In this episode, Michael and Brad are joined by Sarah Allen, MD, and Claire O’Bryan, ANP-C, co-founders of The Skin Clique. Sarah and Claire share how they leveraged compliance to scale their business. We discuss Botox parties, concierge medicine, and their proactive conversation with the medical board.
Listen to the full episode using the player below, or by visiting one of the links below. If you have any questions or would like to learn more, email us at firstname.lastname@example.org.
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 another episode of the Legal 123s with ByrdAdatto. I’m your host Brad Adatto with my co-host Michael Byrd. Now Michael, tell the audience what we’re going to do today.
Michael: As a business and healthcare law firm we meet a lot of interesting people and learn their amazing stories. Brad, this season’s theme is hard conversations. All of this season we’ve been taking real client stories and scrubbing their names to protect confidentiality, and built these stories around having hard conversations. Today there’s a twist. No scrubbed information. We actually have real humans joining us today as guests to share their story of hard conversations.
Brad: Brave guess at that.
Brad: So Michael, before we bring in our guest today, as you know, you love animals so much. Everybody knows that. [00:01:00] And we can do an entire show on dogs and cats and other creatures that you have housed in your house at different parts of your life.
Michael: I would say it this way, Brad. I’m more of a kid person than an animal person. So I have five kids as people have probably learned so far and I’m not much of an animal person growing up. I’ve got some, probably need some counseling on some, a dog I lost as a child issues, but when you have lots of kids guess what you have lots of animals. And so you have had great joy over our friendship and the number of animals that have rolled through my house. And so, yes, I’m not an animal person and I’ve had, since I’ve known you, I’ve had eight dogs, four cats, two Guinea pigs.
Brad: One which was eaten by a dog.
Michael: Yes, yes. Yeah. The other one died of natural causes. A couple of fish, a bearded dragon, [00:02:00] a rabbit, and some sort of bird. The bird was by far and away the worst because it was really loud all the time, and one of my dogs at the time wanted to eat that bird with all of his might. And so it was a constant animal kingdom-like struggle at my house.
Brad: Well, I know an animal that I’m fairly confident that you never owned, even though you mentioned a bird. So Michael, what are your thought on ostriches?
Michael: Well, that’s kind of random, Brad. I don’t know where you’re heading today. I have two things that popped to mind when you say ostriches. Number one are boots because I’m in Texas and those are very distinct types of boots.
Brad: Yes, they are.
Michael: That’s probably not what you’re asking about.
Michael: So I’ll stay away from that.
Michael: And then the only interaction I can think of with an ostrich was at the state fair of Texas.
Brad: Did you ride the ostrich?
Michael: No, it wasn’t a [00:03:00] ride.
Michael: It was more like the kid area where you walk through and you could feed all the different animals, petting zoo-type situation. And one of my kids had the little kind of cup of food to feed the animals and the ostrich reached over and grabbed the entire cup from my kid and engulfed it and you could see the cup in the ostrich’s throat, and I thought we’re going to have a situation here, but nope. The ostrich was just fine.
Brad: He was used to it.
Brad: Well, you know, our audience knows, one of their favorite things that we do on the show is me asking you random questions to show how smart you are or not smart so, to keep it fair, I’m going to ask you questions and you only have to answer fake or real. Okay.
Michael: You’re fake.
Brad: Okay, Michael that was not a question.
Michael: Oh, I’m sorry. Okay.
Brad: Riley, please strike that from the transcript for us. So Michael, the first question, fake or real? The common ostrich is the largest living bird in the world.
Michael: No Siri? [00:04:00]
Brad: No Siri. You gotta answer.
Michael: I’m going to go with real.
Brad: That’s correct.
Brad: Good job. The common ostrich is the world’s largest living bird, and these ostriches can weigh up to 300 pounds and be as tall as nine feet tall.
Brad: Yeah. All right. Ready for the next question?
Brad: Fake or real? An ostrich could fly.
Michael: I’m going to go with real because I kind of want to say it’s fake, so I’m going to say real.
Brad: Yeah, you’re wrong. Sorry.
Michael: It’s fake? I meant to say it’s fake.
Brad: Yeah, it’s fake. Yeah.
Michael: Oh, okay.
Brad: Yeah, it can’t fly. Remember I said it’s a really big bird?
Brad: You know, you don’t want something weighing about 250 pounds flying over your head, so yeah, you got that one wrong. Plus they really don’t have wings. All right. Ready for the next one? Fake or real? The ostrich is the fastest running bird in the world.
Michael: I’m going to go real.
Brad: Yes. Good job.
Michael: 50-50 shot.
Brad: Yeah. You’re doing pretty well there. Yeah. They can cover 10 feet in one stride. And their speed and autonomy is so unique that scientists have been designing mechanical robots inspired by [00:05:00] this bird. All right.
Michael: Where did you get that information, by the way?
Brad: Siri. I mean, my research assistant, my research assistant. So, next question. Ready?
Brad: This is a really important one. Last one. Fake or real? An ostrich buries his head in the sand when he’s scared or frightened.
Michael: I’ve heard ostriches are really mean, so I’m going to go with fake.
Brad: Wow, that’s pretty good. Yeah. It is a common misconception that ostriches, when they sense danger, they stick their head in the sand. Instead, they actually lie down low and press their long necks on the ground, become less visible because remember, they’re nine feet tall and attempt to blend into the terrain.
Brad: But the misconception comes from the fact that ostriches, they nest in the dirt. So they dig a hole and put their eggs in there and they’ll move their eggs all the time. So every once in a while you might see an ostrich sticking its head in the hole, but it’s not because they’re scared, it’s because they’re getting ready to move the eggs.
Michael: Does it count as TMI if you start saying something that’s kind of boring putting everybody to sleep?
Brad: No. What I can tell right now is [00:06:00] Riley’s super excited.
Michael: Oh, okay.
Brad: That’s why she’s pounding Diet Coke on the back.
Michael: Okay, yeah. All right. Well, so where are we going with this, Brad? We’re going to lose everybody.
Brad: All right. So let’s, you know, so similar to ostriches, today’s guests, first off, they’re brave enough to come on our show, but they didn’t bury their head in the sands, per se when they had a difficult situation. Instead, they actually leaned into a hard conversation. So, Michael, let’s bring ’em on to hear their story.
Michael: All right. Well, I’m excited to introduce our guests and, full disclosure, our clients, Sarah Allen and Claire O’Brien. So I’ll start with Dr. Sarah Allen and her stats. She has a Bachelor of Science in Biology from Wofford College. She graduated from, The Medical University of South Carolina in 2008 specializing in internal medicine. She was chief resident and eventually became an assistant professor, teaching internal medicine and family medicine to residents. [00:07:00] She is the founder, CEO, and Chief Clinical Officer of the Skin Clique, a concierge medical aesthetic practice operating in states all across the country. Claire O’Brien’s next. She has a Bachelor of Science and Health and Human Performance from the College of Charleston, a Bachelor of Science and Master’s in Nursing from the Medical University of South Carolina, nurse Practitioner for over a decade, spending the last eight years of her career in ENT with a focus on head and neck, and she is a co-founder of The Skin Clique. And Brad, they are way more qualified than we are, so we better be careful or they’ll just take over this podcast.
Brad: Yes, absolutely.
Claire: Thank you for having us.
Sarah: Thank y’all so much for having us. We appreciate it.
Brad: Yeah, absolutely. Well, obviously this is not y’all’s first podcast because I understand you have your own.
Sarah: Oh. Claire, yes.
Claire: I do, I have a podcast, but we also have an internal [00:08:00] podcast in our company that we use to help educate our providers.
Brad: Well, good. We’ll definitely make sure in our notes that we’ll at least link the ones that the public can listen to also.
Brad: Well, you know, besides your internal podcast and your external podcast, I’m sure the audience is trying to understand, you know, what does The Skin Clique do? Give us y’all’s story. How’d y’all meet? And what are y’all up to?
Sarah: That’s a great question. So, The Skin Clique is the first and only national medical practice of nurse practitioners, physician assistants, MDs, and DOs, who provide aesthetic home visits. So we provide concierge services and perform Botox, dermal fillers, chemical peels, and offer medical-grade skin care consultations in addition to all therapy in the comfort of your home, office, or wherever you may be. And, so in 2018, I founded the practice. I am a [00:09:00] busy mom with four girls and I was teaching full-time. Teaching medical residents. And at that time I was teaching home visits. We were doing all kinds of things in the home, so sterile, picc line dressing changes, joint injections, trigger point injections, whatever we needed to do. And a friend of mine said, well, can you learn how to do this for us? And I was like, learn how to do what? She said, Botox and I was like, huh. So it was something I’d always wanted to get into and I’d always been interested in, but I went and took a weekend course and noticed as an educator at heart how lacking education can be and how to be able to take a day course or a weekend course is not sufficient for education in medical procedures. And so I have found a very kind physician who took me under his wing, taught me everything he [00:10:00] knew, and it caught on like wildfire in my small town. We were giving patients back their time, and convenience because who has time to sit in a waiting room anymore? And it grew so quickly that by 2019 it was time for me to either stop or continue to grow and enter Claire. We were reconnected after years and years and we decided to grow.
Michael: That’s amazing. Well, and, I’m going to get to Claire in a moment, but tell me where all are y’all located now where you’re providing the services?
Sarah: Yeah, so great question. Since 2018, as a solo practitioner, we’ve grown to 31 states with over 220 providers.
Michael: Oh my goodness. That’s incredible.
Claire: Everywhere you want to be. Just like Visa or MasterCard, whichever one it is.
Sarah: We’ll take it.
Michael: That’s amazing. So, Claire, you entered the picture. Tell us a little bit about your story [00:11:00] and kind of your perspective on your involvement in The Skin Clique.
Claire: Yeah, so I too was in academic medicine for quite a while. I was in an academic cancer practice and, you know, my family was changing, having more children. My husband’s also a busy physician, travels a lot, and I just couldn’t do academic cancer anymore. It’s all-consuming. Sarah and I actually knew each other when she was a baby resident and I was a nurse at the VA and she asked me if I might want to inject with her and…
Sarah: Can I tell them our funny story before you start?
Sarah: Because I just thought of this and y’all will appreciate this cause you’re attorneys.
Sarah: I’m so sorry to interrupt.
Claire: No you’re fine.
Sarah: Alright, so this is how I refound Claire. So we were thinking about expanding into Charleston, South Carolina. There was a nurse practitioner who I had been speaking with and she called me one day and she said, well, I went to this thing last night where I met some other people and I told [00:12:00] this girl what I was going to do and she said, you can’t do that, that’s illegal. And I knew before she told me who it was, who it was, and I was like, who was it? She said, Claire O’Brien. I grew up down the street from Claire’s husband. I called Ed who’s also a physician and I was like, Ed, I heard that you think what I’m doing is illegal. And he was like, well, no. I mean, I don’t know. And I was like, it’s not, and let me tell you why. And so I walked him through it. So then shortly after that, when I got to talk to Claire and I got over my nerves, I was like, Hey would you want to do this too? And she was like, Hmm.
Claire: Well, it was something that we had actually talked about doing together. My husband and I, so that I could get out of academic medicine and just this consuming kind of soul-sucking career that, you know, I loved, but it was killing me. And so prior to this conversation, everything that we had researched the laws did not prohibit or did not allow what we were doing in South Carolina, but then the [00:13:00] laws changed in 2017. Sarah started in 2018, and we just hadn’t even looked back into it. We’re like, oh, okay, this is, you know, regulatory prohibits this and we just can’t move forward. We jumped on board.
Sarah: Right place, right time. You know, I think we’re forever grateful for that. And one of the reasons that Claire and I care so much about regulation, because they change all of the time.
Michael: Yeah. Well, and that’s a great kind of lead into where I’m going next is, I mean, as a healthcare attorney, we know when we hear you’re, you know, all over the country, we know what that means from a regulatory perspective. It’s heavily regulated and, you know, being in healthcare, you have to either turn into the compliance or it’ll just catch up to you as you scale. And we can pick up on the importance of it just from listening to you at the beginning of this, that you’ve kind of turned into [00:14:00] dealing with, you know, operating in these different shades of gray, but maybe have each of you just talk a little bit about the importance of compliance for your organization and some of the challenges y’all faced in, you know, finding answers.
Claire: I think for me that one challenge for us that makes it so important is just knowing that what we are doing is different and we cannot do it any way other than by the letter to the T. Everywhere we operate, we’re going to be the safest and the best. And we also know, you know, there’s a previous kind of stigma on Botox outside the office setting, which we can talk about that in the setting of Covid. I would love to touch on that and how things quickly pivoted all of a sudden for everybody. It’s too important with what we do. We know what we’re doing is non-traditional and it’s just at the utmost of everything that we do.
Sarah: And scrutiny. Yeah. [00:15:00] So, and to give you some simple examples, right? We don’t backfill syringes of filler. We don’t save syringes of filler. That seems like such a basic thing, but a lot of practices across the country do that, despite that it’s not the best practice. And we know that we have to be better than everybody else because we are different. One of the things that was so important to us, in the beginning, was we wanted to be safer than a doctor’s office. And, I could tell you a long story, but I won’t bore you. But, you know, we wanted to be able to do everything that an appropriately prepared physician’s office or provider’s office could provide. And so that was very important to us. The other thing that I think took up the bulk of our time, in the beginning, was researching supervision requirements, the scope of practice requirements, and pharmaceutical requirements in every state before we went into that state so that we had an idea in our [00:16:00] head, how many physicians do we need? What do we need to be safe? That has always been very important to us.
Brad: Yeah, it makes a lot of sense. And, did you want to add anything to that? Claire, you’re good?
Claire: No, it’s good.
Brad: So, you know that, and that’s funny cause hearing y’all’s old story about in 2017 the laws changing and then you opening in 2018 and y’all really trying to figure out what to do and especially with how gray, as you guys know, from going from state to state now. That brings us to today’s hard conversation. You know, looking back now, the, well, the audience doesn’t know, in 2021 you, as you said, you have opportunities to fly on the radar. A lot of businesses and medical practices maybe the same. They say, well, I’m not sure if it’s good or bad. I’m just not going to ask. And hopefully, if I don’t ask, then I won’t get in trouble. And for y’all, y’all said, you know, let’s go to the South Carolina State Board of Medical Examiners and present our [00:17:00] model, this business model to the board and see what they think. So why don’t you walk us through the thoughts that you had about going to the board and what that was like because I think a lot of our audience members who are in the medical field, that’s terrifying to them.
Sarah: Yes, it was.
Sarah: Welcome to the Terrifying Game.
Sarah: Yeah, yeah.
Brad: So tell us about that experience.
Claire: A lot of attorneys involved in that.
Sarah: Yeah. Yeah. So, I physically went and this was during Covid, so this is interesting. The board meeting was remote, so I went to our attorney’s office at the time and sat in their office and then everybody else joined me remotely so that I had some backup right beside me. But you know, we had practiced, we had slides, we went through everything and the goal really was to get out in front of it. And not only that, but to also have on a transcript from our home state, our [00:18:00] model, what we are doing, and is there anything we can be doing better so that if we were, as we grew into other states if there was any question, you know, we always could say, well, we’ve been before our home medical board and here’s our transcript to prove it. And that has come in handy so many times. I’m not going to say it wasn’t terrifying. And it is outside of the box. And in fact, at one point one of the board members looked at me and said, you know what are you doing here? And I was like, I really just, we want to be in front of you because we want you to know what we’re doing. We don’t want to hide and we want to show you everything so that you can say, here’s what you can do better, or, no, you’re pretty good. And the one thing that they said you can imagine, what do y’all think it was?
Michael: I’m so curious because this is so…
Sarah: oh my gosh.
Michael: …unusual for them. I’m sure they’re like, well, what do you want me to do?
Sarah: Right. They were, they were, it was great. They were like so, please don’t ever serve alcohol at your [00:19:00] parties. And I was like, you’re preaching to the choir, y’all like I know. And you know, it’s interesting, Claire and I have been approached by numerous people who sell wines and things like that and they want to do events together. And we are very, no, do not put Botox and bubbles on your invitations. Do not cheapen our industry. Like you are a professional, separate that from alcohol and we are very clear with our providers about that.
Brad: Good for y’all.
Michael: Yeah. Yeah.
Brad: And so from the audience perspective, just taking a step back, so you’re sitting there on the Zoom. How many people were you staring at? What was that like?
Sarah: Were there only 13 of them?
Brad: Two of us. Yeah. We’ve sat in these rooms before on the medical board, so we have at least a picture, but it’s from your perspective, how were you feeling? Claire, were you like listening in? Where were you then?
Sarah: She was on the phone.
Claire: There were a bunch of prep calls and slideshows and, you know, all our different attorneys’ [00:20:00] opinions. And there was back and forth with the board. And yes, we watched and listened and it was great. I mean, you know.
Sarah: It was, it was truly terrifying.
Claire: But you did great. I mean, cause, you know, when there’s nothing to hide I think, you know, it of course was terrifying, but for us it was also a moment where, you know, this was shortly after the pandemic still kind of like Dr. Allen said, you know, in the Zoom land, but we had watched as we started to grow, you know, we certainly know the criticisms of our own model.
Claire: And we’re aware of the criticism that you can’t do this, this isn’t safe and particularly from like the core four specialties. And what we saw was immediately, as soon as in-office procedures were just not a thing for, you know, at least a temporary amount of time, everyone pivoted to this model. And for [00:21:00] us, we felt like, okay, this is our moment to say, all right, now if everybody’s going to be doing this, you gotta do it right. You know, we’ve gotta have the appropriate medical malpractice. Y’all know we’ve got regulations that are different in every single state. I mean, even down to the way that we pay our injectors. I mean, every single thing that we do has been vetted by, I mean, I joke when people say like, how do you do that all over the place? I’m like, I don’t know we have like eight attorneys, which it’s probably accurate, but, so that was a huge moment for us.
Sarah: I think we’re down to five. Had to count.
Brad: I’ll just say Jay is like 10 attorneys by himself, so I’m just throwing that out there.
Sarah: So then I get 18, let’s do 18.
Claire: Bless his heart.
Sarah: No, I mean, and then I joke and I said before the call, but I mean I don’t think people realize what an invaluable resource ByrdAdatto is to have been in various legal relationships [00:22:00] previously. It is so delightful to get a clear answer, and I do think that one thing that I never realized in starting this practice was no one is really ever going to tell you what to do. They’re going to tell you what the risk is and you weigh the risk versus the benefit, right? But it’s so nice to have somebody to walk alongside you and give you actionable advice which is rare.
Brad: And I’m going to say one more thing. Claire, you said this, which I completely agree with as everyone started jumping into this with you, trying to kind of copy your model, I’m glad that you said we want everyone to do it compliantly because I know y’all heard Alex Thiersch say this a thousand times. You know, rising tide lifts all boats and all you have to do is have one or two bad actors trying to copy yours and skip all the compliant steps before a state and y’all are in several says, oh you can’t do this anymore. And so that’s what I love about you guys leaning into these hard conversations. Sorry Michael, I know you had to say something.
Michael: No, I was just going to [00:23:00] say, okay, you have this conversation and I think I’m already starting to pick up on some themes of lessons y’all learned, but talk a little bit about, what happened, like what was the outcome of this hard conversation and two, what are some of the lessons you learned from this that you kind of use as you’re scaling your business?
Sarah: So obviously the biggest lesson was never alcohol, right? I mean, that was the most obvious and the outcome was great. I mean, it was. We have our transcript and that’s been helpful in other states, but I would say the lessons that we have learned, there are so many and I have a few. The first is for anybody who is interested in doing this and certainly, you can call your attorney, but you need to do research on your own. In the absence of a [00:24:00] law in a state, if a board has issued an expert medical opinion that stands in the absence of law. I know y’all know that. I would encourage people to look at those. I would say we have looked at everything from pharmacy. We are the first physicians practice in South Carolina to have a distribution permit. We’re very proud of that and that was as a direct result of regulation that was reciprocal in Virginia. So, we have looked at every possible angle that we can to be compliant. And then the third thing I’ll say that we’ve learned is really kind of how unfair all of this regulation can be across the board. You know, probably one of my favorite states to point out is Alabama, it is never lost on me that a PA or an NP can provide a joint injection or do a lumbar puncture and they can’t do Botox injections. That makes no sense to me and it is truly because of the lobbying power [00:25:00] of a select few. And so Claire and I, you know, I always tell people 2.0 for us is advocating on behalf of healthcare providers who are very well trained and just need someone to advocate for them.
Claire: And some of the best injectors in the world are RNs. And we know that in this industry that’s very well-known and we should all be able to practice it at the top of our skills and our abilities and our licensure in every state.
Michael: Well, hearing that you guys proactively went to the medical board does not surprise me that you’re also advocates.
Michael: And advocates for safe and fair treatment, or opportunities for the providers. That’s really cool. Anything, any final thoughts before we let you guys go and go on break to have a little wrap up on the legal end.
Claire: We want people to [00:26:00] say, if you’re going to an event or a Botox party or anything like that, our goal is for people to say, oh, is The Skin Clique doing it? Oh, if not, oh, is it safe? Are they doing it the right way? Because there are so many things patients just don’t realize, you know, going into these things and that’s never lost on us. So that’s our goal, is to be the gold standard in safety across the nation.
Michael: Well, it’s music to our ears.
Michael: For sure. Yeah. Well, we’re so grateful for you guys joining us today. It’s been really insightful and I know a great way to kind of incorporate the theme of hard conversations cause it’s one of the hardest ones we’ve talked about is going in front of the judge and jury and asking for their blessing on your model. What we’ll do next is we’ll let you guys go. We’ll go into a break and on the other side we’ll do a little legal wrap up, but thank you guys. [00:27:00]
Sarah: Thank y’all. We appreciate it.
Claire: Thank you. Thank you for having us.
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Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host Brad Adatto with my co-host Michael Byrd. Now, this season our theme hard conversations and Michael, man, we just had two incredible guests on. Sarah and Claire who really focused on, I mean, when you talk about leaning into a hard conversation, going in front of a medical board to say, are we okay? Are we compliant? And [00:28:00] what I loved about their story from the very beginning where, Hey, I think she’s doing it wrong to, no, we are doing it right, let’s lean into it, is their focus on educating themselves and educating others in the industry and that’s really a breath of fresh air to what needs to be for any medical practice, whether you’re an aesthetic or otherwise. But I’d love to hear some of your final takeaways.
Michael: Yeah. I mean, you think about it, I mean, rather than, you know, wonder if they were okay, they, you know, decided to check and confirm and then leverage that as they expanded and it. The amount of regulation that goes behind, you know, the bright and positive business, listening to them is amazing. And they said 31 different states. Well, if you think about this, number one, we always talk about, you know, the MedSpa industries, like the melting pot of licenses. You have, just on this call, you know, a doctor and a nurse practitioner, but they [00:29:00] mentioned DOs, there’s MDs and DOs and PAs and we talked about nurses and so figuring out how all of those can work together in a state is something that has to be solved. And then in their model it’s concierge and so there’s, you know, rules that go into that. You know, most states it’s a standard of care type issue. And so learning how to navigate that and scaling that across multiple states is really complicated and kind of the flip side to yes they’re kind of leading with compliance. What’s your risk if you don’t do that? And as you scale, the odds that you’re going to come before the medical board by their invitation goes up significantly because that means you have more patients. That means you have more [00:30:00] providers. And so, you know, we talk about who’s going to turn you into the board. It’s going to be a patient or an ex-employee and sometimes a competitor, which they, again, they’re different so they know they have all eyes on them and so, you know, it’s something to take to heart, particularly for any medical practice or MedSpa that’s scaling.
Brad: Yeah, absolutely. So I guess if the question is fake or real, are they the real deal? I think the answer would be yes, they are the real deal. Well, good Michael, believe it or not, that’s all the time we have today. And audience members, we got one show for season 11 for next week, and next week’s story we will not have a guest. So thank you to those guests, Sarah and Claire for joining us, but we’ll have another hard conversation about really bursting our client’s bubble.
Outro: 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. [00:31:00] You can also sign up for the ByrdAdatto newsletter by going to our website at ByrdAdatto.com. ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not 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.