In this episode, hosts Brad and Michael are joined by Dr. Kimberly Evans, board-certified OB-GYN and founder of Sugarland Med Spa. After transitioning from a traditional clinical practice to opening a med spa, Dr. Evans faced the unintended consequence of trying to do it all while also managing patient expectations. She shares how challenging moments led her to restructure her practice, set clearer boundaries, and implement protocols that support long-term growth. Tune in for insights on shifting from traditional medicine to aesthetics or wellness, including operational and legal complexities of combining insurance and cash-pay services, and why letting go can be a strategic move for long-term success.
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 another episode of the Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd.
Michael: As a business and health care law firm, we meet a lot of interesting people and learn their amazing stories. Brad, this season’s theme is Unintended Consequences. We sometimes find ourselves in a situation that can be traced back to a seemingly inconsequential or unrelated decision.
Brad: Yes, and for those of you watching us in TV land, on our YouTube channel, you might notice an outfit change that happens when we bring on today’s guest. We had an unintended consequence where our recording that we had did not work. And so now we’re re-recording this opening. But Michael, before we bring on our guests, I’m real excited to bring on who attended the University of Wisconsin Milwaukee. [00:01:00] Let’s play a little mascot trivia. Michael, what is their mascot?
Michael: Well, first of all, Brad, I’m really proud of you for not trying to claim to the audience that you’re a Clark Kent and that you turn into Superman when we go in our costume change. But back to your question about the mascot. Am I allowed to ask Siri for help?
Brad: Negative.
Michael: Oh, no idea.
Brad: It’s pounce the panther. But fun fact, Pounce was not always, and has not always been the mascot for UWM. In fact, it’s a long and super, super winding mascot history. Pounce was born in 2007 when the prior mascot Victor E Panther “graduated”.
Michael: Yeah. See the quotes there? That kind of reminds me of a book we read about a tech company a few years ago where instead of firing someone, they would graduate them out of the company.
Brad: Yes, that was right. [00:02:00] So he was quote “graduated.” But did you know that Victor was the human form that was created in 1972 around the same time that the UWM athletic Department adopted Trouble? A North American Golden Panther. Yes, I said a North American golden panther to serve as a living mascot at the UWM Panthers seasonal basketball games. Now, as you can imagine, Michael, it was difficult to keep and feed a live panther. So, Victor, the human, outlasted Trouble.
Michael: For those who believe there’s meaning behind a name, this one was doomed the minute they named their live panther Trouble. For those who are more practical, this was doomed the minute they decided it would be a good idea to bring in a live panther.
Brad: I don’t know. I mean, the Tigers, LSU has their tiger. They don’t bring him the games anymore. But you can guess – can you guess what the school’s first mascot ever was, Michael?
Michael: Well, based on their track record, I’m going to go with great white
Brad: Shark. No, but I like the way [00:03:00] you’re thinking. And in fact, I’m going to start a new college that’s going to have a great white shark that will bring to all the games. It was a trick question, Michael. The school was originally founded as the Wisconsin State Normal School.
Michael: Okay. Well, I know you never went there ’cause you never attended any normal school.
Brad: That’s fair. That’s actually really fair. You’re right. Well, when the school began competing in athletic competitions in 1895, its nickname was The Normals, but no mascot was created. It wasn’t until the name changed to the Milwaukee State Teacher’s College that a new mascot came along and to represent them at football games, the Green Goals, which really sounds terrifying or at least scary than The Normals.
Michael: I’m really proud of your maturity with our guest here and not trying to allege that I went there because it was in 1895.
Brad: I didn’t say you didn’t, but in 1956, MSTC now, then known as Wisconsin State College, merged with University of Wisconsin Milwaukee Extension, become the [00:04:00] University of Wisconsin Milwaukee. Following a vote by the student body, they went with red white as school colors and opted for a new mascot going from the Green Goals to the Cardinal. And now Michael, you know, the rest of the story.
Michael: I’m quite confident that our guest does not know the extent of mascot history, or I’ll be very impressed if she does know all of this. But speaking of, I think it’s time to bring our guest on to hear her story. Joining us today, Brad, is Dr. Kimberly Evans. She’s the founder and owner of Sugarland Med Spa. She’s been a long time client of ByrdAdatto, works a lot with our partner, Jay Rojero. She is a board certified OB-GYN with nearly 20 years of experience and a specialist in women’s health care, sexual health, and aesthetic med spa treatments. Kimberly, thanks for being here today.
Kimberly: Appreciate you very much [00:05:00] for having me today.
Brad: Well, we’re going to hit you the very hard question. I think Michael kind of got you a little ready, hopefully, but did were you aware of this vast, vast history of mascots at your school?
Kimberly: I was not. You definitely did more research than I did on it. I really don’t even remember back that far, except that in everything I did, I was always so busy and all the organizations and stuff like that, to where it was really hard to kind of know some of the small details.
Brad: Yeah. Well, I mean, I was lucky enough that at my school we always had the same, you know, we had the horn frog and you always had the longhorn, so we didn’t have the very active student body that that you had, that kept changing it. Although I really liked the live Panther, it reminds me of growing up as a LSU Tiger fan. There we go.
Michael: Well, let’s jump in and I’d love to start just to have you share with our audience. Tell us about you and your background.
Kimberly: Absolutely. [00:06:00] I started off at the University of Wisconsin-Milwaukee. I did medical school and it was MCP Hahnemann, now known as Drexel. Me and my husband at that time, we had joined forces back in 2002 after graduation, and I started my residency in Toledo, Ohio, as well as Cincinnati, Ohio. After graduation, I ended up down in Texas and we’ve been here ever since. I’ve loved it, and the weather’s always great. I’m a sunshine person. And you probably know the Midwest is not very sunshiny all the time. There’s usually a lot of gray skies. Winters are terrible, so being down here, we absolutely love it.
Brad: Well, who could not love Texas? I mean, they took me in, so –
Kimberly: I know. Yeah, definitely. So we have two beautiful boys. One of them is in college right now and the other one is in high school. So it’s just doing great. The practice is doing great. [00:07:00] And again, as I was saying, earlier with the growth of the practice, having that type of support or an excellent team with ByrdAdatto makes a huge difference in just being able to call up and say, “Hey, I got a question,” about whatever comes about.
Brad: Well, let’s talk about your med spa; you mentioned it. Tell everyone where is it, we might be a giving it away here people.
Kimberly: Sugarland Med Spa.
Brad: Tell us what you kind of focus on with your patients.
Kimberly: Absolutely. So my practice started off as a primary OB-GYN. However, I realized through all the ladies, we all had a very common theme as we age, and things start changing, and it happens with both the ladies as well as with the husbands. So I realized in my community, there was actually an unmet need. So I was able to, literally all around me, I had OB-GYN doctors that wanted to continue to deliver babies, which is totally fine, but you get to the point in life where you start to pivot and think about, okay, what’s next? [00:08:00] I never planned on delivering babies forever when I was in my sixties and seventies. So I started to pivot and out came Sugarland Medical Spa. It was named, trademarked in about 2014, I believe. And ever since then, we’ve made year over year growth. So, we’ve been around for a long time. But definitely, I was able to grow a lot through my connections with the American Medical Spa Association.
And really, that’s kind of what set the trajectory of being able to expand so much further and just learn the ins and outs and the necessary things. Because as you all know, the med spa industry itself, it just basically blew up. So being able to have that connection or a little bit of direction about what we supposed to do, what we’re not supposed to do, what are safe ways to grow in that space as well as be compliant with everything that we’re doing. That has really kind of made [00:09:00] our med spa just grow again year after year after year. So I’ve been just very excited to be a part of everything that’s been going on.
Michael: That’s awesome. We have so many clients that have the, what’s next questions for us. I’m curious for our audience, do you still have your OB-GYN practice with your med spa?
Kimberly: Yeah. What I did is, it had to split. One day I was talking to one of my patients who was probably in her fifties, she was menopausal. She was coming in for her hormone therapy. I had to tell her, I said, “I got to run out and go deliver this baby, but I’ll be right back.” And she politely told me, “Why do I have to wait for somebody else’s baby to be delivered? That’s not my baby that you’re delivering.” And I was thinking to myself, you know, you’re really right. So I could be very good at one of these things, but I got to just choose now. And also around that time too, a lot of the hospitalists were coming to the hospital and able to deliver our babies. So I just said, I need to take a [00:10:00] split and just focus on being really good at one thing. So I just chose basically the non-pregnant women and drop the ob. So I still do regular gynecology services. We do various things, but they all have to do with anti-aging wellness, body contouring, just multiple stuff in order to take care of the aging patients.
Brad: That’s interesting because you know, you’re talking about your transition from what you were doing into this space. Do your patients, is it hard for them to think about transitioning into the hormones or other anti-aging?
Kimberly: Not at all. A lot of the people that are getting into the hormones are the ones that I delivered. So literally as I aged, as my practice age, so did the people that I delivered. So that’s the most rewarding thing is that they’re coming to me now saying, “Oh, you know, I’m having a problem with my hormones.” And I said, “You know what? We’ve been doing hormone balancing. Are you ready for that now?” And they’re like, “Oh, yeah.” That’s a great thing. And then of course, too, those same women are not interested in being pregnant anymore, [00:11:00] so it was very easy to kind of just make that transition.
Michael: I know that you’ve probably experienced just from a practice owner perspective, the difference between living in an insurance-based billing system and cash-based or elective-based system. Talk a little bit about what that’s been like, that journey.
Kimberly: Absolutely. So as many of you know, a lot of the med spa, they may not do insurance, but because I chose to hold onto my GYN, it was important to include insurance in some of the things. So that’s when I had to lean on my wonderful Jay. I teased them, I said, “Save me Jay, save me Jay save me.”
Michael: We say the same thing.
Brad: Yeah. All the time.
Kimberly: Yeah. So I was basically like, show me how I can do this compliantly and then still be able to separate the two. And literally we were able to kind of structure it so that when people are on the GYN side, [00:12:00] of course, they’re in insurance world per se, versus if they’re on the med spa, we were able to kind of carve out those services to say, hey, these are definitely med spa services. But definitely it could have been a headache, certainly. And you don’t want to exclude anyone who doesn’t want med spa services because certainly they need to be taken care of too. It just becomes about how to structure the practice correctly.
Michael: That’s great. Thank you. I’m curious too – talk a little bit about your suite of services as far as how they interplay. You have the wellness and kind of hormone-related services and then traditional or aesthetic type services. Talk a little bit about that.
Kimberly: Absolutely. So with our patient population, what I was able to do is to say – basically I looked at my patient and I was able to identify what their needs are. And I think that’s the best way to actually structure a practice. Because for example [00:13:00] I won’t necessarily name any names, but there are some providers that they may not be good, you know, they want to do hormone balancing, but when it comes down to, well, what if the patient bleeds or there’s a complication, they may not be good at how to manage that. So what I was able to say is like, “Hey, if I’m going to do this, I already know how to take care of whatever the consequences may be.” And with that, with looking at my patient as they age, and I’ll talk about women specifically now, but as they age, they’re going to have hormonal problems. As I mentioned, they’re going to have skin problems, so that’s why I have med spa services with menopausal stuff. They’re going to want to lose weight, get their body back, so we had to add that to our, our suite of services. And of course, they’re always interested in getting healthier, living longer. So we just recently are adding IV services, our body contouring services too, as well as just really everything that takes them through life.
So I have ladies, my youngest person I did hormone balancing was actually 28, [00:14:00] and we were able to really turn her life around. She was someone who had addiction problems and things like that. And we were able to really kind of help her shift her whole mind focus. My oldest person is in their eighties. And I think a true representation of someone in their eighties is someone who’s still mobile and not using the walker per se, because they’re still strong. And then of course, a lot of times what I find too is that, as they’re aging, their muscles get weaker. So some of the same devices that we use for prosthetic practices, like our M-scope neo, it can actually be used for functional wellness. So if someone is like, weaker in their knees or legs or things like that, we can use that in order to help them. So literally, like everything I do, I base it on what does my patient need.
And then of course, if I just talk about women, can’t exclude their husbands, because now that of course we have women, they’re feeling better, they’re loving on their honeys more, and then they’re looking at their honey, and their honey comes to me like, Hey, I need to do something because she’s all over me. [00:15:00] So it’s like, I need some help in this department too. So, we’re able to kind of help men where they need it the most. And it’s just such a blessing to have people that you make them feel better, and then they come tell you how you’ve saved their marriage or they’re responding better or they’re able to hang out with their kids more, they’re able to move around more, or they’re simply just able to function better in their job, even. That’s like true medicine to me. You know, things that you get to the end of the line where the medicine ends and they’ve taken, you know, you have a female that’s taking antidepressant and she still feels terrible. She’s like, there’s got to be something else that’s out there. And then that’s when I step in and say, great, we have some awesome things to help you look and feel better from the inside out.
Michael: That’s amazing.
Brad: You can tell how passionate you are about helping people just by the way you’re talking about it. That’s so cool.
Kimberly: Oh, yeah. Yeah, for sure. And I’ll take it one step further. I have ladies that have their own OB-GYN doctor, [00:16:00] and they’ve had them for years, but literally being able to help them where their doctor either won’t, they can’t, or they don’t understand, that’s really cool to me to be able to take it to that level.
Michael: Well, let’s flip the other side of the coin and talk about some of the challenges. So talk a little bit about some of the most common challenges you faced as a physician, owner of a private practice.
Kimberly: Absolutely. So the biggest hurdle is actually something that my lawyer, Jay, helped you with. The biggest hurdle that I had to learn is sometimes you need to just let go. Meaning that, you have this business, it’s growing, and you’re going to have some heartaches that come with the business. Like, you’re going to have to say, I’m sorry that you were not satisfied with this. What can we do to make it better? Or here’s your money back, or how can we replace that with your optimal thing. And this is why I think, again, why I do so many things. Because literally, we’ve had people, they want to do body contouring because [00:17:00] they want to lose weight, but as they know, or you may know that body contouring is not necessarily for weight loss. You need to probably be on a weight loss program and do your body contouring in order to see the effects.
So literally just being able to kind of let go relax, realize who’s in perspective. And there’s a great biblical phrase that goes back to loving the people, not loving the money. I think that that’s where that all comes into. I’ve had had difficult situations. I even had one lady, she had wanted a filler, I won’t name any names, but I really love the patient and she was just unhappy with her filler. So rather than me just saying, “Hey, you know, here’s your money back,” I was like, “Well, I’m right. I mean, I tried to fix you. I spent so much money and so much time fixing you,” and then it just went too far to where literally I could just said here’s your money back. Have a nice day. And it would’ve just been like way easier to kind of cut the losses sooner. So, that’s one of the harder lessons. But now that I’ve matured and we [00:18:00] have this great practice, there’s just so much more that I can do that I learned from it to be able to move further and continue to move forward.
Brad: Well, talking about a patient that you can never meet their expectations, that’s going to lead us perfectly to the next question I want to ask. Because as you heard this season, our theme is Unintended Consequences. And what are some decisions in your life or your practice, however you want to bring it in, that led to some unintended consequences?
Kimberly: Yeah. Basically kind of linking back to what I said is that, definitely having the patient’s expectations in mind, because people will come to a med spa and they will say I want to look like some unrealistic thing. And if you tell them, well, this is what’s going to help you get there, and they need more, then they’re not going to be happy. And at the end of the day, they’re going to feel like you did them a disservice. But it’s much better to say, [00:19:00] “Hey, if this is how we’re going to do it, this is how I need to kind of guide you in order to kind of get you to reach your goals.” And then two, simply just being honest with them and just sometimes you got to say, that’s not going to happen, or you need to go to plastic surgeon to achieve those results. So again, the biggest unintended consequences is just learning for my own hardness of saying like I know that I’m right. I know I told them what’s in the informed consent. I know I told them everything, but even if they’re still unhappy, the hardest thing again is just learning when to say it’s okay. It fine. Have a nice day. Go down the street to my competitor, let them take care of you, literally.
Brad: Yeah. Well, and I think, you can tell that how passionate you’re about helping people, which is great, but that also can be a weakness. And one of our partners, Jeff Siegel, always says, the customer is always right, but not everyone has to be your customer. [00:20:00] And I think that’s a hard lesson for a lot of us to learn as it relates to, because you know in your mind there are ways you can help someone, but as you were articulating, but they have to be part of it. There’s not enough medicines in the world or anything else that’s going to make them lose that weight or gain that muscle. They’re going to have to participate at their own level too.
Kimberly: That’s right. Exactly.
Michael: How do you work with your team for them to also have the same kind of expectation, setting and communication so that everyone’s kind of rowing together with your patients?
Kimberly: Absolutely. Best thing is that we try to have weekly team meetings, and we first start off with what are the struggles for the week? It can include difficult patients, difficult situations, just so that we know when that patient comes in, this is what that patient is expecting, literally. And they’ve been upset with me before too. [00:21:00] I’ve seen people knowing that they told them a different time and they still come in an hour or so late, but I see them because you realize that, hey, we are here to serve. We’re here to take care of these people. And sometimes it’s a little harder, especially with my little 20 year olds because they don’t really understand, my 20-year-old crew. They may not understand like, why I’m saying yes to this particular patient despite the fact of her not necessarily respecting what we do or how we do or things like that. But still, any business is going to have, it’s harder patience to deal with, but this is what we specialize in. This is what we signed up for.
Michael: That’s awesome. Well, let’s kind of getting to our last topic, I want to kind of think forward. I’d love for you to reflect on your experiences and then talk about with those in mind, how has that affected the way you plan for the future of your practice? [00:22:00] And love, just to kind of hear kind of your crystal ball perspective.
Kimberly: What I basically see for the future is something really, really great. I think in a lot of the things that we do, the whole thing with women’s health care and being able to help women in ways that others can’t or won’t or unwilling to, I think that there’s like a huge unmet need in being able to service some of these women in this way. I believe that – and again, this, this may be more of me and my own passion, but I believe that especially during the month of May, as we cherish a lot of mothers and aunties and people that have helped shaped us and be the people that we are, there’s this unmet need that women go through. And being able to tap into that to help women, not only where we are in Sugarland, Texas, but I mean, it would be great to be able to grow this out to where it can actually help women in other states.
I do know that there’s other [00:23:00] practices that specialize in feminine rejuvenation as well as helping ladies in some areas. But I do think that there’s this degree of sensitivity that may be lost and being able to teach and grow the practice even further. So my ultimate goal, things that I would love to see is to actually be able to maybe reproduce what we do in Sugarland, Texas, someplace else and being able to help someone also create that vision for what’s important. Because again, it’s important in general, and unfortunately, not getting political or anything like that. But I do believe in women’s rights and things like that, and being able to take care of ourselves, because as that old saying goes, when the female’s happy at home, then the whole household is happy. So, that’s what I would really love to see and be able to kind of create that vision that is reproducible someplace else. So yeah, so we’re going to be together for a long time, [00:24:00] us, Sugarland Medical Spa, and ByrdAdatto.
Brad: Yeah. That’s awesome.
Kimberly: So yeah, it’s because it’s truly a journey. It’s truly a journey.
Michael: Yeah. We’ve actually reached the end of our time and so we are so grateful for you joining us today. And we will close off here and then Brad and I will jump on after the commercial to do a little legal wrap up.
Kimberly: Thank you so much to Michael and everyone. And Brad, just thank you so much for just having me here on the show. I really appreciate all that you do at ByrdAdatto. Thank you, Jay. I know you’re not here, but please give him my regards.
Brad: Absolutely. Well, thanks again.
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Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host Brad Adatto. I’m still here with my co-host, Michael Byrd. Now Michael, as we’ve said, this season, our theme is Unintended Consequences. We had an amazing conversation with the beautiful and talented Dr. Kimberly Evans. She brought a lot of life to our show. Really you could tell about her passion and her love for her med spa, Sugarland med spa, and her passion and love for her patients. There’s good takeaways that she gave us. I mean, we could probably spend another 20 minutes of different things, but let’s narrow down on a few things that [00:26:00] we don’t really talk that much about, but providers that end up kind of having their feet in two different locations, cash and insurance.
Michael: Yeah, I mean, an unintended consequence of this somewhat common scenario of, you’re in a specialty, insurance-based payments and for your patients, you want to expand into some cash-based options that maybe it’s wellness-related or longevity-related or aesthetic-related. And an unintended consequence sometimes is that you’re still servicing under insurance this patient population, and understanding that you have a contractual arrangement with private pay insurance or in some cases, Medicare or Medicaid, and that there are certain services that are covered under those contracts and that you can actually have some contractual issues and sometimes even [00:27:00] compliance issues if you bleed over and are offering those services on a cash basis. And so, it can get kind of messy when you’re just thinking you’re doing something that’s a service to your patients.
Brad: Yeah, and this is where I would just bring Jay in since he can handle this. But your point, not only that; you have all these regulations now coming into play. I mean, just in a big picture, the moment you start taking federal or commercial payers, you now have to make sure all the federal rules and state rules that come with that are being abided by. But even though maybe even 80% of your patients are cash-based, that still means that you have to a hundred percent comply with these other rules. So, it adds a little bit of a complication to it. And again, it’s not that you can’t do it, I mean, you start having conversations like, do I opt out of Medicare? And what does that mean? Because there’s different levels of opting out of it. And then then to your point of commercial payers, is this a line of services that the commercial payer pays for? If not, did I just [00:28:00] violate the contract, but did it also violate some state or federal rule? So those are things you need from a balancing act.
Definitely want to pause and make sure that as you transition your practice away from commercial payers, that just because you’re going away, doesn’t mean that you’re just in the clear. You have to still figure out what other rules apply. But you know what, we are at time, everyone, and believe it or not, we will be back again next Wednesday, Michael, when we continue down this journey of learning about unintended consequences. And we’ll talk about unintended consequences of medical directors. And for some reason, since we haven’t said his name enough, series regular, Jay Reyero, Dr. Kimberley Evans’ favorite person in the whole world, will be joining us next week too. 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. [00:29:00] 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.
