Shorr Solutions: The Podcast – Ep. 154 – The Growth Plateau Most Practice Owners Hit

00:00:03:15 – 00:00:31:05
Voiceover
You’re listening to Shorr Solutions: The Podcast where our expert consulting team steps behind the mic to share some of the strategies and solutions we implement for esthetic practices nationwide. With decades of combined experience running and coaching esthetic and medical practices. We bring you the guidance that strengthens operation, elevates profitability, and supports long term growth. This is where solutions begin.

00:00:31:07 – 00:01:53:23
Jay Shorr
Well, welcome to another episode of Shorr Solutions: The Podcast. And I’m your host Jay Shorr. And today I have one of my special guests on one of my team members, Nan Maddox. And Nan is the senior Client Success manager. And I have a whole lot of accolades about Nan, and if anyone has ever been on our podcast before, you’ll know who Nan is. If anyone of you ever worked with Nan, you’ll know who Nan is, but allow me to just give a brief intro of what today’s podcast is going to be. You’re busy and revenue is coming in and your team has grown, but something just feels stuck. This episode is for practice owners who are no longer trying to survive, but no longer seeing the same level of growth either. From the outside, your practice looks successful, but on the inside it feels harder than it should. So Nan, let’s get to it. Let’s talk about these practices that you have worked with and that I work with. And you know, they are going through a growth plateau. So let’s talk about, in the very beginning what a growth plateau actually looks like. And we’ll discuss it as we deal with this.

00:01:53:28 – 00:02:57:23
Nanette Maddox
Yeah, certainly. Just like you said from the outside the practice looks really successful, but it just feels really hard. And we actually had one of our clients the other day say pretty much that exact thing. He said, I’m making more money, but I’m working harder and harder than it should or harder than I should. And so this is a very real thing whenever you hit the growth plateau. And it’s confusing because it’s not failure, you’re actually succeeding, but it just doesn’t feel like it. So that’s when revenue starts to level off. You’ve you’re growing, but it’s not meaningful. Your profit doesn’t match the work that you’re putting in. And you’re working harder. You’re more involved, not less involved as a as a practice owner. And the team issues start increasing because you’ve hired more people. Now you have more problems, but you know you’ve built a successful business, but just not yet a scalable one.

00:02:57:23 – 00:03:06:08
Jay Shorr
So it really you’re nothing more maybe than an employee in something that you created, right?

00:03:06:11 – 00:03:07:18
Nanette Maddox
Exactly right.

00:03:07:19 – 00:03:51:16
Jay Shorr
Yeah. Sometimes I’ve seen this happen. I even saw this happen in my own former practice. And to make a disclaimer, when I referred to my former practice, I was a partner in a very large dermatology plastic surgery practice many, many years ago. And for those of you who know my story, you know nothing further needs to be said. But the point is my disclaimers. I am not a physician. You know, Nan, I’ve been through this same conundrum myself, and the revenue keeps coming in and I work harder. I don’t make any more money because, like you said, I had to hire more people. I had to buy more stuff. I had to buy more capital equipment in order to generate the revenue. Why does this happen? Who ends up becoming part of the problem?

00:03:51:17 – 00:03:54:15
Nanette Maddox
Well, part of the problem is the owner.

00:03:54:18 – 00:03:59:03
Jay Shorr
No, no, no. Not me. Never me.

00:03:59:08 – 00:04:17:21
Nanette Maddox
So one of the biggest issues at this stage is the owner becomes the bottleneck. Everything still runs through them. Every decision, every problem, every question. They’ve hired the people, but they actually they haven’t actually transferred the ownership.

00:04:17:26 – 00:04:23:00
Jay Shorr
All right. And what else would that be? Is that considered like micromanagement?

00:04:23:02 – 00:04:29:08
Nanette Maddox
Yes. And if everything still depends on you as an owner, you didn’t build a team. You built a support staff.

00:04:29:09 – 00:04:56:29
Jay Shorr
Right. And then what happens with that owner? I mean, what about the delegation? Because there are certain things that an owner just shouldn’t be involved in. Let your administrator or your manager bring it to you after they have been unsuccessful. All right. So let’s talk about a delegation structure. Because without a shift in a paradigm and delegating things, you’re just always going to be the decision maker, not healthy.

00:04:57:02 – 00:06:09:11
Nanette Maddox
Yes, absolutely. One of the mantras that I had whenever I was a practice administrator is I wanted my surgeon in the operating room operating and to let me take care of everything else. And when that got to a point of something that I needed, his decision or his input, you know, if it was a decision certainly about money and spending money, then we would have meetings and I would involve him in that. But otherwise the trust was there. The training had been there. All the systems were in place for the practice administrator or your practice manager to do all of the day to day things that need to be done in a practice, and most importantly, with HR and handling the staff. I see a lot of physicians that get bogged down with allowing the staff to come to them directly to bring a problem, instead of reverting them back to their immediate supervisor or their practice administrator. And it’s not because they want to do that. It’s just they also don’t want to be known as having a closed door or not being approachable. So it’s a fine line that they walk.

00:06:09:17 – 00:07:15:00
Jay Shorr
Yeah. The downside to that is once a business owner starts that and allows the subordinates, even underneath your manager administrator, to come to you without saying to them. Did you speak with Nan? Did you speak with Paige? All right. Is very, very suicidal because they’ll continue. Because when you do what you’ve always done, you’re going to get what you’ve always gotten, and then you’re not allowing the manager or the administrator if you’ve delegated those responsibilities to them to be able to make effective decisions and then only allow a staff member to come to the owner when they’ve gone successfully to the manager or administrator with unsuccessful results. Right. So now let’s talk about something. We share all the time processes, protocols, policies, procedures being clear, concise and consistent. And we start working with practice. And either they have some that are so poor that could be very well challenged in court or they have none at all. So let’s talk about defining these processes.

00:07:15:03 – 00:08:14:14
Nanette Maddox
Yeah, certainly. I mean, what we do see is a second biggest issue with these growth plateaus is that your systems didn’t scale. And we actually, again, another client the other day that we were meeting with is just opening his practice. And he asked, do I really need protocols if it’s just me being the practice owner and I’m the one doing the services, do I really need protocols? And the answer is absolutely, because your business is going to grow and you need to have that strong foundation. You need to have all of your systems in place. Otherwise you’re not going to be able to scale. So you hit it with no defined processes and no consistent protocols. Training is more reactive than proactive, and your sales and consultations vary widely. You’re not looking at your conversion rates. You’re not putting those systems into place. You’ve grown volume wise, but you don’t have the machine to handle it.

00:08:14:15 – 00:09:32:06
Jay Shorr
Yeah, some of the other points and problems is for those physicians and practitioners out there that are listening PAs, NPs, physicians, if you’re going to open up your own, a brand new practice and you come from a practice and you’ve left them, don’t assume that the processes in the protocols that you’ve worked under at the former practice are going to work for you at the new practice. Now, mind you, it could be a good start. It’s a good template, but a well seasoned oil machine that has some really tight wrapped protocols may not work for you in the very beginning because you have to have some looseness in yours. Still have processes that you can refine to meet the needs of your employees, your staff and your patient base, and more importantly, even the locale. Because things can change geographically. They’re not the same in every city, state and Commonwealth. So let’s move on to the next thing about this visibility in your business. How do you get the visibility? Because you may have been very lucky and you don’t know how you’re getting the business. What got you there may not work for the future.

00:09:32:11 – 00:10:17:22
Nanette Maddox
Yes, you’re running a multi-million dollar business, but you’re not looking at the scoreboard and you need to look at KPIs. And we recently just developed several KPIs for a practice that was not tracking their key performance indicators. Practices don’t have an idea of their revenue per employee. They don’t know what their conversion rates look like or even what they should be. That was a question from a provider. What should my conversion rate look like? And they don’t understand what their cost per lead is. They’re making decisions a lot of times on how they feel about what’s worked in the past, without really looking at what the numbers are telling them. They’re not using their scoreboard to help drive their business.

00:10:17:27 – 00:10:54:11
Jay Shorr
And I really would like you to expand on something for a second, because as your business just isn’t scaling property properly. And I hear I’m spending so much money with my marketing company, my website company, my consultant trying to get leads in and all I get are terrible, poor quality leads. Let’s talk about that for a second, because it’s not a matter of the number of leads. Let’s talk about good pre-qualified leads.

00:10:54:15 – 00:11:58:21
Nanette Maddox
Yes, there are a lot of lead generation companies out there that will try to tell you. They will get you thousands of leads and they will. A lot of them will be bots. A lot of them will be people that aren’t even in your geographic area. So you have to be careful where you’re spending your money to get leads and working closely with your marketing company to make sure that the leads that are coming in do have some type of pre-qualification, and also with your patient care coordinator to make sure that those pre-qualification are really gone through extensively prior to ever putting them on your books as a consultation. Because if they do that without pre-qualifying and you go into a consultation and the person is still breastfeeding and wants a breast augmentation, and that question was and ask ahead of time, you’ve just wasted not only your patient’s time, but your staff and your time as a as a physician as well.

00:11:58:28 – 00:12:21:22
Jay Shorr
Yeah. Can you explain a definition that I heard? Because it could be taken two ways, depending upon how somebody hears this podcast. You said many of them could be bought. Does that mean they could be a bot like a robot or they’re bought all right with.

00:12:21:22 – 00:12:26:06
Nanette Maddox
B-O-T bots. They aren’t real. They aren’t real people.

00:12:26:08 – 00:12:35:16
Jay Shorr
So so where I come from, right with my accent, the bot can mean I purchased the lead, right?

00:12:35:18 – 00:12:36:07
Nanette Maddox
Yes.

00:12:36:08 – 00:12:41:11
Jay Shorr
And they could be. And they could be a bot too, right?

00:12:41:17 – 00:12:42:17
Nanette Maddox
They could.

00:12:42:18 – 00:12:42:25
Jay Shorr
Yeah.

00:12:42:25 – 00:12:44:12
Nanette Maddox
They could. You could buy your leads.

00:12:44:13 – 00:13:05:00
Jay Shorr
So what needs to change in the system in your office? The lack of visibility, the lack of the owner giving, micromanaging the owner, not giving the art of decision making to any of his staff, meaning the administrator or the manager. What needs to make a change in all of this?

00:13:05:01 – 00:13:26:29
Nanette Maddox
Well, you know you need to get out of your comfort trap if you’re actually in a in your comfort zone and there’s no sense of urgency and you want to just keep doing things the way you’ve always done them, you know, comfort is one of the fastest ways that you’re going to stall. But what you need to start doing is to be become a leader.

00:13:27:03 – 00:13:28:21
Jay Shorr
Versus a boss.

00:13:28:23 – 00:13:52:12
Nanette Maddox
Yes, your role has to change. Yeah, you’re no longer running your business and working in your business and doing all of the things. You are no longer the operator of your business. You are the leader of your business. And that has to change up here and also in the way that your team perceives you and the way that you communicate to your team. You are the leader.

00:13:52:13 – 00:14:51:12
Jay Shorr
Very interesting that you say that, Nan. A while back I mentioned this as well. We did a podcast with doctor Randy Waldman, Facial Plastic Surgeon in Lexington, Kentucky, and he is also the chairman of the Global Aesthetics Conference and MAC. And when I had him on, he said to me, Jay, I’m nothing but a choreographer and you may hear me say this a lot, right? When I introduce myself to new clients and prospects. I’m Jay Shorr, I’m the team leader and I’m the choreographer, right? Because all I want to try to do is help put it together and arrange the the moves and the parts, and the people will all do it. And I take more advice from my team than I give to them, because I’ve allowed them to be able to make good, proactive decisions. All right. So being in a team leader Nan, let’s talk about the attitude that you have to have and how we measure things.

00:14:51:14 – 00:16:09:11
Nanette Maddox
Well you have to be proactive as part of running your business. You need to not be reacting to things all day. You need to be proactive and putting systems into place, planning, structure, accountability. All of those have to be in place because growth requires intention is not just effort, and you need to measure KPIs. If you’re not measuring it, you cannot scale it. And we’ve talked about a few of those things a revenue per employee, revenue per provider, conversion rates, lead response times, all of those things are things that you need to be looking at, or having your practice manager or practice administrator looking at and analyzing and providing to you, not you as the surgeon or the provider or the owner doing it yourself, but delegating that, having the KPIs in place and making sure that you’re you’re measuring things and that you’re looking at all aspects of your business, not just you being the one that does everything. You know what the one the practices that we see actually break through those plateaus and keep moving to the next level are ones that actually start acting like real businesses and not just busy clinics.

00:16:09:14 – 00:16:45:28
Jay Shorr
You got to treat it like the business it is. You hear me say that in every lecture? Medicine is a science. But at the end of the day, you got to treat it like the business it is. Nan you know one thing. And everybody that knows me has heard me say this. The one thing that I have been always so proud of you the most was your military career and putting 20 plus years in the Air Force. And thank you for your service. But outside of the military, what did you learn that you wish you would have done sooner? Outside of coming to Shorr Solutions?

00:16:46:01 – 00:17:40:05
Nanette Maddox
Goodness, I owned a medical spa for 13 years, and that was probably one of the most rewarding times in my medical administrative career, but I. I didn’t know what I know now, and had I, I would have done things a little bit differently with growing the practice. But for me, honestly, it became burnout. And I wish I had learned some structures that I could have put into place that would have allowed me to actually learn the lessons that we’re trying to talk and teach today, of not being the one that does it all and not burning yourself out. Because once you do that, it’s hard to it’s hard to turn back. And my decision was actually to sell my practice and move on to something different. So I wish I had learned the lessons that were actually teaching today.

00:17:40:12 – 00:18:26:21
Jay Shorr
Nan that’s nothing more than age and maturity. You and I will suffer from that forever. But fortunately we’ve made the decisions the right way towards the end of our career, and really, our goal is to pass those on to our younger team members so that we can bring them further ahead and allow the business to continue on. All right. What mindset did you need to have to push through the plateau to get to where you are? Because there’s many trials and tribulations. We’ve all tried things and we say, why did I even bother doing this? You know, what was that one final push? Let you know you’re pushing through that plateau to get to where you want to be.

00:18:26:23 – 00:19:30:29
Nanette Maddox
Well, I had to stop equating growth to more work, and instead of being in full control, I had to trust those that worked with me. And instead of being just busy, busy, busy have to be intentional about how your day goes and what you do, and not just look at how much money is rolling in, but look at profitability. How much money is the business making? What is the practice making, not just how much we’re generating. And we see that all the time. We see practices that are generating a lot of revenue, but it’s all going out the door and not in their pockets. And so you have to really work on not having burnout, not having your team confused over your role as a leader versus a worker. And if you’re doing all of these things, then you should be able to get past your growth plateau and get to your next level.

00:19:31:03 – 00:20:58:04
Jay Shorr
So for those listening. I’ve already realized when it was clear that adjustments needed to be made. All right, because as I got older and, you know, I started reaching retirement age and I actually exceeded retirement age and just decided that I wanted to keep on working because we have a successful business and I love teaching. I did retire from Florida Atlantic University teaching, you know, executive business management in the medical arena because it’s just I realize that I’m not having as much of my own time and changes need to be made. All right. And that’s for me. So what did I do? I brought on other professionals that could take over for me and still generate revenue, and let me lead the team and work on the most high level things so that my team could really carry on. So what advice would you give to clients that are listening, or prospective clients that are listening as to when it’s clear that adjustments really need to be made, whether it’s opening up another office, whether it’s purchasing the building, whether it’s to build a surgery center, or even when is it just time to say, I had a good run and it’s all over now?

00:20:58:10 – 00:21:24:24
Nanette Maddox
Well, it’s time for a change when your numbers look good, but it just doesn’t feel good anymore. And so you have to figure out what that is, what is it that you need to do? And it’s not necessarily that you’re failing at what you’re doing. You’re just being called to the next level. And you have to really figure out, dig deep and figure out what that is. What is that next level of leadership or is it selling or is it retiring?

00:21:24:27 – 00:24:30:08
Jay Shorr
Well, I hope I don’t have to worry to be called to the next level because at my age, when he comes calling, I’m not sure I’m ready. This has been great. We all work with people and everyone out there don’t feel like you’re suffering. It is perfectly normal. One thing I will share with you is it may not continue to get easier and easier, because the business have become so lucrative that everybody wants to open up their own business. Now, the people who don’t may be the people that have a fear. Either they can’t afford to do it, or they have a fear of failing the other people. We’re taking them right out of residencies and fellowships now. They never even worked for academia. They never even worked for corporate, the hospital system. They never even worked for another surgeon or a doctor. They’re taking that chance and running with it. The one thing I can share with all of you when you decide to do this and go out on your own, I’m going to leave you with the same pearl that I tell each and every person that comes to me and wants to open up their own business. You’re ready. I give them the same line. You’re not going to come in on time or on budget. And they laugh. Three months in, six months in, I remind them of what I said. They still haven’t gotten the lease assigned yet. Why? The landlord has their lawyers. You have your lawyers. And then next what? That lease didn’t go over. Then you go to another one. It goes on and on. It may not be in your time frame. It will happen when you do it. Make sure you do it right. And the last key that I could give you to your growth. Don’t think that you can do it alone and that you can’t afford to have coaches. You can’t afford not to have a coach. I say this line as well. Do you know one professional athlete that is at the top of their game, whether it’s Rory McIlroy from golf and whether it is the best quarterback and whether it is the best hitter in baseball and the best shooter in basketball. Every one of these people have coaches. Don’t be afraid, and don’t be embarrassed to allow people to know that you have a coach. Share and do what you do best, because you may end up paying 2 to $500 for a coach. While you should be making 1000 to $2000 in an operating room or an exam room, work in your business and allow other people to work on your business with you. With that. Nan, thank you very much for being my special guest and my teammate on today’s podcast, Shorr Solutions: The Podcast, and we look forward to welcome all of you back into our next episode. Good luck and God bless.

00:24:30:11 – 00:24:48:14
Voiceover
Before you go, new episodes are released every two weeks, offering perspective on the decisions, systems, and leadership behind well-run practices for continued insight between episodes. Follow us on social media @ShorrSolutions. This is Shorr Solutions: The Podcast.