The Business of Plastic Surgery: Navigating a Successful Career

Contents......Page 10
Preface......Page 8
List of Contributors......Page 14
Part I: Career Directions......Page 20
Introduction......Page 22
Priorities......Page 23
The Search......Page 25
Recruitment Firms......Page 26
Types of Positions......Page 27
Government......Page 28
Academics......Page 29
Multi-specialty group......Page 31
Single-specialty group......Page 32
Solo practice......Page 33
Income......Page 34
Taxable income......Page 35
Selling Yourself......Page 37
Show me the money......Page 39
Contracts......Page 40
Getting Started......Page 42
Unrest......Page 44
References......Page 45
Introduction......Page 48
Choosing an Academic Career......Page 50
Different Models for Academic Plastic Surgery......Page 51
Problems......Page 52
Getting a Job......Page 54
Summary......Page 55
3. Solo Practice Joshua M. Korman and Heather J. Furnas......Page 58
You’re the Boss......Page 59
Networking......Page 60
Hospital......Page 61
Developing a Practice......Page 64
Staff......Page 65
Relationships and Referrals......Page 66
Appendix A: Business Plan Outline......Page 67
4. The Combined Reconstructive and Cosmetic Surgery Practice Joseph M. Mlakar......Page 70
Developing a Mixed Practice: Schedule Management......Page 73
Making Money in a Combined Cosmetic/Reconstructive Practice......Page 78
Avoiding Fraud......Page 81
Making Reconstructive Surgery More Profitable......Page 84
Managing Emergency Room Coverage......Page 86
Avoiding Practice Burnout......Page 87
Surgery trends......Page 90
Why a reconstructive practice?......Page 91
Predictions......Page 92
Hourly rates......Page 93
Self-worth......Page 94
Practice Analysis......Page 95
Non-participation......Page 98
Carve-outs......Page 99
Efficiency......Page 100
Paperwork......Page 101
Conclusion......Page 102
Coding......Page 103
Back-end billing......Page 105
Summary......Page 106
References......Page 107
6. Pursuing a Career at Kaiser Permanente Robert Pearl......Page 108
7. Group Practice in Plastic Surgery Debra J. Johnson......Page 116
Finding a Group Practice......Page 117
Contracts......Page 118
Dividing Expenses......Page 119
Buying In to a Group Practice......Page 120
Owning or Renting Office Space......Page 121
Medical Malpractice Insurance......Page 122
How to Administrate a Group......Page 123
Conclusion......Page 124
Appendix A: Employment Agreement......Page 125
Appendix B: Buy-In Agreement......Page 127
Part II: Marketing and Monitoring......Page 128
8. Internal and External Marketing and Public Relations Anne Cohen......Page 130
Rule #1: Effective Marketing Follows a Marketing Plan to Avoid Waste of Time and Money......Page 132
Rule #2: Marketing Must be Consistent......Page 133
Rule #3: Each Marketing Plan is Unique......Page 134
What do you have to offer?......Page 135
USP based on procedure......Page 138
USP based on a unique, otherwise-underserved subset group......Page 139
Who are the competitors offering similar services?......Page 140
Internal Marketing bridges......Page 141
Patient-owned Marketing bridges......Page 142
Branding is based on consistency......Page 143
Thoughts about logo development......Page 144
Tips on taglines......Page 145
Other basic collateral for your practice......Page 146
In-office signage......Page 147
Rule #2: Advertising must evoke an emotion to create an impression......Page 148
Print advertising......Page 149
Radio advertising......Page 150
Push vs. Pull Technology......Page 151
Internal Marketing: What it is and Why You Need it......Page 152
How about a Patient Appreciation Day for current and past patients?......Page 154
How about friends and family referral cards?......Page 155
External Marketing: Finding New Patients......Page 156
Cross-channel affiliates (CCAs)......Page 157
Non-profit involvement......Page 158
What is PR?......Page 159
As a rule, it is generally easier to get newspaper exposure than television exposure......Page 160
Media relationships must be cultivated in order to obtain coverage......Page 161
Booked for a TV interview? These top 60 media tips can help!......Page 162
Marketing is Essential in Building Your Practice......Page 167
9. Online Marketing Ryan Miller......Page 168
Define Clear and Actionable Objectives......Page 169
Select an Experienced and Reliable Vendor......Page 170
Understand the Impact of “Optimization”......Page 172
Research your keyword phrases......Page 174
Select your domain name......Page 175
Specify the architecture and the function......Page 176
Design and build......Page 177
Test and release......Page 178
Web site management......Page 180
Web customer service......Page 181
Local marketing......Page 183
Pay per click......Page 184
Social media......Page 185
Demand results, track everything, and stay involved......Page 186
Reference......Page 187
10. Optimizing Your Practice Marie B. V. Olesen......Page 188
Getting from Here to There......Page 189
Getting the Data You Need to Make Things Better......Page 192
Segmenting Customer Relationships......Page 193
Understanding the customer relationship life cycle......Page 194
Learning to listen by tracking decision points......Page 196
Using Metrics to Manage Your Practice......Page 199
Applying metrics to patient relationships (and revenue)......Page 200
Using best practice data to evaluate your practice......Page 202
Dealing with a problematic stage issue — no-shows......Page 204
Taking advantage of a positive stage issue — surgery scheduling......Page 206
Adding metrics-driven processes to your practice......Page 208
Focusing on What is Most Important......Page 210
Using Key Performance Indicators (KPIs) in Your Practice......Page 212
Creating the Future You Want......Page 213
Glossary......Page 215
The Organization and Systems......Page 218
Thermodynamics and Practice Management......Page 219
Handling phone calls......Page 220
Appointments/Templates......Page 222
New patient paperwork......Page 224
The Consult......Page 226
Surgery Deposits and Prepayment......Page 228
Practice finance......Page 229
The flow of money......Page 232
Applications and interviewing......Page 234
Did they make their bed this morning?......Page 235
References......Page 236
Hiring and training......Page 237
Discipline and terminations......Page 238
Inventory Controls......Page 240
A special word about injectable inventories......Page 241
Part III: Enhancing Both Practice and Career......Page 246
Why Develop Your Own Surgical Suite?......Page 248
Third-party reimbursement......Page 249
Paperwork requirements......Page 252
Physical requirements......Page 253
State License......Page 256
Development/Construction Recommendations......Page 257
Physical requirements for a Medicare surgery center......Page 258
Risk management......Page 262
Reimbur$ement......Page 263
Growing the Business......Page 264
Construction Preparation......Page 266
Choosing the Key Players......Page 267
Timeline and Milestones......Page 270
Time Investment for You......Page 272
Billing for the OR Should I?......Page 273
Ongoing Accreditation......Page 274
Summary......Page 275
Introduction......Page 278
How to Publish?......Page 280
Where to Publish?......Page 284
Who Should Publish and When?......Page 287
What to Publish?......Page 289
Why Publish?......Page 292
Conclusion......Page 293
References......Page 294
14. Technology, Toys, and Traps Francisco Canales......Page 296
Will It Be Here Five Years from Now?......Page 297
Predicting the Future......Page 298
Should I Be One of the First to Buy to Get an Edge on My Colleagues?......Page 299
What is the Clinical Research that Supports the New Technology?......Page 300
Customer Service After You Buy is of Utmost Importance......Page 301
“All You Need is Three New Patients per Month to Cover the Payment”......Page 302
How Do I Pay for an Expensive Machine?......Page 306
15. A Medspa: To Have or Not to Have M. Dean Vistnes and Lynn Heublein......Page 308
The Experience......Page 313
Location......Page 314
Employees and Staffing......Page 315
Procedures......Page 317
Equipment......Page 318
Should You Have a Medspa?......Page 320
Step 1: A Good Idea......Page 322
Method vs. device patents......Page 323
Step 3: Building a Prototype......Page 324
Step 4: Proof of Principle......Page 325
510(k) Pre-market Notification......Page 326
Pre-market Approval (PMA)......Page 327
Money from relatives......Page 328
Angel investors......Page 329
Venture capitalists......Page 330
References......Page 331
Appendix A: Mutual Nondisclosure Agreement......Page 332
Appendix B: Nondisclosure Agreement......Page 335
Part IV: Watching Your Back......Page 340
Entity Contracts......Page 342
Financial matters......Page 343
Governance......Page 344
Exit strategies......Page 345
Covenants not to compete......Page 346
Medical practices vs. ambulatory surgery centers......Page 347
Employment contracts......Page 348
Independent contractor agreements......Page 351
Outsourcing Administration: Management, Billing, and Marketing Agreements......Page 352
Sharing Space with Other Physicians: Overhead Sharing Agreements......Page 355
Managed Care and Insurance Contracts......Page 356
Amendment......Page 357
Dispute resolution......Page 358
Renegotiating a Contract......Page 359
Stark Law......Page 360
The Anti-Kickback Law......Page 361
General Considerations......Page 364
Warranty......Page 365
Informed Consent......Page 366
Patient Selection......Page 367
The immature patient......Page 368
Failure to establish rapport......Page 369
An Ounce of Prevention......Page 370
Listening......Page 371
Listening with your eyes......Page 372
Requesting written questions......Page 373
The normal psychodynamics of patients’ anger......Page 374
General Guidelines......Page 375
Common Errors of Commission and Omission......Page 376
The Patient’s Records......Page 377
Instructions to Patients and Personnel......Page 378
Conclusion......Page 379
19. Use of the Internet by Patients: How It Affects Your Practice and What to Do About It Ronald P. Gruber......Page 382
The Problem......Page 383
Why it is a problem......Page 385
Reviewing site’s perspective......Page 386
The legal hurdle......Page 387
Legal recourses......Page 388
The medical justice agreement......Page 389
Short pre-op agreements......Page 390
Consider contacting the patient......Page 391
Legal choices......Page 392
Ranting patients may be violating HIPAA regulations......Page 393
Introduction......Page 396
What is Stress?......Page 397
Unique Stresses of the Physician......Page 400
Unique personality patterns of the physician......Page 401
The mismatch......Page 402
Resistance to Dealing with Stress......Page 403
How personality patterns maintain high levels of stress......Page 404
Making a Commitment......Page 405
Resilience: A Positive Approach to Stress......Page 406
Relationship......Page 407
Organismic balance and mastery......Page 410
Process: how we engage with the world......Page 413
References......Page 415
21. The Challenges for Women in Plastic Surgery Debra J. Johnson, Cissy Tan, Cristina F. Keusch, Sarah Troxel and Heather J. Furnas......Page 418
Debra J. Johnson, MD, FACS, Sacramento, California......Page 419
Cissy Tan, MD, San Diego, California......Page 421
Cristina F. Keusch, MD, Boca Raton, Florida......Page 423
Sarah Troxel, MD, Anchorage, Alaska......Page 425
Heather J. Furnas, MD, Santa Rosa, California......Page 428
References......Page 431
Part V: Retirement and Protecting Your Assets......Page 434
Homestead......Page 436
Downsides to exemption planning......Page 437
Transmutation agreements......Page 438
LPs and LLCs vs. corporations......Page 439
Family limited partnership......Page 440
S corporations......Page 441
Trust Planning......Page 442
Self-settled spendthrift trusts......Page 443
Domestic asset protection trusts......Page 444
The BETIR trust......Page 445
Equipment leasing company......Page 446
Captive insurance company......Page 447
Offshore Planning......Page 448
Offshore bank accounts......Page 449
Offshore limited liability company......Page 450
Summary......Page 451
Auto Insurance......Page 454
Bodily injury liability......Page 455
Dwelling coverage......Page 456
Liability coverage......Page 457
Your health is your wealth......Page 458
The odds of becoming disabled......Page 459
How much can you purchase?......Page 460
What to look for in a policy......Page 461
Cost of living adjustment (COLA) rider......Page 462
Disability insurance for retirement contributions......Page 463
Disability buy-out insurance......Page 464
Term life......Page 465
Whole life......Page 466
Universal life......Page 467
Comparison of types of life insurance Should you consider an irrevocable life insurance trust?......Page 468
Funding the ILIT......Page 471
The three-year (“contemplation of death”) rule......Page 472
Defining your investment goals and objectives......Page 473
Designing an investment portfolio......Page 474
Stocks......Page 475
Evaluating markets and investments......Page 476
Rebalancing or redesigning the portfolio, if needed......Page 477
Figure out how much you will need to save......Page 478
Investment risk......Page 479
Long-term care expenses......Page 480
Costs of catastrophic care......Page 481
The Roth IRA: The Government’s Gift to Residents and Fellows......Page 482
What is a Roth IRA?......Page 483
When and to which IRA should you contribute?......Page 484
Roth IRA strengths......Page 486
What is changing?......Page 487
Fixed annuities......Page 488
Equity-indexed annuities......Page 489
Advantages and disadvantages of tax-deferred annuities......Page 490
Beyond Social Security......Page 492
Minimum vesting requirements......Page 493
Highly compensated employee......Page 494
Federal income tax benefits of qualified retirement plans......Page 495
Defined Benefit Plans......Page 496
Defined Contribution Plans......Page 497
Savings or thrift plans......Page 498
Contribution limits for defined contribution plans......Page 499
Fully Insured Plans — Section 412(e)(3) Plans......Page 500
The appeal of 401(k) plans......Page 501
Roth deferrals (2006 and after)......Page 502
Individual 401(k) Plan......Page 503
Summary of the Different Qualified Retirement Plans......Page 504
Fully insured plans — Section 412(e)(3) plan......Page 505
Where life insurance fits......Page 506
Incidental tests......Page 507
Exit strategies for life insurance from qualified plans......Page 508
Taxation of Qualified Plan Distributions......Page 509
10-percent federal income tax on early distributions......Page 510
Required beginning date......Page 511
The inherited IRA and distributions following an account owner’s death......Page 512
Determining the designated beneficiary......Page 513
When the owner dies after reaching the RBD......Page 514
When no designated beneficiary is named......Page 515
Roth IRA beneficiaries......Page 516
Prohibited transaction rules relating to financial investments......Page 517
Faster vesting......Page 518
Combined defined benefit and cash or deferred arrangement (CODA)......Page 519
Conclusion......Page 520
Index......Page 522