The Operator Gap Keeping Your Med Spa Stuck Under $2 Million

Cameron Hemphill (00:00):
If you get yourself in a situation where maybe you do sell for a multiplier, that's not what you're wanting, and if you could go make some tweaks and double your EBITDA and it's going to take you 36 months anyway, why not do that so you could double your check size?

Jessica Hunter (00:23):
All right. Well, welcome back to Aesthetic Appeal. I'm your host, Jessica Hunter, head of our consulting division here at Aesthetic Brokers, and really excited today to welcome industry legend Cameron Hemphill to our podcast today to talk all things medical aesthetics. Cameron, thanks so much for joining today.

Cameron Hemphill (00:41):
Hey, it's an honor. I know that we had to get the rounds going to get this booked, so we're so busy, but appreciate it and honor to be here.

Jessica Hunter (00:48):
Awesome. Awesome. Cam, we've known each other. I've been in this industry for over 10 years. I know you've been here for over 20 years in a variety of different things. I knew you from Growth 99, digital marketing, CRM tools back in the day. I know it's expanded since then with strategic consulting and doing more stuff with private equity, investing in some clinics. But I think one thing that I struggle with a lot with my clients is sort of understanding that the industry has changed. And I would love to hear your perspective of what you think has changed the most in the last 20 years, and then what you think that we're not doing to adapt to that change.

Cameron Hemphill (01:27):
Yeah, loaded question. Really, really appreciate it too. And I mean, I think if we even just looked at a decade horizon, let's go back even 2016 and let's look at that era from 16 to 20. And 16 to 20, I feel like the lights were getting turned on in terms of people really understanding what procedures were, what the outcomes were. And I saw a massive ramp up from really 19 to 22. COVID obviously shut things down and then it just accelerated dramatically. But if I was to look back, look, I went to the first Amspa conference ever, and there was 10 exhibitors in the hall. And it was very obvious to me that there was unsophisticated practice owners that were trying to grow and scale their med spa. I mean, shoot, this was back when they call them medi-spas. That was a phrase that lasted for a short period.

(02:25):
I'm glad that's done, by the way. It's like the acronyms and how we describe the practices have even matured in the past years. And so I think you looked at provider owned rooftops that were single provider owned that were kind of dabbling or doing this on the side for the majority. And obviously there's been practices that have been around for 20 years, sophisticated plastic surgeons like dermatologies, but let's focus on the segmentation of medical aesthetics, elective wellness, if you will. It was really an unsophisticated entrepreneur that was trying to get patients to come in and see them for injectables primarily and some laser treatments, microneedling. And so there was very limited tech. There were some EMRs out there. Online booking was just starting to get exposed and becoming common. Social media was obviously live and ramping and that's how they would do their marketing. But there was really truly a very unsophisticated way of how to manage your practice from a tech standpoint going through the patient journey.

(03:31):
So how do you acquire a patient? How do you take them through a series of drip follow-ups to make them become a patient, to make them come back to the practice, to introduce them to everything that you have in the practice? That doesn't exist. And to be honest, it exists more now than it ever has. You as a consultant of so many years know that, but it's still quite fragmented. I do think that's going to accelerate too. We could touch on that. I think I have some interesting thesis on where that's heading. But if you were to look where it was, there was just multiple tool stacks that you'd have to glue together. And I don't even think... CRM was not even an acronym that was thrown around until 2022, 23. So I guess what I'm seeing now is the tech is accelerated. And I think if you look back 2000 to late 23, 24, it was almost like if you had a license to inject and run a laser, and if you had a heartbeat, you're making money in this space.

Jessica Hunter (04:36):
It's so funny. I couldn't agree more. If someone asked me what was the difference even five, six years ago, the difference was you could see one patient once and make money in this industry. That was a reality of it. I mean, you could honestly make money just by doing neurotoxin for one client twice a year. Twice a year. It didn't even have to come back. It was just totally different. And now I think the structure that every clinic should really be focused on is what is the lifetime value of every single patient they have through the door and how are they increasing that? How are we increasing frequency and just transactional value? It's all about that. I don't think it's about anything else because it is so difficult to get someone to walk through the door. And so when we actually get that to happen and that conversion takes place, it's really all about driving that value of that patient.

(05:31):
And so anyways, just thinking about that as you're talking about when I think about what's really changed, as you mentioned, it's just that what used to be successful to where the benchmark is now to be in a successful, profitable practice. I just think it's really scaled there.

Cameron Hemphill (05:49):
It's changed completely and it's changed very rapidly. So if you look to 24, late 23, 24 to where we are coming in Q4 of 2026, the way that a practice is ran is completely different if you're still in business and you're still profitable. I've spent a ton of time on the patient acquisition side, a ton of time understanding what return on ad spend was, lifetime value of booking. I mean, 10,000 hours of study in this and thousands of clinics. I got Growth 99 to over 1,200 clinics before I sold it to a strategic investment group. And it was a lot. It was a big company. I mean, our revenues were in the millions monthly, MRR. The company grew, but everybody was desperate for patient acquisition. It was almost like just like timing, fate, tech, me, the year I was born, the whole thing just went together.

(06:45):
But now it's completely different where... Look, patient acquisition is obviously still very, very important in having sophisticated CRM and having sophisticated EMR, but now it's really truly about operators. I'm a big believer in having a front desk engine with a provider engine, with a staff engine. I like to separate them and I call them engines because they have to hum all at the same time. And you have to know your numbers and your benchmarks and your KPIs and trackers. But if I was looking at a practice now, what it takes to be successful is... I mean, you can look at it through so many lenses honestly, Jess, but if you are a provider owner that is seeing patients every single day and you have, let's say you have an office manager that's, let's say on a level of sophistication on how to run a business, let's say that there are skill levels of five, that delta between their level of sophistication of a five to a 10 can be the difference of a $3 million practice to a $7 million practice with the same patient.

Jessica Hunter (07:56):
So tell me, what do you think that practice manager is missing? What's that key component? Because I couldn't agree more and I would even say that practice that's in that one, 1.2 a year million dollar revenue, that's that sort of hump. And I feel like that is a barrier is the practice managers I see because the sophistication level and understanding of the business is so lacking. They're so operational versus really fundamentally understanding of what we need to execute to move forward. So I'd love to hear what do you think is the biggest barrier there that they need to build onto their skillset or have to be able to get over that hump?

Cameron Hemphill (08:40):
I love the question because I have done it, I have seen it, I have walked it and I have invested in practices. I've owned practices and I've actually helped a couple practices exit and we have practices that will exit as well. So here's what I've seen. Traditionally, you have a front desk person that answers the phones, works with patients, maybe sends some texts. They're busy on the front desk kind of managing things, checking people out, trying to get reviews, trying to sell retail product memberships, whatever. And they've been there for a year or two and all of a sudden you have to give them a raise. Well, okay, I'm going to give them a raise and I'm going to give them a title. You become the office manager. Sally, you're the office manager. And so by default, they don't have the backlog or understanding of what it takes to grow a practice to the next level from a sophistication lens and go execute on that roadmap or on that playbook.

(09:31):
It's just not in their DNA. It's not in their core understanding. They were just front desk. I received all of my training from the provider that owns the practice and I'm helping order inventory and I'm helping keep the thing running and clean and I'm doing all my daily objectives. I'm doing my job basically. I'm doing my job and I got promoted as office manager. Well, the office manager is typically, shoot, I would say 10 times out of 10, not sophisticated, even most of the times the practice provider owner of understanding where are the gaps? Are we successful or not? And if we're doing a million two and I'm operating at 25%, sure, I'm making a great living and the office manager's getting paid and I'm getting my paid and the rent's getting paid and the patients are happy and I got great reviews and things are working.

(10:26):
What they don't understand is how to run a business. Most office managers have not gone... They don't have an MBA or they have not built a company or sold the company. They have not consulted. It's a whole new level of sophistication of like, "Hey, let's go sit down and have a quarterly meeting." We would do H1, H2 meetings when I was growing my company. We'd say, "Okay, where are we at? Are we healthy or not healthy? Let's compare our company to other SAS based businesses. How's our churn rate? How's our MRR rate? What's our net revenue retention?" All of these benchmarks. And I would have something to compare to. I think in aesthetics, it was hard to compare what success looked like until recently. No one actually surveyed the industry for quite some time. Amspa finally came out with theirs, then you had QSight that came out with theirs.

(11:17):
There's some other people that have come out with their benchmark and they're honestly all over the place, which I think is kind of interesting. But they don't say, "Okay, we're doing 1.2. How do we get to three million?" What would the office manager say? The office manager would say, "I don't know."

Jessica Hunter (11:32):
Totally. Yeah. I couldn't agree more. And to be honest with you, I just don't think they're set up for success.

Cameron Hemphill (11:38):
That's exactly what it is.

Jessica Hunter (11:39):
That what it is. I come into the practice and to your point, yes, you even have some of these managers who have been in the role for five, six, seven years and still are operating as operational managers. Let me build a schedule. Let me make sure Sally's sick and who's going to cover and let me key in payroll. I mean, that's the extent of it. I always say it's not their fault. It's our fault because we don't have the right person in place probably that has that expertise to be able to guide an owner who doesn't have the time, honestly, to really understand the breadth of their business and then also understand where they want to go. I think that's also the key component. It's really understanding. I'll ask that a lot. What is the most important thing to you? Although I want to say it's monetary, it's money.

(12:26):
It's not always. I have a client just recently and we're going down this rabbit hole and I'm really trying to understand them because I can see that their decision making process is not on money. I can feel it. Everything is a brick wall. Everything that we're talking about, retention, patient communication, everything. And at the end of it, it comes to I really care what people in our community think about us as a clinic. And so you need to know that because that dictates the direction of how we make decisions for your business. It's not to say that we're not going to be profitable. We're not going to understand efficiencies. We're not going... But it is to understand that we're coming from a place of reputation being the number one thing that you and the other owner are very mindful of. So I think that's the other piece is that these managers, not only do they not have the financial skillset, of course, and that can be taught over time really if they have the time and the willingness.

(13:28):
It's also that sort of coaching aspect of are you asking the right questions and do you have enough leadership to be able to get everybody on the same page and stay focused on where you need to be because there's too many distractions in this industry. There's a hundred distractions. There's every conference, there's every social media dance, there's every other thing that comes to you. And it's always more important apparently than understanding where was our revenue spread last month? What was our most profitable service? How profitable are our providers? How efficient are they? What is their utilization rate? It's all of these things that actually move the needle that is so boring and nobody wants to talk. So boring.

Cameron Hemphill (14:11):
To me, I love it. I think it's fantastic.

Jessica Hunter (14:12):
I was gonna say, I mean, I could talk about it all day.

Cameron Hemphill (14:16):
But to the office manager, and look, I was at the point where I was like, "You know what? Somebody needs to create a conference or a training or a guide or something for these office managers and turn them into sophisticated operators." I though a lot about it and it's like some will succeed, but I've had practices where I give them all the coaching in the world and it's just in one ear, out the other. I don't know if it's over the head or they don't want to listen or sometimes I feel like if you bring in a consultant, they're a little bit gated or they're a little inferior to that type of position when really the consultant started to try to help. But look, if reputation is the goal for the community, I think it's a phenomenal play because you're trying to be in business for a long period of time and build something with inside the community that the community respects.

(15:04):
And to lean in on that a little bit, the way you do that is to understand your numbers and understanding what's happening with inside of your patient base because I'll give you an example. I had a practice I was working with about a year ago, still communicate with them today. I worked with them for one year and I gave them, it's like, shoot, 10 hours a week of my time is what we agreed to do, which was a lot for me.

Jessica Hunter (15:29):
That is a lot.

Cameron Hemphill (15:30):
But I was coming out of not working at Growth 99, working there for a year after exit and wanting to chill and wanting a part-time gig and really just wanting to help somebody. I'm like, "Hey, I'll buy in. Let's get some equity trade in this and I'll give you some of my time." It was fun. It was actually a fun exercise and I learned a ton. They want to be the highest, the best reputation. They want to be in business a long time and they're great, wonderful brand, great group, great culture, doing quite well. But if I was to start looking at their numbers on their average ticket and their revenue per hour and utilization, I'm like, "Okay, if you want to have the best reputation, why are your patients only spending $400 here when they're coming in to visit? They're not getting the outcomes that they're looking for, which will impact your reputation." It's because they're coming in and they're signing up for the Botox pluck, pluck, but you're not educating them on everything that you do in that consultation.

(16:31):
You're not asking the right questions. You're not asking them why they're really here. I peeled back the layer and we looked at the average ticket blended across all the providers and I gave them maybe an hour's worth of training. We saw an uptick of roughly $100 per provider per ticket just from -

Jessica Hunter (16:50):
Love that.

Cameron Hemphill (16:51):
Changing a little mindset. I didn't even do anything, Jess. It was somebody that had the time to look through it in a different lens that was brought in because the provider's busy seeing patients every day, the provider owner. The office manager doesn't know what success looks like, and I just unlock something and immediately their revenue goes up without any marketing dollars spent. And that was really rewarding. I'm like, "Oh my gosh, it was that easy? Okay. Well, now let's look at revenue per hour utilization rate. Now let's look at your compensation models." Okay. So I started looking at comp plans and then I started looking at on the provider. I'm like, "Okay, well, this is broken. We're going to change that." I came up with my own complex provider compensation that is tier based, and I've looked at lots of models and I didn't really like too many of the models.

(17:42):
I like to add kickers and penalties. I'm mean, but I'm also rewarding. I'm like, "Hey, if you perform, you're going to make more money."

Jessica Hunter (17:50):
It's not. You in the service-based business. I mean, this is a reality.

Cameron Hemphill (17:54):
It's just reality. It is what it is. Mine was like, "Hey, if your utilization rates are below a certain threshold, there's a penalty because I want you working. This isn't a part-time gig. And if your RPH is above a certain limit, you're going to get a bonus on top of your tiers." So it would quickly sniff out any under performer that would try to have a huge RPH, but low utilization. It's like, no, you have to have both. So then you'd get the ultimate compensation reward. So it's been fun. And then also front desk. The biggest thing for me was front desk, honestly. It was -

Jessica Hunter (18:31):
So tell me about that. What do you mean when you say front desk? What are the challenges right now you think in the practices are? And if you could give the listeners a couple key tips and tricks to implement, what would those be?

Cameron Hemphill (18:44):
Okay. I have a practice that I'm working with that does... I don't like to brand drop or anything, but they do about 10 million a year. Good size group, very functional, profitable skill.

Jessica Hunter (18:56):
Yes. And in this industry, just to caveat for everyone listening, that is a very good practice.

Cameron Hemphill (19:01):
Very good practice.Been around a long time.

Jessica Hunter (19:02):
Just because I think people are very not understanding of what this industry actually looks like until you've been behind the hood of hundreds of financials. But anyways, that is a very high generating practice.

Cameron Hemphill (19:14):
High generating. Yeah. I mean, the average is what, like one, five still, something like that? Is that typical?

Jessica Hunter (19:18):
Yeah. And I would say, I mean, the two and under is really the common theme there.

Cameron Hemphill (19:23):
That's a common theme. Yeah.

Jessica Hunter (19:24):
Very common.

Cameron Hemphill (19:26):
And to go from a one and a half to three is like, from a consultant's lens, my lens, it's easy, but from a practice owner's lens, they don't even know where to go.

Jessica Hunter (19:37):
Yeah, It's a swamp, right?

Cameron Hemphill (19:38):
It's a swamp. Yeah. It's a swamp. You I could talk about this for hours. Yeah,

Jessica Hunter (19:42):
Exactly. Sorry to interrupt. Tell me about this guy.

Cameron Hemphill (19:44):
No, you're good, you're good. All right. So I'll give you the practice. I'm going to give you two. The $10 million practice had a front desk team of three, and they were all part-time. They kind of had KPIs, but there was no manager. There was an office manager, actually quite sophisticated office manager. She's actually very sharp, but the manager for the front desk was non-existent. So there was also no performance-based compensation. It was just hourly, and then here was the tool set. So the first thing I did was I went and I looked at the tool sets. Leads were coming into a CRM that was not talking to... They had two CRMs, different topic for another day. So I connected those together. I'm like, "All right, well, if it's going to come in here, let's just put it in here. Let's build out the funnels and build out the AI, make sure that's all humming and doing its thing.

(20:36):
When after hours leads come in or whatever, let's speed to lead that whole thing." Built that, and then I actually integrated the CRM to the EMR with API connectors. And so now it flows. So I fixed the tech stack, like the kinks, the manual stuff. And then slowly I fired every single front desk person and I hired, I would say, just a uptick of talent. And then I re-engineered the compensation model. The compensation model is all performance-based. Well, there's a small base, like a low hourly plus maximize on performance. And mainly the performance, like the KPIs, there's nine KPIs. It was like, "Hey, there's some team KPIs, reviews, patients that haven't been in five months, calling them, getting them back in, cross sells. You'd get paid 10% on retail sales, 20% on memberships. Before they were getting paid $10 on a membership and they were selling two a month.

(21:30):
So that exercise took about 90 days to rip, replace, comp plan. The whole thing took about 90 days. It was actually, it was a big engineering shift. And so if I was to look at what that front desk was doing before the 90 days, that front desk was bringing in right around 45 to $50,000 a month, which was performing quite well. The front desk cost with the bodies and everything was right around 15,000 to yield a $50,000 return, which anybody would sign up for that. That's a great return. Well, by tweaking a few things and putting the right incentivization behind the right structures, I like paying a 20% reward on memberships if you have the right membership model. That's another conversation. But if you have the right model, because this is monthly reoccurring revenue, annual reoccurring revenue that I've always been a big fan. I'm sure that it creates some liability there and we can talk about that.

Jessica Hunter (22:36):
But loyalty, retention, right?

Cameron Hemphill (22:37):
Loyalty, retention, frequency, upsells, they come back in. It creates massive... Yeah, the whole thing. Yeah. And we pay them 20% on month one, not month two. So then the ARR on that accelerated revenue was substantial. So after the 90 days, month one, then I built a tracker and this tracker is very sophisticated. They log their activity. It schedule reports every day, every week, every month. I can see ROI based on literally within a couple of buttons. I mean, I'm a total nerd, and so I just spend the time. I'm like, "I'm going to build the best front desk engine tracking thing in the world." It tracks your KPIs hit. If you hit KPIs, you're paid out a bonus. If whoever performs the most on top of the team pays out another kicker. In month one, we sold $180,000 of sales, so going from 50 to $180,000 just by fixing the tech, getting the right people, getting the right comp, and then tracking it.

(23:41):
I'll tell you what, everybody's happier, including the patient, including the front desk, obviously the owner. The performance-based comp is just something that's so overlooked and it's so bizarre to me because I have a sales background. How are you not paying this? It's interesting. Are you seeing the same?

Jessica Hunter (23:57):
I mean, I could talk about this all day. This is obviously my bread and butter. I think performance pay in the service-based industry, for whatever reason in this industry in particular, has got this dirty stigma, this like, oh my God, heaven forbid. I think the reality is that you really need to reward someone for their performance. I'm a big believer in coupling that, I won't go down this rabbit hole, but coupling that with some sort of hourly wage or some sort of rigor because I want you to be invested in the team. I want you to show up for team meetings and marketing photo shoots and whatever else is in the gamut of being a part of that clinic or practice. I like coupling both of them for lots of reasons, and I'm a big tear believer. Everyone who knows me knows I love tears and I love visibility.

(24:46):
So again, making it simple enough where a provider is able to actually monitor their performance and know where they're at is so key. But yeah, I couldn't agree more. But you talked about two things in that conversation that I just don't want to lose on when we're talking about that front desk and that sort of reception operation infrastructure. And one was obviously having them have their own metrics, again, outlining the expectations, but I'd love to know how you ideally see AI being involved in that front desk, that inquiry sort of flow in terms of not just new acquisition, but obviously current patients looking to re-book or reschedule, those kinds of things. So I'd love your thoughts on that. And then I'd love you to talk a little bit about immediate feedback loops and how those can be really beneficial, but AI, definitely. Love to hear it.

Cameron Hemphill (25:34):
Yeah. I think I have a very unique skillset for this space because I come from just legacy tech. I'm a very process oriented tech solutions analyst and provider and gap and problem solver. I'm OCD and everything has a process. My wife just teases me about it. She's like, "Sometimes your process doesn't work for the family." I'm very time structured, organized. When I look at stuff like this, I'm like, "Okay, well, the first thing is your foundation's broke, your tech stack is not communicating. So either we need to A, rip and replace, which can be quite painful, and there's contract signed and stuff like that with specific EMRs and CRMs. There's some really cool tools out there that I had found and started playing with, and one was called Kerrigan, which it's an aggregator. It's a HIPAA compliance aggregator like Zapier. Essentially, I can go into Kerrigan and I could connect dots and programs together.

(26:37):
And so this particular practice had Growth9 CRM, they had Podium, they had Boulevard, and then they actually had another EMR for their functional side of the business. I mean, imagine if none of those are talking together, imagine the data entry. Which they aren't. Which they are. Now they absolutely are. And that project alone, I don't know, if you're to hire that out... First off, I don't even know if the practice owner would know where to go. If you're to go enterprise level, hire that out, you're talking easily a couple hundred thousand dollar thing to build out. I don't know. I have a unique skillset and I have unique connections. I mean, I had over 300 employees in India, so I'm very close to some guys that are lifers with me.

(27:21):
And so I'm like, okay, here's the framework, here's the problem, here's the thing. Let's build it out. AI has helped me so much with that. We went and we connected all the dots. And then what we quickly realized was even these tools that they were using, number one, they weren't communicating. Number two, they weren't built out to their fullest capacity. So we had the CRM, leads are coming in. I had to port those over to the CRM that are actually using that integrated with their phones and text messages. Then their funnels weren't built out. So when a lead hits, there was no automatic response. And then if someone calls, we don't answer, there was no automatic text back. So that was all done. We built all that out for them. But there was no funnels like what happens if I make a phone call two and they don't answer a phone call three or phone call four?

(28:06):
What happens when we book them? Does the automation stop because now they go into the EMR and the EMR kicks off with the reminders? And then what about when they leave? Okay, well, they need to be in the post follow-up funnel that is specific to the treatment they had. So it's not like a generic, "Hey, come back in and see us." It was like, "Hey, how are you doing? It's been 14 days since you've had your service and treatment on this with this provider." And so it really took the time to build out the right content messaging, and then obviously you'd see the patient frequency kick up. So we also then flipped on AI and it reduced the amount of hours for the front desk dramatically. So now the front desk can actually spend time on outreach, patients that haven't been in five months and make physical phone calls.

(28:56):
So it just made everybody more productive. And so I think AI is huge. I also think after hours AI is super important. If you call this particular practice after hours, there's a voice agent that answers the phone. "Hey, this is the after hours voice assistant. "We say," Hey, just so you know, this is AI, but it sounds great and I can help you with this, this, this and this bookings, rescheduling.

Jessica Hunter (29:19):
Rebooking.

Cameron Hemphill (29:20):
Yep. And if you'd rather talk to somebody live, leave a message and we'll get back to you.

Jessica Hunter (29:24):
Yeah. I'd love to hear... I think, listen, I get a ton of pushback right now on integrating AI into the customer experience from a lot of my clients. And so to your point, first of all, I think you have to have someone who can really build it out correctly and lay out the foundation and then understand where it should go because it doesn't really fit everywhere. You don't need it, I think, in every sort of funnel or whatever. But I think after hours, great example. I think it does have its needs. What do you say to clinic owners that come up against you saying Hey, my clients don't want to talk to AI. They don't want to deal with automation. They're getting blasted too much with correspondence. What do you say? I'd love to hear what you say to your clients in terms of making them understand how valuable the touch points are.

Cameron Hemphill (30:16):
Yeah, it's a good point because we don't want to over communicate and especially communicate a message that doesn't land well and do not unsubscribe and make a happy patient frustrated. We definitely do not want to have that. So I think you have to be cautious on how you implement it. But what I see is I see practice owners, they hear about AI and because there's an EMR company or CRM that's like, shoot, you go to a conference today, it's like GLP ones, AI and private equity. That's basically what it is.

Jessica Hunter (30:50):
And we'll get to private equity before we're done today.

Cameron Hemphill (30:54):
And so that's the theme. And so they're like, everybody needs AI. If you're not an AI, you're going to fall behind. So they go sign up for all these AI tools or whatever they do and they subscribe to them, but they fail to implement them or they get so far and they're like, it's not working. I got one bad feedback from our patient. They weren't happy about it. So they just kill it. They shut the whole thing down. And that's where I would challenge them is I would say you really have to take the time to implement it correctly and train your AI. So I have AI bots, assistants, admins, I got chain of commands. I mean, my setup's crazy weird, but it's sophisticated and my AIs know how I think and how I talk. So you have to train it and you can train it by having it read your website, having it read your EMR systems, your FAQs, your culture. You can also always give it feedback. You could always give it feedback. And if you don't give it feedback, it doesn't know how to get smarter. It doesn't just get smarter on its own. And so if you take the time to actually do that and feed it the right brain of intelligence, shoot, on the texting side, I would say it's like 90% perfect.

(32:10):
It's going to just get better and better. On the voice side, it's still a little annoying because there's those gaps and maybe they say something weird. Recently they said, "Hey, we can rebook you for November five versus November 5th." It's like, "Well, that's weird." So you got to go in and say, Hey, next time say the fifth. It's not five, it's the fifth. And it will fix itself. But sometimes they just give up, just like the EMR, just like any tech, they give up before they actually get the full benefit of it. That's where I've challenged some practice to say, hold on, let's not kill it. Let's roll it back a little bit. Let's feed it some information and let's implement it and then roll it back out and see how it's worked. And really those have been some really wonderful exercises and the benefit has been a positive in every scenario as long as you're patient and you do it correctly, but people get frustrated and they want to kill it.

Jessica Hunter (33:00):
Yeah. And listen, I can understand that too. As a business owner, again, it was a small business. I totally can appreciate that. I think one of the other things to be mindful of is that at certain capacities, you get to a capacity where the reality is you cannot call every patient. It's just not even in, you know what I mean? You don't have that capacity to do that or in the way that you would like to. And so I think integrating some of these automations or AI tools allows you to continue that touch point and that customer experience when really it's just not within, again, your capacity to be able to do it the way you did it in your first year of business. And I think that whole idea, talking about how do you grow and how do you really scale is about integrating systems that allow you to continue.

(33:48):
And I think on that same, because I don't want to miss this as your third thing at conferences, which I feel like is 80% of conferences right now, is private equity in this industry. But I'd love to hear again, your thoughts on private equity and where you think... Because here's what I see a lot. I see a lot of people who think that their business is worth more than it is. And part of it is that they just don't understand the financial understanding of the business and the evaluation and what that really means. And two is that they just don't understand how private equity works and really what they're looking for. So do you see that? Do you see your clients thinking that their business maybe is worth more and disappointed when you go through what private equity is really looking for when they're looking to acquire a business?

(34:35):
And if so, what are your suggestions for somebody who wants to possibly sell their business three, four, five years down the road?

Cameron Hemphill (34:43):
You're right. Private equity is a massive topic of conversation and I think it's been done a couple different ways. There's a couple different models out there and MSO models. Some I'm a fan of, some I'm not a fan of. But yes, I think that, I don't know, I think this 2026 theme is like everybody's open to selling. They heard a story that a gal had a practice and sold for $30 million and she's 27 years old and they're like, "I want to do that too. So I'm for sale too." And look, maybe she did trade for a certain dollar amount, but again, they hear the positive dollar amount. They don't know exactly what was the actual check size, what was the rollover equity, what does the earn out look like? Is there an earn out? There's lots of things underneath the hood that are behind that big valuation that they heard about.

(35:32):
And the reality is I think valuations have come down. I think Bill would have a lot more intel on that than me, but valuations from what I've seen have come down. And obviously these practices, they trade on EBITDA. So I think practices also don't have a grasp on their financials. So they really have to understand their financials. They have to have a CFO, fractional CFO, wonderful bookkeeper that knows how to use EMRs from a data standpoint and obviously QuickBooks and consolidate those together to get cost of goods sold and all that stuff and look at percentage of revenue to provider costs, to head count, all this stuff, retail sales. But I think if you're going to prepare to sell, you should probably look at it from a three-year window. And the most important thing you could do is get your house in order. I would bring in either a consultant or I would bring in an operator or I would start thinking that way or I would level up my office manager is what I would do.

(36:36):
And I don't know, I think that there's lots of channels. I do think there's too many consulting gurus out there. I saw the same thing in marketing where I pull up on my Instagram feed and so-and-so's marketing. I'm like, "I've never seen you at a conference or speak." I think there's great ones and I think there's ones that are like, "Well, you've never even owned or sold or worked at a practice. I don't know how you could consult one." But okay. Anyway, I think that if you're looking at exiting, I think you should give yourself a 36 month window and get your duck in a row because I think if you get yourself in a situation where maybe you do sell for a multiplier, that's not what you're wanting, and if you could go make some tweaks and double your EBITDA and it's going to take you 36 months anyway, why not do that so you could double your check size?

(37:22):
I see that a lot. I do see private equity. I've seen definitely some practices get taken advantage of. And I wouldn't say I'm anti-private equity, but I'm anti-taking advantage of a founder for sure.

Jessica Hunter (37:34):
I couldn't agree more that understanding your business to the nuance that you're describing is so beyond a QuickBook P&L that your bookkeeper is shooting over to you. It's so beyond that. Understanding what your personal expenses are, what gets to come out, what stays in, understanding what your cost of goods are, how you sort that from consumables and laser and retail products and understanding the percentages there, what those percentages should be, what your payroll percentage should be. I couldn't agree more. And I think for myself, if you were to hire me 10 years ago, I feel really unfortunate for you. It is absolutely, it's just even five years ago because for me, I've just learned so much from being in the weeds of financials over and over and over again throughout this country. And so I think that's really allowed me to understand businesses in a whole nother level.

(38:26):
And if you're not in the weeds like that, I don't know how you learn this industry. I really don't because there's just no other way by knowing that. And so I always say to my practice owners, I understand why you don't know because you just haven't spent the time to learn and to understand. And so that's sort of the role obviously I play with aesthetic brokers is to show them, but really let them understand because EBITDA is such a buzzword that nobody really understands how to get to it. Nobody really understands.

Cameron Hemphill (38:56):
I hear that all the time.That's a new one.

Jessica Hunter (38:57):
Yeah. And to be honest, I'm like, if I have to hear one more person who doesn't understand financial or have a financial background talk about EBITDA, I'm going to just lose my mind because the reality is there's so much that goes into understanding what your practice is worth. And to your point, there are things that, again, you can do today to position yourself 36 months out to actually get an evaluation that would be, to your point, not getting ripped off or getting something that you would perceive enough value for you to leave your baby. So Cam, it's been so great talking to you. I just wanted to say how much I really appreciate your time, really appreciate your insight and how candid and honest and just genuine you are. So thanks so much for your time. I don't take it lightly that you came to talk to us today.

Cameron Hemphill (39:42):
Yeah. Jess, thank you so much. I appreciate it. Let's do it again.