The ‘Ghost’ Director Trap, Outcompeting Medspa Franchises, and The Business of Safety

Don Adeesha: We are operating in the wild, wild west of medicine. Between ghost medical directors, corporate franchises pushing volume over quality, and a severe lack of standardization, the aesthetic industry is full of operational landmines. Welcome back to the Business of Aesthetics podcast. I’m your host, Don Adeesha. To help us navigate this chaos and build a defensible business, we are welcoming back Dr. Kate Dee. Dr. Dee is a Yale-educated physician and the founder of Glow MediSpa. After a successful career in breast imaging, she transitioned into the aesthetics world and was shocked by what she found. She is the author of Medspa Mayhem, the host of Medspa Confidential podcast and the founder of Medspa Board. Having previously joined us to discuss overarching ethics and compliance, today she is back to talk about operational defense. Today we are discussing the financial risks of absentee medical directors. We are talking about how to out-compete private equity franchises and the actual business value of clinical safety. This episode is brought to you by Ekwa Marketing, the digital growth partner behind this podcast and a trusted resource for aesthetic practices looking to dominate their local markets. Now, with that being said, Dr. Dee, welcome back to the podcast.

Dr. Kate Dee: Thanks so much for having me. It’s great to be here.

Don Adeesha: Absolutely. Now, Dr. Dee, you have famously referred to the aesthetic industry as the Wild West. And… have been critical about the absentee leadership model. Now, from a purely financial and liability standpoint, what is the specific operational danger a practice owner invites when they attempt to scale their business by using a ghost medical director?

Dr. Kate Dee: Yeah, so just to state, there are a lot of people who call it the Wild West. It’s not just me, so I did not originate that idea. But one of the key problems in the industry is this idea of a ghost medical director or an absentee medical director. And what I call them in my book is a fake medical director because they’re not actually medically directing. So here’s what I mean by that. So the way the medical system developed, doctors couldn’t do everything and we had all these other people in the system as part of the team in order to carry out medical care. It’s supposed to be the doctor decides the medical care and then it’s carried out by the team. There are all these people in the industry who are practicing medicine essentially without a license. and they’re renting out a doctor’s license who has nothing to do with the practice. And that’s completely illegal and unethical on the part of the physician, okay? So the physician is renting out their license. They don’t even know the staff using it. They don’t know what’s going on in the spa. They are not aware of the protocols and procedures in place. They don’t know where the products are coming from. So what are the risks of that? Like what you’re gaining is not paying a doctor, I guess, of like a salary or not having a doctor on staff or not having a doctor as a partner. But what you’re risking is harm to the patient. You’re risking arrest of your staff members. you’re risking a lawsuit and you’re also risking like really bad reputation and reviews. Now, if you think that that’s overblown, you can just look at recent arrests of RNs and several different places around the country where it was exactly this, right? The medical director was nowhere to be seen. The RN is practicing online. on their own, and that’s not legal. So nurses are not allowed to practice medicine. They can really legally only carry out doctor’s orders. They can’t make medical decisions. There are many states where nurse practitioners can do that, but not all, like about half of the states. A little over half of the states allow nurse practitioners to make independent decisions. But but even half the states, even nurse practitioners can’t do that. And so you have a risk of losing your entire business if you use that model. Now, it doesn’t mean that it’s not happening. It’s happening all over the country. But. There is a clampdown that is starting because of the really bad outcomes that have happened in a number of these places around the country. The authorities are starting to actually arrest people. And so that could be your business. And so you’re risking your nurse’s license, you’re risking all your staff. And so ultimately your business could fail just because you’re using this model. I know that is very common, but it’s not the right thing to do. And as a physician, I can’t even imagine trying to live with myself knowing that someone I didn’t even know was practicing under my license and it was my liability that was at risk. That’s crazy. And that’s the other thing I didn’t mention is the risk to that physician is your license. They will take your license away if they know you’re doing this and you will not be able to do it anymore.

Don Adeesha: There we go. Dr. Dee, I’m also curious as to what are some of the most common ways the boards are catching these ghost arrangements today?

Dr. Kate Dee: Well, I don’t, I mean, I actually think that the boards are not catching it really at all. I think what’s happening is these practices are getting reported either by a patient that’s been injured or or by an employee who’s a whistleblower or by a competitor who knows that they’re doing something illegal and it’s getting reported. So that’s happened. I mean, you know, in one case, it was somebody who was offered a job, who declined it because they knew the practice was illegal. And instead of that practice going, oh, gosh, we better clean things up, they didn’t do anything about it. And then that person who declined the job reported them to the authorities, both to the medical board and to the attorney general. And so, you know, it’s not that the medical boards are sweeping the system to see if you’re really doing your job or not, but you’re very vulnerable if you’re cutting that corner and someone reports you.

Don Adeesha: That was the incident that happened, I think, in Arizona, correct?

Dr. Kate Dee: Yeah, well, there’s been more than one. But yes, yeah.

Don Adeesha: Right. So now, Dr. Dee, you came from breast imaging, which is arguably one of the most heavily protocol-driven and scrutinized practices in medicine. When you first transitioned into the aesthetic space, what was the single biggest operational shock you experienced regarding how most clinics handled their internal clinical protocols?

Dr. Kate Dee: Yeah, well, I think that maybe it’s because I came from such a highly regulated space that it was so shocking that my new industry was so out of control, nobody’s checking. Because, you know, in breast imaging, breast cancer, it’s federally regulated. It’s very, very, very heavily federally regulated. And you could not exist if you were not complying with all these regulations. So when I first opened, I did my research trying to figure out what do I need to do? And interestingly, as a physician, I didn’t need any special license to practice medicine. And basically I could do whatever I wanted if I’m practicing medicine myself. But when I hired an esthetician who is then gonna do facials in my office, we had to get a special license from the cosmetology board that was a salon shop license that allowed us to do that. And then the cosmetology board actually comes and inspects our facial room To make sure cleanliness, you know, there’s a lid on every garbage can and, you know, stuff like that. All your supplies are clean. But nobody’s inspecting the medical rooms, which, of course, I care because it’s my license. So they have to be clean and we have to be really careful and sterility needs to be maintained and all that. But… It’s the way the state governments regulate medicine is that they leave that up to the doctor. Right. So my license is on the line. It’s my liability. I have to have malpractice. And so that’s up to me. But if you are a let’s say an RN with a ghost medical director and you don’t have actually even any of the licenses, Nobody’s checking. Nobody’s checking until somebody’s harmed or somebody reports you. And then all of a sudden you get inspected or you get in, you know, in, in some of these cases, there’s a sting operation, right? And they, they go and they show up and they, they see what you offer to them and they know it’s illegal and then they lead you off in handcuffs. So to me, it was just very shocking that to get a facial or say a haircut, it’s very regulated and there’s inspections and there’s special licenses, but for med spas, there isn’t. So I think that was the most shocking thing to me.

Don Adeesha: Okay, so our listeners are primarily, you know, from the aesthetic space. I’m just curious, how does it look like on the other side, say from breast imaging? What if you were to open up breast imaging clinic? How would that look like?

Dr. Kate Dee: Well, you couldn’t. You couldn’t. I mean, so first of all, if you’re not accredited, you cannot bill for a mammogram. The equipment, it’s all very regulated. The equipment, you have to submit every year a whole spate of different kinds of images that we obtain for breast cancer. It’s… And then there’s also auditing of your practice that you have to submit to the federal government as a whole, whole rigmarole. I mean, it’s kind of a big deal. I’m not recommending that big a deal for, for aesthetics. But I do think that there needs to be national standards. And I think that people both, you know, people in the industry and then also consumers need to understand that it is the practice of medicine. Yeah. And that all the laws that govern the practice of medicine apply to MedSpa’s. And I think for some reason, people just don’t realize that. And I don’t really understand why, but it’s very important because people are getting disfigured. They’re getting injured. they’re getting infections, they’re even dying. And if you just look at the first case of Jennifer Cleveland in Texas, the first one that I know of, of a death at an IV bar, that person who killed Jennifer Cleveland was a friend of hers. She wasn’t expecting it. She had no idea that she did anything wrong. She just had no medical training. And that’s what’s really scary is that when you don’t know what can go wrong, you think, oh, I know I have a skill. I know how to put in an IV. Well, that doesn’t mean you know what to put in a human and not kill them or to make them, you know. So, you know, someone just messaged me, and I don’t know who this is, but about their friend’s sister who just died in an IV bar last week in New York. Now, I haven’t… I don’t know, I know there’s an investigation, I don’t know where it was, I don’t know anything, but like, it’s not an isolated incident that happened in Texas. This is actually happening in a lot of places. And one of the reasons why we don’t hear as much from the victims of these things is that it’s horribly embarrassing because they are told by family members, they’re told by law enforcement, they’re told by prosecuting attorneys that it was essentially their fault for going to that place in the first place. But, you know, like one of my guests on my podcast said, like, when you walk into a restaurant, do you ask to see their business license and their license to sell you a cheeseburger? No, you just assume that they’re being inspected and they’re compliant and they’re doing all the food safety things and they’ve been inspected by the health department and they’re allowed to sell you cheeseburgers, right? But, you know, you walk into a med spa, it looks very fancy, it looks nice, people are in scrubs. People just assume that the law is being followed, but it’s not, it’s not at all. And if you look at the recent studies in New York, there were two recent studies, about 60% of those med spas were found to be violating the law. And I do not think they even looked at corporate practice of medicine. So it was just like cleanliness. Is there a licensed provider there? Are they getting real product? 60% were totally illegal. That’s a number.

Don Adeesha: It’s huge, right?

Dr. Kate Dee: I mean, I’ve been saying for years that it’s at least 50%. But that was the first data that I had to support that guess. It was just a guess. Yeah.

Don Adeesha: So now in your book, Med Spa Mayhem, you pull back the curtain on the rise of corporate-run aesthetic franchises. As private equity continues to consolidate the market and push volume over quality, What is the fundamental operational shift that independent practice must make to financially outcompete the high volume franchise model?

Dr. Kate Dee: Well, you know, I’m on the record as saying that I really think those high volume franchises are going to fail. I think that some of them have already failed. If you look at some of the laser hair removal companies that were in big, giant national chains not that long ago, those are all out of business now. There’s a very famous franchise that is restructuring right now. A lot of them are closing because of those practices. I did talk about that particular franchise in the book. That was one that was there’s one story in the book, for instance, is a patient called my clinic asking how much we would charge for a certain procedure. And we’re like, well, we’d have to do a consult and evaluate you and make recommendations. And then if you’re a candidate for that procedure, then we, you know, but you’d have to come in and do that first. And she said, well, how much will you charge me before I come in? And we’re like, well, we don’t we charge, you know, a nominal fee for our consultation, but that can go towards your service. And she said, so you don’t charge me for the full service before I come? And I’m like, no, that’d be crazy. We don’t even know what you need. But that was the model of this franchise that’s not doing well now. Right. Is they had a national call center. where you would talk to somebody who is really not a clinician, they’re a salesperson selling you something, and they literally take the entire fee ahead of time before you even see a provider. So if you walk in that place and you don’t like the provider or you don’t like what you see or whatever, it’s non-refundable and you’re out of luck, right? Well, is it any wonder that that kind of practice is not popular with patients i mean it doesn’t you know so i think i think ultimately the the way to do well in this industry is to provide amazing excellent care and then patients will trust you you’re honest with them you’re not upselling them and over time you build a relationship with them and they will come back over and over and over again because they trust you um The model that those big franchises are using where they’re like cranking, cranking people, they’re like constantly getting advertising. So they get new patients in the door, you know, is because they’re doing a one and done thing. They’re offering something, they’re selling it. The patient’s not happy and they never come back. And actually, you know, in the in the process of, you know, I’ve been looking at the the the corporate model and and looking at investing and all, you know, dealing with these private equity people. And and I’ve been privy to look at a number of different financials that, you know, from different spas and also from the published data that Amspot puts out every year. the average revenue, the average margin, okay, for a med spa in the U.S. is around 20%. But I’ve seen ones as low as 9%. And I’ve seen ones as high as, you know, high 30s, 35, 37%, right? And it is the really high end, really good, high quality, doctor run, high service, high retention kind of spa that has that high 30s percent margin because they are really effective at patient retention and it costs a lot of money to keep churning through finding new people to walk in your door who don’t have a great experience and then leave right and so the way to win okay is to to really actually practice ethically um If you are a doctor run spa, it doesn’t mean that you’re going to make less money. It means you have to partner with somebody who really understands aesthetics and really loves it and can actually be a real medical director and a real leader. And then people trust that practice more because it’s authentic, like real medical practice. Yeah. So I don’t think that the corporate model actually is a higher margin model at all. And I think it’s kind of doomed to fail because the kinds of cost cutting that these places are doing make the patient experience much less positive. And then you’re not going to retain these people.

Don Adeesha: I was just thinking to myself, how was that even a thing in the first place, that model of charging up front, the whole… Charging up front.

Dr. Kate Dee: I know, I know. Well, you know, it’s… I don’t know. I mean, there are a lot of different models, right? Where there are some where they just, they do a lot of memberships and that’s memberships are very, very valuable for business people and private equity people because it shows this big, essentially your accounts receivable or whatever your income, it’s like guaranteed. This is much coming in as opposed to, you don’t have that. And each thing is, you know, a package or a one service or someone’s coming in for Botox, they might come in again in three to four months. And it’s not guaranteed income, whereas these memberships are. But memberships can be great. They can be really great for the patient, but it does hook you in for a certain amount every month. And it may not be like what somebody really wants, right? So they get, it’s kind of like going to one of those massage chains where, you know, you really want to massage today and you like sign up and then they talk you into doing the massage membership. And then every month you’re like, oh God, I haven’t used that. I’ve been busy and you pay for it anyway, right? And I’m not saying memberships are bad. They’re excellent if that’s actually providing you the service you want. But if you are that good and you’ve got a whole slate of patients that just love you and trust you, and they’re not gonna go anywhere else because they get the best service from you, then when they do want something, they’re gonna come to you. And I think that one of the biggest things in the industry is going to a place where they’re nice to you and they’re not trying to upsell you. And I can’t tell you how unpleasant it is to have like a relaxing facial And the whole time they’re trying to sell you products. We don’t do that at my place. I mean, we do sell lots of products. And if it comes up because it’s going to help their skin or they’re interested in the product we’re using in the facial, of course, we’ll tell them about it. But we are not. We don’t have quotas. My estheticians aren’t, you know, pressured to have X amount of retail per person. you know, facial done. I think, I think that kind of thing is just very unpleasant. Nobody wants to go back to that. I don’t want to go back to that. That makes me feel uncomfortable. And that’s the same with everything. You know, you go for microneedling and they’re pressuring, pressuring you to do something more. I just, I think that that is not a OK, the amount of money that they’re making today matters more to them than the amount that lifetime spend that that patient will spend in their entire relationship with you. And I think that that’s really short sighted. And I don’t actually think that really works for your bottom line.

Don Adeesha: There we go. And now before we continue, a quick message from our sponsor, Ekwa Marketing. Ekwa Marketing are offering our listeners a complimentary 60-minute digital strategy session. This is a one-on-one consultation with the senior strategist to help you map your 12-month high-value patient acquisition roadmap. You will get a personal diagnosis of your online presence and patient funnel, uncover untapped growth levers across SEO, social, and walk away with a clear, actionable plan tailored to your practice. You can check the availability and reserve your spot in under two minutes at www.businessofaesthetics.org/msm. Now, Dr. Dee, many owners view strict clinical safety and rigorous protocols as a bottleneck to high volume sales. How can a practice CEO actually weaponize their strict clinical standards and turn safety into a measurable marketing asset that attracts high ticket loyal patients?

Dr. Kate Dee: Well, I love that question because that’s exactly what the Med Spa Board is trying to do. We are trying to help med spas beat the illegal places down the street. So all the places that have rigorous safety standards, that meet all the laws and are practicing ethically, We are helping with marketing, advertising. We have a national directory that’s growing that we are focused on marketing to consumers. So people will be able to find a certified spa near them. We have really cool digital assets where people can advertise med spa board certified on their website and their social media and And their signage, they can be on podcasts, they can, so they can advertise that they’re certified. And we even have backlinks to all their, you know, websites so that it helps your SEO. So if you want to position your spa as, you know, medically careful, safe, appropriate. We care about you. We are ethical. We use real product. If you want to advertise that, we actually have a way to do that because it’s right now very hard for consumers to tell the difference between the legit place and the totally illegal place down the street. It is really hard as a consumer. And And that is our sole purpose. So if you are sick of trying to compete with those illegal places down the street, we are there to help you win that battle. So that’s been like my passion. And it all came out of really talking about the book and on the podcast because I In the book, I have every chapter is what questions to ask before you go, right, to make sure that that place is legit. And in practice, if you’re on the phone with the front desk of a med spa, you just moved to, you know, Boston and you’re trying to find a med spa near me or Botox near me and you call the med spa. It takes about 15 minutes to ask all these questions in order to figure out if they’re legit or not. So, I mean, it’s, you know, who’s the medical director and what’s their license? And then look up the medical director. Who’s the provider I’m going to see? What’s their license? And then look that up. And then are they using legit products? And are they legally owned? And are they prepared for emergencies? Even that, that’s hard to get them to answer that. um honestly right so there’s a whole slew of questions and and our whole purpose at the medspa board is to ask all of those for you and medspa board certified means they’ve answered all those in the right way and that way you can just see that and and know that the answers are are the right answers they do have a medical director and they are licensed and they’re not using fake botox And I think that that is like hugely powerful. So I’m very much hoping that like, you know, we are going to help the legit med spas win that battle. And there’s no punishment for the places that are illegal. That’s for law enforcement to deal with. Right. But I think that. that if you’re a patient or you’re a prospective person looking to get laser or Botox for the first time, you need an easy way to know that this place is legit. And right now, there is no federal standards. There’s not even any kind of state laws that codify any of this stuff. And I will say a lot of states are considering laws right now. to clamp down on med spas. But the irony about that is that it’s going to be the legal spas that are already legal and doing things well that are going to be you know, complying with these new laws and all the illegal ones that didn’t care about the laws that already existed are not going to care about any new laws. So like, I don’t, I’m not, it’s not that I think that those state laws serve zero purpose, but I just don’t think that’s going to help at all. And I think the bigger thing is if you are really frustrated by all these illegal practices in your general area, we’re there to help you.

Don Adeesha: Love that. Now, Dr. Dee, you have seen the worst of what happens when behind closed the doors in this industry. When you are interviewing a new provider who has previously worked in a high volume, low compliance aesthetic mill, what is the specific interview question you asked to determine if their bad clinical habits can actually be untrained?

Dr. Kate Dee: Right. That is a really good question. I mean, I think I wrote a whole chapter about how difficult it is to find the right people, right, who are going to do the right thing. So I really try to ask about what kinds of procedures they were doing and how they did them. And ask them whether they are open to learning new procedures or learning new things to recommend rather than the old things. So like, for instance, a lot of places have devices that I personally don’t think are very good. And the previous place trained that person to not only do that thing, but push it. Right. Sell it. OK, because they have the device and they got to make money from it. And so they’ve in their mind been selling something. Um, and probably you need to believe, I mean, I don’t, not everybody, I guess, needs to believe in something to sell it, but I do. Um, so I talked to them about like what my issues are with that, that device, that procedure, why we do something else instead. And I, I see if they ask questions about, um, the thing they didn’t know about, if they’re curious, if they show curiosity about the thing that we do instead, or if they kind of dig in and say, well, I always liked that device, you know, and this, I would just never, you know. And that’s, it’s just very difficult to tease apart sometimes. So I really look for people who are interested in education, always learning um always doing new things always interested in the physiology of things if the person can’t explain i also very much ask them can you explain how that device worked and if they can’t explain how that device worked They probably don’t have the curiosity to learn. I mean, they didn’t have the curiosity to learn about the machine they were already using. They probably are not going to have that curiosity about what we do. But it can be very difficult. I hired one person who actually worked for me for one day. But but she was somebody who on that very first day just dug in about a device that was really, really terrible and then just explained why, you know, she really liked that device. And I’m like, well, what about all these problems with it? And and she was like, well, I could sell anything. And I was like, okay, that’s not going to work because I can’t imagine having somebody who feels like they could sell anything even if it’s not good for people. So I know that I’m not really answering your question because I don’t think there’s a particular one question to ask or even a series of questions. But I really try to ask them to explain the physiology of it because that tells me whether they have the kind of knowledge that you would need to be able to do these procedures. I do believe that a lot of people are using these machines and they don’t really actually understand them. And I think that’s extremely dangerous. For example, I just interviewed someone, the podcast’s not even out yet, but maybe by the time this is published, it will be. But she went to a friend, she was a nurse practitioner, went to a friend who is an esthetician who she had worked with for years. And the esthetician had just gotten a new RF microneedling device. And because she trusted the esthetician, she didn’t ask any questions. And this esthetician tore up her entire face. She is scarred for life. It was awful. She had third degree burns. And, you know, it’s just incredible because the esthetician just didn’t know enough physiology or medicine, which of course they don’t study that. Why should they? But like, they shouldn’t be doing procedures that they don’t understand. And in this particular case, she had purchased an illegal non FDA approved device off the Internet and and pretended it was an FDA approved device and pretended she had training on it, which she didn’t. And she essentially assaulted her friend with it. And You know, I know that it’s not malicious, like she didn’t set out to do that, but she did it and she kept going and she didn’t know enough medicine to realize what she was doing as she was doing it. So that’s just very, very dangerous. And I just think none of that really should exist in aesthetics. We really it is the practice of medicine. We shouldn’t have people, you know, purchasing illegal products and practicing medicine without a license. You know, that’s a felony. And, you know, it should be treated like a felony, I think. So I have to apologize because it’s like very sunny where I am right now. It just got even sunnier while we’re talking.

Don Adeesha: It’s totally fine, but yeah. I mean, a lot of these people, like you said, they’re not aware that they’re doing something wrong in the first place.

Dr. Kate Dee: Some of them are, and some of them are not. And it’s very difficult to tell, right? Who really knows? I mean, the truth is that if you go to nursing school, you know you can be a nurse and you know you can’t be a doctor and you know you can’t practice medicine. And you know, like, I don’t know. So I think that in that case, RNs, it’s really hard for me to believe that any RN knows or thinks that they’re allowed to do that and they’re not. I think in the case of estheticians, it’s a little more confusing, but they are taught in cosmetology school that they’re only allowed to treat the surface of the skin. And that is taught in cosmetology school. They are not allowed to put needles in people. And there are, I forget how many states, Washington, where I am, is one of them, that has a special level of master esthetician license where you can do RF microneedling and some laser treatments under a doctor. And those schools are very, very specific about teaching them what they can and can’t do as a master esthetician on their own. And they know they can’t do it without being under a doctor. So- The pleading ignorance thing is a little bit, it’s like, seriously, you really don’t know. And I just don’t really, I think that that’s not very believable, but also the law is, states that ignorance of the law is not a defense. So you can’t claim that you didn’t know something was illegal if you get caught doing it. And that goes kind of across all laws, right? So you can’t pretend, oh, I didn’t know stealing this from the restaurant, steal a fort. I didn’t know that was. Well, or whatever. That’s not a legally allowable defense. So I do think that it does come up, though, because there are plenty of business owners who don’t realize that they can’t own a medical practice. So there is an example that, you know, my lawyer told the story about this couple who went to Vegas and they had a great time and they went to an IV bar in Vegas. And they’re like, you know what? There isn’t one of these in our neighborhood back home. Let’s open an IV bar. And and they had no idea. Because they’re lay people. They had no idea that, oh, you know, one, that’s practice medicine. Two, only a doctor can do that. You can’t own a medical practice if you’re not a doctor. And they actually happen to be in a very strict state about that. So they couldn’t even own a… tiny percentage of it like at all. So but they started a whole business without calling a lawyer. And I think that that is one thing that is like the last thing that people do when they start a business. And it really should be the first thing is call a lawyer with expertise in whatever that business is. So in this case, you need to call a lawyer who’s not just a health care attorney, but also knows about med spas because it’s a very unique area of law. And you have to find out what the laws are in your state, and they may be very different from your neighboring state, right? So like, you know, I mean, there are plenty of cities where half the cities in one state, half the cities in the other state, or, you know, it’s divided. And and something that might be legal in one on one side of the river is completely illegal on the other side of the river. So you really have to be consulting an attorney to know if if what you’re doing is actually legal or what legal hoops you have to jump through in order to make sure that you’re doing it properly. And I think that’s that’s really, really important.

Don Adeesha: There we go. I think that really summed up perfectly why that curiosity and ethical perspective is so important when it comes to, you know, practicing aesthetics. And Dr. Dee, this has been really an incredibly eye-opening conversation. So thank you so much for your time.

Dr. Kate Dee: Hey, thank you so much for having me. It’s been really fun.

Don Adeesha: Absolutely. So that was a very powerful look at the reality of operating in the wild west of aesthetics with Dr. Kate Dee. If Dr. Dee’s approach to raising the bar resonated with you, we highly recommend you picking up a copy of her book, Med Spa Mayhem, and exploring the resources she provides through the Med Spa Board to help practices thrive ethically and profitably. And of course, as we wrap up, if you’re looking for some clarity on your digital side of the practice, Ekwa Marketing is offering our listeners a complimentary 60-minute strategy session. It’s simply a one-on-one conversation to help out map your realistic 12-month roadmap for attracting high-value patients. You can easily grab a time that works for you at www.businessofaesthetics.org/msm. that being said i’m Don Adeesha and this has been the business of aesthetic podcast thanks for listening keep on leading