With a background in nursing and consulting to the health care industry, Rosemary Weiner is well-attuned to the link between health and beauty care and the need for reciprocal relationships with physicians. From the start, her salon, The Brass Rose, has had a policy of referring clients to a doctor when Weiner or her staff thinks it’s in the client’s best interest. “It’s a safe bet to say we in the salon may be the first to notice a potential problem for a client,” Weiner explains. “For example, when we do a skin analysis we send clients immediately to the doctor if we see something that causes us concern. If we’re suspicious of a nail problem our policy is to remove the nails so we can inspect them and send the client to a dermatologist if we think it’s necessary.

“Overall, if we see anything like an infection or if we identify potential circulatory problems, we tell the client she should see a physician,” she continues. “Our computer software allows us to make a note of that recommendation, and we discontinue some services if the client doesn’t follow through. The other area where we make referrals is when clients express interest in holistic health care. We have a nice relationship with a natural health food store, so we’ll send those clients over to speak to the pharmacist there, and he has a nutritionist they can consult: with.”

Weiner knows she’s fortunate: Most physicians in her rural area, nestled in a northwest corner of New Jersey near the Poconos, know her from her previous career and feel comfortable sending their patients to the salon. Likewise, she knows just where to refer clients for almost any kind of medical complaint they have. Most salon owners and nail technicians aren’t that lucky, but that makes their need for establishing referral relationships with a dermatologist and a podiatrist (at a minimum) even greater. Which is why we talked to physicians and nail technicians alike to get their recommendations on how to find a physician, establish a relationship, and make it mutually beneficial in the long run.


Everybody Wins

NAILS has advocated referral relationships since its inception 17 years ago, and the idea finally seems to be one whose time has come, at least from the physician’s perspective.

“I see referral relationships becoming more of a trend because of the managed care environment,” notes Godfrey Mix, D.P.M., a podiatrist in Sacramento, Calif., and co-owner of Footworks in Elk Grove, Calif., with Laura, his wife, who’s also a nail technician. “Doctors are getting more entrepreneurial. I don’t personally promote my podiatry practice to the public because Sacramento is 80% managed care and you have to be in the group to get patients anyway.”

According to Dr. Mix, he, the salon staff, and clients alike benefit from the fact that his wife’s part-time nail business is located in his office. “Basically, we’re helping each other,” he explains. “If our nail professionals have a problem, I’m available to them. If the client has a particularly thick callus, for example, I’ll trim it down. If she has some other, more serious problem, I’ll advise her she needs professional care and make her aware of other podiatrists in the area as well as noting that I’m right here. That makes the client happy and she comes back. My patients, on the other hand, will come for pedicures between their visits to me, and we find they also buy salon gift certificates as gifts. It’s just been beneficial for everyone involved.”

Explains Mitchell Stickler, M.D., a dermatologist and president of Michelle Soignee and Cape Henlopen & Nanticoke Dermatology in Lewes, Del.: “In the HMO environment, physicians are having a hard time attracting patients, and dermatologists and plastic surgeons in particular want clients who have a cosmetic concern because then it’s not tied to medical insurance.” Just collecting payment from an insurance company can absorb as much as 25% of the service fee, Dr. Stickler says.

“The benefit from the doctor’s perspective is getting new patients, which is just a wonderful thing,” says Ivar Roth, D.P.M, M.P.H. In fact Dr. Roth has made a point of developing contacts in the professional salon industry near his practice in Newport Beach, Calif. “We started out by mailing notices to nail technicians that we were here and that we’d be more than happy to see their referrals.”

Next, Dr. Roth had an employee personally make the rounds to salons, handing out his business cards and introducing his practice to nail professionals. As an added touch, he partnered with a pharmaceuticals company to host a dinner seminar for pedicurists where dessert was accompanied by a presentation of foot disorders and a question-and-answer session. Of the dinner seminars, Dr. Roth says technicians benefited from the information he shared, he benefited from the potential referrals, and the clients ultimately benefited from the expert advice and treatment they received from both.

“The advantage for nail technicians of establishing a referral relationship is that it increases client loyalty and allows you to connect your client with someone who recognizes dermatoses of the nail,” adds Susanne Warfield, president and CEO of Paramedical Consultants and the publisher of PCI Journal of Progressive Clinical Insights (Glen Rock, N.J.). “If you’re able to recognize a problem then refer to a physician known to you who can treat it, you gain more credibility with your client.” Even more important, you’re assured that your client has access to a physician knowledgeable about her particular problem rather than a general practitioner who may not be as familiar with the nuances of the various nail diseases and disorders.


“Why” Easier Than “How”

The good news is that medical specialists are more receptive to communicating and doing “business” with salons. The bad news is that nail technicians may be one of the last to benefit. The physicians we spoke to acknowledge that dermatologists in particular are the least affected by managed care on the one hand (because their practice is not generally covered by HMO insurance in the first place), yet they’re also often the most resistant to professional nail services (because in some way they compete for clients/patients and they’ve historically been opposed to artificial nails).


Warfield, who is actively involved with the American Academy of Dermatology, says that not only do many dermatologists discourage patients from artificial nails, they also are concerned with salon sanitation practices. “I think the dermatologist’s concern is whether the nail professional uses sterilized equipment on clients, and whether she can recognize the various things that can happen to the nails because polish covers a lot of things.”

However, nail technician Karol Singleton, who works at Lorie & Kim’s Hair Design in Pinellas Park, Fla., advises technicians not to immediately discount working with dermatologists because of their “anti-artificial” stand. “I have a dermatologist who said he’d be more than happy to share things with me anytime I need,” Singleton notes, adding that she took the easiest and most successful route of finding a dermatologist: She asked her own.

Already under his care, she waited until a regular appointment to discuss her profession and her need for a specialist who could answer her questions and provide informational brochures for her clients, and to whom she could refer clients when necessary.

If you don’t have your own dermatologist or podiatrist to call upon, look to clients as your next best source for recommendations. “As you ask clients who they see, one or two names will start surfacing regularly,” Dr. Mix observes. “Ask those clients about the doctor’s personality and if they know how he feels about professional nail care.”

If you don’t hear one or two names consistently, Warfield and others recommend letting your fingers do the walking through the yellow pages. Dr. Roth says, “You can’t just look in the phone book and see who has the biggest ad. Before you make any phone calls, do your homework. For example, find out if the doctor is board certified, then get references on the ones you narrow down.”

Other potential avenues include your slate and county medical associations, referrals from your family doctor, and even local health fairs. “I met a chiropodist, which in Canada is someone who deals with nail infections and diseases of the hones in the feet, at a health fair for the public in my area,” says Janayre Vaughn, owner of Natural Nail Clare by Janayre in Barrie, Ontario. “We had a long conversation at his booth, which he ended by saying, “You really care about your clients and I think we can work well sending patients to each other.’“

When all else fails, Dr. Mix recommends making them come to you by contacting the local chapter of the state podiatry association (though the advice applies to any specialty) and asking if you can make a presentation on professional nail care and its benefits at the next chapter meeting.


Just Pick Up the Phone

Once you have a few names, there are a number of different strategies you can use to make contact, the simplest and most direct being to call and introduce yourself. This is how Laura Walker, owner of Perfect 10 in Old Saybrook, Conn., established referral relationships with several specialists. “After getting the names, I called and not all of them were interested in talking to me,” she remembers. “But many were willing to see me for 15 minutes. I came with a sheet of questions and when they were open to referrals I went through my questions with them.” With two dermatologists, two podiatrists, and one plastic surgeon that she now can refer clients to, Walker deems her strategy a success.

Singleton took a similar tactic in finding a podiatrist. Emboldened by her dermatologist’s interest, a few weeks later she dropped in to a podiatrist’s office on her way to buy groceries. “I grabbed a card and called him, and he returned my call that day,” she remembers. “I told him what I wanted and he invited me in to his office.”

When Singleton asked how long she should plan for the meeting, the podiatrist told her 4-5 hours. “When I first went in he told me no one had ever called and asked questions like I had or wanted that kind of referral relationship,” she remembers. “He introduced me as an associate to his patients and asked if they minded if I sat in on their visit. He showed me what he was doing, what he was using and why, and what he was trying to attain for the client. He also showed me all the different instruments and how to use them. It’s not that I needed to know how, but he felt that the more I knew, the better able I would be to recognize my clients’ problems and be able to intelligently discuss their problems in referring them to him.”

When calling, Dr. Mix notes that your best chances of catching the doctor or getting a fast return call are at noon or the end of the day because that’s typically when the doctor has a break from patient visits. Another method might be to write a letter introducing yourself and familiarizing the physician with you, the industry, and the issues in professional nail care. For example, Singleton says her dermatologist was not familiar with the use of MMA in some nail products and the effect those products could have on nails. By providing the dermatologist with balanced, non-biased information, you position yourself as a valuable source of information and someone to be trusted.

“Can I Ask You a Few Questions?”

While you may feel lucky to find a doctor who’ll even talk to you, don’t let your enthusiasm overcome your good sense. “Investigate the person,” Warfield asserts. “I think the key thing is that women in the business world need to be clear about what they need. It’s not only a case of you being good enough for the doctor; is the doctor good enough for your clients? You want to make sure that if you’re going to make a referral to the person, he’s going to come through.”

One technician we talked to says that she referred several of her clients to a willing dermatologist, only to later discover he had told them that artificial nails were damaging to their nails and that most salons were unsanitary. Yet another technician told of a dermatologist in her town who routinely diagnoses all nail disorders as fungal infections without doing anything more than a cursory examination.

In your talks with physicians, questions to ask include their interest in and experience with nail disorders (along with examples of previous cases they’ve treated); their position on professional nail care (both manicures and artificial nails); what they look for in a quality salon; their interest in participating in a referral network; and how accessible they would be to answer questions.


Of course, you may have other questions, and your best bet is to write them all down. “I’d also want to know what they tell clients who come to them because of peeling nails, because I think that many people with that problem visit a doctor first. So I’d want to know if they are willing to put those patients on a home-care program or refer them to a manicurist,” says Michelle Conies, owner of The Nail Spa in Silverdale, Wash. “I’d also want to know their pricing structure because I think that’s one of the first questions a client would ask. And what kinds of tests do they run to diagnose disorders? Clients want to know those things, too.”

While many of these questions can be answered over the phone, Dr. Roth and others recommend a face-to-face interview so that you can get a better sense of the person.  “For example, is he or she presentable? How clean is the office? How professional is the office staff?” Dr. Roth asks. Next, Warfield recommends inviting the physician to your salon to tour your facilities and discuss your disinfection and sanitation practices.

When all else fails, though, and you just can’t find a doctor who’s interested, don’t give up. Dr. Mix recommends trying again when you have a real client with a definite need, as some doctors then might be more responsive.

“Have the information you need to talk to the doctor, then call and tell the receptionist that you have a client who needs to see the doctor but that you’d like to talk to him about the particular case,” Dr. Mix advises. “The main thing is that if you have a patient you think needs to be referred, be knowledgeable about her problem and nail diseases and disorders in general so the doctor knows you know what you’re talking about.”

By following up with another call or letter, you may well be able to build a relationship with the physician. Of course, you should also follow-up with the patient alter her first visit to get feedback on the doctor, his recommended course of treatment, and when he thinks she will be able to return for her regular services.


Consider the Possibilities

Even as you work to cover your bases by establishing relationships with specialists to whom you can refer clients for their nail- and skin-related concerns, keep your mind open to the possibilities as some physicians may be open to a more give-and-take relationship. Cross-promotional opportunities abound. For example, Dr. Roth once purchased 10 gift certificates for pedicures that he gave to patients after they recovered from foot surgery. “After a patient recovers and has the bandages removed, the feet can look pretty rough,” he notes. “I think it’s just a nice thing to do for them, and I’m not sure why I haven’t done it in a while.” Perhaps because no one’s reminded him?

“I get patients who ask about seeing a pedicurist for in-between foot care,” he continues, “and I’m happy to give out names and cards. I think there’s a huge potential that’s untapped. And there’s no question that when a pedicurist sends me patients that she’s on my mind.”

Vaughn, too, discusses the symbiotic relationship between podiatrists and pedicurists. “I have a few clients who see the chiropodist every four months, and he’s told me what will help him out in-between their visits to him,” she says. “We’re on the save wavelength and know that our interests are purely in the client’s health. When I see one of his clients, we talk and he’ll tell me things like, ‘Please encourage her to continue using her topical sprays, and keep her nail plate thinned.’ She comes in regularly and I give her encouragement to continue her at-home treatment and the results have been good. Our mutual clients see that we care and want to work with them.”

Footworks takes this partnership to the cutting edge with its location of podiatrist and pedicurist, but Dr. Mix and his wife, while perhaps the only husband-and-wife team, are certainly not the only partners bridging beauty and health.

At Perfect 10, for example, Walker saw her original one-way referral relationship with a plastic surgeon (one of the five doctors she cultivated) become a partnership that eventually led her business in an entirely new direction.

“The plastic surgeon now comes and does seminars and a slide show, answering clients’ questions as he goes through the different procedures,” she notes. “These are services they wouldn’t make an appointment for to learn about but they’ll come to a seminar and we’ll do a free service.” Just the customer appreciation alone was enough for Walker, but she also appreciated it when the plastic surgeon began referring his patients to her salon for body treatments. And when he built a surgical center he invited her to become a part of it.

“It’s a great link, and it all evolved from a nail salon,” says Walker, who is also a licensed esthetician. “I never forget that my client base comes from nails, but with the way the industry has changed ... we just couldn’t survive on $15 manicures. I don’t hard-sell any of my clients on services, but if I’m waxing a client who mentions she hates her cellulite, I’ll share the solutions that I know about.”

Similarly, Weiner noticed a spike in demand for herbal wraps and seaweed body masks several months ago, only to learn that a local chiropractor was referring her patients to the spa for these services. “The chiropractor explained that these detoxifying services are part of her holistic approach,” Weiner explains. “She also sends clients here when her massage therapist is booked, particularly since she found out we’re doing La Stone therapy and Reiki.” She’s found that a few oncologists have referred their cancer patients to her spa for massage therapy, as well. And at least one dermatologist is sending them for facials.

Weiner plans to nurture these referral relationships further by developing a more formal follow-up from her staff to the referring physician in addition to establishing more cross-referral opportunities.

“I think the relationship between salons and doctors will continue to grow closer,” Dr. Mix says. “You’re already seeing it with plastic surgeons and dermatologists seeking out spas. Doctors have to get more people through their medical practice just to maintain the same income they had before, and the more people they can get to help them, the better off they are.” While that perhaps sounds mercenary, Dr. Mix assures us it’s not. “I was in Footworks just yesterday and one of Laura’s clients had a small corn between her toes. I trimmed it out and the client walked out feeling more comfortable than she had in a while. We’re not pushing clients from one side of the aisle to the other. I see this as an alternative to the usual way of practice, and there are more and more doctors out there who are starting to feel this way.”

“Even if I make just one referral a month it’s worth it,” Walker says. “Mine isn’t a big salon, but we’re very personal in what we do. What we have developed may sound quite grandiose, but it’s not. Even if you’re a small salon in a small area (which we are), it’s just a matter of asking your clients who they see and then calling that doctor. For me it really was that simple.”


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