In this episode, hosts Brad and Michael welcome Patrick Blake, MD, FAAD, dermatologist and co-founder of Portrait, to discuss the compliance challenges in the aesthetics industry. Dr. Blake shares his journey from clinician to entrepreneur and how Portrait helps med spas compete while prioritizing compliance. Learn how to navigate evolving compliance regulations, avoid common pitfalls, cut through misinformation, and protect your practice.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real world experiences, creating simplicity in 3, 2, 1.
Brad: Welcome back to the Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd.
Michael: Thanks, Brad. As a business and health care law firm, we meet a lot of interesting people and learn their amazing stories. This season’s theme is Compliance Fundamentals, and we’re taking real client stories and of course scrubbing names. And we are building around these stories, kind of navigating compliance obstacles in the business of health care.
Brad: Yeah. And we’re talking a lot about compliance this season, Michael, and to some people it can be very scary word. For those that don’t know. What does it mean?
Michael: You mean not everyone like you has it tattooed on your back and loves it?
Brad: Well, I think most people would love my tattoo in my back, which says compliance.
Michael: Yeah, compliance is [00:01:00] a broad word. It’s used to, to capture all the laws that govern the practice of medicine or other healthcare practices, and there are both state and federal laws that can come into play. Healthcare, as we’ve talked about, is one of the most heavily regulated industries in the US. And so, if you’re being compliant, it means that you’re running your practice in compliance with these various laws.
Brad: Yeah, absolutely. And as we discussed in other shows, compliance is not stagnant.
Michael: True, it is not. And so Brad, before we have a guest today, I’m really excited about a client of ours, and so before we get started though, I have a question.
Brad: Okay.
Michael: Are you familiar with Lake Superior State University?
Brad: No, but I’m afraid to ask why now?
Michael: Well, they apparently, because I’ve just learned about this recently, each year they publish a list of banished words. [00:02:00]
Brad: Okay. Is that the same as like the seven deadly words you can’t say on tv?
Michael: No, I don’t think it is the same, Brad. So the university has a tradition, actually dating back to 1976 where each year they publish a list of words and phrases that have worn out their welcome.
Brad: 1976? Is that the first year you started practicing law?
Michael: No, but I was alive. I was six.
Brad: So that’s kind of reminds you banish words, kind of like he who should not be named.
Michael: no, I’m not going to get sucked into your Harry Potter talk. Let’s keep it keep –
Brad: This is not a movie podcast. Okay.
Michael: So I’m going to go through the list and I want you to confess and I won’t tell anyone. Which of these words you need to stop using? Where are you guilty? And I may add a little color to a few of the things along the way.
Brad: Perfect. This will be really fun. [00:03:00] I’m looking forward to it. Go.
Michael: Alright. Word number one, “cringe” hearing someone s say cringe is actually kind of cringe in and of itself.
Brad: I get it. It can be cringe to hear cringe said too many cringy times and that can be cringe worthy.
Michael: I shouldn’t have egged you on there. All right, second word, game changer. I mean, we’ve all watched a lot of sports and I don’t think I’ve ever watched a game when an announcer has not used that statement.
Brad: I agree.
Michael: Okay. You ready for the third one?
Brad: Yes.
Michael: Era. I think the Swifties have worn this one out.
Brad: I have to be careful how to respond to that because my wife and daughter are big Swifties, so no comment.
Michael: Okay, good. Well the Philadelphia fans that booed Taylor Swift may agree. Next one is, dropped. And so they’re kind of referring to books or music when they say, this song just dropped. [00:04:00]
Brad: Okay. Yeah. That doesn’t bother me.
Michael: Number five. The acronym, I-Y-K-Y-K, if you know, you know.
Brad: Yeah. I actually have seen that used on as a billboard by plenty of attorney in New Orleans, so maybe it is time for that word to be banished.
Michael: Am I keeping track that so far none of these are words you use too much?
Brad: No.
Michael: Okay. Good. next one is, sorry not sorry.
Brad: Again, not a word to really use, but we do have a great story of one of our colleagues who used it one night and it was very funny. But we don’t think we have enough time for that story today.
Michael: Next one is one that unfortunately is something I know way too well. The word skibidi, which is what the term that the Gen Z’ers called brain rot. And so, I unfortunately have [00:05:00] heard this word many times because of my 15-year-old daughter, Alex. It’s a regular part of her vocabulary.
Brad: First off I don’t use brain rot or the skibidi word, so I’m not concerned. Well, I don’t even think I ever heard Skibidi before this.
Michael: Okay. Well, and I don’t think you’ll ever start using it because I don’t think you could pronounce it.
Brad: Yeah. I already forgot the word.
Michael: Okay, next one, 100%. And I have to confess just to you that I have said this word and I need to stop, 100%.
Brad: Are you supposed to say a lesser percentage than a hundred percent?
Michael: Well, it does lose its emphasis if you did that, so I think we just need to come up with something more creative and normal.
Brad: But I don’t really use it often though.
Michael: Next word is utilize. And I think the point that… the reason they want to banish it is that it would just work fine just to say use.
Brad: Disagree. I love to utilize that word. [00:06:00]
Michael: Oh, okay. And the final one is period, used for emphasis when you just say period at the end of a statement.
Brad: Yeah. Never ever came across my mouth ever saying that, so I think we need to move on.
Michael: It came out kind of clean.
Brad: Yeah, bring on our, our guest. Period, I’m done saying that now.
Michael: Alright, our guest today is Patrick Blake. He is a co-founder and CMO at Portrait. He is a board certified dermatologist. Patrick lectures around the country in aesthetics. He’s a mentor to students interested in dermatology and aesthetics. He’s a client of ByrdAdatto and he’s a first time guest on our podcast. Patrick, thanks for being here today.
Patrick: Thank you so much. Really glad to be here.
Brad: Yeah. This is me fun, Patrick. And we’re going to hit you with a really hard question right up front. Are you a user of any of these banish words that we just went through?[00:07:00]
Patrick: You know, yes. to a degree, but I would say I am like – I do encounter a lot of those much more than I would like. I’m not a heavy user of any of them, so maybe I guess I’m not going to be in a tough spot with these, but the one that I see a lot or hear all the time is that 100%. I think what it really means more like, I agree. I mean, it’s not like you have some kind of complex insight. It’s like, we should go for lunch, 100%. It’s kind of a yes/no or something.
Brad: Yes.
Patrick: And skibidi because I do see patients myself too, and so interact with enough teenagers to expand my vocabulary regularly, but skibidi [00:08:00] is for me, but I’ve heard it enough I think already.
Brad: Yes.
Michael: Yeah, I think we’re all in agreement that we’re supportive of this banish word study. I’ll have to work on my daughter on skibidi. Yeah. Well, cool. Well, let’s jump in. and so for our audience that, that hasn’t met you yet, I would love to hear Patrick, a little bit about your background. You’re a dermatologist. How did you kind of get started in this world and then what led you to where you are today?
Patrick: Yeah, for sure. I mean, take interest in pretty much everything. I’m a nerd through and through. I was in med school at the Cleveland Clinic. Reason that’s relevant is just they do a ton of innovation and even as a student, rethinking how systems flow systems operate and being comfortable kind of changing things. I think it was a very different program from [00:09:00] most medical schools. And then did research at NIH through like Howard Hughes Fellowship, so kind of got really into exploring projects and processes in detail. And I think as physicians most of the time, we’re kind of more what did we do today, thinking a little bit shorter term. And so that was an exercise I think in carrying a long-term project to fruition and fighting through the challenges and that kind of thing.
Finished my derm residency in 2014 and moved out to San Diego and kind of was doing basically everything dermatology, the full gamut, but got a little bit, I guess slightly bored maybe, or under challenged – somewhere along the line, and that’s always a bad spot for me to be in, or a dangerous spot. So I connected with my co-founder of Pravin, and we were kind of interested [00:10:00] in really direct to patient sort of consumer health type thing, so a lot of personalized medicine, compounded meds and a sort of a telehealth delivery system. And that was really cool. I think we developed some really great products. I won’t use the word game changer, period. We developed some really great products, but had some trouble getting, I would say market fit or awareness or figuring out how to get that message across. And in the process, we’re interested – I started talking to a couple of friends of mine, one in particular, who is a dermatology PA I had worked with previously with an incredible aesthetics knowledge and delivers incredible outcomes. We kind of learned about her experience as an employee at a very, I won’t say like exploitative, but they certainly weren’t valuing her [00:11:00] as a person or as a provider at this business.
And so, we saw that as a place to really make an impact in terms of how you could get the right people to realize their value. And I think as a provider, that obviously resonates with me quite a bit. So I never saw myself kind of going down this path of trying to be like a business behind a business. It’s certainly nothing I ever trained for, but it’s been fun and it’s been mission-driven, which I think has helped us kind of push forward. We launched Portrait in what we do now in 2019, right before Covid got cranking, and so not the opportune time, but that’s okay. It’s gone well since.
Brad: Well, so it sounds like in your heart you’re a serial entrepreneur with all these different things going and so you just mentioned Portrait. So for our audience that’s not familiar, tell what does Portrait do?
Patrick: Yeah, so we think of ourselves as [00:12:00] sort of the everything aesthetics company. Our goal is to really level the playing field so that small businesses can compete with large chain private equity backed companies. So sometimes people will refer to us as a franchise or as a rollup, and those things are really couldn’t be much further from the truth, and this is a philosophical thing, but it’s also proven out in real life that I’ve seen and strongly believe that when you have providers sort of really owning that patient relationship and having a chance to really own the outcomes end to end and have the creativity and the ability to influence to drive their own branding and their own reviews and all of that, they can do really good work. It’s just that there’s a lot, as you guys know that through and through just to running a business and getting it set up and operating day to day. [00:13:00] So we try to provide all of that kind of backend work, as well as some things that are very patient facing as well. But we try to set them up so that anyone can really compete and win, I mean, even though I do think there’s a lot of collaboration, a lot of mentorship, it’s also competitive. And so without someone kind of supporting I think small businesses, it becomes pretty challenging, so we’re trying to solve that issue.
Michael: Do you have a lot, are most of your clients that are signing on, are they starting, is that where they are in their kind of life cycle? Or do you also have others that are in different stages?
Patrick: Yeah, so it’s evolved for sure. When we first started going, it was really the people who needed us the most, who were experienced, mostly non-physician providers who were wanting to launch. Since then, we have evolved quite a bit in being more flexible [00:14:00] and being able to be more inclusive and add value for, we think, maybe not really large chain meds spa, but for just about anybody else in aesthetics, and in wellness to a degree as well. And so, so we have people who have been up and running for years and have multiple locations and numerous providers and that kind of thing. Most are still solo provider practices or businesses – but across the board there.
Michael: You know, I just saw an article in the last couple of weeks that came out about Portrait, and I can’t remember the title if it was that Portrait is the antithesis to private equity or the solution. But tell me a little bit about, do you know which article I’m referring to that?
Patrick: Yeah, I think that’s probably a quote from me because I’m a little bit unhinged sometimes, so I hope we’re not going to draw any for that, but I think that’s probably something I specifically said. [00:15:00] I didn’t realize it was used as a title, but yeah, it sounds about right. So yeah, I do think of us that way and probably in part, I’ve seen amazing private equity experiences and deals and seen, obviously because of who I trained with, I think I know more physicians who’ve gone into that private equity motion, and I’ve seen people who got into big complex lawsuits and had their practice changed and they’re good staff were kind of turned out and other folks were brought in. So I’ve seen that where I think people have lost some autonomy in their workflow, which I view as a bit problematic for a lot of reasons. And I also have seen it where it hasn’t always played out great for the private equity backers either, because if you don’t have passionate clinicians, particularly in aesthetics, you’re going to have a [00:16:00] problem that you need people who are enthusiastic, bought in every day, you got to be on all the time, which I think it’s because I do my own aesthetics too, so I experience that in real life, that if you’re having a bad day, like too bad you got to figure that out. So I think, yeah, we try to, but the reality is all of that efficiency, the private equity brings is a huge value. You want people to be able to focus on their work. And when you’re trying to learn to run a business, or even just running a business without support, it makes it hard to see patients. It makes it hard to spend time with your family. So yeah, I would say we’re a low key antithesis.
Michael: Yeah. And I’ll say the article didn’t come across as a poke at private equity. It came across as, here’s another route you can go, but it was really fascinating. [00:17:00] I’m also curious, so you may have heard at the beginning, our theme this season is compliance, and I’d love to hear kind of you talk a little bit about your compliance journey at Portrait and how Portrait helps its clients on that front.
Patrick: Yeah, for sure. Well, first thing I would say, a major shout out to AM Spa because when we first started going on this, and I mean, I’m most dermatologists we’re pretty risk averse. I wouldn’t say neurotic, but we lean that way a little bit, maybe, and a little OCD, and I felt like we had covered our bases pretty well. And then I went to the AM Spa meeting, and I’m not like, for better or worse, I’m not much of a note taker and training or anything. And I took a lot of notes and I came back and had a lot of work to do and to rethink. And so even as someone who – I was trying [00:18:00] to be pretty thoughtful, I guess I’d put it that way when we were first going, and you’re always going to have blind spots. So, I think that was my first. I think that was really helpful for me, I mean, we got lucky in a sense. Not that we had any huge gaps, but there were a lot of things that could be improved upon, and so that was my first experience in saying, okay, the same way you need to know what you’re doing on a medical side before you start doing anything. You really need to know that on the legal compliance side as well. Unfortunately, it’s a little bit harder to get that knowledge than it is sort of the medical stuff, because you can’t go pop into someone’s clinic and you can’t read things and you really can’t YouTube it that much. Now there are a lot of great resources and podcasts and whatnot, but at that time, five years ago, I think there were less. It was harder to get access.
I think the other side is appreciating the same way in medicine. [00:19:00] I’m just drawing these analogs because that’s been my experience that things change and so you can’t keep the same mindset you had five years ago. And the same way the standard of care changes – medically, the standard of care and the standard of operating changes on a legal compliance side. We’ve also, because of the nature of the business, I’ve been involved in helping hundreds of providers at this point, and entrepreneurs as well. And so, I’m sure preaching to the choir here, that of that line of, I think things that should be canceled. Well, my friend don’t care. Don’t care what your friend thought or told you. or is down the road or something because there’s just so much lack of knowledge in this space and people who’ve launched without checking the depths in the [00:20:00] pool first and that kind of thing, or jumped without checking the depths.
I mean, Tuesday night I was talking to a friend, a nurse, who’s here in California about a friend of hers who just went through an investigation of things that transpired three years ago at a non, I’ll call it non-compliant office, and is now on probation. It’s either a one year or two year probation and was trying to do things the right way and now has all that complexity. And so those things come out and I think no one wants to talk about them. Nobody starts like posting about that on their Instagram so folks aren’t aware. And so for us, it’s been just listening to getting good guidance, also not always getting good guidance. So finding the right people to pick their brains, being diligent and process oriented and making sure that people are well set up.
Brad: [00:21:00] Yeah. And that’s understanding that perspective, obviously between your own practice and the clients you’re working in with Portrait, you’re probably seeing a lot of things that are happening with the industry right now. What do you think some of the biggest challenges of the aesthetic industry is facing right now?
Patrick: I think, yeah, several. I mean, one, which is like so many facets of life, right? The pros and cons of social media that I do see. I see sometimes where patients are directing care a bit, and I think there’s some, this is consumer health to a degree, so that makes that they should have a big role. I sometimes see people being pushed into procedures that don’t – providers being pushed into procedures that don’t make sense. And that’s where I’ve seen them get into trouble sometimes. I’ve also feel like I see things where people pick up ideas or decide that something is [00:22:00] well-established based on social media rather than sort of leaning into evidence or good – like strong data, good trials. So I think even though there’s a lot of knowledge, in some ways, there is a lot of misinformation out there as well.
And then just the complexity of the world. So I think again, I see it more from the perspective of small business owners, but anyone who’s been alive knows costs of everything are going up quite a bit, you know? And so I think that creates a lot of challenges for, one, is making sure patients have money in their wallet to spend at somebody’s business. Another one is that I think it does make people think about taking shortcuts a little bit because they feel more pressure in order to be successful.
Michael: That’s amazing. They’re all great points. And believe it or not, our time has flown by. [00:23:00] We have kind of reached the end. Patrick, we’re so grateful that you have joined us for today’s show. What we’ll do next is say goodbye and then on the other side of the commercial, Brad, and I’ll have a quick legal wrap up. Thank you.
Patrick: For sure. Glad to be here. Thank you so much for having me.
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Brad: Well, welcome back to Legal 123s with ByrdAdatto. I’m your host Brad Adatto, with my co-host, Michael Byrd. Now Michael, as we’ve [00:24:00] talked about already, but this seasons theme is Compliance Fundamentals. And we just had a great conversation with Patrick, talking to us about Portrait, but more importantly, about what he’s seeing in the aesthetic industry as it relates to just compliance. And at the tail end of the conversation, he started talking about what is he seeing in the aesthetic industry, and maybe some concerns of things that he thinks could be fine-tuned. I thought it was interesting that people are so online nowadays with all their social media interactions, and they see all these things that are going on, and as a trained physician, he was noticing things that that’s not quite right or I wouldn’t recommend it that direction. And I started thinking about – we’ve talked about this more of a herd mentality, where it must be okay because everyone on social media is doing it this way. And as a reminder, they may be doing it that way, but that didn’t mean it’s going to be consistent with the standard of care that’s required in your particular state. And you have to be very careful that just because someone’s doing it through their media outlets or whatever they’re doing, [00:25:00] that you need to make sure, is that the best way to practice?
Michael: Yeah. I thought that – I mean, he’s so insightful and smart and he says things that we talk about and he says it in a really kind of concise and powerful way. And I loved how he said that basically compliance has its own standard of care and that it changes. It was a powerful way to communicate that point that compliance is not stagnant. And then I loved also him talking about having some banished words in our compliance world. It made me think we should be inspired and come up with our own compliance banished words and create our list. I think starting with the, my friend told me is what he said, but I’m sure we could extend a much longer list.
Brad: [00:26:00] Well, that would be a banish word number one, banish word number two is I heard it from another attorney.
Michael: Yes, yes.
Brad: That enigma attorney that’s out there that no one ever knows their name.
Michael: What about everybody else’s doing it?
Brad: That’s probably a good one also, depending on your state medical director.
Michael: Now the banish word they would probably give us is, “it depends”.
Brad: That would be the number 1, 2, 3, 4, and five word for lawyers of banish word.
Michael: It’s a gray area.
Brad: Yes, that’s true. Well, Michael, before we, we sign off, that was fun. I enjoyed what Patrick had to say. Any final thoughts?
Michael: No, I mean, I love that he was vulnerable and shared that compliance is hard, and that he poked at himself and said dermatologists are almost neurotic and have a little OCD. And yet as much as he felt like he was taking the right steps, he realized [00:27:00] when getting educated about compliance, that there were some gaps, and so it should relieve the pressure valve a little bit for everybody out there to understand that this is an aspect of a business that is hard and that there’s a lot of gap – ground to be gained just by leaning into it and learning and getting help.
Brad: Awesome. Well, that’s all the time we have today. We’ll be back next Wednesday when we continue our journey of learning about compliance fundamentals when our partner and series regular, Jay Rojero joins us again to discuss membership programs and the applications to a medical practice. Thanks again for joining us today. And remember, if you like this episode, please subscribe, make sure to give us a five star rating and share with your friends.
Michael: You can also sign up for the ByrdAdatto newsletter by going to our website at byrdadatto.com.
Outro: ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not [00:28:00] constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.
