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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and being in a solo practice within a group practice.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "Solo Practice Within Group Practice — with Sam Jejurikar, MD".

Some surgeons dream of complete autonomy. They want to do whatever they feel like doing without having to answer to executive boards or other surgeons they work under.

They want to set their own hours, hire and fire staff and buy equipment if they feel like it.

They also want to make more money and assume they will in solo practice since they keep all of the profits and not just a percentage.

However, the flip side of that autonomy means they also get to handle their own books and inventory, while also marketing to attract cosmetic patients.

The business and marketing side of plastic surgery can be fun, daunting, uncertain and confusing.

So, is Solo or Group practice better?

Here's a unique business model that allows you to run your solo practice as you want, but also enjoy the perks of being under the umbrella of a much bigger practice. Very interesting!

This week's Beauty and the Biz Podcast was an interview I did with Sam Jejurikar, MD, a board-certified plastic surgeon and a member of the Dallas Plastic Surgery Institute

that includes 10 surgeons, 4 ORs, 40 staff in a 45,000 square foot facility.

We talked about their unique business model to buy into the practice but run as a solo practitioner and how they make decisions with so many surgeons involved.

Visit Dr. Jejurikar's website

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

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"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

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Transcript:

Solo Practice Within Group Practice — with Sam Jejurikar, MD

Catherine Maley, MBA: Hello and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery, and being in a solo practice within a group practice. I'm your host Catherine Maley, author of Your Aesthetic Practice — What your patients are saying", as well as consultant to plastic surgeons, to get them, more patients and profits. And today's guest is Dr. Sam Jejurikar, who is in solo practice within a group practice. Thank you.

He's a board- certified plastic and reconstructive surgeon, who has a solo practice within a group practice, and a member of the Dallas Plastic Surgery Institute that performs cosmetic surgery, pediatric plastic surgery, breast reconstruction, and complex wound reconstruction. Now, the institute includes 10 surgeons. The Dallas Day Surgery Center of Cloisters Hope Post-Operative Recovery Facility, and the Epicenter Skincare and Laser Center.

Now, Dr. Jejurikar received his medical degree from the University of Michigan Medical School and has been in practice for more than 20 years, and he also has the most incredible podcast name that I've ever heard. So, we'll talk more about that. And he also is very involved with Smile Bangladesh, so, we'll talk more about that.

Dr. J, thank you for coming on and welcome to Beauty and the Biz to discuss on the topic of being in solo practice within a group practice

Sam Jejurikar, MD: Thanks so, much for having me. I really appreciate it.

Catherine Maley, MBA: Sure. So, just quickly, can you give us a recap from Michigan? How did you get from there to here? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, after I finished at Michigan, I actually did an aesthetic fellowship at Manhattan Eye Ear. So, I spent a year there and I kind of circuitously wasn't sure where I was going to end up after I was in New York.

And one of the opportunities that, that I had was to join this amazing group, Dallas Plastic Surgery Institute, which, Is, is really kind of unlike many other business models. And I know you've had a lot of solo practitioners on, on the show, but it's, it's basically an opportunity to set up a solo practice within the greater confines of a group practice.

And so, that was 2009 when I made my way to Dallas. And I'd actually had a, had a little stop before that where I was actually in a multi-specialty group for about three years before I came to Dallas. And that was where I realized I really didn't want to work for anybody else. I liked the autonomy of working for myself.

So, I've been, I've been at D Psi ever since. That's how, that's how that all sort of ended up.

Catherine Maley, MBA: Then and that's why I wanted you on, because it's so, unique what you're doing and I can't tell what you're doing. It looks like it's an LLC. Then I thought, oh, maybe they're hooked up with the hospital somehow, but then they have a fellowship program and I thought, what, can you just explain your business model? How did this influence your decision to have your solo practice within a group practice?

Cause I don't get it.

Sam Jejurikar, MD: Yeah. So, our business model is we are We are basically a confederacy of solo practitioners. We've got in D P S I at this moment in time, we had nine full partners and three associates, all of whom are separate PAs. But we have a common. We have a, a common holdings company that manages our group.

So, we have some economies of scale. We have a business office, which is really robust, which helps all of our individual practices and our, and our entities. We've got some shared front desk employees. We've got shared photography studios and, and, and employees all together. We have about 40 shared employees between all of us.

Then we have our own individual employees as well within our individual pods. And then we have our ancillary businesses. We've got a robust blood ASF certified surgery center that's got four ORs. We've got a really robust skincare laser center called Epicenter. We've had an overnight you know, recovery Center, which is sort of an outpatient recovery center for patients where we kind of teach them how to take care of themselves, or we have four beds as well.

So, we utilize economies of scale to, to run a really efficient solo practice within the greater confines of, of a group practice. So, I feel like I have partners, but at the end of the day, we are competing against each other.

Catherine Maley, MBA: So, does any, do the patients realize that you are all individual or do some patients call the center and say, I'd like to book a consult with a plastic surgeon and if so, divvy. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: We don't really have a main number that, that has like a receptionist that divvies that up. Like if you, we, there is, we do have a group website, which is just to have sort of a placeholder. And it hosts our fellowship. So, we have two aesthetic fellows every year. You know, we think we have the best aesthetic fellows aesthetic fellowship in the country.

Everyone. Yeah. And it, and it, and it hosts, it hosts our you know, it's, it's a portal for the fellowship clinic more than anything, but there's not really a central number for people, for people to call. There's a business office. So, every now and then you know, they might in accidentally call the business office, at which point the, the la the way the group's actually set up will, will be explained to them and then, and they need to figure out what doctor they actually want to see.

Catherine Maley, MBA: Do you own the building or is it lease? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: It's a lease face. It's a, it's a, it's something that we regret in 2008 when we moved to this building, which is in the heart of Dallas. There was an opportunity to buy the building and we did not actually take advantage of that. And so, that's actually a big focus of conversation for the group right now because we're, we're coming to sort of the end of our lease and we're trying to decide do we renew this where we're in such a, you know, fantastic location, or do we, or do we pick up and start all over again?

It's a, it's a huge source of controversy within the group right now.

Catherine Maley, MBA: How do 10 surgeons make a decision of that magnitude? So, far we have, I can't imagine. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Yeah, I mean like any group, there's some people that take more, more interest than others. Some that are leading the charge, some that are following different, you know, as you've been talking to different surgeons at different stages of their career, ones that are closer to the end of their career aren't particularly excited about doing that.

Ones who are starting their career are very excited about doing that. And so, I don't know what the final resolution is going to be.

Catherine Maley, MBA: Give me the pros and cons of this situation, because you were, I guess you'd never really been in solo practice, but you were in a multi-specialty practice. Probably.

How many surgeons were there? Was it a big one? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Oh, I was, I mean, I was with a huge organization there were in, in, in the city that I was in, there was there were about a hundred surgeons altogether for hundred physicians altogether. And then it was part of a much bigger, it was the, it was the Scott White Healthcare system before they merged with Baylor.

So, hundreds, hundreds of doctors. So, yeah. Okay. So, the advantage of where I'm at right now is I have complete auto autonomy to, to run my practice in any way I see fit. I can hire and, you know, hire and fire the employees that I want to. I can market in any way that I want to. I can do the procedures that I, that I want to, but I have the same pressures that anyone in Stella practice does, which is you know, if times aren't as busy, I have to, I have to figure out where my customers are coming from.

So, so, I think the only downside is there's some degree of uncertainty when you're on your own, but I think the, the majority of them are all, are all you know, they're all pluses. It's, it's, it's I mean, I, I think I make a lot more money this way than I, than I did when I worked for somebody else for sure.

So, I mean, I, I think and the other thing, the thing that's different about our solo practice, I know it's been a big topic on your podcast, is about how to exit your practice. Yeah, yeah. So, this is a situation where we're approached by private equity probably once a month about someone wanting to acquire our practice.

No one on the outside really understands what our practice is. What they quickly start to realize is if they, if private equity wants to acquire us, they actually need to talk to individuals within the group. About acquiring their individual practices. Of course, they want our ancillaries as well. And so, we never really get all that far.

The, the, the thing is, is we have an easy way to exit our practice, which is, When we, when we join D P S I, there is a buy-in. There's, there's two sets of buy-ins. There's a buy-in to you know, our, our physical you know, our surgery center to our, to our profit centers basically which is based off of a fair market value.

And then there's also a buy-in to the group itself, which is, there's basically a membership for you to join. You, you pay this membership fee, but you al actually get paid it out as well as you're exiting the group. So, I've paid in my membership fee, but now I'm actually at that phase of my practice where younger guys are actually buying the process of buying me out.

So, when I leave you know, whether it's a, a building that we own or whether it's our lease space, some new associate will probably take my space or they'll hire someone else to do that. So, it does make exiting the practice relatively easy.

Catherine Maley, MBA: Are there like any disbursements along the way or are you just buying in, doing your thing and then when you and it's time to exit, you just get that big chunk then? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: No, just for tax purposes, we get it as it's being bought in. So, the structure is when people are associates in that first two-and-a-half-year period before they're made a full partner a, a portion of their, of their profits go to the, the partner whose turn is to be bought out. And so, from a tax purpose standpoint, the person who, the partner who's actually getting.

Getting that that distribution pay taxes on it. And so, the group doesn't want to hold onto that money because then it becomes a liability for this holding company, which doesn't really have any income. So, so, in, instead we pay taxes on it and we get it when it comes in. So, even though I'm nowhere close to retiring, I'm fairly close to being already bought out.

Catherine Maley, MBA: Nice. Very, very interesting. How do you divvy up the overhead? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, I think there's, there's, there's two. There's overhead that's related to our common expenses. So, that's divided. You know, the denominator is a number of partners and that's equally divided. Then there's overhead that's related to our individual pods, my own individual employees, my own individual marketing expenses, my own individual rent for my individual space.

That's my own, my own to pay for. And then we have ownership, you know of our, of our ancillaries. And so, the same sort of deal, it's your, your percentage equity ownership is, you know, what, what you're on the hook for from a liability standpoint.

Catherine Maley, MBA: I have to tell you, this sounds like an accounting nightmare.

How are you keeping track of all this? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, we, we have we have multiple accountants that are full-time employees of our practice. It's actually, if you saw our accounting, you'd be blown away by the level of organization. Like we all have. We all have things that we love about T P S I, if you ask. You know, the most senior and well-known partner, Rod Rorick, he's going to tell you it's the surgery center.

If you talk to other partners, they're going to tell you it's our great skincare center for me. Who's, who loves numbers? I think our business office is incredible. And the level of organization and the level of detail that I know every single expense in my office would blow you away. And aren't you very involved in the accounting?

I am, yeah, I got an m MBA and so, I'm, I'm not actually doing the accounting, but I'm overseeing the reports and our analytics that go out every month for sure.

Catherine Maley, MBA: Do you have meetings with each other? Like, I, is it, does it feel like a good comradery there? Does it feel competitive? Like, what is your culture like? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: You know, I think with any large group of plastic surgeons, you deal with enough of them to know that not everyone is best friends with each other, but and we have disparate. Thought processes. There are some different visions for the group among different, different people, but there's a healthy respect for all the partners amongst one another.

I think that's, that's, that's uniformly true. We've got a leadership structure that basically has an executive committee of, of currently four of the partners altogether. I'm one of them. We meet every month. Well, we have a regular standing meeting every month. We have a quarterly meeting of all the partners to talk about.

To talk about bigger issues and if there's pressing issues. I mean, my, the surgery center, I work at my office, space Skincare Center. Everything we do is under the same roof, so, we're always there all the time. Should there be a reason to communicate more often?

Catherine Maley, MBA: That's amazing. Do you, if there is you're trying to make a decision, is there a final say? How did this influence your decision to have your solo practice within a group practice?

Is there a dictator there that says this this is how we're going to do it, or is it a democracy? Are you voting? Because if you have four, what you know, that's, how's that working out?

Sam Jejurikar, MD: Yeah, so, if we have a two, two tie, it goes to the partnership. We don't, we don't have a dictatorship because we're not, we're not one corporation, you know, we, we, we, that wouldn't work effectively for us.

So, and if it's a big, you know, the, the executive committee of, of the four of us, we tend to make the day-to-day decisions. We tend to do sort of the relatively mundane things. Big group decisions are decided by all the partners.

Catherine Maley, MBA: I mean, the decision you have coming up that has got to be a big deal for you to try to decide, do we stay, do we go, do we, are, are you thinking about buying somewhere else or completely relocating, or are you thinking about just building in how, how many square feet do you need? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, right now we have about 45,000 in the heart of Dallas. But as you know, I mean, if you're going to think about a time to potentially invest in commercial real estate, yeah. I mean, the market is really depressed right now, right? And so, and so, this wasn't something that had really had really crossed our mind.

More than a few months ago, but there are some opportunities right now. So, yeah, we're having lots of conversations about it. They're, they're healthy productive conversations. We, we have a five-year period of time still before our lease set would actually end. So, so, we're, we're working with a big enough window of time where we're not, we're not rushing into anything.

Catherine Maley, MBA: I would say though, if you, timing is perfect for a really long lease, if you want to stay put, I go long, long, long. Yeah. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: We're getting some pretty competitive offers. Yeah. Like, we're actually we're getting some pretty competitive in fact, the building that we owned was just sold and they really, I mean, as you know, they really want us, we're their primary lease holder.

So, they're offering us more and more because if they want to turn around and sell the building again, having us locked up. For another 10 or 15 years would make it a much more attractive building for sale. So, we'll see what happens. We don't really know.

Catherine Maley, MBA: Yeah. Oh my gosh. Out of curiosity, how does the surgery center work? How did this influence your decision to have your solo practice within a group practice?

Do you have blocked surgical times and or are you fighting over them or who gets there first? How does that working first come, first serve?

Sam Jejurikar, MD: Yeah. And yeah, there's, there's definitely, and it's busy. There're definitely days where I can't. Get on, at least at the times that I want to get on, in which case I have to readjust my schedule to get on, or I have to work at another surgery center.

Many of us have carve outs at other surgery centers that allow us to own a piece of another surgery center as well. So, I'm lucky enough, oh, to actually have an ownership share of another surgery center that's owned by a large hospital system here in town. So, if, if that happens, I, I have another place that I can go to.

Catherine Maley, MBA: Is there an any plans for expanding to more ORs? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, that leads in perfectly into the conversations that we're having about building our own space, because right now we're locked into our building and. There's not necessarily a great way to build a fifth or even sixth or without majorly disrupting operations.

So, yeah, it's a conversation we have all the time. I think our first step though would be before we, before we actually. Before we actually build another or, or two, is we're lengthening the hours of hiring a second shift. So, we're now getting to the point where we have two late rooms that go to later in the evening and, and a second PACU shift that comes on.

So, we're going to start with that before we start, before we start changing the actual physical infrastructure.

Catherine Maley, MBA: That's interesting. So, so, like a patient can have surgery at six, at nine kinds of thing. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Maybe not that late. I couldn't go all day. It's definitely like five o'clock. But five o'clock. Yeah. I mean, if we, we can finish at seven, that's our goal.

And we start as early as six 30. Many of the rooms start at six 30 in the morning.

Catherine Maley, MBA: Gotcha. Okay. So, the, so, the exit strategy, when people come on, they're coming out long term, like they're signing contracts that they're going to stay put Right. Because that's the way your business model works, but just let's say it, it just didn't work out you know, a personal problem, whatever.

Yeah. How, how do, how do you, how do you unravel some of this if somebody needs to leave or wants to leave? Is there a way out? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Yeah, there is. I mean, just like any business or any sort of marriage, sometimes things just don't work out. And we've had this happen before. There's, you know, like many practices, there's a non-compete that's a certain geographic radius.

Ours isn't particularly onerous. I, I don't even know what it is, but I think it's 15 miles. And it's two years. If they want to violate that non-compete, there's a financial penalty that they would pay to stay within that zone. But Dallas Fort Worth is so, large that usually they can find a place within the Dallas Fort Worth metroplex and still not violate their non-compete.

I think we're arrogant enough to think that if you want to leave, we're still going to be fine.

Catherine Maley, MBA: I think so. So, so, let's talk about that because what was really interesting, I like to check you out as a patient would, as a prospective patient. And so, when I Googled you up comes the main website and what was really interesting was.

They immediately, there's a homepage. It's not fancy at all, it just has a bunch of your pH photos on it, and I just clicked on yours, and the minute I did that, I went straight over to your website and I never came back. Like I couldn't come back to the. The big practice. I, I just stayed with you and I thought that was a really, that was really good because now I can't fiddle around and say, well maybe I'll go to somebody, you know, let me check everybody out.

And so, I Is that what ha that I assume that was on purpose. You know, once they say you, it's you. Right. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: That's right. Our, our, our D P S I website is just a placeholder in case somebody wants to know more about D P S I. It's really common because I think, I think my partner is, Or many of my partners are amazing surgeons and, and it's, I can't tell you, but it happens multiple times a week where a patient's seeing me for a consult and, you know, they may be seeing two other surgeons who they think are, you know, are, are great people in Dallas to have the same thing done.

And it turns out they didn't even realize they were my partners; you know? They were just in the building two days before that and they're going to be back the week after or something. So, so, yeah, I mean, in an ideal world, people didn't even recognize that some of these, that some of us are, are, are great surgeons.

I've got, my youngest child goes to a you know, a small private school and, and I can't tell you the number of my wife's friends that I meet at sporting events that are going to one of my partners for surgery. It always kind pains me a little bit. But it also makes me feel good that, that I'm in practice with such good people.

Catherine Maley, MBA: Right. For sure. So, would you say that name has been helpful to you or it doesn't really matter because you're going off of your own name? You're, you're not like trying to ride the coattails of Dallas Plastic Surgery Institute. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: I think it's incredibly helpful. I think I mean I think it, you know, you look at it when you're starting off in practice.

When I came to Dallas, I had no connections to the city of any kind. It gave me legitimacy right away. Yeah. They're like, oh, you went in this group. You must be pretty good. It helps me with, with business contacts and business opportunities because You know, we're a huge contract with Allergan.

We're a top 10 account, we're a huge contract with Citra. We, you know, we, we get approached by a lot of people within the industry who want to, you know, make us a test center for, for something they're doing. So, it, yeah, it's, it's a huge opportunity to be part of this group from an individual marketing standpoint.

Maybe not so, much, you know but, but it is certainly not a harmful thing and, and every other aspect of business is fantastic. So, let's talk about marketing

Catherine Maley, MBA: channels. Your social media. I mean, you've got over a hundred thousand followers. Are you spending a lot of time on content creation for social media or you've got a team doing that, or how's that working out? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Me personally spends very little, spends very little time on it. But yeah, I've got we, you know, we used to work with an outside company. Now it's just redundant internally within the office. Mm-hmm. I think there's different kinds of practices, some practices where they generate a lot of new patients from social media.

Mm-hmm. I don't think I'm probably one of those practices. I think people look at me and they, my social media is just sort of a check mark where they've sort of verified that I'm legitimate, that I. Actually, do exist. I've got plenty of before and after pictures that are on there, and that's how we treat it.

So, I, I don't personally spend a lot of time on it, but, but you know, there's, there's a, an employee in my office who spends half her time filming stuff and putting together videos and things like that.

Catherine Maley, MBA: That's what I, I'm, you know what I, my, the answer is it depends. It depends on your personality and your interest and passion for it.

Some of the doctors are just crushing it on Instagram and mm-hmm. But that could also, you know, shut down the minute something happens with Instagram and it goes down, you go down with it. So, that makes me very nervous. I always say to people, make sure you're getting these followers to give you your, their name, cell phone and email in case something were to go wrong because patient plastic surgery and.

And social media do not get along and it's getting worse. So, but if, but if you like doing it, do it. But if you don't, don't be spending two or three hours a day fiddling with it if it's not what you want to do, you know? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Yeah. I, I don't think I have the personality that's particularly magnetic for Instagram.

I just recognize that about myself. I think I do great work. So, that's what we focus on there.

Catherine Maley, MBA: Yeah, me too. I, I, I'm not a social media queen at all. So, let me ask you about patience. How do you see, you know, you've been around for a while. First of all, are the patients getting older and maturing with you?

So, now you're moving from just breast aug to more mommy makeovers and more to facial rejuvenation. Are you doing any of that? And does it feel like the patients are changing? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Let me answer your second question first. Definitely there's, there's a lot of patients that are in my practice that have been with me for 10 plus years.

And so, so as the, those patients themselves are maturing yeah, that what the, I'm, I'm definitely doing more facial aesthetic procedures on them and if I did a breast dog on them before liposuction, now maybe to tummy tuck or a, a bigger mommy makeover. You know, I, I do think though, with it being a major city and a major market, people tend to look for specialists and things.

And so, even though I am, I have a fellowship basically in facial aesthetics. My reputation is for body contouring. I mean, it's for breasts and Tommy's and butts and liposuction, and that's hard to escape. So, I, I do find, That like today, for instance, instead of my patients maturing, I'm operating on children of my patients.

Like today I did, today I did a breast dog and a liposuction case on two different patients, both of whom are the daughters of patients I did like 15 years ago. So, so, maybe it's not maturing, maybe it's just I'm staying in the family. I'm not sure. Okay. Nothing wrong with that. Yeah, exactly.

Catherine Maley, MBA: Yeah. And do you want to stay body?

Because I have, I mean, some plastic surgeons have said to me, I am so, done with the young, silly patient, the breast dog patient who, you know needs to be out at the, the dance club, you know, two days later. And now they're complaining about pain. Like they were just, they had had it with that kind of a patient.

So, they, they did actually transition to face. And the more mature patient the one that cared more about their skill than they did about saving money. And they were ha I mean; I know I can think of at least five. That said, I, I'm happier now because I'm matured, so, I matured the patients as well. And do, do you see that coming?

Or you're fine with all of it? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: I think my price visit matured. You know, I'm definitely not a cheap press augmentation surgeon. You know, I, I think So, I think as my, as my pricing schedule has matured, I mean, I'm pretty happy. I like my patients. I tend to like that. Like I'm not, I'm not feeling this big need to change.

I love doing facial aesthetics. I love doing rhinoplasties. I love doing faceless. I do. It's but I love doing breast surgery and moneymakers and Tommy Tucks as well. I just, I don't know. I'm not, I'm not feeling this huge push to change anything just because I like my day to day a lot. Yeah.

Catherine Maley, MBA: Well, if you are, I mean there, you know, just know thy self.

If you're happy with what you're doing, there's no need to change. Yeah. What about your patients coming back for more? Are you more like a one and done or patience for life philosophy? Where are you at with that? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Definitely a patient for life philosophy. So, I turned 50 next month. So, I'm very much, I think, in that mid-career aspect of my life and I just want to enjoy like every day.

And so, I. Like the thing that my staff complained to me about, I spend a lot of time talking to people. I get to know them really well. It's really common for me to forget the procedure that I've done on them, but I always remember them and details about them. And so, no, I, I, I mean, you know this if you can hold on to your customers that life, that customer lifetime value is so, much more than having to go out and get new ones.

And when you get to know patients that well, and you genuinely like them and, and you do a good job for them, They get very loyal to you and they tend to, they tend to send people your way as well. So, the number one and number two sources of patients in my practice are either return patients or just direct referrals from them.

Catherine Maley, MBA: Right? Do you have any tips for, I mean, honestly, the, the two most important things going for somebody who's looking for you online are your reviews and your photos. Do you have any tips for how you are collecting reviews and photos or having any success? Getting them more often than not. How did this influence your decision to have your solo practice within a group practice? Sam Jejurikar, MD: I think I think the first part is don't delegate it.

You know, people, people are really happy when they're really happy. And you recognize that as, as the surgeon, you know, they, they want to do something nice for you because you've made such a big impact on their life. And sometimes I don't think they realize that it's as simple as doing a Google review.

I mm-hmm. I mean, if you want to do a Google Review for me, that's way more valuable than. Sending me, sending my office cookies, which are just going to make me fatter than I already am. And, and it's cause it's so, good for, for our practice. So, so, initiating that conversation with them yourself, I think is really helpful.

But then having a way to make it really easy. So, we use podium, you know, in our practice. Yes. And they'll just send them a little text message with a link from them, how to do that at some point. And I find that if I ask someone to do it, more often than not, they do.

Catherine Maley, MBA: That's the secret. The, the surgeon has to ask.

They'll get a much better response than the staff. What about the before and after photos? Is that a priority for you to get more of them or what's your feeling on that? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, again, I think one of the huge advantages that I have in being in the group than I am is because we have economies of scale.

We've got a full-time photography staff and we've got. Three photography studios between two different floors with, you know, amazing setups and a great database. So, yeah, I get before and after pictures on pretty much every patient in every visit. And I think I do really good work. Again, if I'm going to show it, I usually have a conversation with the patient more than just the signed releases, making sure they're okay with it.

And again, more often than not, people in today's day and age, and its still kind of foreign to me, but they want me to show their pictures online to them. That's sort of a sign that I cross some sort of threshold that like they're good enough to, to put on there. And so, I just mentioned, you know, I'll say something like, your results really good.

It'll be really good for my business if I show your results. Are you okay with that? And., They seem to really like that more often, not. Now,

Catherine Maley, MBA: I hope everybody heard that the pearl is, you give them a compliment and then you ask for a favor. And it's very simple. The surgeon does it, it's no big deal.

Mm-hmm. And so, many practices still say to me, there's no way my patients will agree to this. They just will not there. It's much too private. And I say, then how do others make it happen? You know, there's such a mindset shift. When you look at your patients as they're partners of yours and they're, you get, you did them a big favor by transforming their life, then they're more than happy.

Many of them are more than happy to re, you know, give it back to you within a review and, and photos. So, I just, yeah, I just start thinking bigger than that, especially social media for heaven's sakes. The stigma is so, Much diminished now from before. Everyone's out there bragging about everything they have. So, I don't buy that anymore that patients are private. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Oh, I totally agree. Patients take a huge sense of pride in knowing that their surgeon is recognized by other people, is being good, and they, they get, they get more intense about it than, than I do. I mean, I, I, I've never been in it, but I, I've learned that there is a Facebook group that has a bunch of my patients that are in it.

And they're really, really just like, they're very, they're like, they're very proud of me and my results and, and then I don't think I have a great social media. Personality, but I think I've got great before and after pictures. I do think I do good work and, and I think that's been great for our practice is showing it and to the point where now very often I'll get a comment from a patient saying, when are you going to put my photos on social media?

And I'm like, I just want your swelling to go down a little bit, but I promise you they'll go on there. Like I, I mean, patients bring it up all the time.

Catherine Maley, MBA: Ah, that's fantastic. So, I want to switch gears a little bit because the reason you're on my radar is because I was somewhere probably on Instagram and I saw something called this podcast and it was called Three Plastic Surgeons and a Microphone, and that completely caught my attention and I looked at it, I said, Three surgeons on a microphone regularly.

How did you pull that up? First of all, who came up with the name? Because it's fabulous. And then how in the world do you structure it where three of you are in the same place at the same time, or at least in front of the zoom at the same time? It is very hard to corral you, you people. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Yeah. Well, so, the name, my PA actually came up with that name. Her name is Colette Collabro, and we were trying to brainstorm an idea, and I think I had just seen back in concert the musician back and like two turntables in a microphone. She's like, why don't you call three plastics in a microphone? So, that's where that came up from.

The reason why we have an easy time filming it is the other two guys, Sam Re, who's in Bergen County, New Jersey, south Paella, who is in La Jolla, California. We're really good friends. We all train together at the University of Michigan. Sam was one year senior to me; Sal was two years junior to me.

But we're close friends, so, we like each other. We like hanging out, we like we like talking. So, in the pandemic, just like when everyone else was bored and podcasts started just popping up, we. We thought, let's do this. But Sam Re in New Jersey has technologically really savvy. So, he sort of put together, like as we, he, he produces all of them.

He does everything. He does the editing, he does everything. But but he's really savvy at doing all of this stuff. And so, we started doing it in the first few podcasts. We got some pretty big guests. We've got a lot of positive feedback. Then I started getting people that were coming to see me, like from other places in the country who said they found me from the podcast and I wasn't really.

So, then we got, we both, we all, we kind of realized how powerful it could be from a marketing standpoint. So, we kept doing it and it's, yeah, we've gotten a ton of feedback. We've gotten a lot of like; you know feed Spot always Consist consistently ranked us is one of the best podcasts in plastic surgery and.

We just have a lot of fun doing it and, and it's a very efficient thing to do it. We'll typically do it on the weekends. We'll do it on Sunday mornings. We can typically film an episode in 25 to 40 minutes and we'll do three or four at a time and kind of do that once a month.

Catherine Maley, MBA: And the topics, because I can't tell who's your audience, because sometimes you talk about plastic surgery via like the patient, you know, the patient itself.

Then sometimes you have industry people on there. Then sometimes you have colleagues on there talking about like you know, procedures. Who, who are you going for? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Well, no, I think we're just like talking to each other and we're, we're still figuring it out, but Gotcha. No, in all seriousness, its patient driven.

Okay. Cause even when we have industry, it's, you know if we have the ideal implant people on this Yes, I saw that. Yeah, because we're, we're getting a lot of, a lot of patients don't want to know about it and, and Sometimes, I think more often than not, because I'm in d p so, we're all in different sorts of practices.

Sam Re is a true solo practitioner. He's a, he's a one man show. South Paella is the head of plastic sugar group for the Scripps Clinic in La Jolla. So, he's in a, in a, in a very different sort of setting. So, I'm in a group that gets approached by industry all the time. Sometimes it's a way for the other guys to learn about it.

You know, where I'll, you know, I was talking to the CEO of a financing company the other day, and. And learning about some of the things that they're actually doing and, and I ask them to be on a podcast so, the other guys can sort of learn about it. Sometimes it's just each other. We're the audience, but other people find it interesting.

Catherine Maley, MBA: Right. So, you're doing it for fun. It's not like a big marketing ploy. How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: It's turned into a big marketing ploy, but we're doing it entirely for fun. Like, I haven't put, we haven't put much money into it at all. We've turned down people that want to do, you know, endorsements or advertising that have approached us for doing it.

Mm-hmm. I definitely get customers from it, but I have no way to track those metrics. But we're doing it for fun.

Catherine Maley, MBA: We love you. That's the only thing I don't like about podcasting. You can see numbers, but you can't see the details of the numbers. And that just drives me nuts is I think, who are these people watching this?

You know? And I, I, yeah, I have to count on them to like text me or deem m me or do something to tell me who you are. So, ah, that's a little infuriating, but there's no, I don't know how else to do it other than. Just keep saying, come to my website www.CatherineMaley.com and tell me who you are, you know? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Yeah. Well, I mean, I, I definitely know when I get a, someone in my office who's a patient who's blown from another state to come see me and they say, I saw you on your pod on, on the podcast, and I knew I wanted you to be my surgeon. Those are the best consultations. Cause as you imagine, you already know they're going to, they, they feel like they already know you.

Yeah. They know your philosophy about things. They're going to pick you to be your surgeon.

Catherine Maley, MBA: So, but that's a 95% conversion rate. I don't know why everybody just doesn't make their life easier. And try the relationship kind of selling first, you know people who already come. No, you like, you trust you.

They come ready to say yes. All you have to do is not screw it up. You know, like they're, they're ready. I so, much easier than, than that stranger patient, that internet, stranger patient, you know, with their arms crossed, saying, who are you? What do you, don't try to oversell me, you know? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: Yeah, exactly. Hundred percent agree.

Catherine Maley, MBA: Yeah, so, well, we have to talk about smile Bangladesh because that, oh my gosh. I, it's like tear jerking. I saw one Instagram post and oh, the little girl who is holding up her picture of her as a baby, as with a cliff palate, and she looked fantastic now, and I'm thinking, girl, you don't know how lucky you are.

Like, wow. I mean, that was life changing. So, what, what's that all about? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: So, it's a, it's a group based out of New Jersey. The founder of the group is an oral surgeon. He's really well known in the oral surgery world. A guy by the name of Shahi Azi, when I met Shahi, he was the he was on staff at U M D N J.

He's over the, he's now moved over to Hackensack, but back then, this was more than 10 years ago. The, the cranial facial surgeon at U M D N J was Sam Re my colleague from oh three pack Surgeons and a microphone. And, and on the very first small Bangladesh trip that went, it was Shawhead Sam and a couple of nurses.

And on the second or third trip Sam invited me along. So, so, I went obviously I'm, as you know, I'm great friends with Sam Marie, but Shahi and I hit it off really, really well. So, they kept asking me to come back. So, for every, for You know, at least once a year for the first seven or eight years, I would go and I would operate and got more and more involved.

And, and, and at some point, I actually got, they asked me to be on the board of directors. And, and it's grown. The organization, the organization has grown from being a really small endeavor to being huge, huge group. Shahi is built and, and CHAI's story is really interesting. He. He his son was a or his father was a really prominent infectious disease doctor from Bangladesh.

Shawhead had never even been to Bangladesh, but when his father unfortunately passed away, he just told him to never forget where you came from. So, SHA head Made it his mission and he funded this, this organization. And the, the trips now are usually two-week endeavors. The first week they're doing orthotic surgery.

The second week they're do, we're doing clef surgery and I don't do orthognathic surgery. So, I'll go in and I'll do a bunch of clef surgery. And then we come back and, and it's an, it's, they're very emotionally therapeutic. Life-affirming sorts of trips because you'll be people that just have nothing and they are so, grateful that you're providing these services to them.

And so, they've been incredible experiences for me. I've gotten to take one of my kids with me, my, my middle son who's a freshman in college now. And it was a huge life changing experience for him. I look forward to taking my youngest son with me in in a few years. It's just, it's been, it's been amazing for me.

Catherine Maley, MBA: I talk about a different perspective. Everybody who lives in America, who's complaining needs to go see the alternative and be a lot more grateful, you know, than they are anyway. So, any, any comments like any advice for others coming up in the, in the industry or anything you want to, any 2 cents you have that was helpful advice when you, that you were given? How did this influence your decision to have your solo practice within a group practice?

Sam Jejurikar, MD: You know what I think advice that I've heard all the time, but I kind of disregarded. Because it just didn't seem practical enough was to just do what you love. Oh, okay. And to build a practice that you want, because it doesn't seem like worth, if you are doing the procedures, you want to, you know, you want, if you are spending the amount of time you want, like, like in our group, there are guys that make, that, make more.

There are guys that make less, there are guys that see three times the number of patients. There are guys that see a third of the number of patients and, and ultimately, Just deliver really good patient care. Figure out what works for you. And I don't know any plastic surgeons that aren't successful. I mean, everyone, right?

Everyone has varying degrees of success, but ultimately it won't seem like work if you, if you build a practice that you want and you do the things that you want to do.

Catherine Maley, MBA: Such good advice. And the last question, tell us something we don't know about you.

Sam Jejurikar, MD: Don't know about me. Well, I've got three kids, one of whom is a junior in college and one of whom is in kindergarten, and there's one in between.

So, I'm never going to be without children. Same the. No. Okay. So, so, I guess the bit of advice is when your second wife tells you they don't want to have any more kids, that may or may not be true, but, but it's a, it's a great thing and it keeps you young for sure.

Catherine Maley, MBA: You got to get that in writing. Yeah. So, well, thank you so, much for coming on Beauty in the Visit.

Really appreciate it. I hope to meet you someday. I, you know, at a conference or wherever. And someday, boy, I'd love to see your practice. I tried to do a tour of your office, and it's just, it's big. You, you have quite an impressive location there.

Sam Jejurikar, MD: Nice. Well, you're welcome. Anytime. Just let us know when you want to come.

Catherine Maley, MBA: Thank you so, much. And Dr. J, how can they reach out to you if they want

Sam Jejurikar, MD: to? Probably the best way is via Instagram. They can DM me @SamJejurikar.

Catherine Maley, MBA: Sam Jejurikar, I like your name. It's catchy, once you get used to it, Jejurikar.

Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on "solo practice within a group practice".

If you've got any questions or feedback for Dr. Jejurikar, you can reach out to his website at, DallasPlasticSurgery.pro.

A big thanks to Dr. Jejurikar for sharing his experience on being in solo practice within a group practice

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "Solor Practice Within Group Practice — with Sam Jejurikar, MD".

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#drsamjejurikar #samjejurikarmd #plasticsurgeonsolopractice #solocosmeticsurgeon #soloplasticsurgeon

📅 Schedule your free 30-min strategy call with Catherine

⚙️ Restart your practice in 7 days

⬇️⬇️⬇️

Let's face it. Times have changed.

It's way too competitive to be mediocre. It's also way too costly to attract new patients so you can't afford to lose them.

I know you're painfully aware of how difficult it's gotten to convert prospective patients due to the insane amount of competition and information available.

This creates confusion and fickle prospective patients who know if they don't like their experience with you, they can always call one of your many competitors.

However, this is actually an opportunity for you to step up and be better than your competitors, so they choose you.

But here's the harsh reality…

It's not enough to have a gorgeous expensive website do all the heavy lifting for you.

It's also not enough to automate everything (even though that would be great). Chatboxes, Auto-responders, follow up funnels and artificial intelligence are helpful, for sure, but they have their own limitations.

Remember you are in the people business. People with credit cards who want to look good and feel great. People with emotions such as skepticism, fear, hope, trust or distrust.

These people who are using their own disposable income want customer service. They want to feel heard and significant. They want to know you care.

Chatboxes and autoresponders do not give them those warm, fuzzy feelings. People do.

So, in this podcast, I'm going to show you how to convert more cosmetic patients without spending more on advertising or hiring more staff or adding more technology.

Problem

Let's first start with this question...

If you were to listen in on new caller leads your receptionist was handling, would you smile with satisfaction listening to her professionally credential you and book the consultation or….would you cringe hearing her lose the callers and hurt your image all at the same time?

When you ask your receptionist about it, don't they often say the callers were just price shoppers and weren't serious about moving forward?

And, Does this sound familiar:

You do a string of consultations that you "thought" went well.

The prospective patients you met with were engaged and interacting with you.

You were sure many of them would book.

However, when you ask your coordinator how the consultations went, she tells you:

• "Oh, they had to think about it."
• "They were going on other consults."
• "They had to check their schedule."
• "They have to save up."

So now you're either questioning yourself or your staff or the patients.

Is it something you said or did?

Is it something your staff said or did?

Are patients today ridiculous and you're ready to throw in the towel?

It's so deflating putting in so much time and effort, only to NOT get the result you expected.

So now you decide to either spent even more on advertising to get more leads or you fire your staff or you do nothing and hope next month is better.

Instead, here are some insights that should help:

Agitate

I have trained hundreds of receptionists and coordinators from around the world and here's what I know for sure:

Every practice has money-losing holes in their practice bucket (some practices have more than others) and the most common are disappointing conversion rates.

And, even the most seasoned staff could use improvement. Actually, the seasoned staff has been around for the good times, when it was a lot easier to convert callers and consults so they may have trouble adjusting to this increasingly competitive landscape where they need to learn new skills and strategies to keep up.

Frankly, too often the staff is winging it. They just say whatever comes to mind and that leads to them talking too much and confusing the patient and a confused patient is a no so that's not a good approach.

Because it's astonishing to discover the reality of lost revenues leaking out of your practice that add up big time.

For example, if your receptionist loses 1 caller per day that was worth $2K and you multiply that by 5 days per week and 50 weeks per year, that's a whopping $500K per year and let's say you see:

• 12 consults per week
• 40% Close Rate = 5 Booked Procedures
• X 50 weeks per year @ $8K Average Procedure = $2MM

This sound good UNTIL you do the math on the other 60% who did NOT book.

That number of lost revenues is $2,800,000! Yikes!

This is unnecessary and also easy to remedy.

Here is The #1 Tip to Convert More Callers

Prepare your staff to answer the caller's question, "How much is it?"

So often, callers have only one question when they call your office and that is…

How much is it?

Oftentimes, you don't tell them. Your receptionist says, "the surgeon must examine you first" and then you'll get a quote.

That used to work before, but in today' world with so much information available, that can feel evasive or defensive to the caller so they end the call.

Or, you tell them the price and they hang up, never to be heard from again.

Here's a better approach…

The reason they are asking about price is because they are not considering anything else but price.

They have commoditized your services and "assume" they can get the same service and result no matter who they choose.

But maybe in the past, when they had chosen a cheaper alternative, they were dissatisfied because they had to wait, the staff was rude, it was painful, nobody seemed to care, they were underwhelmed with their result and their experience.

So, it's vital you educate callers what else they should consider that goes into it than just price BECAUSE they don't know….until you tell them.

Prepare your staff to "Pre-Frame Before Price" by bragging about you and the practice BEFORE stating the price. Now the caller has more to consider than one price variable. For example,

• You've performed more than 4,500 surgical procedures
• You have a no wait policy
• You offer pain free treatments and/or
• 1st time callers get a special gift card or goody bag

If you have trouble coming up with your brag points, think of all the complaints you get, fix them and they become your bragging points to tell the caller.

And, here's The #1 Tip to Convert More Consultations.

Set your coordinator up to be seen as "The Aesthetic Advisor" and NOT "The Closer"

When you buy a car at the dealership, you are often sent to an office to meet with "The Closer" to talk about the numbers and the terms.

It can be stressful because the negotiator may be pressuring you to add on tinted windows, leather seats, etc.

This is NOT a fun experience and can leave you feeling victimized, or you may just leave because you are uncomfortable with the set up.

The same happens in a typical plastic surgery consultation. The patient meets with the doctor and then is sent to "The Closer", otherwise known as your patient coordinator, to discuss fees and dates.

The prospective patient has never met or talked to the coordinator; yet, they are expected to review the quote, agree to the terms and put down a deposit….all is a matter of minutes.

This is not a comfortable experience for either the patients or the coordinator. That's why the patient so often says, "I have to think about it" or "I have to talk my husband.

A better approach is to set up a process so the patient and coordinator converse ahead of time so they have a chance to bond BEFORE meeting face-to-face.

You do that by sending a personalized welcome letter from the coordinator, then she calls to introduce herself and then sends text reminders using her name.

These several points of contact help the patient and coordinator bond ahead of time and that makes it a much more comfortable and effective consultation that actually books!

The Offer

If this has helped you see how nuances make all the difference in converting callers and consultations, you'll want to check out The Phone Club for Receptionists and The Converting Club for Coordinators at www.catherinemaley.com for a lot more strategies to transform your coordinator into a confident coordinator who converts 30-50% more consults professionally and your front desk staff will convert up to 30% more callers within 48 hours using proven scripts and strategies.

Go to www.CatherineMaley.com for details.

Enjoy!

Catherine Maley, MBA

⬇️ FREE BOOK:

📕 Get my 5-Star Rated Book, "Your Aesthetic Practice — What Your Patients Are Saying," FREE! Just pay S/H

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P.S. If you need help differentiating yourself, schedule a complimentary 30-minute strategy call with me.

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and the future of cosmetic surgery.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "The Future of Cosmetic Surgery — with Erik J. Nuveen, MD, DMD".

While speaking at this year's AACS conference, I heard a surgeon give a talk called "The Future of Cosmetic & Plastic Surgery: Consolidation and Success".

He was saying how difficult it is for a new surgeon, oftentimes saddled with up to $500K in loans, to borrow more money to open their own practice or buy into someone else's, when they enter the marketplace.

He went on to talk about new hybrid scenarios that work well for the up-and-coming surgeon looking for autonomy and support, as well as the mature surgeon contemplating a profitable exit.

Since this is a hot topic lately, this Beauty and the Biz episode is an interview I did with that speaker. It's Dr. Erik Nuveen, a cosmetic surgeon running a multi-surgeon, 10,000 square foot private practice located in Oklahoma, OK; which is embracing the future of cosmetic surgery.

We talked about how he bought someone else's practice (with a shoddy reputation) and built it into an 8-figure practice, while performing 2,240 surgeries per year.

And, how Dr. Nuveen is using the art of consolidation to reduce redundancy and change the landscape of solo cosmetic practices.

Visit Dr. Nuveen's' website

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

The Future of Cosmetic Surgery — with Erik J. Nuveen, MD, DMD

Catherine Maley, MBA: Hello, and welcome to Beauty and a Biz where we talk about the business and marketing side of plastic surgery and the future of cosmetic surgery. I'm your host, Catherine Maley, author of "Your Aesthetic Practice, what your patients are saying", as well as consultant to plastic surgeons to get them more patients and more profits. I have a really special guest today.

His name is Dr. Erik Nuveen. Now, he's a cosmetic surgeon, who is embracing the future of cosmetic surgery, in a multi-surgeon, 10,000 square foot private practice called Cosmetic Surgery Affiliates, and it's located in Oklahoma City, Oklahoma, which I've actually had a chance to visit this year for the first time in my life, and it was really nice.

So, this eight- figure, practice, which is embracing the future of cosmetic surgery, includes face, breast, and body surgical procedures performed by four surgeons in their two onsite operating rooms, which are fully accredited and AAAHC certified. Now, they also offer a plethora of nonsurgical treatments performed by many ancillary staff in their med spa, as well as online store that carries their own skincare line.

Now Dr. Nuveen and I crossed paths very recently. We were at the American Academy of Cosmetic Surgeons annual meeting in San Diego and Dr. Nuveen we were in the practice management session and after I spoke, then I listened to Dr. Nuveen's talk and his was entitled, "The Future of Cosmetic and Plastic Surgery: Consolidation and Success". So, this happens to be a really hot topic lately, so, I wanted to get his take on it because he's very immersed in it and like I said, he's embracing the future of cosmetic surgery.

So, Dr. Nuveen, thank you so, much for coming on to Beauty and the Biz.

Erik J. Nuveen, MD, DMD: Oh, you're welcome. Thank you for having me. I appreciate it. It's an honor, it's always I don't know, may, maybe it's a point of retrospect and, and life, but to, to hear the things that I've done is kind of weird to listen. It just you know, I started off when I was six and always wanted to do surgery.

My father was an orthodontist and oh, He straightened teeth, and that was wonderful to change the perspective and often the self-esteem of o often adolescences. But at the end of that, I was always frustrated with my dad because he couldn't fix their nose or their chin. Oh. And that's really where it started.

And you know, today after finishing, you know, 14 years after college and. And eight, nine years of residency and fellowships. And then 21 years of clinical practice, it's like a blink of an eye. And I, I know I, I sound like a broken record for us that are adding up some years, but what I think what's been kind of special about my situation is when I finished up a full formal fellowship and face end body cosmetic surgery in Salt Lake City, Utah.

I had also finished a year of cranial facial surgery at Toronto Sick Children's Hospital. So, I had a pretty unique bunch of skills and also medical and dental degree. Prior to, I did a total of two years of general surgery. So, it was interesting because I, I had also along the way had taken a little time to fly some airplanes and so, I figured, well, gosh, how can I involve myself with a hobby with a skill to help others and to improve the standard of care throughout the country?

And I, I, I take that statement very seriously. That was my objective and it still is to this day to try to improve each and every day. And I hope when I do exit. That it will be at the top of the game and, and I'm always looking forward to that because each day seems to be a better day. Oh. Yeah. Yeah. So, I, I finished my fellowship and I came to Oklahoma City.

I picked Oklahoma City because the cost of living here was very low. And the opportunity to start off day one in a 10,000 square foot facility that I purchased was not Something I could do in downtown Manhattan, right? Or other major metropolitan areas. So, I live about eight minutes from my office and 12 acres and nice countryside and quiet with coyotes and hawks and owls.

And it takes me 10 minutes to commute to see patients, and it's just been a fantastic choice. It is the middle of the country, so, fortunately I get to use my airplane and go and visit the ocean often. And so, the practice really started there in Oklahoma City and I took over a preexisting doctor's practice.

He was 71 and did exclusively breast surgery. And I saw an opportunity to expand that practice. And fortunately, God willing it did. And so, I purchased that practice from an individual, kind of the old school method, a handshake, a, a gratitude, and pat on the back and. And there I started and did —

Catherine Maley, MBA: Wait, were you in a different building? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yes. Yeah. From the, from, so, he was in a smaller facility and shared with an ophthalmologist oculoplastic eye. Mm-hmm. And that relationship couldn't have lasted too long. Cause I really needed to grow and I needed multiple operating rooms to do what I had set my heart to do. So, my, my plan from day one was to come into the community meet all the other surgeons that did similar things and.

And opened the door for growth. And ultimately, I, I set the bar high. I want it to be the most dominant practice in this region of the country. And I, I think statistically we've been able to achieve that. I do. About, can, can I ask you something? Yeah. Mm-hmm.

Catherine Maley, MBA: Out of curiosity, what exactly did you buy? How did this affect your understanding about the future of cosmetic surgery?

Because, what did he have that you wanted of value? Was that a shortcut to get into the community or what? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah, it's a great question. So, you know, there's an exchange in life, right? You know, you, you ask for, you have communication, you hope for a response. And in the relationship with the physician was this gentleman wanted to exit and I wanted to come in.

Mm-hmm. And he had a patient flow volume of about 750 patients a year. He did a very high volume of breast augmentation and he was very consistent year in, year out. He didn't offer almost any other procedures. So, I saw an opportunity there just in the patient flow volume to expand, and it did. So, we sent out letters to 6,500 pre previous patients and inform them of our expanded services and an opportunity to meet with me and.

So, the first month I was in practice I did 57 major surgeries and I've never slowed down.

Catherine Maley, MBA: Nice. And did you two, like were you feeding off of his credibility? Did he have to stay put for, for a while for the patients to get used to the transition or how did that work? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah, that's, that's a really variable answer if you're speaking to the general public on that topic because it's all about personality will determination.

Effort and I hope good counsel. I think that's an often-overlooked commentary is you, you need to, don't, don't do things foolishly because you think it's the right thing to do. There's been other people there before you and you really should ask some good questions and don't be afraid to hear constructive criticism.

It's, it's very common to think that doctors have done very well in school and that that translates into financial or good decision making, and it doesn't always. So, we have to admit that first and foremost, have the insight that the others have been there and let's get some good advice. So, for, in my situation, I was taking over a gentleman's practice who.

Had done almost 20 years of exclusively breast surgery. So, we had a very long proven statistical track record, and I'm very data driven. So, I did a lot of spreadsheets and demographics, co, you know, cost of living, cost of employment, and the goals that I set for myself and my business, and kind of predicted in a business plan exactly what I thought would happen.

And it's actually remarkable how close I was over a 20-year period to exactly what I predicted. It's actually freaky weird. I was off by less than a hundred thousand dollars in, in, in all the categories, which is pretty, pretty amazing actually.

Catherine Maley, MBA: But did he stay put like did you two work together or did he pretty much exit and you entered? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah, I made a very thought-out contract. There were some issues related to his history that I needed to insulate myself from and isolate myself from. So, I did that legally. And he worked about two hours. And then he was released from that obligation. And then I took it from there. And at that point, I had come down two times during my fellowship met patients, knew I was on good, solid ground of communication and I was willing to take that gamble.

So, he exited immediately and I took it over from there.

Catherine Maley, MBA: So, again, out of curiosity because these are the kinds of things people want to know about. Yeah. If you're taking over somebody's practice who might have some reputation issues or maybe some bad reviews, do you, how do you handle that? Do you just change the name and hope nobody notices, or what do you do? How did this affect your understanding about the future of cosmetic surgery?

Yeah. Well, you over his website with his SEO of 20 years of rankings, or how does that work? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. You know, today's a different era. Yeah. You know, it's 21 years down the, down the road since then. But at that point we did surveys. We sent out surveys to patients. We asked local doctors, because I did communicate with every other plastic surgeon here in Oklahoma City.

Not always to the most welcome response, but they gave me enough ammunition, fuel, and, and energy to try to approach. The challenges and also received the benefit. And the benefit was just a phone number and a website and that. Statistical demographic that was reaching out was very consistent.

And even though there were negatives and I, I have yet to meet a doctor in the country that didn't have a negative of some sort. Right, right. There are risks and sometimes we take those calculated risks and I, I think if we're, we're a wise person, we're going to really investigate background checks histories, people, they're cavorting with their associations, their friends.

It was, my situation was abundantly clear. There were some significant challenges, and I have to say, if I asked 10 of my colleagues, they might have questioned my judgment, but I just looked at the demographics. There was, there was such strong patient flow and opportunity in that patient flow that I, I went for it and, and it was a good choice.

But how does that translate to other doctors? Excellent background. Listen to others, get experts, get lawyers, get accountants. You need to surround yourself by people you trust to the end. I mean, like people you'd give your kidney to if they needed it. You, you really have to have that level of faith because these people are giving guidance about your career.

And to take it lightly is a fool's errand for sure.

Catherine Maley, MBA: What would you say is one of the biggest mistakes made that now you look at back at now and say, gosh, I wish I had avoided that one. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Hmm. Well, I got to be honest with you, maybe I'm, maybe I'm just blissfully happy, but I can't think of a single significant mistake that I made at all.

I mean, it, I really, it, it has been an unbelievable career. Unbelievable. And. Sure there are things I'd, I'd regret taking on too. Challenging a case at too earliest stage in my career. Mm-hmm. I'm definitely guilty of that and thinking that maybe sometimes I have more answers to a problem than I. I rightfully should have.

Mm-hmm. And those can bite you. But you know, it's experience just leads you to those types of mature answers and inexperience leads you to immature answers.

Catherine Maley, MBA: So, how long were you in practice before you bought that 10,000 square foot building? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Oh, I actually bought it before I started, so, I, I, I had made some pretty savvy investments during residency and I saved up a great deal of money.

So, I had no debt. I paid off all my student loans and I had enough money to go in and, and pursue loans. And this was a different time. I mean, gosh forbid a person leaves a residency now with four or $500,000 of debt. I mean, they've got a doctor, doctor at a, at, you know, after their name and that used to buy you, you know, a million-dollar loan just for the handshake and a signature.

Those days are long gone. And it's really an interesting time, which really leads us to the issues of consolidation. For sure.

Catherine Maley, MBA: How did you know that you, were you, so, you knew you were trying to build an empire, like you weren't getting around like you, or were you thinking about renting it out to others? How did this affect your understanding about the future of cosmetic surgery?

Did you know you were going to fill that building up? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah, well, you know, my mom says things to that I'll quote often, and I know she'll listen to this podcast, so, she'll probably get a little teared in her eye. But when I was a little kid, my, my mom always said he's full of grandiose ideas. We'll see what happens.

Catherine Maley, MBA: Famous last words, huh? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah. So, I, I've heard over and over from people and I surveyed as many people as I could find. I went all over the United States, never spared a vacation to, to go to a surgeon and spend time with them. I mean, I missed, I. Almost 10 years of vacation because every vacation was used to advance myself and my career for my patient's benefit.

So, I I had a lot of information, a lot of experts out there, very famous people. I could just run-down a, a lengthy list. And they, the con the con consensus was a few things. No matter how big the space you get, you'll fill it. Just watch, it'll happen. And so, I took that to heart and came to Oklahoma where things were a little bit cheaper and started day one at, with 10,000 square feet.

And, and now we have another facility in Jacksonville, Florida that's going to arrival at, so.

Catherine Maley, MBA: Wow. And then when did you start adding other surgeons? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Hmm. Well, I was in practice for three years before I took our first fellow, and so, I would. Count that as my first experiment with having another full-time doctor with me.

And that was a great experience. And so, I've had. 15 fellows. Now we have one every six months now. Those fellows are all over the country from Seattle to Scottsdale to Park City and down in Florida. And so, that's been a great journey. I, I would say that is a really nice way to bridge the gap from independent practice to developing physician relation skills.

When you're isolated in a practice, there are some strengths that come from that autonomy, but also some weaknesses that develop and that dictatorial unilateral approach to decision making can be a very challenging problem in, in various social arenas. So, I would attribute that first step of growth to fellowship training and devoting oneself to the education and betterment of someone else is, is a, is a really true altruistic art.

Mm-hmm. So, I would say there, now my first associate was 2007. So, I was in practice four years and took on a gentleman for two years. We knew his pathway was to leave, but we were fortunate to have him for two years, and that gave me another stepping stone towards longer term relationships. And I, I'm still learning to this day.

I don't have all the answers. I. But I will say that there, I think there's three categories of doctors you work with. There's a doctor who's very skilled, very capable, and very good, and is just trying to bridge that gap of independent practice from residency, for example. And they're strong enough and good enough that they're going to try to fight it and do it, do it themselves.

Some of those doctors will see value in associating with another doctor and others will not because they're so, capable and skilled. That's one type of doctor and they take a different approach and a different mentality and a different communication style. The next doctor is a doc. Our doctor is a doctor, is completely on the other end of the spectrum, and that's a doctor who doesn't want to own anything, doesn't want to run anything, and just wants to show up.

And they literally don't want to manage. Even the thought of management is, is just makes them almost sick to their stomach. And those doctors are really interesting because you can almost plug and play. You can have a system do consultations, plug in the doctor, minimize their interaction. Quite honestly, because often they're not the most robust in their skillset and succeed very well because if they show up and are happy to do two or three surgeries a day, I mean, they're thrilled to go home.

And maybe that, that term that sometimes confuses me work-life balance, which I don't have. That, that's the third type of doctor. The intermediate doctor is the doctor that I really strive for. But I'll take anybody, I mean, I, I'm not going to say that we have a specific type of doctor that we're looking for because honestly, all of them can work well.

It just. Listening to them, understanding them and respecting their skillset and their what they're really looking for in their lives. So, that intermediate doctor is a doctor that wants their input heard. They want to be respected. They want to add to the quality of the practice or the contribution factor they want to contribute.

Yet they don't want to overly be involved with the bills. And negotiating contracts with anesthesia departments, it's just not what they want to do. So, those are the three kinds of broad-based categories of doctors I deal with, and all of them can be appreciated and all of them fit into a system. You just have to respect their differences.

Catherine Maley, MBA: And, acknowledge them. Because I think a lot of doctors aren't aware of which box, they fit in. Mm-hmm. Because some of the doctors actually, some of the I'll just generally speaking, yeah. The younger patients don't, or the younger doctors don't know anything about business and they've never had to come up with patients in a marketing plan and paying bills and being at risk. How did this affect your understanding about the future of cosmetic surgery?

Yeah. So, they come on a little strong and not be naively, you know, and then there's the older doctor who might be burned out. But, but not willing to relinquish control so, that there's nothing easy about that. I'm sure you take your time, you know vetting these people, right? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah. It, it's, it's really interesting.

It, it's a, it has to be thought of, in my opinion much more fragile than a marriage. I know there's analogies often made, but. I mean, it's pretty easy to get out of a business situation, and it's, it's much more financially challenging to exit a marriage having been there. So, I, I, I would say that identifying egos who needs to be praised?

What, you know, what are their love languages? I mean, it's truly a tort of force of intellectual psychological assessment and appreciation on both sides. I mean, we have to respect each other. We have to show that respect, but constructively, we have to give guidance. I mean, it's really awesome. I mean, talk about fulfilling.

I mean, this type of, of business relationship is just amazing.

Catherine Maley, MBA: Well, I've seen some practices that are a true democracy. Mm-hmm. They meet, but they meet every week. They have the same values. They have honed this. Mm-hmm. I know a practice who has kind of like a coach and the coach keeps everyone on task. How did this affect your understanding about the future of cosmetic surgery?

Mm-hmm. Just in case things, they don't want any big problems that are factoring and they're not talking to each other, so, they really take it seriously. And, and they have a beautiful, profitable practice. Mm-hmm. And then others are just a dictatorship. They just, they. They hire some surgeons and they say, I'm running the show. How did this affect your understanding about the future of cosmetic surgery?

You just show up and, and appreciate that, and that's it. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Right. Right. Yeah. And, and yet there is room for all. I mean, there's enough to go around. Mm-hmm. And the greediness and, and the you know, to, to think that you're the only one to do it. The only way is just foolish.

Catherine Maley, MBA: So, I've been doing this for a long time and I've never heard the same story twice. How did this affect your understanding about the future of cosmetic surgery?

You know, there's no one way to do this. That is for sure. I'm just loving all the creativity that is coming about, that's evolving and that's why we're talking about this. But yeah, if I'm not mistaken though, when I was listening to you speak, do you have 39 staff people? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Let's see this week. And that's a, that's a, a laugh, but also the truth.

It does vary quite a bit. We have. We have one person two people kind of exiting. We have three coming on. That's normal. That's a normal week. So, we have a very open-door policy. I say the same thing every year at a Christmas party. I say, listen guys, whenever you want to leave, it's perfectly fine with us.

Don't ever feel like you got to be the last one in the, in the building. I just thank you for coming. Thank you for being a part of our employment. And just have a good time and leave whenever you feel darn good and ready. Don't, don't feel bad. And I kind of keep that same philosophy in the office. We tell people when they're hired, listen, we're, we're here in this life for a certain amount of time.

You may be here for a long time; you might be here a very short time. Don't ever feel bad about it. Always address things up with honesty and forthrightness. And if things aren't going well or you're seeing things differently, we need to hear about it. Let's just be open about this. Immature adults. And so, we do have a fair amount of turnover in our office, which is both financially challenging and functionally challenging.

So, we've chosen kind of a redundancy and an overlap in employment that allows kind of a rotational cycle of employees. So, I have a set of employees that I work with primarily. Of course, I like to call them "The A-Team", but. They're really just a group that, that has piled around with me, knows my habits, knows my mannerisms, and we work really well together.

So, we work together three days a week. We, we typically do 12 hours a day, three days a week. And we start at six 30 and yeah, usually finish around 7 30, 8 o'clock at night and no, I take no lunch. So, talking about work-life balance. Yeah. I'm not the model of that. I love my work, love my work. I make no excuses about it.

I am no balance whatsoever. Work, work, work. Because I love work and I figure I want to work. And if I die at work, that's okay with me.

Catherine Maley, MBA: Okay. Good attitude. Do you, hopefully you give them lunch, right? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yes, yes. As what's required. But I, it's so, funny because you know, people of personality types, they tend to congregate.

We like to hang around with each other and you know, we have a certain type of humor and we have a certain type of music we listen to. And it tends to be that these young ladies work their living butts off. Cause they love that I do. Nice. So, we're all, it's like a bunch of pigs and mud. I mean, we all love rolling around in it.

So, they take very little launch, often don't take lunch, they'll snack on something. They kind of mop about it, but they also are kind of proud about it and mm-hmm. So, my little set team is they're amazing and I'm very happy for, but we're just one small part of the big group. We have a, we have a big administrative group.

We have a very big IT division, which. I mean, I, I could just talk for hours about just our 13 different IT groups that we work with. It's craziness.

Catherine Maley, MBA: And are you planning, do you go for patients all over Oklahoma? All over the nation? All over the world? Well, where, where are you going with that? How did this affect your understanding about the future of cosmetic surgery?

Where are you? I mean, are all these, like the, those breast dogs, was he getting all those just in Oklahoma City? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah. The so, the, my predecessor, the person I purchased the practice from was, was a, a, a very unique individual. He decided to basically do the Walmart service, so, he did, it was $2,800 cash breast augs saline only, cash only.

And he did four a day, five days a week. So, that's not a bad business model. No, no. He did very well financially. Mm-hmm. You know, there, there were some unscrupulous issues and there were some, some financial misappropriations that occurred.

Catherine Maley, MBA: Well, the cats only probably was a hint there. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah, yeah, yeah, yeah. So, Anyway, but we don't run our, our business like that. So, our, our business is, you know, absolutely to a t run properly. And, and so. What is our recruitment? Honestly, we try to focus on the central Midcentral United States. We do get patients, word of mouth, friends, et cetera, that come from all over the country.

We have a very large military presence here in Oklahoma, so, we have a lot of people that relocate to Japan, Germany, Italy those are the big ones, and all over the United States on a different military basis. So, that has been a big area of contribution to the practice success. But really, I, I think it's been 21 years of, of tremendous service and being available to the patients.

I, so, 21 years ago I made my own website. Mm-hmm. I did it over Thanksgiving. Weekend it cost me 25 cents. Nice. And I started something I'd never heard of and I did, made an online form entry and completely, there was no HIPAA and so, they just sent me pictures. And so, I was getting, you know, pictures of people, body parts from all over the country all the time.

And I was inundated. So, I had never heard of anybody ever doing this before. And you know, of course things have advanced to all the encryption and HIPAA policies and now almost everybody has an online form entry system. Mm-hmm. But you know, 21 years ago it was unheard of. I certainly never heard of it.

Catherine Maley, MBA: Oh, that was a big deal 21 years ago. Good for you. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Oh yeah, we were doing 20, 25 cases a month purely from, without ever visiting with a patient. The patient would come in from out of town, we'd see him the day before, we'd do the consultation, then we'd do the surgery the next day. So, yeah, it was just I have to say that that concept came from a, another doctor who I met in Connecticut, and he was doing that for wisdom teeth removal.

And just inundated. And I thought, hell, why not try that in our business? And sure enough, it was a, a tremendous boost.

Catherine Maley, MBA: That's how I've grown my own business. I always looked at all the other industries and I said, how can I adapt that to our industry here? And it's all y all you have to do is be a little creative and say, how could we do that here? How did this affect your understanding about the future of cosmetic surgery?

And yeah. Now you also have an online store, a skincare line. You have your own skincare line with an online store where they can shop. I'm always curious about that. Is it a good profit center? Is it a pain in the neck? Who's doing the fulfillment? You know, I never, I, I'm not a fan, but, but does it work? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: I mean, yeah. Well, first of all, I, I think you have to have a passion for whatever element of the practice your endeavor might be. So, for me, I'm a surgeon. I do surgery morning, noon, and night. I hire people that have passions for things that I don't have a passion for. So, I have an aesthetician that does all the aesthetic services.

I have two nurse practitioners. That primarily do non-surgical things and supervise my clinics. I have a skincare person that deals with most of the retail services. Is it a profit center? Sure. It makes a profit. You know, I mean, it's probably 50% margins on everything we sell, but, you know, as far as a comparative, I mean, just to use real numbers and I hope that's okay.

I'm always very transparent about, about the practice. You know, selling $10,000 a month of skincare products is, you know, that's $5,000 a profit. That's pretty darn good for buying hamburgers and shoes for your kids.

Catherine Maley, MBA: I'm okay with that. As long as you don't lose focus on the big-ticket items. I find that the vendors or sta like estheticians take it very seriously, but I just, I watch the balance of how many are, how much of your resources are going into that when it becomes only one or 2% of your overall revenues good. How did this affect your understanding about the future of cosmetic surgery?

That money have been made. Easier or elsewhere, or that, that's my only comment there. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: You have. Yeah. Yeah. It's a very, it's a very good point. And you know, some of the consulting services will focus on the quote, the, the money left on the table, right? Yes. That's the common statement. Well, you're leaving money on the table, right?

I mean, that's a term that I just want to choke people out for. Because you're absolutely right. If you have no passion for it, if you have no business doing it, please don't do it. Yeah, you're going to waste energy, time, frustration, managerial nightmares, legal liability. I mean, I could go on and on. If you are really good at something, I think you should do it all the time.

Because you're going to make much more money at it. You're going to enjoy your life. And I don't worry one bit about my skincare related services, because I've got a young lady who loves it. So, there you have, yeah.

Catherine Maley, MBA: I mean, I practices try to train everyone on how to sell skincare and I just think I don't get that. How did this affect your understanding about the future of cosmetic surgery?

I just, I think there's a better use of your time. Regarding, you're doing a lot of non-cervical as well. You have a full-blown med spa, right? Because isn't your, is your philosophy more patient for life or one and done? Or where are you at with that? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah. God, you know, so, right now I, my practice and I as 90 plus, 90% of the overall surgical volume, I do about 2,240 procedures a year.

So, it's almost mind boggling. But I did surgery. Yeah. And so, I, my focus is all there. So, but what would be ideal? If I were to step back and walk into this office as a businessman, which I like to do mentally. I would look at the colors, I would look at the smells. I would look at how I'm greeted. I would see what, what the door presentation is.

I would want to hear the music on the speakers and you know, is there a TV on and what's playing on it and what's being presented. Are there menus of services? What are the services that this offers mm-hmm. That this office. Offers, how is it displayed? Is it displayed on the wall? Is it displayed electronically?

All of these things that would go through my mind if I walk to the office. And it's interesting because even though I, I suppose I'm in the position of c e o, I don't fulfill all of those. Things that I've just told you, there's always room for improvement. There's, and that's undyingly interesting to me, that there's always room for a person's improvement and the practice improvement.

Now, if I were to say in a more ideal situation for, so, I do about 90 major faceless and facial restorations a year in, if I could ideally, Play out for you. What I'd like to have, I'd like to have an introduction. I'd like to have a credentialing period. I'd like to discuss their goals. I'd like to hear from them for 10 or 15 minutes.

I'd like to a, evaluate them and like to give recommendations based on their goals. Now a quote is rendered, but I'd also like them to meet with an aesthetician because as part of the comprehensive care of this patient is not only. Pre-operative preparation for it in many cases, like laser skin reserving, but the post-operative maintenance, it, it is a really important, integral part of, of ideal patient care.

So, it's not just a surgeon comes in, cuts, walks out of the room and never sees the patient again. That would be the, the most cur method of maybe managing the patient. But really ideally that's what I'd like to have. Do I fulfill that each and every day? No, I don't. I, I think if I were to walk in as a consultant, I would say, boy, you really need to kind of systematize that process each and every day to have that integration that I think is more ideal.

Catherine Maley, MBA: Well, as a, coming from a perspective of the cosmetic patient, once they've invested in themselves on one body part, they will move on to another body part. And especially if you help them with that. So, I think you, you, you have a patient there for life psychologically, you know? Yes. Once you get that bug to look good or feel good and all of that. How did this affect your understanding about the future of cosmetic surgery?

Yeah, usually it's not a one-time thing for the patients and nor should it be for the practice, you know? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. The loyalty of patients within the cosmetic surgical field has been well documented. I mean, the average patient is like five procedures over a lifetime. If you can maintain them for a lifetime.

I wish only at five. Yeah, that's, yeah. Way over that. If you look at you know, lifetime income from that, you know, our average price point per procedure is just about $11,400. And so, I mean, that's not something we should shy away from. And we also know that the cost of acquisition of new clients is much more expensive than the preexisting ones.

So, it just, in every way it makes sense to establish and maintain an ideal relationship. But it really starts from. From the moment you meet them, being very direct, very honest, very, very open, and also expressing limitations. Just being a human. I mean, sometimes patients forget that just because you went to school for a long time, you don't have all the answers.

And reminding them that, that humbly, I think, is really important. Have you noticed a

Catherine Maley, MBA: change in cosmetic patients from even, I guess maybe pre-social media to now or pre-internet to now? Like, how do you see them now? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Hmm. Well, I, I, I'd say I'm a little bit biased by my current position in maturity of practice.

Probably 55, 60% of my patients, maybe even slightly higher are previous patients. Nice. So, that's, that's advises me because they already know me. They already trust me. They, you know, their daughter, their aunt, and their grandma came. And so, that's a, that's a no-brainer. You should seal that deal. That should be pretty easy.

It's the new clients, the new acquisitions that are, are Our, our have changed, evolved quite a bit of course during free money time and low interest rates. And, and COVID was, you know, the heyday for cosmetic surgery. I, I've rarely met a practice that didn't show a significant increase because of time available for recovery, but also Liquidity was very high.

Yep. And so, that period is, is certainly changing right now. And we see, seen a macroeconomic tightening throughout the country and all the practices that I deal with. And, you know, you, but it, it's a want and not a need. And thank goodness for that because having weathered housing crisis 2001 bombings there's a, you know, little dips that you take, but.

People want what they want and they'll put off their needs. They will not put off their wants too long. Mm-hmm.

Catherine Maley, MBA: I agree. So, I want to switch gears a little bit because Sure. You've grown this incredible empire. And then I want to talk about the talk that you gave about the future of cosmetic and plastic surgery and the consolidation. How did this affect your understanding about the future of cosmetic surgery?

So, can you go ahead and, and can you just like a brief talk of what your thought was? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Sure. Well, thank, thank you for, for listening to the talk. I appreciate it. Okay, so, five years ago. I sat down and I thought, you know, I'm not getting any younger. My practice has become a, a behemoth and it would be very difficult to sell the practice to an individual for what it's valued or what I'm told its value is I.

And so, I was really struggling with that. So, I thought, well, maybe I could fractionate it, break it down to shares, and maybe five doctors could split it up, and that would bring me some revenue towards an exit. But honestly, it still wasn't anywhere near what the actual cash flow and ongoing value of the practice was.

So, I got really frustrated with that and I, I can I Spoken, met with a lot of people from many different industries, auto industries tech industries all over as many people as would listen to me. And so, my, my grandma always said, if you want to want to learn something, just call. And so, I called CEOs from every website I could find.

It's amazing how many of them were interested to spend just five minutes with me and tell me about you know, it was like I was a kid in, in high school asking on a school project. And so, I learned and learned and learned, and I realized that where the value in the future of our field, in my opinion, is in reducing redundancy.

That was really the central theme. If you think about every garage, you drive by in the United States and it's open in the summer, you'd see a weed whacker and a lawnmower and a trimmer, and gosh forbid they're sitting there like 98% of the time not doing anything. What a waste of money when one community could very well buy a set of lawn, a lawnmower, a tremor, and rotate it throughout the community.

Catherine Maley, MBA: There you go. Perfect. That's a great idea. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah. I think of it that way and. Yeah. And in our business, that's exactly what we do. Almost every small boutique type practice has an office manager, maybe a person in charge of, so, social media, front desk girl, and an accountant. And, you know, maybe that's the size that they're, they're comfortable with.

But my practice had grown so, big that I had, I have, you know, five departments. I've got department heads in each department and ins, subordinates within those departments. And we have department meetings and, you know, it's all very corporatized and just everything was just going that way. So, the more information I got, the more I realized that I, I could very.

Quite honestly, I could very easily just go to a private equity consolidated group and just sell my practice. But what I did was I looked at all the available options and there were very few, and still are, very few actually that have gotten to a point of consolidation. And I realized there were a few significant weaknesses and I spent, I.

Almost 2000 hours. That's no exaggeration by the way. 2000 hours. I documented all of it. I, during residency, I was very obsessive, so, I documented every hour I ever did during residency. And so, I have that all written down. So, I figured, you know, I've got to keep this up. So, I documented all the time, I spent on the phone, at conferences, at meetings with private equity groups.

And I learned a great deal and what I learned was the private equity groups often contributing some form of financing. So, they consistently wanted to take. Plastic elective surgery and Shoe Hornet into the models that they knew. And those models were gastroenterology, ophthalmology, dermatology, insurance-based accounts receivable.

Their due diligence process was very foreign into a cash-based system. They didn't even understand that we were prepaid for surgery, you know, a month in advance. It was just, Whoa. Where's your accounts receivable?

Catherine Maley, MBA: And there's no accounts receivable. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. None ever. So, I had, I was really like walking into these people that I felt I was the ignorant one, but they had absolutely no understanding of what I was talking about.

So, it was actually, I saw that as a great opportunity to, I mean, I always love somebody who's willing to listen to me, so, I had a great. Time kind of going through so, many different groups, speaking to different levels, all the way up to CEOs of these private equity companies, and just hearing what was pleasing to them and what they were scared of.

Hmm. What. Oh my gosh. I mean, the list could be very long. Key operator dependency issues. You know, if there's only one doctor in a practice, how can you show me on a, on a cash-based system that your 90 day and one 20-day revenues are going to be there when I'm used to waiting for accounts receivable for 120 days?

So, they, they want security.

Catherine Maley, MBA: You know, and this, and they want predictable revenues and how you say that in our industry, you know? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: That's right. And all you can do is say, well, I've been in businesses 21 years and it's gone pretty well. Yeah, right. So, I just kept on telling them that, listen, look at the books, look at the data, look at the, the, the cash system is, you know, a 40 to 60% profit margin.

You guys are arguing over 13 to 17% in dentistry. I mean, it makes no sense to me at all that you're wasting all this time with dentistry when you've got a cash cow right down the street. I mean it just over and over again. And then one day I got a call back from one of the CEOs and I was in the Atlanta airport at the time, returning from a, a meeting with another private equity group, and he said, Erik, We like what you've been saying, we've been really talking about it, and we want to meet with you and your group.

So, that was, I mean, I, I almost cried. I've been telling you my hair stood up in my arms. I was like, yes. And finally, it took me four years to hear that type of response that I was hoping for. And, you know, speed ahead and the tides are turning. There's certainly a tipping point. Of familiarity, understanding, and acceptance.

And the world of cosmetic elected plastic surgery is filled with people that make a great deal of money compared to the average person, and they're very autonomous. And this is a tide that's going to take a long time. But that's okay. The, we're, we're in this for the long haul. This is a 10-year project.

This is not a one-year project. This is a 10-year project, and I really came up with that idea with a lot of my buddies in construction. And when they look at a thousand-acre plot, they're not thinking about, you know, one year, they're thinking about 10 years in building schools, community parks restaurants, everything.

That's a part of urban development. And I just thought that's, that's the kind of approach I want to have in this industry is a 10-year plan. I. So, really that led me to some partners with some colleagues I've known for 25 plus years. All of them that are surgeons. Were business people. Yeah. These are all other surgeons that have been extremely, you'd know all their names if I mentioned them, but I won't mention them because they didn't give me an approval to do so, but they're very well-known people that you would know immediately.

And people that after conversations, just like we're having, came to the realization that the future is very strong when you consolidate. Mm-hmm. The strength, and this really comes from the relationship I've had with my wife and my. Fellows and my partners are that we are always stronger together than you are separately.

Always, always. And once people get that mentality shift accepted, they go, ah, I get it. So, we can have one accountant for the entire system. That's one cost. We have one c e o, one procurement expert, one person that's saving us 20% on. Allergan or Galderma just 20% right there of negotiating power. When you've got a 50 million a year cash flow company and you sign exclusive contracts, you're going to get tremendous buying power, strength, and it, it's just over and over again.

I could go on and on, but I, I hope that's exciting for the viewership.

Catherine Maley, MBA: And are you consolidating the HR, the hiring, the managing? Because I find absolutely the surgeons, the number one challenges staff. Mm-hmm. They, they are. So, especially after post covid, they're so, done with staff. Like they're, yeah. How did this affect your understanding about the future of cosmetic surgery?

You know, is, does it include that? Because I can see a lot of practices thinking, oh my God, if I could get this off my plate and get back to doing what I like to do, which is surgery. Yeah. I'd be a happy clam right now. And I'm, and they're, I'm not. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah, yeah, that's exactly the type of person that we're looking for.

And you know, to kind of make this segue a little bit the goal is to have 50 practices that are like-minded, utilizing a centralized call center, centralized HR, centralized procurement. The buying power of, you know, 150 million a year company is just puts you into a totally different league, right?

We want doctors to maintain autonomy if they want to. So, we offer a number of different avenues to try to become partners, and it has to be a partnership. There are people that just want an exit plan and we provide that exit plan. There are people that want administrative roles and responsibilities.

There are people that want equity in a growing and very rapidly growing corporation that pays dividends. And so, we have avenues for all those different types of people, and we have avenues for people that just want to show up and work. I have a couple people right now that, so, we're constantly interviewing.

We're constantly evaluating practices, and you always learn something from that. Those, those communications.

Catherine Maley, MBA: Are you involving private equity or is this a physician led consolidation? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Actually, the answer is yes and yes. Okay. Ultimately in order to fund the growth if you study almost every other industry, there's a reason that loans exist.

Yes. I mean, why, why not just put it on your shoulders? Well, because honestly, there's a point of growth that you need acceleration and you need to get through a, a bridge, a gap that costs money. And it's, it can be a pretty substantial amount. So, the initial phase of development is a minority partnership with private equity where we maintain 80 plus percent of ownership and all decision-making rights exclusive of a few constraints with utilization of funds.

That are appropriate to any financial term, to any company. And but it is a board run by through and about physicians.

Catherine Maley, MBA: So, the board is made up of decision-making powers by physicians and the business people are also on that board? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yes. They have one seat at the board, at the table. They do have some.

Again, you know, lots of details, but ultimately decision-making powers of specific hiring roles. Veto powers do exist, but they're extremely limited due to the minority position.

Catherine Maley, MBA: Gotcha. I'm doing, it's a miracle though. I've worked with, I mean, when I get in when there are more than three surgeons in a room, we have a tough time making a decision, so, Yeah. How did this affect your understanding about the future of cosmetic surgery?

You know. Good, good for you, because I can't imagine all of them coming. How does that work? Can you get a decision made? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Yeah. Yeah. Well, I, I think, again, it all goes back to what I tried to form formally kind of describe, you have to have this mental shift. It's not about me anymore. Yeah. It's about the entity.

It's about growth. It's about the quality of consistency of quality of care. Mm. Mm-hmm. And I think those words play very strongly amongst even egocentric physicians. Mm-hmm. So, but getting that shift from me, me, me, Now I have a two-year-old and he's constantly saying, mine, mine, mine. And I just, I got to take a video of it because it reminds me so, much of the first time I meet with a doctor who's got been a very successful doctor in there.

They've got these barriers that are so, visible. I mean, you can just palpate and trying to get through that to, to a level of, of greater understanding that this is a societal shift. Hmm. You can either sit back and wait, or you can be a part of it. If you join early, you're going to be in a position of more directorial involvement, right?

You're going to have a higher equity value. And what happens if you look at the math and its pretty simple stuff. I'm, I'm the, not the smartest guy in the world, but I do work hard. So, if you look at the math, it's really simple stuff. When you add practices to a group, it becomes stronger. When you exit, meaning when you sell it to a larger fish.

So, a small fish is eaten by a bigger fish, and that's the principle at hand here, is that a private equity group comes along and says, this is a prosperous company. They're running very efficiently. They do good business. I want to buy them now before they get too big and too expensive. And then there's an equity transition.

And then that doctor can consider, do I want to cash in my equity or do I want to stay on for the next? Bigger fish that comes along and it's just a pretty simple process, but you have to buy into it mentally. You have to understand that ultimately, it's not about the individual practice anymore. It's about the opportunity to take best practices from each location and formulate the best practice.

Mm-hmm. Because I can tell you, after spending so, many years and so, much time with all these other practices, there are some things that fall way outside the standard of care. And it's readily available, and I'm very research oriented. I, I'm constantly studying and I don't really do much else except fly airplanes.

So, for me I, I love trying to find out, you know, what is the enhanced recovery after surgery, what is the fastest way to get a patient home? What is the most efficient way? What is the safest way to reduce DBTs and blood clot formation and complications after surgery? That is just thrilling to me, and having that energy and enthusiasm and being able to transfer to multiple practices.

I mean, I, I mean, I don't know what to say. This is the greatest life ever. Okay. I would love to have that. So, when I can find people with similar, like-minded ideas, then we, we blend pretty well. And the decision making is always about what's best for the patient because the financial returns will come, they will come as a result of running the business properly, running it ethically, morally, keeping track of every dime appropriately and, and always best practice for the patient.

Catherine Maley, MBA: So, because this is a business and marketing podcast, I have to ask about the marketing. Yeah, sure. Is the branding now a big name, like your name is Olympus Cosmetic Surgery, is it now like Dr. Smith Plastic Surgery by Olympus? Mm-hmm. Or how does that work? And then who does, who does the patient attraction now? How did this affect your understanding about the future of cosmetic surgery?

Does everyone have a big ad budget and the, the front office handles all the, how does that work out the advertisement? How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah. Well, it, it's always evolving. The current situation is that all the practices are independent, but we're consolidating our services. Gotcha. Now, I, I do view in that 10-year time plan that I've told you that there will be a central theme, a central title AEN, a central logo.

We have our subgroup; we have our website related to Olympus cosmetic surgery group. Brett's really in the stages. For information for future acquisitions or partners to find us. So, it's not a centralized advertising platform. It will be there's no question that's inevitable, but right now, in each individual location, we're trying to find the most successful practices, and they're successful for a reason.

Mm-hmm. Because they've proven their methods successful in their region. So, if they're dominating, we don't want to rock the boat and dislodge that, that dominance from that area, just because we think we know better.

Catherine Maley, MBA: Right. Yeah. Okay, that's a good idea. You know what, I want to wrap it up. Now. I normally, I'm afraid to ask, you know, because I like, I usually like to ask tell us something we don't know about you. How did this affect your understanding about the future of cosmetic surgery?

So, if you can't say that you fly planes, because we already know that. What, what's another one? Cause I'm, you are a very interesting person. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Well, I don't know. I appreciate that. Well, gosh. I would say if I were to, to say the thing that, that you know, I, I, I say it all the time. I'm not, not the smartest guy in the world, but I do work my ass off, and I mean that at a much deeper level than I'm, I'm, I'm admitting I, I think that the.

Interest and the passion that I have for studying humanity is, is unparalleled. I absolutely love every moment of this life, and when I go, it'll be just fine with me because I've lived a full and complete one. But just the, the interactions between highly intelligent people, investment bankers, a private equity group, leaders, I mean, These people, if I were a little kid and somebody said, someday you're going to be hanging out with all these people that went to the best schools in the country, and were top of their class in every way, and you're hanging out with them and you're doing pretty well.

I'd say no way. You know, so, it just, the, the passion has is there for me. And I, I would just say if, if I could surround myself with people with equal or similar passion as I know you have in your field. I mean, gosh, I've, I've known you for like 25 years I think so, yeah.

Catherine Maley, MBA: So, I needed to be in this field to hang in there.

Erik J. Nuveen, MD, DMD: Yeah, yeah, yeah. And so, you have to have that undying, never say die, never quit. Passion that is, is, is, is palpable. So, other know, others know it and, and I somehow have been blessed with that gift. So, thank you for allowing me to say that.

Catherine Maley, MBA: Congratulations, and thank you for your father for being an orthodontist. How did this affect your understanding about the future of cosmetic surgery?

I had braces a million years ago, and I'm so, grateful it was a life changer. Looking back now, if I hadn't had braces. Oh my gosh. That would be a different story, you know? Yeah. So, Dr. Nuveen, how can people get ahold of you? I'm sure there's plenty of surgeons who are interested in your business model. How did this affect your understanding about the future of cosmetic surgery?

It's very unique and I, and I find it's very multifaceted. It seems like it, you don't have a, a process in ink right now. It's a multiple flexible fluid process because you're evolving right. How did this affect your understanding about the future of cosmetic surgery?

Erik J. Nuveen, MD, DMD: Yeah, that's a good way to look at it. There are some rigid elements that you can't hear from due to the relationships.

Mm-hmm. But we're always learning and we got to have that attitude. I mean, if you look at some of the other groups that have attempted to go down this pathway, they've really had some terrible problems. And, and, and actually it's been a wonderful lesson because you look at what they've done and you're like, well of course that wasn't going to work.

You know, lifestyle lift. I mean, I could go down the road. There's, there's been probably 10. That are examples of just poor business practice or lack of transparency, or a lack of partnering. True partnering, it's an overused term. It's one that you really have to focus on is it's got to be a partnership and people have to see eye to eye in the relationship.

So, yeah, we'll continue to learn and evolve with the people that want to join us. My, my contact is probably best just as I give to my patients each and every day. Gimme a call. Give me an email. My email is [email protected]. fxfaces@ yahoo.com or call my cell phone. But also, you can Google, you can get me there as well.

My, my telephone number's openly published. It's (405) 550-7522.

Catherine Maley, MBA: All right. Well, it has been a pleasure having you on Beauty and the Biz. I really appreciate it. I'll see you again at a conference coming up. Looks like you're traveling. Everyone's traveling again.

Erik J. Nuveen, MD, DMD: That's fantastic. Yeah. Yeah.

Well, yeah, I'll tell you any, anytime if there's another in interesting issue you'd like to discuss. I, I do lots of other things un unrelated to this topic, but other business things with many different startups and techs and stuff, so, I'm always interested.

Catherine Maley, MBA: Thanks so, much.

Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on how Dr. Nuveen understands the future of cosmetic surgery.

If you've got any questions or feedback for Dr. Nuveen, you can reach out to his website at, csaok.com.

A big thanks to Dr. Nuveen for sharing his vision on the future of cosmetic surgery.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "The Future of Cosmetic Surgery — with Erik J. Nuveen, MD, DMD".

#cosmeticsurgeonpodcast #plasticsurgeonpodcast #aestheticpracticemarketing #cosmeticpracticestafftraining #cosmeticsurgeonbusinesscoaching #plasticsurgeonbusinesscoaching #strategiesforsurgeons #morepatientsmoreprofits #aestheticsurgeonbusinesscoaching #medspabusinesscoaching #medspamarketinghelp #cosmeticsurgeonmarketinghelp #howtogetmorepatients #plasticsurgeonmarketinghelp #aestheticpracticemarketinghelp #beautyandthebiz #podcastforplasticsurgeons #podcastforcosmeticsurgeons #plasticsurgeonideas #plasticsurgeonagency #plasticsurgeonconsultant #plasticsurgeonstrategies #plasticsurgeonservices #plasticsurgeontrends #plasticsurgerymarketing #marketingplasticsurgeons #marketingplasticsurgery #cosmeticsurgeondigitalmarketing #cosmeticsurgeonmarketing #howtopromotecosmeticsurgery #socialmediamarketingforplasticsurgeons #socialmediamarketingforcosmeticsurgeons #plasticsurgeonsocialmediaideas #howtofindcosmeticpatients #howtofindcosmeticpatients #howtoattractcosmeticpatients #howtoconvertcosmeticpatients #howtoretaincosmeticpatients #cosmeticpatientadvertisingideas #cosmeticpatientstrategies #cosmeticpatientconsultant #cosmeticpatientservices #cosmeticsurgeonads #digitalmarketingforplasticsurgeons #consultanttoplasticsurgeons #consultanttocosmeticsurgeons #seoforplasticsurgeonsusingai #onlinereputationmanagementforplasticsurgeons #leadgenerationforplasticsurgeons #cosmeticpatientreferralmarketing #brandingforplasticsurgeons

#thefutureofsurgery #thefutureofcosmeticsurgery #eriknuveedmd #eriknuveendmd #dreriknuveen

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and how Dr. Kontis is the 2nd female president of AAFPRS.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "2nd Female President of AAFPRS — with Theda C. Kontis, MD".

I had the privilege to interview Dr. Theda Kontis, a facial plastic & reconstructive surgeon in a private, multi-surgeon practice in Baltimore, MD.

Dr. Kontis has been very active in the American Academy of Facial Plastic and Reconstructive Surgery for the past 30 years and was recently elected to serve as the AAFPRS president, making her the 2nd women to hold that title.

We talked about her vision for the Academy under her presidency and the challenge of juggling her duties there, while also managing a big practice with multiple surgeons and lots of staff.

She also shared her opinions on private equity, the change she has noticed in cosmetic patients' attitudes, as well as staff tips to keep turnover at bay.

Visit Dr. Kontis' website

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

2nd Female President of AAFPRS — with Theda C. Kontis, MD

Catherine Maley, MBA: Hello, welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery and how Dr. Kontis is the 2nd female President of AAFPRS. I'm your host, Catherine Maley, author of "Your aesthetic practice, which your patients are saying", as well as consultant to plastic surgeons, to get them more patients and more profits. Now, I'm very excited about today's guest.

It's Dr. Theda Kontis, who is the 2nd female President of AAFPRS. She's a facial plastic and reconstructive surgeon in a private multi-surgeon practice in Baltimore, Maryland, and the name of the practice is The Aesthetic Center at Woodholme. Now, Dr. Kontis completed her residency and fellowship. At Johns Hopkins and is currently an associate professor there as well.

Now, her bestselling textbook, "Cosmetic injection techniques", is in its second edition and has been translated into five foreign languages. She's also authored numerous, and I repeat, numerous research and review articles, book chapters, editorials, as well as conducts research clinical trials. Now, Dr. Kontis has been very active in the American Academy of Facial Plastic and Reconstructive Surgery for the past 30 years, and was recently elected to serve as the AAFPRS President, making her only the second woman to hold that title.

Dr. Kontis, welcome to Beauty and the Biz, and congratulations on being the 2nd female President of AAFPRS.

Theda C. Kontis, MD: Thank you so, much Catherine, and thank you for inviting me. It's quite an honor.

Catherine Maley, MBA: Absolutely. Let's just talk about that for a minute, because I didn't realize you were the president right this minute. I thought it was you were still president and elect.

I'm sorry. So, how busy are you juggling that plus your practice, plus your family? How's it going? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Well, I never could have done it if I had little children, but luckily my daughter's all grown and in medical school. So, it's, it's quite a challenge. It takes a lot more time than I thought it would, but it's really fun.

It's fun to be involved and to be able to make changes. And I've been a member of our academy for many, many years and sort of came up in the ranks and it's fun to give back.

Catherine Maley, MBA: Good for you. I mean, that's putting a lot on your plate. Is there a lot of travel involved or nowadays is it more Zoom? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: It's all Zoom it Recently our marketing firm.

Actually, had me do all these Zoom meetings with magazine editors and they used to take the president to New York City and go in a car and go from one desk to another. And it was fun, but it was not very productive because, you know, how many offices can you go to in a morning, you know? And I could have six.

Meetings in the morning on Zoom. So, it was fun. I, I really enjoyed doing, they call them desk sides and working with all of the magazine editors and it really is fun to get the word about being facial plastic surgeons and to trust your face to a facial plastic surgeon to get that word and that message out is, it's fun.

Catherine Maley, MBA: Oh, that's fantastic. So, let's just talk about your practice. And I noticed when I was doing some research when I met you a long time ago at the meetings and then I was in your office, you had two surgeons, and now I see you have three surgeons. So, what's the makeup of your practice in today's world? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: I joined my fellowship director.

Most everyone has heard of Ira Papel, of course. And Ira was my fellowship director. I was his first fellow. I finished in 1994, and the deal was Ira said, I will train you and then I want you to join my practice. So, when I joined Ira, we had a very small operating room with one nurse who did everything, and we had three secretaries.

Now we have 25 employees. A big operating room, a minor procedure room, about 10 nurses, and we hired a body plastic surgeon who was one of the Hopkins residents who rotated with us. And so, he was a good match for our practice. But we don't when, when people. Have a body plastic surgeon join their practice.

Sometimes they limit them and say, you can only do tummy tucks and breasts and all the face stuff you need to give to me. But Ira, and I thought that really isn't fair to him because if he does a body work on someone and they want him to do their facelift, It's not fair for him to say, well, sorry, but I can't do it.

So, he does everything and it's a really good match. So, the three of us get along great. He's, he's buying into the practice now and it's, it's, it's been good. You know, you have to choose a partner that like a marriage. And the two guys I'm partners with are really, really good. Marriage.

Business marriage people.

Catherine Maley, MBA: Right. Well, you're all, you also are very mild mannered and reasonable, so, I bet that helps a lot. But you also probably share the same values. Are you still doing reconstructive and research and cosmetic? Like what's your, where are you spending your time? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Mostly cosmetic. We all do mostly cosmetic.

We do some reconstruction with cancer. Skin cancer reconstruction. And the research bit sort of comes and goes. It depends. If there's a project that is that we're asked to participate in, we'll do that. We have a great coordinator. You know, it's so, important to have somebody who just takes over.

Like you always say, you know, someone who you don't have to think about. Well, we have someone who does that and so, she just runs everything and we fill in the blanks. And so, I love doing clinical trials. I mean, if I could stop doing all my regular work and just do clinical trials, I probably would because it's fun.

But you know that that mix of things really makes every day just different and exciting.

Catherine Maley, MBA: Nice. And then where are you at with the surgical versus non-surgical? Is it a priority in your office? Do you have that? Like patients for life mentality where they go up and down the ladder, they start the surgery, work their way down to non, go to non-work, their way up to surgical.

What, how did you feel about that? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Well, let me backtrack a little bit on that. When I joined Ira, IRA is a rhinoplasty guy and when I joined him, I actually said, are you sure you want another facial plastics person in your practice? Because we're going to be competitors. Basically. We're going to be fighting over the same patient.

And he said, no, no, that's what I want. So, I, I thought, you know, I will never be the rhinoplasty person in the practice. Am I okay with that? And so, the answer was yes, I was okay with that. So, then the next question I asked myself is, how am I going to. Distinguish myself, separate myself from Ira, like why would someone come to me?

So, I finished in 1994, and that's just when Restylane and Botox started coming out and I thought, I can master this. I can be the injectable person. And so, I wrote a textbook on it. We did courses on it. So, that became my niche and. That way Ira. Ira does injectables and I do rhinoplasties, but he's known for rhinoplasty and I'm known for injectables.

And my injectable patients are patients for life. You know, they love you, they trust you, they appreciate your artistic eye, and when they're ready for something, I'm the person they ask. Is it time for this? Is it time for this? Fillers aren't going to do it for you anymore. You need this. So, it, it's absolutely a gateway and I think that the general plastic surgeons years ago made an error in judgment on saying, We are the surgeons.

Other people should do the injectables. And I think that was a mistake that if you don't do injectables and you don't get good with that, you're missing a nice chunk of patients who love you, who want then to move forward with bigger things

Catherine Maley, MBA: Oh, there's such a balance there. I've seen it every which way where the surgeon says, no, I'm just going to let it go.

I just, I'm, I just want to be in the OR. But then you hire nurse injectors, so, I'm sure you have, you, you have several nurses there. Do you have them doing the injectables at all the, the surgeons are doing? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: No, and that's how we distinguish ourselves in the community. Mm-hmm. That the doctors do the injections.

Catherine Maley, MBA: Nice. All right. And are you going to stick to it? Like have you noticed it's taken you away from the surgical or not? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Not a bit. Okay. Not a bit. But I'm busy. I mean, I see 35 patients a day and some of those are injectables and some of those are people who want to talk about surgery. And you know, I can't tell you how often I'm injecting someone and they start asking me questions about surgery and it becomes a cosmetic consult while I'm injecting them.

So, You, I can't imagine not doing injectables or passing it off to someone else when I have their ear. I can't expect a nurse who is doing the injections to say, you know, this really isn't going to work for you. You, it's, you're at the point now where you need a facelift. They're not going to say that.

They're going to say, you know, I think you need six syringes rather you're four. Yeah.

Catherine Maley, MBA: Yeah. So, what are all these staff doing? You've got 24 staff and a lot of nurses, what are they all doing? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Okay, I have well, secretaries obviously I have a skincare and laser division as well as the surgical side. So, we've got three estheticians.

We've got three laser nurses. So, we've got that side of the business running with skincare, with selling products. The, the Allergan company does a review of metrics to comparison benchmarking. And our aesthetician is off the charts in selling products, so, they, they really have it down and skincare is such an important mesh with cosmetic surgery.

You've got to, to change the skin quality to get the best results. So, we've got estheticians, we've got laser nurses, we've got or two ORs going all the time. So, we need nurses for recovery, nurses for the, or. Two rooms going. So, that's a lot of staff.

Catherine Maley, MBA: Yeah, that is a lot of staff. Any staff tips? I don't know if you had the dip, like others, you know, the post covid.

Did you have HR issues or any tips on managing staff pre Covid or PA post covid? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Well, yeah, the, the staff really sort of laid the law down with us and said, you know, we could go to Wendy's. And make X amount of dollars an hour and you're only paying us this, so, what can we do? You know, we had to give everybody, everybody got a raise to get them up to this competitive with Wendy's and Burger King thing, you know?

So, so, yeah, they sort of held us hostage with that. But they all stayed through covid. They all stayed. They knew we were getting the PPP loans to save them, to keep them with, with income coming in to save their jobs. We didn't lose anybody.

Catherine Maley, MBA: Nice. Nice. So, just out of curiosity, does Wendy still pay like that or can you now like what? How does this relate to you being the 2nd female President of AAFPRS?

You can't take money away from his, can't take away him a raise.

Theda C. Kontis, MD: Yeah. So, what are you going to do? I mean, the cost of living's terrible, you know? So, what are you going to do? Yeah. We are so, busy you know, all the practices around the world that do cosmetic surgery are, you know, going crazy. Yeah. So, you know, it wasn't a hardship for us to give them a raise and probably they, you know, it was the right thing to do.

Yeah.

Catherine Maley, MBA: One thing I have learned or I keep hearing the staff will not work at overdrive for very long. They need fun. They need acknowledgement. They need recognition. But they can't live in a pressure cooker every day. Do you, do you feel that or do they, is that the feedback you get or how do you keep it at least calm, you know, in, in the middle of a storm when you're so, busy? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Well, we fired the one that was the pressure cooker actually. Good for you. Now there's, and that was the mistake, you know, higher, higher, slow fire. Fast. Well, we fired slow, which is a bit of a problem. But there's always a disruptor. There's always something that everybody's upset about. And it was that one person, and we needed, we knew it, but.

This person was very productive. And you know, sometimes they hold you hostage because they're such good workers. It's like, oh, we don't want to let them go because they're so, good, but they're driving the rest of the staff away. So, after a few people leave, then you realize that this is just not going to work.

They've got to go. And so, once you get rid of that person, then everybody's happy. And the, the doctors set the tone. Hmm. You know, and we, they know, our staff knows that they're appreciated. They know that they're valued. And we treat them with respect. And so, I don't think there's anybody in our office who doesn't want to come to work in the morning.

Catherine Maley, MBA: Very nice. Talking about that. I've even been with practices where it was the office manager who was the drama queen and just 80% of the staff left before the surgeon did something about it. And it's just so, easy for me on the outside to say, get rid of her. But on the inside, you have so, many uncertainties about it.

Fear about it losing somebody who's productive, but doesn't it always happen the minute they're gone? You hear the feedback, oh my God, why didn't we do this sooner? Oh, I should have done this. You know, I mean, this has been fantastic. It just, I don't know what the right answer is, except when your gut is telling you that something's not right.

I would say just address it sooner rather than later, you know? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: You know, we all tend to have employees that we think are not replaceable. Right. But they are, and that is part of the issue that we think, how can we let this person go? They do everything well, they're replaceable.

Catherine Maley, MBA: Yeah. I would say though, one of the biggest errors is not getting that employee's intellectual property down on paper. How does this relate to you being the 2nd female President of AAFPRS?

You know, if they know everything and they set themselves up for that, by the way, they need to be irreplaceable in their own minds because it gives them safety. We've all had that employee, God knows I've had it too. And that person becomes so, ESHA can't even be sick for a day. And you're like, oh my God, what would I do?

I fall apart. And, and then you don't, you know, when it happens because then it's going to, it's going to blindside you. So, I have learned, get all this. Get all this on paper, get it in videos, get SOPs, standard operating procedures get checklists do not let them walk out the door being the only person in the practice who knows what's going on. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Absolutely true. And when we let this person go, part of what we had her doing is sort of teaching other people how to do what she did which was not rocket science, you know, but we sort of, Moved her around and had her show people things. And I think she saw the writing on the wall. But to have your staff be able to multitask is so, important.

Never have one person who does one thing and they're the only ones who know how to do it, because they do hold you hostage. And they're done that.

Catherine Maley, MBA: Yeah. Give me like running a practice as long as you have, first of all, the surgeons themselves. Any tips on how, how three surgeons can work together harmoniously? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Well, they all listen to me, which is good.

Catherine Maley, MBA: Are you kind of like the deciding factor if it's pretty much, pretty much there? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: My two partners are very calm, easygoing. They don't get riled up about anything. I'm the more emotional one. I sort of take charge of things and I tell them, look, it needs to be boom, boom, boom.

And they say, okay. So, the, it's not a power struggle. We all. Feel comfortable enough to disagree with each other if we need to. But it's just a very respectful, nice group and so, many times you hear of people joining another physician and it just doesn't work out. And I think it's too much of everybody trying to be the boss trying to Dominate one or the other not agreeing about things.

And then what do you do if there's two of you, you know, you're at an impasse. But my two partners are just easygoing. Easy to get along with guys. And I. Just works. I'm very fortunate.

Catherine Maley, MBA: Yeah. I don't hear this very often, so, please enjoy that. You know? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Yeah, I do it.

Catherine Maley, MBA: It's not always that way. I do think it's true when you have two alphas in the office that just.

Can't work one. It just, one has to be the alpha and one has to be the go along or stay out of each other's way. Like you do the marketing, I'll do the admin, like something like that. Like tight boundaries perhaps. But I'm just glad it's working for you. That's fantastic. Now, are there any plans to. Grow anymore or there's been so, much talk about exiting, like how do you exit these practices? How does this relate to you being the 2nd female President of AAFPRS?

It seems to be changing very quickly. There's a lot of talk about private equity coming in and taking over. Any thoughts about that? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: I don't know of one person who has sold to private equity who said, this is the best thing I ever did. Oh, no. It's terrible selling out to private equity because you've made your baby, you know, and now you're going to give your baby away, but you still have to be parenting for a while and you're watching somebody else take care of your baby.

And it's horrible. Because it all suddenly becomes about the money and it's not about, your staff does not benefit from it. The only person that benefits is the physician who got their millions of dollars for their practice, and we're not going to do it. We, our exit strategy's going to be different.

Ira's older than me. Ira's going to eventually, in a few years start phasing out. We hired on Emile Brown, our body guy as part of the, the next generation. He'll eventually take over the practice after I leave. We're looking now at somebody to replace Ira, somebody who has rhinoplasty knowledge, who can sort of.

Fit into Ira's practice model and sort of take that going. So, our way of keeping the practice going is to have a succession plan. Mm-hmm. If I were in practice by myself, I, and getting older, I think that probably selling out to private equity is. Maybe a good thing. You get your golden handshake and then you leave.

But it's just, it's a really tough thing on your employees who, you know, we love our employees and, and employees aren't happy once the practices get sold. Mm-hmm. So, it's people can do it either way, but I like the way that we've chosen, I'm not going to make millions and millions like I could sell out my practice, but I feel better about it.

Catherine Maley, MBA: The one thing that I find interesting with the private equity is they'll consolidate some of the tasks that you don't want to do, like. HR benefits contractual agreements you know, they can pull the resources and get you a better rate on, you know, the, the cost of goods. That part I find interesting.

It's the part when the people get involved and who could, who controls the shop. You know, like all of a sudden now the staff who does the staff work for the, the surgeon or the private equity group or that part? It's a little fuzzy, but it's really exploding. Like, it, it's all, it's all I'm hearing about right now, so, I don't have an, an opinion on it yet.

I don't know enough about it. All I know is the more people, the more cooks in the kitchen, the more complicated it gets. And I don't know, can you know, can you lose complete control over it? Or can you still have piece of, because one of the things about surgeons, you're, you're in private practice for a reason, otherwise you'd be in the, in the university still, you know?

Yeah. So, then to take that away and say, okay, I'm just going to work for you now, I think that's more difficult said than done. If you've been running your own show. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: I don't know. I'm telling you, Catherine, find, find the people that are happy. They sold out. Okay. They're going to be hard to find. I predict that.

Catherine Maley, MBA: Okay. That's really interesting. Okay. I'm taking a poll. I'm taking a silent poll out, an informal poll of is this a good idea or not? Because I feel like some of this makes sense, but then what's the other side of it, you know, that I don't, I don't know yet. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: I don't have an opinion yet, so, so, I have a, several dermatology friends have sold out.

Okay. Yes. One of them said that all of a sudden there was a new practitioner in her office working with her. Never met her, didn't know anything about her. I don't know if she liked her or not, but all of a sudden, they hired somebody and now she's working side by side with this new person because she has to work in her office a couple years before she's out.

Yes, yes. Another staff member in another practice said to a patient, oh, Dr. So-and-so, she's not the boss anymore. Oh, we don't work for her. We work for so-and-so company. And you could tell that they were really bitter about it. Hmm. So, patient, patient care goes down and, you know, we pride ourselves with patient satisfaction and the things we do to coddle our patients.

Mm-hmm. That's not coddling. Mm-hmm. So, I don't know. I think it's a bad idea.

Catherine Maley, MBA: Right. I do know another, a Mos surgeon and he, but he was pretty burnt out. He was running a big operation and he was more than willing to let the res go. So, in his case, he's like, yeah, I'm still on board, but I'm just, I just do my surgery and leave.

I'm not involved anymore. And, but I think he was at that point. As you do when you get older, you're like, I don't know how much fight I have left in me. You know? So, I think it just has, you have to really watch the variables of this, and you have to know yourself. Are you going to be okay working for someone else? How does this relate to you being the 2nd female President of AAFPRS?

Are you going to be, okay? When your staff looks at you like I. What'd you do? What happened here? You know? Right. That's the part I worry about the staff saying, I don't work for you anymore. Like what? Right. What the heck? Like that, ah, that's not a good culture at all.

Theda C. Kontis, MD: But you, you lose autonomy, like you said.

We go into this to have our own practice, to have autonomy. Right. So, your most surgeon may lose his most tech and they'll say, sorry, we're going to hire so-and-so to do your tech. Well, they're not any good. They're not doing a good job. I'm not happy with them. Well, sorry, that's what you get. You know, and then, you know, it's like working at an academic center.

You have no, you're stay over what you do. Full circle. Yeah.

Catherine Maley, MBA: Yeah. All right. Let's talk about the more fun stuff, and that's the marketing. I want to congratulate you on the incredible outside signage. You happen to get approved on your building. You cannot try by your place without seeing that. How did you ma Nowhere else can somebody have big signage like that on the outside of their building.

So how did you, I know, how did you manage that? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Well, I love to negotiate. Okay. I took a course and learned negotiating and I love it. And I buy all the cars in the family because I love negotiating. So, when we, when we Went into our building, which was 20 years ago, they did not allow any signage on the building.

Yep. So, we had a 10-year lease. So, the urologist moved in above us about maybe seven years into our lease and put a big sign up. Chesapeake Urology. It's like, wait a minute. Now it looks like we're working in the Chesapeake Urology building, and I did not like that. So, when our lease renewal came up at 10 years, I said, you know, we want to sign up too.

And they said, well, Chesapeake has the whole floor. I said, well, we are taking over this other suite next door for our skincare and laser side. Said, that's basically the whole floor. And they said, all right. So, we used the build out money that they gave us to buy the sign, so, it cost us nothing. Yes. So, then when Dr.

Brown joined us, we need a bigger sign because there's three names now, not two. So, now we're much bigger than Chesapeake Urology. So, it's, it's wonderful.

Catherine Maley, MBA: And you, and you got your names on there too. Names on the building. Yeah. You are like celebrities. Your local celebrities at this point. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Yeah, yeah. People say you can't drive by without seeing our names, so, that's good.

And aren't you on like a major thoroughfare? Yeah, pretty. It's in a big shopping area, so, there's a lot of traffic going around. A lot of traffic.

Catherine Maley, MBA: Yeah. Yeah. Oh, that's fantastic. Let's talk about the patients for a second. Do you, what difference do you see now in patients, cosmetic patients that you didn't see before, and how are you handling that? How does this relate to you being the 2nd female President of AAFPRS?

Like their, their tastes and demeanor or how they, how they work with you. Talk about negotiating. Having the negotiation skills is probably brilliant in today's world.

Theda C. Kontis, MD: Well, it is, it does help. I tell you, Catherine, it's really, I've had this conversation already twice today. Oh. People are angry.

People are angry. They're unhappy. They, you know, in nine 11. When nine 11 happened, we all bonded together. Everyone was nice to each other. Everyone was help you do anything you can to help someone else. Covid pushed us all away from each other, like, don't stand next to me. You could infect me. And we were away from each other for so, long.

People have forgotten how to be nice to each other. So, there's this, this undercurrent of anger and unhappiness. With an overlay of social media telling everyone they have to be perfect. So, throw all that into the person that's sitting in our exam chair. You've got someone who wants a perfect result who's already angry.

And it's, it's really, I find the patients today very difficult to deal with. I have a rhino I saw a rhinoplasty patient like took they're splint off. Oh. And they said, when do I get my revision? Oh my God. So, so, I'm entitled to a revision and I'm ready for it. It's just, it's mind boggling. I've had all these one-star reviews recently.

Either I've become suddenly a horrible doctor. I got one that the patient wrote that 17 years ago they had surgery with me and the staff was rude to them and they were unhappy with their results. I had to write now getting, I had to write back. I had to write back. I really don't understand why it's taken you 17 years.

To write a comment like this, I wish you had at least come talk to me so, we could figure out what the problem is. Good for you. But 17 years, they're going to start writing one-star reviews. That's insane. I, I don't know, I, I don't get it. But it's a very interesting question that you ask because people are very different right now.

They're hard to please and it's just a different mindset.

Catherine Maley, MBA: Well, some surgeons now are even videotaping the consultation. They're videotaping the all of the consent forms like it's gotten. That feels so, defensive. Like that can't be building a great relationship if you're videotaping people. But I don't know what the answer is.

You know? Do you protect yourself or do you just hope to God these people are reasonable? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: You know, it's all, you have to protect yourself. I'm not videotaping consents. You have to trust your gut. You know, so, many times if, if the staff doesn't like a patient and I don't like a patient, it's probably better not to operate.

You know, we always say you never regret not operating on someone. Right. And that is so, true. It's, it's a tough world right now, and social media has not helped.

Catherine Maley, MBA: Are you actually active on social media? And if so, like, are you spending any of your time there, your personal time there? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: I had patients tell me, you've got to get on Instagram.

So, I got on Instagram and I realized that it was such a waste of my time that I just, I'll post some things periodically just to let people know what's going on. But it doesn't really bring me patience. So, you know, I think if I were a young person starting my practice, I think you have to be in social media.

But I think somebody who's, you know, I've sort of peaked in my practice. I don't think I need social media at this point.

Catherine Maley, MBA: I'm with you. I, I know I'm older, so, it's not that I don't care. It, it's that I don't care enough to spend my time doing it. So, I have my staff work around, work around me to get it done.

And I would say that for some surgeons, they have embraced it. Wholeheartedly. And it does attract patients because they have the right attitude. Like they, they want to do it, they enjoy it, they, they like it. Right. And, but I would say if your heart's not into it, there has to be a better way for you to spend your time than I don't even go on there. How does this relate to you being the 2nd female President of AAFPRS?

I can't, I'm not allowed to go on there. I'm one of those A c D or O c d or whatever the heck they're called. Oh, is that right? Oh my God. 30 minutes. I'm gone for 30 minutes. I, I, I don't even know what happened around me, and I just think this is not a good use of my time. It's not good for my mental health.

So, I stay away from it, but I, I see how it can help. Rhinoplasty though, I would just say generally speaking, they're the toughest patients already. Gosh, to add social media to that as well. I don't know. I do, you do a lot of revision rhino, because a lot of surgeons don't even do the revision Rhino anymore, and then some do it, but they charge a whole lot for it, but it's a lot more risk there. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: So, what are your thoughts about that? Well, you know, you tell a rhinoplasty patient, I tell them there's no such thing as a perfect, perfect rhinoplasty. Do they hear you? When you say that? I was just going to say, it goes in one ear and out the other, and then postop. You say, remember I told you there's no such thing as a perfect rhinoplasty.

I had mines done. I can tell you six things wrong with it, but it's better. They don't want to hear that. So, y you know sometimes a little bit of filler. In a rhinoplasty, patient can just make a good rhinoplasty, a great rhinoplasty. So, I do offer that to people sometimes. I do revision rhinoplasties on patients who've had rhinoplasty elsewhere.

I do revision rhinoplasty on my own patients when they're not happy. What are you going to do? You know, most of the time we try to do it under local. So, that it's not a huge financial loss. Mm-hmm. But some people need anesthesia, so, at least most of the time you can get them to pay the anesthesia. But, you know, sometimes they're so, angry that's the last thing you need to do, so, you eat that cost.

So, you know, sometimes you lose money doing rhinoplasty surgery. Mm-hmm. So, it's, it's a tough surgery and a tough practice to have. I can't say I have to revise eyelids or facelifts or, you know fat OS very often, but boy, rhinoplasty, I mean, there's a standard revision rate that people just, they want perfection and they want it more now than they used to.

Catherine Maley, MBA: For sure. I had a rhino and I was super happy with mine, but as I've gotten older, the darn the scar under my nose started showing more. And I thought, this never ends this aging process. It just, it's, my face is just constantly shifting. But then so, then I goes to my laser people and I say, can you just laser this darn thing? How does this relate to you being the 2nd female President of AAFPRS?

And psychologically I feel a lot better. I think that's what a lot of times the patient, they just want you to do something. Exactly. Yeah, that's my little tip there.

Theda C. Kontis, MD: And that's the nice thing about fillers. Mm-hmm. Cause they say I just, every time I look in the mirror, I just see this, well, we'll put a little filler there now you don't see it.

"Oh yeah. It's better."

Catherine Maley, MBA: So, so, what's your theory about patient retention? Are you into the "one and done" or patient for life? What's your feeling on that? Patient for life? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Patient for life, absolutely. It's a silly thing to one and done because they love you. And they trust you and so, they're going to keep coming back.

And I mean, that was the beauty of Botox is that they had to keep coming back. You know? So, that's why you have to have, in my mind, you have to have a filler practice. To have people coming back and as they age, they need more filler and then they're going to need surgery. And if you want to have an aging face practice, that's the way to do it.

And then they are happy and their friends come in, you know, all my new patients give me names of two or three people that I've operated on who say, oh, I really like how so-and-so looks. That's why I'm here. So, that's how you grow your practice.

Catherine Maley, MBA: I call that the long tail patient. The aging face is just a beautiful patient retention strategy because she has other friends just like her who need your services, they care a lot more about your credibility and your credentials and your reputation than some of these younger folks do.

They're just more financially. You know, secure. And they're more reasonable it seems. Absolutely. So, they're the ones who but they're the ones who typically will return, refer, review on, approve your photos. How are you feeling about the before and after photos? I'm also doing it in personal study on this one.

How do you get patients to approve their before and after photos? Do you ask yourself; do you have the staff ask? Do you hope they just offer? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Okay, so, this is my routine. Okay. When we do consent for surgery, I ask them if I can show their pictures to other patients, yes or no. And if I can put them on the internet, yes or no, and we circle it and they initial it.

And so, now I have a record of it. Sometimes they'll say, well, just my eyes, if you're doing my lips, or you know, don't show my whole face. Okay, fine. Then after six to eight weeks after surgery, we do their after pictures and I print them up and give them their after pictures. Nice. And I have, I give it to them on photographic paper in an envelope, and staple to the outside of the envelope is a letter from me thanking them for trusting me with their surgery.

And saying, by the way, if you're happy, please write a review, because I'll bet you read reviews about me before you came to me. And maybe 1% of people write reviews, but it does help because they're happy. Now if the results aren't that good, obviously I don't ask them to write a review or if they're mad or something.

But most of the time I ask someone for a review. Some of the time they write a review, but giving them their pictures. Is huge because I don't just hand it to them. I say, now look here. See how you had this hoodie here. See how that's better? See how your eyelids are more symmetric and your brow now is above your bone.

You look brighter. Let me hold your picture far away. See how your eyes look bigger? And I show them what they need to see because they don't see what we see. For good point. So, it's really important. Don't just hand them the pictures, but actually explain their results to them. So, you know this a little bit that you see here, that's probably going to get better.

We'll take pictures again at three months and we'll see. So, I give them their pictures, I ask them for reviews. And then if I think their pictures are really, really good and I do want to show them, I'll ask them again. And sometimes they'll, they'll change their minds.

Catherine Maley, MBA: I think you're doing the best you can is when you ask yourself personally, they'll say you yes, you way more than they'll say it to the staff.

So, I think you're doing all the right things. I have always said give your patients their photos. They need their photos, they want them, they're going to show them. Even somebody who is absolutely private, they will still show them to at least three of their favorite people, you know? Absolutely.

Yeah. And nobody remembers what they used to look like unless you show it to them. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: So, Let me tell you that has, just giving them their pictures has made unhappy patients happy. I agree. You know, I don't really see a difference. Well, look at this. Wow, I looked like that. I had no idea. You know, they, because they think they're going to look like someone else.

There's this, this thought that if they have cosmetic surgery, it's going to completely change their look. Right. And they say, well, no one noticed. Well, what did people say? Well, they say that they, my hair makes me look younger. Well, they noticed. They just don't know what they noticed. And that's a great result.

And then you show them and they get it. Hopefully.

Catherine Maley, MBA: So, true. So, what do you think in today's world, what would you say is one of the biggest challenges of being in a cosmetic practice or running one? Or keeping it competitive. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: What would you say is the biggest challenge in today's world? I think it, it's dealing with these angry patients.

I think that there's a lot of body dysmorphic. Mm-hmm. And we are terrible at, at figuring out who has it. We've done a study that showed that we all think we're great at it and we're terrible at it. I think there's a lot more psychopathology. And, you know, we have to be really, really careful with treating our patients because they, they will sometimes threaten you with bad reviews.

Mm-hmm. You know, if you don't give me my money back, I'm writing a bad review. And it's, it happens. I've had it happen and I'm sure everybody listening has had it happen. It's terrible. So, the patients today are very, very challenging. And I think that you have to go with your gut. If you have a bad feeling about a patient, try not to try not to operate on them or, or treat them.

Catherine Maley, MBA: Or if your staff has a bad feeling too, I would listen to them because they oftentimes treat you differently than the staff, and you just want to know as much intel as you can before you say yes to that patient. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Absolutely. My staff has, has a code at the computer where they put a lot of stars. Yeah. And wonder, that means they don't like them.

Catherine Maley, MBA: And it's so, funny, I always say, don't you have some kind of a code like a for angry, like a big a with a circle on it. And that tells we got a hot one here. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: A lot of stars. No one knows what stars mean. They think it's good.

Catherine Maley, MBA: That's really brilliant too. So, back to ps. As you, as the president, is there like one big like one big issue that you were trying to address during your presidency? How does this relate to you being the 2nd female President of AAFPRS?

Is that too old?

Theda C. Kontis, MD: There, well, there's always. A lot of issues. Our academy itself has an issue with transparency. Mm-hmm. So, I'm working really, really hard at increasing the transparency of what we do, because we do so, much, but people don't know it. So, I'm doing videos, we're doing more e-blasts. We have a Facebook group.

And still people don't know what's going on, you know, I mean, we've done everything but smoke signals, you know? But, so, trying to get people more in the loop. And then what is really kind of fun is advocacy. We're writing, right now, we're working with UnitedHealthcare. They've developed a policy that is really not in the best interest of the patient, so, we're working with them to try to get the policy changed.

So those are some of the big things we're working on.

Catherine Maley, MBA: That must be an act of God, huh? Changing policy. How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Can't imagine. Yeah. Oh my gosh. Yeah. And, they're very good at not communicating and making it impossible to communicate with them. It's, it's really how they hide behind everything. So, yeah.

So, it's a little bit at a time, but we're making some progress.

Catherine Maley, MBA: Good for you. So, I want to wrap it up now, and I like to wrap it up with this last question, which is tell us something we don't know about you.

Theda C. Kontis, MD: Well, that's a very fun answer because you were not going to believe me. But the thing that you don't know about me is that I am ticket number 664 for Virgin Galactic, and I will probably get my space stride in about 2026 or 2027.

Catherine Maley, MBA: No kidding. That is amazing. Really?

Theda C. Kontis, MD: Yeah. I bought a ticket.

Catherine Maley, MBA: I did not see that coming Dr. Kontis. I know, I know. Is there rude to ask? How much is it? How does this relate to you being the 2nd female President of AAFPRS?

Theda C. Kontis, MD: Oh, it's a lot. A lot. It's a lot. But you know you work hard your whole life and you think, you know, what am I going to get out of all this work other than just the satisfaction of taking care of patients and, you know, I have a nice car and I have a nice home and you know, what do you need in life?

But that's a dream that I've always had and I thought, you know, I'm just going to do it. And I asked my husband if it was okay with him if I bought a ticket and he said there's no way he's going. But I did. And I'm really excited about it.

Catherine Maley, MBA: Okay. You win for the most unusual answer. Oh, wow.

Good. My Lord.

Theda C. Kontis, MD: Thank you.

Catherine Maley, MBA: Doesn't that give you something to look forward to?

Theda C. Kontis, MD: Oh, it does. And part of the training is that we got to do this zero-gravity flight. Oh. Where we, you go on this airplane that does parabolic flight, so, it goes up and then when it comes down, you're weightless. Oh. And so, you get to feel what it's like to be weightless and they do that for you so, that when you finally go to space, You can unhook your seatbelt and be weightless, but it's not the first time and you can actually enjoy looking at the earth from space and you know, you've already been weightless.

Catherine Maley, MBA: So, unbelievable, that was fun. Unbelievable. Okay. Wow. If anybody has any questions for you or would like to contact you, how would they do so?

Theda C. Kontis, MD: They can email me: [email protected].

Catherine Maley, MBA: About the AOL.

Theda C. Kontis, MD: I'm old.

Catherine Maley, MBA: Might want to Gmail.

Theda C. Kontis, MD: I know.

Catherine Maley, MBA: What's your website? ACW or something?

Theda C. Kontis, MD: www.ACWPlasticSurgery.com. Mm-hmm.

Catherine Maley, MBA: Okay. Dr. Kontis, it has been an absolute pleasure. I will never re forget this. Yeah, now I think I need a really big goal because I didn't, I wasn't thinking that big. Okay. And then thank you so, much for being here. I will see you at an upcoming meeting, hopefully, and enjoy your presidency.

Congratulations.

Theda C. Kontis, MD: It's always a pleasure, Catherine. Thank you.

Catherine Maley, MBA: Thanks so, much.

Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on how Dr. Kontis is the 2nd female President of AAFPRS.

If you've got any questions or feedback for Dr. Kontis, you can reach out to her website at, www.ACWPlasticSurgery.com.

A big thanks to Dr. Kontis for sharing her wisdom as the 2nd female President of AAFPRS.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "2nd female President of AAFPRS — with Theda C. Kontis, MD".

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and how to Dr. Katz has 50 lasers and devices.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "50 Lasers and Devices — with Bruce Katz, MD".

Non-surgical rejuvenation is a big deal.

The global non-invasive aesthetic treatment market size was valued at 61.2 billion in 2022 and is projected to expand at a compound annual growth rate of 15.40% from 2023 to 2030. (Resource: Grandviewresearch.com)

And, the most popular non-surgical procedures are Botox, Fillers, Fat Reduction, Skin Tightening, Skin Care Treatments.

So, I thought it would be interesting to have Dr. Bruce Katz, MD on the Beauty and the Biz podcast.

Dr. Katz is a board-certified dermatologist who practices dermatology, cosmetic, and laser surgery in Manhattan, Queens and worldwide.

Dr. Katz is a leading innovator and researcher performing clinical trials on advanced laser technology, cosmetic surgery, body contouring & dermatology.

We talked about the plethora of non-SX technologies entering the marketplace and what else is coming down the pike. Very exciting!

He also had great advice for those buying technology, so you actually make money from it (that was promised from the salesperson) ;-)

Visit Dr. Katz's website

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

50 Lasers and Devices — with Bruce Katz, MD

Catherine Maley, MBA: Hello everyone and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery, and how Dr. Katz has 50 lasers and devices. I'm your host, Catherine Maley, author of "Your Aesthetic Practice — What your patients are saying", as well as consultant to plastic surgeons to get them more patients and more profits.

Now, I have a very special guest today because he's not a plastic surgeon, but he is a dermatologist and has experience with 50 lasers and devices. And it's Dr. Bruce Katz. He's a board- certified dermatologist who practices dermatology, cosmetic and laser surgery in Manhattan, Queens, as well as worldwide. Now, Dr. Katz is a leading innovator of advanced laser technology cosmetic surgery.

Body contouring, research and dermatology. He has more than 50 lasers and devices and has been treating more than 95k patients for their aesthetic needs. That's a lot. Dr. Katz is the director of the Juva Skin and Laser Center, and also the Juva Foundation Research Center that has been performing clinical studies for more than 20 years.

As a matter of fact, they have participated in over 70 studies. Dr. Katz, welcome to Beauty and the Biz.

Bruce Katz, MD: Thank you Catherine. Pleasure to be here. Thank you.

Catherine Maley, MBA: So, would you just start us off by telling us describe your practice practices and the services you provide? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know, we're a cosmetic dermatology practice and we do a lot of fillers, toxins, a lot of laser work, body contouring work.

I was one who introduced Smart Lipo here in this country about 20 years ago now. And you know, we also do a lot of clinical research on all kinds of different technologies, whether it's lasers. We did actually the recent F D A trials for dify, the new toxin. We do filler studies as well. And also, you know, laser and body contouring studies too.

And then also we do big pharma type of studies on acne, eczema, psoriasis, and all kinds of you know, medical dermatology as well as cosmetic me, cosmetic dermatology and, and cosmetic surgery. And also, I I'm a clinical professor at the Icahn School of Medicine at Mount Sinai here in New York, and I lecture nationally and internationally.

Catherine Maley, MBA: Dear Lord, do you ever sleep? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Oh yeah, once in a while.

Catherine Maley, MBA: God. Okay, so, I, you know, I'm always curious to find out how can you manage the dermatology practices? I've done a lot of work with them because a lot of them want to take advantage of all of the quantity of people they have and turn them from medical to cosmetic, so, I'm very familiar with that.

But one of the challenges is it's such a busy practice with so, many people in it. Are you focused on like, how do you focus on medical and cosmetic and then don't you also do Mohs. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know, I focus mostly on cosmetics. I have associates who do Mohs and also general dermatology. We do a lot of skin cancer work too.

Yeah, so, you know, my colleagues do the other type of more diverse procedures in medical dermatology and skin cancer work. And I focus mostly on cosmetic dermatology and cosmetic surgery, as well as laser surgery too.

Catherine Maley, MBA: And then the clinical studies, are those also done under the same roof as the cosmetic and the medical, or do you need to spread that out? How did this impact your expertise and procurement of 50 lasers and devices?

I don't know how much space it takes to do that, but…

Bruce Katz, MD: Well, we have three full-time people just doing our research at our center, and we have a large center in midtown Manhattan, about 5,000 square feet. Oh. So, we, we know, we also have a big area for our research studies too, which obviously you need, if you're running 10 and 12 studies at a time.

Catherine Maley, MBA: Wow. Just out of curiosity, you mentioned that new doxy, I think it's called. Mm-hmm. How, how long does it last? Because we, people who love our Botox, the, our biggest complaint is, well, you know, could it last longer? What's the, what's the scoop on that? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, the Scoop, Catherine, is, it does last longer, usually six to eight months, and I saw that in the clinical trial.

So, I don't think there's any question about it. I mean, it could vary in some people, but I think on average, you know, at least six months, some people even up to nine months in fact.

Catherine Maley, MBA: Good. Well, keep, keep researching that. We need it to last longer than that too. All right. I just feel like I'm constantly getting my Botox done. I'd like to. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, now you can try something a little different. That'll last for certainly, certainly a lot longer.

Catherine Maley, MBA: Is it available now worldwide? I mean not, not worldwide, but like easily distributed to everybody or is it still out there in the general distribution. Specifically? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know, we were, we were one of the, we were part of the group that was, you know, introduced to it initially.

Mm-hmm. You know, I guess to, you know, just try it out. Make sure there are, you know, no issues. But there certainly weren't, and now I think it's available around the country.

Catherine Maley, MBA: Oh, terrific. All right. Now let's get back to, you run a pretty big boat there. You've got two locations, a lot, it sounds like three locations. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: A lot of people. actually, four now.

Catherine Maley, MBA: Oh Lord. Okay, so, how many staff?

Bruce Katz, MD: Well, we have about 45 people, you know, between the four offices now, so, it keeps us busy. But you know, we we're really organized, so, everything runs really smoothly. And we have a great team of people. My administrative people as well as our clinical team are great, our research team as well, and that's really important.

As I'm sure you know you know, you're in a consulting business, you know, your staff is what really makes your practice and. You know, the front office people are the face of your practice, so, they're really important as well. But you know, we have regular meetings. I think that's, that's imperative to communicate regularly.

And, and that's why we have a very smooth operation, I think.

Catherine Maley, MBA: That's amazing. And you're absolutely right. I don't understand why there aren't more regular meetings. Just catching up with everybody and getting everyone on the same page. It just, it saves so, much time and hassle with miscommunication. How did this impact your expertise and procurement of 50 lasers and devices?

And when you're not communicating, the staff will make stories up. You know, they did. They're, they're trying to communicate without you, and that's never a good idea. How did you find how. Didn't you have any trouble, like post co covid, post covid trying to get the right people in place. Have you had any issues with that or what's your secret to hiring the right people? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know, we had a great team, you know, even before Covid. Mm-hmm. But we did lose some people as a result. And it has been a little difficult getting new people to come in. But, you know, we try a variety of different ways to do it and, you know, often asking our current staff if they know people, friends or family as well.

And somehow, you know, we do get those people in. Mm-hmm. And fortunately, good people who manages everybody.

Catherine Maley, MBA: There's no way you're doing that. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, no, I have a great, you know, front office manager and clinical manager. We also have, you know, great people in our, in our clinical staff as well to manage back office too.

So, it all works, you know, very well.

Catherine Maley, MBA: Well, let me ask you to get the right people, right, but you, I mean, I would think you have different profit centers set up. Like you would have one for cosmetic, one for research, maybe one for Mohs. Is it like that? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, that's true. We sell, sell products in our, in our practice as well.

That's another area. And we have person who supervises that.

Catherine Maley, MBA: Yeah. I'm going to ask you about that, but where I'm getting to is, are you still, so, are your kind of in silos? Like are, are those teams working separately or are you trying to develop this big mission statement and vision where everyone's under one roof all working together as a big team?

Or is it siloed? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, it's, it's, it's a little bit of both. In fact, I mean, we have one obviously great team that works together, but we have individuals that are responsible for certain areas. You know, one person is responsible, say for the products, and making sure that we keep the right inventory.

Another person is responsible for billing and, you know, making sure, you know, bills get paid. And also, you know, accounts receivable. So, we have these different. Buckets that, you know, people focus on and are responsible for. And then also in terms of research, we have a manager of our research, our research director, and he is responsible for making sure that the studies are done properly and that patients come in, subjects come in and come in regularly.

So, it, it's, you know, pretty well-oiled machine I'd say.

Catherine Maley, MBA: Very nice. You had mentioned skincare and I noticed online you have your own skincare store. Mm-hmm. Give me your thoughts on that. Has it been a revenue stream? Has it been okay? Has it been a great idea? Like, where are you at with that? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Oh, it's certainly a, a very substantial revenue stream.

We use Shopify, which, which is a great technology to help us with that. And You know, it's, we have a variety of different private label products and also other, you know, proprietary products that we promote as well. It depends on, you know, what we need, which, you know, what, what products we think are best in their class, and we go for that, whether it's private label or proprietary.

You know, we always want to find the best products, the newest and the most advanced that will give our patients the best results.

Catherine Maley, MBA: So, that's really interesting what you're saying because most practices say, oh, I'm selling, I, I have a skincare line. And I say, well, how, how's it going? And they say, well, the staff won't sell it.

And you're saying you're not even necessarily marketing to your own patients. You're, you went Shopify, you went to the world like are you on Amazon, kind of thing. Like can they find you on Amazon? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: No, we're on Google actually. We're not on Amazon. Google has also, you know, promotion of, of products.

You know, we don't want to be, you know, I think Amazon is a great venue, but you know, patients can call. Our office or email us and we send them products. You know, we have clientele all over the world, so, you know, they can come to the office to pick up a, you know, a product when they run out.

Mm-hmm. So, we have a great team that just deals with taking care of product sales and making sure when people need more of those products, that we send it to them and, and they, they get it. They don't have to worry about going to Amazon or elsewhere. So, it's very easy for them.

Catherine Maley, MBA: Gotcha. Do you, do you think though, that most of the revenue is coming from your current patients who know you, or have you put enough into Google, I don't know if you're doing PPC or some kind of advertising, to get the public in general to buy it? How did this impact your expertise and procurement of 50 lasers and devices?

Do you know?

Bruce Katz, MD: I say the majority is our own patients. Gotcha. Okay. We do have some people who call us who, you know, may have heard about their products from friends or family. Mm-hmm. But I say the majority are really just from our patient population. We don't really try to sell. To the public. Generally, as you know, that's a very competitive space and the margins are extremely razor thin.

So, and I don't think it's really an area that we can compete in, to tell you the truth, because all the big brands, you know, have a lot more marketing Cloud than we do that.

Catherine Maley, MBA: That's why honestly when I see doctors putting a whole bunch of money into their skincare website. I just say, you know what, let's, let's just, just, if you want to be practical about this, when I look at your revenues by procedure, it's never been more than 2% of overall revenues.

You know, skincare is never more than 2%. And I say, let's just put it in perspective though. If it's 2%, then spend 2% of your time and your staff's time. And your resources on that, but the rest, you know, go somewhere else where there, where there's more money to be made. It's so, competitive. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Oh, I think you're absolutely right, Catherine.

From what I've heard, I mean, I could be wrong, but even from what I've heard from Dr. Lines or quote Dr. Yeah. Lines that are carried in Sephora. Yeah. Or in Bloomingdales, or. Other, you know, retail places. Yeah, I hear that. They, they find it very hard. They have to pay for all their own marketing in, in those stores.

They have to have their own little sections that they have. They have to hire their own people. And I would think that, you know, the profits are extremely thin for all the effort that goes into it.

Catherine Maley, MBA: Exactly, unless you can somehow hook up with the pharma group, you know that you need a pharma budget, frankly, in today's world.

Right. Get that to happen. Yes. So, regarding any mistakes you've made, like, because you have been around a really long time and you've done it all and you've worked with vendors, you've worked with pharma, you've worked with PR agencies, you've worked with a bunch of staff like, and all the research that goes into.

That's a whole other world as well. Like what, what would be your advice to others who maybe are thinking about doing research but also doing their own private practice? Is it viable to try to do both when you're like a solo practitioner? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: You know, that's a very, that's a very important question that you raise and I think, I think you know, a lot of my success over the years, And you know, we are always looking to introduce the newest technologies to our patients and we get a lot of media attention for doing that.

But where does it come from? And it actually comes from the research we do. And a lot of people don't understand that. But if you come out. Say with, you know, you, you're doing research on a, on a new technology, take Taxify for example. So, you know, that was, you know, really a breakthrough technology compared to the other toxins available.

Cause it lasts a lot longer. You know, we did the clinical trials, the f a trials, we were one of the sites that did that. So, we are first to market as a result because we have the experience. People don't come to us because they hear that. You know, we've treated 40 patients even before it was FDA approved in the clinical trial.

So, that gives us a lot of credibility, right, right away. And then the media. Calls us because they know we have experience and we can talk to them about how it actually works and how does it feel for patients? Does it feel any different? Does it act any differently than other toxins? So, by doing the research, and I, and I can repeat this for so, many other technologies that we've introduced over the years, Catherine, you know, Cul, for example, another breakthrough technology, the first to build muscle of any body contour in treatment.

Well, we did the F D A trials there. We've done many studies on cul, cul neo, and other technologies in that, in that sphere. Smart lipo. Also, as I mentioned earlier, I was the first to do that. I introduced it to this country and did the first FDA trials for it, and we got huge media attention. As a result, and that helps our practice.

But it all came from the research, and this has been true of other technologies we've used over the, that we've done research on over the years. And then, you know, we use also for marketing and PR.

Catherine Maley, MBA: I used to do a lot of pr well, decades ago because it was so, new and, you know, new and it was just so, new and, and nobody knew anything or much about it, the consumers didn't.

And it was very easy to call. I could literally pick up a call, pick up the phone, call the station manager of my local radio or my ro local tv and then I'd say, okay, what do you think about this story? And they'd be like, Sounds good. Maybe next week, you know, call me back. And nowadays you, there's nothing else to say.

So, the secret is because you have so, much PR on your website and you are definitely the innovator and the thought leader and your, I can see why the media would go to you because of the research. You didn't just pay to play. You didn't just get a PR company and say, okay. Give me, get me some pr and they'll be like, well, what's our topic?

Like, what, what can we, what does the all the PR people or the media channels care about is what's new for their audience. Exactly. And the only thing that's new is what you've been researching. So, you have the, you're on the front line there. So, that's, that's the secret. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Good for you. Oh yeah. Well, that's, and that's given us a lot of currency.

Another example right now is M Face, that's the new technology for facial lift and building muscle on the face as well. Another similar to M Scope, but for the face, we just did an interview. It'll be coming out tomorrow on Hollywood Life. That's you know, a big website. They get 30 million eyeballs every month.

Mm-hmm. And all, cause you know, I, one of the people at Hollywood Life tried it out at our office. And they had great results. So, they wrote a story about it. And that gives us a, also a lot of exposure for this new technology as well. And that only came out in the last few months. But that's very important, very important to be first to market.

That really Right. Gives you a big advantage compared to your, your competitors. And again, it just comes from the research.

Catherine Maley, MBA: But the holy Grail for us women who are aging, especially women, men too, but you, you know, you can only have so, many facelifts and, or you don't want a facelift and you just, you're, you're afraid or whatever.

If that really, honestly, does it really work? Like, are we talking. Noticeable results are so, subtle that you wouldn't notice, like, oh yeah. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: No, you see, you see noticeable results. No question about it. Great thing about it. Also, it's non-invasive. Mm-hmm. It's a 20-minute treatment. You do four treatments, you know, once a week, and people love the results.

I mean, they, they can see it right away.

Catherine Maley, MBA: No kidding. And is the last thing, how long. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know, we think it'll probably last at least a year. Oh, okay. As have the other mco treatments. And then, you know, you probably do maintenance once or twice a year. The 20 minutes each time is pretty easy. Right, because painful.

Yeah.

Catherine Maley, MBA: Okay. Sometimes I have watched a lot of these where you have to have multiple treatments. Like remember sculpture, you had to have three treatments. The patient journey is tough because the patient journey was you have a sculpture treatment. Then your face is fairly puffed out, like you have some swelling and you look fantastic.

Then it goes away. Then you have to go back and get another one. Then it layers onto that and again, you have a beautiful. Affect treatment and, but then it goes away. Then the third one, you know, supposedly builds that up. The problem is, is half the patients won't get through all three. You know, so, that's one of the issues is the, I love the non-invasive, but there's a cost to that, and that is time, you know, and repetition.

So, it's just, I just find this so, fascinating. Like, what are you finding in the industry, like surgical versus nonsurgical? How much has that changed in, in the world, you know? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, I think you know what really talks to that is the fact that a lot of plastic surgeons are now doing these treatments.

Right? Right. Because obviously they know people want try dose first. You know, we know surgery does. You know plastic surgeons do great work and their results are amazing, but a lot of people, you know, particularly women today who are working, you know, juggling, you know, family life and the workplace as well, find it really hard to do surgery when, you know, they may be just having early changes.

They may be getting a little bit of jowling, a little laxity of the neck, perhaps, you know, some, you know, looseness around the eyes. And they're not ready for surgery. So, what do they do? You know, they want to have these treatments that are non-invasive, no downtime. 20 minutes to half an hour each. So, it's very easy, you know, I mean, we're in Midtown, so, our patients find it very, very easy to come to us.

We're on 56th and Park and you know, they could just jump in at lunchtime, have these treatments and go right back to work rather than taking off two weeks after a facelift or, you know, other major plastic surgery procedure. And they, you know, not, are not necessarily ready for that. Mm-hmm. And even if they see a plastic surgeon, They'll be told that as well, that, you know, that little bit of Jing or a little laxity of the neck doesn't warrant a deep, plain facelift.

Mm-hmm. But you know, plastic surgeons now are offering these non-invasive treatments cause they realize instead of losing that patient, say, well, you're not ready. You know, chow River, dci. You know, we can offer you something in the meantime like evoke, which is another type of radiofrequency technology to tighten the jowls or tighten the neck or another, you know, m face treatment to give you a lift to the face where you may be getting a little bit of a droop.

And they don't lose the patient. They keep them in their practice until they're ready for a facelift and then they see that plastic surgeon. So, you know, it's not, you know, one or the other anymore. It's really a combination of doing both. You offer people, you know, early on with the early changes, non-invasive, even though they have to come in several times for the treatment, they're fine with doing that because they're not losing any time from work or their family.

Mm-hmm. And I think that's a reasonable approach.

Catherine Maley, MBA: And in, and in addition to that, after you've had a facelift, it never stops. The aging process never stops, and nobody wants to go through it again if they don't have to. So, if these treatments, you can get that patient at the beginning when they're just thinking about surgery, but they're not ready yet.

The, they're worth thousands of dollars to you while they're thinking about it. Then they, even if they have the facelift, they're worth many thousands afterwards. Trust me, I'm this patient. Well, that'll keep coming back trying to keep that facelift in order, you know? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Oh yeah. It's so, right. And also, I think by starting early on with these noninvasive, you can actually delay having a facelift because you're stimulating collagen.

The changes aren't, you know, as dramatic as they would've been had you not started with the noninvasive earlier.

Catherine Maley, MBA: Yeah. Just out of curiosity, I feel like I'm doing a consultation with you. It, it used to be, you know, I was around for therapy and the other one, Thermage, and just her, the pain threshold was ridiculous.

Has, have they done anything about that? Has the new technology become less painful? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Oh yeah. Well, those, those technologies are really old technologies, Catherine, but the new ones are not painful. They feel mostly like a warm massage I'll take that, have much more advanced, you know, energy sources.

Mm-hmm. So, you don't have the pain that you would from the whole therapy particularly. That was, you know, I tried it early on when it first came out and I felt the pain. They were treating my face. I felt the pain in my feet, how intense it was. But and also, You know, with homage it's not as painful, but you need to have, you know, a technician working on that person for 40 minutes.

You know, with the pandemic in the last few years, a lot of people who came into our practice didn't want someone working on them cause they're concerned about getting sick. So, these certain, these particular companies like BTL in mode, they developed these hands-free technologies and sign was sculpture as well.

They develop these hands-free technologies, so, we just put the applicators on their face, their neck or their body, and walk out of the room and the patient can sit there, they can read emails, they can listen to music, read a book, and, and not, they're not in pain, but they don't have someone hovering over them for 40 minutes and worried about getting sick.

Yeah. So, that's been a major. I think sequela of the pandemic, which has been very positive because it also is very beneficial for the practice. You don't have to give up one of your staff to perform a procedure for a half an hour or 40 minutes when you can just put on the equipment, the applicators, walk out of the room and let them do something else or treat another patient and not have them only devoted to one patient for 40 minutes.

So, saves you staff time as well.

Catherine Maley, MBA: Aren't you? It's shocking how far the technology has come. Mm-hmm. Just so, many options now and then they, they're trying to do this, do it yourself at home. What do you think about that? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know, those, those technologies are so, dumbed down. Yeah. Because, you know, you know, the companies don't want people to get burned or scarred.

Right. They really have very little benefit and, you know, from laser hair removal to skin rejuvenation with l e d light. Or the helmets to grow hair. You know, they're all, they're all so, you know, modest. In terms of benefits, I would say they may work a little bit. But it takes many, many sessions, you know, hours a week to do these treatments.

So, most people eventually give, give it up. It's the same ideas, you know, you know women when, when hair coloring came out in the pharmacy, so, women could buy, and guys also, they can buy their own hair coloring. Hair coloring. Do it at home. Save money, not go into the salon. What happened? Well, you know, eventually they got stained all over their bathrooms and, you know, splatter everywhere and they went back to the salons and had it done in the salons.

So, you know, they, patients who come back after trying these things at home come back to our offices and realize that, you know, even though they have to spend some time in our office, they get much more beneficial effects and more efficacy as well.

Catherine Maley, MBA: So, it sounds like the theme is tightening, you know, like it's, it's tightening.

Would you, the research you're doing right now, is there anything coming up the pike soon that you could tell us about or down the road? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: I can't tell you about it, but there are, I could tell you that there are things definitely, you know, coming up the turnpike and they keep getting better and better, you know, more efficacy with minimal downtime.

Shorter treatment times as well. So, there, there's new technologies coming along all in a pipeline.

Catherine Maley, MBA: And that's what we're all looking for as a consumer patient. No downtime, no scarring, no pain. Oh yeah, that, that's, that's what we need because we're also darn busy. I, I don't have a week, I don't have a week to take off and hide anymore, you know, if I can get up and running again in a day.

That's the, that's where the money is. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Yeah. Oh, yeah. And I can tell you, you know, right now about one new technology for tightening, please. That is just coming out and it's called Micro Corine. It's actually by a company called Cires, and it actually takes away tiny little pieces of skin without causing any scarring and with minimal downtime.

So, it's actually removing tissue, you know, up till now. The way we did skin tightening was basically trying to stimulate collagen to tighten the skin. Mm-hmm. But we didn't remove skin, you know, aside from surgery now we actually can take away tiny little discs of tissue, almost microscopic, without causing scarring.

And as these little wounds heal, the skin tightens. So, that's a whole new technology. And you know, some say it can actually take away as much tissue on the face as a facelift does.

Catherine Maley, MBA: No kidding. Yeah. All right. When's that going to happen? Because I need, I need that.

Bruce Katz, MD: We'll be getting that probably in the next month.

Catherine Maley, MBA: Oh my God. That soon?

Bruce Katz, MD: Test out. So, I'll let you know and you want to come in, check it out.

Catherine Maley, MBA: Please. I'll be right over. Yeah. Even though I'm California, you're in New York. That would be worth the trip over. All right, so. Lately I've been talking to a lot of surgeons who have been around a long time and they're contemplating their exit strategy.

And I just want to, I, you may be or may not be, but I'm just hearing so, much about how do you exit from this industry profitably, you know, and comfortably. Mm-hmm. Now are you the mindset you're going to stay until the bitter end? Are you going to. Do you have a plan for exiting? Are you going to sell to private equity? How did this impact your expertise and procurement of 50 lasers and devices?

Like what? Any thoughts on that that you want to share? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, I can tell you, you know, my former partner, Dr. Alexander Fisher, was also a very famous dermatologist. Mm-hmm. And he worked till he was 91. So, I have a legacy to fulfill here, Catherine. So, check with me in about 15 or 20 years. I'll let you know.

Catherine Maley, MBA: That's why you're exercising. Yeah, keep that. Keep stay on that electrical machine.

But do you have any, like, just regarding the business side, do you have any advice for the newbies coming up, or guys who've been in solo practice and they're just trying to figure out how to grow or how to scale? Like let's say they're tired of medical and they want to get more into the cosmetic side.

Any advice for any of them on how to not just enter the market, but how to position yourself in the market to your benefit? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: You know, I think it's really important to become expert at one procedure at a time. Mm-hmm. That's the best way to start some. Mm-hmm. Some young doctors try to do a variety of different things and they don't really do any particular thing really well, and that doesn't really help grow their practice because patients may not be completely satisfied.

So, they don't talk to other patients. I think, you know, that's, that's the first thing to be doing. You know, one, learn one thing at a time, get expert at it, and then do the marketing. You know, we do a lot of social media. We have seven different platforms that we, we market on social media. Our Instagram if people want to check it out, is @JuvaSkinAndLaserCenter.

Catherine Maley, MBA: You're doing a good job on that. You've got a nice following going. So, are you putting that time in? I mean, you're in there, but you can tell you're not. I mean, you're not spending a lot of time. No, no. Preparing it. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: I have a person who does great job with that. And she runs all those sites. And then she also works with our in-house marketing person, who also does a great job.

And, you know, we do a lot of videos, as you know. Yep. As your specialty, I'm sure. Yeah. Telling, you know, docs to do lots of videos or procedures they do, talking about new technologies or what's new in there, in their particular practices. So, we do a lot of work there and also, Helping to develop a, a network a marketing.

And I think a media network is critical. So, once a young doctor starts out, they should try to develop relationships with people in the media. And, you know, I just fell into it many years ago because of the new technologies that, you know, I was coming out with and. 20 years ago when I camp with Smart Lipo, I had People Magazine approached me about the story cause they happened to be at a meeting.

I was lecturing out in London and I had a five-page spread on in People Magazine about Smart Lipo. And I had patients coming in from all over the world for the next two or three years to do, you know, liposuction. So, but you know, trying to curry. Relationships, develop relationships with the media is really important because like you mentioned earlier, you know, I think the media, people call it Feed the Beast.

They're always trying to feed the beast, you know, talk about new stories, you know, scoop their competitors cause they're competing as well as, as doctors are competing against other doctors, while media people are competing against other similar outlets To get to the newest stories out first. So, by creating a media network, which, you know, fortunately over the years we've developed, so, when we come out with something new, I can just call them or I say, come in and try it.

Say how you like it. And then they decide if they want to do a story about it. I don't pressure them, I want them to, you know, give an honest appraisal and not say, this works when it really doesn't. And I don't want to ever present a technology that doesn't work to a media person. Cause you know, They're not going to do a, a good story.

And if they do a good story about it and it's really isn't effective, patients are going to come in and be unhappy. So, you want to be honest with the media. Don't ever try to, you know, put something over them about a technology that you're just trying to promote, even though you know it doesn't do very much.

Mm-hmm. Because they'll figure it out and, and you'll end up getting negative feedback as a result.

Catherine Maley, MBA: How important is the Mass media pr. I'm from before the, the good, the goods, like the TV and the magazines and the newsprint versus the new world today of digital. Have you changed your approach on PR and media now that everything seems to have gone online? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Oh, yeah. You have to make, make a big change. I mean, you know, years ago, I'd say probably even five or six years ago, still the most effective media was tv. And, you know, we did a lot of tv. I was on the view all the time. Mm. You know, the Today Show, good Morning America, CNN, and that gave us huge exposure, right?

People coming from over the country, internationally. But in the last five or six years, that's pretty much dried up. I mean, TV still works if you know, if you're lucky to get that. But it's been harder and harder because they're not doing. That many cosmetic stories anymore, and they're leaving it more to their.

They're digital out outlets. So, some, you know, whereas the View may have done a lot of cosmetic things years ago, and we would actually do live procedures on the view, we would treat sunspots with a laser or do a laser resurfacing on someone live on, on the show. Mm-hmm. But today, you know, they may do a, a video of it on their, on their website or on their, you know, Instagram.

But they don't do it on their, on the actual program anymore. So, it's really digital, you know, and social media. I mean, that's really where it is, where it's at today.

Catherine Maley, MBA: In terms of marketing, how much of your own time is spent on social, creating that content? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: I don't really create any of it. Good. I just have our, our, our people do it and they do a great job.

You know, they ask me to do videos and I'll do videos. I'm always happy to, you know, to talk about the latest things. And I encourage them to do stories about, you know, what's new in our practice, what, what we're doing, you know, that's interesting. Or we're even talking about, you know, how to, I'm going to do a video tomorrow on how to make the change in skincare from winter to s to, you know, warmer weather.

Of course, that's, you know, something that a lot of people contending with right now as the weather gets warmer. So, it's not always about just new things that we're doing, but also things that are important to our patients in terms of their own lifestyles. There's,

Catherine Maley, MBA: In today's world, I almost think if you're going to play the game, especially in the jungle you are in in New York you almost have to have a marketing team.

You have to have somebody who understands digital, somebody who understands social you know, someone's got your website covered and that content because your website you have a killer website with tons of content on it. And that doesn't happen by accident. Somebody's got to do all of that, you know? How did this impact your expertise and procurement of 50 lasers and devices?

Oh, yeah. Yeah. I mean, wouldn't you say you have more a bigger marketing team now than you ever did before? Because it's so, mandatory to be everywhere.

Bruce Katz, MD: Well, certainly, you know, in terms of, you know, adding digital and social media. Yes. Mm-hmm. But we've always had, you know, someone doing our marketing. I mean, that's, it's like any other business in a competitive field, particularly in a market like New York.

Everyone has to do that. Yeah. But you know, it's, I think it's also important to mention that you can't just. You know, hire someone to do it or let them run with it. The doctor has to also be, you know, in communication, you know, we meet once a week, sometimes even more frequently. I meet with my, not only my research team, but also with our marketing team and making sure that, you know, they're, we're all on the same page.

They give us a review of what they're working on, and before anything goes out of my office, I review it. So, nothing goes out to the media. Nothing goes out in social media or e-blasts without me or one of my associates who, you know, are providers in a practice reviewing things because sometimes marketing people may not get it right, and you don't want something to come out that's inaccurate or misinformation or, you know, not true.

So, you know, it's always a point. You can't just say, run with it and not be involved. The doctors have to be involved too. That's very important.

Catherine Maley, MBA: But then you have the public coming at you when you do pr and you have a big name out there and you throw a big net out. Now you have to deal with the response to that.

And have you found that the patients are a lot different in today's world? A lot flakier like I've noticed like for example, plastic surgery, they can have 1100 leads. I just saw this the other day, 1100 leads and. All, you know, the journey from the time they call to the time they come in, to the time they have their console, to this time they say yes was 12.

So, they went from really 1100 to 12 paying procedures. And all I can say is that's a lot of work. Talk about a needle in a haystack to find the, the 12 that wanted to give you money. Do you, are you finding that yourself that there's a lot more quantity but not as much substance? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: You know, I think it's probably truer in plastic surgery because you're talking about much bigger ticket items.

Yeah. Whereas here, you know, in, in dermatology, you know, someone comes in to have a Botox treatment. First of all, we tell them, you know, if you don't like it, it doesn't last anyway. So, you don't have to worry about committing to a procedure that you have live with for forever. Right. And it's, you know, a few hundred dollars.

So, it's not a terribly expensive procedure that they have to really. Think about for months at a time. Whereas on a facelift or a breast dog or lipo, you know, people will, will spend more time considering it. I find that to be the case in my liposuction patients. Mm-hmm. You know, they'll come in, we'll do an evaluation, a consultation, examination, and then they may take, you know, a few weeks to decide.

Mm-hmm. But then again, you know, We could also tell when people are just shopping, right? And, you know, we know that that's not going to be a, you know, we're not going to close that deal. So, I think you have to just, you know, put your emphasis on ones that are realistic and more likely to, to close. And then also make sure that your staff follow follows up.

You know, I have, I, I know, you know, not just plastic surgeons, but dermatologists who see patients for cosmetic procedures and never follow up. With them if they don't make the appointment right away or if they don't make it, you know, don't call back. So, it's important to have a person usually, you know, it's ours.

Or cosmetic care or surgical coordinator who does the follow up and tracks it on a sales spreadsheet. And now does certain, you know, touch points over, you know, two or three times after that visit, after two or three, you know, contacts. If they're not interested, you just. Say dead end, but, but it's important to do the follow up because sometimes people may not have un understood something correctly in the consultation, or they weren't clear about, you know, what, what, what's really involved in terms of follow up and, and recovery.

So, by having someone follow up that might actually change the, the nature of their, of their opinion, and then they actually close on the deal. And they make the appointment and have the surgery. So, I think follow up is, is as important as you know, the actual consultation for sure.

Catherine Maley, MBA: Now, what about the competition in your world?

It's been. Fairly commoditized. I mean, the patients think that they can get Botox anywhere or they can get laser treatment anywhere. Do you deal with that? Or you're so, you know, you're so, branded that you don't have that issue. Like people go to, you just, they're going to pay what they, they pay whatever you want because they, because it's you.

Do you have that issue where you're losing patience to the competition, you know? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Not really. I mean, I think in New York they, you know, there obviously are, you know, the non-doctors who are doing these procedures in spas. But you know, I think it's so, busy overall and I think, you know, we also, you know, our, we, we don't have.

A real cutthroat competition with be between dermatologists and plastic surgeons, or, you know, between dermatologists and dermatologists. We all get along really well. We, we talk to each other. You know, you've been in our meetings where it's multidisciplinary and our plastic surgeons, facial plastics, oculoplastics, and dermatologists, we're all buddies.

We lecture together we do research together. I re do a lot of research on cosmetic procedures and laser procedures with plastic surgeons. Very well-known ones as well, and we all get along really well, so, and we refer to each other. So, I just had a re referral from a plastic surgeon today because someone had a bad procedure and asked me to evaluate them.

And vice versa. And I'll refer, you know, to plastic surgeons for conditions I may not want to treat or I don't feel, you know, we have the right treatment, they need surgery. So, I know it's different, other parts of the country where, you know, there are turf battles like that. So, but you know, I think, you know, for the most part patients come to us and they have treatments that are appropriate.

And we don't really lose them to non-physicians.

Catherine Maley, MBA: Yeah. Good for you. And lastly, I wanted to ask you about your podcast. Are you still doing that? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: We do it, you know, periodically. I just have been so, busy lately. I just haven't had a time with, you know, doing the videos and social media and tracking those things and lecturing.

I was just in Hawaii, lecturing in Miami, going to Phoenix next week. Mm. So, it's just it's like you mentioned earlier, it's hard keeping track of everything. But you know, It's all fun. We still have a great time. What we're doing, it's, I don't consider it work. I, I'm always looking forward to getting to the office every day and we're really blessed to be in this industry where we have so, many new things happening and never becomes routine.

You know, there are new things happening, whether it's in plastic surgery, dermatology, lasers, fillers, toxins. It never gets boring and that's really an amazing position to be in. So, we are very fortunate.

Catherine Maley, MBA: But the nuance there is it doesn't get boring because you stay in the game. You are not just sitting in your office, you are everywhere.

You know, you're still playing games. Yeah. Everywhere, everything and learning all the new technologies. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: And all at once.

Catherine Maley, MBA: But but I mean, you're, you're, that's how you keep it interesting. You know, you're, you're really learning what is going to happen in the world. Like how do you see this playing out as an aesthetic patient? How did this impact your expertise and procurement of 50 lasers and devices?

Like, do you see it changing dramatically where we're not going to do surgery half as much as we used to, or how do you see this? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Well, you know with all due respect to my plastic surgery colleagues, we all know that that's coming. You know, that it's going to be less and less invasive over the next few years.

And to the point where, you know, I don't think. People with extreme, you know, loose necks or jowls down to here you know, boobs down to here also are not going to need surgery. They're going to still need surgery. But for people who don't have as severe changes and because people are starting a lot younger to have these non-invasive preventive treatments, even we see kids.

In their twenties are getting a little tiny wrinkle. Rico, they're come in for Botox. We call it rejuvenation. Yeah. Which is actually, you know, some people say, well, that's a, a little bit ridiculous. But it really isn't because we know muscle movements continue over time. So, those lines are going to get deeper and deeper.

And eventually I've had patients come in and say they want to have Botox when they have ingrained, etched in. Lines in a frown area or horizontal forehead lines and you do Botox and it doesn't do anything because they're etched in. And there's no way, even by relaxing a muscle that, that, you know, that wrinkles going to go away, or those wrinkles are going to go away.

So, they need to have laser surgery or, or regular surgery. So, by coming in earlier and earlier, they're going to need less and less invasive treatments later on. So, there'll be a few patients who need. Facelifts and brow lifts breast work, you know, that may continue to be the same case, but also even body contouring.

Mm-hmm. We see it already, you know, there's less numbers of liposuction cases, and we see that in my own practice because we're doing noninvasive fat reduction, noninvasive skin tightening muscle toing, non-invasive muscle toing, cellulite treatments, so, there's less need for the invasive procedures.

So, I think that's going to continue and it's going to get even more advanced and more effective with less and less downtime.

Catherine Maley, MBA: Right. I mean, it's so, good for the consumer. Not so, good for the plastic surgeons probably down the road, but, mm-hmm. I've also heard a liposuction that's going to be done by robot, you know, robotic lipo.

It's like, what? How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Yeah. Well, that's, that's possible. Yeah. I may don't even need liposuction at all if we can take away fat. Well, that's a good point. One area which we're getting to now. With Nia, we can take 30% of the fat layer away in four treatments, which is more than any other technology out there.

Only cause they, they combined with, you know, they two energy sources. So, it's getting there every day. So, it's more, more exciting and a lot more fun. But the plastic surgeons are never going to starve, you know? Yeah. They're going to be taken, you know, up with all these. Noninvasive procedures too. So, whereas their surgery may reduce in number, in number of procedures, they're going to be offering these noninvasive treatments to offset the lack of surgery if they're smart.

Right. Which I think they are. And they're doing that already. So, I know that is the case

Catherine Maley, MBA: for sure. So, we're going to wrap it up. Why don't you tell us something we don't know about you.

Bruce Katz, MD: Something you don't know about me? Well, you know, I have I just had two twin grandsons. Oh. Excited about just a year ago.

They're the loves of my life right now. Are they identical? Two little boys. Twin boys, fraternal twins. So, that's something people don't know, but you know, that's really exciting, and you know no one will be able to steal away my social media director. You know, why?

Catherine Maley, MBA: Why?

Bruce Katz, MD: Because she's my wife and she does a great job with our social media.

She's a graphic designer and she does all the social media. So, that's something that people may not know.

Catherine Maley, MBA: I say this all the time, marry "smart". If you, if you're going to be in business, Mary Smart, you look at that, push your wife to work and she stays in the practice. And who better represents you than your wife? How did this impact your expertise and procurement of 50 lasers and devices?

She knows you definitely, she knows you what you like, what you don't like. That's such a great idea. Anytime you can get your wife to, to run the show. In the practice.

Bruce Katz, MD: Absolutely. And she goes to all the meetings. Also, Catherine and Yeah. Does some videos and all our, you know, colleagues at the meetings know her.

All the companies know her because they all follow her on our social media. We have the CEOs of major cosmetic companies, filler companies that follow her on social media because that's how impactful it is.

Catherine Maley, MBA: Yeah. You have something to talk about after 40 years of being married or whatever. How did this impact your expertise and procurement of 50 lasers and devices?

Bruce Katz, MD: Exactly. Right. Exactly right.

Catherine Maley, MBA: I know your website is www.juvaskin.com. J u v a. And if somebody wanted to get ahold of you, how would they do that?

Bruce Katz, MD: So, I'll give you, first of all, our Instagram handle is @juvaskinandlasercenter, Juva Skin and Laser Center, and my phone number is (212) 688-5882

Welcome to call anytime.

Catherine Maley, MBA: Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on how Dr. Katz has 50 lasers and devices.

If you've got any questions or feedback for Dr. Katz, you can reach out to his website at, www.JuvaSkin.com.

A big thanks to Dr. Katz for sharing his experience on using 50 lasers and devices.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "50 Lasers and Devices — with Bruce Katz, MD".

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#drbrucekatz #brucekatzmd #brucekatzdermatologist #manhattandermatologist

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and how to Dr. Chernoff performs 700 – 1000 surgeries per year.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "700 – 1000 Surgeries Per Year — with Gregory Chernoff, MD".

Some surgeons have two locations usually about an hour apart. They do that to capture a bigger market share than they can with only one office.

However, this week's podcast guest performs 700 – 1000 surgeries per year in his two practices located in two different states that are 2,200 miles apart.

My latest Beauty and the Biz podcast guest was Dr. Greg Chernoff. He's a cosmetic surgeon in private practice in Santa Rosa, CA AND Indianapolis, IN.

We talked about how he manages his time so he can do surgery every day in 2 different parts of the country AND sit on several medical, scientific, and editorial advisory boards, while maintaining his health and marriage. (Hint: He loves what he does and he invests in outside counsel).

Dr. Chernoff also talked about the latest technologies to watch for that will revolutionize the aesthetic industry (Hint: Regenerative innovations).

Visit Dr. Chernoff's website

Enjoy!

Catherine Maley, MBA

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Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

700 – 1000 Surgeries Per Year — with Gregory Chernoff, MD

Catherine Maley, MD: Hello everyone and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery and how Dr. Chernoff performs 700 – 1000 surgeries per year. I'm your host, Catherine Maley, author of "Your aesthetic practice — What your patients are saying", as well as consultant to plastic surgeons to get them more patients and more profits.

Now, I'm really excited about today's guest because I've known him forever. It's Dr. Greg Chernoff who will be sharing how he performs 700 – 1000 surgeries per year. Now, he's a cosmetic surgeon in private practice in Santa Rosa, California, which is maybe an hour up from where I'm at now, and he performs 700 – 1000 surgeries per year. He's been in practice for over 30 years. He's authored several papers and studies from his extensive research, and he's given over 700 lectures and teaches his innovative techniques to surgeons all over the world.

Now, he sits on several medical and scientific advisory as well as editorial boards, and he's a member of several medical societies. He also gives back to Survivors of Violence Foundation that helps men, women, and children who have injuries and scars as a result of violent acts, abuse, illness, or birth defects.

Dr. Chernoff, welcome to Beauty and the Biz. It's a pleasure to have you.

Gregory Chernoff, MD: It's a pleasure to be here. Catherine, as you mentioned, I've known you for a long time and your quality as well has been unwavering, so…

Catherine Maley, MD: Thanks for that. I really appreciate it. Now, a lot of people don't know you. You came from Canada and I'm always fascinated with Canadian medicine because it's very different from our medicine down here. How does this relate to you performing 700 – 1000 surgeries per year?

But you're more innovative. I think you're more bureaucratic, but almost more innovative as well. So, what brought you, how did you get here from Canada? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: So, I did my medical school in Canada. I did my residency in Canada, and then after residency you can do one-on-one training years called Fellowship. So, I, I initially came to Indianapolis and did a microvascular breast body fellowship.

And then after that came to U C S F and did a facial plastic fellowship. I returned Indianapolis opened my practice there. And two years after that my, my fellowship director of Larry Schrock died too young at 58. Oh no. So, he had operated the day before he died, I was asked to come back to, to take care of his post-op patients.

So, I came back with the intention of keeping his practice open so, that they'd have something to sell. I, I knew the patients, and so, most of them said, well, why don't you buy it? So, that was over 30 years ago. So, it's really, it's given me the, the privilege of doing what I love the most, and that's operating every day.

Between Indianapolis and Santa Rosa, we do upwards of 750 to a thousand cases a year. So, it just gives us a great volume of, of nice people to take care of. In addition, 2020 5% of. My practice has stayed dedicated to research. We continue to be alpha, beta test sites for majority of the, of the laser energy companies in many of the cosmetic and drug companies.

So, when we do studies, it gives us a great bell curve distribution of, of all the different skin types. Probably 40% of my practice in, in Indiana is African American, 30 to 40% in, in the North Bay would be Asian, Mediterranean, Hispanic. So, Just a nice bell curve of people to take care. So, how

Catherine Maley, MD: do you, how do you manage a practice when you're there half the time and do you have like extenders who are keeping it going and keeping the money in with the non-surgical while you're somewhere else doing surgery and, and how, how are you managing that? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: So, you, you really couldn't do multiple locations first and foremost without a, without a business plan. And without financial advisors, the key being for whom you listen to. Because I think the, the, the biggest problem with most doctors is that most doctors think they're good business people, but they're not.

And the, the more frightening part is they don't know what they don't know, right? So, we have a, we have a great business plan, second and second, and tied to that are, are great people around me. Julie has been my, my office manager and office nurse for 30 years in Indianapolis. Annette's been my operating room nurse for 30 years in Indie and, and in Santa Rosa.

We have a, we have a, a tremendous lineup of people who, who really take good care of me. I take very good care of them as well as just like family. But I think that's the key is surrounding yourself with people who always have your back and, and in return you always have their back as.

We're having that kind of longevity.

Catherine Maley, MD: Honestly, most of the top practices I work with or know of, there's usually that, that continuity person there, that one who has been there from the, from the beginning through thick and thin, they know it inside and out, and the trust level is over the top. How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: Yeah, definitely Julie. I always tease people at, when I give OC, I tell them from a business standpoint, the first thing that they need to do if they're starting is to find their Julie in their office. Julie for me has been the sister I never had, and I'm the brother she never wanted.

Catherine Maley, MD: So, how much are your, I mean, I know you're doing crazy amounts of surgery is like, is that a good revenue stream for you to have both the surgical profit center for you, but then the non-surgical with you extend is that. How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: No question because as, as part of your business plan, it has to be what, what will happen when you decide that you are, are ready for your exit strategy. And in, in this day and age patients you know, one step back, as you know, through the years that there's such a difference between taking good care of patients and just doing things to people.

But patients these days in the aesthetic realm, they, they appreciate one stop shopping. So, our patients know that they can come to us if it's for a little mole that they want biopsied. If they have unwanted pigment, if they have if they want to improve the tone, quality, clarity of their skin, a above the, the, the shoulders if they have unwanted fat, cellulite, skin laxity, poor muscle tone below the below the neck as well.

They like to know that that we offer. And it, it's really nice. Remember with, with all of these machines, there's always a gm Ford Chrysler. Nice. And so, having, having your story because again, it's all, it's all about what you portray in, in your book to patients. And so, having good reasons why you are using whatever you're using.

But in the exit strategy, if you looked at our p and l's monthly, you know, surgery, you know, my patient coordinators keeping me in the operating room eight hours a day is definitely what, what secures paying the bills. But we haven't downed such since the non-surgical volume is really just in the, in the pure profitability.

Standpoint. But, but both if, if run properly or are very strong profit centers to a practice.

Catherine Maley, MD: You know, I'm very curious though, how do you handle the consultations because you're very streamlined and process oriented. You always were. And it still takes you to do these consults somehow, unless you don't have to do them. How does this relate to you performing 700 – 1000 surgeries per year?

Is somebody else doing them for you? Are you doing virtual? Are you just doing them quickly? Consults and surgery? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: So, having, having stars that are patient coordinators both in, in both of our practices. So, our, our system is really time tested. A patient contacts our office for information and it's our patient coordinators that give them the initial information.

They, they bring the patient in first to meet with them. So, that we can find out definitively what a patient's goals are if they are a non-surgical candidate versus a surgical candidate. We do the computer imaging for them. They get educated not only in what they're seeking. My coordinators highlight my accolades, and then if we have if we know that a patient, because there's a lot of tire kick.

Pardon the expression also that come in thinking that surgery might be neat, but they think a facelift should be $500. So, I, I, I don't need to, to spend my time with those patients. But if a patient is pre-qualified, no different these days than if you're. Buying a house many times, you can't even go and see a home unless you are pre-qualified.

Mm-hmm. So, if you know that a patient is, is, is pre-qualified financially, emotionally, then they, then they meet me. So, I, I meet most patients now after they already have their deposit in for surgery. Patients who want to meet me before that we're fine with that. I think Covid was an excellent eyeopener to show us that many patients are happy doing, doing Zoom consultations.

Mm-hmm. It saves them time as well, and in their process of deciding whom they want to take care of them. So, we really have the streamline now such that I meet our patients once, once we know they're, if not already on the schedule, if they're ready to commit.

Catherine Maley, MD: I will add a caveat though. How does this relate to you performing 700 – 1000 surgeries per year?

The reason you're able to do that is because you've got such a well-rounded and balanced website, you have positioned yourself as the expert. And I tell doctors this all the time. When you're at the meetings, make sure your person's there taking photos of you at the podium, in the hallway meeting. How does this relate to you performing 700 – 1000 surgeries per year?

Really well-known surgeons, you know that's pr, whatever you want to call it, pr, marketing, whatever. It, when I was on your website, all I could think of was he bothered to take the time to show how greedy is, but you're bragging in such a sophisticated, professional way, and that's how you do it. That's why I can, I'm sold on you before I've met you, and I can live off of a Zoom 15-minute console call. How does this relate to you performing 700 – 1000 surgeries per year?

To, to just put icing on the cake. That's how you do it. How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: You know, our best, our best source of referral is always another happy patient. Mm-hmm. And so, we, mm-hmm. We enlist happy patients to talk to perspective patients. That vote of confidence goes a long way. And really, you know, when I. When you and I first started at this, many of the things that we do now, we wouldn't have dreamt that we would've had to do.

I employ a, a full-time social media graduate and you know, I, I employ the full-time photographers, full-time web people whose, whose jobs are, are, are never ending given the, the changes in Google formulas and whatnot. So, times are always changing and if you're not willing to change with them and spend the money to do that, then, then you'll get you'll get.

Catherine Maley, MD: So, going back and forth between Indianapolis and Santa Rosa. Not an easy feat because Santa Rosa is a lovely town, but it's outside of SFO. I mean, I, I, it's probably about an hour. Are you flying private by any chance? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: No, I'd I'm just I'm just a few hundred million short of affording 40. No, we've, we've stayed, we've stayed commercial.

Okay. But it's all, it's all in the planning. I'm, I'm also blessed, you know, I think another key. To success. My, my wife Jill was with Roche for 15 years before we got married, but she really oversees the running of both practices. She, she is responsible for my schedule. All of our, you know, our, our schedule is mapped out during the, the end of the third quarter for the following year.

Our flights. We're all booked. So, we typically fly into, I used to keep a car there, but it's actually cheaper now just to rent a car for the week. It's nice you get to drive vehicles. You might be interested in buying at later date. So, it's really, and we, and we know the timing as, as you and I know, if you if, if we land at non traffic times at SFO. I'm to my front door with, you know, within an hour.

If you land at bad times, it's three hours. So, we, so, we know when to fly, when not to fly, and that's just, that's just, I've done it for 30 years. It's just part of life now and my, my way of preserving my health as well as I promised myself, I don't do any work on the plane. That's my time to read enjoyable or watch a movie.

And that's some downtime where, where people can't get ahold.

Catherine Maley, MD: Oh, that's so funny. The plane for me is my quiet time and that's where I do my best riding. Yes, exactly. Because I'm sitting still with nobody bugging me. Exactly. On that. Yeah. So, because you've been around a long time, just give me one big mistake that you really learned a lot from that others could avoid making. How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: Not having a, and that, that's an easy, you know, fine, because you can break your practice down into it. It's a given, it's a given that we're here to take good care of patients, but we're also a business. Yeah. And, and if you don't run your practice as a, as a business, then you can, you can waste a lot of money and lose a lot of money.

And so, my, my biggest mistake as, as I alluded to at the start, was thinking that I knew everything that I needed to know about the business of running a practice. And now, and now I, I have a business advisory board, if you will, comprised of, of CPAs, accountants, business people. And I have to write a pledge that I will listen to them.

And many of the things that they advise me to do aren't what I want to do, but I, I listen to them and it turns out to be right. So, so, younger docs starting out really need to first define for themselves who are they? What do they want to practice? Do they want to be in an academic setting? Do they want to be in private practice?

Do they want to be a solo practitioner? Do they want to be in. In a group do they want to stay exposed to research? Do they want to be just surgical or have a, a non-surgical limb, which then also involves expenditure in buying, you know, most of the machines that you look at buying or, or are all upwards about, you know, they're all like buying a nice car.

They're all upwards of a hundred thousand dollars to. And you would, you have to also look at your return on, on, on investment with, with those. So, that was probably the biggest mistakes that I made in my first decade because when we finished, so, I was, you know, between fellowships and whatnot, I was, I was upwards of 300,000 in debt with student loans.

And because there's such a delayed gratification, you, you really come out gung-ho thinking, I have to do everything. I have to do everything tomorrow. The first thing you need to do for tomorrow is start saving. Mm-hmm. And so, a, a, a proper business plan that keeps your, your expenditures as low as you can, while you can still you know, operate your practice how you want to, is really important.

But, taking the time and, and, and young docs should do that through their residency as, as you become exposed to more. Things. And I think it's really important to go to all of the different academy meetings, that there's a, as you know, our, sadly our, our meeting industries in such dire need of consolidation.

La last year I did a hundred hours of C M E talks. And, and, but there's, so, that means for, for people looking, there's, there's such tremendous information that's being offered at these meetings, both in the scientific limbs and the business limbs. So, that those things, companies like yours that, that are, that are so, valuable in, in guiding the way you've, you've watched so, many people do well, but you've watched so, many people not do.

And so, you, you're a, you're really a, an encyclopedia of knowledge for someone who's looking to become successful as they start. So, but, but starting with a plan, starting with a budget and, and adhering to those I think are, are very important. Plans change as times change, but, but the essence of who of who, who a person is also shines through in their practice as.

Catherine Maley, MD: Well, you have such a good vast perspective on this industry because you've been a surgeon in solo practice. Then you've had two locations, then you had, I think you even had a third location. Then you work with the vendors, you work with the medical societies. You're very involved in the industry. What would you say to surgeons who maybe are just stuck, like stuck in a rut or they're so, confused that they're like ready to give up, or that it is just not fun anymore? How does this relate to you performing 700 – 1000 surgeries per year?

Like any suggestions for how do you, how do you gain footing in this industry being the uber competitiveness and just all the advances in technology and so, How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: As, as you alluded to, the you know, all of the things I, I I'm humbled by, by what I've been able to accomplish in 30 years. But there are days that I say that even though that I still after 30 years love what I do, I realize that all I do is what I do.

So, it's, it's an enormous time investment to be in solo practice, to also be involved in, in research. But if some, if someone's stuck you know, there, there are many docs. Just like me, who are always willing to talk to people you know, I, I was blessed and, and always being trained by people who, who believed in sharing their knowledge both medical and non-medical.

So, anyone is always welcome to, to reach out to me with specific problems and, and we're always happy to help. People, and I think that's, talk to people who've been at it for a while. And be open. Be honest. Hang, hang your ego on the door, and be willing to, to admit what your shortcomings are and really go with what your strengths are.

Most docs haven't reached the point of, of finishing a residency start. Go into, you know, looking into how they want to practice. If, if they haven't been in the higher percentages of, of IQs and, and, and willingness to work hard. But towards the end of education, I think that's when a lot of people hit a wall and they get very discouraged because they do have, they do have choices you know about which, which road.

And you may choose a road to go down and I that, I did that a few times too. You may choose a road to go down and, and realize that that's not. Right avenue for you. It's okay to change t and to change course midstream. I think some of the most miserable pe people that I've met in my life are people that are doing things every day that they don't like to do.

Sure. Life's too short to live that way. If, if, if you realize that you're not doing something that you have a passion for, that you, because patients will pick up on that as well. It's still my, my nicest compliment every day is when patients say, gosh, by talking to you, we can tell that you still really love what you do.

Mm-hmm. And I, I think that makes the consultation very genuine as well.

Catherine Maley, MD: Would you have any advice for somebody who's like, let's say they, they like research in academia, but now they're ready to make some money, so, now they want to go out into the regular world. Do they go solo? Do they try to buy in with, you know, with somebody else's practice? How does this relate to you performing 700 – 1000 surgeries per year?

Or, you know, that new trend now is all this private equity going on? Do any thoughts on any thoughts on where we're heading here as a solo surgeon? Where are you going to go with this? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: Yeah. Th those are all, all excellent questions. And I think you know, most, most physician multi-doctor practices that have been successful are usually doctors that started together.

I think most, I think most doctors, if they're not in an academic setting, most doctors would like to be out on their own. Mm-hmm. And so, if a person has the inkling that they want to be out on their own, then they should do what I did. And that's Go to a bank, take out a loan. Mm-hmm. And start, you know, and, and start on your own.

And, you know, there are, there are always you know, older guys like me who are looking for new associates. Mm-hmm. I think the, the formulas, the formulas have changed for doctors looking for associates. I think most, most docs who bring on an associate now would require a young doc to take out a loan, do a buy-in right away, away, because we've, there's been many stories of, of young docs coming into practices only to, to abscond with patient lists and.

You know, and, and open up, down, down the block. I think that's one thing that's, that's a across the country, non-competition clauses are weakening. In, in many states, you'll see more, more doctors protecting their established practices by having younger docs buy into them and then, and then earn, you know, earn their, their buy-ins.

Al also then over, over time.

Catherine Maley, MD: But then should there be a honeymoon period before you have a buy-in to make sure you have shared values and vision? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: I think a lot of that is built, a lot of that is built into, you know, the, the, the early, the early contracts. I think, I think younger docs need to also appreciate, though it's, it's not easy to start your own practice.

Patients these days with the internet, they have many choices about where they, about where they can, they can go. So, there's benefits. To younger docs in joining established practices. I think they, they can be mentored into excellence that, that way there's benefit also, and by, by older docs bringing in younger docs to carry, to pick up the baton.

The, the, there's a lot of private equity firms. I think, you know, this really started in the dermatology professional. Where dermatology practice started getting bought up. The doctor was offered a certain percentage in cash, but then the ability of putting some, keeping some equity in the company and for the larger equity company to buy up again, so, to see some profit off of that.

As well. So, those, there's a lot of those formulas around, but I mean, those, those equity companies are looking for more established practices that would, you know, it, it wouldn't be, you know, looking for a, for a, a multiple of, of, of, of earnings. So, you have to have a track record before a private equity company would, would really consider you in that regard.

And as part of that, you have to have clean. You can't have, you can't be running your practice as your own private bank account. As well. You have to show profitability for equity companies to be interested. But I think young and that, that's, that's also a, a positive for young people coming out of training is that they have many options that they can know, that they can look at.

Think you also have to if you're going to. Be in the field of aesthetics. Look at what your primary specialty is, and you have to decide, am I going to be an aesthetic doctor, non-insurance base, or am I going to keep a certain, you know, a, a certain percentage of my practice in the insurance area? Which, which, which can always act as a, a backup if, if times, if, if the economy worsens.

Although I think this is interesting. You know, before Covid I would've been booked on average, you know, eight weeks in advance. I'm, I'm booked here. We, here we are in coming up in April and I'm booked through September, October for many things. So, I think with, even when times get bad, people will always spend money on themselves, and that's what we're seeing with Covid.

Maybe people aren't traveling as much, so, they're spending more on themselves or their house.

Catherine Maley, MD: Oh, I think, I think cosmetic rejuvenation has become a way of life now. The stigma is almost gone. Social media helped that a lot. Social media also hurts it, like everything. There's a 50 50 to it, but I just think no problem with the demand here. How does this relate to you performing 700 – 1000 surgeries per year?

My problem with insurance is it's hard to dabble in it when everybody else. Eating, sleeping and drinking cosmetic, and then you're doing some insurance. And the, and the cosmetic is kind of a hobby. It can't be in today's world, it's just too competitive. And I think you need pretty extreme focus on something. How does this relate to you performing 700 – 1000 surgeries per year?

But I want to talk about that because, Normally in today's world, I say, you know what? Get really good at a few things. Don't try to be everything to everybody but somebody like you who's so, into research and you love the new technologies you offer. Talk about an umbrella, like you talk about a one-stop shop. How does this relate to you performing 700 – 1000 surgeries per year?

Like you offer everything and all the lasers and the injectables. And you're from Canada and you have all the latest like, you know, everything that's happening, like coming up with fillers and non-surgical. How do. Do you think it's a good strategy to provide everything for everyone, or is that difficult to manage? How does this relate to you performing 700 – 1000 surgeries per year?

What's your feeling on that? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: If you're, that's an excellent question. If you, if you have the desire to, and you can break down surgically and non-surgically, if you have the desire to be head to toe surgically, you have to have the appropriate training. Certainly. And you have to, I think most surgeons know what they do best.

Mm-hmm. And I that, that's a better you know, Operate and do the operations that you know you're good at because it only takes, it only takes one unhappy patient. Mm-hmm. I always, I always tease young docs and, and tell them, since most people still don't want folks to know that they've had anything done.

Right. If you make one person happy, they may tell two or three of their friends, but if you make one person unhappy, they have the potential with one bad review of telling millions of. So, you really, you know, stick to, stick to surgically what you do best. Stick to, you know, offer non-surgically, you know what because you can go to all the, the academy and, and, and, and you have lists as well of what you know are the most popular nonsurgical therapies that are people are looking for.

I think first and foremost, and this was advice that was given to me as well in starting, is first pick where you want to live. Mm-hmm. Cause if you go, if you go someplace that you know you want to live, that you're happy living, number one. And then number two, if you do good work and you're nice to people, you'll be busy no matter where you go.

And you'll be happy because you're living where you want to live, you're doing what you enjoy doing. And, and still to this day, the most gratifying part for me every day is watching how the smallest changes for a patient have such a dramatic effect on self-esteem. Mm-hmm. That's really the, the, the gratitude that our patients display to us every day by just the, the smallest of changes that is so, so, gratifying.

You know, once you can make a list for yourself of what you want to offer. You can really map that out in a way that can also become profitable.

Catherine Maley, MD: You mentioned patients and what's your take on how, how different is the patient demand now than it used to be? And how have you molded your consultations to that? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: I think we, we as aesthetic providers have to really show a tremendous amount of tolerance these days because the internet has become such a double-edged sword. Every day I meet patients who've read an article and they know more than I do after 30 years now. And so, it's always, you always have to listen.

The other, the other thing that that more docs need to practice at getting better at is listen. And not talking it it's still our job to listen to a patient as it relates to what has brought them through your door. Then it's our job to give them information relating to what it is that brought them through the door in a manner such that they don't think that you're trying to sell them right.

Any, sell them anything. And, and that that's the, the artistry that's involved in, in the consultation process as well is if, if a patient really senses that you're engaged with them. Once you walk in that room or if you're on the zoom that, that they have your, your, your total attention and that you're really engaged in, in the problem for which they're seeking your, your help.

They'll get the sense that you really want to help them and not just do things to them, but it is very, you know, I walked into one of, one of my consults to a, a 60'ish year young lady, and she was holding two papers and, and she said to me, just like this, I want to make sure that you're going to do my facelift just like this.

Great. And so, it would've been, it would've been easy for me to, to tell her what I was really thinking. Yeah. But again, I, I, I helped her see how that, that really probably wasn't the best tack for her to, to take upon first meeting her surgeon.

Catherine Maley, MD: They have gotten very demanding. They're very educated, they're very demanding. How does this relate to you performing 700 – 1000 surgeries per year?

And you know what I've learned as a, as a consultant, I say to the doctor, you've got to decide who you are and get grounded in your values and your own vision. Because when the public's coming at you from every which way you can try to acquiesce to that or you can say, no, no, no. Here's how we do it. How does this relate to you performing 700 – 1000 surgeries per year?

Here, here, here's what I'm comfortable with. And then let the rest go. Because dealing with the public is exhausting, isn't it? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: So, to that lady, I took my current textbook on facelifts is four is four three that you wrote the book on page volumes. And I, I said, wait, right here, I'll be right back.

So, I went and I got the textbook and I brought it in and I put it on her lap and I said, we're going to do this differently now. We're going to do your facelift with you awake. I'm going to talk you through it and you're going to do your own surgery. And so, her mouth o opened and he thought about it and she said, "I get your point".

Right people. It's so, I, I, I think if you, you know, pa patients have to know that they're coming to see you because you, you are the expert. You are the person who will take good care of them. You'll listen to them. But there comes a point where you, where you have to draw the line in the center. You wouldn't say to your cardiac surgeon who's just said you needed quadruple bypass, just do three minor arteries or two minorities and I'll be fine.

Catherine Maley, MD: So, how are you in today's world with marketing? Like you were always a really good marketer before, but you did it usually through patient education then I really, I mean, this was many decades. You were doing the patient education events before everyone else was, and I thought that's how to do it. How does this relate to you performing 700 – 1000 surgeries per year?

Like you don't have to sell anything to anybody. People want to look good, help them understand what it takes for them to look their best. It's, it's a no-brainer, but how much of your practice nowadays is marketing versus just good old patients coming back for more and referring their friends? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: I think both, both are, both are still equally important, you know?

Mm-hmm. You, you and I could sit down and, and, and show a beautiful equation on the value of one happy patient. Mm-hmm. Cause one happy patient. One patient may start coming in, doing fillers, doing Botox. That will transcend then to maybe some laser work for pigment fine lines. Then as time goes on, they, they see that the gravitational diss.

That they are, that they are now seeing, as well as their volume loss, their loss of elasticity is, is now warranting surgery. So, they may start with doing their eyes, their brows, their liposuction, whatever, they're happy, then they tell a friend or two, then they're ready for something else. So, so, one happy patient when you meet them is worth hundreds of thousands of dollars in, in in the end.

So, protecting that. Is, is very important. So, there's that aspect of, of marketing through meticulous results. Mm-hmm. And then there's, then there's the dollars that you never like spending. We still do public. I think public seminars have been very, Valuable over the years because you can, you can extend information in a, in a very non-intrusive, non-threatening way to, to people.

And, and you can waste a lot of money on, on ads you know, on print ads. The internet is still a very valuable resource that if you, if you know how to play the, you know, the different equation game It all adds up, but, but you really, I think to be successful, you really have to do it all.

You, you can't just, you can't just focus on, on one avenue of, of, of marketing. And, but, but again, my, my greatest recommendation to anyone is to hire someone like you because that's what you, you know, that's what you are there for is to, is to educate and, and to help people be a.

Catherine Maley, MD: Well, and not to waste so, much money. How does this relate to you performing 700 – 1000 surgeries per year?

Yeah, I, it's shocking that they won't pay for my services yet. They'll give it to some PR company that works, what, five grand a month for eight months and you got what from it? You got something in Toledo, Ohio, like some kind of like that, a magazine nobody reads. And I think, what the heck? You know, that's. How does this relate to you performing 700 – 1000 surgeries per year?

I just, I'm on, I'm into marketing in today's world. Smart marketing, you know? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: Okay. Because I've, I've wasted a lot of money on companies that grossly overpromised and even worse, under delivered. And so, you, you, you really have to, there's so, many, as, you know, shysters out there who. You know who, who talk, talk a good story, but, but you know, provide very little inner turn.

Catherine Maley, MD: Yeah. Well, you're really up on the technology because you're on all those advisory boards and you're out there in the world like what's happening. Because half of us, remember when I, when we first started, you surgeons wouldn't even dream of injecting Botox. Like you were like, are you kidding me? I am a surgeon. How does this relate to you performing 700 – 1000 surgeries per year?

And then you really came around full circle and said, no, no, I need to grab that patient. You know, so, now I do injectables as well as surgery, but like I know you're very involved in regenerative medicine. Yes. So, what's coming down the pike? Like, what else do we need to look good and feel great? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: I think we're seeing more; you know, we're seeing more people.

I'm really seeing two, two distinct new peaks. In, in my practice. We're seeing younger people. A lot of the, you know, the, the generation Z patients, the generation X patients coming in c as well. With healthcare being what it is, I'm seeing many more 70, 80, 90-year-old patients coming in. With sometimes letters from their family doctor saying, don't discriminate against this patient because of their chronological age.

They're the biological age of someone much younger. And these elderly folks come in saying, you know, I don't feel my chronological age, but yet the person that I've seen in the mirror doesn't match how good I feel in my heart. So, if you have a safe way of helping me, I'm really interested. So, both of these subsets come.

Seeking what I refer to as preventative aesthetics. Mm-hmm. As compared to corrective aesthetics. Remember the, the three signs of aging. The only reason that anyone comes to someone like me is, is three reasons. Number one is the gravitational dissent of their muscles, both above the. Above the shoulders and below the shoulders.

And for gravitational dissent, there're really no surgical options at a point for which the patient, you'll do the things for them and they'll go, wow. The second reason they come to us, it's all these non-surgical reasons, volume loss. So, all of us lose fat in our faces in the mid-face. Lower, lower third, and this is where the injectable fillers are.

Fat transfer. There's, there's nothing. And then the third sign of aging is the loss of tone, quality, clarity of skin. And this too is where, where many of the non-surgical treatments, the fractionated CO2 systems, the needle rf treatments that they've never been better, but the whole field for, for 30 years, we've been involved in, in the fields of cellular medicine, regenerative and stem cell therapies, medicines is going to change so, much in the next decade.

The whole field we, we've been involved very highly in, in the field. Called exosomes. Exosomes are the tiny little articles that all of our cells communicate with. And they're packed with growth factors just as your own p r P is, but your own p r p is your age, whereas a memal stem cell exosome is, is very robust with growth factors.

And so, there's the therapeutic side of exosomes. They can improve the tone, quality, clarity of skin. They have such a tremendous, because they're loaded with, with regenerative and healing factors. They can help us in wound care and scar therapy. But the whole field of biogenetics and epigenetics we, we know what genes now are responsible for what features in in the body.

Exosome Diagnostics. There'll come a day where you and I can spit in a cup or pee a cup, and based upon the exosomes that our own body is secreting, we'll be able to detect disease states before the first cells even hit an organ. And then exosome therapeutics will be able to load at your own exosomes with disease fighting, fighting drugs will, you know, disease states like melasma like hypopigmented disorders will have very specific treatments coming up from these that are personalized based upon your own.

Your own gene. So, the whole field of gene therapy isn't that far away. There're some great companies we work a lot with some companies at Purdue at Stanford, that, that are involved in, in innovative genetic therapy so, that the field is so, exciting and I really envy people that will be around for.

20 to 50 more years because they'll be doing very different things. Not even today. I, I do very little how I did things 30 years ago, right? And, and, and very little of what I did even 15 years ago, both surgically and non-surgically. Mm-hmm. All geared to give better results, to have healing times. Quicker for patients as well.

So, the technological advancements that we've seen since I started, and it'll continue to see will really be jaw dropping for, for providers and for patients alike.

Catherine Maley, MD: Well, I've been using every technology that they had introduced because I'm going to say, I'm going to fight this aging process forever for as long as I live. How does this relate to you performing 700 – 1000 surgeries per year?

It's why I'm in this industry, although I should probably be more, more interested in the genetic stuff, you know, because I, I don't think, I don't know if I have great genes, but it'd be nice to, you know, I. I already feel really good like everyone else; I feel great. I can't believe I'm the age I am and I don't want to, How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: You and I are both 90 and look how good people.

Catherine Maley, MD: That's right. And so, if you could hurry up and research a little faster, we can get to one 20 looking good. So, what is driving you, where do you get this motivation? Because I'm pretty sure you're not sleeping a lot. When you're doing 700 sur, like a thousand surgeries a year, what the heck? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: What, what's, and I, I really say this from the bottom of my heart. A any my mother was a high school teacher who, who really believed her, her favorite saying to my brother and I was, don't, don't, don't settle for mediocre because there's, there's mediocre all around us. And so, I've always, I've always been driven to, to be my best.

And that that really hasn't changed. And it really, but like I said, I, to this day, I genuinely, without hesitation or reservation love what I do every day.

Catherine Maley, MD: Ah, that's so, nice. Now tell us something we don't know about you? How does this relate to you performing 700 – 1000 surgeries per year?

Gregory Chernoff, MD: Cooking is still my hobby. And so, that's the, what's your specialty? You know, I, with our, with our foundation for survivors of violence, my wife and I put on two charity barbecues.

Last year we cooked for 250 people in our backyard. So, that's still, holy cow. Still, still a hobby. I still play. I used to play hockey. My arthritis doesn't let me. I still love golfing and, and other sports as well. So, there, there's, there's no end to doing things like that in spare.

Catherine Maley, MD: Well, you're probably still cleaning up after that barbecue. Dear Lord, that's a lot of people in your backyard, so, alright. If some, if somebody wanted to reach out to you, what would be the best way? I know your website is called www.ChernoffCosmeticSurgery.com. Is there any way they can or, or, or just www.DrChernoff.com?

Gregory Chernoff, MD: They can also reach me on my email. Just [email protected], [email protected]. And I'm happy to communicate and share, share anything that I've learned over the years.

Catherine Maley, MD: Oh, thank you so, much Dr. Chernoff. I really appreciate it. I'm glad we could catch up. Hopefully I'll see you at a meeting coming up soon and that'll do it for us today.

Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on how to attain 700 – 1000 surgeries per year.

If you've got any questions or feedback for Dr. Chernoff, you can reach out to his website at, www.ChernoffCosmeticSurgery.com.

A big thanks to Dr. Chernoff for sharing his wisdom on how he performs 700 – 1000 surgeries per year.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "700 – 1000 Surgeries Per Year — with Gregory Chernoff, MD".

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#drchernoff #1000surgeriesperyear #gregchernoffmd #santarosaplasticsurgeon

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and insights from Grant Stevens, MD.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "Insights From Grant Stevens, MD".

Dr. Grant Stevens is the who's-who of plastic surgeons and one of the most trusted voices in beauty, and will have lots of insights to share. He's a board-certified plastic surgeon who is the founder and medical director of Marina Plastic Surgery by Athenix and Marina Med Spa in Marina Del Rey, California.

Not only is he the past president of The Aesthetic Society, Dr. Grant Stevens also actively speaks, writes, researches, teaches, consults and participates with national and international medical societies, journals, hospitals, universities, industry, pharma, PR outlets and even government.

This week's Beauty and Biz Podcast is my interview with Grant Stevens, MD where we talked about:

• Insights on new business models available to those who want to simplify
• Insights on equity deals to invest in to shore up your financial future
• Insights on how to differentiate from everyone else
• Insights on how cosmetic patients have changed

You may need to listen to this Beauty and the Biz episode several times since it's packed with pearls on how to market, scale and exit a cosmetic practice.

You'll hear how differently Dr. Grant Stevens thinks about business, marketing and the plastic surgery industry.

Visit Dr. Steven's website

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

Insights From Grant Stevens, MD

Catherine Maley, MBA: Hello everyone and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery and insights from Grant Stevens, MD. I'm your host, Catherine Maley, author of "Your aesthetic practice — What your patients are saying", as well as consultant to plastic surgeons to get them more patients and more profits.

I am absolutely thrilled with this episode because I have Dr. Grant Stevens, who will be sharing his insights. Now, he's a board-certified plastic surgeon, who is the founder and medical director of Marina Plastic Surgery and The Institute, a medical spa in Marina Delray, California. Now, he's also a medical director of Orange Twist Brands, offering multi-location non and minimally invasive aesthetic treatments, as well as chairman of the USC Marina Aesthetic Surgery Fellowship and the director of the USC Division of Aesthetic Surgery.

Now, Dr. Grant Stevens is the "who's who" of plastic surgeons and one of the most trusted voices in beauty and who will be sharing his insights. He has the longest CV I have ever seen because he actively speaks, writes researches, teaches consults, and participates with national and international medical societies, journals, hospitals, universities, industries, pharma, PR outlets, and even government.

Actually, I had Dr. Grant Stevens on my podcast right as the pandemic was... It had kicked in, but now they sent everyone home. So, I was able to catch him for a minute on the podcast and a lot has happened. That was several years ago. So, we're going to hear what's new and his other industry insights.

So, Dr. Grant Stevens, welcome to Beauty and the Biz. It, is an absolute pleasure to have you back and to share your insights.

Grant Stevens, MD: Thank you very much, Catherine. I really wish my mother had been here again. Once again listening to that introduction.

Catherine Maley, MBA: That's very well, I'll say, well, it was really difficult to condense it because you have been around. Wow. Good for you. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Yeah. Yeah. Wonderful career.

Catherine Maley, MBA: So, let me ask you this because today I did a lot of research on you and I see a lot of things have changed. So, let's just start with your practice. When I knew you, you had a very, you know, healthy, busy practice and you had quite a few people. So, tell me what is your practice like today and where do you fit into that? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, thank you very much. And hello to everybody. First of all, my practice is in Marina del Ray. It's Marina plastic surgery in the Marina med Spa, and it's been there for about 33 years and we've enjoyed a wonderful time. And we have a fellowship and aesthetic surgery fellowship that's gone on for over 20 years, actually in conjunction with U S C and also Jay Calvert and the Rocks Institute.

So, it's the Marina Rocks USSC Fellowship, which we're right now in the process of changing to the Los Angeles Aesthetic Surgery Fellowship because we're incorporating more of the LA based surgeons. And you asked about what I'm doing and what my role. And some people mistakenly think I've retired. I certainly have not retired.

I'm working as hard or harder than ever, but I actually am not doing surgery. And you mentioned orange twist. We are so there's orange twist is another endeavor, and that's a number of med spas. By the end of this year, we should probably be up to 30. We're looking all around the country, building and acquiring.

And that's all non-surgical medical aesthetics and it's called Orange Twist. However, the most exciting news I can share with you is that a company out of Texas called Lattice Work Capital, which has been around for 25 years, doing various rollups and other consolidations in the medical business, from veterinary to ophthalmology, to dental all sorts of different subspecialties.

They have 25 years' experience. And they came to me and asked me to be on the board. Of their aesthetic rollup. And this is a couple year or a little over a year ago. And with that in mind, I looked at some of the opportunities because I was working very hard with engaged technology and some other things that will come up a little later today.

And I decided that I would go ahead and go and partner with them. And with that in mind they, they called the aesthetic portion of their business. They called it a phoenix, although I think by the time this airs, it will probably be called something else. And it's through lattice where capital and we are acquiring other top flight plastic surgery practices and around the country and only going for the very best and providing a fantastic patient.

An employee experience in the field of aesthetic exposed surgical and non-surgical. And as a board member of that company, and I always kid people, I say I sold my practice to myself because I took back a lot of equity and I really want to build a, the number one national brand in the country of aesthetic plastic surgeons.

So, Marina plastic surgery, alive and well. The senior surgeon there is Dr. Justin Perez. All of the employees are still there. Everything that you remember is still there. And in fact, I'm swinging by there tomorrow. I'm down here right now in Manhattan Beach, and I'll be there at the office tomorrow.

Check on things and see everybody. I'm actually going to get a little dify in my forehead. Wrinkles, you can see I need it. And then I probably have a Cyan laser in a couple days BL and Halo. So, I'm still very much involved and I'm still a consumer of the product.

Catherine Maley, MBA: You're still drinking the Kool-Aid.

I knew there was a shift on your website because on your website you very strategically marketed him, Dr. Perez as the medical director and you were after him as the founder. And I thought interesting, because you're transitioning, you're keeping that credibility because he needs your credibility. He can't stand on his own at the moment, I don't think he's much younger.

I mean, is that, is the goal though, for you to walk away and, and have him take it? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Yeah, well, certainly Dr. Perez could do whatever he wants to do. He trained at UT Southwestern. He was my fellow for a whole year in the number one aesthetics fellowship in the country. He then stayed with me and worked alongside of me for a couple years, and now he's the director and running Marina plastic surgery.

And, and I assure you that he could do it on his own. However, we are great friends and colleagues and we share, and obviously I have a little experience. I've walked the path a little longer than he has, and we have a great time. Hey, let me share with you. He is going to do my eyelids this time. Oh my God.

He's going to be my surgeon. Not only is he injecting me and doing my laser this week, but this summer is going to tidy up my eyelid. So, I trust him as my surgeon and I could go to anybody obviously, but he's so, and he's such a great guy. He's running that, that office within the whole Phoenix structure.

But like I said, it may well not be called a Phoenix by the time you air this program.

Catherine Maley, MBA: Well, lately on the podcast, that's all we've been talking about is private equity and plastic surgery. So, just to be clear, because it sounds to me from what I, the little bit I do know every deal is different. It depends on how much you want to give up, how much the, the business people want to do.

So, for typically you're going for the economies of scale for one thing, right? You're trying to do group discounting or group special pricing. Is that true or is that one of the objectives? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Are you talking about the acquire or the seller?

Catherine Maley, MBA: The business side, the business people who are going to take it, the private equity people, is their goal to roll you up so they have stronger buying power.

So, now you decrease your, like, hard costs. Is that one of the objectives? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, that, yeah, that, that is one of them, but that's not the main objective because what's the main objective? There are plenty of buying groups. It's, it's the efficiencies, first of all, the back-office efficiencies the running of the office, so all the support and of the office, the marketing, the HR, the employee relations and so forth, and their experience.

Like I mentioned, the company I'm with, with Gladys work, they have 25 years of successful rollups. One of my concerns, and this will come out at the Aesthetic Society meeting at Hot Topics, which may have already happened by the time you play this, but. I actually looked at 13 different groups, and I know there's a few more.

And there will not be 13 groups in a couple years, most of them will fail.

Catherine Maley, MBA: And why is that? Because I can see, but just from my, my looking out, you know, outside looking in, there's so many variables involved, so many egos, so many pieces to that thing. And I don't know how you're controlling it when it's in different locations, different people.

Who has the decision making? Who doesn't? That, that was, that's my take. Like why wouldn't they make it? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, first of all, as I mentioned, this is not a new phenomenon. This has been going on for 25 years with other subspecialties. So, if we look back and we study what's happened in previous verticals, in previous specialties, and we study what's happened, Then you ask why do they or why will this fail?

And, and it won't fail entirely. There'll be successes and there'll be cannibalization. Some will be bought by others at different valuations. But there will be some people that pay too much. There'll be some that can't deliver what they say they're going to deliver. There will be early retirements because people will see the money and they'll retire and, and, and the, the revenue stream will evaporate.

There'll be a number of reasons why they don't pan out and deliver what they're promising. I hope they're all successful. I'm not trying to be heavy downer here, but it can't possibly be 13 different rollups. And in fact, I'm told there's a couple more coming down the pipes, which doesn't surprise me because private equity wants to get in this because they've made tons of.

On other verticals. When I say a vertical like dentistry or pediatric dentistry or cardiology and so forth, they're veterinary, as I mentioned, renal dialysis centers and so forth. And I've studied, I went back and studied the previous models and looked at and interviewed people. I interviewed a couple pediatric dentists who did a three-time recapitalization and their final out was a 14 x.

They had a wonderful exit, foreign excess of the cash they had, and that would be one of the best models I saw.

Catherine Maley, MBA: But, but why has nobody ever done plastic surgery until now? My thought, is it insurance versus cosmetic? I haven't heard of this until a couple years ago now. It seems very popular. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Okay, so let me go back.

It's funny you say that. I attempted a roll up in 1998 with 31. With 31 practices and I took it to Wall Street. We went public and it was called the Plastic Surgery Company. It was 1999. Good for you. How, what happened? And we had 31 practices and more than 31 physicians. But I learned the hard way that managing plastic surgeons was much tougher than herding cats.

As Harvey Zim used to say. It was very difficult. And as I said, we could give a key to a burning building with the plastic surgeons in the building and say, that's the door. Here's the key. Let yourself out and save your life. And they would argue with you that it's not the right door, not the right key, and so forth.

But what we didn't have was private equity. Equity, and we didn't have the knowledge, the backend knowledge. And that's exactly what's going to happen to some of these other groups. I learned the hard way. Mm-hmm. We survived and did fine. Dennis Connan and I did it. And you know, Dennis from the industry and we learned a lot.

And I said to Dennis at the time, if I ever come to you and say I want to manage plastic surgeons again and do a roll up, I want you to shoot me. Well, then I call him and I say, you're never going to believe what I'm about to do. But it's totally different. It's totally different now because the physicians are giving up control of their practice, and that's a key thing they didn't with the previous one.

And that's good and bad, but they will follow the directions of the, of the parent company. In some of the programs, they have more control over others. Right. I think they're going to learn very quickly that that's probably not a great idea. PLA surgeons are independent, physicians are independent, plastic surgeons are very independent.

Mm-hmm. And they're tough to manage. Mm-hmm. But again, Catherine, as I mentioned, this has been done many, many times before, successfully in other fields. And I think what we're seeing here is now the interest in non-surgicals, especially captivates a lot of money people and private equity and, and people want to get on board the aesthetic boat if you will, or train because it's growing at an exponential rate.

And I don't blame them. I don't, that's why I'm on board. I mean, that's why I rolled a lot of my value into equity. Mm-hmm. And why I encourage my colleagues to give it a look. We're, we're going to be talking about it at the hot topics section of the Aesthetic Society meeting and comparing in contrasting some of the models.

And there's not one model that fits everybody's right. There can be many models, depending on the age of the doctors, how many doctors there are what their goals are, you know, what their tolerance is for having people manage them or their staff. There's just so many variables, and I hope they're all successful.

Catherine Maley, MBA: Because one, you, you need commitment though. You, you need them to stay put, right? Like, like for five years at least to make it work. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, so, okay. So, they're men. As I mentioned, every time you ask me a question, there's going to be a variation of the answers. Yeah, for sure. Some of the models are three years.

Some of them go out to five, some go out to seven or infinity actually. Mm-hmm. But if you leave in less than three years in general, you're going to forfeit something in the way of e or more. So, there's not one size of fits all. So, if you, there's as many models as there are companies

Catherine Maley, MBA: For sure. If you were to talk to a surgeon, like the biggest benefit for a surgeon to roll up with this, with a, with a private equity firm, what is it?

Is it to let go of the admin part of their practice and just do surgery? What's their benefit? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: It entirely depends on the age of the surgeon, what their practice is like now, and what they want out of their practice and their life. It's, there's not one size of fits all. Once again, if you're a young surgeon, it might be effective practice management and professionalism and branding and marketing and taking the headaches of running a business out of their hands, allowing them to do what they're best at, which is surgery.

That's one. If you're a senior surgeon in your final third of your life, it allows you to monetize all the work you've done and actually get a healthy multiple that you're not going to get anywhere else. Mm-hmm. Certainly, have to stay around a while. And the middle, sort of a blend of both. So, it's not one size fits all.

And when people say to you, they have the answer, they know, trust me, they don't. There's many, many scenarios here and there are many ways we can actually adjust it for the needs of the younger. I always talk the first, third, second, third, third, third of their practice. Mm-hmm. And it can be, and they can make more money, both even for practice efficiency on a day-to-day basis, as well as have a program extra strategy.

Catherine Maley, MBA: Mm-hmm. The one, the two things I was wondering about with these groups who pays for the patient attraction, does it now become the, the business side of that to, to do all the marketing for you? Or a lot of the groups, they still say to the practice, no, you still do what you do. You still build your practice market the way you've always done it.

But now doesn't it have to be co-branded? You know, like how, how do you divvy up this marketing part? Like where are these patients coming from? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Again, Catherine, once again, same answer. It's as different as there are different practice model. Some are centralized entirely and they only do a central brand.

Some allow the practices to exert their influence. Like for instance, marina plastic surgery is still marina plastic surgery. Yeah.

Catherine Maley, MBA: Well, that's how I noticed this. It said marina plastic surgery by a phoenix. Right. An old, interesting. Yeah. So, you are full branded a little. It's little though. It's subtle, right? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: It's co-branding and eventually as we get bigger, we'll probably have a national brand, but we're still allowing people to have their own local brand. Mm-hmm. And to the extent people want to do their own unique marketing, that's fine. But one of the values of this is we share best practices. Mm-hmm. So, if somebody in another locale who's part of it shows us what they're.

And they're involved in, say, patient financing with patient Fi or subscription services with, with dax, I mean, excuse me, with Privy. And they're doing great. They will share that because now you have partners coming together on quarterly meetings and sharing best practices is nobody can have all the answers.

This allows sharing of the best practices and then incorporating that around the country and maximizing the return and having partners and learning from one another, not just surgical technique, but in this case business management, marketing, and all the various other parts that are outside of the OR.

All right now practices or some models. Take all that off the. Some, some just come in and they just run it and then the doctor goes to work and does surgery and so forth. That's not what I'm doing. It's not what we're doing, and that it's not what most are doing. And most plastic surgeons don't want that kind of model.

But there are some that are that way. I can tell you I looked at them. Mm-hmm.

Catherine Maley, MBA: Well, what would be your advice then? Choose carefully, you know? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Yeah. Again, it would be, it would depend on the age of the surgeon. Mm-hmm. Well, private equity's not interested in hiring a young surgeon just fresh out, unless they're in an established practice.

I would, I would let, let me talk to the people that understand the second, third, or third-third of their practice. Yeah. Yeah. Look carefully. But in my mind, the biggest mistakes people are making, and we're going to talk about this, is that they're, They're falsely thinking that all the management schemes are equal and that somehow that they all be successful.

Mm-hmm. And I don't understand how they can think that when you study the other subspecialists, the other verticals, if you one studies veterinary stuff, or derm or dentistry as I mentioned these other, and you study what happened 10, 15, 20 years ago. Mm-hmm. You see that a lot of people got burned.

However, some did not. And the ones that did not have the best management ches, they have the best, the, the best business people and they partner with the physicians, be they veterinarians or dentists or whatever they are. And learning from the past helps the people now and in the future. Right. I mean, why would you repeat something that failed?

And that's what I see. I see a lot of naive plastic surgeons that I feel sorry for. They're just going for either the highest multiple, and they don't understand that that's not really the big strategy here. Because in a year or two, they're going to be out on the street or they're going to, the whole thing will be, well, what will happen, it'll be acquired.

We'll be re-roll up at a much lower multiple. Hmm. I just would be very cautious, be very thoughtful, be very analytical. The other thing is you don't need to be paying these bankers so much. I see these guys hire all these bankers, which I mean, it makes sense to have one, but they're paying way too much for them.

I don't know. The bankers hate me for saying this. And I have the bankers on my program and they're my friends. But some of the plastic surgeons are getting gouged by bankers. Sorry, bank.

Catherine Maley, MBA: For the surgeons, are they looking for predictable revenue streams? What would make the business people want to take over a practice? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

What are they looking for? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: They're looking for that delta. They want to. Pay the surgeon. They want that EBITDA and they want to drop the revenue, drop the expenses, and raise the revenue. And that delta is what they're looking for. They want to run more efficiently. It's, it's an old model. It's not new.

This is not new. This is ancient. They're coming in with economies of scale that you mentioned on acquisition of product, but way more than economy of scale and product. It's running the business like a business. Right. You know, I started that whole thing called the business of plastic surgery years ago.

And you've actually been involved in that also. And I remember when I first gave a talk called Staying ahead of the competition, I was roundly booed and so forth. Because I said, you're all business people. Then they disagreed. I said, yeah, you are. You're just bad business people and profit's not a four-letter word.

And you may remember I gave that talk profit's not a four-letter word. And I pointed out it funds philanthropy. It funds sitting in that chair. It funds your kids' education, it funds your. And so forth. Then without a profit, unless you're a silver Spooner, you're not going to be successful. You're not going to be able to help your family, help the needy and so forth.

Go on mission trips. So, if it is in fact not a four-letter word, then shouldn't we get the most profit? And shouldn't we run our businesses as business people, not as frat rats? I mean, I looked at businesses when I rolled them up in 89 and 90, they were being run and they still are like fraternity houses.

And, and it's unbelievable to me. I'm a businessman and I'm a surgeon and you know; it turns out you can be both. And I know that was really tough for people to swallow. I'm happy that now it seems that people have gone full circle and they understand they are in the business of aesthetic plastic surgery and aesthetic.

And they want efficiencies and they want help in the back office and marketing and sales and all the management issues in HR and everything that every business in America has. So, that's where the rollups are going to help the doctors.

Catherine Maley, MBA: Is the point of the roll up to eventually then just sell it to somebody else for even a lot more equity? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

But then who would that somebody be? Is it just some more business? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, you know, some are, some are established just to throw off cash and distribute it back. The shareholders. Mm-hmm. Some, I can think of a couple that come to mind. I'm not going to identify any of them, but, and some are clearly in the business of growing and then recapitalizing and then maybe recapitalizing a couple times and then ultimately then selling out.

But the ones that are getting involved right now who tell me, oh, we're going to do this in sell out in three years. Right. I know they're... No question. That's the biggest path to failure to start a new business and say your goal is to sell in three years. Every business school textbook says that. And, and if you look at startups, the people that make the money are do not startup companies with the idea of selling.

Catherine Maley, MBA: So, I'm from the Silicon Valley. I live very close to it, and I was down there for a year and I was in the middle of the, I started in 1998 and I left in 2000 to start what I do now, because I thought, you're all crazy. Nobody, you're all just here to start something and, and pull out the money and leave.

And all of us were, you know, millionaires on paper and we, it was over overnight, it was gone. And I was working for a startup that was burning through so much money and nobody had a. Just so it was so interesting to watch that, but you really have to know business and some where you're going with this.

And now I tell the surgeons, you're not only in in the world of business, but you're also in the, in the game of marketing. You've got to market yourself. And they're still fighting that as well. Like, why should I have to market myself? And I think it's just, I think the surgeons are the most sophisticated of all medical societies because you've been kind of forced to be, but even then, you're, you're kind of behind that until you realize this is a business that includes the marketing.

That's why this podcast is business and marketing. That's how you grow this thing, you know? Mm-hmm. So, tell me about Orange Twist. How is that different from Phoenix? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Okay. Very different. So, Orange Twist was started by Clint Can, Carnell and myself were the co-founders, and it's a Dr. Light approach to med spas.

And we started with one and then we went to fi. We then we went to 15 and now we're going to have 30 by the end of the year. And what we provide are the non-surgical and minimally invasive type procedures that do not require a physician on-site. We have medical directors and say I am not the medical director of Orange Twist anymore, but we do have medical directors of the individual sites.

And a general medical director overall. So, we have medical supervision, we have Orange Twist University. We train our staff. We emphasize quality and safety, number one. But a lot of patients don't want to go to a doctor's office. They want to drive in, get out of their car, walk into the Starbucks and go right next door and have their Botox or the Dify or their RHA or whatever filler, Restylane.

I don't want to endorse one over the other. They want to have their aesthetic experience and it might be a laser treatment, it might be hair removal and so forth. There's the whole myriad of things, not surgery. So, the key thing, it's non-surgical there. It's not, it's on the first floor you can park in and walk in.

So, it's the friction. We've taken the friction out of the experience you're easy to do business with and patients come in and, but they're not patients, they're clients and it's. Sort of like going to your hairdresser. Although I always say to the staff, you know, you're not hairdressers, you are practitioners and, and you know, their hair grows back but sometimes doesn't.

So, but the experience for the consumer is very approachable. It's very simple. And patients love it. We also offer subscription services so that patients are on a subscription. They come in, they get their every three months neuromodulator, or in the case of Dify, every six months, neuromodulator, maybe every year or nine months, they're filler.

Maybe they get one to two BBLs a year and so forth. So, now they come in and they have convenient payments that are taken from the credit card every month. It's, it's seamless. It's no different than Netflix or your iPhone payment, or your gym membership, or your car payment. Mm-hmm. And so forth. And patients love it.

They absolutely love it. They send their friends and we're growing by leaps and bounds.

Catherine Maley, MBA: So, who owns this thing? Are you taking over med spas that weren't doing well or they just didn't want to run it anymore and they're all on the first floor? Like how do you know they're on the first floor or they're all over the country, right? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: You're talking about the buying, the purchasing one. We build most of them. I mean, he would —

Catherine Maley, MBA: oh, you're starting from scratch. You're just built, because I know another surgeon in Texas that he, he's a facial plastic, but he owns a med spa and then he brought you on board. I'm just trying to figure out like, how, how is that working? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Are you going after the plastic surgeon or the facial plastic surgeon who has a me spa or a med spa that's struggling or a brand-new building like you just said, like how's that business model? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: So, as I mentioned, we build most of them, de Nova. We acquire some that fit our model. You're referring to Steve Camp And he's not a facial plastic surgeon?

He's a plastic surgeon. He's not facial. Oh, okay. He did an aesthetic fellowship with Dan Mills. Yes. He's a very friend. Dan and Sarah are fantastic people and have a great practice. And they came to us and we built that de novo with them. Oh, gotcha. They were our practice; they were our partners and they're running a great business.

And there were a few we acquired here in the LA area, but they had to fit our model. You know, they're, you're not getting in an elevator. You're not hopefully paying for parking. Certainly, you're not, it's not there's not a lot of friction. We want to make it simple. Just like Starbucks. We want to make it, you don't pay for park for parking when you go to Starbucks, and I'm not sure you've ever been in a Starbucks on a second floor unless it's in another business.

My point is, we put them conveniently next to gyms and other areas where people have high traffic beauty salons, Starbucks, I've mentioned that a few times. That's actually one of our areas we look for and other. High traffic areas where people can just go from one experience into another. Mm-hmm. People want to have the beauty experience.

So, no, we're not looking for failed established practices at all. That's not at all the model. Mm-hmm.

Catherine Maley, MBA: So, that's in, so is there, are you the owner, is there a board of directors? Is it also private equity? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: We just had an infusion of 40 million last Monday. Of course, there's a board of directors. There are many investors and owners.

It's a thriving business, Catherine. Yeah. It's, it's a, there we have, it's a thriving multimillion dollar business. Mm-hmm. That has valuation, a high valuation. I mentioned we just had someone put another $40 million into it. So, yeah, it's. They're a number of owners, if you will, because they're all investors.

Catherine Maley, MBA: Right. Okay. You're busy, you've got a Phoenix, you've got Orange Twist now, are you still doing your podcast? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, I am, I'm, I'm not doing much with Orange Twist. I'm certainly supporting them and I'm one of their, I'm helping with some of the medical stuff and I'm, I mean, I was just on the phone with c e o today and the chairman of the board yesterday, so, but I'm not actively working with Orange Tri because I'm so busy with various other things, including my podcast.

But more importantly, I'm the chairman of the board of Engaged Technologies. And today is big news because today we announced we have a press release that Engage Technologies and Apex merged, the official merger was announced today. So, we so you know Terry Ross and Isaac Mosley, they have a P X.

Which is a practice management tool, which includes a, a dashboard and a number of KPIs and a lot of management skills and training on the part of dairy. We merged with engaged Technologies. What did they do? And, and I mentioned I'm not, I'm the chairman of the board. I'm also the chief medical Information Officer and so forth.

So, that's keeping me very busy. The technology of Beauty is the podcast and I'd love to plug it. You can watch a new episode every Tuesday. We have over a hundred episodes. Last week we had Carrie and Jason from Allergan. Tomorrow we are. Today we had Dustin Suits from Revance. We've had pretty much every single c e o and chairman of the aesthetic space.

I mentioned we've had a hundred. I could run through it with you. It's a really fun prod podcast. I get to interview the movers and shakers of the beauty business and learn a lot from every one of them. We film it in a studio we have here in Manhattan Beach. It plays every Tuesday. It's on YouTube and all the other podcast feeds.

It has videos, well as audio. We have three cameras. We have a whole film crew editing editorial staff. And it has been incredibly successful. And what, what audience are you attracting? Well, it's really fascinating you asked that because we have a mixed audience. Because we have so many industry people.

It's fascinating to me what's happened. It's morphed. So, we have a lot of industry viewers. We have clinicians, especially entrepreneurial clinicians for sure. We also have people that are looking for jobs in the beauty business, which I never expected. And some of the companies are using the content to push it to their sales staff as well as to potential applicants.

So, someone was going to interview with Dennis the other day, and this person, Dennis Conan, and this person watched Dennis's show. I didn't even know the person, and they called and thanked me because they had some insight into what he was all about. And that has now happened a number of times. And it was something that Max and I max is my producer and director, and he has influx marketing along with Adam.

And we, when we set out, we weren't exactly sure what our goal was, but I was interviewing Richard Gonzalez, as you know, the, the head of AbbVie. And who that bought Allergan. And I got to the, for, I was fortunate enough to meet him off camera and talk to him when he took over and bought Allergan. And he is the chairman of the board and the CEO, and he runs everything with Abby.

And I said, Hey, can I interview you so you can get to know the people in plastic surgery? And my mantra was already, as you know, the, the, the technology of beauty that's been across my, my wall since 1987. And I own that. It's trademarked. I own the technology of beauty. And so, I named the program the Technology of Beauty and, and Rick Richard Gonzalez was my first guest.

And we had so much fun. I said, Hey, let's do this again. So, lo and behold, we started bringing other people. We got a studio, we got cameramen and sound people and editors, and it's just been so much fun over the last three or four years now. Excuse me. And we've learned a lot. I learned something from every single guest.

Yeah, me too. It's incredible to me. We interviewed Eddie Yune not too long ago. He wrote the Super Consumer and he also wrote The Snow Leopard. And if you haven't read the Super Consumer, it's an amazing book and it relates right to what we're doing in aesthetics. I hardly encourage you to. And Eddie came and he presented some fascinating marketing information.

Like what did you know? That people that make generators, companies that build generators sell a lot right after a natural disaster, you'd expect that an earthquake, a flood. Of course, people run to the local Home Depot or wherever you buy a, a generator. I must confess I have one because I lived in Southern California.

I've been through earthquake, but. Did you know that when there hasn't been a natural disaster that their sales plummet? Not unexpected. Cause they're asking you to, you know, shell out, I don't know, five to 10,000, whatever it is, to buy one of these things and stick it in your garage and hopefully you'll never use it.

Right? Right. Okay. Well, they came to Eddie asking about marketing advice. He's a consultant. So, what he did was very creative. He started looking at what people do that have generators. So, let me ask you something. Do you have extra refrigerator freezers in your garage? Do you, so you don't have a generator.

Do you take an excessive number of. Yes. Okay. So, it turns out people that buy generators, number one, they all have more than one refrigerator freezer. And Tuesday in the garage they have backup freezers or they, they, and they keep frozen food out there. So, that's number one, predictor. Number two, they buy a ton of vitamins.

So, then if you want to target your marketing, instead of geo-targeting like we do, you just for that com, for those companies, they targeted people who purchased these refrigerators, freezer, extra second and third, and then vitamins. And there were other collateral things. And in the book, he lists a ton of them.

And 20% of the people consume 90% of our product. Again, 20% of our patients consume 90% of our product. And if we can identify who those 20% are and market to them, we're way better off. And Eddie was on the show, but we've had bankers, we've had CEOs, we've had some. A few doctors, not many. We've only had a handful of doctors, and they are, again, to be on, you have to be a mover and shaker of the beauty business.

But we've had some docs on and they're big-time aesthetic surgeons and medical people. Mm-hmm. And it's great. I encourage you to check it out. We have a website. We also have Instagram page [email protected].

Catherine Maley, MBA: Gotcha. You mentioned marketing, and I want to go back to that because you have such a well-rounded background in all facets of aesthetic medicine. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

What's working in today's world for at patient attraction? What, what has been working that you know about or you? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: It's so great you asked me that because this weekend I worked on this last weekend I worked on my talk to the residents and fellows coming up. They've asked me to talk about that.

It's going to be a kind of a morphing from staying ahead of the competition talk. Mm-hmm. But you know, Catherine. Too much time is spent talking about just the peer marketing. The number one way to get patients is to be the best surgeon and physician you could possibly be and take the very best care of the patient sitting in your chair right now because that person will tell her sister or her family or her neighbor, and there's nothing better than word of mouth marketing.

We have gotten so distracted by the other digital, which I'll talk on, but we've gotten so distracted that I see a lot of young people just jumping around on TikTok and not thinking about the fact that at the final analysis, if you don't deliver the very best services, the safest and best surgery or non-surgical aesthetic services, I don't care how much marketing you do, you will fail.

It starts with the best surgery and, and medicine and being the best. After that, it's, it's communicating with your patients and then they will communicate with their friends and family and then you expand. And then it's building a website and have me before and after pictures, and then of course social media and we can talk about, you know, in the old days it was Facebook, then Instagram, now TikTok and others, and we can debate it all day long.

We can talk about the target audience. If you're looking for facelifts, it's Facebook perhaps, although now that's moving down. Anything we talk about today be antiquated tomorrow. Right. Except that, except my first premise. Patient care, quality and safety will never be antiquated. And the biggest disservice I see are these people jumping around like a bunch of non-knuckleheads and thinking they're going to track.

A bunch of patients and they will, short term, they will, but long term, if they're not delivering the goods, their history, and I've seen this over and over again. I remember when the internet was new and I performed my first webpage in 1994 and I remember being told by Harvey Zuru, patients will never find a doctor on a computer.

And that's the quote he used. And that's when he heard I had something called a webpage. And my first webpage I built in November, 1994 and it was three pages and I did it myself. And then I went on to build tons more. And then obviously had people helping me such as Ryan Miller and, and Max and Adam and so forth.

And that was the mainstay of it. And I still believe that's the lifeblood because it, that's where you can put the "before and afters" as a library and that's really what people want to see. But of course, that's not the whole answer. You need to have a social media presence. There's no question. And I'm, and I'm suggesting that everyone does that.

And at this point, having someone help you with it is probably essential to tell you the truth. One PR one surgeon can't do it.

Catherine Maley, MBA: Yeah, I agree. I think you've got to have that person walking around with the iPad and, and videotaping you the day in the life of a surgeon if they want you involved in that, because you guys are so busy to add this social media to it. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

And some of the surgeons who come on my podcast, they'll spend two to four hours a day on social media, and they're getting a lot from it. But on the other hand, their staff is worn out trying to come deal with all these, they're not leads their inquiries, you know, or whatever you want to call them. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Yeah. In today's world, I think you've got to triage what's coming at you. You know, because when the public's coming at you, wow, your staff's going to get burned out from the all the crazy, you know? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Yeah. Handle that. And it's a moving target, and it will continue to accelerate. The movements will not stop.

And we can't even imagine what's going to be out there next with AI and all kinds of things we're going to be seeing.

Catherine Maley, MBA: Yeah. AI's really interesting. I tried it myself and it wrote some pretty darn good blog posts. I was really surprised. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Isn't that incredible? I had it do, I had one of them doing one of my slide decks just to see how close it was.

The one I built. Yeah. And you know what, I got some great ideas from it. Mm-hmm. And I put it in my slide deck.

Catherine Maley, MBA: Yeah. I was, and then I think now Google's not going to appreciate my writing anymore because I live off of content. You know, I write a content a lot and now they're going to, they're not going to value it like they used to because they're going to think everyone did the ai and I think, where are we going with all of this? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

This is crazy, but interesting.

Grant Stevens, MD: R2-D2 is going to be writing all of our content. Yeah.

Catherine Maley, MBA: All right. So, I wanted to talk about competing because you are so good at differentiating and that's how you compete. You just differentiate yourself from everybody else. Would you please explain the "Marina Man Land". How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Oh, "Marina Man Land — Where a man can feel good about looking great!"

So, you know, historically men have occupied, occupied about 10 to 15% plastic surgeons of busy plastic surgeons practice for an aesthetics. And it varies. I know it can be less than 10, I know it can be over 15, but that's sort of the sweet spot. You can look at what the Aesthetic society might say, and I'm not sure the exact number they'll give you year to year, but that's kind of the range.

But I was convinced that that number could expand. But it was going to take a new way of thinking. About aesthetics and the male and the male's, a unique creature. And when I started with Cool Sculpting in 2009, if you could believe that I brought it into the Med Spa. And then I looked at my experience in 12.

I looked at the experience of 10, 11 and 12, 2000 10, 11, 12, and I learned a number of things and I wrote it up. It was published in August of 2013, the Aesthetic Surgery Journal. And what I found was that 74% of the people that came in my office in the first three years to for Cool Sculpting, had never been to Marina Plastic Surgery.

They had never heard of me. They'd never been there. I thought, well, that's kind of interesting. It's kind of a magnet. And they all wanted to lose a little fat. And then we drilled down lower further, and we looked at those people and we said, have you ever had anything aesthetic at all, including a medical grade facial?

And 84% had never had any aesthetic procedure. So, not only were they new to my practice, they were new to what I do for a living. And then I drilled down even further. And guess what? 41% of them were men. Huh? So, then I interviewed on Paper, 200 plus Men. I had over 200 responses, and I asked them what they liked and what they didn't like about being in my office.

This is before Man Land. I asked them, you know, what would stop them from coming? What would encourage them from coming in? Of course, we got the smart asses that, you know, would talk about, you know, beer, tap beer, and you know, topless women or whatever. We got all the crazy answers. But when I drilled through it, There were some absolute trends and consistencies guys hate sitting on couches.

Oh, amazing. This is almost like Eddie Yoon stuff. They love chairs. Yeah, they love leather, they love the smell of leather. They hate the smell of this fufu stuff That was pump pumping into my established reception area with all these women. Because I had been very successful with my model and I wasn't targeting men, but the men came in for CoolSculpting because I was running it on ESPN.

And the ESPN guys Mason and Ireland were talking about themselves getting it. So, I got a bunch of guys in the Lakers show and so forth, and that's what grew my men. But then I got a chance to find out what they wanted. They wanted a combination between a sports bar and a, a cigar lounge. They wanted flat screen TVs in every room.

They wanted to smell leather. They wanted to sit in chairs, not couches, and on and on and on. So, I decided, guess what? I'm going to build Marina man land like Disneyland. And it's the same fun where a man can feel good about looking great. And so, with that in mind, I put a flat screen on every single wall of every single structure of every single room, including the restroom.

I also put a standup urinal in the restroom, and I ran the Sports Illustrate bathing suit edition on the restroom television over the urinal, 24 hours a day it never turned off. Scantily clad bathing suit, bikini women from. Sports Illustrated? No. Topless, no. Cause it was all approved by Sports Illustrated.

And there's a little side story to that. We did it in darker colors, we did it in wood, we did a lot of leather. And I actually put together a proprietary smell that I pumped into the space because one of my thesises actually, when I, I was an experimental psychologist actually, and I studied olfactory stimulation as one of my oh my, one of my papers, actually, one of my research areas was the, the effect of olfactory stimulation.

So, I put together the smell of leather and cigars and one other proprietary smell that I never revealed, and I still haven't. I got a company to put it together and we pumped it in every single room except the bathroom. Mm-hmm. And., I remember I put pictures up in all the rooms with, with women and, and guys doing all kinds of fun stuff.

A lot of motorcycles and sports and horses and guns and all kinds of male stuff. Mm-hmm. And I brought my mom in before I opened the door. I didn't let a single woman in before I opened the door. I built this and no females were in it. I brought my mom in; she made me take down two of the pictures.

Okay. And that was fine. Okay. And we're good to go. And then we opened the doors. Now the amazing thing, not even men love it. And we had, you know, it was amazing. God rest us soul Larry King came all kinds of people. I just thought someone, I, I think it was on says Charlie came, you can fill in the blanks.

I had many of my friends and neighbors. Who came in and checked it out and loved it and loved it. How much free PR did you get from them and they, how much, what, how much free PR did you get from Oh my God, they did a thing on the, on the morning news show where what's her name? Harvey channel nine.

She was there the whole morning. They starred the news show in the morning and they kept cutting away for two or three hours. They cut away back to Marina Man land where a man can feel good about looking great. I had a rule, no one could say the name of MML without saying the tagline that I invented.

So, that's why I say it because I, my staff will go crazy if I don't say that when I say the name of M n l to. But we had so much media coverage actually when Larry came, Larry King came in one morning about nine in the morning to the regular office and said, Hey I understand you've got a s special place for men.

Can I see it? I said, boy, I'd love to take you, but I'm kind of tied up. Let me take you briefly and then my staff will take you around. I got a full office of patience. I took him back there. He would not stop talking about it. He couldn't believe I had a ural. He couldn't believe I had the sports illustrator thing.

I had so much fun with people just wanting to come in. And then lo and behold, they wanted Saturday hours. Then they wanted beer, then they wanted to smoke cigars. And of course, we can't do that. And I couldn't serve beer. But guys smuggled it in to have cool sculpting. And when I found it, of course I disposed of it.

But my staff would say, the guy back in such and such room, he's drinking beer out of a whatever. And I'd say, dude, you can't do that, man. But it was so cool. And guys would sit around in their leather chairs and the number one question was, Hey dude, what are you in for? It was like, it was like a prison, but it was what you in for.

And I also played a lot of pre and post-op stuff because the wives sent them enzyme sometimes and the guys would watch stuff that they didn't know could happen. A lot of guys are not as well versed as women and they would say, Hey Doc, what happened on that patient? Back in on, I we had photo books there.

It was absolutely incredible to me the naivety of so many men. They might be there to lose a couple inches with cool sculpting, but boy, they morphed into surgery like you wouldn't believe. One quarter in 2015, 51% of our patients were men of, of the coast company. It was unheard. The baseline was 10 to 15%.

As I told you, it was 41% in our first three years and one quarter we eclipsed 50%. We went to 51. We didn't do it after that. But that was the one quarter yeah, marina Man land. It was a ton of fun building. We kept morphing it. It's a ton of fun now. We got tons of media coverage. Yeah. And I'd love to talk to anybody who has questions about it.

It's, it's a big deal.

Catherine Maley, MBA: Yeah. It was really cool. What do you think about the patients today? How much have they changed from, let's say pre-social media? Have they changed much? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Oh, yeah, they changed a ton. So, so how, A couple ways. So, as you know, the average age is going down mm-hmm. In general, and we have released some statistics on that last week.

So, the average age of a consumer getting a non-surgical has dropped 10 years in like two. That's one big difference. If you look at a picture of a person from 10, 15, no, 20 years ago, a 50-year-old person compared to now, or even better yet, a 70-year-old person today versus a 70-year-old person 30 years ago.

Mm-hmm. It's remarkable how different they look. Mm-hmm. And a lot of that is aesthetics, but not, not all. I mean, skincare, it's health, overall health and wellness. So, we have people come in saying in the, well, I did years ago, say, well, I'm 65, this is my la I'm going to have a face that, but I'll never be here again.

I remember hearing it over and over. I saw an 83-year-old woman on March 22nd, 2020, no, 20 March 21st, 2022. And I know that because I walked in and I announced I had just done my last surgery. Yeah. And she turned to me and she said, no, that's not true. You're going to do my surgery tomorrow. I said, no, I'm done.

I just did. My friend's daughter, you'll have to talk to Justin Perez about it. She said, Nope, you're going to do my surgery tomorrow. I said, ma'am, I'm sorry. Sorry kids. I said to Maria, what, who exactly is this? So, she said, you know, you don't remember, but over 20 years ago you did my first surgery. It was my breast augmentation.

And then about 10 years later, when I was 70, I told you, this is my last time. And I, you did my tummy tuck and you didn't touch my bra. Oh. And my facelift, you did my tummy tuck and facelift. And I told you with certainty that I would never be here again. And now I'm 83 and I'm here. And I, my face looks great.

My tummy's still flat. And she picked up her blouse, she pulled up her bra and her breast fell down and she said, these puppies, this is her. These puppies need to be lifted and smaller. 83. She then turns to me and says, I'm sexually active. My husband and I want you to do this, and I care about how I look.

And you were her and you were right. You told me. I would always care because if I cared at 60, I'd car at 70. If I cared at 70, I cared 80. And that's the difference in the consumer. They're the super consumers.

Catherine Maley, MBA: And I can assure I'm in that group. My vanity knows no bounds. Every time I say I'm not going to do something, I hit that age and I completely change my mind and say, no, no.

I'm, I need another five years getting used to this "Getting older".

Grant Stevens, MD: Absolutely. I'm doing my eyelids this year and I'm turning 70 this year. So, there you go. You know we're going to go down kicking and screaming. We're the boom. We are not. It's going to fade away into the sunset. Yep. You know, we've got Keith Richards and Mick Jagger and Bruce Springsteen ahead of us.

Mm-hmm. And we are not giving up hear It's, and you know that's when you're talking about differences, there's part of the differences. Yeah. We're not tolerating the, we don't, we know we're getting older, but we're not going to look older. Well, we're going to try our best not to. Yeah. Stay in shape, eat good food work out, have a healthy lifestyle, and have plenty of aesthetic services.

Non-surgical for the most part. Yep. And then every now and then have a little nip and tuck and that's the difference. And that's my game plan. Yep. That also creates the other thing, I built a private door to my big office for the stars and for the people that were embarrassed, guess what? In the last decade, it had cobwebs.

No. Used it. Even the stars didn't use it. Mm. And I rattle off the names of tons of them, and they didn't use it. They didn't care. They were signing autographs for God's sakes. And they're on social media. It's crazy. So, the privacy thing that the stigma of having aesthetic plastic surgery or aesthetic cosmetic services, it doesn't exist anymore.

Catherine Maley, MBA: Yeah. I have no qualms about saying all the, oh my God, I've had so much done. It's crazy. And I'm 65 and I don't want to look like my grandmother at 65. I just, I can't get there. I'm, I'm going, I'm going kicking and screaming with you.

Grant Stevens, MD: Yeah. Why don't you pull a picture out of your grandma at 65, take it and put it side by side with you in marketing this talk and say Steven said, you are not your mother.

You're not your grandmother. Exactly.

Catherine Maley, MBA: Okay. I'll do that. I'll do an Instagram post as well on that, and I'll tag you.

Grant Stevens, MD: because My sister-in-law did that recently. She took a picture of her grandma, same age of as, as this woman is, and it was so funny. I swear to you, they're the same age and you look at them and the other one looks 20, 25 years older.

It's crazy.

Catherine Maley, MBA: Right? So, to wrap it up is there, like, if you were going to give, cause this audience is basically surgeons and residents and fellows and it's more b2b, let's say. What, what advice would you give, not just the newbies, but people who have even like some of the surgeons who have been practicing for 20 years saying, what has happened here? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

I don't know where I'm going with all of this. Any advice for them to stay in the game because some of them aren't tired? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, obviously I touched on some of it and I still believe, I still believe. That we are physicians, the surgeons first. I still believe the crux of it, the core of it is being the best physician and surgeon.

But I know that's not where you're going with this. You're talking about sort of practice success and marketing success and so forth. But I, the number one thing is that but also home, the road less travel. I have a T-shirt and I have a whole mantra that always be yourself unless you can be a pirate and, and then always be a pirate.

And what I mean by that, and I didn't make that up. I read it. Okay. And I, but I use it. It's on t-shirts, it's on mugs, it's everywhere.

Catherine Maley, MBA: All I can think of is Johnny Depp right now. So, where are you going with the buyer thing? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Yeah. Well, I am certainly a pirate and so is it's funny. So, is Eddie Yun, and I didn't even know, used that pirate analogy till we got together.

If you do what everyone else does, you are bound for mediocrity. So, the toughest thing, especially surgeons and physicians, they're, they're not the most creative people and they do follow rules and that's good. And we want our doctors to follow rules and we want our doctors to be safe, number one. But it turns out you're asking me what advice I give my fellows, and I have all 40 fellows, about 39 or FO 40.

First be safe and, and, and, and the best surgeon, but think outside the box. Think of ways that other people haven't done it. Don't do it the same way I did it. Don't do it the same way your neighbor does it. If, if you do, that's fine, but. It's a guaranteed of mediocrity and it's a guarantee with one of —

Catherine Maley, MBA: Have you always thought this way, this open? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

You are so entrepreneurial and open-minded and creative. And that's not normal for surgeons. You, you, you had to be pretty conservative and go by the books when you're becoming a surgeon. But then you have to ship gears and now be creative and that's, can you make that shift, you know? How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Well, I've always been an entrepreneur.

When I was four years old, I had a tomato route When I was five years old, I had an egg route. When I was seven years old, I had a paper route. When I was nine years old, I had four paperboys working for you. For me, I mean, and so forth. I've always been an entrepreneur. I just happened to love science and people.

And I went to med school and I came from a degree in psychology because I really love people and art and. I recognize because I interview all the fellows, I in residents, and I recognize I'm a unicorn. I reco. So, I call myself a pyro. But I'm telling you right now, these are the best and brightest people that I see.

These plastic surgeons and Platy residents are so much brighter than I ever was and at am and they need to think outside the box and not be afraid of it. Not be frightened by it. Again, start with best patient care and then think of ways in which they can put themselves on the map. You know, the other thing is the golden rule.

You know, your mother taught you before you went to, to in kindergarten, if you're fortunate enough to have a mother. Some of us weren't. I did have a wonderful mother, but do unto others as you would have them do under you, right? So, if you live by that credo, And you're a great surgeon. You just, everything follows thereafter and you'll be criticized for sure.

I remember I was criticized for my seminars and for all kinds of crazy things I could go into forever. But, but I, you asked for advice. My advice is think outside the box. Do creative things. Hey, and if it is TikTok, God bless you. Let it be TikTok. That's just not my gig. Right. And I'll, I'll respect the fact that that's what you chose to do.

And you'll get a bunch of patients, but then you better take great care of them because number one, they're getting home and tell their sister. And if you screw up, they're going to tell their sister. And bad news goes way faster than good news. The other thing is, you know, I'm not sure how much these guys are and gals are taking business school, but.

It takes a lot more effort to get a new patient than to keep a patient in the practice or the dry cleaners. It's oftentimes said it's seven times more expensive, sometimes eight. I've heard 10, but it's a big multiple. Yeah. So, keep the patient in your practice for God's sakes. Don't keep patients for life.

Don't just be a breast dog guy and just rotate and go around round, round, round. Keep them in there. Keep them in non surgicals. Even if you specialize, say in breasts or whatever, bring them in for non surgicals. Get someone else to do body or face, but keep them in your practice. It's far cheaper than acquiring new people.

That is a key part of being successful in.

Catherine Maley, MBA: I'm so glad you said that. That has been my main message for the last 23 years, working with plastic surgeons, patients through life. It's cheaper, easier, they convert better. They give you that patient flywheel. If you get it right, it, there's no more, you're not advertising 10 times what you need to because you've got the patients doing it for you. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

I'm just glad you said that. Thank you. And so, for the last question, tell us something we don't know about you.

Grant Stevens, MD: I love my doodles. I have three double doodles. I have tuxedo, I have blaze, and now I have little Gucci. Tuxedo is a double doodle, which is a cross between a golden doodle and a Labradoodle from American hunting doodles in Portland. One of his little nephews is Blaze and he has Tuxedo is named Tuxedo because he's a white spot here in his chest.

And he looked like a tuxedo when I first got him. And Simeon Wall gave him to me. Dr. Sin Wall gave him to me as a gift. Can you believe that? Did you want another dog? I had so many dogs up at the ranch. I never even dreamt of having another dog. He said on a Sunday, go down to Alaska Air Freight. I'm sending you a puppy as a thank you.

And I said, Simeon, I live at the beach. I don't need another dog. I have dogs. I've got 31 Labradors up at the ranch. I don't need a dog. He said, just go get it. It's Jelly's brother. I fell in love instantly. And Tux has been my sidekick, along with Aaron. Aaron Stevens, I might add. And, and Tux has been our sidekick only.

And then we got Blaze. And Blaze has the blaze pattern of horses. Of those of you who are who know horses, blaze is the white face and the white chest. And he's lovely. And he's tux is nephew. And then finally, recently we got Gucci, the first girl in the, in the deal. And Erin wanted Gucci. She fell in love with Gucci online, called up Scott Ferrell, who owns American hunting doodles.

And we were blessed to have Gucci. And she's down here in Manhattan Beach and she's in the Puppy Academy here in Osa Beach. And the other two are up waiting for me to go back to Sun Valley. I'm living in Sun Valley most of the time. I'm. Beach here temporarily to see a couple people and do a little business with companies, you know.

Catherine Maley, MBA: Okay. Well congratulations. I didn't realize you got married.

Grant Stevens, MD: Yeah, well, we're not married. Oh, no. We have the same last name. She changed her name and we're domestic partners for now. We haven't had wedding yet, but we just got Enough is enough. And so, it's Erin and Grant Stevens, and we're so happy.

And we'll announce when we have the marriage and the wedding.

Catherine Maley, MBA: I think you had to tell Google, because you know what happened when I was researching you today, I just put in like, grant Stevens, MD Surgeon, California Grant, Steven's wives, and you have four wives. You have photo. Yeah, you have four wives.

One of them was your old you know practice manager and then the others, I think. I don't know. But anyway, it looks like you had four wives, so I, you might want to tell Google that. How dare you. There's only Karen.

Grant Stevens, MD: Okay, let's be perfectly clear. My practice manager was never my wife. Let's get that clear.

Catherine Maley, MBA: Well, Google doesn't think so.

Grant Stevens, MD: Well, I'm going to go check out and find out. So, I did have one wife before. Right. And a wonderful marriage. And that ended like for 30 years, right? 34-year months. That's a good run. Good for you. Yeah. Wonderful. And then I'm in the second phase and then I was working with and, and getting to know Erin and we've been together for many years now and so forth.

And we are domestic partners and we will be getting married and we couldn't be happier.

Catherine Maley, MBA: Ah, well Congrats you have Yeah, go ahead.

Grant Stevens, MD: I've seen that about Google, but I'll go on as soon as we're done right now Cause I, I've never had, I, I've only had one. My, I don't have four wives.

Catherine Maley, MBA: I know. I was offended for you.

I said, this is, this is misinformation. But anyway, I just, I'm, I'm so pleased to see how you have transitioned because that's what a lot of the surgeons I hang around with, they're trying to figure out what do I do now? Like what do I do with this practice that I'm kind of ready to wind down, you know?

And look at all the options that, I mean, I hope everyone's clear that they have so many options. They can work with industry, they can work with business, they can work with vendors. They can do real estate. There's a lot of things you can do. You don't just have to be a surgeon anymore. So, think outside the box. How does this relate to this episode's title of "Insights From Grant Stevens, MD?

Grant Stevens, MD: Right? And the, you asked about advice number one. I would check out Engage Technologies. It will help. What is that? Well, hold on. And number two, I would use Patient five for all your patient financing. And number three, I would use subscription aesthetic services, the best of which is Privi, P R I V I. That is.

Without a doubt, the very best you get paid the very next day after you do the services, you don't chase down the patients, you will double your, your volume and double your patient revenue. I can show you from the Hi MD experience, I'll be talking about this to the Aesthetic Society and in octane in Nashville and, and other meetings coming up.

It, it will change everything in your practice. Okay.

Catherine Maley, MBA: That's enough of that. You're the only one who's been allowed to promote stuff, so we're okay. Yeah, we're a clean podcast here.

Grant Stevens, MD: That's fine. You asked me what I do and I help them. They're going to hear me talk about it anyways. For sure. You can cut it out if you want.

Catherine Maley, MBA: No, no, no, it's fine. Alright, well thank you so much Dr. Stevens. I do hope to see you someday. I'm, I'm just —

Grant Stevens, MD: So, hopefully get the next meeting?

Catherine Maley, MBA: Well, that's not going to happen, but maybe the next, next one. So, everyone with that I'm going to wrap up Beauty and the Biz and Dr. Stevens, if somebody did want to get ahold of you, what's the best way?

Grant Stevens, MD: [email protected]. [email protected] or [email protected]. They don't like Hotmail. My daughter gives me grief about being on Hotmail.

Catherine Maley, MBA: I have not heard Hotmail in a long time. Yeah, but I'm glad you went Gmail eventually. So, good for you and thanks again for sharing your insights, Dr. Grant Stevens.

Grant Stevens, MD: They both worked. They both get.

Catherine Maley, MBA: Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on insights from Grant Stevens, MD.

If you've got any questions or feedback for Dr. Stevens, you can reach out to his website at, www.MarinaPlasticSurgery.com.

A big thanks for sharing his insights from Grant Stevens, MD.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "Insights From Grant Stevens, MD".

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and my 10 top practice pearls.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "200th Episode — 10 Top Practice Pearls".

Time really does fly. I am so excited to record this 200th episode of the Beauty and the Biz Podcast.

Four years ago, the Beauty and the Biz Podcast was created to talk about the business and marketing side of plastic surgery, and it's been a great ride.

It's fascinating to hear how every practice is unique and runs differently because each surgeon is different in their beliefs, perceptions, understandings, and past experiences.

This week's Beauty and the Biz podcast is a compilation of the 10 Top Practice Pearls I gleaned from my guest interviews that you will find thought-provoking and even mind-bending.

Thank you so much for following my work and enjoy!

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

200th Episode – 10 Top Practice Pearls

Time really does fly. I am so excited to record this 200th episode – 10 top practice pearls of Beauty and the Biz. Four years ago, the Beauty and the Biz Podcast was created to talk about the business and marketing side of plastic surgery, and it's been a great ride.

It's fascinating to hear how every practice is unique and runs differently because each surgeon is different in their beliefs, perceptions, understandings, and past experiences.

The majority of surgeons I interview are in solo practice, so they have the freedom to build and control their practice as they see fit.

However, there's a flip-side. It can be a lonely existence. You live in your own myopic world with no one to bounce ideas off, so you can easily lose perspective and waste time and money guessing what to do next to grow your practice.

There's also a lot of fear around financial failure. Even though you've had years of training to be a surgeon, you have not had equal amounts of training on running a business, leading a team, managing staff, working with fickle cosmetic patients, and marketing yourself in an uber competitive marketplace.

That's why the Beauty and the Biz Podcast came about. It's a resource for you to learn from others who have been there and done that. Their challenges, opportunities, insights, mistakes, and wins.

I did the Top 10 Take-a-Ways from the FIRST 100 podcasts on episode #100, that you may want to go back and listen to since it's full of good stuff, so I went through the last 100 podcasts and pulled out 10 more Top Practice Pearls and here they are:

Top Practice Pearl #1:

Build a Brand You Are Proud Of

Branding is how you present your practice to the world. It's how you build connection with prospective cosmetic patients. It's the way you're seen through their eyes, which is a key point in my 10 top practice pearls.

It's your persona. It tells prospective patients what to expect from you in terms of quality, service, results, and price.

Branding is more than just your logo and website.

It's your story. Who you are, where you came from, why you became a surgeon, what you stand for, as well as your core beliefs and values.

It's your vision and your mission statement on your website that you and your team actually live by consistently.

It's your reviews, social media, before/after photos and your streamlined processes.

It's all facets of your practice representing you including your location, office, furniture and details count: It's Your hair, clothes, shoes, as well as your staff's hair, clothes, shoes and so on.

The point is to be who you want to attract. If you don't want price-shoppers who haggle with you, invest in your own high-end brand to attract high-end patients. It's that simple.

Top Practice Pearl #2:

Don't Hope for New Patients – Market for New Patients!

A successful cosmetic practice is not happening by accident or by luck. They are doing something to make that happen. In today's competitive world, top practices execute many strategies to attract new patients, which is a key point in my 10 top practice pearls. For example….

They enhance their online presence by updating their website look, making it mobile friendly, adding social media buttons and B/A photos and videos. They consistently add fresh, updated content that is informative, entertaining, and compelling because that's how you increase your digital footprint on the Internet.

They open their mind and embrace new marketing strategies such as Instagram Reels, YouTube Shorts and Facebook Lives since video is hot!

They have a marketing team of 1 or an agency with a good video editor they meet with regularly to plan and create content, so they are active on social media.

They may even start a podcast and/or patient webinar to educate consumer patients on their services.

And reviews, B/A photos and referrals are a priority. They focus on their patient relationships and the journey the patient has with them because they realize that's where reviews and referrals come from.

BTW, the surgeons who have thousands of before/after photos on their website got them because they asked the patients themselves. Typically, 1/3 said yes, 1/3 said yes with restrictions such as don't show their face or only show them in the office and 1/3 declined.

The top practices typically have an ad budget and plan since organic SEO has become more challenging, so they need to advertise. However, they watch those numbers carefully to be sure they are at least breaking even, since they can make it back with valuable patients returning, referring, and reviewing.

Top Practice Pearl #3:

Automatic Marketing System

The top practices use marketing automation to map out automatic marketing plans with funnels, email automation, SEO, landing pages, opt-in forms and follow-up sequences to handle incoming leads more efficiently, which is a key point in my 10 top practice pearls.

They realize this is a numbers game and not all leads are equal, so they get help setting up technology to triage and respond accordingly.

And they also train their staff and hold them accountable on their lead gen process, so staff is clear where they fit into the system. This also frees up their staff to focus on priority leads and great customer service.

Before I go on, I want to comment on these first 3 pearls. Branding, advertising and marketing cost money. Hiring enough staff and the right staff costs money. But surgeons hate to lose money. So, they skimp in these areas and wonder why their competitors are doing better. The answer is because the top practices invest in their growth and hire the best they can afford. It's a mindset shift worth considering.

Top Practice Pearl #4:

Get Good at the Fundamentals

The biggest problem holding you back might be your narrow focus on "getting more leads". You might be throwing a ton of money at SEO, google AdWords, social advertising and directories OR you're spending a ton of time creating content for your Instagram and Facebook followers.

Yes, it's exciting to get lots of leads and comments but here's the kicker…Leads are only one part of it.

These leads need to be converted because if you can't monetize these leads, then you're throwing money down the drain, , which is a key point in my 10 top practice pearls.

The top practices know this and focus on all 5 key areas to attract and convert patients. That includes:

• Lead Generation
• Converting callers into appointments­­­­
• Converting appointments into procedures
• Ensuring the patient is comfortable throughout the process and gets a good result
• So they become a raving fan who refers, reviews, returns and shares you on social media

That's how you build a practice flywheel that keeps your practice humming along, so instead of buying a new $150K laser and hoping new patients flock to it, you fix your phones and train your coordinator to convert consultation to give yourself a $500K+ raise because you are not losing high value patients trying to give you money.

Top Practice Pearl #5:

Surround Yourself with A-Players

Staffing issues will be one of your biggest challenges when running a cosmetic practice. Miss hires cost you a fortune in time, money, sleepless nights, and bad mojo in the office, , which is a key point in my 10 top practice pearls.

On the other hand, (1) A-Player will produce more than (3) of the miss hires so the top practices spend more time finding, training, and retaining top producers than fiddling with those who are not up for the challenge.

They get the right people on the bus and in the right seats, they give the right tools to do their job quickly and efficiently and they hold them accountable with metrics and evaluations.

They make it a priority to develop a positive culture that employees enjoy and are loyal to, because a negative culture creates angry or frustrated employees, poor communication, lack of passion, and staff feeling underpaid, overworked, and unappreciated.

They treat staff as a revenue-generating asset, rather than an overhead cost because they know their staff is their differentiator. They also acknowledge and recognize their staff with perks, bonuses, and fun.

Top Practice Pearl #6:

Predictable Revenue Streams

The top practices realize the value of cosmetic patients who want to look good today, next month, next year and for years to come, , which is a key point in my 10 top practice pearls.

So, While surgery is their main focus, there is much money left on the table when that patient is treated as a "one and done" rather than as a "patient for life".

It's getting too confusing, expensive and time intensive to constantly refresh with brand new stranger patients, so the top practices offer a loyalty/rewards program to nurture their patients to return, refer, review, approve their B/A photos and share you on social media with their friends and followers.

This gives them a competitive edge because it costs a fortune to attract a new patient and almost nothing to keep that patient loyal to you without spending a dime on advertising.

BTW, I can help you with that so let me know.

Top Practice Pearl #7:

Embrace Change

The top practices are not only good with change – they embrace it. They see challenges as opportunities to learn and grow. To improve their practice and better their best. To learn new skills, , which is a key point in my 10 top practice pearls.

To take calculated risk, but plan for the unknown.

They face many challenges, but they keep their optimism that the future will be good and that gives them strength to tackle problems.

They are adaptable and able to abandon their old ways in favor of where the world is moving, i.e., they go digital and embrace social media and video.

They believe they have control and the power to shape their destiny. They depend more on themselves than on the whims of the world.

Top Practice Pearl #8:

Lead the Team

There's a popular business quote from Peter Drucker that says,

"Only three things happen naturally in organizations: friction, confusion, and underperformance. Everything else requires leadership."

The top practices know that success starts at the top. They take responsibility for their wins and their losses and look at failure as feedback and keep on going.

They have passion and love for what they do and are driven to build a successful practice. They push themselves and their staff to excellence.

They study leadership principles and lead by example.

They are decisive and communicate clearly and meet regularly with their team to talk about their vision, values and goals.

They celebrate their wins, while acknowledging and appreciating their team.

They collaborate with their team and see this as a group effort since they can't do it alone.

Note: Every top practice I have interviewed on Beauty and the Biz is giving back. It makes them feel good, it gives their staff a bigger "Why" and it's also good for their brand, which is a key point in my 10 top practice pearls. Just saying.

Top Practice Pearl #9:

Resilience is a Skill

Resilience is defined as the capacity to withstand or to recover quickly from difficulties and challenges through mental, emotional, and behavioral flexibility and adjustment to external and internal demands, which is a key point in my 10 top practice pearls.

The surgeons running the top practices have resilience. They have bounced back from all sorts of setbacks including partnerships breaking up after working together for years, having long-term office managers abruptly quit, rogue associate causing drama in the office, embezzlement, frivolous lawsuits, illness, hurricanes, build-out permit delays, and it goes on and on.

But no matter what, they get back up, dust themselves off and get back at it. They know this is just a part of doing business and they keep their focus on the end result and solutions. They also turn to their trust advisors, colleagues, and friends for guidance.

AND LASTLY,

Top Practice Pearl #10:

Streamline, Scale and/or Sell

The top practices use their business and marketing skills to set up an efficient money-making machine that runs smoothly. They streamline their processes and have others manage the practice while they lead the way and oversee the numbers, which is a key point in my 10 top practice pearls.

Then they scale to have predictable revenue streams that are transferable. They set up profit centers and bring on other revenue producers to build value and revenues that are not dependent on them. Because the surgeons in the top practices are thinking ahead.

They ask early, "How do I get off this treadmill and get my equity out when it's time?"

They plan to have enough money to retire WELL and not have to step down in their lifestyle.

But oftentimes, their income is their lifestyle. Their assets become their wealth.

But they discover you make it on equity – not on income so they find investments that build their equity that is NOT dependent on them.

The current trend is private equity coming into plastic surgery practices and consolidating administrative areas such as payroll, HR, benefits, hiring, negotiating purchasing contracts for economies of scale and so on.

The practices that join the group build up their value by decreasing their overhead costs and streamlining their processes for increased efficiency, so they build equity to secure their future.

Stay tuned since I'll have more guests on Beauty and the Biz talking about this, so you know your options.

And there you have it!

the Top 10 practice pearls I gleaned from the surgeons I interviewed in the last 100 episodes.

Thank you so much for listening. I appreciate your interest and I'm working on the next 100 episodes so be sure to subscribe.

And, of course, please contact me if you could use some guidance OR, if you are looking for unbiased strategies to grow your practice, check out the www.CosmeticPracticeVault.com guaranteed to get you more patients and profits,

Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on my 10 top practice pearls.

And if you have any questions or feedback for me on my 10 top practice pearls, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "200th Episode — 10 Top Practice Pearls".

A special thanks to all of my guest speakers over the past 100 episodes!

103 Kristi Hustak, MD https://kristihustakmd.com/

104 Philip J. Miller, MD, FACS http://www.drphilipmiller.com/

105 William P. Adams, MD https://www.dr-adams.com/

108 Michael T. Somenek MD https://somenekpittmanmd.com/

108 Troy A. Pittman MD FACS https://somenekpittmanmd.com/

109 Randy Waldman, MD https://www.waldmanplasticsurgery.com/

112 Dr. Andres Gantous https://www.torontofacialplastic.com/

118 Dr. Marco Pelosi III https://pelosimedicalcenter.com/

120 Dr. Angela Sturm https://drangelasturm.com/

122 Dr. Stanley Okoro, MD https://www.georgiaplastic.com/

126 Frank L. Stile, MD, FACS https://www.drstile.com/

135 Harvey Cole, III, MD https://oculusplasticsurgery.com/

137 P. Daniel Ward, MD https://www.wardmd.com/

139 Edwin Williams, MD http://www.williamsfacialsurgery.com/

141 Lauren Umstattd, MD https://faceleawood.com/

143 David Mandell, JD, MBA https://www.ojmgroup.com/

146 Robert Singer, MD https://www.primeplasticsurgery.com/

147 Joe Niamtu, DMD https://www.lovethatface.com/

149 Lionel Meadows, MD https://www.meadowssurgicalarts.com/

151 Brock Ridenour, MD https://www.ridenourplasticsurgery.com/

155 Mark Beaty, MD https://www.beatymd.com/

157 Michael Persky, MD https://www.drpersky.com/

159 Carlos Mata, MD https://www.naturalresultsaz.com/

161 Bradford Bader, MD https://www.baderfacialplastics.com/

163 Sheila Barbarino, MD https://barbarinosurgicalarts.com/

164 Diana Ponsky, MD https://www.drdianaponsky.com/

166 Charles Boyd, MD https://www.boydbeauty.com/

167 Paul M. Parker, MD https://www.parkercenter.net/

168 Jeffrey Spiegel, MD https://www.drspiegel.com/

170 Sam P. Most, MD https://med.stanford.edu/drmost/about-us/meet-dr-most.html

171 Jennifer Levine, MD https://www.drjenniferlevine.com/

172 Alexander Rivkin, MD https://westsideaesthetics.com/

173 Steven Camp, MD https://www.campplasticsurgery.com/

175 Kristina Zakhary, MD https://facialcosmeticsurgery.ca/

176 Lamar Rutherford, MBA https://excellenssolutions.com/

177 Jason S. Hamilton, MD https://blacknosejob.com/

178 Thomas P. Sterry, MD https://www.drsterry.com/

179 Giancarlo Zuliani, MD https://www.zulianimd.com/

182 Jeremy Warner, MD https://warnerplasticsurgery.com/

186 Burke Robinson, MD https://www.robinsonfps.com/

187 Lawrence B. Keller, CFP https://www.physicianfinancialservices.com/

188 Jason Pozner, MD https://www.sanctuarymedical.com/

189 Ryan Neinstein, MD https://neinsteinplasticsurgery.com/

190 Gregory Mueller, MD https://drgregmueller.com/

192 Nicholas K. Howland, MD https://howlandplasticsurgery.com/ 193 Sam Lam, MD https://www.lamfacialplastics.com/

194 Lisa Marie Wark, MBA https://www.lisamariewark.com/

195 Jason Bloom, MD https://www.bloomfacialplastics.com/

196 Emily Hartmann, MD https://www.beautyeternalchico.com/ 198 Jeffrey J. Segal, MD, JD https://byrdadatto.com/

199 David Kaufman, MD https://www.thenaturalresult.com/

#cosmeticsurgeonpodcast #plasticsurgeonpodcast #aestheticpracticemarketing #cosmeticpracticestafftraining #cosmeticsurgeonbusinesscoaching #plasticsurgeonbusinesscoaching #strategiesforsurgeons #morepatientsmoreprofits #aestheticsurgeonbusinesscoaching #medspabusinesscoaching #medspamarketinghelp #cosmeticsurgeonmarketinghelp #howtogetmorepatients #plasticsurgeonmarketinghelp #aestheticpracticemarketinghelp #beautyandthebiz #podcastforplasticsurgeons #podcastforcosmeticsurgeons #plasticsurgeonideas #plasticsurgeonagency #plasticsurgeonconsultant #plasticsurgeonstrategies #plasticsurgeonservices #plasticsurgeontrends #plasticsurgerymarketing #marketingplasticsurgeons #marketingplasticsurgery #cosmeticsurgeondigitalmarketing #cosmeticsurgeonmarketing #howtopromotecosmeticsurgery #socialmediamarketingforplasticsurgeons #socialmediamarketingforcosmeticsurgeons #plasticsurgeonsocialmediaideas #howtofindcosmeticpatients #howtofindcosmeticpatients #howtoattractcosmeticpatients #howtoconvertcosmeticpatients #howtoretaincosmeticpatients #cosmeticpatientadvertisingideas #cosmeticpatientstrategies #cosmeticpatientconsultant #cosmeticpatientservices #cosmeticsurgeonads #digitalmarketingforplasticsurgeons #consultanttoplasticsurgeons #consultanttocosmeticsurgeons #seoforplasticsurgeonsusingai #onlinereputationmanagementforplasticsurgeons #leadgenerationforplasticsurgeons #cosmeticpatientreferralmarketing #brandingforplasticsurgeons

#10toppracticepearls #topplasticsurgeonbusinesstips #aestheticpracticebiztips

📅 Schedule your free 30-min strategy call with Catherine

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and how outsourcing is trending.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "Outsourcing is Trending — with David Kaufman, MD".

There is a trend happening in our industry to outsource the parts of your practice that you don't enjoy doing such as:

• HR
• Benefits
• Management
• Inventory and so on

Its popular in other industries to consolidate these tasks for increased efficiency as well as economies of scale to decrease overhead costs.

This week's Beauty and the Biz Podcast is an interview I did with David Kaufman, MD who is a board-certified plastic surgeon in private practice in Fresno, CA.

He is in the process of transitioning his practice to allow him to focus on surgery versus the business side of surgery.

He explains what he gains and what he loses when he hands off this part of this practice and how this outsourcing is trending amongst cosmetic practices.

So interesting…

Visit Dr. Kaufman's website

Enjoy!

Catherine Maley, MBA

⬇️ FREE BOOK:

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

Outsourcing is Trending — with David Kaufman, MD

Catherine Maley, MBA: Hello everyone and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery. I'm your host, Catherine Maley, author of "Your aesthetic practice, what your patients are saying", as well as consultant to plastic surgeons to get them more patients and more profits.

Now I have a really special guest today. He was on here before, but he came back for a new topic on how outsourcing is trending amongst cosmetic practices. It's Dr. David Kaufman. Now he's a board-certified plastic surgeon in private practice in Folsom, California. And for those of you who know, it's near Sacramento, California. So, he's been on Beauty and the Biz before.

But this time we're going to talk about a new trend that we're calling private equity and plastic surgery, and how those two fit together. Dr. Kaufman, welcome to Beauty and the Biz.

David Kaufman, MD: Thanks for having me back, Catherine.

Catherine Maley, MBA: Sure. So, let's just start with, just describe the, your practice that you have right now in Folsom. How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Sure. So, we have a, a primarily cosmetic practice. It's basically full service, aesthetic surgery. So, we currently have three surgeons under roof. I've been here for 16 years. My associate, my senior associate's been here for five. And then we just brought on a new surgeon a few months. So, like I said, now there's three of us.

We have a med spa that does really pretty well. We've got two nurse injectors and an esthetician. And then we have two operating rooms. We have a 13,000 square foot building and you know, we're just living the train here in California.

Catherine Maley, MBA: Yeah, me too. Yeah. So, I didn't realize you brought on another surgeon. How has this factored in with your understanding that outsourcing is trending?

Good for you. Wow.

David Kaufman, MD: She's great and she's a she, which is a differentiator. You know, I think for us that was a nice gap in our practice that we didn't have before.

Catherine Maley, MBA: And are they associates, as in contractors, partners, what? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: They're employ, they're employed surgeons, so, they're employees.

Catherine Maley, MBA: Gotcha. Okay, so, let's talk about private equity.

This subject keeps coming up and I'm so, glad you are in the middle of it and you can help under help us understand it because I'm hearing different stories about it and what, what is private equity and how does that fit with plastic surgery?

David Kaufman, MD: That's a great question and that's hopefully what we're here to talk about today.

So, certainly that's a trend in plastic surgery. Our practice recently underwent a, what I call a strategic partnership, where we joined another group of practices. They have private equity backing, so, we're not directly contracting with private equity, but there are certainly some practices out there now that are being acquired by private equity groups to roll up practices and then create some economies of scale.

And obviously the private equities plan is to then sell them again, hopefully for a profit. You know, if I look at my personal situation, I turn 57 this week. Oh, by the way, ha. Happy birthday, Catherine. You too. And then, you know, if you look at historically the exit strategy for plastic surgeon is not great.

Typically, you know, plastic surgeons who to close down their practice or sell their practice to a junior associate for what might be, you know, one EBITDA or even less. You know, if you look at what private equity brings to the table, they're certainly bringing in. To take some equity off the table, but they also have a much better sense of how to run a business.

At this point, we have 35 employees and, you know, we're now a big business. We're not just a little mom and pop shop anymore. And our hope, at least in our perspective, is to be able to draw on the experience of these larger firms to consolidate HR, consolidate payroll, improved purchasing, create some economies of scale, and really take a small company and.

Run like a, a big, more efficient company. So, what turned me onto this was actually when I listened to your podcast, I heard Dr. Singer and he's actually the group that I ultimately ended up joining. Okay. But certainly, in medicine, these rollups I've worked across dermatology, across GI, across cardiology and, and others.

So, this is a thing. It's happening and even with a pretty tight debt markets transactions are still, still happen.

Catherine Maley, MBA: Let me just ask a stupid question. Is this a roll up business? Are you selling your practice in, in essence, are you selling your practice to private equity? So, then they build it up for you so, then everybody can roll up all of these practices and then sell it again like, and then you all leave with money, right? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: So, there's different strategies, of course, but at a very basic level, if a private equity firm comes. They will acquire part of your practice, there's going to be an expectation that you will stay on and re retain some equity. The goal then, though, is to aggregate profitability because let's say your practice has a profit of $1, it's really not worth that much on the open market.

Mm-hmm. If your practice has a profit of $10, that becomes more interesting to bigger private equity firms and your multiple of EBIT, it becomes. So, you know, the goal is to aggregate practices, to create greater EBITDA, to create efficiencies across the different practices and then create a much more interesting platform to purchase for another group.

Or in theory you could go public, but you know, I think the second private equity play for bigger firms is probably the most likely play.

Catherine Maley, MBA: Gotcha. By the way, he's saying EBITDA, just in case you don't know what that is. It's earnings before interest taxes and amortization. Yes. And that becomes really important, that word, when you're trying to create value for somebody else. How has this factored in with your understanding that outsourcing is trending?

Yes. To buy. So, is this your practice buying into here? Here's why I say this. I do real estate syndication. And the way you do those is a bunch of people who have extra money, they get together and they put in like how much they want, a hundred thousand, 200,000 for, and somebody has found the property.

There's going to, it's apartment rentals. So, somebody has found this property with two or 300, 400 units, and they can't buy it on their own. So, they get a bunch of investors together. We all put in ours. And then they buy it and they manage it and we're passive income, so, we're not involved. They make all the decisions, but when it's comes time to sell it, then we all get our money back, hopefully, and then a whole lot more with it, or it's affinity.

We try to hang onto that forever as a cash producing asset and then we never leave, you know? Right. Because well, we get our money back. Is it like that or is it something?

David Kaufman, MD: I wouldn't say it's like that. Okay. So, in this instance, and in most instances of, at least my friends that have done this, they sell some interest in their practice and they retain some interest.

Ah, the goal, of course, is to continue producing and creating value to the overall company. And then when the company sells, I eat that proverbial second bite of the apple. What's called rollover equity would be even more valuable than it's at the time of the original transaction. Most of these transactions are structured in that you roll over 20 to 40% of your purchase price.

And the reason why they do that is, you know, in plastic surgery you are the value. It's not like a management company where a manage management or a manager could be. I can't be replaced very easily and I'm not irreplaceable, but there would be a lot of value out loss if I left. So, the goal is to take some equity off the table with a cash and close, but then, you know, build a company so, that the role of equity becomes also a very valuable consideration down the road.

Catherine Maley, MBA: Gotcha. So, why would a surgeon want to do this? Let's do the pros and the cons. Why would you want to? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: So, the pros are, you know, there's a lot of pros and granted, I'm fairly new into this, you know, we've only been acquired two months ago. But if you look at the things that you know specifically, we don't like doing as most plastic surgeons or office managers or practice managers, HR, payroll, buying you know, all the things that really are not sexy or interesting, those can all be aggregated into a central.

Office or essentially, you know, the backend could be shared through practices. There're also economies of scale. You know, if I buy one implant, I might get it for $800. If I buy a hundred implants, I might get it for $400. So, there's certainly an economic consideration to increasing purchase power.

Catherine Maley, MBA: Would that go also with the injectables? With all the Absolutely. Pharma companies? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Yeah.

Catherine Maley, MBA: So, we would consider you one big client of theirs then, because you'd be under the umbrella of a bigger…?

David Kaufman, MD: Right. So, we become a corporate account as opposed to individual account and the buying power is meaningful.

Gotcha. And you know, even if you reduce your costs 10 or 15%, you know, over the course, Many dollars, it becomes meaningful. So, you know, if you could take a, a company and increase its profitability by 10 or 15%, just that in itself I think is a win. What else? You know, the, the world of plastic surgery is always uncertain.

You know, we are a luxury item and to some degree there will be some economic headwinds that we face occasionally. And I think doing a transaction like this for someone like me who is. More senior in their career, takes some equity off the table and gives me some financial security. So, that should things go, you know, very downhill.

Mm-hmm. Some of the equities off the table, so, there's some value there. And then, you know, ultimately my goal, and I think most surgeons' goals are that when we aggregate our efforts together, we improve our own practices and, and those of others, so, that when a second bite happens, if that happens, It becomes a, you know, a very valuable transaction.

So, you know, it's nice to have a little bit of security up at the upfront, and then hopefully there's some meaningful upside on the, on the back end.

Catherine Maley, MBA: Well, I'm also thinking is does that. When they take over some of this HR and the inventory and all of that, does that mean you cannot hire two or three more people to do it yourself?

So, you're not managing it, you're not hiring for it, and you're, you're not spending money on that kind of labor cost. Is that a benefit or is that part of what you're trying to do here? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Certainly, that's the, the hope we haven't gotten there yet because at this point, you know, our integration into the parent company is requiring a fair amount of.

You know, the goal, of course, is to centralize a lot of the stuff that we currently have employees to do. Mm-hmm. And frankly, even if I can offload Kate, who's my wife's and office manager's plate that would be a win too. And I think that's going to happen because, you know, these, these functions are definitely being taken offsite.

Catherine Maley, MBA: Okay. Now, who is managing or who, who does the employee work for?

David Kaufman, MD: So, The employees, in my case, work for the parent company and my parent company is Prime Plastic Surgery. Mm-hmm. So, my former employees are now employees of Prime Plastic Surgery, as are the other surgeon's practices who have been acquired.

Catherine Maley, MBA: Do you see that as an, I'm just going to be devil's advocate here. I've talked to some of the doctors at Stanford, let's say, and Stanford, they're not employ, you know, they work for Stanford, they don't work for that doctor. And then you have to hope that that staff is okay with that. You know, you don't need to hear them saying, you know, I don't work for you.

Like, can you imagine that happening? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Well, you know, I think that then becomes an issue of leader. You know, I'm still the leader of this practice. I still make, you know, most of the decisions. Obviously, if there's something critical, I would ask for input from the parent company, but for the most part, our day-to-day existence is very similar as it was previously.

You know, we still have the same surgeons, we still have the same teammates. They didn't install someone in here as like the new practice manager? They did or did not? They did not. Okay. You know, we have historically been a successful practice, at least by, I, I don't know, however you want to find success. And I think we've been reasonably successful.

We want to maintain that. So, you know, we don't want a cultural shift. And that was something that I carefully investigated before we made this transaction is. You know, we have a successful practice with a very wonderful staff. And I was assured that I would still be able to make decisions about compensation bonuses and things like that to make sure that people still have, you know, the right focus and incentive to provide great care for our patients here.

Catherine Maley, MBA: Did you have any resistance to the staff or anybody thinking, oh, what just happened? Did you, how, how did you handle that? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Well, we had basically a, a screw up. We announced that we were going to do this transaction almost six weeks before it happened. We thought it was going to happen sooner than it did, and for, you know, some number of reasons it didn't happen as quickly as we thought it did.

So, at first there was a lot of anxiety because change brings anxiety. Yeah. But I think as time passed people realize that, you know, they still come to work, they still take care of patients, they still work with the same people that. Benefits were very, very similar to what they were previously, and that their work really isn't that different.

It just, you know, the, the person who signs the check now is different. So, we've lost no employees. I think we have very good buy-in from them in terms of still focusing on great patient care. And so far, so good. Okay.

Catherine Maley, MBA: So, why wouldn't you want to do this? Yeah. Like, gimme the, the, what's the negative? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Yeah. It's risk. You know, you're, you're doing a deal and you're getting into bed with people. You hopefully, you know, but you never know until probably years down the road. So, you're going to give up some autonomy and that's not always easy. Ultimately, you'll have to play in a sandbox with other people.

You know, the parent company may have ideas of how to do things and you may have ideas of how to do things and somehow another, you need to reconcile those and that everybody is happy enough.

Catherine Maley, MBA: Like do they stay out of the surgical side and then you stay out of the HR side? Is it like, can it be that like line in the sand?

Can it be like that? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: I'm sure any agreement is possible. I don't imagine that some bean counter's going to come in and show me how to do surgery. But you know, I think they probably have ways that they want to do inventory or HR sort of thing. But again, you know, we're only two months into integration and we're trying to figure some of this stuff out.

Catherine Maley, MBA: Hmm. You know, you, I know this was your second go around. You had tr you had actually almost closed with a different group. Can you just talk about that for a second? Because I really want the audience to hear what, to watch for sure. What, what are the yellow flags or what could go wrong? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: So, the first go round, we went out to market, had some suitors.

We went through management meetings and ultimately, we chose to enter into a letter of intent with a private equity group out of Chicago. And we lawyered up. We got all our documents ready to go. We had gotten to essentially within 10 days of close, it was going to be a very different structure. It was more the traditional private equity purchases, some portion of our practice.

In that case, it was going to actually be a minority interest they were going to buy and we were going to be the platform on which to go out and acquire other practices. Mm-hmm. It's unclear to me exactly what happened, but in the. When we got very close to sort of consummating the deal, they didn't follow through on what they were supposed to do and the deal blew up and we were done.

It was incredibly disappointing. There was four to six months of efforts negotiating management meetings, onsite meetings you know, in excess of a hundred thousand dollars of legal costs, not to mention the time. And in the end, you know, I was smarter. But, you know, I had nothing to show other than, you know, a couple of bumps and bruises and a little bit of a, a little bit of an experiential learning.

Catherine Maley, MBA: Yeah. D was this like, so, with the lesson B, don't be the first, like, join a group, like join private equity that's already been in the game. Is that this, the, the point to that. How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: I think it would've worked had we gotten across the finish line. I think it depends on what you want. I think if you, in that case, we are going to be the platform on which to build other practices.

Right. And I think that is an enormous amount, amount of work as opposed to being an add-on, which we are now. Because being an add-on, you know, the, it's already working right, and we're just integrating ourselves into that as opposed to sort of creating the. But it sort of depends on where you are in life, what your ambitions are, how much time you want to dedicate to it, because, you know, being the platform and building out the infrastructure is enormous and that should not be underestimated.

So, you know, that's sort of what the private equity firms are there to help with. But ultimately, if you're the first, you're going to be doing a, a lot of work.

Catherine Maley, MBA: Right. So, what's the private equity? How are they looking at this and why? Why plastic surgery? Because they never went there before. They went with derms. How has this factored in with your understanding that outsourcing is trending?

Like derms were just obvious to them. They had a lot of volume. They could com commoditize it. Like why? Why does plastic surgery look interesting to them now?

David Kaufman, MD: Well, I think the other markets have proven to be successful and now I think they're moving into this space. I think they've been very successful in dermatology, certainly in dentistry.

Gi. And I think that, you know, the world is now accepting that plastic surgery is just a normal part of life. Mm-hmm. And, you know, look at plastic surgeons. Not many of them run their businesses exceptionally well. And here's a chance for an equity group to get in there, inject a little capital and operations, and improve, improve profitability.

It's a little bit of a beta test now because there haven't been too many plastic surgery groups that. Hit it big, but like, look at Air Sculpt, they're a, you know, I think there's 17 or 20 lipo center sites and they're valued in the 700 million. It's absurd. So, you know, I think it's, it's a real thing and the firms are interested.

I think it, as more and more practices are acquired and aggregated and hopefully exited will prove a successful model and even create more.

Catherine Maley, MBA: So, I, I like to follow the money. That's kind of my thing. Sure. So, a plastic surgeon who's doing really well, but is so, tired of the running of the practice, they would buy in or the other way around, the PE would buy into them.

Who's buying into whom? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: So, the, the, the cash flow was from the PE firm to a strategic partner to a practice or directly from the PE firm to. Plastic surgery practice, but understand, you're, you're basically selling some of your EBITDA to the private equity firm.

Catherine Maley, MBA: Gotcha. So, it's not like, you know, there is transaction, there's, there's value being traded for cash, who decided what the value is? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: So, that's a good question. And if you look at how practices are valued mm-hmm. You look at what your EBITDA is, and as you mentioned, earnings before interest, taxes, and amortization. That's essentially what your annual profit is. Okay. You then take away from that what your ongoing salary is going to be.

So, let's say I'm making $10 a year and I'm going to make $2 a year. The EBITDA that I'm selling is $8. Okay. So, then that EBITDA is multiplied by some multiplier, and that in the plastic surgery world could be probably as low as three or four to as high as maybe 10 if you've got a super robust practice.

Mm-hmm. And that's called your. Total enterprise value. So, let's just say for ease of numbers, you've got eight of saleable EBITDA and your multiple is 10. Mm-hmm. Your total enterprise value is now $80. That's the value of your practice. Mm-hmm. Then that value is sort of parsed up into three parts.

Those parts are the cash should close, the rollover equity, equity that we talked about before, and then there's sort of a middle grounds, which is. Earns. Mm-hmm. So, those are monies that are paid as long as your practice continues to perform and those levers can be moved up and down. Like the more rollover equity, you would be willing to put in, you might be able to squeak your multiple a little bit higher.

Mm-hmm. You know, if you want a lot of cash on clothes, they're going to crank down in the multiple because, you know, there's more flight risk of you just leaving and leaving them high and dry with a practice that doesn't produce. But that's, you know, that's sort of a nutshell of how practices are. I think in general it's a very good idea to go out and get an outside quality of earnings evaluation so, they can actually look at your practice an expert can, and run the numbers so, that when you go to market, you know you're not going to market with some inflated or completely ridiculous estimation of your own.

Catherine Maley, MBA: Do the private equity people, do they understand our industry or is it, one of my issues is although everyone says my business is different, we all say that my practice is different. But business is business for sure. But how much creativity do you still have on your own, like for marketing or branding?

Like who are you now? Are you brand, are you still branded? Is. PE company branded. How's that working? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Yeah, so, that's a great question and I think it, again, it depends on who you work with. So, there's a company out there called a Phoenix, which I'm sure you're probably all, at least on the West coast familiar with.

Mm-hmm. They brand their practices as the athe group of plastic surgeons. Mm-hmm. The one I'm with is different. We maintain our own branding, so, just like hotels, like you might stay at a, a Kimpton by Marriott. Mm-hmm. Well, my practice is my practice name. Part of the practice network or something like that.

So, we allow, or we're allowed to maintain our own branding because I think we have a lot of brand equity in our area. We don't want to scrap that. Mm-hmm. But there is some co-branding with the parent company, so, that way, you know, someone takes a look, they, they understand that we are part of a bigger group.

Catherine Maley, MBA: And then are they paying for the marketing efforts of everybody? How is that going? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Well, ultimately, since they're the owners of the company and all the money is theirs, both in terms of income and outflow. Mm-hmm. In theory they are, yes. But we still largely control what we're doing from a marketing standpoint.

That's one of the things that we're working on collectively in terms of how to optimize our marketing. So, we now have a central VP of marketing trying to coordinate some of our efforts, look at be best practices, track the data, and see what's successful and hopeful. You know, disseminate best practices and try and minimize the ones that have historically not worked.

Catherine Maley, MBA: Okay. So, they bring the, the value that they're bringing to you is like business people. They're bringing you the, the market, the VP of marketing, the VP of inventory, the v, like they're, they understand the, the numbers part of a practice. I just find this so, interesting. It's a lot of players involved. Like is it, is there like a board of directors?

Yes. Or…? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Yeah, there is. And you know, most of us who have put our practices into this group have a seat on the board so, that we have some say in how things are done. Yeah. But you know, the goal. Taking a bunch of small practices and turning them into a big practice with economies of scale efficiencies and best practices across the platform with the goal of when it's time for you to exit.

Catherine Maley, MBA: Because they don't need you there for a year. They need you to stay put.

David Kaufman, MD: Right, right. So, in my particular deal, I have a few years of turnout. So, it's not like I got a big pot of cash and walk, I could walk away. Mm-hmm. Like, I'm, I'm tied to this both because I have financial ties, but also, I really want to see this through.

Like, this is something that I think could be transformational within plastic surgery. Right. And may change the landscape. And I think if we do it well, it could be the model for, you know, many years to. You know, if you screw it up, then you know, it's just crash and burn and that's no good, but it's going to take some effort.

And, you know, I'm, I'm committed as I believe the other people who have joined this group are committed.

Catherine Maley, MBA: Well, you joined a good group with you know, I mean, Robert Singer is solid, you know, he's, but now like, like let's say he's getting older, you know, how, how do you step out of this if you need to or want to? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Yeah. So, in theory, after. Earnouts. Mm-hmm. I would still have equity in the overall company and if I wanted to work less, I could, because I would just earn less because I still have a salary based on production. But I would just write off into the sunset and, you know, hopefully our group will start a fellowship because we have these multiple locations for fellows to learn through multiple different surgeons and locations, how things are.

Our hope then is to take those fellows and backfill the people that leave. We'll see how that works. Cause this is all very new and mostly conceptual. Mm-hmm. But it, I think there's something to be said for a, a fellowship that has five or six different practices to draw from, from in multiple different geographic locations.

And then of course, you know, we'll be looking at them and hopefully they'll be looking at us. And if we find a match, if it's time for someone to leave or another practice is ready to bring on another associate, that will be a perfect person to quit in.

Catherine Maley, MBA: Well, you know, with the trends, the way they're going, you can't be a fellow with a million or two extra to invest in some practice you know, to buy somebody else's practice.

So, that actually makes a lot of sense because those days it's not going to happen. Usually if they had one or 2 million, they'll just open their own place, typically. But if you let them get into a, something like this, I assume, They're walking in without an investment, maybe being, making an investment.

However, that also holds them back from equity. They probably don't get equity for a while. So, is that also one of the points? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: So, certainly there's zero risk to onboarding and for a young surgeon who is right out of training. It's a great opportunity to both learn aesthetic surgery, because historically residency practice, the residencies have not been great at training in that regard.

Mm-hmm. You know, at that time in your life, typical, typically people don't have a whole lot of money to buy a practice or buy a building or build an OR. Right. And then the goal is, you know, if a, a younger surgeon joins and over the course of the first few years shows promise or commitment, you know, Trying to craft some ways to create equity or at least phantom interests for you know, younger surgeons to keep them committed to the long-term success of the practice.

Catherine Maley, MBA: Okay. And then would you want more and more practices joining? Is that helpful to have that big economy, scales of economy, however, or economies to scale? However, is there a point of getting too big and getting lost in all of this and imploding? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Sure. Well, I think that the answer to that, Growth is always well usually desired.

Mm-hmm. Certainly, we need to work out the kinks of onboarding so, that as PR new practices are integrated in, they're done in such a way that it's not disruptive to the practice, so, that they don't take a hit on the way in. I don't know what the exact right number is for a target to either, you know, sort of go up for a second offering or consider public.

My sense is in the, you know, the 30 to 50 million of EBITDA, so, once you aggregate to that level, that big, that puts you on the radar of big PE firms or maybe even considering, you know, public offerings. Mm-hmm. But you know, we're not anywhere near that, but we're working in that drip general direct.

Catherine Maley, MBA: I just thought of something for you to make this work, somebody like the centralizing has to know the numbers.

Yes. And they have to consolidate and know they, they need data. Yes. Is everybody going to need to be under the same EMRs? Yes. Phone systems payment plan, all of that is, will all of that be consolidated essentially? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Well, we, we are already on the same EMR. Okay. Some of the practices have use of the MR than others.

And that's one of the things that certainly the IT department will work on is bring everybody up to speed. So, there's similarity across platforms. I believe we're all running on the same accounting system. Oh, the same bill pay system. So, that's truly a centralized company with essentially, regional offices as opposed to just a bunch of people strung together on quick.

Catherine Maley, MBA: Right. That would be confusing.

David Kaufman, MD: Yeah. Well, they, they have a, in my opinion, at least from the feedback I've gotten from Kate, an exceptional chief financial officer and, you know, there's a, there's a lot to keep track of. There's a lot to keep track of for sure.

Catherine Maley, MBA: Is, has this been like a part-time job for you?

A full-time job? What kind of time goes into it? How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: Well, I would say that my lovely wife, Kate, it's been all consuming because she runs our practice and she's always made it. So, you know, I just have to operate and, you know, see patients and she takes care of making the machinery work around us. Mm. So, it's been an enormous undertaking on her part, for which I am deeply, deeply in depth.

But no, it's, it's a you know, it's been a lot of. But I think we, I hope that we see the light at the ender of the tunnel, which is efficiencies that take a lot of the crap that she doesn't like to do off her plate.

Catherine Maley, MBA: Yeah. And make them. Not everyone married as well as you. You know, others are really stuck in the middle of all of this drama that goes on in the office.

And if you, I mean, most surgeons I talk to would like nothing more than to do surgery and nothing else, you know? Yeah. And not deal with this. So, this is a new option for those who are really looking for a way to not exit so, much as to just. Shift things. So, you're just a lot happier doing what you like to do, and I'm not bogged down with what you don't like to do. How has this factored in with your understanding that outsourcing is trending?

David Kaufman, MD: You know, there's a lot of merit in what you just said and you know, I think there's, there's something, something there.

Catherine Maley, MBA: Well, Dr. Kaufman, it is always a pleasure talking to you. If anybody wants to reach out to you, how would they do so?

David Kaufman, MD: Sure. My cell phone is (650) 387-6066.

Email works, [email protected], or certainly you can find me on the internet.

Catherine Maley, MBA: All right, and his website is the natural results.com or is it one result?

David Kaufman, MD: Singular. Singular.

Catherine Maley, MBA: You only get one result. Yes. www.TheNaturalResult.com? Yes. All right. Thank you so, much. I really appreciate it. And let's see what happens.

I mean, this really makes logical sense. It's the matter of, I just my 2 cents. Know your business partners. Intimately because you are going to be in a relationship with them for a very long time. Things can go sideways. Make sure you're with somebody who can negotiate and debate nicely without going to war.

You know? I mean, what, what, what do you think, what, what, what, what would you be, what would be your advice to others who go into these kinds of partnerships?

David Kaufman, MD: Well, I would say work with people that you generally like, because there will be difficult decisions that need to be make at some point in concessions that have to be made for both sides.

And having someone that is a reasonable and has the big prize in mind, I think that's critical. So, we're at the, the, you know, the early stages of this and I'm very excited the way, see it, how it turns out. And I'll certainly keep you posted as, as things progress.

Catherine Maley, MBA: Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on outsourcing is trending.

If you've got any questions or feedback for Dr. Kaufman, you can reach out to his website at, www.TheNaturalResult.com.

A big thanks to Dr. Kaufman for sharing his insights on the fact that outsourcing is trending.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue.

-End transcript for "Outsourcing is Trending — with David Kaufman, MD".

#cosmeticsurgeonpodcast #plasticsurgeonpodcast #aestheticpracticemarketing #cosmeticpracticestafftraining #cosmeticsurgeonbusinesscoaching #plasticsurgeonbusinesscoaching #strategiesforsurgeons #morepatientsmoreprofits #aestheticsurgeonbusinesscoaching #medspabusinesscoaching #medspamarketinghelp #cosmeticsurgeonmarketinghelp #howtogetmorepatients #plasticsurgeonmarketinghelp #aestheticpracticemarketinghelp #beautyandthebiz #podcastforplasticsurgeons #podcastforcosmeticsurgeons #plasticsurgeonideas #plasticsurgeonagency #plasticsurgeonconsultant #plasticsurgeonstrategies #plasticsurgeonservices #plasticsurgeontrends #plasticsurgerymarketing #marketingplasticsurgeons #marketingplasticsurgery #cosmeticsurgeondigitalmarketing #cosmeticsurgeonmarketing #howtopromotecosmeticsurgery #socialmediamarketingforplasticsurgeons #socialmediamarketingforcosmeticsurgeons #plasticsurgeonsocialmediaideas #howtofindcosmeticpatients #howtofindcosmeticpatients #howtoattractcosmeticpatients #howtoconvertcosmeticpatients #howtoretaincosmeticpatients #cosmeticpatientadvertisingideas #cosmeticpatientstrategies #cosmeticpatientconsultant #cosmeticpatientservices #cosmeticsurgeonads #digitalmarketingforplasticsurgeons #consultanttoplasticsurgeons #consultanttocosmeticsurgeons #seoforplasticsurgeonsusingai #onlinereputationmanagementforplasticsurgeons #leadgenerationforplasticsurgeons #cosmeticpatientreferralmarketing #brandingforplasticsurgeons

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and reputation management.

I'm your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients, more profits and stellar reputations. Now, today's episode is called "Reputation Management — with Jeffrey J. Segal, MD, JD".

At the medical conferences I speak at, there's usually a talk about reputation management and how to keep %*@^ from hitting the fan and ruining your name.

So, I invited one of the country's leading authorities on medical malpractice and reputation management to update you on how to stay out of trouble and keep your reputation as stellar as possible.

Jeffrey Segal, MD, JD is a board-certified neurosurgeon, but he's also an attorney and partner at ByrdAdatto law firm. He's also a reputation management expert. Dr. Segal focuses on keeping doctors from being sued for frivolous reasons and to minimize the need for difficult reputation management.

On this week's Beauty and the Biz Podcast on reputation management, Dr. Segal and I talked about:

How to protect, preserve and manage your reputation online

How to spot trouble early so your reputation management take far less effort

How to handle patients with mental health issues who can cause havoc with your reputation management and a lot more…

Every surgeon who has done enough surgery has or will experience patients who become problems, so this episode gives you strategies to help with your reputation management.

Visit the website of Jeffrey J. Segal, MD, JD

Enjoy!

Catherine Maley, MBA

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Catherine Maley, MBA:

Everybody that's going to wrap it up for us today on Beauty and the Biz.

If you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

"The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It's guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I've gleaned over the years into one playbook of the most successful practices and what they do to win.

Go to www.CosmeticPracticeVault.com and let's grow your cosmetic revenue."

Transcript:

Reputation Management — with Jeffrey J. Segal, MD, JD (Ep.198)

Catherine Maley, MBA: Hello and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and reputation management. I'm your host, Catherine Maley, author of "Your aesthetic practice, which your patients are saying", as well as consultant of plastic surgeons. To get them more patients, more profits and better reputation management. But today's talk is a little different.

We've got a very special guest who's an expert at reputation management. His name is Dr. Jeffrey Segal. Now he's not only a board-certified neurosurgeon who trained at Baylor College of Medicine. He also just happens to have graduated from Concord Law School. So, he's also an attorney and he's also a partner at ByrdAdatto law firm, and a reputation management guru.

So, Dr. Segal launched a company called Medical Justice in 2002, and Medical Justice is the physician-based organization focused on keeping doctors from being sued for frivolous reasons and to help with their reputation management. That's why he's on here. This is becoming more and more of an issue. So, Dr. Segal also founded eMerit to help doctors protect and preserve their reputations and teaches reputation management, particularly online.

Now, Dr. Segal has established himself as one of the country's leading authorities on medical malpractice, online reputation, and reputation management, and I hear him talk at the meetings all the time. He's a really popular, he's got such a popular topic because it's a hot topic, and it probably always will be. So, Dr. Segal, welcome to Beauty and the Biz.

Jeffrey J. Segal, MD, JD: Hey, Catherine, thanks for allowing me to participate.

Catherine Maley, MBA: Absolutely. Just out of sheer curiosity, how does, how does one go from a neurosurgeon to an attorney and reputation management expert? Because that didn't take a couple minutes. That took years and years to become one, to then become a lawyer, and that took a whole lot of time to then become more entrepreneurial.

What was that path like? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Well, it's interesting because I did not intend that to be the case, and it's like having that conversation with your parents and your wife, how that happened. In between, I was in biotechnology, so, I practiced as a neurosurgeon for a decade. Perfectly happy doing that. And then I had a son who became ill.

He's better now, but I took a year off. We moved to North Carolina to seek services for him, and I became persuaded that a certain set of pharmaceutical compounds might help him. And in that process went to where they were on a shelf, university of North Carolina licenses, compounds, raised money, and started a biotechnology company.

So, if. Knowing what I now know, I probably would not have done it, but we're able to move these compounds pretty far along from preclinical to phase two, get the company sold to a medical device company. By then, a number of years had gone by. Question was whether I can go back to practicing neurosurgery.

I thought since so, many years had gone by, it'd be a challenge to per, you know, to reasonably persuade a passion to go under the knife, even though I'm arrogant enough to believe I could do it. I'm not sure I had these, the persuasive skills to do that. So, I formed medical justice and got a law degree along the way.

So, in some sense you could just say, I'm confused. Another sense you can say I'm a lifelong student.

Catherine Maley, MBA: You're probably both, right? So, the thing about frivolous lawsuits and subpar reputation management: How did that come about? Because you wouldn't have had that issue as a neurosurgeon, but you certainly would as a solo practitioner, plastic surgeon.

So, how did you segue into that world? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah, it's a great question. I actually did have it happen to me as a neurosurgeon. Oh. And I was sued one time for what I perceived to be a frivolous reason. The single expert who testified against me had actually been expelled previously from our professional society, the American Association of Neurological Surgeons.

Why? Because he was delivering frivolous testimony. Yet, even though he'd been booted out of our professional society, there he was on the circuit making a very handsome living testifying, saying one thing on one coast, saying the exact opposite on another coast, but his core competence, He had good communication skills.

He could speak well to a jury, so, he was in demand. In any event, I, he had never seen or done the case at issue, but it didn't stop him from running his mouth. The case was dismissed about two weeks before trial. I never felt as if I lost won anything. I just felt as if I lost less and I thought there has to be a better way.

So, we started medical justice as a way of holding proponents of these frivolous lawsuits accountable. In one sense, what do we do? We sue lawyers that inappropriately sue doctors. And more broadly, over time, we've expanded our mission to deal with all types of conflicts. Goal is to deescalate a conflict.

I mean, by the time people get to lawyers. There's a lot of conflict in the background. And there are, and in fact, this is probably a good segue to talk about, well, what kind of conflicts are there, what types of, what types of Sabre rattling takes place and well, all types. The, it typically gets started with yelling, screaming, or nasty emails.

Somebody doesn't, somebody says they don't like how they were treated, for example, that's the lowest level. Or they could put a nasty note on the internet. They can file a complaint to the Board of Medicine. All of that requires no effort whatsoever. They could sue you in small claims court. They could hire a lawyer to send a threatening demand letter or they can sue you.

So, a gazillion ways for a conflict to take place. That's the bad news. The good news is there are ways, if you are attentive, To the process to head this off at the past before there's litigation, before there's a nasty note on the internet before they even start yelling at you. There are plenty of ways to identify trouble before it shows up at your door and avoid this before it creates a headache.

Catherine Maley, MBA: I'll tell you being a cosmetic patient myself and just, and just being in this industry for decades, I have noticed that a lot could have happened at the beginning to prevent the drama happening at the end. And let's just talk about patient selection, in terms of reputation management. I know so, many surgeons, and I don't know if it's arrogance or just.

Whatever, but they don't want to say no to, to the surgical procedure or the money or whatever, and they always think they're going to be able to handle it. Even if staff is saying, I don't know about this one, I'm not feeling good about that. Can we just start there? Like, what? What can they do to just cut it off at the beginning? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah, so, the first thing is to select your patients carefully. It's a cash pay business. There's this tendency to want to get everybody through the door. Nobody will ever have on their epitaph. I wish I had done one more patient that that epitaph does not exist on a gravestone. So, be. There are a handful of patients you not only should say no to, you must say no to.

They're not great candidates for surgery. You may believe they have a cosmetic problem or an aesthetic problem that you can solve, but that's not their underlying problem. If a patient comes in there and says, Hey, look, I just want to take three or four years off. I just want to feel better. That's probably a good candidate for a procedure.

If a patient comes in and says they're struggling to put food on the table and a roof over their head and they're struggling financially, or if they believe that the procedure will shave off 30 years, or if the procedure will save their marriage. Not a great candidate. Those are people who have expectations that cannot be managed.

You cannot manage those expectations. The best thing to do is to say no. And the other thing is that there are. Cash pay businesses where patient will have a particular budget and you say, I can't do that for you, but I can do something at 10% of that cost. But you know, in your heart of hearts, it's not really going to do what the patient wants.

They'll be back, they'll believe, they will have believed that somehow, they're getting a permanent solution when they're only getting a four-week solution. Expectations aren't managed, just don't do it. I'm telling you that the amount of extra revenue that you get for that one patient will pale, pale in comparison to the headache that you will experience.

And I've often said that in with the benefit of hindsight, if you had known that this particular patient would cause this much agony in your life, would you have paid them? Would you have given them a check in advance of seeing you to stay out of your practice? Hundred percent of practices say yes, I would've paid them.

I'm still waiting for the one to say no. I probably would not have paid them to stay away. No, they, they will, they will tear your soul out and they'll rip out. You know, your, you know your desire to practice medicine right at your bone marrow.

Catherine Maley, MBA: Do you have a professional way to tell a patient No, because I have found these patients are still going to slam you online when you say no, you know, is there a w the right way to do it without them giving you a bad review about it? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Maybe, I think I, I'm going to say upfront that even if, first of all, you should be capturing feedback from patients so, that if you get the inevitable bad review, it's not a showstopper, it's not going to destroy your practice. In fact, I will argue having an occasional negative review amongst a C of positive reviews is actually a good thing.

I think it's actually better than having a hundred percent positive reviews. Why? Because it demonstrates authenticity, credibility, et cetera. If you have a hundred percent five-star reviews, let's say you have 500 five-star reviews and just says, great doctor, love you, you know, there's no meat to the review it.

It looks like marketing material, but having an occasional negative reflects reality. The public knows you cannot make everybody happy. The Ritz Carlton doesn't make everyone happy. The public wants to see how you can solve a problem. So, if you have an unhappy patient and you've at least work to try to solve their problem, you can tele telegraph that in a HIPAA compliant way.

Good for you. I think you're better off now when you get that negative review. You don't feel like sending flowers and chocolate to that patient. Of course, but you should. You probably should. Only because I think holistically it's, it's helping you. But anyway, back to your very good question. How do you gently.

Give somebody the boot, if you will, you know, without being offensive. And I think the way to do it is to validate them. Say, look I'm not disagreeing with your, you know, with your treatment plan, what you're requesting. I just do not believe I will be able to meet your expectations. I'm not suggesting no one will be able to meet your expectations.

I just don't believe that I can meet them. And I. I just want you to be happy. I want you to be happy, and in doing so, I don't think it would be a good idea for me to take your money, ultimately go through a procedure and you not be satisfied or happy. Now, that will work with most people. There are, there's a small subset of patients who do not have a core aesthetic problem.

They have a mental health problem. Mental health problem may be something like body dysmorphic disorder, just to give this a, a name and there it's a body image problem. It doesn't matter what they see in a mirror. They don't. They experience a different image. And when you operate on somebody with body Dysmorphic disorder or B D D, you're actually doing them a disservice.

I mean, arguably it's malpractice, but I would just say, you know, more, more charitably, you're doing them a disservice. And the proper thing to do is to refer them to a healthcare professional, mental health professional who deals with body image problems. As an aesthetic practitioner, you do what you know how to do.

But let's say for example, a patient came in there and they had, they had a kidney stone, or say they had chest pain. You'd send them to a urologist for the kidney stone. You'd send them to a cardiologist for chest pain. You would properly refer. Then if you can identify, if you can make a presumptive diagnosis of something like B D.

D. Having a preexisting relationship with a mental health professional that you can gently pass the baton over to for additional screening. You're doing them a favor. And in some sense, you could say, I'm not saying no forever. I'm just saying no for now. I just want you to be screened and be evaluated by somebody that I know, somebody that I trust, and they can give you a clearance.

But if you've got a good screening tool for b d d, being able to gently. Get them referred to the proper individual in many senseen. I mean, you were really doing them a favor. Will they write you a bad review? Typically, they will not. Can I promise? They will never write a bad review. No, I can't. But I, I can tell you that if you, you do the right thing most of the time on balance, you will be better off than operating on that passion or just kicking them out the door and saying, I can't help you.

Catherine Maley, MBA: Just good luck with that. But now that we have social media, I see every day I, I don't know if it's B, d, d or whatever you want to call it, but the outrageous big boobs, big butt, little waist, huge lips. Is that b d, d or is that just, what is that? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: You tell me. Yeah, so, I, I'd have to plead ignorance there. I'm in North Carolina.

I don't see it as frequently as perhaps you do on the West Coast, but, but you know, I've been to Miami and I've definitely seen it there and I can, I can tell a trend and every three or four years the trend changes so, that it's something else. I think you just got to do what you do. Okay. If, if the patient wants something that is outrageous, they'll eventually get it done.

There's always somebody who will do it. Even remember Michael Jackson was able to find a doctor to put him to sleep at night and ultimately put him to sleep permanently. But you don't have to be that. You don't have to be Michael Jackson's doctor. You, you, you just do good work., you'll have a good practice.

Don't feel compelled to have to do outrageous things just to, just to keep the lights on. Most people are reasonable. I, I know sometimes it's hard to believe that, but most people are reasonable and want reasonable things. And if somebody's pushing the envelope to get you to do things that you're not comfortable, things that you think are not within the standard of care, just say no.

Because if you, if you do say yes, sooner or later, you're going to get burned. I, I, is it b d, d? I don't know, but I know it's not something that I know that most practitioners should stay away from. Let's just talk about, you know you know, putting in breast implants that are ginormous. Okay. It's possible that there will never be a complication associated with that, but it's just physics.

You're putting in a, a mass under the skin or under the muscle. And if the skin or muscle has to stretch, Beyond what it's capable of doing, and it outstrips its blood supply. I can tell you with a hundred percent certainty what's going to happen, that the skin is going to slough off, the implant will be exposed and it's going to get infected, and then the implants are going to need to be removed.

Now, they may not have liked their breasts beforehand, but I can assure you they're not going to like having a giant gaping hole in their breast without any mass in it. I think to, to me, that's a worse outcome. But all you can do is what you can do. You can try and persuade them based on the best evidence and your judgment.

And if you say no, maybe they'll go somewhere to say yes. But I, I, I know that you can't beat physics a hundred percent of the time. That much I'm confident of.

Catherine Maley, MBA: So, what about the patients who schedule surgery, put down the deposit, then change their minds, cancel the surgery. Now they want their deposit back.

The date can't be filled, or they're scrambling to try to fill that date. Who I realize that's the patient's problem, you know, they caused that. However, what's the best way to handle that? Because of this online situation. You know, they'll, they'll be online saying, I can't get my money back. The guy stole my money.

How do you handle that when a patient reneges on what they've… How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: This is a challenge, and I have changed my opinion on this over time. If you had asked me 15 years ago, I would say a deal is a deal. You basically stuck your deposit down. That's. I scheduled you for surgery. I wasn't guaranteeing you an operation.

I was guaranteeing you a slot on the schedule, and I honored my end of the bargain. I'm keeping the money. So, that was Jeff Segal me speaking 15 years ago. I've changed my mind. I've changed my mind over time because here's what I think happens. I think if you're dealing with a significant sum of money here, you're putting the patient in a bind.

The bind being that. Are being forced to choose between Forfeit Inc. A large amount of money. Let's say it's $10,000 just to make this a round number or have a procedure. They don't want to have, have a procedure. They don't, an elective procedure they don't want to have. And what I've seen over time is that if you push them into that situation, They'll ultimately have the procedure.

They're not going to forfeit the money, but that's when the fireworks begin. They'll have the procedure. You will have done what you, what you, you know what you said you would do. You honored your end of the bargain. Then they're going to. Tell you how horrible you did the job. They don't believe it, but they're going to tell you how horrible a job was and they're going to demand their money back.

They're going to demand their money back or slam you on the internet. So, as unsavory as it is to just swallow hard and let them go, I would probably most of the time give them their money back. Now, I think it depends on the situation. If it's, if the patient has a good reason for. For canceling the procedure and if they gave you adequate advanced notice and you could potentially fill the slot.

I'm saying just do the, be good, be a nice person and give it back, particularly if you can fill the slot. Okay. Because really you haven't been injured, you haven't been harmed, and you're just trying to be nice and do the right thing. If they have a medical event or a life event that took. And it looks like they really do want the surgery down the road.

Just ask them gently, you know, would you like to postpone this at no charge? And we'll do this when the dust is settled. You know, it sounds like you're going through a lot of life stressors right now. This is an entirely elective procedure. You don't have to have it done. But if you think you want to have it done, we'll just go ahead and, you know, keep your funds you know, stored away and we'll, you know, we won't raise our rate for you because typically we will.

Raise rates, you know, twice a year, once a year, and we'll honor our end of the bargain and flesh that out. But if they basically just say, look, it's the day before the surgery I'm canceling. Do I have a reason? No, I have no reason. I just don't want it. What don't you understand about that? And that's a nasty individual.

Okay. And do you really want that as your patient? I mean, I, I think you're probably better off not operating on that individual and just flipping it around and. Giving them the cash back. I mean, to me, deposits are mostly there to get people to commit to a date and it serves its purpose. It gets people, it puts something on a calendar.

So, when I say I'm going to, I plan on going to Europe, to me that's a wish. It, it has no substance whatsoever. Once I stick that on the calendar, that baby's real, I'm going, I know, I'm going ticket. Yeah. Once you buy an airline ticket, it's real. Now, you know, if I, I can change my mind and I can cancel the flight as, as I just did for my wife the other day.

So, now she's got x number of months to go ahead and use those dollars for something else. But I mean, over time we've hotels and airlines have kind of figured out how to find that nice balance between the two, at least holistically. You may get screwed on a particular patient, but. In aggregate, I think you'll be better off by adopting that philosophy.

Catherine Maley, MBA: Well, here's another thing that can go sideways. You've had your surgery and now you as a patient, you get this bill and it's for another thousand dollars for or, and anesthesia because the doctor took longer than expected. I personally, Thought, why is that my problem? Like, I'm the patient, he's the expert.

Why am I paying for him to take longer than he said he was going to? Do you have a comment on that? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah. I don't disagree with that. With your interpretation of that, I mean, look, in the elective space people are looking for. One shop pricing, they're not looking for surprises. If it's an insurance world, it's not really your money.

I mean, let Blue Cross manage that, not my problem. And once you've hit your deductible, it's just break out the champagne, all of everything done, you know? But I mean, if, if indeed there's going to be extra fees related to taking more time, Then the rational argument is, well, do I get money back if the surgeon was fast, if the surgeon was faster and only took half as much time, because I was simple, do I get a refund?

And we know the answer to that. The answer is that a big no. So, if I, I think the proper way to do it is to try and work with facilities and other professionals who are willing to accept fixed. With the understanding is that you are already arbitraging this, you have more knowledge than the patient and you're in aggregate.

You're going to come out ahead. Mm-hmm., if you basically say, I'm going to accept the risk of the case going longer, I'm just going to eat it. But you know in your heart of hearts that you're benefiting by the case going. If you could stuff in more cases good for you, you, you've actually benefit. So, I, I think barring extremely unusual circumstances, you're probably better off eliminating surprises to patients.

Nobody likes a surprise. I know. I don't like a surprise, you know, when I get a letter from the I r s, if it doesn't have a check in there for me, I'm, I'm not happy. That's an un, that's an ugly surprise. And even if I do get a check and I'm not expecting it, that's also an ugly surprise because if you cash that check, You're going to get hosed a year from now.

So, my, my larger point is try to eliminate surprises for those in the cash pay business and you'll eliminate future headaches for yourself. Oh, and let me tell you another thing. Avoid billing patients for $24 and, and 32 cents. You know, it just pisses people off Now. Particularly if they're not expecting it.

I've seen people sent to collections for under $25. I don't get that. I don't get it because if the patient is unhappy or suffered a complication and they, they just ate it and they learn to live with it, that's the, that's the one thing that rubs salt in their wound. It's, it's a, it's an unforced error.

You don't need to do it. If you've got a $24 bill with a hangover, write it. Just write it off.

Catherine Maley, MBA: Here's the next surprise that comes up. The patient has their procedure. They're not happy with their result. The doctor agrees and says I'll; I'll do a tweak in the office if possible. Mm-hmm., if he can't, he says, I'll, we'll go back to surgery, but you're paying the OR and anesthesia and I, I will forfeit my feet again.

The patient says, why am I paying? It's, you know, you are the expert, you did it. You can see there's a problem. And I know that's murky because sometimes the doctor can't see there's a problem. But oftentimes there really is. I mean, he did he, he does need some kind of revision to be made. How, how tricky is that?

Or is it more black and white than it seems? Because I, as me, as a patient, if I see something's wrong, I mean, but I'm reasonable too. What if it's a reason? Revision? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Yeah. So, the answer, I'm going to give you a lawyerly answer. Okay? It depends. Every, every doctor is different. Every patient is different.

Right? Here, I would say if you're going to do a revision procedure where you waive your professional fee, then. You do want to spell out in advance who is responsible for anesthesia and the facility. Okay. And try that. That's a trial balloon. See how it goes. If the patient thinks that's reasonable, they'll sign off on it.

Get them to sign off on it. Get them to say, here's the deal. The deal is this. And most of the time they'll say yes, but not always. Then you got to recognize who is that individual that is going to need something more just to solve their problem. Do. Would I roll over? I probably, I might, I might. I'm actually thinking about myself at that point.

I'm thinking about do I want to go to World War III over a modest amount? And. Or do I, will I eat some of that fee even partly because I already received a large amount of money from them in the first place. Now is it as much? No. But is this really going to change my financial statement at the end of the year?

No, it's really not. And if I'm already psychically invested in this particular case, and it's starting to raise my blood pressure at this stage of my life, I'm going to opt to decrease my blood pressure. It's not going to bother me One. But that's me. I, again, if you had asked me 20 years ago, I would've given you a completely different answer.

I would've gone to war.

Catherine Maley, MBA: The, the reason patients will go online, typically, I'll just say in general because I talk to them all the time, is because nobody fixed their problem. They had a problem, nobody heard them or listened to them or did anything about it. How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Repeat what you just said. That's the most important point of this conversation.

They did not feel listened to. They didn't feel listened to. Listen to them. If you listen to them, they'll give you the answer still. Sir William Osler said, the patient will deliver the diagnosis to you, and here it's the same thing. It's a communication issue. If you stop talking for a moment and you start listening, they'll tell you their perception of what they believe the problem is, then you've got a question, can you solve their problems?

In my estimation, Once you've listened to them, you've already, you've, you're 90% of the way there to solving their problem. You may have to go a little bit more and some problems cannot be solved. I, I don't, I agree. Not every problem can be solved, but where else do you get 90% success rate? I think that's pretty good that those are pretty good odds.

Catherine Maley, MBA: When you do know it's not your best work and the patient knows that too, like everyone knows that but you don't want to do it again. You're, you're kind of done with it. What is the easiest way to detangle? I personally, I like the refund idea, the one with, and you agree not to disparage me? Yeah. In any way, shape, or form.

Is that still the best way to handle that? Or what is your approach? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Couple ways to do that. That to me is tried and true, meaning that patients unhappy. It may not be your best work. It could have been the patient, you know, biology. Biology, and it is what it is. But being open to the idea in the cash pay field of giving the patient their money back.

You give, you, get, you give, you get. So, what do you want from the patient? I want a release. I want two things. No legal mischief, no online, mechi. 99% of the time, they think that's a pretty good deal. And they'll say yes, and you become a beneficiary of that too. And the reason I say you become a beneficiary if you're seeing a patient 12 times post-op and you see the name on the schedule and your sphincter tightens up because of your nose coming in during the day.

That eats into your longevity, you're going to live a few minutes less the more, more of those experiences that you have. So, in, in a sense, you're paying for longevity and we, I mean, to me, that's the cheapest way to live longer and live well longer. So, yes, you give, you get, it's got to be a nice crisp release.

And a good release is typically five pages long and, and we, we have those available. Something you can also. If you could potentially have the patient seen by a colleague of yours that you trust. If you think the patient is not malignant and they're a reasonable human being, but you believe, or both of you believe that the trust that is necessary in a good doctor-patient relationship is gone, you can offer to say, look, I know that our relationship.

As good as it could or should be. But I'm open to sending you to somebody that I trust and I'm hoping you'll trust him or her too. And I, I can get you on their schedule, you know, to be seen as s a P. That often also helped. Now, they may say, any friend of yours is an enemy of mine, and they don't want to see that person.

But by and large, you. You're coming up with potential solutions, you're solving a problem here. Can always fall back and giving the money back. But sometimes if you can kind of keep it in the fold with people that you know and trust every, you become a beneficiary of that, and hopefully it solves their problem and they're happy to.

Catherine Maley, MBA: So, what about arbitration? Because I think egos get involved and it gets overblown and a third party that could smooth things out makes sense to me. When do you, how does all that work? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: The arbitration? Okay. So, there are a couple ways to think about this. One is, I'll call it informal mediation and then arbitration.

Let me explain the difference. So, sometimes the love is lost that the doctor and patient really do not want to talk to each other any longer. They don't like each other. It's a bad marriage and they need to divorce, but they need to separate amicably. So, sometimes hiring an attorney like me, because I will do this, I will reach out to the patient.

I'm not formally mediating. I do represent the doctor, and I do tell them that, but I'm a person who will actually listened and validate what is obvious. I mean, if a patient had an infection and they had an unexpected complication, I'll just acknowledge the obvious they're unhappy with how this turned out.

Why would, why wouldn't, why would they be happy with that? I mean, it makes no sense to, to perceive otherwise, and hopefully we can negotiate a detant a way out. Perhaps how to give the patient summer all of their money back. Or we even had it where the doctor will donate to a charity so, that something good comes out of this instead.

So, there are a thousand ways to come to an amicable resolution. So, that's that one bucket. The other bucket, arbitration is more formal. Arbitration is an alternative to court. Arbitration is alternative to court. So, why do I like arbitration? A court is, so, what is arbitration? Arbitration is. The sides agree to resolve their dispute informally in a private setting, typically with a retired judge, and it'll be private and binding.

It'll be private and binding. So, why do I like that? Well, to resolve a case in the normal system in a court, it's public. Everybody can see it. They can read everything. And when you're dealing with an aesthetic case, I mean everybody benefits by this being private, at least I think they do. It's faster, typically because it's less formal, typically costs less, not always, but typically it's less expensive to go through.

And it's binding, meaning that you can't appeal it. So, when the decisions in the decision's in with court, you never know when it ends because you can certainly appeal it and there could be no end to this stuff, at least, you know, no conceivable and to the process. So, I'm a big fan of arbitration and while I, it clearly benefits the physician, the doctor, the provider.

I also think it benefits the patient. I think everybody benefits from this.

Catherine Maley, MBA: So, let's say the patient wants to, let's just talk about reviews, because reviews are going to be the being of every plastic surgeon's existence. And I, I feel for them because nowhere else on the planet can you complain about somebody with no recourse at all.

And the doctor. You haven't? I don't know. It's just, it's so, unfair. Because most of the time the surgeon is not, their intent is fine. They have no ill intent. And you're getting bashed online for things you can't fix. You can't get it down. You can't. Although just recently on the West coast there's a federal lawsuit against a surgeon who was filling around with the reviews.

And I hear this a. Either they're having their staff write good reviews or bad reviews for the competitors, or they're paying right the reviews for all unnecessary… How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Here's the deal. Here's how I would do it. Look, if you're a high performing practice doing great work, there are ways to get honest reviews and they're mostly going to be positive from your patients.

But don't filter reviews. It's called review getting. Have as many patients as you're possible, participate in the process, have it so, that it's done at the point of service. I'm making a plug. Our organization does this stuff with the merit. We're not the only one that does it. But aggregating reviews from your patients, not filtering them, not getting them, you will be perceived for the most part, for what you are as long as you get them up there.

You will get an occasional negative review. It's inevitable everybody gets it. As I told you earlier, having an occasional negative review is actually better than no negative reviews as much as you.

Catherine Maley, MBA: I tell doctors this all the time. I say your three hundred and thirty-six five-star reviews. Is so, inauthentic.

I wouldn't trust that at all. How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: So, plus, who's going to read 336 reviews? People read 10, 15 reviews. They may ask to read the lowest one. Great, get to the lowest one, and then see if there's a HIPAA compliant response. Did the doctor or the provider take the high ground? Did they try to solve a problem? Do they look to be reasonable?

Why the patient is trying to identify if they become the complainer, will their problem be solved? And that's all they're looking for. They're looking for insurance or reassurance and typically it's, you can provide it, you can solve that problem.

Catherine Maley, MBA: Yeah, well a lot of times too because we patients, we love to look at the one-star review and see what happened.

And a lot of times that one star is so, chaotic you can tell it's not a balanced. Person who's writing that review. So, that's handy. But otherwise, if the reviews are just, he made me wait forever like, I hope that's your worst review. Like, he was so, busy. He, you know, I got two minutes with him.

Like, that's a, that's still a really good review. How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: It is because how does it get positioned? So, if he made me wait, it means, look, I spent as much time as needed with a particular patient and after the patient before. Had a crisis or had additional questions. I gave them the benefit of the doubt. I gave them extra time, just like I'll give to you.

If you become that patient, you turn a negative into a positive. If You know, if they say you only spent 10 minutes or not enough time, you go the, the, the, the subtext is that you're so, many people want you, you're in demand. The public must know how great you are. So, not all of these are really bad. I think the things that are manageable, if there are money issues, you just.

Put down a statement, which is our patients sign off on the expected amount they will pay in advance. And if there's if there's a disagreement, they'd they need to do little more than come to our office and we'll fix it. I mean, it's, it's the type of thing. If it's in writing, you're just honoring what's in writing.

It is what it is. I think if they're just unhappy, and I said, Segal's a butcher. Yeah. There's only so, much you can do with that, but. You know, if the patient, for example, had an infection you turn a negative into a positive, you say something to the effect of the infection rate for this particular procedure is, 2%.

In our practice it's 1%, so, it's less than the national average. However, patients are not statistics. A patient either experiences an infection or doesn't, a hundred percent or 0%, but regardless, we'll stand by our patients and try and fix them until they're satisfied, something like that. And so, what have you done with that?

You're basically. Acknowledging the obvious that infections do happen, that in your practice it's lower than the national average. And number three, you'll do your best to try and make it right. That's per that's a great answer, by the way. And by the way, There's no violation of HIPAA in the way I just described it.

Catherine Maley, MBA: Mm-hmm. You know the big ones that end up usually on TV or something, it's when the doctor didn't respond they told them they'll be fine. We'll they'll be fine. Just get some rest and days go by and then it becomes a very big issue. So, a lot of this can be prevented, but what's the, what's the most frivolous and the least frivolous?

Do you have any like, like extreme example? How does this tie in with reputation management?

Jeffrey J. Segal, MD, JD: Oh my God, for the most frivolous, there's so, much attention to that. My, here's my favorite case with the frivolous lawsuit, and it's not an aesthetic case. Okay. But hopefully you'll bear with me. So, a. I believe in this case it was a urologist and a small town performed a vasectomy on a particular patient.

And a year later, the patient's wife became pregnant. Okay? A year later, the patient's wife became pregnant. The male comes back and is livid, is saying that the vasectomy didn't work. Now, by the way, the postoperative sperm count was zero, and in rare cases it does happen where the, the vast deference, which is tied off and cut.

Come back together. It, it does happen. But that's not what happened here. What happened here is that they lived in a small town and everybody knew that the patient's wife who got pregnant had a lover on the side. So, this was a lawsuit, and until they were able to get a paternity test to demonstrate it wasn't his child.

This was a, this was a lawsuit and I would argue a frivolous lawsuit. So, that's one of my favorite cases. I, I typically ask the audience if they have a hypothesis as to how this might have happened. You know, when the. Patient's wife became pregnant after he had a vasectomy. Is there a hypothesis as to how this could potentially have happened?

I can't believe she let it go that far. Oh, I know. and it was a small town and basically the doctor said to everybody in the town who knew she was seeing, you know, there was no mystery here. And we, but they, I guess the patient, the husband was the last to know here in terms of. Least frivolous cases. Look, if a patient has a complication, that's an unexpected outcome for them.

And to them, that's a big deal. I think one thing to pay attention to is this, that much of the aesthetic world is cash pay. And if you've got a Blue Cross policy, they exclude cosmetic procedures. So, what happens if the patient ends up getting a local infection? What if the patient gets a local hematoma?

It depends. Blue Cross may not pick up the tab for that. So, if the patient has an urgent problem goes to the er, they may or may not pick up a tab. I will tell you we had one client. I would say this wasn't pretty decent outcome. The patient was operated on, I think in Southern California and then went up to Washington State and developed post-op day number three, four, developed a hematoma, breast hematoma.

And so, the doctor says, look, just go to the er, just get it taken care of. She goes to the ER, phone call, doctor comes in, finds a hematoma, removes it done under general anesthesia. Blue Cross would not pay for it. They basically said, this is a complication of a procedure that we don't. We're not covering it.

But interestingly enough, this the anesthesiologist or the surgeon did a pregnancy test on the patient just to dot all their eyes and cross the T's and to everybody's shock, it was positive. So, the patient was pregnant I guess newly pregnant at the time she was going to be put to sleep. So, the argument that we made was.

Because they wouldn't pay the anesthesia bill. So, the argument was that, well, look, they weren't just taking care of mom, they were taking care of the baby. Anesthesiologists were taking care of the embryo or the fetus, and they accepted that appeal. So, they, they bought it, meaning that there are ways to do it.

And in addition, if the patient has a systemic illness like sepsis or a pneumothorax, Something that's potentially life-threatening. Typically, on appeal, they will pay for it. But be careful. If somebody has just a local infection and they are sent to the ER and now the I C U and they've got tens of thousands of dollars, this could be a potential challenge.

So, I, I tell people, look, if people are spending their last. On a particular procedure and they truly don't have the resources to weather a potential storm, just be careful because they're going to be looking you to make that payment. You know, if they can't, otherwise they'll have to file for bankruptcy.

Catherine Maley, MBA: For sure. Well, we're going to wrap it up. I don't know how you're a lawyer. I was going to be a lawyer for about a minute and I realized how negative it all is. Like you have to live in that mindset of what could go wrong. And I didn't. So, I went into marketing instead. I thought that was a lot more positive and fun.

But good, you know, you're probably doing God's work there. So, good for you.

Jeffrey J. Segal, MD, JD: I try to maintain a sunny disposition. So, my, my feeling broadly is that I'm here to solve a problem. Not to say no. Good for you. I typically say my feeling is ye, so, I, I have two ways of saying something. I could say no because, or yes.

If no, because, or yes. If I try to say yes, if more often than not.

Catherine Maley, MBA: Good for you though. Good mindset. So, how can others get ahold of you if they do have a little issue and they'd like your 2 cents out?

Jeffrey J. Segal, MD, JD: I'll give you my email address, so, it's [email protected] and my office phone number is (336) 691-1286, and you can just look us up. at medicaljustice.com. It's one-word medicaljustice.com. We've been at this now for over two decades. Every time I think we've seen it all, I'm proven wrong, but we have worked with over 11,000 practices across the country over two decades, and lots of problems to solve.

Lots of conflicts, but the good news is most of the time things go smooth.

Catherine Maley, MBA: Oh, that's all. That's a lot of problems to solve there. 11,000. Holy cow. But thank you so, much. I appreciate your time, and I will see you at a conference coming up soon, I'm sure. And everybody, thanks for joining us. And if you haven't already, please subscribe to Beauty and the Biz and share this with your staff and colleagues and anyone else who's interested in the frivolous lawsuits because they're going to happen.

They're just going to happen, period.

Everybody that's going to wrap it up for us today, a Beauty and the Biz and this episode on reputation management.

If you've got any questions or feedback for Jeffrey J. Segal, MD, JD, you can reach out to his website at, www.ByrdAdatto.com.

A big thanks to Jeffrey J. Segal, MD, JD for sharing his tips on reputation management.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you've enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don't miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

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-End transcript for "Reputation Management — with Jeffrey J. Segal, MD, JD".

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