Dr. Tea Nguyen (00:54.008)

I want to welcome Dr. Sarah Neitzel, a wonderful friend, a beautiful mind, a very successful clinician, coach, and she has a small practice set up all at the same time. I don't know how she does it, which is why I brought her here. So welcome to the podcast.

Dr. Sarah Neitzel (01:12.462)

Thank you. Such kind words. I always love talking with you. Makes me feel so good.

Dr. Tea Nguyen (01:18.146)

You’re like my favorite person because it's like, how are you doing all of these things? And the reality is nobody knows.

Dr. Sarah Neitzel (01:26.826)

Yeah, no, mean, some, some days I don't feel like I even have a great grasp on that, but.

Dr. Tea Nguyen (01:32.994)

I think that's what happens when you're an entrepreneur. You just solve problems. And one of the problems that I saw you solving that I was very interested in how you did this is that not only are you a podiatrist, but you also have a spa that generates cashflow for you. So if you don't mind, take us back to the inception of this idea. When did that come into play in regards to your clinical practice and all that?

Dr. Sarah Neitzel (01:59.842)

Yeah, well, okay. So like, I am a little bit of a girly girl. I've always gotten pedicures done. I love it. And then of course, once you're in this kind of a field, you, you recognize what's clean and what's not so clean and a little questionable and like, and then you start to see patients where they're getting infections from places and you're like, okay, this is like totally preventable. So actually it kind of started in residency, my third year of residency. Like I remember talking to a couple of my attendings and asking like, Hey, like, why doesn't anybody have like a nail spa in their office? Like that?

That seems like a home run. Like that seems like a no brainer to me, especially for what we do. And everybody that I had just told me like, no, nobody does that. Like that's silly. Why would you have that in a medical office? And realistically, like I came out and I kind of let them talk me out of it. And I came out of residency and I had a couple of years where I was like building my private practice, kind of office sharing with somebody.

And I just kept thinking about it and it really like bothered me for like a full five years. And I realized the big reason that nobody did it is because they didn't want to run two businesses. Like now that I understand how little business education we all got, I understand how like intimidating that's going to be to be like, great. So now I'm going to take on not just one business, but a second one. And I think that really truly was probably the reason. I don't think it was a like, You know, there's not a market for that, or where are you going to get those clients are like, like, it's a self feeding system, you know, like I have people that are literally there for foot problems in the pediatric clinic. And yes, I don't do nails anymore. That's one of the other things I don't do nails and callus care anymore. I gave that up years ago. This is like an easy option. And it's like, and it's safe for the people that are higher risk that like, can't really go other places, you know, so like my diabetics, chemo patients, like anybody, you know, compromise can come in and do this and just

anybody for that matter if they just you know care about having things be clean. So when I decided to build up my office space in my current space it was gonna be a really big build out and I decided I wanted to go ahead and have the nail spa part in there. And there were just certain things about it that I wanted to have that would make it different because

Dr. Sarah Neitzel (04:16.48)

One of the things when you're starting any business, whether like practice or otherwise, that I always tell people is like, make sure that you're looking at what's in your market. What is your competition doing? And what can you do that's going to be different? Because especially if you're going to do this at a higher price point, which at a doctor's office, people are expecting to pay a little more. But that's not enough of a reason. So you've got to figure out what it is you're going to offer that's going to be different. So I did get to write off a whole bunch of market research and go get myself lunch pedicures around town which was great. 

Perfect. Yep, business credit card, ran that. And then honestly, it became really clear through a couple of years worth of just looking around at what was out there, like, OK, this is what I can offer people. It's medically safe. We're autoclaving everything. We are offering more in terms of the types of treatments. We're approaching it more from a medical standpoint. So I knew market-wise I could do it.

plus having a referral source within the practice. The big thing then became like, how do I do this in a way that doesn't necessarily tie into my practice? And one of the things that like, I know can be intimidating for people is that they wanna do this really quickly by just like putting somebody in a back room with a pedicure chair and like calling it good. And like, that's fine, but like you...

you have to make sure that like liability wise, you're gonna be covered. Because if somebody gets injured while getting a pedicure by a nail technician, is your malpractice going to cover that? And do you want your malpractice covering that, right? Or do you wanna have a separate office liability policy that covers that, which I would definitely recommend going with the second one. And basically how I was advised was like, these needed to be two separate businesses, two separate LLCs with their own.

No liability policies their own websites that can definitely cross reference each other but you wanted to make it as clear as possible that these were two technically separate businesses so that if anybody wanted to sue one business they couldn't come after the other. So like this also protected my source of income because now if something happens in the practice. I'm not worried about the spa over here having completely interrupted operations and being unable to earn income right so.

Dr. Sarah Neitzel (06:38.338)

For me, that made the most sense. And honestly, once I got everything set up, it really wasn't that bad. But I think that's the part that's really intimidating for a lot of people is like, god, I have to run this as a separate business. It's all systems. You just have to figure out how, however you would normally run your practice is exactly how you run this kind of thing.

Dr. Tea Nguyen (06:57.486)

I think that's the thing. That's exactly the thing. We haven't even figured out how to run the first practice. And then we're adding on the second load. And so for me, that's really important to understand as you were saying, that you can't just jump in and just autopilot a situation. You really have to know what you're doing, what you're building, and the liabilities involved. And when it comes to building a small practice,

Dr. Sarah Neitzel (07:03.342)

Right.

Dr. Tea Nguyen (07:24.834)

For me, I've seen it happen in residency. was shadowing a private practice and he had hired a nail technician, but I was very unimpressed with the system. And I used to work at Burke Williams. So if you want to talk about bougie experiences, that's like up there where we got a massage every month just for working there. And so my expectations of like what is a massage is not just the massage, it's the whole experience from start to finish.

And I'm so willing to pay more because I know what I'm going to get out of that. But I didn't know early on in the prior years that I didn't know you was that you're building two LLCs, two businesses with different structures and different types of people to run it. So you had shared with me in the past that the types of people you hire in your spa, the mentality is very different. It's very independent contractor like.

compared to let's say a medical assistant in your clinical practice. And I think this is important to know what you're going to get into before you dive deep into it. So can you elaborate what you mean by that?

Dr. Sarah Neitzel (08:32.236)

Yeah. Yes. So that's another thing that I usually will encourage people to look into before they do this. It's like figure out what the market is in your area for nail technicians in general. Because like, one, if you're in an area like mine, where like there's maybe not as many spas, or there's not like a, you know, cosmetology school nearby, like, it's you're gonna have a harder time finding them.

And this is a group that is used to typically this industry is very different. They're used to being able to come into a salon. It's typically high turnover, which is one thing. So like, as soon as somebody is not happy, they up and leave. And they're used to kind of doing it on a split, where it's like they'll it's like a 4060 split, typically, we're like the technician will get 60 % of their service, and then the shop owner takes 40%. And then you know, a lot of times when they're doing that kind of a split, the technician is on the hook for providing all of their own supplies. So like, it's actually they end up making very little. And so they're really quick to like job hump, like, or job hop to like the next, you know, the next place that maybe will offer him like slightly more percentage. 

So that was something that I, you know, having worked and owned a practice for a while, I was like, I'm pretty sure we can do this better where there's a little more stability both for them and me. like doing out my pro forma and all my numbers ahead of time, I was able to figure out that like, if I go ahead and just do an hourly rate and I have them keep 100 % of their tips, it gives them some security to know that like they're there, they're putting in the hours, they're getting paid. It's not much because it's basically minimum wage but they're essentially on a commission structure and they're encouraged to do better because they get to keep their whole tip. And I'm covering all of their supplies. So like, they feel a little bit more secure about just coming in to the job. They know they're gonna put their hours in. They can go ahead and provide the quality level of service that they can provide. They get to keep those tips and like, we're both happy. I actually make more money, they actually make more money. Like once you count the tips in like,

Dr. Sarah Neitzel (10:49.868)

I mean, in some cases at our price point, they're pulling like $40 and $50 an hour. Like my MA is not pulling that. So granted, and then they're also, they're on the hook for the taxes for their tips, depending on what's going on with that. So that's an additional thing as a business that I'm not having to take on because I'm paying the payroll tax based on a lower hourly. So I actually really like that better personally.

I understand that it doesn't necessarily work that way. Some markets that are really saturated with nail technicians, like one of my clients, is in an area that's really saturated with them. And they have a pretty high turnover just in the industry, right? She's been doing well with her office, but like they're coming in and they're wanting like high splits. So we've just had to talk through like, okay, how do we do this? And like actually having conversations with those employees about like, what is it you need? What are you looking for out of this job? Because if somebody says stability, you're probably better off doing hourly. If somebody's like, I just want to make as much as I can, and I want to do this split, you're going to be stuck with that. You just got to figure out what numbers you're going to work. So it's a very different group than hiring your front desk or your MA for your practice, because they're there on hourly. They're not used to even making a commission of any kind. So it's just very different.

Dr. Tea Nguyen (12:08.622)

Let's talk about the services you provide in your spa. What do you offer?

Dr. Sarah Neitzel (12:14.542)

Um, so the biggest thing honestly that we were able to offer that other places couldn't was privacy. That was like, that's my number one thing. Everybody who has to go into a place like if they have even remotely funky nails, like, or they're embarrassed about their toenails, which let's be real, like a lot of people are, um, they do not want to be lined up sitting next to somebody that they have toenails. Like it's embarrassing. It's like, wants that.

And that is literally the thing that everybody compliments on is the fact that it's in a private room with your own tech. Like that's hands down the biggest thing we offer. Otherwise it's like, it's like your standard pedicures. Like we do, you know, we have our, have four packages that people can get. One of them's got like the hot towel wrap and the paraffin wax that, you know, diabetics can't have, but like everybody else can. We do the hot stone massage. we, it's pedicures are pedicures, right? Like you definitely want to follow some of the higher end places that are in your area in terms of what to offer. But I think where you get to have that leg up is that your cleanliness standards are already going to be known to be higher. And if you can do it in a private room, you're already killing the competition. Did you just say up? Yeah, like literally I made it. Yeah, totally did.

Dr. Tea Nguyen (13:28.844)

just say a Lego. I love that. Okay, cool. So offering privacy, higher standard of sterilization and cleanliness is great. I went to get my manicure done and I was traumatized myself and this is all you as mortified and I don't know if you know my background but my mom owns

Dr. Sarah Neitzel (13:48.686)

Remember you sending me those pictures?

Dr. Tea Nguyen (13:55.52)

a nail shop. She has owned it for many years in Las Vegas. She had sold it and bought it again because she was bored of retirement. So I come from a lineage of expectations of what I expect out of a nail salon. We want it cheap, we want it fast. And unfortunately, most people experience that. And they also experience consequences like infections. And myself, of all people, had gone to get a manicure by a lady who was very careless.

And she's using a hand drill to take off the old polish. And she was also yapping on her cell phone simultaneously. And she I think she passed the level of nail that caused the nail bed burn multiple times. And she also nipped me multiple times. And you may think that hey, she's one of my people, she should have been more careful. Right? I'm like, I did not have that. And I did. I definitely did not have the privilege of saying I'm also a doctor. Like who does that? You don't.

Dr. Sarah Neitzel (14:48.843)

Ha ha, isn't it?

Dr. Tea Nguyen (14:55.47)

I don't go to a nail salon to flaunt my degree. I went there as a customer as is. And I was like, if I had this terrible experience, imagine what other people are going to. So I don't think there's a question as to does this work or not. It does work. It's just the structure that needs to be sorted out. So I was mortified. And that was when I reached out and I was like, we need to do something. I need to do something in my clinical practice. But what held me back

Dr. Sarah Neitzel (15:14.19)

.

Dr. Tea Nguyen (15:24.372)

is knowing that this is a secondary business structure. And I don't have the mental capacity or the bandwidth to do that. And I was wondering if you can share a little bit about the process you had to go through in order to build what you have today. Because I know today didn't look like they won or even you won. For the doctors who are listening, where do they start? What do they start with?

Dr. Sarah Neitzel (15:27.522)

Yes.

Dr. Sarah Neitzel (15:44.149)

No, no.

Dr. Sarah Neitzel (15:50.764)

Well, think the very first, gosh, yeah, this has been so many years. I'm like trying to think back through. I think the first part of it is really sitting down and designing for yourself what it is you want, right? Like, do you want this to be something that can essentially kind of stand alone on its own? That's like higher end luxury that you're going to use the best products and like there is nothing wrong with doing that. Trust me. Like it's just gonna take a little more upfront investment.

Or, you know, are you kind of looking to just kind of dip your toe in the water with one tech, maybe convert one room and see how it goes kind of thing. The process of getting like an LLC and all of that started is usually really easy. And I would recommend just honestly filing for yourselves. Like it's, you don't need to pay somebody to do that. It's like a $50 thing online. You form your LLC, so that that way everything's limited liability corporation in case anybody didn't know. You don't need to go through and necessarily have a tax ID number or an employee ID number. Like you don't need any of those things. You need your LLC to legally protect you and you need whatever license the state that you're in is gonna require that you have. So we have to have a salon shop license. That's what literally just a Google search, which we had to apply for.

And like we applied, I paid the, think $125 and boom, here you go. This is what you have. My employees, technically I pay them through the payroll that I run through the practice. I just came up with a space sharing and employee sharing agreement between my practice and my spa. Literally create a document that just says, my spa is going to pay my practice back.

whatever the payroll amount is that gets run through for those employees. Like, it's not like you're running two separate, you know, payrolls. It's not like you're running two separate books even, really. And then it's a matter of just figuring out when you've got to hire. So it's hard if you're like just getting started and you haven't really like hired anybody yet because you don't know how long it's going to take you to find that person. So I usually recommend like just put the ad out there.

Dr. Sarah Neitzel (18:09.398)

like on Indeed or with some of the cosmetology schools in the area. And just let that kind of run. If you get a whole lot of responses right out the gate, great. Hiring is going to be easy for you. Like, congratulations. If you're like mine is, where it's like you don't see any traffic for like two months, you're going to wait a little bit before you start making those big purchases.

And then you have to decide if you want to have a full massage chair spa setup, which involves plumbing and all of that. Or if you want to literally just have kind of a, like some people will just do a normal chair and like they'll have the tech bring a basin in. Like I've hired two nail techs that they've worked in situations where they had to carry their basin with them.

Personally, I don't feel like you can ask for as high of a price point if we're just kind of doing it that way. That really does come more across as like, this is just a medical level pedicure. That's it. They're expecting to basically pay probably no more than what they would pay to get their nails trimmed. I wanted to be at a much higher price point. So I had the room plumbed for two full spa massage chairs. And so I picked the chairs.

downloaded the schematics off of it. gave it to the plumbers and I was like, I need this to happen. And so that's what they did. And so I had to pay for the plumbers paid for the chair. And then it was a matter of buying a few sets of the supplies. The polish is super expensive. I will tell you like, almost as much as the frickin chairs like why though I mean,

Dr. Tea Nguyen (19:37.067)

No idea.

Dr. Tea Nguyen (19:43.118)

He had a puddle for like $10, so that makes sense if you need to have 100 colors.

Dr. Sarah Neitzel (19:47.374)

Because you got to have options, right? And then we decided to do both regular polish and gel polish. I wasn't willing to do acrylics. Also, you have to look up some of that kind of stuff in your state, what the ventilation requirements are, if they have any for a salon spa. All of that's usually on your Department of Health website. If you do things like acrylic and you're using those drummels to get that kind of dust off, there has to be a certain suction at the table that can inhale that dust.

There's all of this kind of stuff. So we just decided to stay away from acrylics. I didn't want to deal with all of the craziness with it. So it was like, all right, regular polish gel. So expensive to get all of that. Like, I think I probably spent like four grand just on freaking nail polish. But like, that was part of what I budgeted for this. So I budgeted like, I want to say the chairs, granted this was five, six years ago, I want to say the chairs were like three or four grand for the whole thing.

I think it costs me probably 700 and 800 bucks to get it all plumbed. The polishes were super expensive. And then the rest of the stuff, what's really crazy is actually how cheap most of the stuff that places use is.

It's all the same stuff. It's all the same lotion. It's all the same scrub. So you just, you do have to have a little bit of kind of an upfront budget or line of credit that you're like, Hey, I'm just going to go ahead and stick these initial kind of capital expenses on. You do get to write them off at the end of the year, which is helpful, but your big expenses are typically your chair. If you have to plumb the chair and then your polish. So, you you kind of want to time that if you don't have a huge startup budget to be as close to actually opening the doors as possible. And then the other key is like drumming up excitement about it before you even officially open the door, right? Like that's getting it out there online, talking, literally talking to like all of your patients about it. And I did this for like two years before I even like pulled the trigger on this because I was like, I want to see what kind of interest there is.

Dr. Sarah Neitzel (21:49.486)

So I talked to my nail patients. I'm like, hey, hypothetically, if I had somewhere that was like totally medically safe and everything was sterilized, would you want to come in for pedicures? And people were overwhelmingly excited about it. So I would say we started out, had one tech.

She was great. I really didn't have to send her around a whole lot to like other places. We did a little bit of online presence, but it was mostly just from being in the clinic. Like it was in office marketing because we already had the clientele there. they just needed to sign up for the actual service. So, you know, there was a period of time where I was paying her to be there and there wasn't much to do. and that is one of the unfortunate parts of starting any new gig. but you know, I,

we were profitable by month three max. mean, was, was even with all the polish, polish, polish, Like it was, it was profitable and it had paid itself back within 10 months or six months. Like it had paid itself back. And by 10 months, I mean, we were booking out, like we didn't have enough room and I was like, Oh God, I'm gonna have to hire a second person and go through this again. So that's what we did.

Dr. Tea Nguyen (22:41.686)

Even with all the polish.

Dr. Tea Nguyen (23:05.144)

So expectation wise, you funded it, you had specific services and options, you upleveled the people's experience that also funneled between your clinic, and you were able to be profitable in a short period of time. What do you think helped in your success?

Dr. Sarah Neitzel (23:26.434)

I think it was the ahead of time planning and marketing it within the practice. Because you can't avoid the expense of starting something like that up. You can cut it down a little bit, like I said, if you don't go with the full massage chair and stuff like that. But if you really want something that people are going to come in, even if they're not in your practice, I would go higher quality.

I think it's Mike McCallewicks in like the pumpkin plan that talks about the whole, can be price, you can be convenient, or you can be quality, but you can't be all three. And like, you can be price and convenience, which is what McDonald's is, but you can't be price and quality, and you can't be convenient and quality. So like, you command higher prices when you're in the quality, like category.

And that's where I really think it fits so well in a physician's office, because I think that's what people have come to expect. So if you go ahead and put that investment in, it just pays itself in dividends later. I mean, I think it's totally worth it. Yeah, that's the thing. And that's part of the other reason to have this as an LLC, where it's like, you have a separate liability.

Dr. Tea Nguyen (24:36.898)

without you doing the work.

Dr. Sarah Neitzel (24:46.686)

Now, insurance policy going because there is no question about, was a doctor supposed to be there to supervise this technician because technically they're part of the practice, right? Like I wanted this to work so that like I could be home. That was the whole goal was like, I don't want to work five days a week. I would like to work there.

And so this was the way for the space itself to be making and earning an income without me there. They do not need my oversight if they are working under their technician license. But I think marketing really early, drumming up excitement about it, talking to people about it, we even started pre-booking people, which was hard because we didn't know when we were going to get the state approval. And there's all those fun things that happen with.

starting and opening a business.

Dr. Tea Nguyen (25:41.962)

But luckily my nails grow every four weeks.

Dr. Sarah Neitzel (25:44.238)

Exactly. it's like, you know, well, if we don't get you in this week, like we could definitely get you in next week. So no, I mean it. And it worked out great. It I think she was she was probably about 20 % full by the time we like opened the doors. So I think getting that jumpstart and drumming up excitement about it ahead of time is probably the single most important thing that we did.

Dr. Tea Nguyen (26:04.91)

Is there anything that you would have done differently knowing what you know now?

Dr. Sarah Neitzel (26:10.028)

I probably would have designed out more rooms initially to do this.

Dr. Tea Nguyen (26:14.222)

How many links do you have now?

Dr. Sarah Neitzel (26:15.726)

We have two rooms, four chairs. So realistically, we've got two techs. We can run four chairs at a time if they're kind of doing a double service. So each room's just got the two chairs in it, which is nice, because people like to get their pedicures together, but they also don't always want to be in there with another person. Yeah, I probably would have dedicated more rooms to this, to be honest. It's been so nice.

When things slow down in the practice as they naturally do, the nail spa seems to just keep going. And it's like, everybody has nails. They all need to get them dealt with. And they don't just stop growing when deductibles all hit again. You know what I mean? Unlike when people are coming in for the office, they're like, well, my deductible went up. So I think it's kind of

It's a little more seasonal proof. It's not as busy in the winter, I will say, but it's pretty consistent. Once people have their person that they go see and they have a trusted place that they go to, they typically don't deviate in that industry. That's the other part that's really nice. So we don't take walk-ins. We're literally by appointment only. People get scheduled, again, for their follow-up before they leave. It's very much like a physician's office in that sense.

just open sitting for walk-ins. Like people know that this is by appointment only, which has also really made it so that we don't have a lot of downtime for those texts. Like we don't have a lot of no shows. Like it runs like a very well oiled office.

Dr. Tea Nguyen (27:56.738)

I've been told that personal care, your nails and your hair are recession proof. Whereas you were just saying in our practice when that deductible reset, nobody has a medical problem.

Dr. Sarah Neitzel (28:10.414)

Suddenly all your ailments are cured. I get it. We did the same thing. I'm not even gonna lie. Like I'm not that sick. It's fine. Yeah. Yeah

Dr. Tea Nguyen (28:19.342)

Yeah, so I think this is such a brilliant idea, which is why I think you're a brilliant clinician, brilliant business person, because I don't have the stomach for this. I think it sounds awesome, but I would need a lot of guidance. And that leads me into, isn't this what you do? You're a collecting client. Yeah.

Dr. Sarah Neitzel (28:38.392)

Yeah. Literally at this point. Well, and it's so funny because I've been, I've been coaching physicians for like several years now, just like you have. it's, you know, you've, you've had your space, which has been so needed with doing direct care. and I feel like a lot of practices are moving that direction anyways, but mine has been more just like all the things business for physicians across all specialties. And what was interesting was a few years ago, I realized like, actually really what I'm who I'm working with is female physicians that are trying to add like these kinds of aesthetics things, either like as a side business or like within their practice. So I have, you know, I have a gynecologist who's got, you know, now lasers that she's using, you know, to like really fix some things up, which is pretty great for a lot of menopausal women. Yeah, yeah. Speaking of self care, like it's kind of big deal. So

Dr. Tea Nguyen (29:27.276)

So can assume, yep.

Dr. Sarah Neitzel (29:32.394)

Right. You know, so like, she's got that going. You know, I have other podiatry clients that are that are adding just different cash pay services to their practices. But like, you know, are considering a nail spa, one of them has opened a nail spa. So yeah, like I realized, like, this is actually more my jam. Like, I actually really want to get everybody away from having to be so dependent on insurance. Yeah. yeah. No, you're super passionate about it. You just have more guts with it than I do. Like I get like,

Dr. Tea Nguyen (29:53.582)

Yeah, you and I both.

Dr. Sarah Neitzel (30:01.068)

I don't know if anybody in my area is going to pay for it. And the truth is, they will. But I have a very high population of people that are very strict on their insurance. So I have to work more on the sales part of that for me and the confidence in the stuff that I offer that is not insurance-based. And that's what I typically kind of work in every day. So that's more what I'm working with my clients on is, OK, how do we add cash services?

How do we do this in a way so that you have a funnel of people coming in? How does your conversation with patients go? And then, yeah, if you decide you want to build something that's completely on the side or that can function without you, great. What are the options? For some people in some states, their MAs can do a ton of the work unsupervised. And I'm so jealous because I don't have those options. I have to do everything where I'm at.

Dr. Tea Nguyen (30:57.39)

We have to be creative problem solvers.

Dr. Sarah Neitzel (31:00.386)

we are. Yes. So you know, if you're somewhere where it's a little more laissez faire, like, great, let's get your MA's doing, you know, your shockwave and your nail laser and like whatever else they can do. But if you can't do that, like if you're more in the situation, I'm in where it's like, no, if it's within the medical practice, like doctor better be the one doing it, then like, yeah, start a side gig, like run out your office space to yourself as a separate thing that can run without you. Like, that's how you get yourself to where you're like,

Okay, I'm living a life I actually want to live and I have a business that's working for me.

Dr. Tea Nguyen (31:31.918)

This is not exclusive to podiatry. We've seen dermatology do it because their clinical side, they've got their aesthetics, plastic surgery, oculoplastic. I mean, it's kind of endless. Think about Botox clinics. Those are independently run by certified nurses. So for podiatry, this is newer because we're unwilling to talk about it. We're unwilling to confront that Medicare does not want to pay for preventive services that can save lives.

And therefore we have to, or anything else, right? So now we have to be creative and we are solving a very real problem. My personal experience being traumatized at a nail salon, and it's well known in this community, like with my people, quote unquote, my people that I want to support, like I see these people, like, I could be my mom, you know? Like those are my people. But listen, if you, but no, if you don't have the skills, you don't have the skills. There's no allegiance to that.

Dr. Sarah Neitzel (32:30.178)

Yeah.

Dr. Tea Nguyen (32:30.802)

But this kind of clinic and we see its growth in other arenas. I've trained foot care nurses. I've trained nurses who want to do medical pedicures. I have technicians reaching out wanting to get their 40 hours with a podiatrist to shadow so that we can share and, you know, hopefully create a relationship where they do the stuff I don't want to do and they send stuff that I can do, you know, prescribing and things like that.

Dr. Sarah Neitzel (32:42.028)

Yeah.

Dr. Tea Nguyen (33:00.39)

But there's also, I know a group of doctors, podiatrists, who are very hesitant to offload, to delegate because they fear it'll interfere with their profits because they are doing some of these things. And to that, how would you talk with this doctor who says, I can do all of that? How would you approach this problem?

Dr. Sarah Neitzel (33:26.158)

That's my favorite one. This is probably the thing that I ask the majority of my clients the most often is you can be doing it, but should you be doing it? Like, and that's, that is probably the hardest thing I think for anybody who's like a highly successful and academic person, right? And I know it's for other people too, but we get into this place where we assume

that it should just be done by ourselves because we can do it quicker. It's faster for me to do this than it is for me to teach somebody else how to do this. And that is such an insidious little trap about how you're spending your time. Because really, I think there's a couple of maybe three components to that. The first one is knowing how much you're actually getting paid.

for doing the particular thing that you're talking about offloading, right? So whether you're getting paid by insurance or you're getting paid just out of pocket, you know, if you're doing cash nails or whatever, because a lot of insurance is not even covering that stuff anymore. You know, what are you actually getting paid? And then the second part here is like, what is your hourly rate that's your goal, right? So a lot of docs are kind of approaching practice still in a, well, I'm going to work and see as many people as I can. And what I get paid is what I get paid.

Instead, I would encourage people to look at this as what are my profit goals? What do I need to make in order for this business to function and for me to get paid what I want to get paid and then figure out based on how many days a week you want to work what your hourly rate is. So like, for me, my hourly rate needs to be like 600 an hour at my minimum. That's what I better be earning within the clinic if I'm in there.

And so for me, that could look like I see a follow-up patient, a new patient, and a pair of orthotics. That would hit that number for me. Nail care isn't going to get there for me. I think the lowest check I got for nail care was an $11 check six years ago. And I was like, yeah, no. That is unsustainable.

Dr. Tea Nguyen (35:43.992)

Okay.

Dr. Sarah Neitzel (35:52.056)

the minimum That's inappropriate. It's not only, yeah, like it's not only just unsustainable, like it's insulting and inappropriate. Yes, like I have to pay my front desk more to answer the phone call to make said appointment than I earn doing said appointment. And so like there's also that differential, right? So knowing what you're getting paid and how that compares and if it's even getting you close to what your desired hourly rate is.

And that could go for anything. Like we're just using nails as the example, because it's a really obvious one. And then the third part of it is, OK, if you do give that time and that particular income off onto somebody else, what does it free you up to do? if yes, if I go ahead and let's say it's somebody that's not going to get covered for nails, I'm like, I charge a hundred bucks to have them come in. I'll do nails, calluses, whatever.

Still takes me a good 15 minutes, right? If I hire somebody to be in there, whether it's a nail tech, an MA or otherwise, and it's like, okay, I have to pay them $25 an hour. Well, how many nail patients can they see? Is it worth me offloading it? Well, it will definitely pay for themselves. So that's great. It's not hugely profitable, but it's something. But the other key factor is what did I just free up 15 minutes to go do?

Probably a follow up and a pair of orthotics, which is going to be a heck of a lot more than $100 nails. But I'm the only one that can go do that, because that is the degree requirement. So I think there is a difference, too, in understanding, one, is the activity that you're doing generating enough revenue? Not just is it generating revenue, but is it generating enough revenue to justify somebody with your degree being the one to do it?

That's actually kind of it. And it's a little bit hard to look in the mirror to think about doing that. it's a very important assessment to do. And it's usually one of the first things that I will sit down and do with some of my coaching clients is we go, OK, what are you doing during your day? And what is your goal for your hourly rate? And then we start x-ing out all of the things that are not even getting them close and figuring out who else could be doing it.

Dr. Sarah Neitzel (38:10.376)

it's like that Dan Sullivan book, like that who not how. It's such a life changing book. Like, like almost anybody in most.

Dr. Tea Nguyen (38:17.24)

book.

Dr. Tea Nguyen (38:24.497)

I'm pretty a little like I'm a lot more straightforward. I'm like, well, the Naltek is charging 175. So why are we accepting $50 payments?

Dr. Sarah Neitzel (38:31.042)

then there's that. absolutely. Like if you really want to look at it, yes.

Dr. Tea Nguyen (38:38.094)

I think it's because I live in California as if I'm in Beverly Hills. No, I'm like next to Watson though. That's a strawberry farming town. Like this is just going raper stuff.

Dr. Sarah Neitzel (38:48.344)

literally what people are charging. I mean that, you're not going to be able, most likely, you could try to charge $175 to do nails. But people will, for some reason, pay a nail nurse to do $175 nail care. And that's fine. What if you just rent out one of your rooms to this nail nurse and figure out what

whatever rate you want per day based on the square footage and your rent payment and like have them just pay you to be there and they can take home what they want and then you don't manage them. Like you're not going to be in that room anyways. Like don't give up your room if you need it, but like you can't be in two places at once. So if it's freeing you up to see other patients and then you're referring to her, she's then going to refer back to you. Like you could also just do it as straight independent contracting. It's just a matter of figuring out like, I feel like what is, what is actually going be the best situation.

for each person, right? Because if you don't feel like you've got the bandwidth to manage multiple nail tacks and have a spa manager and all of this stuff like I've got, that's totally fine. Some days I don't think I can manage it. It makes me crazy. And then other days I'm like, no, no, this is totally great. You just have to figure out what's actually really the best for you. And I think there's so many ways to do this that could be beneficial.

Dr. Tea Nguyen (40:09.806)

I charge $2,500. So if people want access to me, that's what it takes, but it took time to build it. You the point is not to flaunt our money, but it's to really show the power in our degree and having a strategy. So the strategy we've talked about, you know, setting it up as a second LLC, making sure you've got the market, making sure you take advantage of your medical degree. Honestly, it's your leverage.

We are not technicians. That's the whole point as to why we can charge when we charge. And we care. Who would handle the money better? It's the person who actually cares, right? Compared to the people who are just charging just to charge.

Dr. Sarah Neitzel (40:50.574)

Right.

Dr. Tea Nguyen (40:52.078)

With that, you're able to add cash flow without you physically being there. And I think that's everyone's dream. think that's a lot of us. We just want to touch grass and have a lot of

Dr. Sarah Neitzel (41:03.31)

myself outside, in the sun. Yeah. Yeah.

Dr. Tea Nguyen (41:07.64)

So I think there's no doubt as to us implementing a cash flow service, whether it be regenerative medicine or a spa in your specific case. What can doctors do right now if they're thinking about adding a spa? What should they be doing right now to get started?

Dr. Sarah Neitzel (41:26.904)

I think you should probably honestly look around what's in your area. Start doing a little bit of market research. Like think about it as you're going around to each place and you're looking at the ease of getting in, you know, what kind of services they're offering, you know, look at their menu, look at everything, everything they're doing and take some notes on what you could do different and better. And like that then becomes the basis of your business plan. Like

this is what I know I can offer that is going to be above and beyond my competition. Because I will say the other thing is that, you know, just because it's in a doctor's office, yes, you do get a little bit of a kind of boost in terms of, you know, the whether they know like and trust you, right, because you're a doctor, but it if somebody is shopping around online, you're not necessarily going to look any different from any other spa.

So you really want to make sure that what you're offering is very clear on why it's different, why it's standing out. And then just start looking at your actual space and whether or not you think you've got room for it. And if you need help from somebody, that's usually where you start asking for help.

Dr. Tea Nguyen (42:49.624)

Which is you, you're my go-to person of all things spa related. Cause you have the structure, you have the evidence and you're helping other doctors, not just podiatry, but other specialists as well. Which is nice. And I love coaching doctors of all varieties. Cause we can all blend what's working and share ideas, give solutions. And that's fun for me to meet different specialties too.

Dr. Sarah Neitzel (43:14.51)

Absolutely. mean, business is business, right? And like, it's also fun when you're talking to their specialties and they're saying something about treatment, you're like, I didn't even know that was a thing.

Dr. Tea Nguyen (43:23.362)

Yeah, my gosh, like the laser for the gynecologist. When I learned about that, I'm like, there's so much I don't know. There's just so much.

Dr. Sarah Neitzel (43:32.494)

Oh, yeah. Because like, I don't feel like we had much of that in school. So yeah, the first few times she told me that stuff, I'm like, wait, you can do what? This is amazing. Also, I need to get on a flight, know? Like, hypothetically. Yeah, so no, I love, I love working with, I love working with, like, docs of all, you know, all specialties, because it's like, really, this is all the same basic stuff. It's just we get to cultivate that to like, whatever.

whatever types of services people are wanting to add. There's so many options.

Dr. Tea Nguyen (44:04.48)

And it's scalable. I don't think doctors realize that you can make money without your one-to-one interaction.

Dr. Sarah Neitzel (44:09.966)

Yes. I think that's the hardest part is the idea that it's not volume-based. When we're in residency, it's all about how many people you see, even in insurance-based practices, it's all how many people you see, how quickly you can move, how many people you can get during the day. You're taking notes home with you. You're fricking miserable because you're not spending any time with your family. And as soon as you add cash services of any kind, you get to breathe. You can honestly spend.

Quality time with like 10 people as opposed to trying to get through 30 It's like I don't see more than 10 to 12 people in a day right now But it's all like it's all specialty stuff now coming in and that's been part of marketing this for the past 10 years Like this is what I do. This is what I do and I'm not I'm not trying to do a to Z in my field I picked regenerative. I picked certain things and really hammered in on those

And that's kind of really what allows you to like basically create a practice that you actually enjoy being in.

Dr. Tea Nguyen (45:13.942)

This was such a fun conversation because I know there's so many doctors who want to do this. They have concerns, legality and things like that. And I think that's why you're here. So if people want to reach out to you, what's the best way to do that?

Dr. Sarah Neitzel (45:28.11)

You know, probably my website actually, you can just kind of reach out to me that way. It's visionarypracticesolutions.com. I'm actually going to be probably looking to do a small cohort of people for, you know, a course with kind of group meetings. That'll probably be about an eight week thing. I'm still developing it, but that is something that will be coming down the

types. I'm going to keep it limited because I really want to make sure that like, we are able to literally work through everybody's whatever their hold points are each time we meet because like that's the best way to get the momentum going. So we'll probably be opening that up. That'll also come out on the website. We have a newsletter and I have a podcast on the website. So if people want to take a listen, that's where we can be found.

Dr. Tea Nguyen (46:20.066)

I'll put all that in the show notes and I want to insert a very strong opinion about group coaching. Doctors who hesitate to share their personal stuff in a group, even if it's a small group setting. And this is what I have to say about that. That is the best way to learn. When you force yourself to be uncomfortable, when you sit in a room with people just like you who have different problems, who ask questions that you didn't even think of, and now you've got a think tank. Now you have a board of advisors.

to work with instead of working by yourself. So if you're in a situation where you think you just want the one-on-one, I know it's available, but also consider the momentum you get when you're in a group and you learn from everybody who's present. And that way, you know, you're never alone. It's kind of like residency, right? You always have that one co-resident to lean on. And think that's what group coaching has done for me. And I know that's what it can do for you.

Dr. Sarah Neitzel (47:16.556)

Yeah, that's how you and I met.

Dr. Tea Nguyen (47:18.729)

Right. So many.

Dr. Sarah Neitzel (47:21.514)

So many people I know, that's how I met.

Dr. Tea Nguyen (47:23.67)

So many. Yeah. Wow. Full circle. Right. It's exactly how we met. Okay.

Dr. Sarah Neitzel (47:29.555)

So, proof point.

Dr. Tea Nguyen (47:33.006)

And we are the legacy here. Yeah. Okay. Well, thanks so much for being here.

Dr. Sarah Neitzel (47:38.402)

Thank you for having me. Bye, everybody. Thank you.