The Silver Lining of Getting Fired

Blake Lucas (00:00):
On our last episode, we brought you Heather and Jenna's perspective on hiring and managing, as their plastic surgery practice in Med Spa grew from 30 to 100 team members in under a year. This week we're giving you the opportunity to hear the other side, their boss's point of view. Hope you enjoy this chat with Austin Plastic surgeon, Dr. Johnny Franco.

Andrea Watkins (00:23):
Well, hi there. I am Andrea Watkins, and if you're listening to this while juggling three patient calls, checking in a couple patients, taking a payment, selling skincare and trying to catch your doctor in between procedures, you might be working in an aesthetic practice.

Blake Lucas (00:37):
And I'm Blake Lucas, and this is Practice Land. This is not your doctor's podcast.

Andrea Watkins (00:43):
Well, it's super nice to meet you, Dr. Franco. We're here at Octane in Newport Beach, California and want to learn a little bit more about you. Our podcast here is really to support the administrative and the sales staff in plastic surgery and aesthetic practices to really help them learn what's important in their jobs, how can they be a indispensable asset for their doctors and for their practices. And so who to learn best from than somebody of your stature that has a very booming successful practice, a huge social media following. Can we just start by learning a little bit about you?

Johnny Franco (01:18):
It's definitely been a rollercoaster ride for sure. As we were talking about earlier, super interesting. I made my way back to Austin. I did my medical school here, way back in the day, I won't say so, I won't date myself, but then trained in St. Louis, then in Miami, went abroad for a little bit and then came back. I actually joined a big dermatology group and then only about seven years ago started my own practice and started with about three employees in this little 700 square foot Pepto Bismol pink office. And then slowly have grown. Now we have three offices, about 90 employees and added about 60 over about a 14 month period. So it definitely was super challenging from all the things you're talking about, staffing, hiring the right people, making sure you keep the right culture as you expand. I think that's really, really challenging.

(02:04):
But I'll say one of the things was probably being true to what I do is when I first came to Austin, came from Miami and I did a lot of BBLs, lipos. I actually had somebody come up to me and be like, well, what are you going to do now that you're in Austin, Texas? Nobody really wants this lipo, fat transfers, butt stuff. And I was like, I don't know, but I'll do what I do. And it was super interesting because that actually helped our practice have a very quick niche. And I do believe that riches in the niches, especially in this day being very good at one or two things, and that's what we've done our practice is we've bring in providers, bring new things to the practice, but everybody has a part of the kingdom because it's hard to keep really quality people if they don't have something they feel super special about.

Andrea Watkins (02:42):
Absolutely. When it comes to the key quality people, what are some key attributes for those key folks that helped you grow that they provided your business and that you could really trust them with independent upon?

Johnny Franco (02:54):
From an admin side, we've actually had the best success of promoting within. And promoting within has really been the most successful route for us because, I mentioned earlier, but culture has been the most important because I think people always want to hire this unicorn admin practice administrator. And don't get me wrong, there's some absolutely fabulous people out there and if you can recruit them, but they're far and few between and then they may be a perfect spot for something else, but no two practices or businesses are alike. I think it's been challenging when we've tried to bring outside people in. So the most important things for us is obviously what's their personality, their drive, because I can teach them that the stuff that I want in terms of things. So I think that's been huge. One a tip I heard from another podcast is when you're hiring higher level people, whether it's a CMO, whether it's a vice president, whether it's something else for your practice, I always ask them, teach me something.

(03:44):
If I'm going to bring in somebody who's super specialized, I want them to know more than me. And so asking them to just teach you something, one, they're typically not expecting that question, two, it actually sees how they do under fire. And it's been interesting. We hired a marketing person recently and actually two marketing people and both of 'em, when I asked them the question, they jumped right in it. And some of the things I knew, some of 'em, I didn't, but the idea that they weren't afraid to be like, Hey, here's some of the stuff I'm super passionate about, I really feel super strongly about. And just whether they truly teach you something or not is a little bit irrelevant, but you get a real feel for what they're excited about, what they really know, and you can tell if somebody's super confident about something right away and willing to engage in this. So I think that's great because as a practice owner or whether you're the CEO stuff, you don't want, people are just going to say yes or you're the greatest, and then everybody's sticking their head in the sand and so want to be collaborative, but also somebody that's going to be like, Hey, I'm worried about that because of X, Y and Z.

Andrea Watkins (04:39):
So I heard that you have champions in your practice. Tell me a little bit about that.

Johnny Franco (04:45):
We do this no matter what we do in our office. So if we bring in a new laser, if we bring in a new device, a new treatment, we try and find somebody who is going to own this, whether it's a surgeon, whether it's an Pnjector, if it's something like PatientFi, one of the admins. Because the problem is if you bring something in, even if it's the greatest device, laser, whatever it is, but nobody owns it, it's just going to fall by the wayside. Because somebody has to be talking about it, somebody has to be engaging the staff, somebody has to be making sure that this is making moves forward. And we actually have a new device, new item checklist that we do. So any new thing we bring in, we bring up our sheet, we go through, we assign tasks, and then that way we make sure that everything gets done.

(05:24):
So there's the lead up to it, they actual do it, the 30 day check, the 90 day check, and then champion is the person in charge of being that. It also too gives people in the office a chance to own something. So we have somebody that truly thrives in cellulite, we have someone else that does sweat control with Brella. We have someone else that's a trainer for Allergan. We have somebody else that that's now taking over our wellness program and the GLP and peptide stuff. And so I think it does multiple things. One, it keeps a project moving. Two, it keeps a device from collecting dust.

Andrea Watkins (05:53):
When you've looked at someone and said you're the champion for this new laser or for this new device or for GLP-1 product that we're bringing in, how have you been surprised in the way that maybe one of your team members has responded?

Johnny Franco (06:05):
It starts even before we bring it in because if we're previewing something and nobody's excited about it

Andrea Watkins (06:10):
Yeah

Johnny Franco (06:10):
Then I'm really worried that if we can't even build excitement in our office, are we going to be able to build excitement for our patients coming through? Typically somebody gets super really excited about it and then we start talking about it and then they're helping kind of push some of it along, which is a good test because if they're going to help get this to a spot, we're going to bring this in,

Andrea Watkins (06:26):
Yeah

Johnny Franco (06:26):
Then they're going to be excited afterwards. So I think that's been the spot where it's really made a big difference for us.

Andrea Watkins (06:31):
Perfect. And how does that impact their daily workflow? If they're already busy, they already have a task and this is what their job is on a daily basis, and then we say, okay, you're the champion, we need to do this. How is that impacting them on a day-to-day and how do they embrace that and run with it?

Johnny Franco (06:48):
I think it's been two points. So there's some that are super busy and they want to bring something else on. Also for other providers, this is a way to get busy. If you think about it, if you're a city like Austin or Dallas or somewhere else, you could be the 1000th toxin injector and try and carve your space, or you could be the person talking about cellulite and make your own pathway and now you own a space that there's only two or three other people in the entire city talking about it. So I think it's been a way that our providers have now seen it because seen it be successful, then it's a way for somebody to get super busy really, really fast.

Andrea Watkins (07:19):
Mmm hmm

Johnny Franco (07:19):
It's a way for somebody to make themselves a national niche because they own something that's super personal. I do think there is times that we have to, if somebody like most, you have alphas at different things, and so you probably have the one or two people who would take on every single project. So sometimes we do have to kind of rein that in.

Andrea Watkins (07:34):
I always say the front office is the hardest to keep staffed with really great people. So what do you do for, in your practice at least, for your call center or those first touchpoint, how does the training work for those folks?

Johnny Franco (07:47):
We definitely, it's been kind of our biggest priority last year was really formalizing that training process and just for people listening not only for our call center front desk, but even through our MAs now, they all have checklists. They have the one week, the two week, the 30 day, 60 day, and the 90 day. I would say probably the biggest mistake, and I think you've probably see it in plastic surgery practices is most of us got into this to help people, and we definitely have held on to people that just weren't good fits way too long. So if there was one piece of advice I would give somebody listening is if they're not a good fit, they're not a good fit. It's like a bad relationship. If it's not working, it's not working and just trying to pour more energy and time and honestly it becomes exhausting for both of us and that filters in. And then if people aren't happy, that starts to spread like a cancer throughout the office and then it resonates on the phones, it resonates with patients.

(08:34):
So I think that's been our huge thing, and I heard someone say, if we're just not a good fit, whether it's in the office, relationship, tany of hose things, you're keeping each other from finding the right fit. If they're not a good fit for this, they're not going to have the potential to move up to actually reach their dream stuff. And so you're just actually hurting both of you. So at some point, if this isn't a good fit, you just need to cut ties and that's one of the things that we've tried to be much better about. We still have room to improve for sure.

Andrea Watkins (08:57):
I think we all do. What are some of those red flags that maybe you'll see little tiny semblance of them in the first couple of weeks?

Johnny Franco (09:05):
One, taking feedback. It's pretty rare that you're going to get somebody that has a ton of experience, and even if you do, every practice is a little bit different, and so if they can't take constructive criticism or training very well, that's a huge red flag because we need to be there. I think too, if they're not willing to jump in and help, we've really tried to create a culture on our office where everybody can take out trash, everybody can pick up if there's a wrap on the floor. The Mayo Clinic has a system where nobody gets pointed in a direction. If somebody needs to go somewhere, you walk them there. And so there are little things that go a long ways, but if they're not willing to jump in and help if they're not willing to take feedback, those are typically the things you see right away.

Andrea Watkins (09:42):
I assume, and with such a large practice, you guys probably have regular performance reviews, things like that with whoever is your practice manager, COO, HR folks. With your compensation and the way that you guys are structured, do your sales and administrative teams work with incentives?

Johnny Franco (09:58):
One of the things we've done in the past is we've made bonus or incentive plans too complex. People don't understand where this is coming from, and then it becomes unhelpful because if people can't even correlate their action to a positive event, then that's really challenging. If it's taking your admin forever to run these reports and do it and then you're not getting them out quick enough, then people don't tie it to the action. So I think that's some of the stuff we've cleaned up. I think that's some of the stuff with some of the technology to be able to run these and pull specific stuff has been super helpful. And this is where I think having CRMs and some of these, there's all sorts of different phone tracking systems where you can actually see individual people's conversion rates and bonuses and stuff where it's very clear, it's very transparent. We try to be very transparent where people see exactly where they're coming from at any point.

Andrea Watkins (10:40):
What if somebody in your team, they think they're doing a great job, but they don't feel that they're getting rewarded for the incredible job that they're doing, how would you like them to approach you?

Johnny Franco (10:51):
If you track this and can build the data, then I think it's super helpful because then you can make stuff matter of fact instead of emotional. And so then you can know like, Hey, Andrea, you're at 50 percentile, so you're at the average. You're not crushing it as much as you think. And when you can show it, even if you de-name it and have you there, then people know exactly where they fit. I think it also helps because if somebody comes in and they want a raise or something, but they're on the bottom 20th percentile, you can be like, Hey, here's where you're at. If somebody's in the top 20 percentile, then they probably do deserve a raise or bonus. And so I think it becomes, you take the emotion away and then it's just pure data, and I think that has made it very transparent.

Andrea Watkins (11:26):
Exactly. For you and your team, what are the key performance indicators that you measure when you are looking at that data with them?

Johnny Franco (11:33):
It depends on the position. If we're talking about a call center, for example, we look at appointments booked. Appointments booked is a huge, and that's an easy one for us in our system. For our injectors, we look at their revenue per hour and how efficient they're being. So those are the type of things that we measure daily for our marketing team. We track the leads per month and per place. And then conversion of those, cuz just a ton of leads isn't great if they don't convert.

Andrea Watkins (11:59):
Exactly.

Johnny Franco (11:59):
So I think those metrics are super important.

Andrea Watkins (12:02):
Awesome. And when it comes to people in your call center, your patient care coordinators or somebody working up front at your front desk, can you think of a specific example of where you were just really wowed by somebody's performance? What was that situation?

Johnny Franco (12:16):
Well, we actually had a patient care coordinator and she actually developed this whole spreadsheet stuff that we actually use now, and she's now moved into admin role. Stuff where it basically breaks it down, so every coordinator, every surgeon is tracked, and we send this out every Monday to all the docs, to all the coordinators. So every surgeon sees where they're at. Every coordinator sees for that. So every surgeon can see their personal booking rate. Every coordinator can see their personal booking rate. Everybody can also see how many consults every person has seen. I think that level of transparency also holds people accountable because if I'm only booking 20% in your booking, 80% of your consults all of a sudden be like, well, shoot, I need to figure something out. Something's not right. And so taking the initiative to do something like that was obviously huge and then led to this person moving up.

Andrea Watkins (12:58):
So the reward was her promotion into a new role with new responsibilities. I love that. Wonderful. Well, I think that pretty much covers everything we're going to talk about today. One thing we do like to ask everyone is we do a little segment called "She did what?" So if you have just a de-identified patient story or even a team member story of something that was just kind of last missed or random that everybody was kind of shocked at, I would love to hear about it.

Johnny Franco (13:26):
Ooh, that's hard. This list becomes a little bit endless in terms of stuff. One of the things that there was a super cool, and this tells multiple stories. One of our staff members, we were kind of behind for the holiday stuff and we had had a company that did it, and I messed up and forgot that we didn't renew the contract stuff, didn't tell anybody. And so actually over the weekend went to, I don't even know, Hobby Lobby, Michaels, wherever, came in on Monday and they had set up the entire lobby with holiday decoration stuff. The idea that, again, taking the initiative, just doing something like that was just super cool to be able to do something so positive and just seeing there was a problem and just doing something about it.

Andrea Watkins (14:06):
Being the person that's going to fix it. I love that. Well, that is a wonderful note to end on. Thank you so much for your time today.

Blake Lucas (14:12):
Awesome. Appreciate it. We'll see you guys.

Andrea Watkins (14:13):
Thank you.

Blake Lucas (14:14):
Got a wild customer service story or a sticky patient situation? Send us a message or voicemail. If your tale makes it into our "She did what?" segment, we'll send a thank you gift you'll actually love. Promise, no cheap swag here.

Andrea Watkins (14:26):
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