Enhance Your Practice Podcast
Enhance Your Practice Podcast
E68 WPS Remix Edition of Enhance Your Practice: WPS Symposium, Office Structure Panel
Office Structure Panel moderated by Ashley Amalfi, MD
• Vinaya Rednam, MD: Group Private Practice: The Good, The Bad, and The Confusing
• Renee Burke, MD: Go Solo, Go Far
• Amber Leis, MD: Academic Practice
Thanks for tuning in to the WPS Remix edition of the Enhance your Practice podcast brought to you by the ASPS Women Plastic Surgeon's Forum. We hope you enjoyed our coverage of the WPS Symposium and gained valuable insights from our guests. 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 exciting updates and expert advice to help you enhance your practice.
Speaker 2:I'm so excited to be here on our office management panel to talk with all these amazing women about their different practice styles. My name as your host is Dr Ashley Amolfi. I'm a board certified plastic surgeon in Rochester, new York, and excited to engage in these conversations because I started in academics at the University of Rochester and then transitioned to a group practice at the Cotella Center for Plastic Surgery. Today I am joined by Dr Vinaya Redman to discuss her practice style, which is a pretty large group practice, and she gave an amazing presentation here at the WPS Symposium, and so we are so excited to welcome her. So will you just start, dr Redman, with your credentials?
Speaker 3:Okay, well, my name is Vinaya Redman. I'm a board certified plastic surgeon and I practice in Houston, texas, and I am part of what I would categorize as a large group practice. We are a practice that is made up of both cosmetic and reconstructive surgeons, and many people do both in the practice. I'm in my eighth year of employment after my training and I was really excited to talk about this topic in particular, just because it was something that I never thought I actually would enjoy as being part of a surgeon.
Speaker 3:I very much remember joining practice and being excited about the job aspect of it and thinking I know nothing about business and this is going to be terrible and on the flip side, it's actually been amazing, like I really realized that I not only enjoy it, but want to be one of the leaders in my group for really figuring out how to do things well and to really build something that I feel like is our legacy as a group.
Speaker 2:So is that kind of the best part of it for you is like the leadership potential and sort of that aspect of control over kind of all the facets of your practice, yeah, I guess.
Speaker 3:so I really do like it. I like being able to bring everyone together and I like seeing what we've created, because I do feel that, having a group and all of our minds together, that we've been able to provide a level of care that I don't think I could just on my own.
Speaker 2:Yeah, absolutely. Sometimes the details. You know, when you're a small team it's so hard to cater to the details, and when you have bigger people and people focusing on all the smaller things, it's sort of such a more cohesive experience for the patient.
Speaker 3:Exactly, Exactly. A lot of times when I talk to patients I always say we, we, we. And you know I'm referring to my team, my staff team, but a lot of times, just because that's how I think.
Speaker 2:I always think of us like the group it's always a we. Oh, that's such a great thing to say. And I mean obviously there's challenges to working in a big group too, and we can talk more about both. But you know, what would you say are some of the challenges for someone who's looking at joining a group practice.
Speaker 3:I think, first and foremost, the biggest challenge is giving up a little bit of your own independence as a surgeon. We're all pretty fiercely independent. We all have strong ideas and ways that we want to achieve them, so there is a little bit of giving up. Not giving up, that's not the right word. It's more of a compromise, Like a marriage. Whether you're an associate in a group or a partner group, there is an element of a relationship between you and your other surgeons in the practice and I think that that's the hardest thing. But if you can get past that and you realize that there's so many more positives for the small amount of your maybe independence you're giving up, I think it's definitely worthwhile.
Speaker 2:Yeah, absolutely. And when you were thinking about going into practice, how did you arrive at this situation, like were you thinking of going solo? How did you find the group? How did you? Because you, right out of the gate, landed in a really awesome spot and that's not always the case for everyone, so how did you get to where you are Right?
Speaker 3:This has been my practice from day one.
Speaker 2:So I've been very, very lucky with that, which is not typical.
Speaker 3:It is not typical at all. I think there's a pretty good percentage of people who don't state their first practice. I knew what I wanted. Solo was never in my mindset, partially again because I wasn't quite ready to accept the business aspect of it. I really just wanted to get there and collect my cases and I just wanted to start building a practice. I just wasn't really sure what that was going to be yet. So I knew what city I wanted to be in. So I started googling plastic surgeons in Houston and I just started looking. I looked at a lot of people's websites. Social media wasn't quite what it is now, so it was just coming up then. So it really wasn't as much for me to learn about people that way. But I just I looked on their websites and I kept looking for people who seemed to have a similar idea of what they wanted for their practices from their websites. And that's how I found and I started writing letters.
Speaker 3:I wrote letters to everybody and anybody who interested in these, that I'm coming to Houston, I'm looking for a job and I want to be part of your team, so they weren't necessarily even advertising a job.
Speaker 2:You were just like kind of cold calling faces.
Speaker 3:I just cold called, I used some people might throw that letter right away and I knew that people would open it up and give me a call.
Speaker 1:And I did.
Speaker 2:I got lots of calls when I told people I'm coming Whether or not you give me a job, I'm coming, yeah, yeah, I did that too. I made a lot of phone calls. I'm not sure I got any Any back, but I think that's like good advice, especially like in this group setting, because I think you know like we got cold called by someone who really wants to move back to Rochester, and so we're always sort of entertaining those ideas. So for anyone in practice or going out there, it's always okay to just call and ask, and maybe, if you don't get an answer, maybe what I did wrong is I was probably talking to the wrong person, because I was just literally calling on the phone and Lord knows who I was actually talking to and how that message was actually portrayed. But you know, reach out to the docs If that's something you're interested in, because groups, I think, are always looking to grow.
Speaker 3:Exactly that, even though we weren't a big group at that time, they were looking for something that weren't advertising.
Speaker 2:Yeah, exactly so it was like okay, so now the new I was perfect, perfect. And then you know, when you join a group there's like so much to learn. I felt like for me that learning curve was so steep, especially learning about the business side of things, like because when you walk in, like I didn't even know, like, what all these acronyms mean, I didn't know how to look at a profits and loss statement, and so how has that growth of the business learning curve been for you in a group setting?
Speaker 3:It's been good, but it's largely because the senior partner in my practice wants to cultivate that in all of us.
Speaker 3:Yeah, he's always been very open about wanting to make us better business people, and so it this came down to is, if I wanted to learn, I just had to sit with him and he wanted to explain. He wanted us to have as good an understanding, which I think was important, and he instilled that in me. So when we bring new people on, I want to make sure that they understand what's going on too, because I had a good mentor.
Speaker 2:Yeah, that's awesome that you kind of pay it back. I think that's super important and I think it's something we don't really think about in a group setting or in private practice. I was looking for mentors in academic practice and I didn't have them, and I Found them in my senior partners, which I was.
Speaker 2:It was just totally unexpected for me and really cool and I was learning things that I like, actually wanted to learn, like the business side of it, like you, and if you could say, like, looking back, is there anything that you like regret or you would do differently that you know you've learned in your experience so far?
Speaker 3:Looking back. I don't know if it's regret, but I wish I had delved into the business aspects sooner. I wish that I had familiarized myself with it more. I think you know when you're first out you're so focused on collecting for your cases. You just don't really think about those things. But I think that if I thought about earlier that I'd be, I feel like I'd be even better positioned than yeah. I think you're still.
Speaker 2:I think you're doing great. And then, lastly, you know, for anyone who is either junior out there and looking to start or join a practice, or who is in a practice that they're unhappy with and looking at a group practice, what kind of advice do you have for someone who's looking at that type of, I'd say, just kind of almost what I did is start looking targeting kind of places that you think you could see yourself at.
Speaker 3:Most big groups are not gonna really advertise because, like you said, both the practices were in. We're always kind of open to things. Yeah, so go meet them, go visit places, actually spend some time. It is not enough just to talk to somebody on the phone you have to go there, you have to talk to their staff.
Speaker 2:You can talk to everybody you know a good idea, that's great advice. Well, thank you so much. It was an amazing panel and we're so grateful for all the girls who shared with us Thank you so much for having me. Thank you, Dr Rednam. So we are so excited to have our next panelist who has an academic practice, Dr Amber Lease, and I'm going to let her tell you guys a little bit more about her practice and herself.
Speaker 5:Thank you so much for having me. I am a board certified plastic surgeon, but I have a sub-specialty certification in hand surgery as well, and I serve as the residency program director for the plastic surgery residency at University of California, Irvine. I have a practice that is mostly focused on congenital hand and peripheral nerve, but I do dabble in a lot of different parts of plastics just by virtue of being in an academic setting Awesome.
Speaker 2:I mean, you aren't just like so involved and I see you everywhere all over social media, all over meetings, all over academia. Give us an idea of what that looks like for you in a typical week.
Speaker 5:So we can be a lot of different places, and part of that is just because our academic setting covers a VA hospital and a children's hospital as well, and so my time has to be a little bit divided among those sites. So I might spend a Monday at the main hospital doing clinic and doing some educational work, and then on Tuesday and Thursday I'll be operating either between the children's hospital or the adult hospital, just depending on what's been scheduled. Wednesday I have clinic at the children's hospital and Friday I see patients at the VA and in spots in between there I will have time with the residents for education or time with the medical students for teaching Great, and so how much like administrative stuff do you have to do?
Speaker 2:I mean, I know you have that part as the program director, but when it comes to like running your practice and that kind of data, are you involved in that at all and how do you feel about that?
Speaker 5:That is one of the things that you kind of in this give and take of different practice models give up a lot of control over in an academic setting and for me that works wonderfully because I don't have a lot of control over the day-to-day of running the practice. We have a faculty meeting every month where we'll sit down and we'll look at the metrics of the practice and just kind of like how clinic volumes are and how the health of the department is. But when it comes to like hiring and firing staff or things like that, I have like zero. Say, like, do I control the block time at the OR? No, I do not, and that's something that I enjoy because my mind share is better focused in other places. For just my personality type.
Speaker 2:I think I would probably lose my mind if I were in charge of that other stuff, I mean, and I think that's why it's so cool that there's so many options when it comes to plastic surgery, because it all kind of suits our needs and our strengths and it seems like it's obviously a model that really supports you for the best that you can be as a physician. What would you say are kind of the top positives and negatives to being in an academic practice?
Speaker 5:I think the things I like the most are being connected to education, and that's a combination of connecting to residents and trainees and then to have medical students that you're mentoring. I feel like those relationships really feed my soul. I think being with the team so having a lot of other people in practice doing different things to kind of keep me current on a lot of different information and advancements in our field always feels really exciting and I like being kept on my toes by the residents.
Speaker 5:We're asking questions about what I do and why. The downsides are that lack of control and that lack of say over how my time is spent or how the clinic runs or things like that. You give up a lot of control in order to have those other positives. Yeah, absolutely.
Speaker 2:So when you're thinking about going into practice, especially academic practice, you know, initially when I went into academic practice I felt like I already knew that model because I had trained it. Obviously in academics and we all do I was just so blown away about how different that is as a student and a trainee and then as faculty, and so I just wondered what that transition was like for you, because you've really made it work.
Speaker 5:Thank you. Yeah, that's a. It's a really important point. I think we do a poor job of educating our residents about what different practice models look like, and the truth is that 90% of them will end up in some kind of group or private practice, and so we really do an especially poor job preparing them for that, because most of what they've been exposed to is an academic setting, and their experience in academic setting is really focused on, like the call burden and a lot of a lot of work and patient care, which gets lifted a little bit when you get into the faculty positions, and so for me it's I mean like the reason I ended up there the kind of like thing that drove me to that space was that I really love the Teaching and the cases that I wanted to do could really only be done in an academic center like pediatric cancer.
Speaker 5:Drie is just not profitable.
Speaker 5:I can't do that in like private practice, but trying to show my residents that I have control over my schedule to be able to go on vacation or take time to take care of Sick family members has been really important and helping to kind of elevate the like. You know there's parts of your life that you get back. You give up a lot of control and like the running of your practice but you get a lot of control in the running of your life. I think that's a thing they don't necessarily see as much.
Speaker 2:I think it's so important that you said that, that we like kind of make it visible that we are people too and that we have Personal needs. And I remember one of my attendings in training used to put her family members birthday on the schedule. So when I was looking at the schedule I knew that that was an important day, but equally I was paying attention to the fact that she was taking a half day and like those little things I think are so meaningful, and so I think it's so important to have a woman in academics who's really doing that in teaching. My last question for you is really just that. You know, we hear of so many women who go into academics and then, for those personal and balanced reasons, they leave, and so that's certainly a leaky pipeline. What kind of advice do you have for someone who really wants to pursue an academic career that would help them be successful in that path?
Speaker 5:That is such a good question and such an important topic.
Speaker 5:I think the the best thing to prepare for is just really having a clear visibility about what the practice like pros and cons are and so really knowing that for you yourself the things that you're looking for are only met in an academic practice, because otherwise all those other things that you give up control over become like reasons to burn out and really kind of like hurt your soul and it's, you know, better for all of us if we're not hurting each other spiritually, you know, in order to figure out where we're supposed to be in life.
Speaker 5:So I think, having some mentorship and guidance, talking to some people in different practice settings and really finding out what they like, and then if you know that you want academics, choosing that in a way where you're sitting down like you know who the cheer person is, you know what their personality type is like, you know what tone they're setting for the department and you have really really good visibility into what the finances of your practice look like, even in academics, like how much will be charged for overhead, how much you're gonna get paid for call, what the bonus structure looks like, how you get bonus and how you earn those bonuses, what the expectations of you are in order to earn your salary. Really having a clear sense of what they are going to demand of you in order for you to be successful there, I think it's gonna be key. And then, just looking at the crews that you're with, because those people become your work family and you know it's like there's lots of different family personalities in the world. You want the one that matches well with you, absolutely.
Speaker 2:I think that mentor thing is so important because you sometimes don't have all that information. Sometimes the facade that's put on is not actually what the Actual the culture is of that place are going to. So I think it's so important to reach out to people, to colleagues, to Faculty that you've been with in your passing, just, you know, to get the lay of the land, to make sure it's gonna be a really good fit for you.
Speaker 5:Yes, thank you that too diligence.
Speaker 2:So thank you so much for all of your knowledge and advice. It was amazing talk and we appreciate you so much.
Speaker 5:Thank you so much for having me. It was such a pleasure to be here. Thank you.
Speaker 2:I am now so excited to introduce our third panelist, dr Renee Burke. Doctor Burke, will you just give us a little idea about you, your credentials and what your practice type is like?
Speaker 4:so I'm a board certified plastic surgeon and just outside of Chicago and Barrington Illinois and I did the traditional general surgery training followed by Two years at that time which was always required at Vanderbilt for my plastics fellowship I did a cranial facial fellowship with Tony Wolf in Miami and a cosmetic fellowship with Mark Codner. You know my original intention was to join Cranial facial surgeon out West.
Speaker 4:So that was that was the impetus, but I kind of took a whole U-turn the economy turned down and most of his practice was transgender based and and it was out of pocket revenue and at that time, you know, the economy is not good and he couldn't bring on a partner. So I ended up going up to Chicago, join a small group for two years and then just deciding. You know, I wanted to really start building the brand and the vision that represented me and I didn't feel like that group was doing it at the time.
Speaker 2:Yeah, I mean I hear a lot of people who I guess that the commonality of most of us is that we start in some type of practice and then we transition to something else. I've heard like statistics like 80% or something. So very few of us kind of get it right the first time but I don't think that's always bad.
Speaker 2:You know, Like I hear people talk poorly about these transitions, but for me I feel like if I didn't have my experience in academics at first, I don't think I would know or appreciate what I have now in my group practice. Did you have the same feelings about your transitions?
Speaker 4:Yeah, and I think that you know there's positive, negatives to take from each scenario that you're involved in. Is that you can you absolutely learn what brings you happiness when you're not happy?
Speaker 4:you know, and you have to know what you don't like you know about a practice to maybe ensure that you don't bring that into your new practice. So, you know, for two years, having two partners, in my first two years out of practice, I'll say it wasn't awful to have senior people to bounce ideas off of. You know, it was a really comfortable position to be in. It was just that you know the senior partner. When I told them that I thought we should put an ad in this magazine that goes out to all the homes in this certain zip code it wasn't much money his response was no, I'm already advertising the yellow pages. And I realized that I'm like you know, we're just at two different points in our practice and where we wanna put our money in our time. And you know, that was just sort of where I don't think it left. I left on the worst terms at all, but it was just I wasn't working, you know, towards my own vision.
Speaker 2:Yeah, absolutely yeah. If you're not aligned and those core values aren't the same and you don't want that experience, you know what. You envision the patient experience to be different. It's just never. No, I think you have some people listening to this, don't?
Speaker 4:even know what the yellow pages are you know?
Speaker 4:But I mean, I think that you also have to just start to see early too, like I mean, I talked about the fact that if you don't feel comfortable driving into work, if you're not excited to be there, you know the staff isn't treating your patients the way you want them to and it's not. You don't have enough, say eventually it's just not going to work and, before it blows up, start thinking about your exit strategy and how to do it, you know, in the most painless way possible.
Speaker 2:Yeah, I think that's really a great thing, because nothing is ever, you know, perfect and always gonna work out. And so I think, you should always be thinking of like what if?
Speaker 2:right, yeah, absolutely, you know, I think there's probably a lot of people who are this is really resonating with, and they're in a practice that's not fulfilling their needs and they're thinking about leaving and going solo. But the reality is that is so scary and I was wondering if you could speak to what that's like to actually make that jump. How fearful were you, what were your biggest concerns and then how are you able to overcome that?
Speaker 4:Well, it is really scary because you have to initially just think I mean, everything in the beginning is money. What can I afford, what can I do? You know, and most people aren't having this huge thriving cosmetic practice when they leave and or they go into solo practice. So you know you're really looking at not overextending yourself, but how do you give yourself, for example, enough space where footage to expand if you want? You know how do you do this. And there were definitely some lean years.
Speaker 4:You know those first couple of years out I remember talking to my friends in academic and it was embarrassing how much?
Speaker 1:more they were making you know that I was making.
Speaker 4:but I was building something and you know it's good to have. You have got to have a business advisor, somebody you know with an MBA, somebody looking at your numbers, who actually will tell you you need to make some cutbacks here, because you know, this isn't the right direction, or here's where we should be growing.
Speaker 5:or look at this you know you have to have some help there and it is a gradual progression.
Speaker 4:You know it doesn't, but you start. You also start learning as you get busier. Where do you take off the things that are the biggest time sinks and the least revenue generating? You know the first most private practice that's insurance based for you.
Speaker 2:Yeah you just have to start to work smarter and those are the things that you don't think about in other models and sometimes are hard conversations to have. I think the best way I've ever heard it put was a no thank you list.
Speaker 3:So Dr Ashley Gordon told me, you know you're at this tipping point.
Speaker 2:You need to create a no thank you list and start realizing. You know what is it that's gonna be useful for you to grow and what is really holding you back. But sometimes those are hard jumps to me, oh yeah oh yeah, that's so funny.
Speaker 4:It's just on. Some of my favorite quotes from Ashley is that the grass is not green, or on the other side, it's just a different shade of brown.
Speaker 5:Where do we wanna live?
Speaker 4:Which brown side do we wanna live on? You know, and it's so true because you know, the hard part too is, as you are expanding and growing, you are always thinking about your head. Okay, now, how do I maintain? You know, I have to grow, I have to maintain it, grow up to me and it is a constant. You know when I heard the discussions like on academic practice, you don't have to go home and check the competitors on Google sites or see who's getting good reading.
Speaker 2:Just see who's you know?
Speaker 4:looking at all of this, so it's given a take.
Speaker 2:Yeah, it's a different level of anxiety and control and that comes with its own positives and negatives, and I think what we've kind of been hearing today in this panel is that really just you have to decide what's important to you, what's your goals, what's gonna make you happy, and sometimes I think you have to just, like you said, figure out what doesn't make you happy, to help make that picture just a little bit clearer.
Speaker 4:And the more people that you can bring on, that can help alleviate some of that burden like a practice consultant you know, I mean once I was able to, you know, make that work into my practice. It just takes a huge stressor off you know, and then that way I can just come in and operate, I can really just work four and a half days a week and not just stay all night doing the admin things.
Speaker 2:If you could look back I mean, you have built this beautiful and successful practice If you could look back and give yourself advice when you were first making that jump and first starting out, what would that be? I think?
Speaker 4:the advice was yes, you can, yes, you can, you can do this. But a couple of the I think you know. I talked in my lecture a little bit about some of the biggest mistakes I made too was don't overextend like. Know what your practice is now. You know, keep on brand. You can be the classiest reconstructive surgeon out there, absolutely. And as you transition, if your goal is to be cosmetic, you can keep that same level, that brand, that same level of class. But know that if you are right now reconstructive surgeon, don't get sucked into buying that huge, expensive device until you're really ready for it. You know, I mean, that's the hardest part is you have to really look at the reality of your situation now you know, understand what you can acquire, because trust is built.
Speaker 4:it takes a long time, you know for in a community, for people to get to know you, people to trust you, and so when you go and you buy these big, expensive devices and things, why does somebody trust a new office that has?
Speaker 5:that.
Speaker 4:Why not start small and just keep being the best you and showing up and representing yourself in the best way possible? That's great advice honesty and patience. Yes, so true, so true.
Speaker 2:Well, thank you so much. Your talk was amazing. I think this is so helpful for anyone who's either you know, deciding what to practice, to pursue, or looking to switch practices, and so we're so grateful for you and on this, I can say one thing it's another of my talk and I just love this is that you know, make sure you build your dream.
Speaker 4:Do not let someone hire you to build their dream. Okay, last one will work.
Speaker 2:Sorry, thank you so much. That's a pretty quick way to end, and thank you so much to our amazing panelists.
Speaker 1:Thanks for tuning in to the WPS Remix Edition of the Enhance your Practice podcast brought to you by the ASPS Women Plastic Surgeons Forum. We hope you enjoyed our coverage of the WPS Symposium and gained valuable insights from our guests. 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 exciting updates and expert advice to help you enhance your practice.