Enhance Your Practice Podcast
Enhance Your Practice Podcast
S14 E67 - Special Episode: WPS Remix Edition of Enhance Your Practice: WPS Symposium, Practice Management Panel
Hosted by Patricia Mars, MD
•Janelle Wagner, MD: Let's Talk About Money: How to Master Your Personal Finances & Actually Enjoy It!
• Mary Gingrass, MD: Let's Talk about the Hard Stuff: Hiring, Firing, Outsourcing, and Maintaining a Healthy Partnership
• Heather Furnas, MD, FACS: Owning Your Own O.R.J
Join us in a conversation with Janelle Wagner, a hand surgeon and speaker at the WPS Symposium. In this episode, we explore how incorporating small daily challenges can help us develop better financial habits, as well as Janelle's monthly routine of looking at cash flow, investments, and debt, and tracking net worth for a healthier relationship with money.
We also gain valuable insights from Dr. Mary Ginbrass, a cosmetic practice veteran with 27 years of experience, on how to manage personnel and financials effectively. We discuss topics such as hiring and firing, job descriptions, expectations, probationary periods, bonuses, raises, and adapting job descriptions for new technologies – crucial aspects for any successful practice. Heather and I also dive into the nitty-gritty of building and owning your own OR, from assembling the right team to maintaining certification. Don't miss out on this engaging and informative episode packed with practical advice for both new and seasoned plastic surgeons!
Welcome to the WPS Remix Edition of the Plastic Surgery Hot Seat Podcast presented by the ASPS Women Plastic Surgeons Forum. I'm Dr Paige Myers, clinical assistant professor at the University of Michigan, and I'm excited to share the latest pearls and pitfalls in aesthetic and reconstructive breast, body and facial surgery straight from the WPS Symposium.
Speaker 2:Hello, my name is Patricia Myers. I'm a board-certified practicing plastic surgeon in Tucson, Arizona. I've been in practice for 25 years and I'm your moderator today for our practice management panel. I'd like to introduce Janelle Wagner, who practices at a Wurris, New Jersey. She's a hand surgeon in practice for seven years. She's going to be talking about financial health, Janelle.
Speaker 3:Thank you, Dr Myers. It's great to be here.
Speaker 2:Thank you for being here. Would you like to give us some key points about your recent talk to WPS Symposium?
Speaker 3:Yeah. so I think the biggest takeaway is that you have to be willing to look at your money, because that is the first step in getting started, And if you can make it easy for yourself and just keep looking at it regularly, that will help you to make it a habit. And once it's a habit, it gets easier and faster.
Speaker 2:Janelle, I love the concept of your mind trash and mind reset. What are your recommendations on how to work on these, changing these habits, these financial habits daily?
Speaker 3:Daily. So you know you can do little things, like one time I did a little credit card challenge with myself and every day for a week I would look at my credit card statement, okay, and you didn't get scared. No, i didn't get scared, but to be honest, the second day I forgot. so then I had to go back And then sometimes I would. actually the most common thing is I would be surprised because in my mind I was like, well, i don't really spend much, i barely use that thing. I'm sure after a week I only like see two or three charges on it. And then, as I went through every day, i was like, oh well, maybe I do spend more, but it's not a bad thing. It's just is that where I want to be spending? And you just get curious and you ask yourself questions, and so you can do little challenges like that, or. but I think having a routine and just sitting down once a month is a little easier, because doing it every day can be a little daunting at first Right.
Speaker 2:So tell me, what do you look at monthly, what is your routine, what is your habit?
Speaker 3:Yeah, so the routine. Well, I need to mention mind trash because the first thing is. I have a little journal that prompts me to ask questions about my finances. So I've already set out my goals and I'm always asking myself is what I'm doing reflective of my goals? And so there's six areas I look at. the first is mindset. I'll sit down I'll say how am I feeling about this? Because sometimes you just don't want to do it Absolutely And sometimes you feel, well, maybe I didn't do it last month and now I'm behind, or you?
Speaker 2:know, and then that can feel overwhelming, right Yeah?
Speaker 3:And then you'll start eating yourself up and thinking, well, you got behind last month. I mean, I guess it's too late, you know, forget it And then you get in that.
Speaker 2:you know that bad mindset.
Speaker 3:Yeah, and so you can defeat yourself before you even get started. So part one is just jot down all of that, get all of that trash out, because it gets in your way and it's just trash, it doesn't mean anything. So, yeah, write all that down, get it out. And then the next step is look at your cash flow. So I look at what came in, what went out. Briefly, look at my pay stub It's all about looking at things. So then I look at my bank statement and I see what went in and out, because everything flows through there. So that's usually the best way to keep track. And then my system automatically calculates when I put in expenses or income, it automatically calculates my cash flow that month. So then I see right away did?
Speaker 4:I spend more.
Speaker 3:Did I, you know, and I don't itemize stuff like tracking expenses. Such a waste of time, no.
Speaker 2:Oh, it's the worst thing.
Speaker 3:It's just not worth doing And that will just get you. that will stop you before you start. If you think I have to track every expense. So I look at the big picture was the cash flow positive or negative And is there anything I need to adjust? And then I'll sort of choose if I need to deep dive or something but usually you don't.
Speaker 3:And then I look at you know I put in my investments just check on those, see how they went, Make sure they're actually gaining, And then see if there's any adjustments need to be made. And I look at my debt and see how I'm doing with that. And then all of these things, as I'm entering them in, automatically builds a net worth number for me, so that then I can see oh, what's my net worth this month? What was it last month?
Speaker 3:And I get trapped in a path and like in one Do you, so I can see how it went all year And it's just, it's repetition and just getting used to patterns.
Speaker 2:So tell me, i've been wondering, like what was the key thing that just made you come up with this whole new concept? What was the final straw that said enough, i need to control my finances. Did you have one thing, or did it come to you gradually?
Speaker 3:It. I had a moment where I saw some random webinar on options trading and I had no idea what that was, but I don't even know how I got on that email list. But I thought this is interesting And as I watched it, i just got introduced to the concept of how you can use your money to make money by trading or whatever, and That just got me interested in it. And then I started learning more about it. So I built it One step at a time. I didn't sit down one day and say I have to do all this stuff. I just something triggered my interest and then I built on that and I thought, oh Well, that's interesting. Hey, i wonder how my investments are doing. Hey, i don't know. I that brings me to the question How do I check on my investments? Oh, okay, once I learned that, oh well, how do I know if they actually made money And what do you compare them to? so these little questions would build up to other things and that it just kept leading me to get more educated.
Speaker 2:Okay, i have a question about how we're trained, because Financial and business acumen are sadly not part of our training. We're busy learning surgery, taking care of patients, saving lives. So if you had the opportunity to educate the next generation of plastic surgeons, what would you do to change this? How would you educate them? What would you say to them to start early?
Speaker 3:Yeah. So for residents, i tell them to start. It's different from Nowadays, because when I trained we didn't have a lot of these student loan Regulations, but right so things have changed in our favor. So now I say listen. What you want to do is, first of all, recognize that you make about. You probably make a little more than the median average US Income. Don't fall into the trap of thinking that you're a poor resident, you can't afford anything and I'll wait till I get a real job or a boat, because you're actually doing fine. And so you want to Make sure that you're addressing your student loans right away, and I always recommend using the repay for the federal loans, because they actually give you interest subsidies, which helps you reduce how much interest you pay. So you want to be paying something the whole time, because if you put stuff on forbearance This is something I wish I knew It capitalizes. This is a good pearl. Then, with that, yeah.
Speaker 2:I didn't know this.
Speaker 3:What that means is Once your, when your loan is in forbearance if it's not a subsidized loan Then all the interest it accrues while you're on forbearance will then be added to the principal when you go back into repayment. Yikes, that's lovely.
Speaker 1:Yeah, now your balance is even higher.
Speaker 3:Yeah, but if you start it off paying early, you pay a reduced rate based on your income and it prevents you from getting that hit with capitalization, with forbearance. So that's one thing. And I also also also tell residents number one thing you're like, number one resident money superpower is your youth. So true, you know, you can start investing now, make, even if it's $50 a month, it does not have to be very much because, because you have time, small amounts early will be worth more than huge amounts later.
Speaker 3:So, just make sure you're addressing your loans and you're addressing some investing anything. Just put it in a s&p 500 index fund and you know, let it go. However. $50 a month, a hundred dollars a month. It's hard when you're a resident, but I think that's just because of how we think of it and you can definitely do it. So start now.
Speaker 2:I do think they have that. You know, starving student, poor resident mentality, and you're saying that's another one of those mind resets that they need to do. Okay, so Tell me, for those of us that are happy with our financial advisors I know that might not be, is that an oxymoron, i don't know but And we want more involvement How do you approach a healthy relationship, a better working relationship with our F, our financial advisor, so that we know we're getting What we need out of them and that they're doing the best for us?
Speaker 3:first of all, you need to feel comfortable with that person.
Speaker 3:So when you're interviewing advisors, you need to understand, like you need to Feel like when I ask this person a question, do they answer it directly Or do they try to confuse me or condescend. So you want to pick someone who you already have a good, you know you can have a good relationship with, who answers your questions You know directly. And then you also want to know how they get paid. So are they getting paid based on a percentage of your money? Are they getting paid based on a fee? probably both, and that's key to understanding how they're motivated, and So it's the best if you can find a fee based only and not one who does assets under management There are advisors who do that or who will?
Speaker 3:meet with you for Like a one appointment or whatever and just charge for that.
Speaker 3:So that's helpful. And then, just, you have to have a way of checking their work. Yes, because if you just I think we get into this mindset of, oh I, i don't want to deal with that, i'm just gonna give it to someone else to deal with, they'll take care of it for me, and They are trained to do that. But the thing is, it doesn't matter if someone else is taking care of it. You have to check, right, you have to be on top of it. And so, yeah, you need to set up a little system for yourself, because otherwise it'll be too daunting.
Speaker 2:Okay, um, let's talk about what you think are some key points from the talk that you gave this morning. Anything else that you would add that you think is really important In the system of evaluating your financial wellness?
Speaker 3:um, the other thing that's important is once you get Over, you know, looking at it and making it a habit is just believing that you can do it. This is not our.
Speaker 5:I always think of, uh, legally blonde when Yes, she goes when she runs into him at law school, Yes, and he's like, oh my god, you're here.
Speaker 3:And she's like what? like it's hard. And I feel the same way about this. I'm like we think it's hard but it's not yeah, not as hard as medicine.
Speaker 2:Yeah, i think it's one of those mindsets. We've kind of been told that it's, you know, very daunting, it's not very easy to understand. And then we look at all those graphs like the s and p 500 that you show today, and then our mind just kind of wanders.
Speaker 3:Mm-hmm, exactly, yeah, yeah, yeah.
Speaker 2:So you're saying having the mindset that you really can look at these things, you really Can be in control of your finances?
Speaker 3:Absolutely, and I think it's important to pay attention to the feelings that you have when you start doing it, because that's gonna um, that's gonna direct you towards where your little mind trashes are like Oh, when I go to open my student loan, um, you know, you know bank statement or whatever and I see how much I owe, i feel bad about myself because I'm in so much debt. you know things like that, right. So you want to identify that and just be curious about it and observe it and think why do I feel bad about it? You know I invested in my future and then used to, can start reframing. So identify when things are triggering feelings for you and address them with questions, because then you can get past it and just work with your money.
Speaker 2:So let's talk about some of the statements that we're looking at on a monthly basis, like the profit and loss, you know, like the balance sheet, which, like you said, needs to balance, and the cash flow. Of those three statements, which one do you think is the most important for us? So maybe we need to start slow, janelle. Okay, which one of those should we really be looking at and trying to understand first?
Speaker 3:I think income statement.
Speaker 2:The income statement. Okay, yeah.
Speaker 3:So the cash flow is what came in and what went out and how much cash do I have, and balance sheet is sort of your overall what are my business's assets and what are my business's debts and equity. But income statement is interesting because it shows you if your business is profitable.
Speaker 3:It's not the same as a cash flow statement because, it can be confusing because it does include revenue how much money came in or how much, how many sales did I make? Okay, or services did I sell And it includes expenses. But the difference is those expenses are related to the revenue you generated. So, for example, how many cases did you do last month and how much did that bring in? So let's say you brought in $10,000 from cases that you did, that's your service that you provide.
Speaker 3:That's your revenue then $10,000. But when it comes to expenses, the question is how much did it cost me to earn that revenue? So you're looking at okay, well, I had to pay for my staff, I had to pay for my office, I had to pay for my marketing.
Speaker 4:I had to pay for all these things, all that overhead, all that overhead and all of the operating costs and all of that other stuff.
Speaker 3:So it balances that out, so you can see how much it costs you to generate revenue And that tells you whether you're profitable or not.
Speaker 2:Okay. Well, thank you so much, janelle. I really appreciate you elucidating, opening our eyes and making this a bit simpler to evaluate, and then we'll start with our next panelist. Our next panelist is Dr Mary Ginbrass. She's been practicing for 27 years and her practice is a cosmetic practice, and she talked today about the important subject of hiring and firing, employment all those things that we hate to deal with but have to deal with on a daily basis. So, welcome, mary. Let's first of all give maybe a brief synopsis of your talk for today, just maybe some pearls that you'd like to start with.
Speaker 5:Well, thank, you very much for having me. I think one of the hardest parts of running a business, whether it's a medical business or a retail business, is managing personnel. Oh yeah, and it's Okay. Well, that ends our video Bye. It's just so vitally important for your bottom line, but for your emotional health as well.
Speaker 2:So and the health kind of of the practice, the health of the practice for sure.
Speaker 5:The employee revolving door where people are just coming and going. You all know those practices that they just go through people. Maybe they're there a year, maybe they're not And that's extremely expensive. It's hard on morale for your practice. It's emotionally draining for everyone. So you know you want to hire really carefully And if it's not a good fit, fire relatively quickly.
Speaker 5:And that's that was a hard lesson for me to learn. I think one important thing when you're hiring is to make sure people you have really, really careful job descriptions. You have to reevaluate those pretty you know, at least yearly. You also want to really clarify your expectations. So some people will even have, in addition to a contract for their job description, they have a contract for their, their expectations. So I expect you to be on time. I expect you to be be kind and courteous. I expect you to be respectful of people's financial situations. I expect you to be as nice and courteous to people who schedule as people who don't schedule And I think if people really understand what you expect of them and that's given right up front.
Speaker 5:It's given right up front and it needs to be reevaluated. And that 90 day probationary period I think is really key And I think that's hopefully you can kind of figure out if they're able to to meet your expectations.
Speaker 2:Mary, let's talk about who, in your practice, develops jobs descriptions, because I think they're also very important. Does management, do you, is the employee part of that? When they leave, do you relook at that and change it? So who's in charge of this in your practice?
Speaker 5:That's a that's a great question. It's a combination of all of these things. So we started out what we didn't even have an employee handbook to begin with, and that's one of the things that our professional employment organization of PEO was really instrumental in making sure we know it. You really need to have an employee handbook, you need to have the rules.
Speaker 5:And when. when we sat down to do that, we also were much more intentional about what the people's job descriptions are And the way we started that, in case you don't have those in place, is you ask the employee what, what do you do?
Speaker 2:That's exactly what we did.
Speaker 5:You're, you will get a really long list.
Speaker 2:I do all of these things Exactly. That's what we got. I love that.
Speaker 5:And then I think you need to to sort of condense it. It is what we found that we have to do, so the office manager was very instrumental in that.
Speaker 5:And fine tuning, yeah, fine tune it kind of make it a little bit more cohesive. Okay, and then. but but the doctors are are involved in it as well. And it's interesting because, having been in practice I think 28 years it's things have evolved a lot, and when you know you get new technology when all sorts of things come up that weren't in their job description. like you didn't have to check off the emails every day, right, you know, 25 years ago. But now the patient care coordinators have to check the emails and somebody's got to answer the website inquiries and all those kinds of things.
Speaker 2:So it is, you do have to tweak it reevaluate, tweak them All right, great, so let's talk about bonus and bonuses and raises, because this is always a big question for practicing plastic surgeons And it's it can be confusing. Tell us how you approach both of those, how you approach bonuses and how you approach raises. First of all, raises.
Speaker 5:We do evaluations once a year And again our practice manager keeps track of that. I would forget to do it. So, like somebody keeps a timer somewhere, that okay, and we. We finally do everybody at the same time in June, And that seems to work better. So we do raises every year And, for instance, when COVID hit and there was little to no income, we did not give big raises or any raise at all. And everybody sort of knew that, yeah, but I would say, generally speaking, we give two to 5% yearly We do, and but bonuses.
Speaker 5:It costs you a little less in the long run to give a set bonus, like you know, $1,000 or $10,000 or whatever it is, because that's not compounding over years and years of time. So each time you have to kind of sit down and decide how are we going to tell this person that they did a great job? So right, generally speaking, if somebody's really performing highly, they're a team player, they're doing great. It's usually a 5% Okay. Of course you have to take into account the cost of living in the world and inflation.
Speaker 2:What's happening in your practice? you know the economy, the economy for sure.
Speaker 5:But you know, one to two percent is kind of yeah, you showed up, i mean.
Speaker 5:I think you're doing your job. So I mean, that's kind of how. But bonuses, i think, is a great way to kind of get everybody to have skin in the game. Yeah, so we have a bonus plan for everyone in the office. You have to be there two years before you're on the bonus plan. It's different positions in our office get a little bit different percentage. So the patient care coordinators, who are just so key to scheduling and sort of efficiency, they each get there. There's a 7% of a certain amount of money that is going to be bonus And then the coordinators get like one and a half percent. So we have two coordinators at one and a half percent.
Speaker 5:The nurses, you get 1%, and blah blah blah.
Speaker 2:It's a little bit different.
Speaker 5:It's very scientific Okay. And it takes years to develop And we absolutely had to have help to develop the bonus program, but it's I think it's really really key to our long retention. We've had people in our office for over 20, two people over 20 years, two people over 10 years.
Speaker 2:That's pretty incredible And a testament to how you manage your team and treat your team. I know that you feel like the PEO has been instrumental in your practice, so can you tell us a little bit more about that, because I certainly did not know about a PEO And I know that it's really changed your practice for the better. So let's discuss that a little bit.
Speaker 5:So a PEO I kind of fell upon by accident. I I've left a group of four, i went out on my own, but I had my my now partner of 20 years joined me at that point And she was an employee for a couple of years. So I was kind of doing this all by myself and figuring out how to do it And that when it came to getting benefits like health insurance benefits and stuff like that, it was just this big slap in the face.
Speaker 3:And I had someone that I met at a women's networking thing.
Speaker 5:That was her business, she, she had a PEO and I'm like, well, that makes sense.
Speaker 5:Yeah, it does, and I think it's been worth its weight in gold. So what a PEO is is basically it's an outsourcing firm And you have a contract with the PEO, but you're still your business. I'm still an LLC, but I have a contract with the PEO and and so it's a client service agreement. The PEO is sort of the employer of record that cuts the checks, but they do all that administrative stuff that is so hard. They do the payroll, they do the, the W2 forms. they are amazing with a resource for, you know, human resources. They do new hire reporting, 401k, you know and they give us access to these big group health plans, which so that it it's way cheaper because they have 5000 employees where and I have 11.
Speaker 5:Yeah, so I go out on the market to get health insurance for 11 employees. It's way more expensive than them going out to the market to get health insurance for their 5000 employees. I have 11 of those. Okay, that worked for me.
Speaker 2:How would you research one in your local area, or do you use a national one? Is it local to you or is this, that's.
Speaker 5:that's a good question. We started with a very, very local one, and it was a woman, and she eventually sold out because she was doing so well.
Speaker 4:Sold her business And she sold it for her, And and we then went with a more.
Speaker 5:It's still local, but it's a bigger firm, okay. So at that point we kind of knew what to look for, right. So it's, it's a bigger, it's a bigger company. They often go hand in hand with accounting firms, I'm not sure. Okay, interesting. So, mary, i so appreciate this discussion.
Speaker 2:We could really go on and on because you're a wealth of information, but could you please give us your, your last pearls of wisdom? I loved your last slide that, really, you know, just showed a synopsis of these important things that you learned in your 27 year career.
Speaker 5:I would say hire slowly, fire quickly. Get professional advice. If you don't know something that we, that's what you do for your practice. You would consult with another plastic surgeon if you weren't quite sure how to do something. I think an office manager is absolutely key. I would advise that I learned is in start your investments early. Start your 505 29 plans for your kids as soon as they get a social security number. Start a 529. And just try to kind of build a work family, because going to work and being happy with your employees is worth its weight and goal.
Speaker 2:Yeah, it's so true. Thank you very much. I appreciate you. Our next panelist is Dr Heather Furness. Heather has been in practice for 30 years in a cosmetic practice in Santa Rosa, California, where she practiced with her husband. She also recently as a aesthetic fellow And she has been a visiting professor for both ASAPS and ASPS. Welcome, Heather. She's going to tell us all about establishing your own OR.
Speaker 4:Well, thank you so much, Patricia. It's lovely to be here.
Speaker 2:So nice to have you. So, heather, can you please give us maybe a little introduction to this talk and what it was about today?
Speaker 4:Yes, it's about owning your own OR, starting with the question should I own my own OR? And it's not a simple yes or no. It really depends on your needs, how much you are going to be doing non-hospital-based surgery and where you are geographically. There are a lot of costs that are involved and that varies by geography, and reimbursements vary by geography, and so there are many different factors to consider, right?
Speaker 2:So what was your factor? What really made you say, okay, this is it, we're going to build our own, or?
Speaker 4:Well, that happened because we were operating out of a surgery center and their rates were going up And we were in an area where hospitals just didn't give cosmetic rates And our colleagues were doing their surgery in little tiny office OR. So we figured that to compete we needed a place to do our surgery. So we embarked. First, in our first office, we built a very small OR And then, in 2003, we knew we still wanted an OR And we built another building So it's a freestanding office And within that we built a two operating room, three bed recovery room operating room suite.
Speaker 2:Okay, So, heather, i think the timeframe for a surgery center build out it can be varied and definitely it's different from different sides of the country. I don't think you know probably some plastic surgeons understand how long it really takes. So let's discuss concept the concept of the OR to getting the certificate of occupancy and how long that takes and some of the pitfalls that you came across when you went through this process.
Speaker 4:So finding the land was was one delay, but once we had the land, we hired the right people, including an excellent contractor. We had an OR consultant and he was really key, and then we hired engineers and all the people to make it happen, and after that the biggest barriers are the city, and we were able, actually, amazingly, to get our OR done within nine months once we started breaking ground. Okay, but that's because we invested in the right people, Okay upfront, that really made a difference.
Speaker 2:When you found those people, did you have to interview a lot of people? Did you get recommendations from other surgeons that built surgery center? I mean, how many people did you feel like you had to, you know, maybe interview to get the right people on your team? because obviously it made a difference. Nine months is really excellent.
Speaker 4:Yes, what we did is we called around and I think that's really important to call around colleagues, colleagues who have built their own ORs. What consultants have they used? We got a recommendation. We got a recommendation for the architect, a contractor and engineers and basically our contractor recommended people. So it was really starting with the research before really embarking on anything.
Speaker 2:Yes, and you did your good research and that really helped the whole plan flow into place Exactly. Okay, let's talk about certification, because there's a lot of different entities and yours in particular is QuadASF. Is that right, correct? Okay so tell me how you decided QuadASF and what the different entities are and why you went in this direction.
Speaker 4:Well, we knew again a lot of friends who went with QuadASF and so that was, that was a natural for us. We weren't gearing towards insurance-based reimbursements. If that were the case, then we would not have chosen QuadASF, that would have been triple A, c would have been a better choice or joint commission, and we went through their checklist and became familiar with it, and so that sort of was our decision. Yeah, okay.
Speaker 2:So then, once you got into your building and you got certificate of occupancy, the next step is really getting your OR up and running and capable of doing surgery and getting your certification. How long did that take?
Speaker 4:Well, we, because we had one OR, initially we already had staff, but staffing was a big deal. But getting the certification by QuadASF and you know, to be honest, i don't remember exactly how long it took, but any time we recertify, you know there's, there are a lot of checklists to go through, and and so we, we just do what we do.
Speaker 2:Yeah, let's segue into how much effort and work it is to maintain certification, because that's the other thing I don't think people realize I own my own OR I know how much employee time and effort it it takes because you have to check all these boxes in order to maintain certification. So tell me who handles that in your practice, how it's handled and just any you know pitfalls that you found with you know having to recertify.
Speaker 4:So our nurse we have a nurse who is an expert in recertification and so she goes through that checklist and we prepare every couple years and go through that whole process again.
Speaker 2:Okay, all right. Have you been able to because this is kind of, you know, the golden egg, you know have you been able to actually rent your OR to outside surgeons? is that something that you would want to do, because some surgeons build an OR thinking that perhaps they can get other surgeons to come? Do you have a pro and con with this experience?
Speaker 4:Yes, I first. We have tried. We've not been able to find surgeons to come to our practice that we would feel comfortable with and yes, because you want surgeons who are quality surgeons.
Speaker 2:You have the same values that you do, Exactly so that does narrow the pool.
Speaker 4:When you build your OR, it is really helpful to know are you anticipating inviting other surgeons to use the OR, inviting other surgeons to buy into the OR? are they going to be insurance-based, because that may drive your certification agency, because, as I mentioned, quadisf does not, would not be good in that aspect. and then, once you allow other people to use your operating room, does that crowd your own flexibility? So there are a lot of things to consider. on the other hand, if you use your OR very infrequently and you've got a lot of fixed costs you've got to cover, it's ideal to bring somebody else into continue to use that OR, right, right.
Speaker 2:Well, heather. Thank you so much. I really appreciate this. This was a very interesting discussion. I would like you to give us your final pearls of wisdom, the things that you learned and, in the end, from building your OR. What would you like to add?
Speaker 4:Well, first, if you don't have to build an OR, don't, because it is a huge responsibility. On the other hand, it's very expensive to find OR time elsewhere, and you can price yourself out of the aesthetic market, and so choose very carefully who helps you. Is this decision the best one for you? if you're still heavily hospital-based, it probably doesn't make financial sense to run this full-time thing that's gobbling up money, and proceed wisely. Thank you so much.
Speaker 2:Thank you.
Speaker 1:Thank you for listening to the WPS remix edition of the plastic surgery hot seat podcast brought to you by the ASPS woman plastic surgeons forum. We hope you found our coverage of the WPS symposium informative and engaging. Remember to subscribe to our podcast. Check out our other episodes on your preferred platform or download them directly from ASPS EdNet. Stay tuned for more insightful conversations and expert advice to help you navigate the latest trends and challenges in plastic surgery.