The Aesthetic Guide is part of the Informa Markets Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

Top 5 practice management Q&As

Article-Top 5 practice management Q&As

Executive consultant Sandy Roos says whether she’s speaking at a cosmetic meeting or working with physicians’ practices, doctors always seem to ask these five questions.

Ms. RoosRoos, cofounder and part owner of Practice Enhancement Specialists, presented the most-asked practice management questions at the 2016 Vegas Cosmetic Surgery (VCS) meeting in June. She answers the big five for Cosmetic Surgery Times:

1. How can I make as much money but not have to work as hard?

2. Should I charge a consult fee?

3. How can I decrease my no-show rate?

4. How can I reward my staff?

5. How do I hire and retain good employees?

NEXT: How can I make as much money but not have to work as hard?


1. How can I make as much money but not have to work as hard?

Roos: That’s a two-part answer. The obvious one is to bring on an additional resource for the nonsurgical part of the practice to help create a jump in revenue. Some examples are fillers, toxins, lasers, fat and noninvasive fat reduction devices. It’s not enough to simply add the nonsurgical resource. You have to be prepared to market and position it so it actually generates more revenue in the practice without surgeons having to do more surgery.

Part two is a theme in my approach to practice management. You’ll make more money without working as hard by being efficient with the first call or contact into the practice. A lot of practices I work with are at a point in their careers where they do not have time to see unqualified buyers. They understand their time is wasted on seeing patients who should not have been on the schedule. The solution is to teach the practices to better qualify and educate callers. In essence, making sure the callers are prepared to buy at consult. Data shows after day seven post consult, most practices only convert an additional 9% to 14% of the patients to surgery. The bottom line is, do you want to see 50 patients and do 40 surgeries, or do you want to see 100 patients and do the same 40 surgeries? (Hint, you want to see 50.)

NEXT: Should I charge a consult fee?


2. Should I charge a consult fee?

Roos: That’s a touchy and hot topic. There are consultants in the industry who will tell you that you have to charge a consult fee, they claim it’ll bring in a more qualified buyer and decrease your no-shows. I have data that shows charging a consult fee does not bring a more qualified buyer, and it does not decrease your overall cancellation or no-show rate. I’m not saying you shouldn’t charge a consult fee, just ensure you are doing it for the right reasons. For my practices charging a consult fee, we track the data to ensure it is not affecting the consult number. I try to encourage practices who feel they need to charge the consult fee to consider a no-show fee instead. 

I have a practice that started charging a consult fee, and their consults decreased. Their market competitors were not charging consult fees, so patients were calling to schedule and once they heard of the fee decided not to. The staff didn’t report this in a timely fashion and they had a sharp decrease in consults, thus a sharp decrease in surgeries.  It did decrease their no-show rate but at the expense of less surgical dollars.

This goes back to being more efficient with the first call, and treating patients in a way that creates a five-star experience. By bonding with the caller on the first call, we’ve shown that patients are going to come to you, and they’re less likely to be a no-show.

NEXT: How can I decrease my no-show rate?


3. How can I decrease my no-show rate?

Don’t panic if you have a week or two of increased no-shows. If you track data, look at the prior year and find out what months trended with high no-shows. There are trends. Back-to-school and the December holidays traditionally have higher no-shows and cancellations and lower conversion rates.

If no-shows are a real concern, you can decrease the no-show rate by being smarter and more efficient on that first phone call. I call it touch points.

If you recognize a referral source that has a high no-show rate, be sure you do something different for those types of patients. For example, our data shows internet/website have the highest no-show rate of all resources, but they also have one of the highest conversions rate. The goal is to ensure they show up. For my practices who we have determined fall under this category, we implement a different set of touchpoints for these patients. We might email or text them one additional time before they show up or have a special ‘gift’ for them when they come in for consult.  We saw a decrease in the no-show rate when we implemented these into practices.

Also, text appointment reminders do not take the place of a confirmation call. Our data shows practices who eliminated the call in lieu of the text saw an increase in their new consult no-shows. You can send a text, but you need to call as well. 

NEXT: How can I reward my staff?


4. How can I reward my staff?

Roos: When it comes to incentive plans or bonuses, each staff member requires a different type of “reward.” We typically recommend you incentivize or bonus patient care coordinators and front office staff based on practice growth and/or proficiency goals. We don’t recommend you simply reward staff with a percent of what they collect for surgical patients. It doesn’t incentivize growth.

Compensation for nurse injectors and/or non-surgical services varies. What I have seen works best is a tiered-type program. Since offering a percent of the net is acceptable, increasing the percent for each tier does promote an environment of higher revenue.

For practice administrators, I always recommend a bonus based off the practices performance as a whole. [This includes] setting goals based off the profit and loss inefficiencies, creating plans to improve employee morale, etc.

NEXT: How do I hire and retain good employees?


5. How do I hire and retain good employees?

Roos: The key is hiring correctly, but, more importantly, having a truly defined training schedule in place. It has to be outlined according to what happens each day and followed. You don’t want to have new employees show up, follow people around and hope they learn everything.

To retain a good employee, you need to have employee reviews, open lines of communication and regular team meetings. Physicians have said they don’t want to do employee reviews because every time they do a review, employees expect a raise. That should not be the expectation if presented correctly. You have to encourage your employees to be better and grow, or you’re going to have unhappy employees. You need to have consistent office meetings, with clear, defined goals for the practice, and an open line of communication.

Hide comments


  • Allowed HTML tags: <em> <strong> <blockquote> <br> <p>

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.