is something to think about by having multiple providers, if possible. And then I agree with Kelly, I think one of the things that can be done, because you are going to see matriculation. There's just no question. It's just… it's just the nature of the business. Even if they're not marketing directly to those patients. You can, though. So one thing, if you haven't done already, I would suggest is offering, something for that provider's former patients to come in with a time-sensitive call to action, so that at least you can get a chance up at bat to try to retain it.

John Bergano 00:51:41

I'm also also a deal maker, and so I would also reach out to that provider, and if they haven't set up, like, a brick and mortar, or there's flexibility for them to return for an ownership stake or equity, you know, maybe make it worthwhile. You know, try to retain, you know, your top talent. And so, you know, that's something, you know, you should do while they're still on your payroll, but, you know, if they do depart, but there is a chance to get them back. and to boost what they mean to your business, I would try to do that as well.

Kevin Kassover 00:52:13

That's a good point.

Kelly Jamorski 00:52:14

That's a great point, John, and I think sometimes you can almost head that off, right? It goes back to the growth conversation and growth decision-making, right? So if you're recognizing your business is growing, and you're recognizing that your, you know, injector, your provider is doing incredibly well, consider that proactively as an option, versus… it just… it feels different versus them saying, I'm gonna leave, and now you want them to stay. So, as you're thinking about your growth decisions, that could be a variable that you consider, especially if your business is scaling. And to John's point, you want to retain your top talent.

John Bergano 00:52:52

Because if you're a $2 million practice, and you have a million dollar injector, well, that's 50% of your revenue going out.

Kelly Jamorski 00:52:59

deal.

John Bergano 00:53:00

So everything is a numbers game, so you've got to always be looking at what someone means, you know, and, you know, again, like, I've been in that situation, you know, where my wife and I have hired, you know, providers, and, you know. they threaten to leave, and sometimes we weigh it and say, okay, do we, you know, boost their compensation, or do we show them the door? You know, and so sometimes, you know, you just gotta think critically as to what someone means to your… to your company. You know, do you want to… do you really want to put forth that effort to keep them in? Or, you know, do you want to cut them loose? And it sounds like in this case, you know, this person meant a lot to the revenue of the practice. So, you know, again, I would try to almost, you know, bring them back into the fold, but, you know. Up that equity, that compensation, you know?

Don Adeesha (Host) 00:53:51

Threaten. That's the great word that you used over there, John, and I'm just curious, how are we on forgiveness? what does that look like? Because, you know, when they do threaten to leave, or they.

John Bergano 00:54:04

whom?

Don Adeesha (Host) 00:54:04

upshot ahead and becomes your competition. It's a little bit more than numbers at that point.

John Bergano 00:54:13

Yeah, I mean, you know, look, people are motivated by different things, right? Money, personal relationships, you know, maybe they need to be closer to family, you know, so there might be, you know, a number of different reasons, but, you know, this almost sounds like it was, you know, probably financially motivated. You know, and so those, I think, you know, again, if you look at your financials, you figure out a way that you can compensate that makes them happy and you're happy too. you know, you gotta try to figure out a way to make it work, you know? But again, yeah, it depends how escalated things got. I mean, if that employee, if that provider is… Threatening, you know, and, you know, they're gonna become a toxic, you know, contributor to the workplace, then, yeah, it might be better to cut ties with them.

Kevin Kassover 00:55:02

Yeah, I would be aware, you know, people leave… people… people don't necessarily leave companies, per se, and so I would be open to also looking at what… why that person left. If it's Financial, sure, that might be one thing, and maybe you did have that conversation, but if it's cultural or how they're managed, I think you also need to take a look at either yourself or the organization.

Don Adeesha (Host) 00:55:28

Very interesting. Thank you very much, panelists, for really, joining in on that and answering some of these questions from our community. Now, Kelly, when a team member needs to escalate a decision, what's a good handoff look like in that moment?

Kelly Jamorski 00:55:46

Sure, so this is, this goes back to something Kevin said earlier on the call, that you have to prepare for things that are going to happen, and this will happen. It is absolutely a… not an if it will happen. And it's also a really great, role-play training exercise, so if you've not done that, I would encourage you to do that with your team. And escalation really should feel like a continuation, not necessarily a breakdown. And a lot of times, they're generally over the same few things, right? It's usually pricing, you know, buyer's remorse, or so we're scheduling issues. Like, you can almost… Kind of categorize what a lot of these patient concerns could be, or even, you know. if your front desk is handling that, for example. But really, it's just making sure your team practices this, I think, because people get flustered in a situation where there's an escalation that needs to occur. So I think role-playing, as I mentioned, is a really great training tool, and then just going through, like. what is the clarity in the next step? You know, in some… and when I've done this in offices, we had a very specific email subject line that went out that essentially just said, like, escalation support, so it was very easy for me, or the manager to quickly kind of go through and look at it. We had details on what actually occurred, and then you needed to find a case resolution period. And that needs to be between 24 to, ideally, 48 hours, but sometimes 72 is acceptable in healthcare. And that needs to be consistently communicated to… to your team, right? So not one person saying, oh, someone will get back with you in a week, or someone will get back with you by tomorrow. You need to have consistent verbiage so your team knows what to say, but you have to follow through with that. And then if you are actually out of the office, or the primary person who's out of the office, there needs to be a dedicated proxy who's handling these situations. No client wants to hear, oh, my manager is on vacation, they'll get back to you when they're back in the office. So, you want to make sure that you consider all of those kind of variables when you're teaching your team on how to appropriately navigate an escalation.

Don Adeesha (Host) 00:58:04

Really appreciate that. I just want to get a little bit more insight. Oh, we are at top of the hour here, so I will have to keep things moving. John, how do you reset your decision approach after a poor outcome, when confidence is affected?

John Bergano 00:58:21

You know, I mean, at the end of the day, I think business is business, and, you know, when it comes to money, you know, money is just money. You know, you might lose some at the end of the day. But, you know, the part that I think you've got to pay particular attention to is patient care. I mean, at the end of the day. Aesthetics is medicine, and so… you know, I don't think that there's… there should be any shortage of discussing any patient complications, adverse events, and making sure that, any… any complications that, that arise in a clinical setting are addressed, and addressed thoroughly, and over and over again, you know, to try to learn. So that's… Kind of my two cents on, you know, that.

Don Adeesha (Host) 00:59:08

Kevin, Which operational metric best reflects improved decision consistency across a growing practice?

Kevin Kassover 00:59:17

Sure, and I did get this question beforehand, so I'm going to answer it quickly, knowing that we're at the end of our time. I'm going to say there's really six categories. One is employee satisfaction. 2 is customer retention. I'm gonna also talk about, your annual visits and annual expenditures per patient as a key metric. provider revenue, and then, as I, as I mentioned before, this is tied to also service line revenue. So, as you're looking at each of your devices, injectables, etc, and using and benchmarking those. So, those are really the basic ones for me.

Don Adeesha (Host) 00:59:58

Basic, but the most important ones.

Kevin Kassover 01:00:01

Exactly.

Don Adeesha (Host) 01:00:02

Okay, okay, you can elaborate a little bit on it if you would like, Kevin.

Kevin Kassover 01:00:10

I'm actually… I want to throw it to the panel and see if you guys want to elaborate. For me, they're… they're pretty… pretty basic.

Kelly Jamorski 01:00:18

I think they're straight, I think they're straightforward. Yeah.

Don Adeesha (Host) 01:00:22

Absolutely, and I really appreciate that as well, because I think that'll be a key takeaway for our attendees here tonight.

Kevin Kassover 01:00:28

It asks.

Don Adeesha (Host) 01:00:28

Speaking of which, I would love to get the number one key takeaway from each of the panelists here for our attendees. What can they put in place tomorrow to make better decisions moving forward? Kelly, can we start with you?

Kelly Jamorski 01:00:42

Sure.

Don Adeesha (Host) 01:00:43

1\.

Kelly Jamorski 01:00:43

Yeah, so I think one of the biggest key takeaways is get very aligned on what's actually driving your business, and then being very clear on what you need each person in your business to do to get to your overall goal.

Don Adeesha (Host) 01:00:59

Check. John, how about you?

John Bergano 01:01:03

get comfortable with your financials, you know, understand your P&L, understand your benchmarks, know where you're at. I'm happy to be a resource for anyone who's listening in on this call, if you need to understand your financials and how they look in the grand scheme of things.

Kevin Kassover 01:01:20

And I would say, as I've said before, make sure you have the right people in place, and the right positions, and know your KPIs, which really ties in with what John said, and understanding your P&L also.

Don Adeesha (Host) 01:01:33

Wonderful. Alright then, right, so… one last… poll for our attendees here tonight, because we don't want this to be a shelf-help, session, right? We want to see some commitments. So, let us know, what's… The first action, you're committing to your practice tomorrow morning. Is it booking, the strategy session to find your number one growth opportunity, or is it going to map out a clear decision authority matrix for your team, to understand how decisions should be made? Or is it going to identify the one North Star metric that'll guide you on your next big investment, or is it… Fourth one, holding a decision reset, meeting with your staff to improve that handoff process. Let's see if we can get anything over here. Or perhaps everyone is set to go to the evening. Okay… Check. I think everyone is, ready to… head on out for the evening, and I think I will respect that cordially. Really appreciate everyone tuning in here tonight. So, with that being said, one last quick reminder of the strategy session. If you haven't booked it, go ahead. Link's in the chat. One last time. Make sure if… clients in your area are searching for the services that you offer, you're the one that is found and trusted. And with that being said… Here we go. I would really appreciate… I'd like to thank our incredible panel here, Kelly, Kevin, John, for… pulling back the curtain on what leadership will look like, and to our attendees, you'll see a quick feedback survey pop up as you exit. If you can, take 30 seconds to fill it up. It'll help us keep these sessions high value for you. And For everyone here tonight, thank you so much for investing this hour in your practice of success. Go make those high-stakes decisions with confidence. Good night, everyone.

Kelly Jamorski 01:03:47

Good night, thank you.

Thank you.

Don Adeesha (Host) 01:03:50

Absolutely, thank you.

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