00:00:04:12 – 00:02:00:22
Jay Shorr
Welcome to Shorr Solutions: The Podcast. And I’m your host, Jay Shorr, CEO and founder of Shorr Solutions. We are a team of national and award winning practice management consultants with experience running a multimillion dollar cosmetic, dermatology and plastic surgery practice. We’re here to share strategies and insights that will help you grow your practice viciously and profitably. In each episode will explore the steps and actionable insights to guide you through your journey to increase efficiency, boost revenue and decrease costs. Tune in and discover how to improve your patient experience and take your aesthetic practice to the next level. Well, welcome to another episode of Shorr Solutions: The Podcast episode number 128. My oh my, how they go so fast. And I’m your host, Jay Shorr. And along with me today I have a very special guest, and my guest is none other than Nan Maddox. Nan Maddox is a client success manager with Shorr Solutions, and she assists with the operational, administrative and financial health and guidance of our clients as well. Now let me share something about Nan. Nan is retired from the United States Air Force as an air woman after 21 years, and she retired as a Chief Master sergeant in the Health Care Division. Health Care Administration. Upon retiring from the military, she went on to own her own med spa and then most recently, before joining Shorr Solutions, she was the practice administrator for a very large, very profitable plastic surgery practice and med spa in the Midwest. So, Nan, welcome aboard. It’s a pleasure to have you join me on this podcast today.

00:02:00:25 – 00:02:02:06
Nan Maddox
Thank you. My pleasure.

00:02:02:10 – 00:03:33:09
Jay Shorr
So today’s podcast title is In the Trenches Practice Challenges and Triumphs. I like to think that there are more triumphs than there are challenges. But let me tell you, in today’s world, challenges, challenges, challenges. So let’s just get to it. One of the main things in running a practice, let’s talk about finance. I know there’s going to be H.R. And there’s going to be administrative issues, but finances. So we’ve gone through so many ups and downs, rocky portions. I called them ebbs and flows and, you know, financial warfare because there are unexpected expenses. There are cash flow problems and there are economic downturns. Now Nan, let’s share what happened during 2020. That unexpected Covid 19 happened in 19, hit us in 20, and we had unexpected expenses. We had cash flow problems, and we certainly had an economic downturn. And even though it’s five years ago, literally five years ago, to people like us, it still seems like current events. I don’t think it’s ever going to not feel like current events, because it’s nothing that we had ever lived through. Hopefully we will not ever have to live through it again. So now let’s talk about unexpected expenses, cash flow problems, and economic downturns.

00:03:33:12 – 00:04:29:25
Nan Maddox
Yes, absolutely. Covid was quite the experience for me personally. I had just been hired for that position at the plastic surgery practice, and it was closed for the first two weeks that I had arrived in the area and getting started under those circumstances was very challenging in and of itself. But then the reopening and the expense of everything, those shortages of the supplies and having to look at other resources and other areas to be able to even operate and to stay in business. So it was very challenging and everything was very expensive. The ironic part of it, though, is that it seemed everyone wanted to get plastic surgery during that time. So even though all of our operating expenses were more expensive, our business was booming.

00:04:29:25 – 00:05:08:15
Jay Shorr
So we talk, you know, cash flow problems. But what about economic downturns, people that were losing their jobs and people that were being laid off and people that were furloughed, and those people who nurses and doctors and medical staff that didn’t have essential because I’m in Florida, you were in Arizona. We had a much more major shutdown in certain areas than many. All right. I don’t want to talk about who and why and when. However, it became a little bit of a nightmare. So let’s talk about the economic downturn of why businesses may have been slower because people just didn’t have the money.

00:05:08:17 – 00:06:02:25
Nan Maddox
Yeah. So absolutely no one was going to work. You know, of course the money was short during that time. And so a lot of businesses, a lot of the smaller stores, a lot of the malls, a lot of the places that even the big box stores you saw after Covid closing down. I remember ordering things online and trying to return them after Covid and the store didn’t exist anymore. It was just a very unfortunate time that we all had to live through and learn how to survive. I tell people fighting over toilet paper, you never saw any time frame of your life that you would see someone fighting over toilet paper. So it was just a very unique time in our lives and, a lot of financial challenges, a lot of unique challenges that I hope we never have to go through again.

00:06:02:27 – 00:06:57:23
Jay Shorr
Yeah, there were other shortages other than the toilet paper, if you recall, lidocaine was a shortage IV saline was a shortage. There was propofol. That was a shortage. And, you know, there’s always something that happened. You know, let’s talk about the surgical versus the non-surgical. And, I mean, there were people that may not have had the money for surgery or they didn’t have necessarily have downtime for surgery, but truly, they may have wanted the quick non surgical fix, the dermal fillers and neurotoxins. Let’s talk about that for a second. What did you see. Because what you may have seen may not have been you know, the norm. It could have been an anomaly because of where you were located and you know how they were reopening and not. So let’s talk about surgical versus non-surgical during those economic downturns. Covid aside, there’s always an economic downturn. Right now, we’re in an economic downturn.

00:06:57:24 – 00:07:40:10
Nan Maddox
Yes, of course, I went through one of those while I owned my med spa, and I think we spoke of it with a client the other day who asked the question about how to deal with a recession. And I think we both agreed that people still came for those non-surgical procedures. They wanted the Botox, they wanted the dermal fillers, those that had money before the recession still had money during the recession. And even that those that had to cut back still wanted to look good and feel good. So they somehow found the time and the resources to be able to come in and still partake of of spa services during that time.

00:07:40:13 – 00:09:00:21
Jay Shorr
Yeah, well, we hope that it will continue and flourish the next struggle, and we speak about this all the time, and every one of our clients tells me the same thing. There are no good staff in West Virginia. There’s no good staff in Detroit, Chicago, LA, Boston, Atlanta, Miami, Dallas. I mean, I hear it all the time, right? And, you know, there’s good staff. We just have to find them. Because my summation to this truly is most of the good people already have jobs. All right. However, whenever you’re thinking about it, I would just speaking with a client yesterday and she tells me she’s firing somebody today. And I said, why? And she said, well, the person gives me an attitude. Now this is the business owner. And I said, well, that would be the first chance you get to give me an attitude. You get one get out of jail card free. Drugs, alcohol theft are the killers. But let’s talk about a time when staffing issues felt like a battle. And I don’t mean yesterday. I don’t mean today. I don’t mean tomorrow. I’m just talking about last week. Yeah. Let’s talk about generically high turnover, office drama, underperformance and theft. Let’s talk about that for a minute. We could take one at a time.

00:09:00:23 – 00:09:40:00
Nan Maddox
It’s very unusual to me. There is a high turnover in staff and I think that people just aren’t satisfied anymore. It’s almost like the, you know, they want it now and if they’re not getting it where they’re at, they’re they’re always seeking something bigger and better, rather than taking the time to nurture where they are and grow where they are and prosper where they are. And so it just seems like it’s just too easy. These days just to pick up, pack up and go somewhere else. And it’s very unfortunate in our industry.

00:09:40:03 – 00:09:42:13
Jay Shorr
Let me ask you something. Do you think it’s generational?

00:09:42:14 – 00:09:44:12
Nan Maddox
I do, yeah, I do.

00:09:44:12 – 00:09:50:06
Jay Shorr
Why? What did we do wrong?

00:09:50:09 – 00:10:44:19
Nan Maddox
I don’t know, we talk about it every day with our clients with the I don’t want to say quality because there are truly good people and the people that we do hire or that the practices hire have great qualifications. They have great potential. It’s just they they won’t take the time to just hone it and to make it better. It’s a want it now generation. And social media I think has had a lot of influence over that. And I think Covid did influence that as well, because people got used to staying at home and working from home, and that became very comfortable to them. And the thought of having to go back into an office or into a practice five days a week, 8 or 9 or ten hours a day is just not appealing to them. And so they’re always looking for something that require that.

00:10:44:20 – 00:11:14:09
Jay Shorr
I remember when I was in my every day, day to day working years, I was thrilled to death to have an office or somewhere to go to work to every day. You know, just the mere fact that I was able to have a job to go to every day was truly a blessing. And look, you know, there are many things that you can do remotely, but medical practices aren’t one of them. All right, let’s talk about office drama. Nan. Why is that such, a thing?

00:11:14:10 – 00:11:52:04
Nan Maddox
I, you know, again, there’s always drama. It’s that is that’s been around forever. I don’t think that it’s anything that you’ll ever get away from. I think the best way to deal with it is to ensure you have policies in place, that cover a lot of the things that cause the drama. And if you have that in place and you enforce it equitably and evenly across the board, then it helps to eliminate a lot of that and to try to keep the emotion out of running your business.

00:11:52:05 – 00:12:13:00
Jay Shorr
All right. So I’ve known you a pretty long time and, you know, understandably, you were, the administrator for one of my clients, all right. In the past. And then when you left and moved from the west to the east coast, is when we joined forces again. And I know the drama that, you know, went on under your tutelage. How did you handle it?

00:12:13:03 – 00:12:14:24
Nan Maddox
It wasn’t easy…

00:12:14:24 – 00:12:16:00
Jay Shorr
but I know that. That’s why I’m asking you.

00:12:16:02 – 00:13:15:19
Nan Maddox
And some days I don’t think I did handle it. It handled me. But for the most part it was really just trying to keep good order and discipline. I reverted back to my military training a lot, and just had to keep good order in the practice and correct those that needed to be corrected and reward those that needed to be rewarded, and just try to keep harmony and peace among the workers. And I think my biggest thing is just to be fair to everyone not have preferential treatment, not to show any special favors, to just have everyone being treated the same way. And if you do that, and if you follow that and practice that, then that eliminates 90% to 95% of the drama. You’re still going to have it, you’re still going to have it. But that does help eliminate a lot of it.

00:13:15:21 – 00:14:58:26
Jay Shorr
I remember in, my former practice, and just for a disclaimer, I do this every time I mentioned my former practice here in South Florida. I am not a physician, but I was a partner and the administrator in a practice here in Florida, where in Florida you are allowed to own a medical practice with certain guidelines and conditions. And my team actually policed the drama themselves. They really didn’t want any part of the drama because there were penalties for work not getting done because of drama and penalties. Meaning, you know, the parties that we used to have with the team, the lunches that the vendors used to have, but there was drama. I would cut a lot of this out. These are rewards. These are give me. All right. Now let’s talk about underperformance for a second. Because why is there underperformance. Many times underperformance is because a staff member doesn’t have a clear, concise and consistent job description and our expectation of them is higher than what theirs is of themselves of. Because I hate and I mean I despise when anybody would look or say to me, that ain’t my job. Well, that’s the importance of job descriptions and then other duties as assigned, because everything is your job. Your pay stub does not say what your job is. Your pay stub says who you work for with and how much you earn. The underperformance portion of that you know may be our fault sometimes because we give them a performance review and we doing them without doing periodic performance reviews for their underperformance and their opportunities. And we never coach them. Right. So how do we work with underperforming staff members?

00:14:59:00 – 00:16:00:17
Nan Maddox
It’s like you said, I have very clear guidance, a well-written job description, very thorough job description, a great onboarding for that individual, so that they understand what is expected of them. And a periodic review to call them in. I used to like to meet with mine the first week. The first two weeks, the first 30 days, it was, a scheduled meet with a new person to find out how things are going and to discuss anything that I’m seeing that may be not up to par or that they need to do better or need to do in a different way. So one is communication and two is clear guidance and expectations, and three is accountability. And then follow through. So you have to make sure that you’re following through with what is discovered and that you’re letting them know. And it is being documented if it needs to be documented and then eventually dealt with.

00:16:00:19 – 00:17:28:10
Jay Shorr
And next I’ll take this one because this is one of my favorites. It’s not a favorite in the practice, but it’s one of my favorites to talk about theft. And the reason I really like speaking about it is because it is a zero tolerance item. You heard me speak about what’s a no brainer? Drugs, alcohol in the workplace. Because we work with drugs. Those of us who work in the plastic surgery and have ORs we literally have drugs and medications that can kill you. All right. If they’re oral medications for, you know, nerves and or pain in the we have them in the office. Some of us in my former practice we had a pharmacy. So therefore we had a lot of these drugs, you know, theft you steal enough. It can kill you. So theft alcohol, drugs are zero tolerance items and it really can cost the practice a lot of money. Whether or not as an administrator is stealing money, whether or not employees are stealing supplies, whether or not they’re stealing cash by deleting transactions and then taking the cash that was associated with those transactions theft, fraud and embezzlement is another podcast and lecture that I do, but I don’t want to expound on it too much other than it’s a struggle and you have to be accountable, and you constantly have to be on the lookout, because many times people don’t even know that you’re being stolen from.

00:17:28:13 – 00:18:20:11
Jay Shorr
Let’s take a quick break. We know that maintaining a profitable aesthetic practice while managing all the moving parts of your business is challenging. While your passion and dedication lie in caring for your patients and practicing medicine, the same enthusiasm might not extend to crunching the numbers in your business. Well, here at Shorr Solutions, we can help you with your financial analysis. Our services are designed to help you identify opportunities for growth, reduce unnecessary expenses, and maximize your practice’s profitability. Whether you’re seeking to streamline operations, increase revenue, or gain clarity on your financial performance, we provide the tools, strategies, and expertise you need to succeed. Schedule your free consult with our team today to get started.

00:18:20:13 – 00:19:50:15
Jay Shorr
Now we all have competition, all even in the consulting business. But when people ask me who my competitors are, even though we have good, solid competition and I mean good, solid competition, there are a lot of consultants. This business that I really respect. However, I like to collaborate versus to compete because there are consultants that we compete against for deals and they get the deal and we lose it. And then once again, there are clients that come to us and they’re also speaking with our competitors, and we get the deal. You can’t get hung up on competition. How did you handle the pressure of competition and what strategies did you use to differentiate your practice? Because it really is about differentiation. Let me make one point. I always made it a point when a patient came in and they would try to make you feel good, you know, you’re the best doctor in town. And I went to this doctor and they do this and they do that. The key to it is never, never knock your competition. Even if they need to be knocked. Don’t do it. Just you share the benefit of what you can provide because that same doctor that you’re knocking the patients going into their office and they’re knocking you don’t start that. So let’s talk about it now. And how did you handle the pressure of competition? Because I know in your area you had a lot of good doctors.

00:19:50:17 – 00:21:52:21
Nan Maddox
Yes. Two things. One, from a personal perspective, I did go to a physician years ago, a plastic surgeon for a consultation. And during that consultation and he did mention competition and how I should not go to that person because of their reputation. And it put such a bad taste in my mouth that I did not go to that person that told me that I went to the competition. And so it’s never, ever just like you said, a good idea to knock the competition. I think the second part of that was I dealt more with it from the time that I owned my med spa, and I had 12 employees, and we had several different places open up in our general vicinity every time they would come to me and go, oh, no, did you hear there’s another med spa opening up right down the street? And I said, you know what? I may have heard it, but I don’t pay attention to it. To me, they’re not competition. Everyone’s entitled to open up a business, and I wish them well. The only thing that we have control over is what we do and how we do it, and what we’re going to do is treat our patients or treat our clients well. We’re going to do the job to the best of our ability. We’re going to train, we’re going to learn. We’re going to seek advice, and we’re going to be the best that we can be. And if we’re the best that we can be, then we can’t be anything better. So if someone chooses to go to a different location, then they choose to do so. But don’t worry about who’s moving in next door or what’s opening up down the street. We have no control over it, and that’s the same with any business and any practice. You can’t help. When I worked in Florida in a plastic surgery practice, we had another plastic surgeon move in to the same building. You know, we just had to do what we did and do it to the best of our ability.

00:21:52:24 – 00:28:21:18
Jay Shorr
Have you ever been in the triangle of Beverly Hills? All right. You go into any one of those buildings in the triangle, and there’s 50 plastic surgeons in each one of those buildings, right? And they’re each better than the next. Just ask them, they’ll tell you. All right. So, you know, I have always said and thought I, you know, I still get a newspaper, but the newspaper is for the birdcages, actually. But I do read it because I look at advertisements, I still look at some of these, high gloss magazines that we get. I go into the recycle bin very, very quickly, but I want to see what doctors and everything and surgeons are advertising and what they’re doing and how they’re doing it, because that really leads to competition. If you’ve ever heard the expression, I use it all the time, I never stole an idea I didn’t like. All right. And what happens is there’s nothing illegal about stealing ideas, all right? Maybe you just improve them and that’s you hit it right on the nail on the head. When you talk about differentiating your practice from that of others, train them. Be clear, concise, consistent. You make sure you credential the practitioner, whether it’s the the, the doctor, the statistician. Everybody needs to be credentialed with a smile. I’m sharing with you. I can’t tell you how many times I go to places and they just I feel like I’m an interruption of their day. Not that my business is their day. All right. Whether or not people answered the phone, I know whether or not you’re happy to be there and you’re glad to take my call. I’ve said this in many different podcasts. When you ask, how are you? When they say, oh, I’m fine, and I feel like saying, well, tell your face, because your face isn’t saying that you’re fine. All right. And remember one thing we deal in a fee for service cash type business elective. They can go anywhere they want. And the mantra of airlines, when you’re getting off of that flight, we know that you’ve had a choice of flying Delta, southwest, American, United. Thank you for spending a part of your day. And we look forward to seeing you in another flight. All right. It’s those that differentiate themselves. And that’s what we have to do in our business. As well. Now let’s talk about tough calls in the heat of the moment where there was a sit, that there are always decisions that you have to make quickly during a crisis that you may never have thought that you’re going to have when you have staff cuts in service changes and restructuring. And, for example, in the West Coast, most recently, we’ve had these horrible fires. And don’t think for one second that we haven’t had to make service changes and restructuring. If the business survived, if the houses of the providers were still standing. I’m in Florida, where we have hurricanes every year, and sometimes we lose power for days, sometimes a couple of these different hurricanes that we had with for weeks. So what do you do? You have to close. So you have to cut staff. You have to like service changes because you have to forget surgery because people are either laid off or they don’t have the electricity. You may, but they may still may not. You can’t have them have a surgery and then have them go home and recover in either under sterile conditions or no electricity. So what do we do? We have to restructure our business. Covid was a perfect example. Unfortunately, we laid staff off. We furloughed them. We had to change the services that we had because we may not be able to do legally. Some places we’re doing it illegally, but I’m only going to speak about the legal side had to nonessential role. All right. And our business for the most part was nonessential. And then when they allowed people to come back, they did. But then people didn’t have any money or they had less or money. And then brought up a point. We always talk about people that have money may have less, but they’re still going to have money and they’re still going to spend money on eating, on travel, entertainment and beauty. Those are the four things people will still spend money on that have money. Now, most of the people live, on average to modest incomes and therefore what’s more important, food, shelter, education, clothes for the kids but the family. I will share that. I’ve actually had conversations with patients that my colleagues have told me. You’re crazy. I’ve actually shared with people, why don’t you save your money and take care of some of the things that are more pressing in your life right now? Don’t be taking out ten and $15,000 finance loans with our medical finance companies to do this procedure. I would prefer that you spend this money on yourself and get your life in order because you know they share all the problems with you, and then I’ll make a concession with you later on. And you know what? That went a long way because people thought and felt that we really cared about them. Quite frankly, I really did. You know, I don’t want to be the one that’s going to take all your money. Other people told me, why not? I just said, it’s not something I could do. There are other pressing priorities. So we had to change our services. More nonsurgical than surgical because people didn’t have the down time. And we structured we restructured our business that way. So I hope that, you know, there’s always going to be tornadoes. There’s always going to be wildfires. There’s always going to be hurricanes. You know, we have to think keep our priorities in order. And lastly, turning setbacks into comebacks. What motivates you to keep persevering Nan, what motivates you to keep persevering? You’ve had quite the career 21 years in the military, the highest ranking noncommissioned officer that you could achieve in the military. I don’t want to, you know, DEI and gender bash but for a female in your time was quite an accomplishment. You know what keeps you motivated to keep going?

00:28:21:18 – 00:30:05:27
Nan Maddox
I’m very goal driven, so I always set a goal for myself. But one of the unique challenges that I had when I first opened my Med Spa, I purchased an existing one, and the two employees that worked at the spa had been there for several years prior to me purchasing it. Within the first four months of me owning it decided that they were going to walk out, take all of my book of business, open up a place literally two miles from my current location, and just no warning. No, I’m leaving. Just literally there one day and gone the next. And I walked in and looked around and very new to the industry, just out of the military. And I said, wow, now what? So, I just had to really pick myself up by the pants and go, okay, here we go. And I set a goal for myself to double what the business had done the year before. That I bought it, and at the end of the next year I did that. I had called the school that I graduated from had recently graduated. I was brand new, out of aesthetics school. At the same time, I had never owned my own business. I called a consultant to help me on the business side. I called the owner of the school to help me with staffing. She sent me two wonderful ladies, one of which actually ended up buying my spa from me 13 years later. So, you know, it’s just persevering. It’s just ma

00:30:06:00 – 00:32:33:05
Jay Shorr
Perseverance is a personality. I’ve always, always thought that. And, you know, for me personally, you know, I’m at a point in my 70s already that I’ve had setbacks personally, I’ve had setbacks professionally. I’ve had tragedy in my life multiple times. But what keeps me going is my personality, because I love to yield success and I love to yield others. Along with the ride with me. You know, my end goal really is to turn our business over to our team and, you know, create a legacy and therefore, you know, allow others to be able to live that dream of being a business owner with the training that I’ve given them and the coaching that we all work together as La Familia, I say that all the time. Our team is like a family. We don’t have the drama, and I think cohesively it’s because none of us want that drama. All right. It usually drama, you know? And then the lack of drama starts from the top in my and our business. I don’t I’m not going to say that it is collectively none of us want that drama and we all work together to help one another. It’s just a chemistry. And I think when a new member comes in and sees that and they may not be used to that, they conform to it and they like it because drama and the lack of success is very painful. But when you see success and you know, we win these awards and what we do, every team member gets an award and then we celebrate it together. It’s not one person, it’s not the leader. You know, I’m not a boss. I’m a leader. And then all my team members are leaders in their little domains. Each of us have a little domain and a part to play in this, so that that perseverance turns into success. You notice there is no letter I in success. It’s the you in success. So with that, then thank you so much for joining me on this special podcast. All right, ladies and gentlemen, that concludes another episode of Shorr Solutions: The Podcast. Good luck and God bless.

00:32:33:08 – 00:33:11:15
Jay Shorr
Don’t go anywhere just yet. If you enjoyed today’s episode, make sure to subscribe so you never miss the latest insights. New episodes are. Released every two weeks. For more valuable information and. Resources to elevate your practice, sign up for our E! Newsletter. You’ll get the latest industry updates, expert tips and exclusive strategy straight to your inbox. Also, don’t forget to follow us on social media at Shorr Solutions. If you’re ready to take your practice to the next level, schedule a free consult with our team today. Thank you for joining us on Shorr Solutions: The Podcast.