The Business of Plastic Surgery: Navigating a Successful Career

The Business of Plastic Surgery
Title Page
Copyright
Dedication
Contents
Preface to the 2nd Edition
From the Preface to the 1st Edition (2010)
Contributors
Part I Career Direction
	1 Beginnings
		1.1 Plastic Surgery: What Is It?
		1.2 Am I a Good Fit for Plastic Surgery?
			1.2.1 Traits that Make a Good Plastic Surgeon
		1.3 Path to a Career in Plastic Surgery
			1.3.1 How to Get into Medical School
			1.3.2 How Can a Medical Student Prepare for Career in Plastic Surgery
			1.3.3 Plastic Surgery Residency Paths
			1.3.4 Interview Process
			1.3.5 Plastic Surgery Fellowship
			1.3.6 Becoming Certified by the American Board of Plastic Surgery
		1.4 Foreign Medical Graduates
	2 The Job Search
		2.1 Introduction
		2.2 Priorities
		2.3 Choosing a Practice
			2.3.1 Government
			2.3.2 Academics
			2.3.3 Multispecialty Groups and Large Healthcare Organizations
			2.3.4 Single-Specialty Group
			2.3.5 Solo Practice
		2.4 Types of Positions
		2.5 Recruitment Firms aka “Head Hunters”
		2.6 When Should I Start Looking for a Job?
		2.7 How Do I Find Jobs?
		2.8 Should I Do a Fellowship First?
		2.9 Need
		2.10 Income
		2.11 Selling Yourself
		2.12 Show Me the Money
		2.13 Respect
		2.14 Contracts
		2.15 Getting Started
		2.16 Unrest
		2.17 Boards
		2.18 What If It Does Not Work Out?
		2.19 Conclusions
	3 Academic Career
		3.1 Introduction
		3.2 Choosing an Academic Career
		3.3 Different Models for Academic Plastic Surgery
		3.4 Compensation
		3.5 Institutional Structure
		3.6 Academic Advancement
		3.7 Getting a Job
		3.8 Summary
	4 Solo Practice
		4.1 Introduction
		4.2 Evolving Vantage Points from Residency through Practice
		4.3 Location
		4.4 Is Solo Practice for You?
		4.5 Elements of a Solo Practice
			4.5.1 Entrepreneurship
			4.5.2 Independence and Responsibility
			4.5.3 You are the Boss
			4.5.4 Writing a Business Plan
			4.5.5 Networking
			4.5.6 Hospital and Emergency Call
			4.5.7 Family and/or Hobby Time
			4.5.8 Developing a Practice
			4.5.9 Staff
			4.5.10 Billing
			4.5.11 Relationships and Referrals
			4.5.12 Location
			4.5.13 Small-Group Practice
			4.5.14 Hiring Staff
			4.5.15 Your Practice Culture Begins with You
			4.5.16 Financial Aspects of Your Practice
			4.5.17 How to Run a Meeting
		4.6 Monitoring Your Practice
		4.7 Marketing
		4.8 Conclusion
		4.9 Appendices
			4.9.1 Appendix 4A
			4.9.2 Appendix 4B
	5 Group Practice
		5.1 Introduction
		5.2 Advantages of Group Practice
		5.3 Disadvantages of Group Practice
		5.4 Why a Group Practice Adds a Partner
		5.5 Finding a Group Practice
		5.6 The Working Interview
		5.7 The Associate Physician versus the Employed Physician
		5.8 The Seven Principles of an Offer
			5.8.1 Salary
			5.8.2 Workload
			5.8.3 Buy-in Provisions
			5.8.4 Purchase of Other Assets and Basic Furnishings
			5.8.5 Benefits
			5.8.6 Buy-out
			5.8.7 Management
		5.9 The Contract
			5.9.1 Expenses
			5.9.2 Profit Center Profits: Medical Spa
			5.9.3 Office Space Expense and Building Ownership
			5.9.4 Payment Processing Expense
			5.9.5 Capital Expenditures
			5.9.6 Utilization of Practice Resources
			5.9.7 Governance
		5.10 Patient Referrals
		5.11 Conclusion
		5.12 Appendices
			5.12.1 Appendix 5A
			5.12.2 Appendix 5B
			5.12.3 Appendix 5C
			5.12.4 Appendix 5D
			5.12.5 Appendix 5E
			5.12.6 Appendix 5F
	6 Transitions
		6.1 Part I: Adjusting the Tiller Early- and Mid-Career
		6.2 Part II: Transitioning into Retirement
Part II Marketing and Monitoring
	7 How to Get the Media’s Attention
		7.1 Learning the Basics
			7.1.1 How Do I Prepare to Go on TV?
			7.1.2 Should I Always Say “Yes” to Being in the Media? When Should I Say No?
			7.1.3 Can Being in the Media Hurt Me?
			7.1.4 What Not to Do
			7.1.5 Do I Need to Keep Up Media Appearances Long Term?
			7.1.6 What Do I Do If I have been Misquoted by a Reporter in a Way that Makes Me Look Bad?
			7.1.7 Social Media
		7.2 Making Connections
			7.2.1 How Do I Hire a PR Agent?
			7.2.2 What to Know about Speaking to a Reporter for Print, Radio, and TV
			7.2.3 Contacting People with TV Shows and Journalists and Creating Your Own Opportunities to Get into the Mainstream Media
			7.2.4 Preparing to Go on Radio
	8 The Wonderful World of Marketing
		8.1 Introduction
		8.2 Who Are You?
		8.3 Create Value
			8.3.1 Types of Value
		8.4 Communication
		8.5 Unique Selling Proposition
		8.6 Who Is Your Target Audience?
		8.7 Customer Experience
		8.8 Engage with Your Target Audience
		8.9 Branding
		8.10 Writing Good Content
		8.11 Blogs
		8.12 Social Media
		8.13 Marketing Campaign
		8.14 Editorial Calendar
		8.15 Other Marketing Ideas
		8.16 Events
			8.16.1 Virtual (Online) Events
		8.17 Appendices
			8.17.1 Appendix 8A
			8.17.2 Appendix 8B
		9 Optimizing Your Practice
			9.1 Introduction
			9.2 Optimizing Practice Surgery Conversion
				9.2.1 Sales is Service, Service is Sales
				9.2.2 Creating Three Dates
			9.3 Optimizing Lead Efficiency
				9.3.1 The Data
				9.3.2 Reaching Out and Leaving Messages
				9.3.3 Keeping Track of Patients
			9.4 Tracking Your Success: Are You Truly Optimized?
				9.4.1 What Metrics Matter
				9.4.2 Motivating Staff
			9.5 Summary
	10 Upping Your Game with Systems
		10.1 Introduction
		10.2 The Organization and Systems
		10.3 Thermodynamics and Practice Management
		10.4 Operational Systems in Practice Management
			10.4.1 Patient Intake and Handling
			10.4.2 Surgery Deposits and Prepayment
			10.4.3 Revision Policy
			10.4.4 Financial Controls
			10.4.5 Practice Finance
			10.4.6 Human Resource Systems
		10.5 Appendix 10A
	11 Saving Money
		11.1 Introduction
		11.2 Ways of Saving Money
			11.2.1 Preventing Mistakes
			11.2.2 Track Your Expenses on a Monthly Basis
			11.2.3 Join a Group Purchasing Organization
			11.2.4 Medical, Surgical, and Office Supplies
			11.2.5 Utilize Marketing Efforts that are Already Available to You
			11.2.6 Build Relationships with Your Vendors
			11.2.7 Know Where in Your Patient Cycle Your Practice is Losing Money
		11.3 How to Make a New Piece of Equipment Profitable
Part III Internet University
	12 Website Optimization
		12.1 Introduction
		12.2 Hosting of the Website
			12.2.1 Speed of the Website (Load Time)
			12.2.2 Secure Socket Layer Encryption
			12.2.3 XML Sitemaps
			12.2.4 The 301 Redirect
		12.3 Design
			12.3.1 Responsive Design
			12.3.2 Mobile-Friendly Ranking
			12.3.3 Bounce Rate
			12.3.4 Conversion Rate Optimization
			12.3.5 Accelerated Mobile Pages
		12.4 Content
			12.4.1 Google Panda Algorithm Update
			12.4.2 Structuring a Page
		12.5 Schema Markup
			12.5.1 Search Engine Result Page Optimization
		12.6 Links
			12.6.1 PageRank Algorithm
			12.6.2 Paid/Unnatural Links
			12.6.3 Google Penguin Algorithm Update
		12.7 Google Local Business Page
			12.7.1 Local Optimization
			12.7.2 Google Reviews
			12.7.3 Google My Business Posts
		12.8 Conclusion
	13 How to Make and Post Effective Videos
		13.1 How to Make and Post Effective Videos
			13.1.1 Planning Begins with Establishing an Objective
			13.1.2 Your Audience
			13.1.3 Video for Marketing
			13.1.4 Improving Office Efficiency with Videos
			13.1.5 Staff Education
			13.1.6 Setting Goals to Guide Content
			13.1.7 Narrow the Topic
			13.1.8 The Videography Team
			13.1.9 Optimizing Equipment
			13.1.10 Video Duration
			13.1.11 Storyboards
			13.1.12 Scripts
			13.1.13 Title
			13.1.14 Video Consent
			13.1.15 Filming
			13.1.16 Live Videos
			13.1.17 Editing
			13.1.18 Uploading and Posting
			13.1.19 Measuring a Video’s Performance
			13.1.20 Repurposing Videos
			13.1.21 Final Thoughts
		13.2 More on Videos and Social Media
			13.2.1 Length of Video
			13.2.2 Camera, Lighting, and Sound
			13.2.3 Content
			13.2.4 Where Should You Post Your Videos?
			13.2.5 Live, Unedited Video
			13.2.6 How Often to Post Videos
			13.2.7 Managing the Workload
	14 All about Reviews
		14.1 Introduction
		14.2 Factors Other than the Surgeon Can Affect Reviews
		14.3 Step One: Implement a Review Strategy for Consumer Sites
			14.3.1 Asking for a Review
			14.3.2 Fake Reviews
			14.3.3 What to do about Negative Reviews
		14.4 Step Two: Surveying Your Patients to Validate Satisfaction and Improve Practice Performance
			14.4.1 Striving for Five: Focusing Your Team on Creating Memorable Patient Experiences
		14.5 Bringing It All Together: Marketing with Ratings and Reviews
		14.6 When There Is No Choice but to Sue the Patient
		14.7 Final Thoughts
	15 Digital Marketing and Advertising
		15.1 Introduction
		15.2 Developing a Digital Marketing Plan
			15.2.1 Section 1: Executive Summary
			15.2.2 Section 2: Mission Statement
			15.2.3 Section 3: Short-Term Marketing Goals
			15.2.4 Section 4: Long-Term Marketing Goals
			15.2.5 Section 5: Review of Procedures and Services
			15.2.6 Section 6: Buyer Persona Profiles
			15.2.7 Section 7: SWOT Analysis
			15.2.8 Section 8: Competitor Profiles
			15.2.9 Section 9: Sales and Growth Goals
			15.2.10 Section 10: Strategies and Action Plans
			15.2.11 Section 11: Marketing Budget
		15.3 Digital Marketing Budget
		15.4 Building Your Digital Marketing Team
		15.5 Navigating the Whirlwind Internet Environment
		15.6 Marketing Plastic Surgery in a Mobile World
			15.6.1 Mobile Responsive Design versus Mobile-First Design
			15.6.2 Website Design Strategies
		15.7 Leveraging Google Analytics
			15.7.1 Website Design Hints
			15.7.2 SEO-Related Data
			15.7.3 Paid Advertising Insights
		15.8 Choosing the Right Media Makeup
			15.8.1 Hands-on Search Engine Marketing Strategies
			15.8.2 Social Media
		15.9 Stay Current
		15.10 Transitioning and Newly Employed Surgeons
Part IV Enhancing Both Practice and Career
	16 Building and Managing Your Own Surgical Suite
		16.1 Part I: The Process
			16.1.1 Why Develop Your Own Surgical Suite?
			16.1.2 Which Agency to Use for Accreditation?
			16.1.3 Third-Party Reimbursement
			16.1.4 Paperwork Requirements
			16.1.5 Physical Requirements
			16.1.6 State License
			16.1.7 Approval Terms
			16.1.8 Development/Construction Recommendations
			16.1.9 Differences between Accreditation and Medicare-Deemed Status Certification
			16.1.10 Why Be Accredited?
			16.1.11 Tenant Improvements versus Free-Standing Building
			16.1.12 Equipment Considerations
			16.1.13 Construction Preparation
			16.1.14 Time Investment for You
		16.2 Part II: Managing your Surgical Facility
			16.2.1 Growing the Business
			16.2.2 Billing for the OR
			16.2.3 Establishing Insurance and Fee for Service (Cosmetic) Fee Schedules
			16.2.4 Establishing a Legal Entity
			16.2.5 Rewards
			16.2.6 Risks
			16.2.7 Expectations
			16.2.8 Ongoing Accreditation
			16.2.9 Medicare Surveys
		16.3 Summary
	17 Publishing for the Profession and for the Public
		17.1 Introduction
		17.2 Writing for the Profession
			17.2.1 Impact Factor
			17.2.2 Evidence-Based Medicine
			17.2.3 How to Publish?
			17.2.4 Study Design
			17.2.5 Systematic Review and Meta-Analysis
			17.2.6 Randomized Controlled Trials
			17.2.7 Cohort Study
			17.2.8 Case-Control Study and Cross-Sectional Study
			17.2.9 Case Series and Case Reports
			17.2.10 Survey Research
			17.2.11 Patient-Reported Outcome Measures
			17.2.12 Institutional Review Board
			17.2.13 Writing Your Manuscript
			17.2.14 Peer Review
			17.2.15 Delays
			17.2.16 Presenting the Abstract at a Conference
			17.2.17 Open Access Journals
			17.2.18 Predatory and Hijacked Journals
		17.3 Writing for the Public
			17.3.1 Writing for Print and Online Newspapers and Magazines
			17.3.2 Writing a Book
		17.4 Publishing
			17.4.1 An Agent
			17.4.2 Book Proposal
			17.4.3 How Good Is an Agent?
			17.4.4 Rejection
			17.4.5 Acceptance
		17.5 What’s Next?
	18 Technology, Trends, and Traps
		18.1 Introduction
		18.2 Big Data: Measuring What Matters
		18.3 Real-Time Data Analysis
		18.4 Beware of the “Latest Technology”
			18.4.1 Will It be Here 5 Years from Now?
			18.4.2 Facts to Consider before You Purchase
			18.4.3 Predicting the Future
			18.4.4 Should I be One of the First to Buy to Get an Edge on My Colleagues?
			18.4.5 Avoiding a White Elephant in Your Treatment Room
			18.4.6 What Is the Clinical Research that Supports the New Technology?
			18.4.7 Customer Service after You Buy Is of Utmost Importance
			18.4.8 Beware of the Cheaper Version
			18.4.9 “All You Need Are Three New Patients per Month to Cover the Payment”
		18.5 How Do I Pay for an Expensive Machine?
		18.6 Future Trends of the Aesthetic Market: Subscription Services
	19 A Successful Medspa
		19.1 Introduction
		19.2 Starting Out
		19.3 Qualities of a Medspa Space
		19.4 Developing the Infrastructure
			19.4.1 Staff Education
			19.4.2 Patient Safety
		19.5 Keep Track of Your Inventory
		19.6 Long-Term Success
		19.7 Operational Measures
			19.7.1 Financial Performance
		19.8 Clinical Staff Compensation
			19.8.1 Commission versus Performance Bonus?
		19.9 Fixed and Variable Costs
			19.9.1 Buying a Machine
		19.10 Prevent Embezzlement and Losses
			19.10.1 Comped services
			19.10.2 Accounting
		19.11 Medspa or Dayspa?
		19.12 Rightsizing Inventory
		19.13 Customer Satisfaction
			19.13.1 Unhappy Clients
		19.14 Establishing Good Internal Business Processes
		19.15 Human Resources
			19.15.1 Getting the Most Out of Your Employees
			19.15.2 Strategies to Motivate Your Team
			19.15.3 Systems and Protocols
			19.15.4 Training Your Sales Staff
		19.16 Marketing
		19.17 Business Systems
		19.18 Summary
	20 Medical Inventions: From Idea to Funding
		20.1 Introduction
		20.2 Step 1: A Good Idea
		20.3 Step 2: Protecting Your Idea
			20.3.1 Method versus Device Patents
			20.3.2 The Nondisclosure Agreement
		20.4 Step 3: Building a Prototype
		20.5 Step 4: Proof of Principle
			20.5.1 510(k) Premarket Notification
			20.5.2 Investigational Device Exemption
			20.5.3 Premarket Approval
		20.6 Step 5: Getting People to Understand the Value of Your Idea
		20.7 Step 6: Getting Funding
			20.7.1 Your Own Money
			20.7.2 Money from Relatives
			20.7.3 Crowdfunding
			20.7.4 Grant Money
			20.7.5 Small Business Loans and Bank Loans
			20.7.6 Angel Investors
			20.7.7 Venture Capitalists
		20.8 Conclusion
		20.9 Appendices
			20.9.1 Appendix 20A
			20.9.2 Appendix 20B
Part V Watching Your Back
	21 Contracts
		21.1 Introduction
		21.2 Oral Contracts: Not Worth the Paper It Is Written On
		21.3 Chart on the Life Cycle of a Plastic Surgeon’s Practice
		21.4 Preliminary Considerations for all Contracts
			21.4.1 Scenario 1
			21.4.2 Scenario 2
		21.5 Due Diligence
		21.6 Letter of Intent
		21.7 Authority Does Matter
		21.8 Medical Practice Relationships
		21.9 Medical Practice Relationship: Academic Relationship
		21.10 Medical Practice Relationship: Hospital Relationship
			21.10.1 Purpose of a Recruitment Agreement
			21.10.2 Benefits of a Recruitment Agreement
			21.10.3 What Is Income Guarantee?
			21.10.4 What Are the Hospital’s Obligations in a Recruitment Agreement?
			21.10.5 What Are the Physician’s Obligations in a Recruitment Agreement?
			21.10.6 Hospital Employment Agreement
		21.11 Medical Practice Relationship: Private Practice Relationship
			21.11.1 Collections versus Billing
			21.11.2 Compensation
			21.11.3 Considerations in Private Practice Employment Agreement
			21.11.4 Considerations outside the Private Practice Employment Agreement
		21.12 Medical Practice Relationship: Independent Contractor Relationship
		21.13 Medical Practice Relationship: Partner Relationship
			21.13.1 Cost
			21.13.2 Compensation
			21.13.3 Control
			21.13.4 Contingencies
		21.14 Staff Relationships
		21.15 Patient Relationships
	22 The Wheel of Misfortune: Managing Medical Liability in Plastic Surgery
		22.1 Part I: Avoiding Litigation
			22.1.1 Standard of Care
			22.1.2 Warranty
			22.1.3 Informed Consent
			22.1.4 Patient Selection
			22.1.5 An Ounce of Prevention
			22.1.6 Effective Communication as a Claims-Prevention Technique
			22.1.7 Anger: A Root Cause of Malpractice Claims
			22.1.8 General Guidelines
			22.1.9 Common Errors of Commission and Omission
			22.1.10 The Patient’s Records
		22.2 Instructions to Patients and Personnel
		22.3 Part II: Managing a Possible, Impending, or Verified Malpractice Claim
			22.3.1 Steps to Manage
			22.3.2 Why Not to Countersue
			22.3.3 Other Areas of Liability Exposure
	23 Building and Protecting Your Wealth: In Three Acts
		23.1 Act I: Financial Focus for Young Physicians: “First, Build Your Foundation”
			23.1.1 Young Physicians’ Greatest Asset: Future Value of Income
			23.1.2 The Need for Disability Insurance
			23.1.3 Employer-Provided Coverage Is Often Inadequate
			23.1.4 Getting the Best Insurance Coverage for the Money: Personal Disability Coverage
			23.1.5 Protecting Future Income for Dependents: Life Insurance
			23.1.6 You Refinance Your Mortgage When Rates Go Down… Did You Know You Can Do the Same for Your Life Insurance?
			23.1.7 Protecting Assets from Potential Liability
			23.1.8 Baseline of Asset Protection: The Mixed Blessing of Property and Casualty Insurance
			23.1.9 The Sliding Scale of Asset Protection
			23.1.10 Important Planning Ground Rule: Fraudulent Transfer/Voidable Transaction Laws
			23.1.11 Exempt Assets: The “Best” Asset Protection Tools
			23.1.12 Beyond Exempt Assets: Family Limited Partnerships and Limited Liability Companies
			23.1.13 Using Trusts to Protect Assets
			23.1.14 Special Topic: Divorce Protection
		23.2 Act II: Two Common Mistakes Plastic Surgeons Make with Their Finances and How to Avoid Them
			23.2.1 Being Human: Succumbing to Fear or Greed
			23.2.2 Bad Advice: Failing to Get Quality, Unconflicted Investment Advice
		23.3 Act III: Retirement Planning: Three Long-Term Planning and Preretirement Tactics to Consider
			23.3.1 Treat Your Retirement Like a Patient: Have a Plan and Monitor It
			23.3.2 Build Flexibility throughout Your Plan
			23.3.3 Do Not Expect a Practice Exit without Advance Planning
		23.4 Conclusion
	24 Taking Control of Your Life
		24.1 Introduction
		24.2 Burnout: A Normal Response
		24.3 Impact on Patient Care
		24.4 Stress versus Burnout
			24.4.1 The Practice of Medicine
			24.4.2 Your Specific Job
			24.4.3 Our Medical Education
			24.4.4 Personal Life
		24.5 Symptoms of Burnout
		24.6 Possible Outcomes
		24.7 Higher Burnout Rate among Women
		24.8 Work–Life Balance
		24.9 The Role of Money in Burnout
		24.10 Solutions to Burnout
			24.10.1 Electronic Health Records
			24.10.2 Improving Physician Autonomy
			24.10.3 Compassionate Leadership
			24.10.4 Improving Collegiality
			24.10.5 Wellness Officers
			24.10.6 Maternity, Breastfeeding, and Childcare Support
			24.10.7 Accepting that You Are Not Indispensable
			24.10.8 Achieving Work–Life Balance
			24.10.9 Communicate and Delegate
			24.10.10 Managing Up
			24.10.11 Institutional Relief
		24.11 Recovery
			24.11.1 Get a Financial Education
			24.11.2 Describe Your Ideal Practice
			24.11.3 Reducing Stress
			24.11.4 Work–Life Balance
			24.11.5 Remove Guilt
		24.12 Final Words
	25 The Changing Face of Plastic Surgery
		25.1 Introduction
		25.2 Panel Discussion
		25.3 Stories from Our Midst
Index