In this episode, hosts Brad and Michael are joined by Mary Beth Hagen, the CEO and founder of Titan Aesthetic Recruiting. Mary Beth combines her education, training, and industry insights to help injectors and aesthetic practices grow without compromising ethics or patient outcomes. Learn proven strategies for attracting and retaining top talent, key considerations for scaling from both the patient and provider perspectives, and the profound impact of investing in provider development. Discover how to achieve mutual success for employees and employers while expanding your aesthetics practice.
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 info@byrdadatto.com.
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 Legal 123s with ByrdAdatto. I am your host Brad Adatto, my cohost, 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 we’re talking about businesses who decide to double down. They’re going to scale their business. Our theme this season is Growing a Business.
Brad: Yeah. Now, Michael, for those that don’t know, growing a business is really just one season of a business. There are actually four seasons. What are all four?
Michael: Yeah. So you have the building season. You kind of think of starting a business. You have the operating season, so you’re running a business. And then where we’re camping out this year, if a business decides they want to grow, it’s the growing season. So we’ll talk about all the issues that go in with that. And then finally the [00:01:00] buying and selling season. So you just, it’s time to sell or to buy another business.
Brad: Awesome. Well, I’m excited for our guest today. We have been staged with her and she’s heard us talk and we’ve heard her talk a number of times. She’s very engaging with us and teams and speaking of teams, actually, did you ever dream of being on an Olympic team?
Michael: Well, you really shoehorned that one in there. Have I ever dreamed of being on an Olympic team?
Brad: Or an Olympic athlete? How about that?
Michael: Well, what pops to mind immediately is young Michael and 1980’s speed skater Eric Heiden. Does that name familiar to you?
Brad: No.
Michael: Okay. Well, the 1980 Olympics were magical.
Brad: Yeah. I remember where it was.
Michael: Hockey team, all that stuff. Well, Eric Heiden won all five speed skating events in the Olympics. And I was so inspired by Eric Heiden that00:02:00] I found roller skates in my closet that I’d probably worn once ever, and worked on my speed skating for at least two weeks. And then I was done after that because it’s speed skating and no one speed skates. But that was probably the height of my Olympic dreams, I thought I was going to be the next Eric Heiden when I grew up for about two weeks. What about you?
Brad: I mean, obviously looking over me, I have the body of an Olympic athlete, so I really didn’t have, but I was really busy with other stuff, so I couldn’t really get to it.
Michael: Yeah. Yeah. I’m sure. Well, I guess if telling really bad dad jokes were an Olympic event, that you actually would already have multiple Olympic gold medals.
Brad: That’s not fair. All right, Michael, fun fact. Did you know that the ancient Olympic Games featured many competitions that are still taking place in our minor Olympics, such as foot races, jumping disc, throwing, javelin, throwing, [00:03:00] wrestling, and boxing, and only a few sports have actually made it since the Olympics of 1986. So the original five, that is said…
Michael: 1896, I’m assuming 1896, speak Brad.
Brad: Yes. Did I said 1996.
Michael: You did.
Brad: Oh, yeah. This is why I need readers, audience members. The original five, so what we just talked about, cycling, fencing, gymnastics, and swimming, have all been a part of the Olympics since 1896. And over the years Olympics have added new sports.
Michael: Okay. Give us some examples.
Brad: For 2024, they’re adding break dancing.
Michael: Oh, man, you already had me in the eighties with Eric Heiden. Now you’re really kind of getting me going back, but I never thought of it as a sport.
Brad: Yeah, and going forward, audience members in 2028 Olympics, they’re planning to add squash, lacrosse, cricket, flag football, and they’re actually bringing back baseball and softball. And previous Olympic sports also included polo, tug of war, plunge [00:04:00] for distance, underwater swimming, which I think is amazing, obstacle racing for swimming. And of course, in it was 1908 motor boating.
Michael: Oh, didn’t even know they had motor boats in 1908.
Brad: Apparently they did.
Michael: Okay. Well, interesting. I assume all this Olympic talk is based on the fact that the Summer Olympic games have just closed.
Brad: Yes. Okay. And as you know, we’ve talked about the Winter Olympics before on our podcast, but this is the first time we’ve ever had a chance to talk about the Summer Olympics.
Michael: Although I love the fact that tennis is a summer event. I do have to say I prefer the winter events for some reason. Okay.
Brad: Also, fun fact, did I ever tell you about the time I jumped off an Olympic diving platform?
Michael: No, but I’m assuming you want to tell me about it. Yes, I do.
Brad: Oh, and since you love context, an Olympic diving platform is 32 feet high, basically above the water. The highest comparable to a three story building. And the platform is at least 20 feet long. [00:05:00] And then basically before the summer before my senior year of college.
Michael: Okay. that’s enough. I’m don’t want to hear about streaking Brad or other bad decision Brad; you’re making me nervous here. So, I think we have a nice podcast with a nice fan base and I don’t want you to ruin it.
Brad: Okay. No streaking. But I did go up on that 32 foot platform and went all the way up the stairs and there’s a guy standing there. I go, “Are you going to jump?” He goes, “No, you can go jump.” And again, college Brad, so not very intelligent. I think I got more intelligent. I just ran full speed and I jumped off this platform. And it’s one of those sensations that I was falling for so long I realized, oh my God, I’m still falling. So I ended up crushing it, obviously. And I’ve had a perfect dive. I’m sure it would’ve got a ten.
Michael: No splash? Yeah, I’m sure it was a cannonball, probably.
Brad: No splash at all, right.
Michael: Okay. Well, let’s bring our guests on Brad. Joining us today is Mary [00:06:00] Beth Hagen. Mary Beth is the founder of Titan Aesthetic, LLC. She has worked in the aesthetic field since 2005, first with Medassist, which is now Galderma, and then Allergan. She has held roles in sales, sales management, product management and national accounts. She founded the learners and Legacies mentoring meeting for new and developing injectors. Mary Beth is the lay representative on the plastic surgery nursing certification board, and is just an icon in our world. Mary Beth, welcome.
Mary Beth: Thank you. It’s always funny listening to those introductions, but you guys gave me so much material to work with in your opening banter that I’ll tell you, it’s just like I’ve got like an entire set of comebacks that I’m ready to throw out at you.
Brad: Well, that’s perfect. Because now I’m going to hit you with that tough one. Have you ever had a dream of being an Olympian?
Mary Beth: You know what, I have never believe it or not, [00:07:00] I had a dream of being an Olympian, but I did want to be an international reporter and wanted to actually go to Russia and be a foreign correspondent. Part of that is because you guys were talking about the 1980 Winter Olympics. And I do remember Eric Heiden. Good Minnesota girl. Or at least up north from back then. But what’s funny is that I’m not sure if a lot of people remember as wonderful and as many great stories as came out of the 1980 Winter Olympics, we did not participate in the 1980 summer Olympics, because that was when they boycotted because they were in Moscow.
Brad: Yes.
Mary Beth: I actually was an exchange student that summer over in Finland, so was one of the few Americans who actually did get to watch the Summer Olympics that year. And remember very, very vividly watching there in Finland and watching Olympic without American athletes in it.
Brad: That’s fascinating.
Mary Beth: An interesting perspective to have. And maybe that started out my ability [00:08:00] to be able to kind of look at things very non-biased. And that’s what I really enjoy about my role now in aesthetic medicine, is being able to be someone who can champion and support and cheer for a lot of people within this specialty. And hopefully provide resources that help everybody reach their goals, whether they’re Olympics or aesthetic medicine.
Brad: Man, that’s smooth.
Michael: Very smooth. Yeah.
Brad: I’m glad we have her on. She needs to stop now, or she’s already crushed it.
Michael: We need to do less talking and let Mary Beth do more. So that’s a great segue, Mary Beth. I would love for you to share with our audience, especially the ones that haven’t met you yet, kind of a little bit about your background, talk about tight aesthetic and what you do.
Mary Beth: Thank you for that opportunity. It is really a labor of love for me. As you said, I’ve worked in aesthetic medicine since about 2005 and have had the opportunity to hold a variety of roles in the industry side of the specialty. But what I noticed throughout my career was [00:09:00] that we were looking at transitioning from physicians doing a lot of the injectable procedures, especially as the opportunity for patient-based crew. And what I found was that it really is the RNs, the NPs and PAs who had that comfort with the needle and with injecting, and certainly with the very strong amount of patient interaction and consultation communication, which is key when you’re looking at cash or patient choice medicine. And so I looked – having worked with a lot of the national accounts in aesthetic medicine, it made me really realize that we are going to see more and more aesthetic practices, and that they were going to have to be staffed by RNs and PS and PAs.
Because when you look at what we’ve developed from a health care standpoint in the United States, physicians go to school and they train to be physicians. And it’s always fun to listen to your legal ideas about is aesthetic medicine [00:10:00] are injectables, are they a service or are they practicing medicine? And I always tell everybody, not attorney, not a provider, and don’t play one on tv. But what I wanted to do was be able to say, how can I help support injectors? There are a lot of organizations to support the physicians, but there’s a real lack of support and there is no national organization really that provides medical training and business support specifically for RNs and PS, and PAs in the injectable community. So Titan’s original mission statement really was that we support great injectors in great practices for great patient outcomes.
And our goal is really to focus on training and development, to focus on supporting practices that hire injectors and the injectors within those practices. We support peer mentoring and education, not only from an early beginning aspect, but all the way through their career. And then we do a lot of business consulting, compensation work00:11:00] some exit strategy from aside many times for the injector who’s saying, my practice is getting bought, what do I do? And so we’ve really tried to kind of fill a little bit of a gap in the market to be able to support those RNs and PS and PAs who work in aesthetic medicine, particularly on the injectable side.
Brad: Yeah. And so that leads us into, so since you’re helping them, tell us how you help your clients actually attract these right talents that they need.
Mary Beth: Yeah. Well, and it really has to be a win-win because there has to be the need from the employer or from the practice. And then there has to be the desire and the ability to invest in themselves and to continue to work and grow from the provider side. So we work closely with both those aspects. So when we’re talking with a provider, we do a lot of work of helping them really identify three things. Why are they looking to add a provider? It may be that they’ve lost their provider and they replace someone. [00:12:00] Are they looking at their business that is growing very fast and so they have more patients than they can handle with their current staffing? Or number three, are they looking to add a different aspect of medicine and do they need to add someone? And so I think a lot of times people think that they need a different injector or a different staff member for a different reason than what reality would support.
So we always try to talk through that, and I do a lot of consulting to make sure that what they’re looking for is going to be right to meet the needs of their practice. So why are they looking to add someone? Secondly, how is adding this person going to support the goals of that practice? And I always ask them to talk through what are your short term and your long term business goals? Because these are businesses, but they’re also medical practices, and we need to make sure that they are thinking about both aspects, the medicine and business. But then the third thing is, have you really thought about what you want that person to do [00:13:00] and contribute and how they’re going to fit into your total care practice? Do you have a good job description? So those are the three areas that we really work to support employers before we start an actual search, so that when we do go find someone, we find someone who’s a good cultural fit, who has the right innate aptitudes and talents to do the job, and they understand what the job is and what the long term opportunities are going to be for them to stay.
Michael: I’m curious, I just listening to you for your perspective. So one of the things I would say, if I had to draw a common theme or common problem amongst all of our clients, our practices, whether it’s surgeon owned or non-surgeon owned, is they say, the biggest problem we’re trying to solve is recruiting and retraining injectors. Do you agree that that’s kind of one of the biggest problems? And do you have any thoughts on, on why that is? If that’s the [00:14:00] case?
Mary Beth: Yes. Yes and yes.
Brad: Of course, that’s why we have her on Michael. Okay. Good.
Mary Beth: I do a lot of business consulting and throughout the last three or four years. I have spoken with many of the people within financial sector in different aspects to see, or private equity, or even entrepreneurs who look and hear, Ooh, the aesthetic market is growing so fast, it’s such a great hot market. And I think what’s so interesting is they think about everything around where is my space going to be? What is it going to look like? What are my beds going to look like? What’s my EMR? What’s my branding? What are my colors going to be? What’s my advertising budget? But the last thing so many of them tend to look at is who is going to be the provider that gives these products, services, and the experience to the patients? And the thing that everybody has to realize in health care, and this is very much health care, is that if you do not have a provider that is adequately trained, [00:15:00] that is safe, and that can communicate that opportunity to patients effectively so expectations are matched, you don’t have a practice. And it doesn’t make any difference how beautiful it is or what your marketing is if you don’t have that provider, especially in a med spa, you don’t have a practice.
I guess the other side of that is where do you get those? Because there is no academic training program in any of the RN and NP or PA programs around the United States. There are no national credentialing programs that somebody can go and say, I’m going to be board certified to do this. There’s the CANS exam that they can take after they practice for several years. And it is a wonderful board certification for plastic surgery nursing board, but as a new injector, it’s very much up in the air in terms of what they get in terms of development training.
So when you are a practice owner or a physician looking to hire an injector, everybody comes [00:16:00] to me and says, “I want an experienced injector that’s been doing this for three to five years. It’s going to come to my practice and bring their book of business or their patient-based to my practice.” And if you’re a surgeon or a physician of any other kind, that kind of makes a little bit of sense. But if you are someone starting a new practice, if you’re an entrepreneur, if you’re building from scratch, it really doesn’t make sense to ask an experienced injector to come join your practice unless you’re going to give them a large majority of the equity or stake in that practice. Right. Because they don’t need you. And that’s the thing, I guess that I always want people who think this is an easier area to come into to know that the injectors do not need you as much as you need them.
So I always start with that and you guys probably see this in your world as well. And that’s a little bit of where Titan kind of tried to create and close the gap. So we let people know we have [00:17:00] a program where we can help develop people, but you have to start with, are they the right fit for your culture? Do they have the innate aptitudes to be able to do this well? And are they someone who understands what their role will be as an employee within your practice so that you can invest in them while they’re investing in their own skills and knowledge to develop and to be able to help you create this part of the practice. So if someone is a newer entrepreneur or they’re starting a new practice, I will always encourage them to hire someone new. Hire somebody who fits with your values and your culture, who has the innate skills, and you can develop and they can develop their skills and their patient base as you are developing the new business in the new practice
Brad: And how often though, when you sit down there and you ask those questions, they look at you like a deer staring at the headlights, like, I have no idea what you’re talking about. What do you mean by culture? Or what do you mean? Like, as to my short term long term? [00:18:00] I just need somebody to walk in here today and I was told to call you.
Mary Beth: They don’t look at me at the deer in the headlights because they don’t acknowledge that at all in many cases. But they all say – and there are a lot of experienced injectors that they can find. But what makes experience? Have you worked for someplace where 99% of what you’ve done is laser hair removal? And so now you say you’re an experienced aesthetic provider and this person says, I’m going to bring you into my practice and put you in charge of all my injectables when you’ve done five injectable patients. That’s not going to meet the need to therapy. So that’s why I think a lot of times you see people come in with one idea of what they’re going to do in aesthetic medicine, and then literally based on who they can hire, what skills and aptitudes that person has, their practice will then evolve, develop to fit the needs and the services that that provider can promote. And that’s gets very interesting looking at where do we go from what’s [00:19:00] the original thesis as a business plan to what’s the model that we’re actually promoting to support.
Michael: That’s awesome. I want to get to this because we had a little bit of a side conversation beforehand and I’m fascinated by this, but we see private equity in the space and we see just this energy of growth in this aesthetics world. And you have some considerations that go into this. Talk a little bit about kind of how you talk about when clients come to you and say they want to scale, what are the things that they should be thinking about?
Mary Beth: It’s such a good question, Michael. And I know that this is something that is definitely on the minds of so many people in aesthetic medicine because of the finance interest in the specialty. And so I try to first ask, why are you interested in investing in a medical practice? And [00:20:00] it’s always surprising to me how many times I will get a response assessment. Well, I don’t want to buy a medical practice, I just want to do a med spa, so no. Medical practice isn’t that you’re signing HIPAA forms. You are providing medical services. There are a whole lot of laws and compliance regulations that you need to be aware of. And that needs to be your first stop and thought with this. Secondly, I will ask them tell me, you’re telling me that you want to build an entire chain aesthetic med spa or practices. Have you ever worked at a med spa before? No. Why don’t you open one med spa first, learn the business, try that. Well, I don’t want to just have a med spa. I want to have a chain of med spots. I literally have gotten that response several times.
So then we usually go into, well, help me understand, why do you think this is a good best for you? Well, this is an area that’s so fragment and it’s an area of medicine that there’s so much opportunity for increased efficiencies in economies of [00:21:00] scale. And if we have a whole group of practices, we could really make a lot of money. And so I will step back and ask them some questions to hopefully give them some thoughtful considerations. Number one, why do you think aesthetic medicine is frightening? And I guess I’m going to throw that back to you guys for a second before I give you my answer. Why do you think aesthetic medicine is developed in a fragmented farm?
Michael: Well, I’ve never been interviewed on my podcast, but I love it. My reaction is that because the nature of these services are elective and it’s based on the skills at the hands of whoever and whether it’s surgical or non-surgical, there’s an art element to it, especially in injections that if you partner with someone that does the same thing, it, it feels [00:22:00] like you’re partnering with a competitor. And so, we definitely see that on the surgical side more than we do on the nonsurgical. But I do think it because of it being an elective business where someone chooses to come to you, it also makes it a lonely business.
Mary Beth: Well, and you did a great job of describing why it’s fragmented from your side in a couple of areas. But I’ll throw out another thought to kind of add to that. In many ways, think about who the consumer is that’s walking in the doors of aesthetic practice. They are usually someone who has looked in the mirror and there’s something that they wish could be different. And so, it takes a lot of internal thought to get to the point where you’re saying, I’m going to go walk into aesthetics clinic. So it needs to be a place where you feel safe, where you can still feel personal, because I don’t care how much we talk about [00:23:00] it on social media, that decision to go to an aesthetic provider and walk into an aesthetic practice is still a scary thing for many first time patients. And I’m not talking about the 25-year-old who’s looking for a lip slip or something like that. I’m talking about the 45 to 50-year-old who’s spent their life taking care of others and whether male or female, now they’re going, “I wish the outside looked like what I found inside.”
That feeling of self-investment that the patient is going to make is something that needs to be a very soothing, a very calming, a very trustworthy and a very private experience. And if you think about a large multi-state chain of med spas with large national advertising, that’s kind of a different feeling from what the average woman feels like the first time they want to walk into an aesthetic practice. And I say one because it’s still 90% of our aesthetic base [00:24:00] is still primarily female. And when you look at what the patients want, that’s when you start thinking about what can you get in a solo or a small group practice or a safer, more personalized environment in a practice as opposed to a reproducible margin state chain.
Brad: Yeah.
Mary Beth: So that’s one of the things I ask people to think about. It’s not about what you want with the business. You have to always stop and think about who is the patient walking in the door and how is your practice going to meet their needs?
Brad: I love it. Well, believe you or not, we have time for one last question and I’d love to hear if you can give a takeaway for our audience today. What should the employee and employer have to really have mutual success, whether or not they’re trying to maintain and internally grow or actually scale a business, what should they be thinking about as they’re like the one big takeaway you can give them today?
Mary Beth: [00:25:00] You want to think about always creating a win-win for both your injector or your aesthetic provider and for the practice. And that starts with three things. Number one, you have to have the product mix that allows that provider to be able to give great results to the patient with the right product that’s going to be able to meet the patient need or their expectations. So always have a win-win with product mix. And don’t make unilateral decisions of we’re going to buy this product line because it’s cheapest or because we get a good deal on it. It has to be the products that get the patient results. Number two, think about compensation. And compensation is something that should be thought about in January and not in December. It should always be a what are we working toward? What do we need to do in order to allow this compensation need or request to event?
So in January, sit down and say, you know what? From the practice side, here are our goals for what we need to achieve this year financially and in terms of where our business is going. And let’s talk about what you want Mr. And Mrs. Injector or provider [00:26:00] from your compensation goals. Great, if you want to make this much money, here’s how much revenue I need for you to bring in so that we have enough growth within the practice that can afford to pay you that. So then when it comes to the end of the year, it is not a provider marching in and saying, look, you need to give me more money, or I’m going to leave to go down the street. It has been a win-win plan from the beginning so that at the end of the year you can have success or you can say, we didn’t quite make it. How can we adjust what we’re looking at to make sure that next year’s result?
And then the third thing that I think really is important with all of that is to continue to invest in education. Education for patients who walk through that door so they know the credentials of the providers there, so they know that this is a place that they can trust, that it’s a safe outcome, and they follow all the compliance rules, invest in education for the providers. So they’re always updating their skills, their knowledge, and what they can do for patients. And then always invest in education from a business aspect for the [00:27:00] practice owners, whether it be a physician or a non-provider owner, because they need to stay up on the laws, they need to stay up on compliance issues. They need to stay up on what new products, services, and basically how to keep it successful. Because if the provider leaves, you don’t have a business. The business shuts down. Provider doesn’t have a place to practice. And then the patients are always going to be at the root of it. As long as they keep coming at the door, providers they love, the environment they feel comfortable, that’s the trifecta of a blend.
Michael: Wow. That’s amazing, Mary Beth. I believe it or not, the time has passed. It’s flew by. Thank you so much for joining us today. It was really insightful. I know our audience is going to benefit from it. I know that Brad and I benefited from it. What we’ll do next is we’ll go into a commercial and on the other side we could wrap up with a few legal insights. Thank you.
Mary Beth: Thanks for having me.
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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 Michael, this season our theme is growing a business and we had an amazing – Mary Beth came in and dropped some serious knowledge on all of us. And she made some great points about working through your team. But one of the things we both thought was interesting was, she raised the point about how are you growing your business? And if you just bring in that outside injector that already has a business, how’s that going to impact your actual business? And I know we had some thoughts on that.
Michael: [00:29:00] Yeah. I mean, she nailed a big issue, which is just the transient nature of injectors and them having their own following and bouncing from place to place. But you pause for a minute and think, okay, well this injector with their own following shows up to your practice and they’ve got their own kind of brand that goes to it. And she mentioned their brand starts confusing your brand, so there’s a whole just marketing angle there. But from our perspective in the compliance world, we know what really happens is that they have their social media handle and they’re going to put the before and after pictures from the patients they treat in a practice on their personal social media handle. And so, you have a compliance consideration from a patient privacy perspective. Do the consents allow for this patient health information of the practice to go out to a personal social media handle? And then secondly, what happens when that person leaves and takes their book of business and goes to the next place, which happens often. Do they have to take those pictures off their social media handle or do they get to take them with them? Do they have to watermark them and credit it to your practice? There’s any number of scenarios, but you want to solve that kind of on the front end, then deal with it on the back end.
Brad: Awesome. Well, audience members, we will be back again next Wednesday where a team member from Skytale, Annie Hockey, will be joining us and talk about another way of looking at scaling. 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. [00:31:00]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.
