Who did well in the Great Depression and why should we care?

Many of the businesses that prospered in the Depression were known as Sin Industries , referring to alcohol, candy, and cigarettes. Prohibition was repealed in 1933 after crime and consumption of alcohol both soared, and America learned that prohibition of two mutually beneficial exchanges is doomed to failure. Two other goods that did well during the Sin Industries were chocolate and cigarettes. Hershey’s prospered after they introduced Mr. Goodbar and Hershey’s Syrup, and Camel emerged as the leader in cigarette sales when the economy eventually returned. Interestingly, in addition to the Sin Industries, another realm that did well was the cosmetic industry. L’Oréal and Revlon both expanded, and Estée Lauder is reported to have remarked that “…after a woman feeds her kids and husband, she would rather buy lipstick than eat herself.” Is this still true today?

What do all the Sin Industries have in common?

The Sin Industries allow a temporary escape from reality, an ability to satisfy a guilty pleasure, with the key factor that gratification is immediate. If the key is a quick fix, right behind that is “inexpensive.” Affordable pricing is essential to achieving maximum gratification and repeat business.

Many can relate to the feeling of euphoria after buying an item such as a new article of clothing, a new watch, or a new car. However, how much better is it when that new item is affordable and immediate? If it is expensive or has a long lag time until the benefit is achieved, there is a risk for buyer’s remorse and, even worse, negative ill will toward the place from which it was purchased. When finances are limited, consumers are less likely to purchase any luxury that does not provide an immediate benefit, especially if the price must be justified. Retail businesses that prospered during the Great Depression sold quick-returning pleasures at an affordable price.

However, in the world of retail, the bottom line is frequently determined by the dollar, and a business’s success is measured in financial statements. Although a little retail flair seems to be a necessary component to a successful aesthetic practice, medicine is not a retail business. Aesthetic medicine is also not a general medical business in that aesthetic physicians are selling an expensive pay-for-service luxury, not a necessity for health. However, aesthetic medicine is still, first and foremost, medicine, and physicians have taken a very prominent oath. Beyond any other profession or business, physicians have an enormous fiduciary responsibility to always do what is in the best interest of someone other than themselves. No other profession is granted this great a responsibility or holds its members to such a high standard. This truism guides aesthetic physicians, with success measured by the patients’ well-being, not the dollar.

So herein lies a dilemma. The core principles in medicine and business are sometimes contradictory. Aesthetic medicine is uniquely positioned between a general medical practice and retail. Aesthetic physicians do not really fit into any one category. If the business principles used in a general medical practice are applied, a compromise may need to be made regarding the customer service flair essential to selling a luxury item. However, if retail principles are stressed, such as up-selling and increasing profits per customer (patient) visits, aesthetic physicians risk violating basic tenets inherent to medicine. So what business models can be referenced that prioritize the consumer’s well-being above that of financial return, yet allows enough room to stay financially solvent in an economic environment with less consumer spending? The field of aesthetic medicine is essentially a new type of model; it is in between retail service and general medicine. The authors call it Retailicine .

In Retailicine, aesthetic physicians not only have a responsibility to treat the patient using the most responsible and appropriate treatments but also have to frame it with the luxuries of retail to stay profitable and keep consumeristic patients happy. How can physicians practice Retailicine in a down economy and still thrive?

Certainly, a fortunate few are recognized as the best at what they do and are able to maintain a busy schedule regardless of the economic conditions. However, for most physicians, seeing a contraction of their practices means they must act fast to ensure their practice thrives.

The Sin Industries prospered in a down economy. Can the aesthetic physician’s services parallel this prosperity, yet still stay within the moral boundaries of the granted profession? Yes, today they can, because at their disposal are products and services such as neurotoxins, fillers, facials, and laser treatments that provide quick results and an immediate improvement in mood. For the most part, these products and services have been proven successful and valid in the marketplace and fall within the fiduciary core to provide responsible treatments. For patients more surgically focused, the demands are for a quicker result. No longer is a 2- to 6-week postoperative recovery period well tolerated. Cosmetically interested consumers still expect great results, but with the most minimal sacrifice of their busy schedules. Patients will often choose a provider that can meet this demand.

Price matters now more than ever. It is no surprise that the Walmarts and Aldi Superstores are expanding, whereas many high-end luxury stores are faltering. If a consumer has limited funds and wants a glass of wine, they may be more likely to choose “Two Buck Chuck” (Charles Shaw) over the expensive Silver Oak. If the product is a commodity, then the store offering a lower price is likely to gain the business unless a consumer is willing to pay more for convenience or experience.

However, aesthetic medicine is not a commodity, and discounting a hard-earned skill and well-respected services is probably not the answer for long-term prosperity. The irreversible knee jerk response of lowering price to become instantly more competitive risks turning an aesthetic practice’s service into nothing more than commodity that can be attained at the local CVS. Of course, all strategies are predicated on the product being good, and, in aesthetic medicine, that means the physician. If the physician is not good, then regardless of strategies and tactics, the business (practice) is doomed. A qualified aesthetic physician wanting a higher-end clientele must find a reason to bring value to their product to charge a greater price. Usually this means more convenience or a better experience. Starbucks follows this same principle. By offering a better experience and more locations (convenience), they are able to charge twice the price as Dunkin Donuts for a cup of coffee. An aesthetic physician wanting to charge a higher price for services may validate this by providing better customer service or hours that are more convenient.

On the other end of the spectrum are practices such as “medspas” that frequently work on a high-volume, low-priced model. However, many medspas are currently failing financially. One might think that the affordable pricing and convenience of medspas fulfill the criteria of a business that would do well in a down economy, but price alone is only one component. This area is one in which the high-volume discounted retail business model fails with aesthetic medicine. Cosmetic medical procedures are still medical procedures, and a person exposes vulnerability when undergoing the procedure. They may want a little assurance and are willing to spend more money at a doctor’s office for the perception of quality.

Additionally, medspas as a volume business may struggle with maintaining customer service because often they are believed to be an expensive, non–revenue-generating investment. This assumption couldn’t be farther from the truth. With the ensuing economy, going above and beyond with customer service will be critical to maintaining and growing market share. Improving customer service can be done inexpensively. Whether they have a high-end luxury practice or a high-volume, lower-priced practice, practitioners must think like mice, not rats: mice always get the cheese, rats get exterminated .

At the center of the Retailicine model is the MICE formula. The MICE formula is a simple, easy-to-remember mnemonic device stressing the basic principles of success. Through dissecting each one of these four components, straightforward solutions for meeting the challenges of the economy are identified.

MICE stands for

• •
  

  Messaging

  
  
• •
  

  Information,

  
  
• •
  

  Customer service

  
  
• •
  

  Efficiency

The full details of these formulas are beyond the scope of this article, and the authors instead refer interested readers to the book Thrive, Pearls to Prosper in any Economy. To summarize, “M” for messaging is intended to strengthen and narrow the brand, perhaps focusing on fewer procedures that have the highest consumer demand, and becoming more credentialed in these procedures. “I” is for getting important information to the consumer at a very affordable price. “C” for customer service is self-explanatory and not difficult to raise a notch or two. Lastly, in a less flexible economy, “E” for efficiencies should be monitored closer.

Of the four acronym letters in the MICE formula, “C” (customer service) may be the most important because the only outcome that matters in cosmetic medicine is making people happy. Cosmetic physicians do not make people look better, they make people feel better. Conventional wisdom brands aesthetic physicians as purveyors of beauty, but perhaps this is an oversight. At times, aesthetic physicians act more as psychologists than proceduralists. If people feel better about themselves, then physicians have done their job. Facial plastic surgeons may have many tools for achieving this goal: sometimes it is Botox, a filler, a face-lift, or a laser procedure, or perhaps nothing at all. Occasionally, a person is only seeking reassurance, in which case they do not need anything! Rarely is the patient who is not operated on regretted, but the converse is not true.

At a time when consumers have limited funds and many areas to spend their money, plastic surgeons must make the service they provide worth the effort and expense. However, the promises these physicians make must be genuine or the patient will see right through them. Customer service and attention to the patient’s best interests are the guiding principles of a successful practice.

Although not hard to amplify, superior customer service requires a selflessness that is not innate. Physicians must ask themselves several questions: What is the patient thinking? What would make them more comfortable? What would make their life easier at this moment, and what does it take to help them achieve that? Surprisingly, answering these questions is not expensive or difficult. The investment is so minimal and the return so great that not addressing these concerns seems nonsensical.

The core to customer service is the WIFM principle. WIFM stands for “What’s In It for Me?” This is the primary concern of the patient seeking aesthetic procedures. The aesthetic practice’s best strategy is to look at all communications and marketing efforts from the perspective of the patients. What value will they get out of it? Choosing to go to the provider that offers them the best value for their investment sometimes may mean paying a lower price, but more often it means being provided a better or more assured experience. If an aesthetic physician is going to charge a higher price, then the experience offered should cater to the targeted market with the patients’ best interests in mind, not the physicians’. Walking in the footsteps of a patient, parking where they park, entering the waiting room during office hours, or evaluating staff appearance from the reception area can quickly define if the office projects an image of a five-star hotel or a no-frills roadside motel.