Plastic surgeons today face a unique set of challenges, from changing patient demographics to increased competition in the marketplace. In this podcast episode, Plastic Surgery Practice Editors Keri Stephens and Alison Werner talk to Nicole Chiaramonte, CEO of Advanced MedAesthetic Partners (AMP). Chiaramonte joins them to discuss how AMP can help plastic surgeons overcome these challenges and grow their practices. What’s more, she explains why AMP is an alternative to the private equity consolidation model sweeping the industry. 

AMP works as a management service organization, coming in, as Chiaramonte describes it, as a consulting firm of sorts to take care of the business side of running a medical practices—specifically those aspects doctors often don’t want to deal with or don’t feel they have the knowledge to handle effectively and efficiently. According to Chiaramonte, AMP takes care of HR, IT, marketing, and overall day-to-day management, including inventory systems and data management for its partner practices. As she explains, AMP allows “physicians to do what they love without the headache of the business side of medicine.” 

In this episode, Chiaramonte talks about how private equity is changing the playing field, and how she wanted to create a model that protects private plastic surgery practices. As she explains it, Advanced MedAesthetic Partners partner practices retain their public-facing identity. AMP’s goal is optimize the business side, investing heavily in marketing and training, while allowing the plastic surgeon to focus in on what he/she knows best: clinical treatment. 

As Chiaramonte explains it in this podcast, for plastic surgery practices looking to partner with Advanced MedAesthetic Partners, the key characteristics include a commitment to patient satisfaction, a willingness to adapt to changing market conditions, and a desire to grow and scale their business over the long term. She also explains how this model can be just as attractive to mid-career plastic surgeons as those at the beginning and end of their careers. 

From there, Chiaramonte shares how AMP has helped partner practices scale up their business. That has included adding additional surgeons to fully book out the practice to building out a practice’s non-surgical recurring revenue opportunities. Chiaramonte also shares how AMP can help practices struggling with staffing—a problem affecting all of healthcare. 

To close out the episode, Chiaramonte and PSP’s editors talk about trends and how the industry is evolving. And Chiaramonte explains the role she sees Advanced MedAesthetic Partners playing in the future. 

Podcast Transcript

Alison Werner 0:00
Hello. This is the plastic surgery practice podcast on the Medqor Podcast Network. I’m Alison Werner and I’m joined by Keri Stephens. We are the co-chief editors of plastic surgery practice. Joining us for this episode is Nicole Chiaramonte founder and CEO of advanced medaesthetic partners or AMP, a company specialized in partnering with aesthetic practice owners who are looking to grow their practice and who are looking for an alternative to the private equity consolidation model. We wanted to talk to Nicole to find out about how AMP works as a business partner and the managerial, administrative and clinical support it brings to the table. Nicole, thank you for joining us.

Nicole Chiaramonte 0:34
Well, thank you for having me.

Alison Werner 0:36
Great. Well, can you tell us tell me how you got started your background, and how you got into the medical esthetics industry? Sure, well, I you know, I have a highly entrepreneurial background. So I partnered into and sold my first business while still in my teens, and fell in love with this whole high risk, high reward factor that where I could build a business, which created enough value that another company would want to purchase it at a price that was well beyond what my hours were when I first started. So it’s the whole concept of entrepreneurism, taking high risks, putting the effort in and being rewarded for it was something I fell in love with at a young age. And that laid the, you know, the foundation in the path for the rest of my career. About 10 years ago, after I had been in the MSO model in legal, I’ve moved into medical and for those who aren’t familiar with a MSOs, it’s a management service organization. So I’m neither a doctor nor a lawyer, so I can’t own a medical practice or a law firm. But the MSO model allows me to invest in help run and operate and benefit from the profits that are resulted in that. So moving into medical, it’s a half hour conversation, just how I got there. But the short version is that I fell in love with a non surgical body contouring device, I was in my mid 30s, I found out about it as a consumer, and nobody in my area had it. So I called all the doctors in the area and said, you know, if I buy this machine, you can use it, I just want to use it at cost.

Nicole Chiaramonte 2:11
strictly a professionally a personal decision. My husband said I couldn’t buy $150,000 machine and put it in the master bathroom. So I was telling the ladies at my book club that about my dilemma, it was a class three V laser. And, and I needed a doctor to sign for the laser and then have medical oversight on it. And that evening, the the husband of one of my girlfriends called and said I heard you want to get into medicine. And he was an ocular plastic surgeon. I told him what I wanted to do. And he said, Let’s do it. And I will love Mike and Claire forever for that they had so much faith in me. But we did we started that about six weeks into it. We had that machine, that particular machine was going 12 hours a day, four days a week. And we’re like, Okay, we’ve got something here. And I kept promising my husband, I wasn’t going to start a med spa for about eight months until we officially started a full service Med Spa. But that that was my entry into medical esthetics and then from there, ended up partnering with other surgeons and with other non surgical physicians and opened quite a few med spas over the years developing our secret sauce. And I just fell in love with the industry.

Alison Werner 3:28
Oh, great. Well, so then, from there, what led you to create advanced metastatic partners? Why did you see a need for this MSO model? And can you talk a little bit more about what the MSO model is you said it’s that manager of support.

Nicole Chiaramonte 3:41
It really is. And it basically allows somebody who is a non surgeon or non physician to create a, I think the best way to think of it is like a consulting firm, but we’re able to come in with our management services and take care of all the business side of running a medical practice that doctors usually don’t want to have to deal with. We take care of the HR, the IT marketing, overall day to day management, inventory systems, data management, so all of these things that the physicians didn’t get into medicine to do, they got into medicine to care for their patients. So this allows me to take that on and my teams and allow the physicians to do what they love without the headache of the business side of medicine.

Alison Werner 4:27
Okay, and so that then led into a MP.

Nicole Chiaramonte 4:31
It did so about three years ago, I really became aware of how much private equity was looking at this space, and really has been circling they were approaching me on a weekly basis. I actually went down the path twice to sell and both times pulled out in the 11th hour it just didn’t feel right. It was wasn’t that they were bad people. It was just in my gut. I wasn’t confident about it.

I would say it wasn’t competent with who was making the decisions. It was a bunch of MBAs and accountants who were eventually and a board that was going to make decisions related to the clinical aspects of our practices. And that just isn’t the correct way to do things. And I didn’t necessarily feel that I could trust the decisions they’d be making. So AMP was created almost defensively against that I recognize that private equity coming into this industry is going to change the playing field. And so I wanted to have a way to protect my practices and the practices that I had partnered in with,

Unknown Speaker 5:34
against what may be happening because right now, a plastic surgeon and who has a maybe a med spa, non surgical and his surgical practice, is competing against the person across town the same way single owner, we’re making decisions in the same vacuum. And when private equity comes in, it turns everything upside down the end, I wanted to be able to give all the strength to my practices and other practices that private equity can provide. Without the the downside of it.

Alison Werner 6:08
Okay, and so the practices retain their identity on the public facing side.

They do. Yep, and that is something that’s a little different about amp. There are there are different ways that this is done. But we we partner in with practices, realizing that there are good, strong, healthy practices, often with wonderful cultures, we don’t want to mess with any of that, in fact, the reason we partner with them is because they are great practices. But we want what we can do is come in and help optimize them and amplify, if you will. Some of the things that the physicians and the professionalized part of the business haven’t had a chance to do we really bring in high level specialized staff to manage that marketing and the HR and all those other aspects.

Keri Stephens 6:56
Okay, so how is the amp model different from private equity?

Unknown Speaker 7:01
To answer that, you have to understand private equity. Essentially, private equity is a group that comes in, it has investors that are expecting a return on their funds within a very specific period of time. So traditionally, what they’ll do is they’ll come in, they’ll consolidate a huge number of practices, they squeeze out as much profit as possible by squeezing those expense lines. And then they turn around and sell the practices to the next largest private equity group at a profit. And they’re not usually around to have to deal with the mayhem that’s leftover from doing that. It’s not historically been good for practices. So amp was created as the exact alternative and opposite of that, we’re going to bring all of the strength of consolidating, but instead of squeezing out all of the profit by shrinking expenses, and do cutting all over the place, what we’re doing is actually investing into the practices, we invest heavily in marketing and leadership training, and management training. We actually, we’re in the process right now of creating an entire clinical training division, which allows us to really

Nicole Chiaramonte 8:08
promote each of the providers along their career path. So currently, people prior to transaction or partnership, their clinical and medical staff really tops out within those four walls, once we bring amp in all of a sudden their career path is is so much larger, they have the ability to work at a regional management or a training level. They’re able to do the things that they love, and and also mentor other people within the group. So what are some other key benefits to plastic surgeons.

So when we’re partnering with plastics, one of the things that we’re doing is being very careful about who we partner with we’re we’re primarily Med Spa, non surgical, we’re going to be about 20, potentially 25% surgical, but we were creating a hub and spoke model. So and we have a surgical center that we partner with the plastics, you know, we’re looking for somebody who we can continue to grow, we can bring other surgeons and we can grow the plastics revenues for them. But then we are also looking to take the med spas that we have geographically surrounding them, and refer patients to them. And that’s our hub and spoke model. There’s a tremendous referral network that we did successfully prior to amp being founded last year, I was doing that within my own locations. And since amp has been founded, we’ve been able to do that nationwide.

Keri Stephens 9:33
So are there key characteristics of plastic surgeons who are looking for a partnership like this? That you notice

Nicole Chiaramonte 9:39
There are and I think there’s two main groups that we’re looking at right now. One are the the surgeons that are at the end of their career, they think they might have five to 10 years left, and they want to have a succession plan. Essentially, if you are the only revenue generator in your practice when you’re done operating, there is no value to your business.

Nicole Chiaramonte 10:00
So there’s a way for us to come in partner with you create value, allow you to, to really pull some equity out and and then benefit later from the foundation that you have built as a as a plastic surgeon in your practice. The other part is we’re seeing a lot of younger surgeons come in, they see the value of what we can create together, they can pull a little equity out, put some money in their nest egg, and and yet still have a part of this company that is growing exponentially and make more long term with their practice and with this partnership than they would again on their own.

Alison Werner 10:39
What’s the relationship to amp to a plastic surgeon who’s just starting out?

Can they come to you for that managerial support as they’re setting up their practices?

Nicole Chiaramonte 10:51
They can. That’s an excellent question. So if someone is just coming out of their fellowship, and they’re wanting to get started, there’s the option of being hired at an app practice. And then there is the option we have actually spoken with a few providers about helping them set up their practice. And they have the ability to partner in to that practice and into amp by earning into that equity, and the same that way that would in a smaller practice. So there is a path for that. And there’s a few different ways to go about it. So for people who are coming right out of fellowship, and they don’t necessarily want to go to work for a traditional office, there is a way to make that happen. Yes.

Alison Werner 11:32
Because our audience has plastic surgeons, are there any other benefits that you hear from them that they didn’t realize they would experience with this kind of model?

Nicole Chiaramonte 11:39
There are, there’s actually quite a few part of it is not doing it on your own anymore. So we have an incredible group of surgeons already, who have formed our executive surgical committee. And you know, to be able to just pick up the phone and call someone, when you’re an independent practice, you don’t always have that on the clinical level.

To be part of something that’s bigger to be working towards something that is going to ultimately give you more return on your practice than you could do on your own is something that has surprised the surgeons repeatedly. That’s the thing I hear over and over. And the fact that they love how we’re able to come in and just support their staff, their staff starts once they get past the fear factor, which is always the thing, we have to communicate who we are, what we’re going to do and how it affects their staff, once their staff understands this only has an upside for them. There. They’ve been noticing just a recharge of energy and excitement about the practice from their own team members.

Keri Stephens 12:42
So let’s get into specifics. Now. Can you give an example of how working with ANP has helped partner practices scale up their business?

Nicole Chiaramonte 12:49
Absolutely. So I think my first first thing that I love to do when we go in and take a look at practices is see what we can optimize the most, I think the easiest one for us. And it’s easy because we have Drew Fine who has this incredible

history within this industry, he headed marketing for Galderma. And for Allergan, he has done business to business business to consumer and is leading this incredible marketing team. So we’re able to go in, see how we can get that practice busy, optimize what they have at the time. From there, we scale forward with adding new surgeons if it’s appropriate for that location, or making sure the surgeons that are there are completely booked out and optimized in their time, we also open up the non surgical part. And this is a big part of what we’re able to do quickly and effectively, which is to generate that non surgical recurring revenue alongside surgical practices. And we can do that rapidly in a way that the teams love. It’s it’s high energy, a lot of fun, the culture is amazing. And it really adds to the profitability of the practice. And it allows the surgeons to keep a relationship with patients who have come in for a surgery that they might not need another one for a year or a decade or, or two decades, but they’re going to come in for their Botox and their device treatments. So those are some of the fastest ways that we scale. Then the other parts are related to HR, we find that there’s going to be less patient or I’m sorry, employee turnover, once they come in and understand what their career path looks like with AMP.

Alison Werner 14:31
Excellent. Okay. So in your opinion, what are some of the biggest challenges facing plastic surgeons today? And how can they overcome them with this model?

Nicole Chiaramonte 14:40
What we hear over and over the biggest challenge is the human resource part of it, practice practicing medicine, having a really solid team that they can count on that there’s not an attrition level. I think that’s a big challenge for them right now. It’s also the marketing

Aspect bringing new patients in. Again, a lot of plastic surgeons really don’t know what all those analytics reports mean, and is it a good spend, they’re spending a huge amount of money on marketing for very limited results. Those are things that were able to take care of right off the bat.

And then the other part is that you are seeing some consolidation in the markets, and it’s going to move faster, as we saw in Derm, it’s going to move faster in plastics. And for those, it’s not that they’re not going to be successful, I think plastics will always be successful. It’s how much peace of mind you have while you’re building your practice, and how much support you feel that you have when going against private equity backed practices.

Alison Werner 15:42
Can you talk about the importance of staying up to date with the latest advancements and technologies in plastic surgery and how amp helps facilitate this?

Nicole Chiaramonte 15:51
It is incredibly important for every practice to stay up on technologies. Because I think, first and foremost, the safety aspect, the development of new technologies is keeping patients safe and healthy, assisting plastic surgeons in doing their job better with higher levels of efficacy. The other part of this is the fact that patients are looking for the highest level of technology. So we want to make sure that our practices are

outfitted with all of the technology and the training that they they need. And we are also bringing in the highest level of surgeons and our executive committees to make sure that existing plastic surgeons have people to bounce their ideas off of ask questions about if they have challenging cases, they can bring them to them. It’s a it’s a collaboration that just makes us all better.

Keri Stephens 16:45
Great. So what advice do you have for plastic surgeons who are interested in expanding their partner practices through partnerships with companies like amp? And, you know, what question should they be asking you?

Nicole Chiaramonte 16:57
I would say if you’re curious about it, this is the time to go out and see what’s going on in the industry. It’s a time where there’s a tremendous amount of activity going on. So it is an optimal time to look at partnering. i The questions that they need to be asking, are who’s in charge? Who’s making the decisions? How are how are expansion decisions made? Am I going to be able to grow my practice or open a second location?

There’s also financial aspects where like, Where does my equity lie? Am I going to have a piece of only my practice? Or does my equity lie at the top of the organization where I have ownership and all of the practices? Those are really important questions to ask as you explore this process.

Keri Stephens 17:43
Great, I want to get to the future now. So how do you see the future of the plastic surgery industry evolving? You know, specifically in terms of private practices? And what role do you see AMP playing in that evolution?

Nicole Chiaramonte 17:55
I do see plastics going the way of Derm, where there’s going to be a consolidation, it does help the surgeons focus just on surgery and not have to worry about the vast amount of aspects of running a business and a medical practice, that where I see am coming in is for the surgeons who aren’t looking just to sell out and leave. They’re looking for being a part of something that is setting the gold standard in the industry, we’re looking to really create something that if you’re an app certified practice, it means something that patients will start to look for that, because they understand it means that we’re investing not only in the surgeons, but in their staff and the practices and patient outcomes.

Alison Werner 18:38
Before we wrap up. Can you tell us about any exciting new developments or initiatives that amp has in the works for the near future?

Nicole Chiaramonte 18:45
There are so many, as I said, we’re only five months old and growing so quickly. So I can’t give away all the trade secrets. But I would say the thing that I’m most excited about is our training platform, we’re going to be able to train in esthetics, Derm, plastics and in the full gamut of services. So I think bringing together the best of the best in plastic surgeons. And having those roundtables specifically as it relates to surgery is going to be the thing that the surgeons that we partner with should see as the highest value.

And and to be able to set the gold standard in the industry. There really hasn’t been an entire organization that is nationwide that can say this is what the best of the best and best price practices looks like. And that’s what we’re going to be building at amp.

Alison Werner 19:35
Great. Well, Nicole, thank you so much for taking the time to talk to us. If a plastic surgeon or a practice owner is interested in learning more how can they get in touch?

Nicole Chiaramonte 19:44
Oh, you could email info at we ramp W E Or go to WE To learn more about us and reach out through the website.

Alison Werner 19:57
Great well to our audience thanks for listening. Be sure to

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