First 2 weeks in Practice

[GSresident]

Hi everyone.
I thought I would give a little update. I'm planning a series of posts about opening a practice. Hopefully people will have a little better idea of how it is done when I am finished and will be able to learn from my mistakes.

So my first day of practice was July 1. I spent that day at hospital orientation.
I got all moved into my office and looked out the window. I am literally right next door to a Planned Parenthood. So now whenever a fertilizer truck drives by (and a lot of them do in Iowa) I get all nervous. I'd probably be the first to go as collateral damage in the event of a bombing.

I started a Microsoft Access database of all of the physicians and PA's etc. within a hundred mile radius who would ever have any possible reason to refer to a plastic surgeon. The database is a powerful tool because I was able to print out practice announcement letters and address each one and make envelopes automatically to hundreds of recipients. I got all of their names mostly from the internet but then I found about 25 or so that weren't on the internet using a little book listing all the practitioners in Iowa. If I were you I would start something like this now if you are planning to open a practice. Its a pain entering all of the data but once you have it you're good.

I am also planning on starting an Access database with all of the addresses of cosmetic patients to make mass mailings easier.

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[GSresident]

The next thing I did was print up a few hundred business cards on my own computer. Since my address and phone number have a high probability of changing in the not too distant future I decided to print them myself rather than having a professional print a few thousand cards and then throw them out later.

I hand signed and stuffed every envelope of my practice announcement with a business card. That is the last time I will be personally doing that. There are services on the internet that can do mass mailings for you. I did it myself this time to save money and to put a personal signature on each letter. I thought it would have a little more charm and credibility that way.

To earn my rent for the month I dug and laid an 8 by 12 foot patio using a layer of gravel, a layer of sand and finally 16X16" pavers. One month rent free thank you.

I met with the Botox rep and scheduled a meeting for this monday with the Mentor rep. I also got accounts started at Allergan, Mentor and the Restylane company.

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[GSresident]

I met with the marketing/development lady at one of the hospitals. We are in the initial planning stages for a cosmetic surgery program at the hospital with private rooms etc.

I sent in all of the credentialing stuff for all of the major insurance companies, medicare and medicaid. I had it all filled out ahead of time but you have to wait until you get your certificate before you send it in.

I did an interview with my satellite clinic's PR person, which eventually got plastered all over the local newspaper and their website etc.

I did a 20 minute radio interview with the radio station in my satellite clinic's town. I'm not sure how that one came about but they wanted to interview me so I said OK.

I set up business banking and met with my tax attorney about a few details.

I hired a local guy to do my website. He is working on it as we speak, with lots of input from me. It will be cheap and I hope it looks ok when its done but I can always redo it once I get a little cashflow going.

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[GSresident]

I first assisted on several laparoscopic gastric bypasses last week. Hey, its money. Of course until I am credentialed for insurance I won't see a penny. I have about 25 or so of the things to assist on in the next month. I have been scheduling my days around being available for them.

I met with the billing lady but I don't trust her. I've caught her in a lie. I fired her.

I fielded calls from 3 practices in the state looking for a plastic surgeon. I said I would get credentialed and get some cashflow coming in and call them back. I said I wanted to be able to offer at least a referral base to a practice if I joined.

My front office fielded an angry call from a local ENT doc. He said "nobody asked me if he could come to town. He's not going to do any botox or facial surgery right?" I called his office twice to talk to him but he never called back. His secretary said he was out with poison ivy.

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[GSresident]

As of yesterday I have 6 patients scheduled to come see me in the office in the next couple weeks. 5 of them are abdominoplasties and one of them wants a brachioplasty.

As of Tuesday I have 3 patients scheduled for next friday in my satellite clinic. One is a breast reduction and the other 2 want blepharoplasties.

I met yesterday with someone from my local newspaper about a news story they want to do and about advertising in the local paper. We'll see what comes of it.

Yesterday I removed an expertly placed nail from my right rear tire and plugged the hole. I'm wondering if someone who has poison ivy didn't put it there.

Finally, because all work and no play makes Jack a dull boy, I brewed 5 gallons of an English Ale. It should be ready for bottling in another week and ready for drinking 3 weeks after that.

 

[NPR]

Interesting stuff, thanks for sharing.

(Not related to what I want to do but still fascinating to see how someone constructs a practice from the ground up)

 

[Winged Scapula]

Fascinating stuff. You sound very organized.

I found personal visits to offices to meet referral coordinators, office manager and of course, the referring physicians very helpful. I brought along a folder with a list of the insurances I take, the services I offer, an article which was relevant to my practice, patient oriented pamphlets on services I offer and business cards.

I'm going back out next week - I think it important to do a couple of months after you start, to thank people for referring to you, to ask if there have been any problems with scheduling and to remind others about my services. Lately we've been hit with a local Rads group who has been heavily marketing their biopsy skills and I've gotten some patients come in already biopsied. So its key to know the referral patterns, pay attention when they change and investigate the cause, and be able to answer any problems.

When you do market yourself, there's nothing wrong with asking them who they currently use or ask if they have had any problems. Offices may tell you, "we refer to Dr. X but he doesn't take Y insurance that a lot of patients have" or "we try to get patients in to see Dr. Y but it takes 6 weeks", etc. That tells you what you need to do to get the referrals. I had to agree to see patients without imaging because 1 office told me that "Dr X" sees patients without it. It may be a nuisance for me and the patient (because I have to order and they have to come back), but its paid off: I get TONS of referrals from that large Ob-Gyn group.

At any rate, best of luck! I'll sticky this for you (presuming that Dr. Oliver will approve) so that others can benefit from your experience.

 

[radslooking]

what were you planning on telling the ENT doc?

 

[GSresident]

I'm going to kill him with kindness.

 

[Winged Scapula]

I'm going to kill him with kindness.

Bring cookies to the office staff if you go and see him in person.

 

[droliver]

what were you planning on telling the ENT doc?

"Resistance is futile. You WILL be assimilated"

 

[Tiltnpse]

what were you planning on telling the ENT doc?

"Your clothes - give them to me, now."

 

[Playmakur42]

I'm going to kill him with kindness.

This thread is great. The info about the business side of starting a private practice is appreciated. Thanks for including us.

 

[BlondeDocteur]

"Your clothes - give them to me, now."

This picture is SOOO much scarier since it comfortably predates photoshop.

 

[DrDre311]

"Your clothes - give them to me, now."

I said exactly that to the ENT PD on my first day as a plastics 'tern: "I need ya clothes, ya boots, and ya motahcycle...and all ya facial plastics cases. Gib dem to me now."

 

[GSresident]

The second 2 weeks was just as busy as the first 2 weeks.

I am starting to get consults from area physicians for things which is nice. I have seen a handful of panniculectomy patients and sent off pre-approval letters. One of them was seen by another plastic surgeon and quoted a price of $5400 surgeons fee (above what insurance would pay). She needs a lot more than a panniculectomy but at this point in my career I can do it for less than $5400. I've seen a couple cosmetic patients, one for blepharoplasty and one for liposuction. Scheduling those is in the works.

My website still isn't together, I just sent an email to the guy. If it isn't done by Friday morning hes fired. I can put it together in 3 hours on my computer but I wanted to throw a local guy a bone. I guess that teaches me.

I deposited my George Bush check into business banking and I am using it to stimulate the economy - my economy. I put together a few adds and they will be running twice a week in the local paper.
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[GSresident]

I established a satellite clinic in another small town. The hospital is advertising for me. That one will run the 2nd and 4th Friday of every month.

I am all set up to go to a wound healing course (hahahaha) in Columbus Ohio. After I do that I will have yet another clinic, Wednesday afternoons, to see wound healing patients. Since the hospital runs that clinic I pay no overhead for it. They heavily advertise that clinic. They have it set up so that I see patients and I can bill for supervision for services by other providers.

This brings my total clinic time to:
2 half days of my own clinic
1 half day of wound healing clinic
1 half day of satellite clinic

That should be enough for now. If I decide to move to Des Moines I will keep these clinics open so that I will have the referral base. When I get busy enough with cosmetics to not need those clinics I will recruit a partner. If it will feed me it will feed the partner until he/she gets up and running with cosmetics.

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[GSresident]

I put together a billing sheet that has my most common CPT codes and most common ICD-9 diagnosis codes. Billing is everything. You must bill correctly or you won't be paid. You also must dictate correctly or you will not be paid. Learn it, love it, live it.

I carry around a little notebook. Every time I see a patient I get all their info and put it in the book along with what I did. Later in the day I write down the CPT codes and the diagnosis codes. You must keep track of all of that information because no one is going to do it for you.

Blue Cross and Medicaid came through. Still waiting on the other insurances. Big suprise, medicare is pulling a bunch of crap.

I put together a spread sheet with every patient, date of service, location of service, CPT codes, ICD-9 codes, RVU's and a column for payment. I'll do this every month. It allows me to keep track of where I am owed money. It also lets me keep track of my total RVU's for each month and each location. That is extremely powerful information. I can keep track of my actual reimbursement per RVU, my expense per RVU etc. You can imagine for yourself what can be done with that kind of data.

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[GSresident]

I built a pergola to pay my August rent.

I have continued assisting in lap gastric bypasses.

I got my Hawkeye football tickets. Because the team was so lousy last year and they have had so much trouble with the cops, I was able to get ridiculous seats. I donated a tiny amount of money per seat but I got 50 yardline, home team side, 12 rows off the field. They also gave me a parking pass.

In anticipation of all the tailgating, I brewed another 5 gallons of ale.

 

[operationivy]

I built a pergola to pay my August rent.

I have continued assisting in lap gastric bypasses.

I got my Hawkeye football tickets. Because the team was so lousy last year and they have had so much trouble with the cops, I was able to get ridiculous seats. I donated a tiny amount of money per seat but I got 50 yardline, home team side, 12 rows off the field. They also gave me a parking pass.

In anticipation of all the tailgating, I brewed another 5 gallons of ale.

I have to admit, your posts are very interesting. You have a great business sense. Seems like you are doing a ton of work though. Why not just throw in the towel and work for Kaiser instead (or some sort of multispecialty group)? Obviously, your salary cap would be lower and you would have less autonomy but you would save yourself a lot of other headaches.

 

[operationivy]

I have to admit, your posts are very interesting. You have a great business sense. Seems like you are doing a ton of work though. Why not just throw in the towel and work for Kaiser instead (or some sort of multispecialty group)? Obviously, your salary cap would be lower and you would have less autonomy but you would save yourself a lot of other headaches.

On second thought, ignore the Kaiser thing....I doubt HMOs provide cosmetic surgery services although I am not sure.

 

[GSresident]

Because I'm the boss. If I don't want to work tomorrow afternoon I just don't work tomorrow afternoon. I don't answer to anyone.

Also, if I joined a multispecialty group all of my revenue would go into a big pot and someone else decides how much of my own money I get to keep. Multispecialty groups make it nice for family practice doctors. Instead of driving Suburbans, if they can hire a plastic surgeon they drive Escalades.

I have to admit, your posts are very interesting. You have a great business sense. Seems like you are doing a ton of work though. Why not just throw in the towel and work for Kaiser instead (or some sort of multispecialty group)? Obviously, your salary cap would be lower and you would have less autonomy but you would save yourself a lot of other headaches.

 

[JaggerPlate]

Because I'm the boss. If I don't want to work tomorrow afternoon I just don't work tomorrow afternoon. I don't answer to anyone.

Also, if I joined a multispecialty group all of my revenue would go into a big pot and someone else decides how much of my own money I get to keep. Multispecialty groups make it nice for family practice doctors. Instead of driving Suburbans, if they can hire a plastic surgeon they drive Escalades.

Sounds like you are moving along nicely. Congratulations!!! Did you ever have a sit down with that villainous ENT/Facial Plastics doc??

 

[GSresident]

Sounds like you are moving along nicely. Congratulations!!! Did you ever have a sit down with that villainous ENT/Facial Plastics doc??

That problem seems to have resolved itself with conservative management. I called twice and left a message. The ball was in his court and he didn't hit it back. I haven't gotten any more phone calls from him. I see his partners like every day and neither has ever said anything to me except they are glad I will take care of facial fractures. One of them even pointed out that he saw my ad in the paper and liked it.

Speaking of facial plastics guys, I got a call a few months ago from a "facial plastic surgeon" who wanted to know if I wanted to share office space. I went to meet him and saw the office etc. Everything went very well, he was a very pleasant guy etc. He said he would have his office manager send me a quote on how much it would cost for 8 days of office time a month. That was just for the space. I would have to hire my own help, purchase my own supplies and everything. The cost - $5000. Apparently he didn't want a PRS guy in the office with him. I found out a week ago that he is doing breast implants and tummy tucks. More power to him. I hope he never has a bad result or gets sued.

 

[operationivy]

Because I'm the boss. If I don't want to work tomorrow afternoon I just don't work tomorrow afternoon. I don't answer to anyone.

Also, if I joined a multispecialty group all of my revenue would go into a big pot and someone else decides how much of my own money I get to keep. Multispecialty groups make it nice for family practice doctors. Instead of driving Suburbans, if they can hire a plastic surgeon they drive Escalades.

You might make more money on your own, but you also have a lot of headaches. You are going to have to keep track of all the billing and collections on your own. At some point you may be able to hire someone to do it for you but that person could be a complete idiot and cause you even more problems. In addition, your future employees are going to ask for lots of time off, holiday parties, salary raises etc. When you get busy enough to hire even more people, you better boost your productivity even more because you are going to have pay more salaries...."the harder you work, the harder you work." The best thing to do would be to keep your practice relatively small so your office staff #'s/overhead is lower. In a multispecialty group, office staff is already in place and is more streamlined. As I am sure you know, the overhead would be divided multiple times and would be cheaper per physician. Yeah, obviously, the staff could consist of idiots and you have no power to fire them, but if you get a few bad seeds in your solo practice that could be devastating as well. In addition, you are going to have put ads in the paper to try to recruit staff to your office and you will quickly see how poorly qualified most people are. Maybe you will hire one or two and they will fool you into thinking they are good. Then you find out a few months later that they are stealing your money or are so rude on the phone that 20% of your business slipped to another surgery office without you even knowing about it. Or perhaps you get a great employee who you never want to leave and after 2 years they tell you they are moving to California and you better look for someone else....devastating! Money isn't everything and the autonomy you are talking about can certainly be a facade. I would rather make less, have fewer headaches and not be on call all the time so I can enjoy the tailgate party.

 

[sestamibi]

You'll never get rich working for someone else.

 

[GSresident]

You make good points but ...
I'm the boss. My headaches are having to crack the whip on an inferior. An employee's headaches are having the whips cracked on him by an inferior. Besides this is loads of fun.

You might make more money on your own, but you also have a lot of headaches. You are going to have to keep track of all the billing and collections on your own. At some point you may be able to hire someone to do it for you but that person could be a complete idiot and cause you even more problems. In addition, your future employees are going to ask for lots of time off, holiday parties, salary raises etc. When you get busy enough to hire even more people, you better boost your productivity even more because you are going to have pay more salaries...."the harder you work, the harder you work." The best thing to do would be to keep your practice relatively small so your office staff #'s/overhead is lower. In a multispecialty group, office staff is already in place and is more streamlined. As I am sure you know, the overhead would be divided multiple times and would be cheaper per physician. Yeah, obviously, the staff could consist of idiots and you have no power to fire them, but if you get a few bad seeds in your solo practice that could be devastating as well. In addition, you are going to have put ads in the paper to try to recruit staff to your office and you will quickly see how poorly qualified most people are. Maybe you will hire one or two and they will fool you into thinking they are good. Then you find out a few months later that they are stealing your money or are so rude on the phone that 20% of your business slipped to another surgery office without you even knowing about it. Or perhaps you get a great employee who you never want to leave and after 2 years they tell you they are moving to California and you better look for someone else....devastating! Money isn't everything and the autonomy you are talking about can certainly be a facade. I would rather make less, have fewer headaches and not be on call all the time so I can enjoy the tailgate party.

 

[operationivy]

You make good points but ...
I'm the boss. My headaches are having to crack the whip on an inferior. An employee's headaches are having the whips cracked on him by an inferior. Besides this is loads of fun.

Power to you and much respect. You have a great business sense and it sounds like you will do great things. Just curious, can you get away with not taking insurance? I've heard that many plastic surgeons have people pay out of pocket, especially for cosmetic stuff which I am sure insurance companies would be reluctant to pay for.

 

[Winged Scapula]

RE: Not taking insurance

Times may be different where GS is, but here in the land of Botox and augmentation, aesthetic procedures are falling off as people are feeling the recession.

Plastic surgeons that "dissed" my partner when she first came to town, preferring to do only cash based aesthetics, are now calling and offer to "serve your reconstruction needs". Yeah, where were you when we really needed you, is what we think? (but of course don't say, because you have to play the PC game).

Tis probably better for him as the new guy in town to get on some insurance policies so that he can get the referrals for reconstructive work (which he may enjoy doing anyway) and make a good reputation before attempting a cash only aesthetics practice. Besides, some aesthetic work will be paid for by insurance companies (reductions, scar revision, etc.).

 

[GSresident]

Regarding insurance,
I actually am signed up for every insurance plan I could find including medicare/medicaid. As I have stated in earlier posts, I really enjoy a lot of the reconstructive surgery cases. On Friday I did a Moberg flap for a partial thumb amputation and it was loads of fun.

Right now I am not taking the BS ER call for lacerations and stuff. The ER docs know that they can call me if they really need me, and they do call me, but I don't get the stupid "I got this 95 year old guy who fell and has a 1cm lac to his cheek. I think it needs a plastics closure" calls. It just isn't done that way in private practice. I get called when someone really needs me. I'm not just here for the ER docs' convenience. The other thing is, that since I am not officially "on-call", I can't get dumped on. I can always refuse the 4:30PM Friday afternoon transfer for a septic 75 year old liver/kidney transplant patient with an infected decub. I prefer to have a choice when it comes to accepting patients. That isn't so easy if you are part of a group.

 

[JaggerPlate]

Regarding insurance,
I actually am signed up for every insurance plan I could find including medicare/medicaid. As I have stated in earlier posts, I really enjoy a lot of the reconstructive surgery cases. On Friday I did a Moberg flap for a partial thumb amputation and it was loads of fun.

Right now I am not taking the BS ER call for lacerations and stuff. The ER docs know that they can call me if they really need me, and they do call me, but I don't get the stupid "I got this 95 year old guy who fell and has a 1cm lac to his cheek. I think it needs a plastics closure" calls. It just isn't done that way in private practice. I get called when someone really needs me. I'm not just here for the ER docs' convenience. The other thing is, that since I am not officially "on-call", I can't get dumped on. I can always refuse the 4:30PM Friday afternoon transfer for a septic 75 year old liver/kidney transplant patient with an infected decub. I prefer to have a choice when it comes to accepting patients. That isn't so easy if you are part of a group.

None of the insurance companies cover the cosmetic procedures do they??

 

[GSresident]

None of the insurance companies cover the cosmetic procedures do they??

No and if they did you wouldn't want to do it for insurance rates anyway.

 

[maxheadroom]

No and if they did you wouldn't want to do it for insurance rates anyway.

Amen! I'm not dealing with some narcissistic, pain-in-the-ass cosmo patient for pennies on the dollar. All those jerks who try to get body contouring post GBP surgery are idiots. Make the former-fatties pay for their cosmetic surgery, especially when it's a long and painful case.

 

[JaggerPlate]

No and if they did you wouldn't want to do it for insurance rates anyway.

Yeah, that's what I've always figured.

 

[GSresident]

Amen! I'm not dealing with some narcissistic, pain-in-the-ass cosmo patient for pennies on the dollar. All those jerks who try to get body contouring post GBP surgery are idiots. Make the former-fatties pay for their cosmetic surgery, especially when it's a long and painful case.

I suspect that you will be operating on these people when you finish your training or you will starve for a long long time. There are just so many of them around.

Here is what I do. I explain what a panniculectomy is and what it isn't. I explain that their insurance company pays for a panniculectomy. It doesn't pay for me to save their belly button, to carry the resection around to their flanks so that it looks good, it doesn't pay for me to fix dog ears, it doesn't pay for me to tighten the abdominal wall and it doesn't pay for me to do anything about that fat roll at the top of their belly. I explain that if they want all of the extras that they will have to pay me extra. I haven't had a patient refuse yet. If someone eventually does refuse I will just say "I'm not the surgeon for you."

 

[beastmaster]

here in the land of Botox and augmentation, aesthetic procedures are falling off as people are feeling the recession.

I wonder if this has been carefully studied. There are many impoverished, unemployed, in-debt folks out there, watching the news about recession on their HDTV plasma screens. At an old contracting summer job, I saw quite a bit of this. People have strange priorities.

 

[maxheadroom]

I agree that body contouring is a major part of plastic surgery, but I'm not going to do those cases on the cheap. If you want a Belt Lipectomy, Thigh Lift, or Brachioplasty, you're going to pay the full rate -- I'm not taking some insurance company's 1/3 reimbursement for a case that I don't particularly enjoy doing. I've seen some surgeons try (and occasionally get) Belt Lipectomies and Thigh Lifts approved -- that's insanity. Make the cosmetic patient pay cosmetic prices for cosmetic surgery.

You're right about a panniculectomy. A panniculectomy involves cutting off the stuff that hangs beneath the umbo. It's a functional surgery to get rid of redundant skin and fat that hangs down and causes a functional problem. Aesthetic abdominoplasty is an entirely different operation.

 

[GSresident]

Today was a landmark day for numerous reasons. First, when you finish residency it is like you have been in prison for the last X number of years. You don't know what normal life is, you have no idea how everyone else lives, and while you were away everyone else was moving on.

Today I knocked off at noon and invited my oral surgery buddy to go play a round of golf at the local country club. It was so naughty. Like, backseat naughty.

I'm still a long way from being adjusted to the non-servitude life but it was one step. I still wake up every day at 4. I can't help myself. I still spend every waking hour either working or doing a hobby which requires work. I still only spend maybe 3 hours a week on pure leisure. I am hoping today was a step in the right direction.

The other reason today was landmark was I had my first day at one of my satellite clinics. Rather unexpectedly, I signed up my first face lift. Yesterday I did my first bleph but it was one no one else would touch because i also had to do a rather complicated ptosis repair.

I am on a billboard now in town. The hospital put it up. I was also the subject of a front page, above the fold, full page article in the local newspaper on Sunday. Its really weird. I'm not used to all the attention. Everywhere I go, literally EVERYWHERE, people know who I am and approach me about stuff. Thats a pretty weird thing to happen after being basically anonymous for 34 years with the exception of some sporting activities and some musical activities.

 

[GSresident]

I almost forgot. Yesterday I was in my office and the UPS guy came to deliver something from Mentor. The UPS guy was someone who graduated with me. He was super popular and I was (and still am) a huge dork of a pariah. He knew who I was but I didn't recognize him until we talked for a little bit. Anyway I was Mr. Uncool back then but he sure was interested in talking to me now. Strange indeed.

 

[DOCTORSAIB]

I almost forgot. Yesterday I was in my office and the UPS guy came to deliver something from Mentor. The UPS guy was someone who graduated with me. He was super popular and I was (and still am) a huge dork of a pariah. He knew who I was but I didn't recognize him until we talked for a little bit. Anyway I was Mr. Uncool back then but he sure was interested in talking to me now. Strange indeed.

Classic!

Keep 'em comin doc.

 

[GSresident]

I had a busy last couple weeks. I went to a week long course on wound healing and hyperbaric medicine. I had to do that to get credentialed to consult in the hospital's wound care clinic. I'll be in there about 4 hours a week but I have already picked up some fairly sweet reconstructive cases from there.

I took my grandmother to the eye doctor and I had about a half hour chat with him. As a result of that chat, he and the rest of the members in his practice are sending me ALL of their blephs, ptosis repairs etc.

This lady from a national telephone book company has been a major thorn in my side. The first time I met her she came into the office and demanded a meeting with me. This was a couple weeks ago. She was pushier than hell in that meeting and proceeded to argue with me about how I should be running my practice etc. I was planning on placing a small yellow pages ad anyway so I got a quote from her for an ad and sent her away for a couple weeks. Yesterday she returns to my office with the same attitude, argues with me about stuff for about 15 minutes and is generally being pushy. So at the end of this meeting she wants me to sign something and giver her my credit card. I asked what the total bill would be and it was about $1000 more than what she quoted me. I brought this to her attention and she reworked the quote, this time giving me a black and white ad instead of a color ad to knock about $700 off the new price. I am still waiting for an artist to finish my practice logo so she was planning on coming back and getting the logo. When she left I was in a bad mood for the rest of the day and I couldn't put my finger on it.

When I got home I sent her an email asking if there were any other reps that cover my area. This AM she writes back and asks which one of them called me. I wrote back that no one called me but that 'I didn't think we were working well together' and I requested a new rep visit me. She wrote back saying she was sorry if I offended her and could she ask why etc etc etc blah blah blah. I replied 'I am not offended. I just don't think we are working well together. Lets leave it at that.' Man that was satisfying.

 

[droliver]

Kyle,

The conventional wisdom is that the Yellow Pages is now too expensive and largely irrelavent. A good web site is 1000% more effective then the phone book if you listen to practice consultants. I only get the cheapest listing that lets me put my web address next to it.

Also, are you sure you really want to be getting into lid ptosis surgery? It's so tedious & modest reimbursing (with some real signifigant potential complications) that even most opthamologists won't even do it anymore.

And in re. to upper lid blephs: for insurance cases, the hurdles for getting coverage and documenting visual field obstruction are formidable and they don't cover brow-pexy (which most of those patients actually need to offload the lid)

 

[maxheadroom]

I agree with Ollie. Lid ptosis surgery is both tedious and frustrating. I occasionally work with an Occuloplastics guy who gets burned out on those cases. He is pretty high volume and he has lots of revisions. Much better to take your 10 free sets of implants and aug the attractive, flat-chested nurses at the hospital -- that's some serious advertising.

 

[GSresident]

About ptosis -
I didn't say I would do them forever. My thought is do them while I don't have anything else going on - for example the 10 breast augs on 18 year old girls. Its nice to talk about doing breast augs instead of ptosis surgery but it takes a while to get those patients in the door and until you do you have to eat.

About yellow pages - I agree. I bought a small ad. I'm never buying a bigger one. I agree that website is the way to go.

I just now met with the local artist who has finished my practice logo. It is freaking HAWT and it was cheap. I'll be putting it on my stationary, business card, website, newspaper ads etc. Eventually when I open my own office I'll have signs made with the logo. This thing is so badass I can't even believe it.

 

[maxheadroom]

I guess my feeling on the ptosis thing, especially when you're fresh out in practice, is that you want only good results for people in the community to see. I remember a friend who would only do chip shot breast reductions when he first got into practice because he didn't want anybody to see anything less than spectacular.

 

[chris1264]

mind posting your logo? and how is the website coming?

 

[GSresident]

Another update -
Over the long weekend I decided to learn how to make my own website with my own graphics etc. This guy's website helped a lot. I bought a bunch of photos and the rights to use them from another online site. I made my own site with graphics etc. from scratch with photoshop and dreamweaver. I think it looks pretty good and now I have the ability to change things any time I want with a few clicks of the mouse. I also (finally) had a professional photograph taken and I will be including that in my ads and on my website.

I will also be designing my own ads now for the newspaper, at least until I can find a competent ad agency. Once I get some money rolling in I think I will hire one firm to handle all my ads etc but for now I need to do it myself.

If and when you start your own practice I strongly urge you to learn how to do your own web design at least to start. Hiring someone to put a site together like I did would be at a bare minimum about $10 grand and then you wouldn't be able to update things on your own or you would have to wait for some douche to change things. Also, there is no way that a web design guy is going to make things exactly like you want them. Seriously, it isn't that hard. You just have to sit down and do it.

My first page I hired a local guy to do and it was OK for a while until I could get a little free time to design my own. It was a place holder for the real site, which should go live in a couple days. I have assumed control!

Last week I had my first complication, albeit a minor one. I did a flap to close an infected hip wound from a prosthesis. It was fine for a couple days until she was back on anticoagulation. Post-op hematoma here I come. All is well that ends well though. I took care of the problem and the patient is doing well and will go home soon.

After a huge amount of arm twisting I finally got cosmetic pricing from my local hospital and it looks like it will work. I've signed up a bunch of stuff that has been waiting.

My instruments are finally coming in. I tried a couple lighted mammary retractors today and they look bomb-ass. I also played around with some liposuction equipment today but I get a full demo with the rep next week.

Tomorrow I do the first cosmetic case ever performed within about a hundred mile radius - abdominoplasty. Wish me luck.

 

[radslooking]

great stuff. thanks for posting.

 

[Rogue990]

GSresident,
Excellent posts, I've really enjoyed following your story. Out of curiosity, what are your expectations regarding gross and net income for the first year? What about thereafter?

Thanks.

 

[maxheadroom]

GSresident,
Excellent posts, I've really enjoyed following your story. Out of curiosity, what are your expectations regarding gross and net income for the first year? What about thereafter?

Thanks.

Do you really expect him to publish his income on a public bulletin board? What are you pulling down right now, Rogue?