In the final installment of the series, meet Andre Berger, MD, and learn about the operation of Beverly Hills-based Rejuvalife Vitality Institute.

In an era when many doctors don't hide their gripes about the practice of medicine, Andre Berger, MD, is unapologetically happy in his profession. Two years ago, he founded Rejuvalife Vitality Institute, a Beverly Hills medical spa that blends aesthetic medicine, holistic medicine, preventive care and wellness.

"I've done many things in medicine, but I never enjoyed any of it as much as I love what I do now," Dr. Berger says. "It's fun. I get to use all of my skills-procedure skills, people skills, business skills-and I get to deal with nice people. It's a great way to practice medicine."

A member of the Los Angeles County Medical Association, Dr. Berger found his bliss and his niche after more than 25 years of practicing internal medicine, emergency medicine and clinical pharmacology. "After working in the managed care environment in a very large group practice, I realized I wanted to take my practice a different direction to the preventive side," he says. "I wanted to spend more time with patients, delve deeper into patients' problems, and come up with more natural methods to make them feel better inside and out."

The idea for Rejuvalife actually rolled around in Dr. Berger's head for more than a decade. He used that time to improve his understanding of aesthetic medicine, to plan and to get training. Finally, the time was right and the market was ripe. "I deployed a medical model that was right for me and consistent with my holistic philosophy," he says. "And the trends in the marketplace are such that people are now open to it."

Rejuvalife opened in November 2003, combining "the best of Western technology and allopathic medicine with Eastern wisdom," he says. "Beauty is way more than skin deep. Some people come in because of vanity, seeking the aesthetic quick fix, but I want to examine them internally and healthwise as well," he says. "It's not just about consumer demand; it goes beyond that. I'm trying to educate people and bring them to the realization that everything about their health and appearance is a web."

For example, a 45-year-old patient with a droopy face and lots of wrinkles gets a full consultation, Dr. Berger says. He asks about lifestyle, nutrition, stress levels, hormones, family genetics and mental outlook. "I want to be able to address underlying causes and fix the aesthetic problem. If I work on the inside too, then the positive effects of the procedures last longer."

The top five procedures Dr. Berger performs are thread lifts, mesotherapy, facial fillers (Sculptra and Restylane), Botox injections and intense pulse light therapy.

The Place and the People
Just where does Dr. Berger work on patients' insides and outsides? From a 950-square-foot suite on the ground floor of a medical building on Bedford Drive. "It's a very good location with an address that has some cachŽ to it," he says. Location is important in attracting medical spa clientele.

The suite has a large procedure room, two smaller treatment rooms, a consulting office, a small reception area and a small back office. The decor is tailored to the tastes of customers; it's stylish without being ostentatious. It incorporates mellow, dark earth tones and natural elements of bamboo and orchids. "The environment emphasizes tranquility and peacefulness," he says.

To be sure, however, Dr. Berger says that Rejuvalife is more about the people (staff) than the place. "I take care of the patients myself personally," he says, to emphasize that Rejuvalife is different than other spas where the doctor may be less involved. Dr. Berger is joined by four employees, including an esthetician, an esthetician/medical assistant, an office manager and a front office person/receptionist. His wife, Tracy Berger, is a partner, serves as patient coordinator and is in charge of marketing and advertising. An exercise physiologist, a psychologist, a nutritionist, a hypnotist, a reflexologist and an herbalist provide medical support and consultations under contract as needed.

"The staff is critical," Dr. Berger says. "How they respond to patients is critical. They have to be warm and inviting. They have to be credible, presentable, professional and sincere."

It's a tall order and clearly the most difficult part of the business, Dr. Berger says. In his search for the right employees, he's gone through 10 people in two years. "It's easy to talk about what you should have; it's very difficult to attain it," he says. He's learned that he has to invest time in the interviewing and training process and be clear with expectations. "The doctor has to supervise. That's the key to survival. Whoever controls the front desk, controls the doctor's income stream in a medical spa."

Speaking of income streams, patients pay by cash, check or credit card at Rejuvalife, Dr. Berger says. "I don't take insurance." However, he does provide the patient with a detailed bill if the treatment could be covered by insurance in some way. The patient can then pursue reimbursement directly.

Having lived for decades in the managed care payment world, Dr. Berger now appreciates the simplicity of retail transactions. "[Collecting cash] is a much easier way of doing business," he says. "For most cases, it's the only possible method of payment. There is no other method that would work. This is all that's possible in the medical spa realm."

Even so, Dr. Berger has a lot to say about the perception that medical spas mint money. "It's naive and a stereotype," he says. "Just like any other type of business, medical spas have the potential to be successful and unsuccessful economically, depending on how well they are run. Money does not fall from the heavens in a medical spa."

Through hard work and planning, however, Rejuvalife is doing well financially and broke even after 17 months in operation, Dr. Berger says. "I am very happy with where I am. I feel very fortunate with my success. Anybody who thinks this is automatic is way off. It takes time, effort and sweat."

And there will be a little more sweating early next year as Rejuvalife undertakes a move to a slightly larger facility just blocks away, Dr. Berger says. The bigger place will provide breathing room in the waiting room, expanded space for procedures and the opportunity to add staff.

Key Drivers of Success
Rejuvalife draws strength from its consistent, professional marketing campaign. From the beginning, Dr. Berger has been committed to a plan that includes advertising in newspapers and magazines and offering educational seminars at a local country club. "I have a marketing plan and a budget, and I monitor how it is working and make adjustments," he says.

Rejuvalife's marketing budget during its first six months was about $10,000-$12,000 each month. After that, it went to $7,500-$10,000, and now it's at $7,500 a month. Dr. Berger anticipates that even after the spa is more established, he will always spend at least $5,000 a month on marketing. "When you start out, business is driven almost exclusively by marketing. Later, happy customers start referring others, which decreases your need for marketing somewhat," he says.

The Internet has been a boon to business as well. The sophisticated site at www.rejuvalife.md contains detailed information presented in a way that reflects the spa environment, Dr. Berger says. Lots of customers find the spa through the Web. To date, about 75 percent of the business is generated by advertising, seminars and the Web site. The rest is referrals.

Rejuvalife gets referrals based on another strength: physician involvement. "I'm not using mid-levels," Dr. Berger says. "I like to take my time and do the treatments myself. They are not innocuous and they do have risks." In fact, he worries about the industry's over-reliance on medical assistants and estheticians. "People love it that a doctor does the work. They are coming here from other spas where that is not the case."

Indeed, patients are singing Rejuvalife's praises. Case in point: a post-menopausal woman came in because she wanted to look and feel better in preparation for her 60th birthday trip to hike in the Himalayas. Dr. Berger and his team worked with her for eight months, refreshing her skin, rebalancing her hormones, retooling her diet and reinvigorating her exercise program. "She got in the most incredible shape," Dr. Berger says. "She took the trip, had a great time and then threw a big party to show the slides of the incredible scenery of Bhutan. At the end, she gave us credit for helping to make it possible. It was very gratifying."

As time marches on and Rejuvalife continues to serve patients, the number of success stories is bound to increase. "The greatest thing about this business is helping patients feel better about themselves. I always ask myself, 'What can I do to make this person feel better?' That's my role."