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.
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…
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.
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 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.
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.
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.
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 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.
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.
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!