Pharmacy Growth

The Bottom Line Pharmacy Podcast – Building a Competitive Edge

How can an independent pharmacy build a competitive edge in the market by becoming the recommended pharmacy for health care professionals? On this episode of The Bottom Line Pharmacy Podcast, your hosts Bonnie Bond, CPA, and Scotty Sykes, CPA, CFP® are excited to hear Dr. Nicolette Mathey, PharmD, RPh share proven methods to create relationships with doctors and offer services outside of filling prescriptions.

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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If you prefer to read this content, the video transcript is below.

Scotty: Welcome, everybody, to another episode of the Sykes Bottom Line Pharmacy podcast. And today we have the wonderful Nicolette Mathey, wonderful client of ours, and Nicolette, so glad you are here. We saw you at the NCPA show, you had a booth, and of course Jen was there. I love talking to Jen and seeing Jen. She is fantastic. Tell us a little bit about what your experience was at the NCPA show this year.

Nicolette: Yeah, absolutely. Thanks for having me. I love seeing you guys on the road and everything. And of course, we work closely together in both my companies and then even my husband’s fishing company you guys help out with. But.

Scotty: I get in the middle of that one sometimes.

Nicolette: Yeah, I know. I am like, Scotty, tell him he cannot buy a new boat.

Bonnie: Because Scotty is trying to get an invite.

Nicolette: Right, see?

Scotty: Yeah, so Brian would email me a question and I will answer it and then he is like, see Nicolette?

Nicolette: I know.

Scotty: And then I’m in the middle, but.

Nicolette: It’s a mess. No, but NCPA was good. I was like a real worker, there. So, we had a booth for Atrium24, our consulting firm, where we are connecting the dots in your pharmacy’s sales and marketing initiatives, is what we are doing. But the booth was really busy. It is always fun to see all of our pharmacy friends. And I took a bunch of selfies this year because I always kicked myself because I did not take enough pictures with our friends that we see on the road all the time. So, that was good. And then I had a speaking engagement, too. I had an hour-long CE about kind of hiring and compensating a marketing representative for your pharmacy. So, it was good.

Bonnie: We know about stepping up the social campaign. We definitely are trying to do more pictures and videos. Some that I was a little embarrassed that we were part of. I am not sure if you saw us doing some strange things in the walkway of the trade show this year.

Nicolette: Yeah, I have been seeing all your posts. I like it. I like anything kind of more, just normal and relatable I think, is nice. Even if…

Bonnie: Yeah. Trying to be a little more personable.

Nicolette: Yeah.

Scotty: Definitely outside of my comfort zone, some of the stuff we were doing.

Bonnie: Really?

Scotty: Oh yeah. I do not think it is going to make the cut.

Bonnie: It may not be released to the public. We have not decided.

Nicolette: Yeah, come on, who cares.

Scotty: But we did a bunch of vendor highlights. Did we get Nicolette on there? I have not seen them all yet.

Bonnie: I have not gone through them all yet.

Scotty: I do not know if we have Nicolette on there.

Nicolette: Well, I know anytime I… because I make a lot of videos or even if I am out doctor detailing, I will take a lot of selfie videos in my car, like reflection videos where I just talk and anytime I question like, “Oh, should I publish that?” or “That is embarrassing,” I say, “Yes.” I just.

Scotty: Just do it.

Bonnie: Just do it.

Nicolette: Because everybody is learning, every day. Everybody is making mistakes, every day. Everybody is saying like, “Oh, next time I will be better at that.” Or… and I think that is what is engaging now: things that maybe are not so polished.

Scotty: It is kind of being more just yourself, I guess. So, people really are attracted to that. But you know, so you did marketing in the pharmacy, so you got advertising, you got marketing. I guess there is a difference there to some degree. And what is your… I mean you hear about doctor detailing all the time and I do not think a lot of pharmacies are doing much of this at all. So, there is a huge opportunity, I think, in pharmacy for this area. But kind of explain what you were talking about in that talk.

Nicolette: Yeah, there were two important distinctions that I made probably just even in my own mind and in my own pharmacy. Two important distinctions recently, like within the last year. And the first distinction is you have perhaps different departments in your pharmacy. You have your workflow and operations as a department and of course that is essential to the pharmacy business. And we are all pretty good at that. And there is a ton of software companies, dashboards, analytics, even consulting about…

Scotty: Automation.

Nicolette: Your operations. Yeah, all the automation, the inventory, compliance, accounting, all that stuff. So there is that. But then we also have to look at, there is another department in your business, which is your sales and marketing. And when I tell pharmacies that, and I say, “So, who works in your sales and marketing division?” Or “How much…what is the budget for sales and marketing?” or “How much effort do you, as the owner — if you do not have anyone in it, how much effort do you put towards sales and marketing?” And I get a lot of blank stares. And I anticipate that because we have to think of it that way. You know, like somebody has to feed the beast. Somebody has to be like bringing the business in that we want.

So, that is one important distinction. And then the other one really is… marketing. So, then we say, okay, sales and marketing, I need to do marketing. What is that? That is just so nebulous. Like it is not tangible. What do I do? Well, there is digital marketing, which perhaps is what we all think about. Like, “Oh, who can I pay? Who can I pay to do my marketing?” Right? You could pay people to do your digital marketing and I have strong opinions about that whole aspect. But.

Scotty: You mean like social media posts and all that good stuff?

Nicolette: Yeah, yeah. Social media, website, SEO, blogs, all that stuff is digital marketing and it is super important and we invest a ton in that here in my pharmacy. And there are companies that are pharmacy-specific and all that who do that. But what about your physical marketing? So, sales and marketing is usually lacking in independent pharmacies and then specifically physical marketing is lacking. And that is someone from your organization has to go out into the streets and talk to people.

Scotty: Knock on doors.

Bonnie: Absolutely. And build the relationships for sure.

Nicolette: It is so important. And it does not have to be perfect. It does not have to be overcomplicated, it does not even have to cost you anything. So, just getting out there, but it is so uncomfortable, which I understand. I have plenty of selfie videos in my car that I have not even shared with you all yet. Maybe I am defeated, you know, I got back in the car and they totally blew me off or, but whatever. It is getting out there and it is the consistency. And then at Atrium, I have really, in the past, well we just turned three last month. So, in the past three years, it has just become so apparent that, you know, because I consult all around and I used to work for the big firm and everything, but it has become so apparent in these past three years that is what pharmacies really need help with. And that is where we can really help them.

So I have hired… Jen is a true pharma rep. She is Eli Lilly. And then we have Brian. Brian is a pharma rep and he has even been a rep manager for regional pharmaceutical companies and stuff. So, he is on board now as our rep manager.

And then we have a rep, Lisa, who is an independent pharmacy rep. And she is an old ex pharma. We have David. So, we have reps in a few different states now. And we have a whole initiative where Atrium is actually hiring them, training them on our process and our strategy for how to rep. But that is probably one side of the spectrum. And that is expensive. I mean, if you want to hire a real rep, a true ringer rep and they are professional and that is what they do, that could be expensive. But then on the other side of the spectrum, maybe the owner just has to get out one day a week or one day every other week. And just like you said, knock on doors and really ask questions. Just introduce themselves and ask questions.

Bonnie: And Nicolette, I work a lot with many startups. That is primarily what I do, and transitional pharmacies. But that is something that we preach a lot and it is shocking to me that so many do not do that right out of the gate. So, you start your new pharmacy and sometimes these people are not known in their community at all. Like, they did not grow up there or purchase a store there- – that people already know them. So, I think it is just, you make a good point. It is so important. And I would…I am just interested. So, you talk about sometimes being turned away, but is that really the norm or do you find that people, doctors or offices, are pretty accepting to spend a few minutes with you?

Nicolette: That is a good question. And you never know what you are going to get, but you know, you are coming in on them. They might be having a bad day, they might be super busy. So, you can imagine when we tell pharmacy owners or you know, we consult too with Atrium. We have like monthly consulting and there are certain tiers where they can call us, text us, email us — all this anytime. And we make all their marketing materials and we coach them. They call us all the time when they are in the parking lot and they are like, “What am I saying?” Or I had a rep yesterday and they are like, “In this compound, what is this ingredient for? I’m at this ENT office,” and I had to explain it all to them. So, with that, you can just imagine how many questions there are, but we pharmacists tend to get like way too granular and complicate things way too much. We overanalyze everything to death. It is just part of the job. But if you go into an office unannounced, what Jen teaches all of us is walk in, read the room, see what is going on, see how busy.

Bonnie: Read the room. I love that term. Yeah. Look around and see if it looks terrible. If there is a fire going on, it is not a good time. Come back another time.

Nicolette: If someone came into your pharmacy and it was, the wheels were falling off and you like, “Oh my gosh, I don’t have… no!” So, read the room, see how busy the waiting room is. If they seem really busy, Jen will just go up to the front desk, and is like, “Hey, I am Jen from Home Harbor Pharmacy. I was just in your area, wanted to pop in and introduce myself. I can see you are super busy. So, are there better days of the week that you guys see reps?” Because some of them have policies. “We only see reps on Tuesdays and Thursdays” or whatever. There are certain times, certain days they do not see reps. Certain days the doctors are in surgery.

So, you have to, just kind of go and introduce yourselves. Just say like, “Hey, oh I see. Ooh, ooh, you’re having a day, I am going to come back. What day is best for you? I am just going to pop in. Is there a certain day or time I should?” You know, so they appreciate that. And then you just leave. You do not even… but you note it down. So, we use a CRM and we actually have a custom-built CRM for Atrium, for doctor detailing, for pharmacies. It is really cool. But just however, even if you have to use a legal pad, just organize yourself so that you do not forget what you just learned. But when you do go in and it seems pretty chill and the waiting room is not full and the receptionist or whomever seems friendly enough, Jen will a lot of times just walk in and say, “Hey, it is Jen from Home Harbor Pharmacy, I am just stopping in. Can I talk with your doc for a minute?” You know, she kind of assumes she is supposed to be there or assumes that they will talk to her. You have to have confidence. If you come in timid and you act like they are going to tell you no…

Bonnie: You ask, yeah.

Scotty: And you never know. I mean, you never know what can come out of that, right? I mean you could get completely shut down or you could hit a gold mine right there.

Nicolette: Yeah. And different things happen. Jen and I are actually putting together a CE presentation for next year and I just loaded all the 2023 events in the Atrium industry calendar, yesterday.

Bonnie: I saw that last night. I made some notes myself of all the trade shows that are coming up next year and the locations. I was like, “Oh, she has got this all right here for us.”

Nicolette: Yeah because it frustrates me because I can never find it. So, I want to start putting all the state associations and everything in there, too. And all the buying groups and all the smaller wholesalers. I want to put all those shows in there. So, if anybody knows of any, let me know and I will put it on the industry calendar. But we are working on a CE for next year, perhaps like a… what to say when you go on a doctor detailing visit.

Bonnie: Yeah, that is awesome.

Nicolette: Yeah, it is not obvious.

Scotty: And I imagine, like you said, I mean when you go is probably a big key as well. Is there a particular, I mean is it afternoon, like right before things are winding down or?

Nicolette: Yeah.

Scotty: I mean what do you typically see?

Nicolette: Yeah, definitely not Mondays. That is not a good detailing day. Fridays are typically not a good detailing day. A lot of them will have half days, but every office is different. And then you will have… we work with a ton of podiatrists here and they have multiple clinics, so different doctors will go to different clinics on different days, too. So, it is a whole thing. You have to know… you have to do your research, take your notes do a lot of online research to see who is where. And then two: you have to see what group practice they are with. I was out visiting GI doctors a week or two ago and so many of them have been bought up by like Florida Gastro or something. So, they have 50-something providers now because they just keep buying everybody up. So, I would go to a clinic and I did not realize they were part of Florida Gastro and they have their own pharmacy. And then… but I just tell them, once I realize it is Florida Gastro and I am already there, I just tell them, and that might not be exactly the name of it, I do not remember, but I will just tell them, “Hey, I know you have your own pharmacy. I just wanted to introduce myself. I own the pharmacy down the street. If there is anything that your pharmacy does not do or that you are sending your patients online to buy, I am nearby and I am happy to work with you guys and keep anything you want in stock so your patients can just come get it, same-day.”

Scotty: So, once you get in the door though, what is the strategy there? What are you looking to do necessarily?

Nicolette: So, you kind of like walk in, read the room, assume that you can talk to the doctor. Like, “Hey, can I talk to your doc for just a minute, even in the hallway?” And sometimes they will say yes, sometimes they say, “Oh no, he is with patients or he is busy.” So, we will say, “Okay, is the office manager available? I just have a couple quick questions.” “No, they are whatever.” Or sometimes they will go check and they will come back; they will say, “No.” Or, “Oh, gimme your card.” They will go back, “No.” “Okay, well is the doctor’s nurse here?” You know. “It will just take a minute.” Then sometimes they will just tell you, no, no, no. So, you will just have to tell who is ever at the front desk, just what you are trying to do. So, you just tell them, you know, if you brought anything… a lot of times I will bring — I am going to post a video about it tomorrow, I think a car selfie video. But I will bring like a thing of chocolates with some like pharmacy-themed ribbon on it and a little like brown craft paper bag with some pharmacy pens and branded sticky pads, mints.

Bonnie: I hear a lot about donuts, but I do not know if that works or not.

Nicolette: You know, surprisingly it does.

Bonnie: It may get you past the front desk.

Nicolette: Their attitudes seem to change drastically. And I will walk in and I have like a $9 thing of like fancy chocolates, you know, within the team. My team will put like the pharmacy sticker on it and the ribbon and all that. And I will walk in and I will have my little tote bag with my folders and my craft bags and my chocolates. And when I start asking at the front desk, you know, “Who can I talk to?” “Who can I see?” And they start blowing me off and I say, “Well that is okay, I am sure you guys are busy. Let me just leave this little goody with you that the girls put together.” And then like their face lights up.

Scotty: You bring food, it changes everything.

Bonnie: Changes the whole game.

Scotty: Especially some sweets.

Nicolette: I know, I know. We love sweets at the pharmacy. I get so mad,

Scotty: Who does not?

Nicolette: I know because I pack this healthy lunch and then like one o’clock I am like, “Okay.”

Bonnie: Somebody brings something in.

Nicolette: What is happening.

Scotty: The box of chocolates. But when you go to a doctor, you are there for a reason. It is a particular compound or something you have in particular to…that is very maybe profitable for the pharmacy that you are trying to achieve there?

Nicolette: We do. So, that is my job at Atrium as the clinical analyst. Because we can make this as complicated as we want to. Right. And that is my job to like really dig in and say like, “Okay, if you can curate an opportunity to be in front of a GI doctor in your area, exactly what is the most profitable way that you can work with them?” Of course, while helping patients and helping them and like solving all these needs. But you are never going to solve all the needs for all the providers in your area. So, you might as well, if you are going out and targeting certain business, you might as well target stuff that you want; stuff that is going to be potentially profitable for you, I say.

So, at Atrium, we have about 25 to 30 different physician-specialty programs and GI for example, I’ll pick on. We make sell sheets for the doctor. So, it is kind of a nice leave behind for you and it gives your messaging, like it tells all the conditions that you can help with all the types of custom compounds you make. Even like DME, over the counter, wound care, supplements, all the different things that you can do for that type of office.

Scotty Sykes: That is neat.

Bonnie: That is good.

Nicolette: And that takes a long time, not only clinically, but what wording are we putting on here, or whatever. And I even work with big compounding companies, with their clinical departments, to ask them, “What are your most commonly downloaded formulas for this specialty or for this one?” So, we have really good relationships there throughout the compounding community and we are always tweaking it. But then on the regular PBM prescription side, we have a data analytics program where I am able to analyze the dispensing data from over 200 pharmacies, right now, every night. So, I can see what is potentially profitable.

And then when I look at it, I look at perhaps therapeutic categories and I will kind of break down. So, when I go in to do some clinical research… and we have another clinical pharmacist, Annie, who works with us here at Atrium, too, because it is just too much for me to do anymore, and then do all the business stuff. But we look at the data set, we look at all the compound databases, we have our pharma reps where we are like, all right, help us put together the sell sheets, like what messaging is actually going to resonate. We take all that information and then we are like, okay, this is what we should put in a GI marketing packet. And then, so we have like 25 to 30 different packets for like podiatry, GI, cosmetic surgery, pain management, PCP, all kinds of the different… dentistry, orthodontics, all the things you can imagine.

And then for our premier members at Atrium, we custom brand all those pieces for their pharmacies. They are in the portal. So, literally all these pharmacies have to do, I tell them like, “Let’s say you are out and about in town and you meet at your kid’s ballgame. You meet like someone who works at the surgery center, well you should be able to go back to your pharmacy, print out that packet that is already branded for your store, put it in a folder and go.” Because that stuff takes way too long. Like, “Oh, now I have an opportunity, now I have to go back and figure out what I want to tell them.”

Scotty: And once you get in the door like that with a provider, I mean you have pretty much sealed that relationship, so to speak. I mean, you have to keep nurturing that relationship, but once you are in, you are in, right?

Nicolette: Yeah. You just have to do a good job. And, of course, once someone local in your community experiences the difference that your pharmacy provides, then yeah, I mean they are like, “Oh, I would never go back to just blindly sending my patients to a chain where they do not get taken care of properly or whatever.” But then it just comes down to consistency. So, that is in your CRM and like pharma reps, they will have their A list, their B list, their C list and like the A list are ones that they are kind of maybe visiting every single week and they are working on and they are trying to maybe prove themselves or get the attention. The B list, they do not need as much attention. You know, you can just pop in once a month instead of once a week or whatever. And then your C list, either they are not being responsive, but you do not want to abandon them completely. So, you even go maybe a little less frequently. Or maybe they are just doing well and they are kind of on autopilot. But like you said, you do not want to completely forget about them. So, you have to pop in every now and then.

Bonnie: That is really interesting. So, you know, I have always considered the relationship part, but it sounds like just as you know, the other half of it really is the research of figuring out what those… what the need is, what is profitable and what you know you can do to help. So, that is a big part of it.

Nicolette: Yeah, it is both, really. And our goal is for our pharmacies to focus on the relationships because that is hard and I cannot, no one can do that for you.

Bonnie: Right, but that person.

Nicolette: But if we have everything ready on the back end, you know, like we say, “Atrium is like your back office on your sales and marketing,” like we will make sure that you have really nice, sharp, strong branding. Quite a few pharmacies now who come on with us, we do a complete rebrand for them.

Scotty: Do you do that or do you outsource that to somebody?

Nicolette: We have graphic design. We do it, yeah.

Scotty: Oh, that is cool.

Nicolette: Yeah, because it is necessary. So, we are like, you know, they come in, no offense, thousands of pharmacies around the country, but they come in with their clip art, boring pencil logo.

Scotty: Yeah.

Bonnie: We know about that.

Scotty: The old classic clip art. Oh yeah, we have had experience with that.

Bonnie: We have been working on a rebrand ourselves and man, that first stage is nothing but clip art.

Nicolette: Yep, and then… so, they are like, “Oh, here, brand all your packets with this.” And we are like, “Ooh,” we are like, “Since we are just jumping in and getting started, do you want to refresh this? Do you want to…” and that is a lot of fun, actually. We did a rebrand for a pharmacy in North Carolina, and they are wonderful to work with, and they love the rebrand so much. And they were also going through a remodel at the same time that they came on with Atrium. So, they have done an entire rebrand. They have a ton of like clinical and functional medicine forms, but you know, it was stuff they had made over years or whatever.

So, it was just Word and it was not formatted all very well. It was very strong clinically, and it served its purpose. But we were like, you know, “Let’s breathe your new brand into all this stuff.” And they got new shirts embroidered with the new logo and the whole branding scheme. They got a new sign put out front, they got everything remodeled. So, now they went from a mom and pop-looking, good, smart people organization. And now they went to like Amazon branding or something, you know, real strong brand. Yeah.

Scotty: And that makes a big difference.

Bonnie & Nicolette: It does.

Nicolette: And especially when you are going to go out marketing and you can present yourself with that brand, but then with all that strong content and special programming in the back, it matters.

Scotty: It matters to the team. I mean the team is on board and then the… you look professional on the outside. Go ahead, Bonnie.

Bonnie: Well, I was going to say, this just hit me as a little off topic, but you know what this reminds me of, this whole process? When we first got started in pharmacy accounting, this is basically what Scotty did for like a year, about 10 or 12 years ago.

Scotty: What, knocking on doors?

Bonnie: Knocking on doors,

Scotty: Yeah, I did.

Bonnie: Going around all the pharmacies and just walking in.

Scotty: Yeah, I went to Virginia, North Carolina and South Carolina, knocking on pharmacy’s doors and you know, introducing Sykes & Company, P.A. So, I have doctor detailed accounting.

Bonnie: You have, it just hit me. I am like, you have done this work.

Scotty: And I got shut down all the time. But I had some success as well. And I noticed one time I was, I had a whole day of visiting pharmacies and I looked down at my feet at the end of the day. I had two different shoes on the whole time.

Bonnie & Nicolette: Oh no.

Scotty: So, but yeah, I have been there, done that. It is… I like doing that kind of stuff. So, it was fine with me. But Nicolette, what about those pharmacies in the rural areas that there are not a lot of providers, you know, they may be the only provider in their communities. How does, what do you say to folks in those situations?

Nicolette: We work with a lot of rural pharmacies and it is interesting. You are right. Because when I talk to them, they are like, “Oh, we have two nurse practitioners and one doctor in town and we already know them. We already work with them and we do not have…” They are not going to utilize our cosmetic surgery program or any thing like that. They are like, “We do not have all these specialists.”

But I tell them, “I do not care if you are selling hats or you are selling pizzas or whatever you are selling, you have to put a marketing strategy behind it. And you have to determine who your buyer is, your consumer. So, do you want to sell stuff and like work with local businesses? Do you want to start doing vaccines and screenings in like local factories? Do you want to work with the schools?” Like what, because you have a business, you have to grow, you have to stop just doing like a high volume, low margin prescription dispensing.

So, what can you make money on? You want to sell hats? Like let’s sell hats. It does not matter. And they, once we dig in, they do a lot between their vaccine programs, between their diabetic shoes, their nutrient depletion, diabetes education. They do a lot of different things. They do more in rural pharmacies than they give themselves credit for.

Scotty: So, it is more along the lines of finding that area that is profitable for them, that they enjoy doing, that fits their community. And really running with that, with the marketing program behind it, and growing that area.

Nicolette: Yep. Yeah. We say, “What can you do that aligns with, you know, your patients, your payers, your providers and your passions?”

Bonnie: Yeah, we get that question a lot. People, you know, they want to know what are other people doing and we can give that information. But I think what I am hearing you say is you really have to figure out your particular community. Like you said, it could be hats, it could be something completely random that is very different from what works for someone else.

Scotty: Sometimes those T-shirts can fly off the shelf. I am telling you, with the right rebrand or the right logo.

Nicolette: Right. You never know. Boutiques: a lot of pharmacies do gifts and boutiques and you know, a lot of people in pharmacy consulting kind of poo poo that. But those are really good margins.

Scotty: Oh, yeah.

Bonnie: It works.

Nicolette: Yeah, I know in our pharmacy we have a really strong DME rental program. So, we rent knee scooters and wheelchairs and we rent some walkers. But the knee scooter rental program has been huge. I want to say we charge like a $50 deposit and then $35 a week with a two-week minimum. And we just keep running out of knee scooters. We keep having to order more and the team will, when they get them back, they will sanitize them and tune them all up. And I, we have a 19-year-old clerk, and he will ride it all around. I guess he fell off the other day. I am like, can you sign a waiver before you do these things?

But that is a great thing to market, too. When I go to all the local podiatry clinics, if I find out that they are a podiatric surgeon, I will let them know about our rental program. Like, “Oh, you are doing surgery on people’s feet. We have this knee scooter rental program. They are like, “Oh, that is fantastic to know. Because I just tell them to go buy one on Amazon.” Like no, we have a rental program.

Bonnie: Yeah that’s great.

Scotty: Make a big difference. And what else are you seeing out there in the marketplace these days, Nicolette?

Nicolette: You know, I am a big fan of opportunity and I mean I think that is why we all like getting together at these trade shows because you usually do not plan what ideas you are going to come home with, right? It just happens. So, you have to put yourself out there in those situations. You have to go to dinner with folks at these shows. You have to talk to people who you may not know that well and you have to ask them a lot of questions. So, I can be awkward sometimes and not ask people questions because I do not want to be too personal. But it is funny. Jen… it is a verb now. I am like, go Jen Rolewski them. Which means ask them all the questions, she would get all…

Scotty: There is not a filter there.

Nicolette: No, but she is so genuine. She will just ask them.

Scotty: She is great.

Nicolette: You know, maybe it is the New York from her or something. Just ask them all these questions about all of this. Or, you ever know if somebody tells you something kind of weird and I will just look at them like I do not know if that is a joke or I am not really going to unpack that, Jen will dive right in. “What do you mean? What do you mean you broke your rib? How did you break your rib?” “X-ray over here?” “Did you wrap it over there? “What do you do?” “Does it hurt when you breathe in like this?” “Does it…” I am like, “Jen.”

Scotty: Jen’s the one when you get the airdrop on the airplane. She is like, “You got to open it.”

Nicolette: Oh my gosh, yeah. I am like, “Nope, I am not digging into that rabbit hole.” If you… you do not open this airdrop on the plane. Who even are you?

Bonnie: By the way, I thought about you, that specific thing. We made some, again, some weird out-of-our-comfort-zone social media videos while we were gone. And one of those, we were attempting one night, it was late in the lobby of the hotel, we were trying to airdrop it to all the pharmacists that were sitting in there. There were a lot of brave souls that would just accept those things.

Nicolette: That is actually a good idea. I am here at a trade show. Just airdrop your whole marketing message to everybody. All the unsuspected.

Scotty: Are you talking about the COVID video?

Bonnie: Yeah, the COVID video.

Scotty: Lord. We will just, nobody else needs to see that. Yeah.

Bonnie: It may make it one day we will see.

Nicolette: Well you got to send it to me.

Bonnie: We will send that to you. When we get off.

Scotty: You might like it. It might fit your marketing. I do not know, you might be able to put it somewhere.

Nicolette: Hey man, I’ll take a look. But just yesterday I had a client call me and it is funny now my clients anymore, the ones that we work the most closely with, with one-on-one consulting, I will talk to them the whole way home because I am Eastern time. So, a lot of consulting, you guys, it might be the same thing. They do not really call you ’til the end of the day because they got all their stuff done and they are like, “Oh, now I need to call about this marketing thing or ask about this new idea ahead or whatever.”

So, I am Eastern, so I have clients in every different time zone. So, they will be calling me, I am pulling my car in the garage, I am coming in the house, all my kids are yelling all my this. And they do not miss a beat. They are just telling me all about their ideas and their things and okay, we will keep talking about it. But yesterday, so it was that same thing. I am pulling in the garage, I am coming in the house, I am putting them on mute to yell at the kids to tell them what to do. And he said that he went to an ENT office and he was marketing, but then he determined that they were doing a lot of different things in there because one of the nurses gave him a tour all around.

And that is the best thing, if you get just kind of a captive audience and you are asking them questions. People do love talking about themselves or talking about their passions. So, she is giving him a tour all around and he sees that they have an IV room, so like with the recliners and the IV poles and IV drips. And so he started asking about… “Oh, I thought you guys were ENT?” She is like, “Ah, we were, but really the money is in functional medicine.” And just like the infrared saunas and all the different things like this that certain markets can get into. But this person said that they are making, like sometimes with all their IV chairs, they are making like $15,000 a day.

Bonnie: Wow. In IV-drip therapy.

Nicolette: So.

Scotty: Yeah, IV’s a hot area.

Bonnie: That’s becoming big. Yep.

Nicolette: It is. But then you know what, because I like, I like all those things. I like nice things and so I was like, because I take all the vitamins and I do all the tests and I like all to know all the health stuff. But I was like, but I have never gotten an IV vitamin drip. But I mean would you, so if it was accessible and it was in a nice thing, would you go get an IV vitamin drip?

Scotty: I guess if the doctor told me I needed it.

Bonnie: I guess if our pharmacist friend, Nicolette, told us it was a good idea and it was safe.

Nicolette: Yeah, well it is definitely safe. I just wonder are you going to feel it? Are you going to feel a difference? I mean maybe if you are hungover or something and you get kind of like a banana bag kind of thing.

Scotty: I hear those work miracles.

Bonnie: Yeah, we have been seeing those in Vegas for years.

Scotty: Yeah.

Nicolette: Right.

Bonnie: For breakfast.

Scotty: You will be eating breakfast, there will be somebody rolling around an IV drip.

Bonnie: An IV pole, yep.

Nicolette: Yeah, like I will get all my vaccines. I just got my flu shot recently and it does not bother me. I do not mind, I do not like it. But I do not know… IV vitamins.

Scotty: I mean some people do not like the needles and stuff so like, I do not know.

Nicolette: There are a lot of people that do not like needles.

Scotty: In the right market, I am sure it can work.

Nicolette: See, but I have a doctor friend, like I mentioned to you, coming into this office. So, we are moving some stuff around and he is going to come in and start a weight loss clinic. He does his own concierge clinic. And it is funny, I have known him for over 20 years. He used to be my PCP and he is kind of an odd duck and I mean that in the nicest way possible. He just does his own thing. He has got like long hair and he plays the guitar and he is just… I like it because he does not conform.

Scotty: What is a weight loss clinic? Like what is, well what do they do?

Nicolette: And he used to do weight loss clinics in his old practice before he sold it to a big group. And then he was like, “Ah, I do not want to do this.” But you essentially have like a book or a plan that just teaches your patients about just proper nutrition. Sugars: a lot of times you do not know about all the hidden sugars in fruits. A lot of times you might want to start with like a cleanse period, like a five-day, getting into ketosis, to kind of like ramp your body and your metabolism up. You might want to take like a calcium pyruvate supplement. You will need to get an EKG. You will need to get some initial blood work and just make sure that everything is addressed. And so you do need a doctor to do it. And then so you come in for your initial consult, you get your blood work done, you get your EKG done, you have your consultation so that the provider can learn about what your goals are for weight loss or what you have tried in the past, what your health conditions are, things like that.

And then they will go over the diet plan and all this and what you are supposed to do in the first week. And they will give you injections like an MIC injection or like a fat burner injection. Which sounds very technical but it is usually just a combination of B vitamins. But it does give patients energy so they, you know… and you do a weigh in, of course. And they have some really fancy scales out there now, which I love because it will tell you like just all these different percentages and how much muscle you need to gain and how much fat you need to lose and it will just break down everything, take your measurements, do all that kind of thing. So, that is the initial consult. It is all cash, too, which I love.

Scotty: Yep, oh yeah.

Bonnie: It is always good.

Scotty: Cash, cash, cash.

Nicolette: And then you can either sign them up, depending on how you have developed your program, you can sign them up for a 12-week program where they come in every week. You can charge them just weekly to come in and have their weigh in and their MIC injections. The problem is, and my doctor is not too happy about this, but a lot of patients expect phentermine or they expect the diet pill, like the appetite suppressant prescription and he does not like it. It stops working after a while. And I mean it is a little bit of a crutch, but patients love phentermine if they are trying to lose weight. So, we are talking about that. He might prescribe a little bit of it.

Scotty: That is kind of the whole point of the weight loss clinic. You have to…

Nicolette: The part that really works though is the education about nutrition and then the accountability.

Bonnie: The accountability.

Scotty: That is what I was going to say because nutrition is… the average person has no idea about nutrition. I mean, we just do not. I mean I do not know anything about nutrition so.

Nicolette: I thought I did, but I really did not. Because I did one of these weight loss programs myself earlier this year. I think I lost like 10 or 15 pounds but my husband did it and so he cannot even look at a carb, poor thing. He is just a big, solid guy. So, he does really well if he goes on like kind of a keto program and if he, but he cannot be just running around eating snacks. So, we did this weight loss program with the local renowned doctor in town with all the billboards and all the program and all the thing. I really just, I mean I was eating too many, a little too many snacks, you know, after the pandemic so I could lose a little fluff.

Scotty Sykes: Can’t we all.

Nicolette: Yeah. But I really wanted to learn about the program. So, what does the visit entail? What equipment do they need? What supplements are they pushing? And I learned a lot about it and so I have been, throughout the year, kind of convincing my physician friend to come in and we will start our own clinic. Because on the pharmacy side, I am like, “Okay, let’s get some healthy snacks.” Like the Kehe, K-E-H-E, distributors is a big one and I know Michael Nunez in Texas has kind of this model that I really like. I have been talking with him quite a bit. So, all this kind of stuff is fun. You know like, let’s start a program and let’s make our patients healthier and let’s become a destination for some fun cash business.

Scotty: Wellness.

Bonnie: Something other than filling a script, you have to do something else.

Nicolette: Yeah.

Scotty: It is wellness so it is…

Nicolette: Prescriptions and we will help them. But imagine if you could have a patient like lose 20 pounds, they might be able to get off of a lot of medications and you could start de-prescribing. If I sell them a bottle of vitamins once a month, I will probably make more money than filling six of their scripts and they will be a heck of a lot healthier for it.

Scotty: And they are probably going to be taking a lot more than one vitamin.

Nicolette: Oh yeah.

Scotty: Two or three.

Nicolette: I love vitamins. Too much. Well you have to take a probiotic all the time. B vitamins, magnesium, maybe a multi, maybe a fish oil. Like there are a lot of vitamins that we should all be taking every day.

Scotty: But Nicolette. So, I guess we are coming up on our hour here. Appreciate you obviously getting on with us today. Always glad to have you on and we always end the podcast here with the bottom line, obviously the Bottom Line Pharmacy podcast, here. So, what would be your bottom line for our listeners out there today?

Nicolette: Well, I could sing it for you like Kendell does do that because I know he likes to get on there.

Scotty: Kendell is actually on vacation so.

Bonnie: Yeah, we missed him today.

Scotty: He hated to miss this one, but…

Nicolette: I mean I could fill in, I do not know, but I will spare you.

Scotty: Yeah, there we go.

Nicolette: Bottom line. I would say you do more in your business than you give yourself credit for. You do, you really do. If you start listing out all the things that show up on your P&L as income, you do a lot of different things and probably the people in town do not know that you do that. So, without over-complicating it, I would just go out and try to go on like three detail visits in the next week. You do not even have to bring anything with you. Just bottom line: go introduce yourself, give them your business card and just ask when would be a good time for you to come back and follow up. And that is how you start.

Scotty: Awesome. And a box of donuts can help. So, that will be my bottom line on that.

Nicolette: Yeah, why not?

Bonnie: Somebody will eat them, I guarantee. That would be my bottom line: someone will eat the food, the donuts, the snacks. So, maybe when you come back the second time, they will let you in a little bit further into the office.

Nicolette: Yep, exactly.

Bonnie: No, but really what I have learned today is how important the research is. I mean I knew about the contact and the detailing and how important that was, but to know your community and know what is needed and what is lacking, maybe, is huge.

Scotty: And get outside of just filling those scripts.

Nicolette: Absolutely.

Scotty: Yep. Well thanks, Nicolette again, appreciate you coming on and we are going to have to have you back because you are one of our rockstars.

Bonnie: So many things to talk about with Nicolette.

Scotty: I know. All right. Thank you all for listening and until next time we will see you again. Thanks.


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