Interview with Dr. Rachael Degurse
In today's episode, Dr. Rachael Degurse describes how she escaped corporate-style practice by merging medicine and marketing to open a medspa. She shares her inspirational journey from traditional medical practice to successful entrepreneur in the MedSpa industry.
Dr. Rachael Degurse is a board-certified family physician who took a bold leap after years in traditional medical practice. Her journey led to the creation of Pearl Skin & Body Rejuvenation, an intriguing MedSpa in Colorado. There she masterfully merges her medical skills with entrepreneurial acumen.
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Medicine and Marketing: An Entrepreneur's Journey
Dr. Degurse's decision to start her own business, Pearl Skin & Body Rejuvenation, stemmed from her desire for greater control over her life and medical practice. She valued the ability to manage her schedule and time spent with each patient, which she felt was slipping away in the traditional healthcare system.
While considering entrepreneurship, Dr. Degurse explored various business ideas but ultimately settled on the medspa industry. This decision was driven by her belief that aesthetic medicine, particularly in a traditional medspa setting, offered her the opportunity to retain her medical identity while owning a small business. She found this choice to be the best of both worlds, allowing her to practice medicine and run her business her way.
Growth & Vision: Inside Pearl Skin & Body Rejuvenation
When starting her medspa business, Rachael embarked on a steep learning curve. Apart from the intricacies of running a business, she had to acquire new skills related to various cosmetic procedures. She began with entry-level treatments like facials and Botox. She gradually expanded her skill set by attending courses, conferences, and self-learning. This ongoing education allowed her to offer a wider range of services over time.
Pearl Skin & Body Rejuvenation, started with basic procedures. It now offers a comprehensive range of aesthetic services. These services include facials, neurotoxin injections (such as Botox), laser procedures, microneedling, radiofrequency noninvasive body contouring, and medically supervised weight loss.
She has plans to introduce more complex procedures like fillers in the future. Dr. Degurse's vision involves continuing to expand her service offerings as her business grows. And she really enjoys the procedural aspects which benefit from her education and training as a physician.
Summary
Dr. Rachael Degurse's entrepreneurial journey highlights the benefits of autonomy and aligning one's business with personal and professional values. Her commitment to continuous self-improvement and expanding her services fulfills her meeting her clients' needs.
To connect with Dr. Degurse and explore insights into opening a med spa or business, you can find her on LinkedIn under Dr. Rachael Degurse. For more information about her medspa and services, visit pearlskinbody.com.
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Links for Today's Episode:
- Pearl Skin & Body Rejuvenation
- Dr. Rachael Degurse LinkedIn
- From Here to There: Leveraging Virtual Medicine
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Transcription PNC Podcast Episode 318
This Family Doctor Successfully Merged Marketing and Medicine in a Medspa
- Interview with Dr. Rachael Degurse
John: I'm really happy to have today's guest here because for some reason I'm drawn to people that start out in medicine and they have to follow this entrepreneurial bent that they have. Going to school and residency for 11 to 15 or 20 years isn't really necessarily the way to become an entrepreneur, but there's a small set of physicians that do it because they want to control what they're doing, and they want to get away from the hassle and the burden of the corporate style of medicine. I'm really happy to have today's guest here. Welcome, Dr. Rachel Degurse.
Dr. Rachael Degurse: Hi, John. Thank you for having me. I'm excited to be here.
John: Yes. I've been talking recently on the podcast a couple times about small businesses in general, and what you do obviously is a startup small business, and it's hopefully going to grow a lot. But you've already taken that plunge and you've done a lot of the work to get this thing going. And so, I like catching up with physicians that have done that. I'm just glad that you're here to answer my questions today.
Dr. Rachael Degurse: Thanks. Thanks. I'm excited to be here and talk about what we're doing.
John: Also a favor because you're a family physician, which I am too. So, why don't we start like we always do with a little bit of your story in terms of your education and practice, and then how and when you started this new venture?
Dr. Rachael Degurse: Okay. As you mentioned, I'm a family medicine physician trained, and I've been doing this since 2013. I came to Colorado, I'm a native from Colorado and came back here after residency and got a job in a federally qualified health center. I worked that for two years and then I went into a group practice setting that was physician owned and led, and I've been there since, but it's no longer physician owned. It got purchased by a large corporation, twice actually.
And since then, my clinical career has been much different than what I envisioned when I joined medicine. And that's when I decided to open my med spa because it gave me an opportunity to get some of the control back and taking care of my patients and the more autonomy that I enjoyed. That's why I decided to open this. And I officially opened the doors April of 2022 but it's been in the work since December of 2021. So it took me a couple months before I actually opened my doors. But I've been doing that part-time in addition to my clinical work at my day job is what I like to call it, ever since.
John: Well, from what I can tell from the website and maybe LinkedIn and other things that I've seen, you've got a pretty broad array of services. You've got come a long way. It takes at least six months to a year to really plan a business. So it sounds like you're right on schedule as far as the planning part, like you said, you had to spend a few months.
But before we get into that in detail, I want to just talk about you as an entrepreneur. There are a lot of things a physician can do when they get frustrated or they just want to make some kind of a change. So, how did you come to think, "Okay, I think my own business." Is it the control issue? Is it just the flexibility? What is about that?
Dr. Rachael Degurse: Well, firstly, I never grew up wanting to be a business owner. In fact, I had an opportunity to join a practice right out of residency that was owned by a physician who wanted to retire and turn it over to kind of like some fresh blood. And I turned down that opportunity. It just didn't seem like something that I would necessarily want to do. However I have learned that being in control of your own life is very important.
And that's something that I've learned to value more and more especially as there's been changes in the way healthcare is being run. So, not only control of my schedule and my day, but control of how many patients I want to see and how long I feel like I need to take with them. And just being able to have that time to develop my relationships with my patients again, where I feel like I've lost a lot of that in my current clinical, traditional family medicine.
There was definitely a time when I thought, "Well, maybe I just go to a different office or different practice", but I just felt like the face of medicine was changing so much that I couldn't guarantee I would be able to regain some of that back that I had lost in a different setting that might get sold.
The only way I could control that completely, was to be my own boss and decide whether or not I would sell my business. And yeah, it's been a real joy, learning all the ins and outs of how to grow a business. It's also been a huge challenge, but that's kind of part of it.
John: A couple questions about that then. First, going way back. Many of the people that listen, let's say have been in practice longer than you, perhaps. I have all ages and lots of different locations around the world and in the US and so forth, but there's a lot of people that have been 20, 30 years in practice. And so, my question to you is, back 13 years ago and you're in the middle of that transition and coming from residency, was there any evidence, any inkling that at that time, either during your training or even early into your practice that you thought this might all just go away because of the changes, or was it just like a brand new concept?
Dr. Rachael Degurse: Perhaps I'm naive, but I did not expect healthcare to go quite as much the way it has. I grew up going to a doctor who was a private practitioner, worked solo, didn't have a partner, and wasn't owned by an organization. And that's all I knew growing up. I just assumed that there's some practices that were affiliated with hospitals, but for the most part a family medicine doctor was a business owner essentially, or they worked in a group with other people and they had a shared business. So, that's what I fully expected to go into. And like I said, perhaps that was naive of me, but it has not turned out that way.
John: Well, the reason I ask is because I think even to this day it seems pretty obvious to someone who's gone through it. And I've interviewed many guests who actually made a change because of the very issue you brought up, which is their company was bought or whether it was a practice or maybe it was more of a small hospital based practice, but then there was some large corporation that bought it.
And I still think that the med students and the residents, depending on where they are, they have no idea that this corporate takeover of medicine is well underway. And if it hasn't affected them yet, it probably will. And I almost blame the faculty for not letting their students and residents know that what we're in right now is kind of a bubble and life's going to be different. But I don't know.
Dr. Rachael Degurse: Well, thank you for not assuming I was naive to not know that.
John: No, I think it's still happening, which is really frustrating to my colleagues and some that I talked to about this. Okay. Now the other thing. You came to the realization that you need more control, more freedom to do things the way you want to do and not be threatened by the next takeover or the next merger, whatever. Did you consider any other businesses besides the med spa and how did you come to that choice?
Dr. Rachael Degurse: Yeah. Well, I sort of jokingly considered some other businesses. There was a brief time where I talked about becoming an alpaca farmer. I did toy with local honey, but in all honesty, this was the only business that truly made me feel like I could still practice medicine, and own my own business because the aesthetic medicine realm is still relatively untouched by corporations, although that is changing sort of.
There are some private equity companies that are trying to acquire med spas and there's definitely some larger chain med spa type places. Most likely laser hair removal and that sort of thing, but for the most part, a traditional med spa is still very much like small business ownership. And it still feels like medicine to me. Because I didn't want to just give up on my dream of being a doctor. I still felt like I needed that and wanted that in some capacity. And interacting with patients is very important to me. This gave me kind of what I felt like was the best of both worlds.
John: Yeah, that makes sense. I kind of equated somewhat to becoming a coach, but that's more like in the realm of the mental health wellbeing. A coach is a couple steps away from a therapist, but you know what I'm getting at.
Dr. Rachael Degurse: Yeah.
John: And it's something you can do independently and build a business around. But I could see the interest in being sort of someone that's taken care of, what is the largest organ in the body. Isn't it the skin, the largest organ?
Dr. Rachael Degurse: Absolutely.
John: And so, skin and beauty and hair and all that kind of thing. And you get to do some procedures. So, to me that makes perfect sense. Did you have to do anything to prepare or let me just put another way. What were the things you had to learn the most about let's say at the beginning in terms of beginning this venture?
Dr. Rachael Degurse: Yeah, it's actually been quite a steep learning curve. Let's just forget about all of the learning how to run a business part because that I did not know anything about. I just thought you just come up with a name and put out your shingle and then it's all good. But it's not.
I definitely had to learn a whole new set of skill sets. I had to take courses specifically for all of the procedures that I perform. And I started with, still to this day, because I'm the only one doing any of the procedures, everything we offer, I have to learn how to do. I started with the easiest most entry level procedures possible. Facials, Botox.
And then I've just gradually increased my skills since then, doing a lot more conferences and lectures and book learning and breeding and podcasts and all of those things I do in all of my free time, what limited it is, to just become better and better honing my craft so to speak. But it's definitely out there. There's a lot of opportunities to go to courses all over the country, and a lot more online and digital resources compared to maybe in the past. So, it's definitely possible to do.
John: That helps. That helps. As far as the business side, one of the things that I hear about is, and that physicians typically don't think about unless they're really aggressive in their practice, and that's marketing. Was that a big part of the business aspect that you had to learn more about?
Dr. Rachael Degurse: Absolutely. I hadn't even heard the term SEO before. Just things like that that I didn't even know. I didn't know. I had to learn. Fortunately, I am very lucky to have my husband who's been a real big partner with me in this. He has a business background. He comes from an entrepreneur family, so he's just been huge and helping me with a lot of that. He does most of our social media marketing and SEO. I'm lucky in that I haven't truly had to learn all of that information. Of course I still know the terminology and that's still very important, but marketing is essential as far as getting your name out there because I just thought it would be easy to open up and have people come in. And that is definitely not the case. So, that's been really a big factor in getting us off the ground.
John: Most typical entrepreneurs have a great idea and decide they're going to start something, they're not good at everything. And so, they always rely on other people to fill in. My wife runs a business so I know exactly what you're talking about. And she's excellent at certain things and then in other things maybe she needs a little help, but that's just every business owner.
I've talked to, like I said, other med spa owners and there are, like you said, so many conferences and they probably go into pretty great depth in terms of marketing for that type of business, which helps a lot.
Dr. Rachael Degurse: Absolutely. A lot of the conferences are kind of a combination of business development and learning. So, that's very helpful.
John: Nice. Nice. Okay. Now tell us more about the actual med spa and also you're doing a lot of different procedures now. Tell us about which ones you really enjoy or which ones do you think are the most helpful? Just to get into kind of the nuts and bolts of what a med spa does, at least in your case, so that people who are thinking about this can get some ideas.
Dr. Rachael Degurse: Sure. My med spa is in a professional complex building with other suites. I just have a small suite in this building. It's about a thousand square feet, so it's very efficient so to speak. I have just me, I've got my chair and I offer facials, neurotoxin injection. I have three different devices. I have a laser that can do IPL procedures. I can do microneedling, radiofrequency microneedling and I have a non-invasive body contouring machine. I do offer medically supervised weight loss. And I'm getting ready to offer my filler.
Filler by far is in my opinion the riskiest procedure you can offer. So that's why it's taken me the longest to add it on because I just want to make sure that I am a hundred percent solid in being comfortable with that procedure before I add it.
That's pretty much almost everything that you can offer in the aesthetic world in just a very small space. It doesn't take a lot of footprint to offer most of these things. You just have to be efficient with your space and your time.
Anyone that I would suggest who wants to offer or start a med spa, they need to be able to offer neurotoxin. That's what we call kind of the gateway drug to aesthetics. Most people will start with wanting to do Botox or something very similar to that just to relax the wrinkles. And then that kind of opens the door to discussing other procedures and services that people might want. And then sometimes people say they want Botox, but they want it to treat a problem that isn't actually resolved with Botox.
It's just a very important thing to be able to offer right away. I started off with offering facials and Botox, and those were the only two things that I offered for quite a while. And then about eight months ago, I purchased my first laser device and that really expanded how much I could offer. And then about a month ago is when we brought in the radiofrequency microneedle and the non-invasive body contouring right around when I started my weight loss program. So, it's kind of been ramping up in the past couple of months offering more things.
John: Well, this is another question. It's a little bit off the topic in terms of the actual services you're providing, but as you're trying to ramp up, as you are ramping up and you're obviously committing a lot of time and effort and of course, investment as well. How does that work in terms of negotiating with your current employer? Just any tips on how to... People are usually fear having that conversation. Now usually when they have the conversation it goes better than they thought because we just tend to be pessimists when we're talking about that. What is your advice and what is your experience in trying to slowly make that change?
Dr. Rachael Degurse: Well, when I decided to open this, I had already had a day off during the week. I was working there four days a week, and then I started being able to work in my med spa three days a week. Yeah, that's a seven day work week but if you're going to be building your business, you kind of have to work every day. Even if you're not open every day, you're working every day.
John: Right.
Dr. Rachael Degurse: So, that's how it initially started. And then for better or worse, we did have some attrition in our office where we had some providers leave, and that kind of helped me to open the door and be like, "I'm planning on opening this business and I need a little bit more time to do that. Now I will stay committed to you for a period of time as long as you let me have a little bit more time to do my business."
And it's really only another half a day a week, which is not a lot as far as me leaving my other job for that half a day. But it does allow me to be open a whole other day here, which time is money when it comes to having a business, so you got to be open as much as you can.
That's how I started, kind of scaling back. Now I think I've probably maxed out the ability for cutting down my hours there. The next step is going to have to be the leap of leaving there if I'm going to, and I do have kind of a timeline where that might be a possibility. We'll see if that actually pans out. But so far I don't know that I have a great solution to have that conversation unless you have a lot of leverage like I did.
John: Well, it's good to use that leverage and plan ahead. We didn't discuss this beforehand, but I'm going to ask this question in that. Do you have much of a notice requirement, I guess? Some people think I'm going to do this, and they realize they have a nine month or a year notice for leaving a job, which is ridiculous, obviously. But you've already kind of considered that and have that worked into your plan, I'm assuming?
Dr. Rachael Degurse: Yes. I have a 90 day notice, so it's very generous on my end.
John: Yeah. Yeah. That's better than most. Most people are stuck for six months unless someone's trying to kick them out. Because there's a shortage of physicians and it's because of the changes in medicine, but it sounds like you're positioned well to pull a trigger when you get there.
Dr. Rachael Degurse: That's the goal. The goal is to be able to replace as much of my income as possible with med spa income before I officially leave. Hopefully it will happen.
John: It's always a good plan, right? You don't want to have that dip that lasts longer than you need to. Now you were talking about fillers. I'm going to switch back to the medical side in my mind. What's a medical part of it? That sounds like it's a little more complex. Is it typically done by non-physicians? Are they technicians? Are they some kind of licensed professional normally? How does that work?
Dr. Rachael Degurse: That's a good question. It's actually state by state dependent on who can perform what procedures. Some states are more strict than others. New Jersey being an example of a very strict state that most procedures, including operating of a laser, needs to be performed by a physician. That's a state where it's great if you are a physician to open a med spa. Not so great if you're not a physician or you want to be opening a med spa, but not doing all of the procedures yourself and having extenders.
You really need to look up the state specific laws about what you can do yourself and what you can delegate to other people. But in some states, a filler can be injected by anybody that you delegate to, that you say is qualified to perform that procedure. In most cases, the lowest level of training that you're going to encounter with that is like an RN performing a filler procedure.
John: Is there a license for med spa where you're working? Or is that just another business?
Dr. Rachael Degurse: You just need a business license. So, it's a little gray area.
John: The reason I ask, I'm familiar with what I talk about in the podcast, like senior care business. And those didn't used to be licensed, but in most states now they are licensed. So, it's just something to remember another licensed, another hoop to jump through.
What do you think long term, looking forward, are there any more procedures that can be done down the road that you might be interested in? For that matter or other, I've seen med spas bring all kinds of services in. What are you planning for the next few years once you ramp up even more?
Dr. Rachael Degurse: Yeah. Once I'm able to expand into a more medical sterile space, then there are some procedures that are more invasive, that are essentially like a nonsurgical face lifts and body lifts that I would be very interested in offering. And those do really need to be performed by a physician because it's kind of like liposuction in the office. So you have to be a little bit more trained and qualified to perform something like that.
John: Okay. Well, it sounds like you're on your way. Tell us more about how to find you in your spa, where you're located or where the website is and that sort of thing.
Dr. Rachael Degurse: Well, I would love to connect with anybody who's interested in opening a med spa or has questions about what it might look like for them or even if they just had questions about opening business. And they can find me on LinkedIn under Dr. Rachel Degurse. And certainly if you have more interest in our business itself or med spa, you can look for us on our website at pearlskinbody.com.
John: All right. I'll definitely put those links in, for sure. And if people have questions or if they're geographically anywhere within distance they can talk to you and maybe even visit you, at some point.
Dr. Rachael Degurse: Yeah, I would love that.
John: I'm just thinking if there's anything else that I've forgotten today. Any advice you have for my listeners, basically who may be where you were a few years ago in terms of either this opportunity or just doing something outside of a corporate style of medicine.
Dr. Rachael Degurse: Absolutely. Firstly, I think one of the things that I hear from some physicians who are hesitant to just do something else but they're interested is I hear a lot that "I don't have any other skills", but when it comes down to it, that's just never true. When it comes to being a doctor, you've developed a massive amount of skills over years of training and just fortitude and diligence and like working hard. You can translate that into just about anything that you want to do. You just have to put your mind to it and you can do it. Because if you got through residency, then you can get through just about anything else. So, that's one thing I would say to people.
And then secondly, I sort of jumped into this completely headfirst. I don't know that I did a ton of planning about the business part before I started. I wish I would've done a little bit more of that, learned about business taxes before I actually opened my business. That would've been great.
I would just encourage people to plan a little bit. While in advance of opening your doors, make sure you've researched the laws in your state, how to set up your books, all of those things, before you actually start working. I've kind of learned a lot of the things on the way and it would've been maybe a little bit easier for me to research more ahead of time, but for what it's worth, I was committed to doing it and I just jumped in and made it happen. So there's pros and cons to that, but I would just encourage people to do more research.
John: When I talk to other people, and I've been advised what I'm going to say here in a second, it's hard when you're starting a business because you don't want to spend money upfront that you could be used for building your business and so forth. But I'd say in most cases it makes sense to consult with an attorney and an accountant. Even though your books might not really seem like they're going to be very complicated, but to me it's worth a thousand bucks or a few hundred bucks just to have that conversation. They might tell you, "Look, all you got to do is fill this paper out, sign here and you're done" or set up your books a certain way, but you just never know. You're getting coaching basically when you do that. So, I would agree with what you said.
Dr. Rachael Degurse: Yeah. And like I said, I'm happy to answer any questions for people because I did sort of learn about these things on the fly.
John: Yeah. It's always good to be able to say here's the thing I did wrong, so I want you to do it just a little bit better than I did because I didn't plan it out completely, or I didn't know what I didn't know. That's very common. Which actually brings me to another question that I wanted to ask you earlier.
I see on LinkedIn and maybe on your website more so that you're doing some more speaking and I think even on the website mentioned that you don't mind sharing with others about your story. So tell me, are you doing some formal speaking? Is some of that for marketing purposes? Is that some of that to connect with other entrepreneurs? It just sounded pretty interesting when I saw that.
Dr. Rachael Degurse: Yeah, I would love to do more speaking and more podcasts like this or even more in-person formal engagements. One of the things that I'm pretty passionate about is hopefully finding a way to change the face of healthcare. I think that corporate takeovers of healthcare doesn't do anybody any service in the long run for our patients or for us as providers.
And I think part of what might change some of that is talking about what is this healthcare landscape that we're encountering now, just like you said, but I think a lot of people coming out of training don't realize that this is happening. And certainly our patients don't know what's happening.
I would like to talk more about that and talk about how people can participate in change for that and hopefully providers and physicians and patients can find a better experience for all of us and not be ruled by the big corporations anymore.
John: Yeah, we look at it as physicians and it's frustrating because we're running patients through, we don't have enough time to spend with them and really hear what their issues are. But I can't imagine that for the patients, it's just as bad. People that I know that go to the doctor, I was not rewarding at all. I went in there, the nurse was rude, pushed me through, I had three minutes with the doctor and then I had to move on. And it's not like the doctors are choosing to do that just with the RVUs and other things, it's not a good system.
Dr. Rachael Degurse: It's not, and there's far more patients out there than there are physicians. And I think that as physicians, most of us are, for lack of a better word, people pleasers. We don't want to make waves or none of us picture ourselves as being the leaders of businesses or large organizations. We just want to see our patients and take care of them and go home. But for us to be able to continue to do that and do it well, something needs to change and I'm pretty passionate talking about that.
John: Good. That's also very helpful to your community to get the word out and also to other prospective medical students who maybe really don't know what they're getting into. And they have to think long and hard about that, especially if they're going into huge levels of debt, which kind of binds them into something that they may end up not enjoying.
Dr. Rachael Degurse: Absolutely.
John: All right, Rachel. I guess I've taken up enough of your time today. So, this has been really good though.To
Dr. Rachael Degurse: This is a good conversation. Thank you.
John: You're welcome. It's been fun. I hope I can follow up with you sometime down the road. I like to follow up with the people particularly that have started new businesses. Because you just never know, a year or two down the road, you can learn a lot more from my guests when they've been doing something like you have for a longer period of time. I guess with that I'll say goodbye.
Dr. Rachael Degurse: All right, thank you.
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Transcription PNC Podcast Episode 318
This Family Doctor Successfully Merged Marketing and Medicine in a Medspa
- Interview with Dr. Rachael Degurse
John: I'm really happy to have today's guest here because for some reason I'm drawn to people that start out in medicine and they have to follow this entrepreneurial bent that they have. Going to school and residency for 11 to 15 or 20 years isn't really necessarily the way to become an entrepreneur, but there's a small set of physicians that do it because they want to control what they're doing, and they want to get away from the hassle and the burden of the corporate style of medicine. I'm really happy to have today's guest here. Welcome, Dr. Rachel Degurse.
Dr. Rachael Degurse: Hi, John. Thank you for having me. I'm excited to be here.
John: Yes. I've been talking recently on the podcast a couple times about small businesses in general, and what you do obviously is a startup small business, and it's hopefully going to grow a lot. But you've already taken that plunge and you've done a lot of the work to get this thing going. And so, I like catching up with physicians that have done that. I'm just glad that you're here to answer my questions today.
Dr. Rachael Degurse: Thanks. Thanks. I'm excited to be here and talk about what we're doing.
John: Also a favor because you're a family physician, which I am too. So, why don't we start like we always do with a little bit of your story in terms of your education and practice, and then how and when you started this new venture?
Dr. Rachael Degurse: Okay. As you mentioned, I'm a family medicine physician trained, and I've been doing this since 2013. I came to Colorado, I'm a native from Colorado and came back here after residency and got a job in a federally qualified health center. I worked that for two years and then I went into a group practice setting that was physician owned and led, and I've been there since, but it's no longer physician owned. It got purchased by a large corporation, twice actually.
And since then, my clinical career has been much different than what I envisioned when I joined medicine. And that's when I decided to open my med spa because it gave me an opportunity to get some of the control back and taking care of my patients and the more autonomy that I enjoyed. That's why I decided to open this. And I officially opened the doors April of 2022 but it's been in the work since December of 2021. So it took me a couple months before I actually opened my doors. But I've been doing that part-time in addition to my clinical work at my day job is what I like to call it, ever since.
John: Well, from what I can tell from the website and maybe LinkedIn and other things that I've seen, you've got a pretty broad array of services. You've got come a long way. It takes at least six months to a year to really plan a business. So it sounds like you're right on schedule as far as the planning part, like you said, you had to spend a few months.
But before we get into that in detail, I want to just talk about you as an entrepreneur. There are a lot of things a physician can do when they get frustrated or they just want to make some kind of a change. So, how did you come to think, "Okay, I think my own business." Is it the control issue? Is it just the flexibility? What is about that?
Dr. Rachael Degurse: Well, firstly, I never grew up wanting to be a business owner. In fact, I had an opportunity to join a practice right out of residency that was owned by a physician who wanted to retire and turn it over to kind of like some fresh blood. And I turned down that opportunity. It just didn't seem like something that I would necessarily want to do. However I have learned that being in control of your own life is very important.
And that's something that I've learned to value more and more especially as there's been changes in the way healthcare is being run. So, not only control of my schedule and my day, but control of how many patients I want to see and how long I feel like I need to take with them. And just being able to have that time to develop my relationships with my patients again, where I feel like I've lost a lot of that in my current clinical, traditional family medicine.
There was definitely a time when I thought, "Well, maybe I just go to a different office or different practice", but I just felt like the face of medicine was changing so much that I couldn't guarantee I would be able to regain some of that back that I had lost in a different setting that might get sold.
The only way I could control that completely, was to be my own boss and decide whether or not I would sell my business. And yeah, it's been a real joy, learning all the ins and outs of how to grow a business. It's also been a huge challenge, but that's kind of part of it.
John: A couple questions about that then. First, going way back. Many of the people that listen, let's say have been in practice longer than you, perhaps. I have all ages and lots of different locations around the world and in the US and so forth, but there's a lot of people that have been 20, 30 years in practice. And so, my question to you is, back 13 years ago and you're in the middle of that transition and coming from residency, was there any evidence, any inkling that at that time, either during your training or even early into your practice that you thought this might all just go away because of the changes, or was it just like a brand new concept?
Dr. Rachael Degurse: Perhaps I'm naive, but I did not expect healthcare to go quite as much the way it has. I grew up going to a doctor who was a private practitioner, worked solo, didn't have a partner, and wasn't owned by an organization. And that's all I knew growing up. I just assumed that there's some practices that were affiliated with hospitals, but for the most part a family medicine doctor was a business owner essentially, or they worked in a group with other people and they had a shared business. So, that's what I fully expected to go into. And like I said, perhaps that was naive of me, but it has not turned out that way.
John: Well, the reason I ask is because I think even to this day it seems pretty obvious to someone who's gone through it. And I've interviewed many guests who actually made a change because of the very issue you brought up, which is their company was bought or whether it was a practice or maybe it was more of a small hospital based practice, but then there was some large corporation that bought it.
And I still think that the med students and the residents, depending on where they are, they have no idea that this corporate takeover of medicine is well underway. And if it hasn't affected them yet, it probably will. And I almost blame the faculty for not letting their students and residents know that what we're in right now is kind of a bubble and life's going to be different. But I don't know.
Dr. Rachael Degurse: Well, thank you for not assuming I was naive to not know that.
John: No, I think it's still happening, which is really frustrating to my colleagues and some that I talked to about this. Okay. Now the other thing. You came to the realization that you need more control, more freedom to do things the way you want to do and not be threatened by the next takeover or the next merger, whatever. Did you consider any other businesses besides the med spa and how did you come to that choice?
Dr. Rachael Degurse: Yeah. Well, I sort of jokingly considered some other businesses. There was a brief time where I talked about becoming an alpaca farmer. I did toy with local honey, but in all honesty, this was the only business that truly made me feel like I could still practice medicine, and own my own business because the aesthetic medicine realm is still relatively untouched by corporations, although that is changing sort of.
There are some private equity companies that are trying to acquire med spas and there's definitely some larger chain med spa type places. Most likely laser hair removal and that sort of thing, but for the most part, a traditional med spa is still very much like small business ownership. And it still feels like medicine to me. Because I didn't want to just give up on my dream of being a doctor. I still felt like I needed that and wanted that in some capacity. And interacting with patients is very important to me. This gave me kind of what I felt like was the best of both worlds.
John: Yeah, that makes sense. I kind of equated somewhat to becoming a coach, but that's more like in the realm of the mental health wellbeing. A coach is a couple steps away from a therapist, but you know what I'm getting at.
Dr. Rachael Degurse: Yeah.
John: And it's something you can do independently and build a business around. But I could see the interest in being sort of someone that's taken care of, what is the largest organ in the body. Isn't it the skin, the largest organ?
Dr. Rachael Degurse: Absolutely.
John: And so, skin and beauty and hair and all that kind of thing. And you get to do some procedures. So, to me that makes perfect sense. Did you have to do anything to prepare or let me just put another way. What were the things you had to learn the most about let's say at the beginning in terms of beginning this venture?
Dr. Rachael Degurse: Yeah, it's actually been quite a steep learning curve. Let's just forget about all of the learning how to run a business part because that I did not know anything about. I just thought you just come up with a name and put out your shingle and then it's all good. But it's not.
I definitely had to learn a whole new set of skill sets. I had to take courses specifically for all of the procedures that I perform. And I started with, still to this day, because I'm the only one doing any of the procedures, everything we offer, I have to learn how to do. I started with the easiest most entry level procedures possible. Facials, Botox.
And then I've just gradually increased my skills since then, doing a lot more conferences and lectures and book learning and breeding and podcasts and all of those things I do in all of my free time, what limited it is, to just become better and better honing my craft so to speak. But it's definitely out there. There's a lot of opportunities to go to courses all over the country, and a lot more online and digital resources compared to maybe in the past. So, it's definitely possible to do.
John: That helps. That helps. As far as the business side, one of the things that I hear about is, and that physicians typically don't think about unless they're really aggressive in their practice, and that's marketing. Was that a big part of the business aspect that you had to learn more about?
Dr. Rachael Degurse: Absolutely. I hadn't even heard the term SEO before. Just things like that that I didn't even know. I didn't know. I had to learn. Fortunately, I am very lucky to have my husband who's been a real big partner with me in this. He has a business background. He comes from an entrepreneur family, so he's just been huge and helping me with a lot of that. He does most of our social media marketing and SEO. I'm lucky in that I haven't truly had to learn all of that information. Of course I still know the terminology and that's still very important, but marketing is essential as far as getting your name out there because I just thought it would be easy to open up and have people come in. And that is definitely not the case. So, that's been really a big factor in getting us off the ground.
John: Most typical entrepreneurs have a great idea and decide they're going to start something, they're not good at everything. And so, they always rely on other people to fill in. My wife runs a business so I know exactly what you're talking about. And she's excellent at certain things and then in other things maybe she needs a little help, but that's just every business owner.
I've talked to, like I said, other med spa owners and there are, like you said, so many conferences and they probably go into pretty great depth in terms of marketing for that type of business, which helps a lot.
Dr. Rachael Degurse: Absolutely. A lot of the conferences are kind of a combination of business development and learning. So, that's very helpful.
John: Nice. Nice. Okay. Now tell us more about the actual med spa and also you're doing a lot of different procedures now. Tell us about which ones you really enjoy or which ones do you think are the most helpful? Just to get into kind of the nuts and bolts of what a med spa does, at least in your case, so that people who are thinking about this can get some ideas.
Dr. Rachael Degurse: Sure. My med spa is in a professional complex building with other suites. I just have a small suite in this building. It's about a thousand square feet, so it's very efficient so to speak. I have just me, I've got my chair and I offer facials, neurotoxin injection. I have three different devices. I have a laser that can do IPL procedures. I can do microneedling, radiofrequency microneedling and I have a non-invasive body contouring machine. I do offer medically supervised weight loss. And I'm getting ready to offer my filler.
Filler by far is in my opinion the riskiest procedure you can offer. So that's why it's taken me the longest to add it on because I just want to make sure that I am a hundred percent solid in being comfortable with that procedure before I add it.
That's pretty much almost everything that you can offer in the aesthetic world in just a very small space. It doesn't take a lot of footprint to offer most of these things. You just have to be efficient with your space and your time.
Anyone that I would suggest who wants to offer or start a med spa, they need to be able to offer neurotoxin. That's what we call kind of the gateway drug to aesthetics. Most people will start with wanting to do Botox or something very similar to that just to relax the wrinkles. And then that kind of opens the door to discussing other procedures and services that people might want. And then sometimes people say they want Botox, but they want it to treat a problem that isn't actually resolved with Botox.
It's just a very important thing to be able to offer right away. I started off with offering facials and Botox, and those were the only two things that I offered for quite a while. And then about eight months ago, I purchased my first laser device and that really expanded how much I could offer. And then about a month ago is when we brought in the radiofrequency microneedle and the non-invasive body contouring right around when I started my weight loss program. So, it's kind of been ramping up in the past couple of months offering more things.
John: Well, this is another question. It's a little bit off the topic in terms of the actual services you're providing, but as you're trying to ramp up, as you are ramping up and you're obviously committing a lot of time and effort and of course, investment as well. How does that work in terms of negotiating with your current employer? Just any tips on how to... People are usually fear having that conversation. Now usually when they have the conversation it goes better than they thought because we just tend to be pessimists when we're talking about that. What is your advice and what is your experience in trying to slowly make that change?
Dr. Rachael Degurse: Well, when I decided to open this, I had already had a day off during the week. I was working there four days a week, and then I started being able to work in my med spa three days a week. Yeah, that's a seven day work week but if you're going to be building your business, you kind of have to work every day. Even if you're not open every day, you're working every day.
John: Right.
Dr. Rachael Degurse: So, that's how it initially started. And then for better or worse, we did have some attrition in our office where we had some providers leave, and that kind of helped me to open the door and be like, "I'm planning on opening this business and I need a little bit more time to do that. Now I will stay committed to you for a period of time as long as you let me have a little bit more time to do my business."
And it's really only another half a day a week, which is not a lot as far as me leaving my other job for that half a day. But it does allow me to be open a whole other day here, which time is money when it comes to having a business, so you got to be open as much as you can.
That's how I started, kind of scaling back. Now I think I've probably maxed out the ability for cutting down my hours there. The next step is going to have to be the leap of leaving there if I'm going to, and I do have kind of a timeline where that might be a possibility. We'll see if that actually pans out. But so far I don't know that I have a great solution to have that conversation unless you have a lot of leverage like I did.
John: Well, it's good to use that leverage and plan ahead. We didn't discuss this beforehand, but I'm going to ask this question in that. Do you have much of a notice requirement, I guess? Some people think I'm going to do this, and they realize they have a nine month or a year notice for leaving a job, which is ridiculous, obviously. But you've already kind of considered that and have that worked into your plan, I'm assuming?
Dr. Rachael Degurse: Yes. I have a 90 day notice, so it's very generous on my end.
John: Yeah. Yeah. That's better than most. Most people are stuck for six months unless someone's trying to kick them out. Because there's a shortage of physicians and it's because of the changes in medicine, but it sounds like you're positioned well to pull a trigger when you get there.
Dr. Rachael Degurse: That's the goal. The goal is to be able to replace as much of my income as possible with med spa income before I officially leave. Hopefully it will happen.
John: It's always a good plan, right? You don't want to have that dip that lasts longer than you need to. Now you were talking about fillers. I'm going to switch back to the medical side in my mind. What's a medical part of it? That sounds like it's a little more complex. Is it typically done by non-physicians? Are they technicians? Are they some kind of licensed professional normally? How does that work?
Dr. Rachael Degurse: That's a good question. It's actually state by state dependent on who can perform what procedures. Some states are more strict than others. New Jersey being an example of a very strict state that most procedures, including operating of a laser, needs to be performed by a physician. That's a state where it's great if you are a physician to open a med spa. Not so great if you're not a physician or you want to be opening a med spa, but not doing all of the procedures yourself and having extenders.
You really need to look up the state specific laws about what you can do yourself and what you can delegate to other people. But in some states, a filler can be injected by anybody that you delegate to, that you say is qualified to perform that procedure. In most cases, the lowest level of training that you're going to encounter with that is like an RN performing a filler procedure.
John: Is there a license for med spa where you're working? Or is that just another business?
Dr. Rachael Degurse: You just need a business license. So, it's a little gray area.
John: The reason I ask, I'm familiar with what I talk about in the podcast, like senior care business. And those didn't used to be licensed, but in most states now they are licensed. So, it's just something to remember another licensed, another hoop to jump through.
What do you think long term, looking forward, are there any more procedures that can be done down the road that you might be interested in? For that matter or other, I've seen med spas bring all kinds of services in. What are you planning for the next few years once you ramp up even more?
Dr. Rachael Degurse: Yeah. Once I'm able to expand into a more medical sterile space, then there are some procedures that are more invasive, that are essentially like a nonsurgical face lifts and body lifts that I would be very interested in offering. And those do really need to be performed by a physician because it's kind of like liposuction in the office. So you have to be a little bit more trained and qualified to perform something like that.
John: Okay. Well, it sounds like you're on your way. Tell us more about how to find you in your spa, where you're located or where the website is and that sort of thing.
Dr. Rachael Degurse: Well, I would love to connect with anybody who's interested in opening a med spa or has questions about what it might look like for them or even if they just had questions about opening business. And they can find me on LinkedIn under Dr. Rachel Degurse. And certainly if you have more interest in our business itself or med spa, you can look for us on our website at pearlskinbody.com.
John: All right. I'll definitely put those links in, for sure. And if people have questions or if they're geographically anywhere within distance they can talk to you and maybe even visit you, at some point.
Dr. Rachael Degurse: Yeah, I would love that.
John: I'm just thinking if there's anything else that I've forgotten today. Any advice you have for my listeners, basically who may be where you were a few years ago in terms of either this opportunity or just doing something outside of a corporate style of medicine.
Dr. Rachael Degurse: Absolutely. Firstly, I think one of the things that I hear from some physicians who are hesitant to just do something else but they're interested is I hear a lot that "I don't have any other skills", but when it comes down to it, that's just never true. When it comes to being a doctor, you've developed a massive amount of skills over years of training and just fortitude and diligence and like working hard. You can translate that into just about anything that you want to do. You just have to put your mind to it and you can do it. Because if you got through residency, then you can get through just about anything else. So, that's one thing I would say to people.
And then secondly, I sort of jumped into this completely headfirst. I don't know that I did a ton of planning about the business part before I started. I wish I would've done a little bit more of that, learned about business taxes before I actually opened my business. That would've been great.
I would just encourage people to plan a little bit. While in advance of opening your doors, make sure you've researched the laws in your state, how to set up your books, all of those things, before you actually start working. I've kind of learned a lot of the things on the way and it would've been maybe a little bit easier for me to research more ahead of time, but for what it's worth, I was committed to doing it and I just jumped in and made it happen. So there's pros and cons to that, but I would just encourage people to do more research.
John: When I talk to other people, and I've been advised what I'm going to say here in a second, it's hard when you're starting a business because you don't want to spend money upfront that you could be used for building your business and so forth. But I'd say in most cases it makes sense to consult with an attorney and an accountant. Even though your books might not really seem like they're going to be very complicated, but to me it's worth a thousand bucks or a few hundred bucks just to have that conversation. They might tell you, "Look, all you got to do is fill this paper out, sign here and you're done" or set up your books a certain way, but you just never know. You're getting coaching basically when you do that. So, I would agree with what you said.
Dr. Rachael Degurse: Yeah. And like I said, I'm happy to answer any questions for people because I did sort of learn about these things on the fly.
John: Yeah. It's always good to be able to say here's the thing I did wrong, so I want you to do it just a little bit better than I did because I didn't plan it out completely, or I didn't know what I didn't know. That's very common. Which actually brings me to another question that I wanted to ask you earlier.
I see on LinkedIn and maybe on your website more so that you're doing some more speaking and I think even on the website mentioned that you don't mind sharing with others about your story. So tell me, are you doing some formal speaking? Is some of that for marketing purposes? Is that some of that to connect with other entrepreneurs? It just sounded pretty interesting when I saw that.
Dr. Rachael Degurse: Yeah, I would love to do more speaking and more podcasts like this or even more in-person formal engagements. One of the things that I'm pretty passionate about is hopefully finding a way to change the face of healthcare. I think that corporate takeovers of healthcare doesn't do anybody any service in the long run for our patients or for us as providers.
And I think part of what might change some of that is talking about what is this healthcare landscape that we're encountering now, just like you said, but I think a lot of people coming out of training don't realize that this is happening. And certainly our patients don't know what's happening.
I would like to talk more about that and talk about how people can participate in change for that and hopefully providers and physicians and patients can find a better experience for all of us and not be ruled by the big corporations anymore.
John: Yeah, we look at it as physicians and it's frustrating because we're running patients through, we don't have enough time to spend with them and really hear what their issues are. But I can't imagine that for the patients, it's just as bad. People that I know that go to the doctor, I was not rewarding at all. I went in there, the nurse was rude, pushed me through, I had three minutes with the doctor and then I had to move on. And it's not like the doctors are choosing to do that just with the RVUs and other things, it's not a good system.
Dr. Rachael Degurse: It's not, and there's far more patients out there than there are physicians. And I think that as physicians, most of us are, for lack of a better word, people pleasers. We don't want to make waves or none of us picture ourselves as being the leaders of businesses or large organizations. We just want to see our patients and take care of them and go home. But for us to be able to continue to do that and do it well, something needs to change and I'm pretty passionate talking about that.
John: Good. That's also very helpful to your community to get the word out and also to other prospective medical students who maybe really don't know what they're getting into. And they have to think long and hard about that, especially if they're going into huge levels of debt, which kind of binds them into something that they may end up not enjoying.
Dr. Rachael Degurse: Absolutely.
John: All right, Rachel. I guess I've taken up enough of your time today. So, this has been really good though.To
Dr. Rachael Degurse: This is a good conversation. Thank you.
John: You're welcome. It's been fun. I hope I can follow up with you sometime down the road. I like to follow up with the people particularly that have started new businesses. Because you just never know, a year or two down the road, you can learn a lot more from my guests when they've been doing something like you have for a longer period of time. I guess with that I'll say goodbye.
Dr. Rachael Degurse: All right, thank you.
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