As a part of my interview series with prominent medical professionals about “How To Grow Your Private Practice” I had the pleasure of interviewing Dr. Trent Douglas, co-owner of Restore SD Plastic Surgery in San Diego, CA. Dr. Douglas is now in private practice after having served 22 years as a Navy plastic surgeon. He, and his business partner, Dr. Katerina Gallus, won the 2018 New Practice of the Year and Best Practice Design awards at the My Face My Body awards in Beverly Hills in November 2018.
Thank you so much for joining us! Can you tell our readers a bit about your ‘backstory”?
The decision to start a private plastic surgery practice was not made lightly and the research and due diligence were performed over a period of five years prior to opening the doors. After completing a 22-year career as a Navy plastic surgeon, it was time to do something else. The decision was a binary one — start a private practice or become a hospital employed surgeon. The choice was to take the more challenging path…
What made you want to start your own practice?
Starting my own practice has always been a dream and the decision was an easy one to make. When contemplating the end of my 22-year career as a Navy plastic surgeon, I had the option to remain in the realm of hospital based and employed surgeons or take a far riskier yet more rewarding path. Having the ability to control my day-to-day was a large consideration but also having the knowledge that patients were seeking me out for my own skills and expertise was a driving factor in my decision to open my own private practice.
Managing being a provider and a business owner can often be exhausting. Can you elaborate on how you manage both roles?
The fundamentals of business are not taught in medical school, so becoming a business owner was a calculated decision. In preparation of opening my practice, I started researching business models, corporate structure, human resource management, and state hiring guidelines well in advance of opening. Even with a basic working knowledge of business ownership, the first year of being open was a very steep learning curve. I set aside time each day that is specifically dedicated to patient care and to business management. The times and ratios will change from day-to-day based on business needs and patient care needs, but there is always dedicated time on the schedule for both activities. In the early organizational and logistic building days, it was not uncommon to take calls, have meetings, and see patients during the day and then come home and work another several hours answering emails, lining up more meetings, and tending to the organization of our new electronic medical record, inventory management, or vendor contracts. With time, this all became part of the daily routine and once the initial startup phase was complete, the work life balance has been put back in order.
As a business owner, how do you know when to stop working IN your business (maybe see a full patient load) and shift to working ON your business?
As a plastic surgeon, these two issues are one in the same. I am always working in the business seeing patients, performing surgery, establishing relationships that will bring in more referrals and working on the business by maintaining a high-end reputation, providing exceptional customer service, and with my business partner, managing the intricacies of the daily business needs. As the business grew during the first year, time-management was exceptionally important. The lean early days gave way to a busier middle of the year, and the last quarter found us staying late after work to complete charts, review the books, and ensure that all of the invoices were paid and that the emails were answered.
From completing your degree to opening a clinic and becoming a business owner, the path was obviously full of many hurdles. How did you build up resilience to rebound from failures? Is there a specific hurdle that sticks out to you?
The beauty of spending eight years in residency training after medical school is that you develop a healthy appreciation of delayed gratification as well as very thick skin. Resilience comes in the form of believing that success is inevitable. There were definitely hurdles along the way, the biggest being obtaining a small business loan. Shopping multiple banks and filling out mountains of paperwork were the easy parts — the bank we chose had some internal inconsistencies that proved quite frustrating. We remained patient, pointed out the inconsistencies to the bank management and eventually found a smooth path. Because we had put all of our loan eggs in that one particular basket, there were a few stressful moments when it looked like the financing package may fall apart.
What are your “5 Things You Need to Know to Grow Your Private Practice” and why?
- Be consistent — Being consistent is the most important characteristic that I have found to be beneficial in growing our private practice. Staying on message and on-brand provides our current and potential patients with information that is congruent with our mission and core values. Maintaining consistency with employees is also critical. Having an even tone and temperament on the good days and the bad allow employees to see that there is a calm and steady presence at the helm and that there won’t be wild variations in policy or application of the rules on a day-to-day basis.
- Be organized — If you are not organized, it is impossible to be productive and grow the practice. Prioritizing the day and having a systematic approach to handling payment of bills, meetings, and patient care will allow flexibility when urgent or emergent matters arise. In medicine, it is not a matter of if something unexpected will come along each day, it is a matter of when and how disruptive it will be. Remaining disciplined in organization will let the daily disruptions be more easily absorbed and conquered.
- Be patient — Your practice is not going to be busy right out of the gate. Early on, you may occupy your time by deciding if the stapler goes on the left side or the ride side of the desk. When you are bored with that, you can move along to optimizing the placement of the tape dispenser. Knowing that you will ultimately be successful is a powerful motivator, so do something productive that benefits your practice every day. Get out and meet your neighbors, hold a open house event, write a blog, post on social media. As a new practice and a new business, there is always something to do while you are waiting for the business to pick up.
- Be willing to step outside of your comfort zone — Building a high-end plastic surgery practice in an already competitive market was an enormous risk. My business partner and I each incurred personal debt in addition to our small business loan to create a customized boutique practice in an ideal location. We were confident in our surgical skills, our reputations, and our ability to provide exceptional customer service. That is where our comfort zone ended. We had to quickly learn the ropes of the business world and how to optimize our start up funds to yield the best results. It was an uncomfortable feeling at times, knowing that we possessed the skills to succeed but knowing that many arbitrary factors outside of our control could affect the success of the practice. When is came time to choose the safety of hospital employment or the risk of private practice, we did not hesitate to step down the private practice pathway.
- Always take the meeting — Meetings take time from your day but are often rewarding with regard to learning information about new or upcoming opportunities or picking up a tidbit from a vendor that strengthens your negotiating power with one of their direct competitors. In plastic surgery, there is always a new fancy laser or filler. We always make time to talk to our vendors because they give us the latest on what our competitors are charging or if there is a valuable employee leaving a practice who might be a good fit for us. The topic of the meeting isn’t always where the valuable information is shared.
Many healthcare providers struggle with the idea of “monetization”. How did you overcome that mental block?
In the world of private practice aesthetic medicine, monetization has long ago left the station. Most aesthetic practices do not take insurance and operate on a fee-for-service basis. I look at the long road that I took to become a plastic surgeon as well as the years of Naval service and four overseas deployments and the concept of monetization evaporates. As a specialized plastic surgeon, I have developed a skill set that is on par with professional athletes and having worked 80–100 hours a week during 8 years of residency after medical school, I feel that I have earned the right to charge a premium for my services. Working countless nights, weekends, and holidays is all part of the job and contributes to the delayed gratification seen in many surgical specialties that require many years of advanced training to master.
What do you do when you feel unfocused or overwhelmed?
Whenever I feel that I am not focused, spinning my wheels, or otherwise not having a productive day, I step back and take a moment to recognize and address those feelings. After taking a minute to take a deep breath, I write down 3–4 things that I want to get done in the next hour. Just getting a few minor tasks off the “to do” list often makes a big difference and sets the tone of productivity. Occasionally there will be a set of circumstances over which I have absolutely no control such as waiting for a vendor to return a contract or a surgery center to tell us if they have room for us on a particular day. When that happens, I either find something productive to do in the office such as organizing the before and after gallery on the website, making sure our monthly specials are widely posted, or scheduling the next few weeks’ worth of video content on Facebook. If there is not anything else to do that can benefit the practice, I will very rarely have the opportunity to leave a bit early and get some family time or stop by the gym on the way home for a little change up in my exercise routine.
I’m a huge fan of mentorship throughout one’s career — None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?
I have been fortunate enough to have several mentors who have been instrumental at various phases of my career. Overall, the person who had the biggest impact on my career and who taught me the most about plastic surgery was Dr. Glyn Jones. Moving up through the ranks of the American Society for Aesthetic Plastic Surgery has been facilitated by Dr. Foad Nahai and learning the nuances of running a busy private practice was done at the hands of Dr. T. Roderick Hester. As important as learning what to do from “positive” mentors is also learning what not to do from what I call “negative” mentors. There are been a few of those who shall remain nameless but who taught me valuable lessons of what not to do.
What resources did you use (Blogs, webinars, conferences, coaching, etc.) that helped jumpstart you in the beginning of your business?
To get started, we utilized practice startup courses that are offered at the annual professional society meetings. After taking these courses in the two-three years prior to opening the practice, we were able to identify our specific needs with regard to space, business loans, equipment, and the initial hiring and staffing process. We engaged the services of a specialized practice consultant who assisted us with the logistics of patient flow, scripting phone calls, and assisting with the sales and closing aspect of scheduling elective cosmetic surgical procedures.
What’s the worst piece of advice or recommendation you’ve ever received? Can you share a story about that?
The worst recommendation that we received when starting out was to buy more inventory of a certain product line because “it is so good it sells itself”. We learned quickly that nothing sells itself and that every detail of ancillary sales requires just as much attention as filling our surgery schedule.
Please recommend one book that’s made the biggest impact on you?
Where can our readers follow you on social media?
Facebook — RestoreSDPlasticSurgery
Instagram — RestoreSDPlasticSurgery; trentdouglas02
Twitter — RestoreSDPS; drtrentdouglas
LinkedIn — RestoreSDPlasticSurgery
For other incredible interviews, please check out our podcast: Healthcare Heroes.
A special thanks to Dr. Douglas again! The purpose of this interview series is to highlight the entrepreneurs, innovators, advocates, and providers inside Healthcare. Our hope is to inspire future healthcare providers on the incredible careers that are possible!