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an A to Z Checklist


Key Considerations for Opening and Maintaining a Successful Anti-Aging Clinic: An A to Z Checklist By Robert M. Goldman, M.D., Ph.D., D.O., FAASP and Ronald M. Klatz, M.D., D.O. Robert M. Goldman, M.D., Ph.D., D.O., FAASP and Ronald M. Klatz, M.D., D.O. are the physician co-founders of the anti-aging medical movement and serve as Chairman and President, respectively, of the American Academy of Anti-Aging Medicine (A4M; Chicago, IL USA;, a nonprofit medical organization dedicated to the advancement of technology to detect, prevent, and treat aging related disease and to promote research into methods to retard and optimize the human aging process. Visit the A4M's World Health Network website, at, to learn more about the organization and its educational endeavors. INTRODUCTION The elderly population in the US will double in size over the next quarter-century, as Baby Boomers reach retirement age. Eight in ten Americans will be age 65 or over by the year 2025. Today, Boomers now represent 28% of the U.S. population and are the largest single sustained growth of the population in the history of the United States. Their mass alone has had an enormous impact on the national psyche, political arena and social fabric. By many measures, the Baby Boomer generation has redefined every life-cycle stage as they pass through it. In the 1960s and 1970s, they created a youth culture of rock n' rollers and hippies, who grew up to become the young urban professionals of the 1980s. As a group, today's fifty-somethings control 70% of the wealth in the U.S., own 77% of the financial assets, represent 66% of stockholders, and own 80% of the money in savings and loans. As the oldest of the Baby Boomers approaches later adulthood, they are again poised to redefine the next life stage – retirement. The Baby Boomers embody a seemingly universal yearn to retain their lean and mean mental and physical stature, and with each birthday they celebrate they push anti-aging health care to the forefront of clinical medicine.


With the founding of the American Academy of Anti-Aging Medicine (A4M; in 1992, the A4M created the anti-aging medical movement. Anti-aging medicine is the fastest-growing medical specialty throughout the world and is founded on the application of advanced scientific and medical technologies for the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases. It is a healthcare model promoting innovative science and research to prolong the healthy lifespan in humans. As such, anti-aging medicine is based on principles of sound and responsible medical care that are consistent with those applied in other preventive health specialties. The phrase "anti-aging" is, as such, a euphemism for the application of advanced biomedical technologies focused on the early detection, prevention, and treatment of aging-related disease. The goal of anti-aging medicine is not to merely prolong the total years of an individual's life, but to ensure that those years are enjoyed in a productive and vital fashion. THE ANTI-AGING MEDICAL SPECIALTY Anti-aging medicine serves to fill a void in quality, wellness-oriented preventive healthcare that is sought specifically by Baby Boomers. Baby Boomers across this nation are, at this very moment, seeking the medical expertise of anti-aging physicians to provide very early detection, as well as the aggressive yet gentle treatment of disease, to help them live long and fulfilling lives. A recent medical study suggests that 60% of people over the age of 65 are exploring options that help to enhance quality of life and possibly help to extend the quantity of life. Anti-aging specialists typically generally devote 80% or more of their practices specifically to the early detection, prevention, treatment, and amelioration of age-related dysfunction, disorders, and diseases. The A4M estimates that in 2006, worldwide, there were more than 50,000 anti-aging physicians practicing at more than 30,000 practices and clinics. These 30,000 practices and clinics are in large-part responsible for the exponential growth of the anti-aging marketplace. Industry experts report that the US market for anti-aging products and services exceeded $45.5 Billion in 2004. Growing at an average annual growth rate (AAGR) of 9.5%, the anti-aging market is projected to reach $72 Billion by 2009. Of 2004 expenditures, about $36.5 Billion was spent on drugs and supplements targeted at specific diseases of aging, whereas $7.7 Billion was spent in appearance-related products and services. ["Antiaging Products and Services" Report PHM041A, Business Communications Company, Inc., February 2005.]


an A to Z Checklist



professionals, and the organization's education and advocacy initiatives have expanded the availability of advanced biotechnologies and leading-edge preventive healthcare throughout the world. The A4M is a member-based organization. Approximately 85% of A4M members are physicians (MD, DO, and MBBS), and approximately 12% are scientific healthcare practitioners (DC, DDS, ND, DPM, RPh, PhD, RN, NP, and PA). Membership dues specifically support the educational and advocacy initiatives to advance the acceptance and adoption of antiaging medicine around the world. Physician members receive many valuable benefits, including the opportunity to participate in the Online Referral Service. A4M fields more than 1,000 inquiries per month from the general public interested in finding a qualified anti-aging medical specialist. The Online Referral Service, accessible at, strategically positions your practice or clinic at the avail of potential clients from around the world, 24/7. In this article, we present twenty essentials, in alphabetical order, that are worthy considerations for opening and maintaining a successful anti-aging practice or clinic. To conclude this article, we provide a list of Resources that readers that those interested in this pursuit may find helpful.


The American Academy of Anti-Aging Medicine (A4M; is the world's largest professional organization dedicated to advancing research and clinical pursuits that enhance the quality, and extend the quantity, of the human lifespan. A4M is comprised of 19,000 physician, scientist, and health practitioner members from 90 nations. Since its founding in 1992, A4M's scientific educational programs have trained over 100,000 medical

The A4M co-sponsors the Annual International Congress on Anti-Aging Medicine & Regenerative Biomedical Technologies. This Congress is the largest and most influential academic event worldwide in the space of cutting-edge preventive medicine. With three sessions taking place annually, the Congress is the world's leading forum on clinical and research breakthroughs in anti-aging medicine and regenerative biomedical technologies. Presentation topics at the A4M's Congress include: • Bio-identical hormone replacement therapy • Nutritional therapies • Laboratory testing and diagnostics for anti-aging medicine • Environmental toxins and clinical detoxification • Biological age markers • Aesthetic medicine and non-invasive skin rejuvenation • Medical spas and marketing


an A to Z Checklist


Visit for program details and online registration about the upcoming 2007 Sessions of the 15th Annual Congress, including: • • •

April 26-28, 2007: Spring 2007 Session [Orlando, FL USA], projected attendance 3,500 physicians and health practitioners August 3-5, 2007 [Chicago, IL USA], projected attendance 4,000 physicians and health practitioners December 12-15, 2007 [Las Vegas, NV USA], projected attendance 7,000 physicians and health practitioners

OWN 77% OF THE FINANCIAL ASSETS, REPRESENT 66% OF STOCKHOLDERS equipment, will help to substantiate your financial projections. In order to be financially successful, your practice or clinic's Business Plan must reflect specific and measurable objectives. The Business Plan must also chart the attainment of such objectives on a realistic timetable. Don't be afraid to update your Business Plan on a periodic basis, to reflect course corrections and lessons learned. Your Business Plan should up-to-date and reflect your most current objectives as well as significant achievements. Be sure to convey the objectives of your Business Plan to your staff. Make sure your Plan objectives are universally understood, so your personnel can complete their responsibilities in a fashion conducive to moving your Business Plan forward.

Additionally, the A4M co-sponsors/co-supports more than 25 anti-aging/regenerative medical scientific conferences worldwide. IS FOR CERTIFICATION Professional certification for both physicians and health practitioners serves as a significant professional landmark that assists you with successfully deploying the clinical applications of anti-aging and regenerative medicine in the practice setting. The American Board of Anti-Aging / Regenerative Medicine (ABAARM) was established in 1997 as a professional physician (MD, DO, and MBBS) certification and review board which offers physicians recognition in the form of a specialty-based examination in anti-aging medicine. The American Board of Anti-Aging Health Practitioners (ABAAHP), established in 1999, provides recognition and specialty representation for healthcare professionals (DC, DDS, ND, DPM, RPh, PhD, RN, PA, and NP). Becoming certified in anti-aging medicine helps physicians and health practitioners in three key ways. First, it demonstrates to your patients at your practice or clinic that you have taken an active interest in the science of longevity. Secondly, because they include a written proficiency examination, ABAARM and ABAAHP help to ensure that anti-aging medical professionals have a sound understanding of essential knowledge relating to the clinical IS FOR BUSINESS PLAN Your "Road Map" to success, a Business Plan provides operational details as well as financial projections for your practice or clinic. In your Business Plan, it is essential to define the strategies by which you will achieve financial success. An overview of diagnostic and therapeutic procedures to be offered, as well as the projected number annually to be conducted, along with the up-front and ongoing costs of related


an A to Z Checklist


application of anti-aging medical care. Thirdly, for physicians, maintaining ABAARM credentials requires attendance at anti-aging scientific conferences (see "A") and securing CME credits, thus helping to enhance the physician's commitment to receive ongoing medical education. More than 2,000 physicians and health practitioners are in-process, or have completed, certification through either the ABAARM or ABAAHP programs. To register for either ABAARM or ABAAHP, send an email inquiry to: Later this year, clinics and spas will be able to secure facility certification through the A4M (see "A"). Clinic/Spa Certification aims to recognize those facilities that hone in on facets of service and safety that set them apart from others. Certified clinics/spas will demonstrate characteristics including: physician oversight (preferably one who is Board-Certified, see ABAARM above); compliance with confidentiality standards; multi-modality diagnostics and therapeutics; patient education and compliance guidelines; and other requirements. For more information about the A4M Clinic/Spa Certification program, send an email inquiry to:

IS FOR DEMOGRAPHIC A successful anti-aging practice or clinic understands its target demographic. Typically, the anti-aging patient is on-average about age 45, but it is not uncommon to see those in their early 30s start on a program. Moreover, the typical anti-aging patient is what The Robert Wood Foundation has described as the new “top-tier healthcare consumer,” a demographic who are, as a group: • • • •

college graduates, highly educated high wage earners, household incomes of US$ 50,000+ computer literate “have empowerment as their primary issue,” thus expect to engage “in shared decision making with their physicians”

The typical anti-aging patient will expect personalized care customized for the individual's medical needs. It is common for the precipitating reason for a person to see an anti-aging physician for reasons of looks, such as developing a pot belly, facial wrinkles, or a receding hairline. In many of these cases, an underlying medical reason for the initial "vanity issue" may be identified, such as hormone imbalances, nutritional deficiencies, or toxic overload. These


diagnoses form the basis for an anti-aging regimen that is individualized. It is also important to accommodate the needs and preferences of this demographic. Read more about these considerations under "H" and "R."

IS FOR EQUIPMENT It is first and foremost to comply with federal, state, and local regulations regarding the maintenance of a sanitary patient contact environment. It is also important to prepare for medical emergencies, for which basic resuscitation and hospital transport equipment are requisite. Be sure to provide these essential equipment and supplies at your practice or clinic. Next, it is important to define which anti-aging medical diagnostics your practice or clinic will offer, and secure the appropriate equipment and supplies to carry them out. A basic of anti-aging medical diagnostics is laboratory testing. It is critical to assess all antiaging patients prior to initiating anti-aging therapies on patients, so as to establish baselines (starting points). For follow-up testing, it is strongly recommended that anti-aging patients be tested at least twice a year. Either/both blood and/or saliva testing can be offered. The basic lab tests for anti-aging include: • Basic blood chemistries: CBC, Electrolytes [Sodium (Na), Calcium (Ca), Phosphorus (P), Potassium (K), Magnesium (Mg), Creatinine (Cr)], etc. • Nutritional profiles: Vitamins (including antioxidants), Amino Acids • Hormonal profiles: Thyroid (T4 and T3), Cortisol, DHEA, Testosterone, Progesterone, Pregnenolone, E2, HGH, Melatonin, 17- ketosteroids, 11-OH steroids; Femalespecific; and Male-specific • Toxic load (for some individuals, depending on environmental and/or occupational exposures): Markers for exposure to xylene, toluene, benzene, trimethylbenzene, styrene, phthalate, etc.; Candida; etc. Equipment for the anti-aging medical therapeutics that your practice or clinic will offer also needs to be secured (see "S"). It is both operationally and fiscally wise to select a few therapeutics to offer initially in opening an anti-aging practice or clinic, and then add on therapies as you grow.


an A to Z Checklist

LAST YEAR, THERE WERE MORE THAN 50,000 ANTI-AGING PHYSICIANS IS FOR FIRST IMPRESSIONS The adage "There is only one opportunity to make a good first impression" holds very true for the anti-aging practice and clinic, because the anti-aging patient can be quite discerning. Pay particular attention to the entrance area, signage, Reception and Waiting Areas, and Consultation Rooms, making sure that each is clean, bright, and neat. Decorate in an inviting but clutter-free fashion, and assign a staff member to maintain these areas in their optimal presentation. Invest in high-quality stationery and letterhead. Because much of a first impression is made via phone, make sure your Reception personnel are pleasant, courteous, and helpful. Remember, your practice or clinic won't have a second chance to impress your patient base.


IS FOR INSURANCE Anti-aging practices and clinics are exposed to certain risks associated with alternative medicine procedures like hormones and aesthetic medicine. Procuring quality medical malpractice insurance protects you as a healthcare practitioner and your business assets as your practice expands. Standard medical malpractice insurance markets, dominated by a few large carriers and state physicians owned mutuals, have been slow to adapt to the changing needs in providing coverage for such activities. The medical malpractice market is currently in flux. Certain insurance specialty markets have emerged recently who provide top-rated coverage at competitive prices. Providing insurance broad enough to cover practically all alternative and aesthetic medicine procedures. Key issues being the types of procedures and treatments you are performing at your clinic/spa and your specific training and experience for same. Since your practice is also a business, your Business Plan (see "B") should include addressing this key issue.

IS FOR GOALS Establish a set of long-term goals for your anti-aging practice or clinic. This should be accomplished in conjunction with your Business Plan (see "B" above). What is it you seek to do by the one-year anniversary of your anti-aging practice or clinic? By the five-year anniversary? In ten years? When setting your goals, be sure there is a way to measure your progress towards them. If you are aiming to be the most popular anti-aging practice or clinic within a 20-mile geographic area, you should be able to document from where patients are coming, how often they come for consults, how you secure new patients (see "M"), and how you retain existing patients (see "R").

IS FOR HOURS The typical anti-aging patient is discerning and savvy. To succeed, your practice or clinic must be accessible to the target demographic (see "D"), which as a group are high-achievers commonly plagued by time constraints. As a group, anti-aging patients may not be available during standard "9 to 5" business hours. To accommodate these highly stressed and time challenged clients, consider keeping your practice open late for at least one day a week, and/or open for business on Saturday or Sunday. Be mindful, too, that anti-aging patients are not afraid to comparison shop. If your competition offers consults at more conducive hours, you need to make an effort to make similar hours available.

IS FOR LOCATION As goes the adage, "The three most important points in real estate are location, location, location," such holds true for the consideration of where to open your anti-aging practice or clinic. First and foremost, your facility should be strategically located for easy-of-access. Next, because your practice or clinic caters to a discerning demographic (see "D"), it should be located in a safe and professional part of town. It should also have accessible parking (either street-side or lot). Your patients, both prospective, and existing, need to be able to get to your location easily and simply, and feel secure in spending a half- or full-day at your practice or clinic. Your staff needs to feel similarly reassured, so they can focus on their work responsibilities in servicing your patients.

IS FOR MARKETING When opening an anti-aging practice or clinic, it is paramount to have a sound marketing plan by which you will secure new patients and maintain existing patients. Make the investment in print advertising and distribution. Create an informative, eye-catching newsletter, brochure, or postcard that you will direct mail to a selected target audience (the anti-aging demographic, a specific geographic area, etc.). The mail


an A to Z Checklist


piece should compel the recipient towards the conclusion that it is absolutely imperative that s/he comes to your practice or clinic and initiates his/her anti-aging program without delay. It often takes six to eight iterations of a marketing message to be comprehended by recipients, so be prepared to create and mass-mail multiple times. You should expect a 1 to 5% response rate to direct mail campaigns. Word-of-mouth advertising will commence once your patient base begins to become established, and your patients see the value (see "V") of your services and your expertise (see "C") in providing them. A well-crafted website (see "W") can encourage your existing patients to spread the word about your practice or clinic readily and effectively.

IS FOR NETWORKING Networking, in the form of community outreach, can be a powerful and costeffective mode of marketing. Offer free educational seminars informing the public about the latest anti-aging diagnostics, therapeutics, or biotech advancements at your practice or at the local school or library. Advertise in a local publication and arrange for editorial content to be published in conjunction with the ad. These approaches both help to establish you and your practice or clinic as an expert in anti-aging medicine in your community. Cooperatively advertise your practice or clinic at other businesses that attract the similar demographic (see "D"). Place your business card or mail piece (see "M") at surrounding restaurants, coffee houses, Internet cafes, fitness centers, gyms, bookstores, and natural grocers.

IS FOR OVERSIGHT The most successful anti-aging practices and clinics are those overseen by a physician, often who is a member of A4M (see "A") and is Board Certified in antiaging medicine (see "C"). This is because A4M physicians are among the most proactive preventive healthcare professionals, often routinely attending scientific conferences (see "A") to keep up-to-date with the latest advancements in anti-aging diagnostics and therapeutics that can readily be deployed in the clinical setting. There are also federal, state, and/or local regulations in-place stipulating requirements for operating equipment utilized for anti-aging diagnostics and/or therapeutics, and often these require the onsite presence of a licensed physician. Additionally, the anti-aging practice or clinic will be well-served by appointing a


management board, one comprised of adjunct physicians, healthcare practitioners, and business experts. It is the objective of the management board to keep the practice or clinic true to its Business Plan (see "B") and goals (see "G") and propose course corrections where appropriate.

IS FOR PERSONNEL Your staff can also serve as an important marketing outlet (see "M"). Management and key practice or clinic personnel should treat each staff member with respect, while engendering in them that each patient is to be afforded the highest level of attention and service. Be mindful that each and every employee affects patients and how they relate and perceive your practice or clinic. Such patient relations and perceptions are key in positive word-of-mouth advertising (see "M"). When your practice or clinic begins to grow, be sure to expand the staff as well. Doing so ensures continuity of the highest level of attention and service to patients while reducing the burden on existing personnel. Consider hiring Nurse Practitioners and Physician Assistants to support the overseeing facility physician. With growth, be sure to supplement the administrative/support staff as well, to account for expanding numbers of patient records and scheduling tasks.

IS FOR RETENTION It is estimated that it is six to ten times more expensive to gain a new patient than to keep an existing one. Retention strategies are paramount to the long-term success of the anti-aging practice or clinic. Each patient should receive complete and detailed post-consult instructions, which include at-home care instructions for post-treatment. Two to three days post-consult, a follow-up by telephone is conducted, during which your staff asks the patient about their consult experience schedules future appointments. This phone call is also an appropriate time for follow-on upsell (see "U").

IS FOR SERVICES Some of the most common treatments at anti-aging practices and clinics include: • Hormone Replacement Therapy


an A to Z Checklist


• • • • • • • • •

Antioxidant and Vitamin Supplementation Maximization of Immune Function Detoxification Cardiovascular Protection Cognitive Function Repair Metabolic & DNA Repair Skin De-Aging & Repair Lifestyle Modification Musculoskeletal Rehabilitation-Sports Medicine-Conditioning

Choose to offer those services that appeal to you based on your clinical expertise and interests, as well as the anticipated needs of your target audience (see "D"). Optimally, the anti-aging practice or clinic should offer a menu of services that are optimized for both client satisfaction and profitability. For example, skin de-aging and repair offers ongoing product needs by patients, visible and/or immediate progress to patients, and high-margins for the practice or clinic.

IS FOR TRAINING Postgraduate education and hands-on training are essential elements that define the long-term success of an anti-aging practice or clinic. Consider enrolling in the Fellowship in Anti-Aging & Regenerative Medicine, offered by the A4M (see "A"). The Fellowship program affords anti-aging physicians with an intensive series of seminars as well as on-site training with a Board Certified anti-aging physician, complemented by teleconference discussion forums. From the Fellowship program, physicians learn comprehensive, real-world diagnostic and treatment protocols from world-renowned clinical experts. Additionally, DVDs, videotapes, and MP3 recordings from scientific conferences (see "A") can further your medical education in the anti-aging medical arena.

BUT TO ENJOY THOSE YEARS IN A PRODUCTIVE & VITAL FASHION deficiencies, ask her/him whether s/he has the possibility of environmental and/or occupational exposures to toxins, because that can adversely interfere with nutritional uptake. If that is the case, take the opportunity to schedule a toxic load lab test and encourage the patient to consider initiating a detoxification regimen which your practice or clinic offers.

IS FOR VALUE As a whole, the anti-aging patient demographic (see "D") is comprised high wage earners with household incomes of US$ 50,000 or more, so they are able to afford optional products and services to improve their everyday lives. However, this demographic is price sensitive. They expect value for their dollars. When pricing the services (see "S") your practice or clinic provides, be sure not to surpass the pricing of surrounding or similar facilities. If you do, your services should offer some distinctive characteristic that your competition does not provide, and your patients should be made aware of this fact.

IS FOR WEBSITE With the interconnectivity of today's world, a website is now practically requisite for the visibility and success of your practice or clinic. Your website should present basic practice or clinic information, such as your hours of operation (see "H"), the services you provide (see "S"), and the corporate vision (see "G"). Often times, you can also use your website as a medium through which to showcase your patient accomplishments. You may also elect to offer informative content relevant to your area(s) of expertise in anti-aging, and perhaps an opt-in electronic newsletter. Be sure, however, that your website adheres to HIPAA (Health Insurance Portability and Accountability Act) and/or HON (Health on the Internet) codes.

CONCLUDING REMARKS IS FOR UPSELL As part of patient retention (see "R"), your staff will call each patient postconsult. This is a one-on-one marketing opportunity not to be underestimated. When your staff asks the patient as to their consult experience, s/he should also inquire whether they are interested in any other services your practice or clinic provides. For example, if a patient was identified with nutritional

If you knew with certainty that you could potentially live a healthy, productive, vital, disease-free lifespan of 125 years or more, we expect that you would embrace the new science of anti-aging medicine and adopt the anti-aging lifestyle. Indeed, in the coming years, we can look forward to the Life Extension Dividend, which extrapolates continued robust gains in life expectancy assuming successful application of anti-aging biomedical and technological advancements that are proven in the laboratory setting to expand the lifespans in multi-species studies.

nti-aging medicine is now practiced by thousands of physicians in private medical offices as well as some of the most prestigious teaching hospitals around the world. Many medical schools now include anti-aging in their programs and physicians have clocked hundreds of thousands of hours of advanced medical education to train in this new medical specialty. Acknowledging the social, economic, and medical dilemmas anticipated to arrive with a rapidly growing aging population worldwide, anti-aging medicine has also garnered important recognition from leading public policy groups and members of academia.


Universally, those involved in healthcare or those whose fields of expertise intersect with healthcare issues support anti-aging medicine as a healthcare model promoting innovative science and research to prolong the healthy lifespan in humans. Public policy organizations and government agencies are now embracing anti-aging medicine as a viable solution to alleviate the mounting social, economic, and medical woes otherwise anticipated to arrive with the aging of nearly every nation on the planet. By practicing anti-aging medicine in your practice or clinic, you are part of the solution to the healthcare dilemma that plagues the aging population worldwide.

USEFUL RESOURCES "A" is for A4M: American Academy of Anti-Aging Medicine (A4M) Website: Tel.: 773-528-4333 Email: "C" is for Certification: American Board of Anti-Aging / Regenerative Medicine (ABAARM) and American Board of Anti-Aging Health Practitioners (ABAAHP) Website: Tel.: 561-997-0112 Email: "E" is for Equipment: Laboratory testing (blood and saliva) is available through Age Diagnostic Laboratories (ADL) Website: Tel.: 773-528-8500 Email: "I" is for Insurance: Edward Kuhn, Liability Insurance Solutions Website: Tel.: 800-871-6871 "T" is for Training: DVDs and videotapes of A4M's scientific conferences are available from Instatapes Website: Tel.: 800-669-8273 MP3 recordings from A4M's scientific conferences are available from Digitell Inc. Website: Tel: 800-679-3646 ŠMEDI CAL SPAS REVIEW • APRIL 2007

A4M Anti Aging Clinic  

Key Considerations for Opening and Maintaining a Successful Anti-Aging Clinic: An A to Z Checklist By Robert M. Goldman, M.D., Ph.D., D.O.,...

A4M Anti Aging Clinic  

Key Considerations for Opening and Maintaining a Successful Anti-Aging Clinic: An A to Z Checklist By Robert M. Goldman, M.D., Ph.D., D.O.,...