Board Forum: On Course: Tips for Long-Term Success

Did you learn any valuable lessons early in practice? Is there anything you would recommend a younger doctor should do early in his/her career to assure long-term success?

Sachin Shridharani, MD: Early in one's career, I would recommend that unless absolutely necessary to the success of your practice, stay away from large capital purchases like devices. When starting a practice, there is a need for capital injections into the practice, and wrapping up large single purchases or expensive ongoing leases can jam up a practice. On the other hand, I found investing in good staff and EMR to be worthwhile and paying dividends today.

Adam Scheiner, MD: Spend time with a physician who practices in the field you intend on pursuing. Sometimes the intellectual fascination and preconceived notions about a field can clash with the actual practice of that field. Best to understand this up front before dedicating your years to studying that specialty.

Daniel Friedmann, MD: I would highly recommend taking a set amount of vacation time periodically. It is easy to become a workaholic early in one's career without leaving time for mental and physical recharging. Not working is just as important as working.

As far as cosmetic procedures, I recommend watching as many other providers as possible. Cosmetic dermatology is as much art as it is science. By watching others perform treatments, you can learn to develop your own artistic style.

Ryan Greene, MD, PhD: Against the advice of one of my mentors, I invested heavily into expensive devices as I opened my practice. This was a major, but not fatal, mistake. I was ultimately able to overcome this monthly burden, but it could have led to long-term financial difficulties if I hadn't become busy quickly in my practice. My advice to new physicians would be to avoid large capital purchases early in your career, until you have established steady revenue streams. Do not believe the forecasts and ROI projections of laser representatives and salespeople; these are grossly skewed and do not paint a realistic picture of what can be achieved in a newly established practice.

To achieve long-term success in a cosmetic practice, it is essential that a young doctor should continually learn from the successes and failures of their outcomes. This can only be achieved through the continuous critical analysis of before and after photos taken with standardized photography. Most staff members who work in medical offices have little to no training in photography, and it would greatly benefit the young physician to take a rudimentary course in photography. Without being in control of the photography of their patients, the young physician if often faced with too much variability in their patient photographs to adequately scrutinize them. Before and after photographs are the best learning tools that can be utilized by any young physician.

Christopher Khorsandi, MD: There were some devices early on that promised to perform well and had a great number of surgeons purchasing them as they came to market. I regret not talking with more users of some of the early devices to determine if they really worked as billed.

I recommend any young physician make sure that any procedure you do is to the best of your ability. Do not cut corners, rush, or try to get the case done in a less than ideal manner. Good results lead to more patients.

It's been said that you should think about your exit plan the moment you start planning your practice. What is your personal approach to exit planning? What tips would you share with other doctors?

Dr. Shridharani: I feel thinking about contingency plans and practice diversification to be important, though I do not feel an exit plan was part of my thought process at the beginning. I wanted to focus on being “all in” and how to build my practice as opposed to how I will retire. Prior to purchasing my office space and building my operating room, I started to think about asset management, making sure I do not acquire “white elephants” with no ability to sell in the distant future.

Dr. Greene: I strongly disagree that a physician opening a new practice should consider their exit strategy. They should instead be completely focused on growing their practice in the most efficient way possible. Additionally, there are fewer exit strategies available in the current medical climate, as practices are less likely to be purchased than in the past. As a practice grows, however, opportunities may present themselves that could ultimately become exit plans, such as the purchase or construction of an office suite or building.

Dr. Khorsandi: Make every attempt to buy your office as early as possible; when you retire you will have a valuable asset.

Invest in a good Universal Life Insurance Policy with a guaranteed income payout; there are no pensions in Plastic Surgery.

Put aside money every month for investment in stable equities (stocks) that you plan on holding for a long time.

What is one thing you plan to implement in your practice in 2019 with an eye toward long-term practice growth?

Dr. Greene: One of the most effective ways to expand and grow a practice is through the addition of an extender or mid-level provider. I plan to consider adding another mid-level provider, possibly in 2019.

Dr. Shridharani: I plan on implementing new technology/devices in my practice that physician extenders can utilize to help care for patients and continue to add value to the practice.