Special Episode: YPS - Early Career Plastic Surgery

The hardest part of becoming a plastic surgeon isn’t always the operating room, it’s building a career that still feels like yours once training ends. We sit down with Drs. Ashley Amalfi and Smita Ramanadham  to talk candidly about early career plastic surgery, why both started in academic medicine, and what ultimately pushed them toward private practice. 

We get specific about the decision points that don’t show up in residency: board case collection, the underrated value of colleague support, and the real-world friction that can come with red tape, weak mentorship, and misaligned RVU compensation. Dr. Amalfi shares how a group practice model can create freedom through shared resources and reliable partners. Dr. Ramanadham breaks down the solo private practice reality, from HR and operations to the discipline of not discounting and instead building a boutique patient experience that matches your brand. 

We also dig into plastic surgery marketing and branding, including why social media matters for modern aesthetic patients, how to stay authentic and professional, and what a thoughtful consent process looks like. From private equity trends to the idea that it’s okay to change your mind after your first job, the big takeaway is simple: your practice model should fit your priorities, your personality, and your life outside surgery 

Transcript

Speaker 4 0:02

Hi everyone, welcome to our uh Young Plastic Surgeons YPS uh ASPS podcast uh series. Um we're very excited to be bringing you this uh series. Today's lecture or podcast is about um early career plastic surgery and building a practice. My name is Omar Beidas. And my name Said Azoury. Today we have two awesome guests. Most people are probably very familiar with them. Ashley Amalfi and Smita Ramanadham are joining us to discuss this topic. So we'll be asking them a series of questions, uh, getting to know them better and getting to know their origin story. So let's get into it. So, surgeons, ladies, you both started in academic plastic surgery, if I'm not mistaken, before eventually transitioning into private practice. So let's start with what originally drew you to academics. And Smita, maybe you want to take this one first and we can go on to Ashley.

Speaker 0:54

Yeah, well, first of all, thanks for having me. I'm excited to be on this podcast. Yeah, I mean, for me, I think academics was such an important um decision because I really wanted to educate. And in my mind, you know, having gone through residency at UT Southwestern, um, general surgery and plastic surgery, teaching uh was very important to me. And I wanted to continue that in my professional career. And the only way that I thought I could do that at the time was in academic medicine. I liked the camaraderie of working with other surgeons, working with medical students, with residents. And so, you know, at the time I thought that was the only way to do it. I've learned since then that there's other ways. And you know, I was lucky enough also to have been trained by really amazing surgeons, both in general surgery and plastic surgery. And I sort of felt this desire to kind of pass on what they taught me. A lot of them have since retired and some have even passed away. And I think, you know, it's our duty to sort of pass on their knowledge to the next generation of younger surgeons. And so I think that was like a big part of me choosing to stay in academics.

Speaker 4 2:10

Awesome. Ashley?

Speaker 1 2:12

Yeah, my story is kind of similar. I mean, if you think about like our education and training, it's always in an academic environment. So, in a way, I almost didn't know that the grass could be greener on in the other side, or you know, and not that it always is, but like it was really the only model that I was like used to. And so I was pretty comfortable with it. And I don't know that it was like, oh my god, I have to do academics, but it I felt comfortable. And um my husband at the time, well, he's still my husband, but at the time we were um, I know, see, this is what you get. Um and so we were residents and we are graduating um just like a year apart, and so we were looking for jobs at the same time. And so for us, being dual recruits to an academic center also made sense. Um, so sort of a two-for-one thing. And so it just it just worked out that way, and and I loved it, especially for my early career. When I was, you know, studying for boards and collecting for boards, I felt like I had a really nice diverse practice. And even though there were parts of plastic surgery that I really loved or, you know, thought I was better at, I still at that point in my career like loved all the things and didn't want to necessarily like say no thank you to any of the things. And so being in academics allowed me to have a little bit more diversity in my practice, which is like the antithesis of where I'm at now. But then what worked really well. And it was great in my training. I think it helped me get really confident and get really good experience and learn how to take care of difficult patients. Um, and the diversity from my boards I felt was an asset. And I fell in love with teaching. I don't think I like felt as like compelled to do it like Smitta did, but again, it was like something in me that I didn't know was there. And I knew that, you know, when I eventually left academics, that I had to find a way to still be able to teach and to mentor and to give back. Um, and again, at that time, I don't think I knew that you could really do that outside of an academic model because I had never really seen that modeled for me. And so for all those reasons, it really made sense as like that first job for me.

Speaker 4:49

Yeah, I love how you said that, um, the diversity in the beginning too, because you know, I think I remember when I was a resident, there was always this misconception like the further out that you are and away from residency, the more comfortable you feel doing these really complex procedures and surgeries. And I remember talking to Jeff Janice actually, and he um was like, no, no, no, you feel the most comfortable when you're straight out of residency, right? Because you've you've had years of just doing these complex, like free fibulas and microsurgery and all of these like complex facial reconstructions. Um, and so going into an academic setting where you have that exposure and that opportunity to grow that part of your practice right after residency, I think is, and it's great for the boards, you know, to be able to get your case numbers and not have to defer for a year. Um, so I think it's sort of uh, you know, I don't regret that time at all. Um, although, you know, things have changed since then, but that was like invaluable at the time.

Speaker 1 5:50

Yeah. I think it's good advice, you know, for young people. It's like probably not something that they all think about, right?

Speaker 5:57

Yeah, yeah, exactly.

Speaker 4 5:59

I do, I do agree with both of you, right? It's good to come out of residency and have people to lean on to, right? I mean, it's it's not the worst thing to go into academics, and I don't think that's what you guys are saying, but it can be helpful for board collection and getting fed cases.

Speaker 3 6:15

Let's let's hope I'm still in academics by the time this uh podcast is over.

Speaker 6:20

I know. We're sorry.

Speaker 1 6:22

We're cheering for your success from the sidelines, don't you?

Speaker 4 6:25

We really are. Let's say there's pros, right? You have a you have colleagues clean up immediately with complex cases, right? And the teaching's always there. I mean, I think all of us have gone through residency, so clearly we are people who like to learn. And on the flip side, I think most of us, maybe not everyone, um, but I think most surgeons, whatever field you're in, you're you're you like to teach because you want to, you know, kind of educate the the upcoming class, right?

Speaker 1 6:50

Um I think the colleague thing is underrated. Like it's huge. It's huge. And I'm like, I was, you know, when you're young, like you want to run everything by someone else and and have sort of local experts in in your field. And you know, I think where I'm at now, I have some partners and I I honestly use all my colleagues that I've made through my involvement in ASPS to run things off of if I have questions or you know, something challenging. But to have that right out of the gate from residency and early training, you know, those first five years are like are so pivotal. And I don't think people talk about that. They like we get our training and you think you're gonna like jump into it and like, yeah, you're a fully trained surgeon, but like you kind of go through your own residency to figure out what works and doesn't work for you and your practice in your hands, and that's almost as long. And if you have people to rely on during that period, I think as long as you don't have ego and you're willing to like, you know, share your mistakes and talk to other people about things, it it really makes you a better surgeon in the long run.

Speaker 3 7:58

Yeah, I totally agree. I I felt that same way. And I and the one thing that I'd like to add to is like, um, I think that some of my best mentors and the educators who have had the greatest influence on me have been in private practice. My lifelong mentor, Larry Colin, has been in private practice maybe his whole life. Um, and this concept that you cannot teach or mentor somebody in the private practice realm, in fact, I would probably say I have greater mentors and and um educators in private practice. So I think that's also a really good point for listeners. But but the one thing that I definitely agree on is I was I was incredibly grateful of all the support, the phone calls, and everything that I was able to do uh when I was in board collection. So um, anyways.

Speaker 1 8:51

Yeah, all valuable things. And again, I don't know that any of these things are like reasons why people make the decision to go into that, but sometimes I think it's important to think about you know the things less commonly talked about, and and there certainly are pros there.

Speaker 3 9:06

Yeah, so I guess to that point, what made you guys do private practice? Like it sounds like it was maybe a little bit of a difficult decision, but what ultimately made you think that private practice was the better fit?

Speaker 1 9:22

Smitta, who left first, you or me? It was like so I think I did you guys do it together?

Speaker 3 9:28

That's totally hard to do. I was gonna ask, did you decide together?

Speaker 1 9:31

We're like we sort of did it together. Yeah, we like do life together. Like it was it was really similar timing, and we like talked to each other about it before it happened, and then like the both of us simultaneously.

Speaker 9:47

I feel like it was maybe you. Yeah, I think we started talking about it at the same time, yeah, but then I probably jumped, yeah. I probably made the first jump, like the first move. But you were right there like a few months later, it wasn't that far off.

Speaker 1 10:04

Yeah, because I remember you doing some of like the early practice building and like sitting in our hotel room at ASPS and you like looking at logos with you.

Speaker 10:13

Yeah, exactly.

Speaker 1 10:17

I remember it vividly. I'm not sure why, but it's like a core memory, Smenna.

Speaker 2 10:23

Hilarious. I love that.

Speaker 1 10:25

Well, do you want to talk? I guess you go first. Talk about like our because our reasons are maybe a little similar, but also different.

Speaker 10:32

Yeah. I mean, I think for me, like ultimately the biggest like decision-making point was I just felt like I needed autonomy, you know. I think in academics, there's so much red tape. Um, I felt like I wasn't able to really provide the care that I wanted to for my patients. Um, and you know, and I don't think I would I felt supported, you know. I think that was the biggest thing. I had really great mentors in residency. Um, and I found that I didn't really have that as much as I needed my first few years into practice at my institution. And so I think that with the fact that, you know, I just felt like I wanted to build a brand and a practice that I was proud of, that I could really deliver, you know, the best care that I could for my patients was ultimately the decision. And I had looked at, you know, I spent, I didn't make the decision lightly, and it certainly wasn't a quick decision. I think it was years of me thinking about this. I certainly wanted to make sure I was done with board certification before kind of jumping to another um job. But um, you know, I looked at other academic practices, I looked at hospital-employed positions, I looked at joining um surgeons or practices, and ultimately it just came down to, you know, I wanted the autonomy and I wanted to sort of be able to grow things the way that I wanted to. And I felt like this was the time to do it. And if I failed, at least I tried, but um, I would always regret not trying. So I think that was ultimately um, oh gosh. I think I was about um four years, four or five years into practice. Four years into practice, actually.

Speaker 3 12:20

Gotcha. Okay.

Speaker 1 12:21

And I was also also four years into practice. Yes, of course. I was at the un I was at the university like almost four years to the to the day. Um when I when I when I resigned. I um I mean I kind of echo the first two things Smitta said about like the patient experience and in an academic hospital, you know, my practice evolved from I mean, I did all the things, I took hand call, um, I did general instruction. I know I took hand call for all those the whole time. I know. And and I had, you know, two babies, and I was doing mostly breast recon and started to get extremely busy doing cosmetic surgery, just like as a natural progression of that practice. And um, I hated the ability to control the patient, uh the the lack of control of the patient experience for my cosmetic patients. They could never get a human on the phone, they had no idea where I was. It, you know, they couldn't, I couldn't get them a quote in a timely fashion. I didn't even know where these quotes were coming from. I mean, I just had no control over the experience. And for aesthetics, you know, it's important for everything, but you know, for aesthetics, you're paying for an experience. You know, cosmetic surgery is not a commodity. And and it just was not anywhere near where I envisioned my brand to be in that way. And um, the support was lacking for sure. I had some extremely incredible junior partners who are still all dear friends and colleagues, and I talk to I mean literally every day. Um, but this the senior leadership was just not anything I had experienced in my training. It was um, it was not supportive, it was competitive, it was um honestly, frankly, malignant. And and I am not the type of person who you know complains about something and doesn't do anything about it, and I could not live in that environment. And as my cosmetic practice grew, um it it did not align with the compensation model at the university because it was RVU based. And so I was making money for the division, and there was really nothing that I could do to see that. And that didn't seem fair to me, and it was certainly not strategic for the university in any way um to fairly compensate me, and it wasn't in their interest to to change that model. Um, so I tried really hard and I like I'm not a quitter. So if I leave something, I want to know that I did absolutely everything I could to make it work. Um, and I have no doubts that I did. Um, and I was completely confident, you know, making that call and saying, you know, this is no longer for me, and I'm walking away. Um, and one of the best decisions I've made, um, and I never looked back.

Speaker 4 15:38

That's awesome.

Speaker 1 15:39

Sounds like a bad breakup, doesn't it? Sorry.

Speaker 4 15:42

I mean, if you're extremely exactly. Yeah. I think everyone says, you know, joining a practice is a marriage. So of course, you know, if you leave a practice, it's gonna sound like a, you know, or it can sound like a breakup. So that makes sense. Yeah, of course, exactly. So I think you know, all good reasons to to to go private, but um kind of just wrapping up this section, what was the hardest part of leaving, or was there a difficult part of leaving academics? And you can you can summarize quickly, Smitha, again, we can go back to you.

Speaker 16:14

Yeah, I mean, I think it's um sort of the fear of the unknown. You know, this uh we're not taught any of this in residency, right? Like the business of medicine, of plastic surgery, of you know, how to I didn't even know how to write a business plan. So um, you know, so it's just like, okay, I'm leaving something that, you know, I may not be happy and like professionally satisfied in, but I know this, right? I know academic medicine, I know how to navigate this. Um, and so it's just this fear of sort of um what happens next. And then, you know, there's also these, all these other uncertainties. You know, if I'm solo practice, does that mean I can never leave town? You know, I can never have a vacation again. Like, who's gonna cover my patients? You know, it's just like all of these random things. And I remember I joked about this, I think, on an older podcast um with ASPS, but I remember vividly waking up. I was having a nightmare about uh like a Xerox machine, literally a Xerox machine. I remember waking up and I was like, wait a second, do I have to purchase one of these big Xerox machines for my office? It's like all of these things that you like don't even think about all of a sudden become your reality. So um, you know, so I think logistically, like that was a big um unknown. And I think as surgeons, you know, we have, especially as plastic surgeons, right? We have a plan A, a plan B, plan C. There's like multiple levels of plans when you walk into the OR and you see a defect that needs to be closed. So um to not have that is uh pretty scary. Um and I think also at the time I was not really sure how I could continue to educate um because that was still something that I really wanted to do. Um but you know, ultimately the the beauty of of private practice is that you can sort of create what you want to create. Um, so that ended up working out fine.

Speaker 1 18:14

I think I think the biggest, like surprising, maybe hardest thing with the transition for me is that private practice is a hustle. Like there's no there's no hours of the day or you know, work hours, or you know, you just get a paycheck and you can kind of chill out and lay back. Like it's a hustle and it's a grind and it and it's it's 24-7. And I suppose like if it's not like you're maybe just like not as busy, and that's fine too, but you know, I'm all in. And and so I think that that was like the biggest transition. I mean, like literally even physically, you know, the amount of surgery I do now compared to what I did in a hospital setting is just like physically so much more demanding on my body. Um, you know, not to mention the mental, not to mention, you know, that you're dealing with patients with body dysmorphic disorder on a daily basis. And that is, you know, mentally consuming in a way that's very different than, you know, closing a defect in a patient who has cancer. And so, you know, I think it's it's a grind mentally, physically, um, from a financial and a business perspective. And so it's it's just a different kind of hustle that I kind of love, but like that never there is no off button once once you make that switch in your private, it's like game on.

Speaker 19:48

Yeah. But I love it because it's sort of like you put in all of this work, but it doesn't feel like you're working, right? Because it's it's your baby, right? And so um I feel, you know, I'm I'm sure we've all never worked as hard as we do now, but it it doesn't feel like work, whereas, you know, it did in the past.

Speaker 1 20:06

Yeah, and that's the control, you know, like you can be as busy as you want because you know it's it's yours. And um, and when you're working for someone else, you know, it it's it's just not motivating in the same way.

Speaker 3 20:23

Yeah, and you guys have brought up a lot of good points. And I know Ashley, you talked a lot about autonomy, which I think is so important. And obviously, you know, anyone who's generating a lot of money, unfortunately, that's the academic world. You generate a lot of money for medicine for the institution and for your division, and you don't see a lot of it. Um, so I could see how that's very unsettling. And I think another another thing that you mentioned that is so important for listeners, is there's another common misconception that for whatever reason people think, and probably it's more at the medical student or trainee level, that private practice is easier or perhaps like easy. I don't know why. Like it has that it has that sort of stigma. But every practice private practice person that I know, regardless of whether they're doing cosmetic or recon in private, uh, are really hustling. And I think it's because of everything you guys said. Like it's their baby, they it's their reputation, and they love it. And you know, one of my greatest mentors told me that if you love what you do, you'll never work a day in your life. And yeah. So I guess with all with all of that, like what do you think? Um one of the other questions that I had is what do you think was the most surprising part or common misconceptions of private practice?

Speaker 21:40

Um, I think, you know, I think you nailed it right on the head that it's easier. I think, you know, especially in solo practice, I mean, everything is on your shoulders, right? Like you, you know, you're making decisions about everything, you're dealing with HR, you're, you know, so it's all of these things that we were never taught. So you're sort. Of learning it on the go. And, you know, hopefully you have people that you trust that are sort of experts in these little areas that you can rely on. But ultimately, you know, you're you're not only kind of taking care of patients, which, you know, is challenging in and of itself, but you're you're running the business too. So, you know, I think that uh it's um, you know, it's I don't think people realize how how much work goes into that. It's yeah. And I think the other thing for me too, um, for solo practice, I mean, I it took a while for me to to end land here. And I think the the biggest thing is, you know, you sort of think, okay, if you're a solo practice, you're like out on your own on this like little island. Um and and in reality, you know, I rely so much on my other colleagues that also have private practices in my area and we cover for each other and you know, we back each other up if somebody's on call and needs help, or you know, if there's something challenging that happens in the OR, we like pop into someone else's OR, you know. So I think there's still a lot of camaraderie and support, even if you are sort of solo. Um, and that's something I didn't realize going into this. I was sort of, you know, I was scared. I was like, okay, well, I guess it's just me, but it's in reality, it's it's not. Um, and I think that's sort of the beauty of it is that we can rely on each other and still learn from each other, not only locally with your local plastic surgeons, but even amongst, you know, members of the society and different committees and or you know, our friends and colleagues across across the country. So um, so yeah, that was that was nice, a nice surprise.

Speaker 1 23:48

I would I would say the like the thing I was most sad to leave it was the residence. And so I sort of had no idea what it would look like even if I had interest to teach in private practice. And so um as part of my separation agreement, I uh with the hospital, um it I asked for a clinical title so that I could keep my clinical title and still teach and be a part of their education. And and I've continued that for seven years now. So I was excited that I could figure out a model that worked for me in private practice that would still allow me to mentor residents and students. Um, I have medical students and other residents from other specialties who create electives with me. Um, so I've still been able to like maintain the reputation of being a mentor and a teacher. And, you know, like this week I have an OBGYN resident who created her own elective just so she could spend time with me and see a labia plasty and um and now wants to spend uh the rest of the week in the operating room. And then last week I had a medical student from Virginia spend the entire week with me as a mentor for her in her application process and to just see what private practice was like, and you know, and you know, that kid flew to spend time with me, and my whole spring is just filled um with all of these experiences. So not only do I have a clinical appointment at the university and still teach the residents aesthetic surgery, truly they're only rotations in aesthetic surgery. Um, but then I have all these, you know, students and um I have mentored um four college students now to get into medical school and they spend the summers with me doing um clinical visitation in the operating room, and then I've hooked them up with some of the breast surgeons at the hospital, and they write papers and get on the podium and get into medical school. So I never would have imagined that I like teach more and mentor more in private practice than I did in in an academic basis, but um, but it's actually worked out that way. So um that's been surprisingly really fulfilling.

Speaker 4 26:16

That's awesome, very rewarding. I feel like I don't know, I feel like the students like it sometimes are just wanting to get a research paper and then move on.

Speaker 1 26:28

They like hanging out. I don't know.

Speaker 4 26:31

Maybe I'm just gonna teach the gynecologist to do breast augmentations and breast lifts.

Speaker 1 26:36

Yeah, I was gonna show her, I was gonna really focus tomorrow on showing her how I close the layers of a tummy tuck so that she can make prettier C-section scars for you. I love that. The next generation, you know. That's my plan for it. Fort, yeah.

Speaker 4 26:55

Um, have you seen the they usually close it with like a keith needle? I don't know if you guys can see it. Yeah, one layer. One layer.

Speaker 1 27:01

Yeah, just one layer usually. Yeah, you don't need layers, just one.

Speaker 4 27:06

Um all right, so let's move on. Those are those are great insights. Um, you know, kind of phrase trying to summarize a few questions here, but what were some of the decisions you made early on that you feel like had the biggest impact on the success or maybe like the fail early failures in your practices? I don't know actually if you want to take this one first.

Speaker 1 27:30

You know, I made the decision when I left the university and went into private practice to join a group. Um, and so I had considered going out in my own and um the there's a very large aesthetic group in town that's been around for a very long time, had been around for at least 20 years when I joined, and had a beautiful reputation and um is a multi-specialty group, so facial plastic surgeons and plastic surgeons. And um I made the decision to join that group instead of going solo. And I honestly, you know, really could have gone either way, and for me, it's been a really positive experience. Um, it allows me to do the things that I love the most and to mostly focus on being a very busy plastic surgeon. You know, I get to do the brand building, but I don't have to do the HR, the hiring, the firing, the finance, um, the management. We have a pretty elaborate, huge organization structure that allows all the people to do what they're really best at and to me to do what I'm best at, which is you know, be a plastic surgeon. And so it has given me a lot of freedom to control exactly what my practice looks like and become pretty, pretty focused and specialized. It allows me complete control over my schedule so that I can set aside time to do all the the things with ASPS that I love. And so all of my um all of that time I have control over. Um, it allows me to travel a lot and spend a lot of time with my family and kids because I have very reliable partners. So lifestyle-wise, I think it was a really nice choice. And you know, when I make decisions, I don't get to be the only one to make decisions. You know, there's four partners, and and so we all equally make those decisions. But but for me, I'm really glad I ended up doing it this way. I think um it has been a really good fit.

Speaker 4 29:52

Awesome. So it's me to have a different viewpoint because you went out on your own, if I'm not mistaken.

Speaker 29:56

Yeah. Um, yeah, you know, being solo, you know, I I sometimes I hate doing all the all the things that Ashley mentioned, like the HR and the business. But I think for me, what's really stands out as sort of what I kind of stuck to in the beginning was I didn't want to compromise on sort of the brand that I wanted to build. And I remember, you know, when you first start your practice, right, you have all of these expenses, maybe you have business loans. And so you just, it's so um easy to just be like, okay, I'm gonna discount this, I'm gonna do a free consult, I'm gonna, you know, you know, basically like cut my prices just to get people in the door. Um and and I didn't do that because I really just wanted to make sure that um, you know, I was delivering sort of this VIP experience for my patients, or I, you know, I have a boutique um aesthetic practice and I wanted to sort of stay true to that. Um, and so it's sort of the struggle in the beginning where, you know, you're losing patience because your pricing is maybe higher than what they what they expect or what your competitors are doing. But I think in the long run um it pays off for you to really build that reputation. So um, you know, but I think that's a decision that you have to make up front, you know, because it is so easy to be like, okay, well, it's a slow month. Am I gonna be able to cover my bills this month? All right, let's just get people in the door, you know, and then you realize, well, those are not really, you know, I don't want to, I don't want to build a group on practice, right?

Speaker 2 31:33

Yeah.

Speaker 31:33

Um so uh so you sort of have to struggle a little bit in the beginning in order to create sort of what you want in the long term.

Speaker 3 31:45

I think this is such a valuable conversation, particularly the different perspective, uh perspectives of starting your own practice or perhaps joining a group practice, both of which present their own challenges, but also substantial rewards and just having the confidence, and just like you what you said, in your own practice to know, you know, when it's okay to stay calm and not like take anybody walking through the door. But um, I guess with all of that, like is there any advice that you can impart on somebody else doing what you both did or common mistakes that that you think could be avoided looking back?

Speaker 1 32:26

I mean, I think you gotta really think long and you have to think long and hard about like your priorities, your lifestyle, how well you work with others, because you know, I have four partners, five surgeons, you know, that's like being married to that many people. And that's not for everyone. And I, you know, I do well and I think I navigate the personalities very well, and we have a wonderful partnership, but there is definitely people out there, and you have to know yourself that that is never gonna work for you. You know what I mean? And I you have to have a little bit of self-awareness of you know, what kind of situation are you gonna thrive in? Where have you had conflict in the past? Are you someone who needs to control the details? Do you want to control the narrative? Um, can you make sacrifices for the benefit of your partners? And and, you know, how much control do you want versus how much do you really want to work? Because when you want the control, a lot of times that means you're adding responsibilities to your plate. And is that going to burn you out? Or is knowing that it's your baby and you have control going to fulfill you and keep you motivated on a daily basis? And so you kind of have to do some self-reflection. You know, it's less about the practice type and model and more about you as to, you know, what is going to be fulfilling for you. And and I think, you know, when people bash one or the other, yeah, I think that that's maybe the wrong way to put it. It's it's where am I gonna thrive and what's gonna be fulfilling for me.

Speaker 34:16

Yeah, I mean, I think you said that so perfectly because I think, you know, whatever decision you make should not be taken lightly. I mean, I think Ashley, I was talking to you about all of this for years, I think before I sort of decided to actually it was at a WPS conference where I was like, all right, this is exactly what I'm gonna do. But it was years before I, you know, made that decision. So, you know, I think like you had said, you know, you really have to kind of dive deep into who you are and what will satisfy you professionally and and personally, right? Because whatever we're doing at work carries right over to our personal lives. Um so um, and that shouldn't be a decision that's taken like, and you know, you should really look at every single aspect, right? I mean, I looked at, I thought maybe it was my actual institution that I really still wanted to be an academic. So I looked at other academic institutions. I mean, I pretty much looked at every single option and then uh landed in solo practice. Um, but and I think the other thing too is it's okay to change, right? So, you know, I think we were both pretty adamant and um firm in our decision to stay in academics after residency. Um, and at the time we made the right decisions for ourselves, right? But that can change. And I think as you learn more about yourself, especially when you're not, you know, a resident, um, your priorities can change too. And I think, you know, you should give yourself grace and and um be willing to kind of change and adapt with that.

Speaker 3 35:53

Yeah, that's yeah, I think yeah, I think one of the, I know Omar wants to ask a question. One of the things I just want to chime in real quick and say that it's but it's it sounds like on your path, by you continuing to look and entertain some other academic jobs, it must have given you just that extra reassurance that hey, you know, I tried. Like I I tried to look at all jobs and see what would ultimately make me happiest. And so I I really like that um that that sort of perspective that you had. But anyway, sorry, Omar.

Speaker 4 36:25

No, I was gonna say the same thing. And I mean it's I think you guys both made a great point, which you know, I'm like six or seven years in now, and I think you have to realize that A, you have to know yourself before you kind of take a job, or if you're looking for another job after your first or second, you really have to kind of know what you're looking for and what you will accept so you don't make the same mistake again if your first job wasn't perfect. And then I think one of you also said it's okay to change, which is true, everyone changes, right? We don't we don't all just kind of stay the same. Um, and so doing wanting something different is not wrong. Um, and you shouldn't feel guilty about that. Sometimes I think we guilt ourselves into like, well, I joined this and I want to make this work. Um, I think Ashley, you mentioned like you really wanted to give it a good try, but maybe it's just not for you anymore.

Speaker 3 37:12

Yeah. But that's all that's all our personalities, you know. It's going back to the type type A personalities, unfortunately.

Speaker 37:18

Yeah. Um I think it's so interesting too is you know, as residents, you know, I think the time when we really learn who we are is when we're not residents, right? Because I think this whole pathway of becoming a plastic surgeon, right? You're in med school, you know exactly what you need to do to match into a residency. You get into a residency, you know exactly, you know, every step of the way, there's like a checklist of what needs to be done successfully to get onto the next step. And then all of a sudden, you're there. It's time to make a decision. Like, what job do I take? And so, um, in a lot of residency, as we all know, we're we're in survival mode, we're learning as much as we can. We're not, you know, we're on call all the time. It's, you know, so um you don't really know who you are until you're like out in the world.

Speaker 1 38:05

So um, you know, I think it's you don't have exposure to other models, like you don't know who you are, but like you mostly see academics and then like the little one-off rotations, you know, where you're somewhere else, but you know, do you really know what it's like to work in that environment? It's it's really hard. Yeah.

Speaker 3 38:27

Yeah. I think too, you know, one of the things I've realized about myself is is that in going back to like we're all used to being like residents and trainees, and it's say the same kind of mention. It's like we're all used to just putting our heads down, working hard, not asking questions. But one thing that I've realized, like going into my fourth year, and I'm uh in my fourth year of practice, but is like when you start to gain that confidence where you're like, okay, I got this, like I know how to do cases now, I know how to get along with people. I know to then you start to like ask more questions and tell yourself, like, is this really what's best for me? Or can I now rather than just doing what you're told? And and I remember like when I went into academics, one of the first things I never negotiated my salary ever. I I was just so grateful to not have a resident salary and just to get paid something that was reasonably reasonable that I'd never negotiated. And then one of my mentors told me, at one point you're gonna care. And and that's so true, you know. And I think it's it takes some time, maybe a few years, to recognize your worth, build that confidence to start realizing that you you have the confidence to do things, anyways. Omar, sorry, I interrupted you again.

Speaker 4 39:42

No worries, these are all good discussions. So um we're gonna kind of switch gears a little bit um and try to advance. We had a few more questions, but in the for the sake of time, um, you know, we kind of already covered the business stuff, but being in you know, aesthetic medicine now and a private practice, how important has social media and branding um been for you guys?

Speaker 1 40:06

It's everything. And then it's everything.

Speaker 4 40:10

And then how do I sorry? It's a two-part question. And then how do you balance that by but also like being authentic um and professional? So sorry, go ahead. I don't know who wants to take that one first.

Speaker 1 40:20

Smit is like the brand, the brand guru.

Speaker 3 40:24

Um you guys are both so good at it, by the way. I just have to get that. You guys are so good.

Speaker 40:30

We inspire each other. Yeah. We do, I know. Um, you mean I think you know your brand is is really everything, right? It's who you are, it's what patients identify with. It's, you know, there's there's so many plastic surgeons, especially on where I am in North Jersey. There, there's a lot. And, you know, and so you have to sort of set yourself apart a little bit. And so um, I think that's how patients relate to you. And, you know, social media is where they find you, right? I think that the modern day patient is not what they used to be, right? They want to feel that connection and they want to feel like they know your personality and the, you know, you potentially could be their friend. And so it's that comfort level that they want in addition to your expertise. And so that's why I think with, you know, especially being authentic, being yourself, educating, doing all these things on social media is important. Um, because those are the patients that convert, you know, when they come into my office, like if they found me on TikTok or Instagram, like they are saying the words before like I can say them. You know, they've already heard my spiel because they've watched my videos on TikTok and and they convert because they feel like they already know me. Um, they're not trying to feel me out. So um I think it's so important to build that um, you know, in in practice.

Speaker 1 41:53

Yeah. I mean, I guess the unique thing about my situation is like I've built a personal brand and and you know, I started that at the university. You don't have to only be in um private practice to do that. You just have to know what the rules are of your own institution. And so I was able to work within the boundaries that I was given in in academics to start building a personal brand. And then I got to really, you know, build upon that now that I'm private. But I also have not just my own brand, but the greater brand of our um our practice, the Quatella Center for Plastic Surgery. So I have a personal brand within a larger brand umbrella, and that's a kind of different thing to navigate as well, because I'm, you know, beholden to myself and the brand that I've built and the people who follow me and the patients that I have, but also again in my partners. And so I have to make sure that that brand, you know, is polished and professional in a way that fits and aligns with the values of my partners and the values of our overarching practice. So that's been interesting. I wouldn't say challenging, but just like a little bit different and and also fun. And, you know, just like Smitta, I I feel like it's been nothing but an asset to me to have a personal brand and to have a following and and to show what I do, but more importantly, who I am to to people on Instagram. And that has created a lot of loyalty and helped build and grow my practice. And people come in knowing who I am, but maybe more knowing knowing more so about who I am as a you know, as a mom and a family member, and my values, and you know, the things that are exciting and interesting to me. And that helps them know me on a deeper level, which has nothing to do with my ability to do their surgery in a in a satisfactory way, but more so the trust. That they have in me. And so, and so I think that that's just been really huge. And then, you know, the bonus is when you are good and you do good work, and then they're like, okay, done. And and they are converted leads before they even step in the office. And and that's invaluable.

Speaker 3 44:18

Yeah. And it's so important because like web pages are so stagnant, you know, like how often do we update a web page? But social media, like almost multiple times a day, you see a new post or a new statement. And and when you're advertising your results, there's nothing better to kind of show your brand. Um, and I'm assuming do you both get consents for your patients who you put on social media?

Speaker 1 44:43

Oh, yes.

Speaker 3 44:44

Yeah, we have to.

Speaker 44:46

Yeah, absolutely.

unknown 44:47

Yeah.

Speaker 2 44:47

Okay. Yeah.

Speaker 1 44:49

Even when I was at a university, there was um we had like legal consent forms. Um, and I use those for posting when I was at the university. And again, that was within the confines of of the rules that were there when I was there. But yes, absolutely. Now we have um legal documents uh that that consent to the use of no use of photographs. Um they can consent to the use of photographs for educational lectures and teaching. Um, the operating room photos are separate than the clinic photos, and they can consent to one or both. And then they can either be used in the office for patient consultations or on the website or on social or you know, ideally all of the above, but um it's whatever they're comfortable with. And and asking for consent has become a pretty normal part of my my process, and it doesn't feel salesy, it feels it feels genuine, and you usually get a sense if people are gonna want to share or not, and um, it's just part of the process.

Speaker 3 46:00

Yeah, and it's it goes back to you the fact that it's very much business-minded and building your brand, everything that you guys are saying. Um and you shifting gears a little bit, you know. We we obviously we're doing this sort of under the umbrella of the Young Plastic Surgeons group. Um, Ashley, you're the chair, a lot of really, really cool initiatives this year, thanks to you. And it one of those was this podcast initiative. So we're very grateful for that. Um, so thinking in that lens of like the chair of the YPS, what do you think that are perhaps the biggest challenges facing early career plastic surgeons?

Speaker 1 46:41

I mean, I think, you know, 11 years into practice and looking at what that world looks like, you know, just a decade or so later, I mean, I think it's a different economic environment. And and I think that the world of private equity-owned practices was was really not a thing when I was coming out into practice. I mean, there wasn't even really employed opportunities at that time that was few and far between. Um, you know, if you wanted to move to Royal Dakota, then you could be employed. But otherwise, you were like either private and most people were solo, or you were academic. And um, I think that the culture is shifting. I think that I think that, well, I know that from data that group private practices are becoming much more common for shared resources and overhead, and that solo private practice is becoming less common for new graduates. And so I think that's an important thing for people to think about. I think that understanding how to navigate private equity-owned practices is a new challenge for new graduates. And I think that there's certainly pluses and minuses to that, and ultimately I'm not sure that that's going to work extremely well in our field. But I think that there is so much more out there, and I think that sometimes that can be challenging because it's it's overwhelming. And so, you know, my best advice given the landscape and you know, radical sort of shifts in the roller coaster of the economy, you know, it's just a different world and and you need to really look into the different options and see what might be the right fit for you. And I think you just the earlier you start asking questions, the better. And every time you're on a rotation, even if it's with a private oculoplastics guy in town, start asking them questions about their business and what works and what doesn't work. And, you know, come from a place of curiosity and it won't seem um indulgent or um, you know, too inquisitive. And and just start learning early on what all of those different environments look like, and then do the work throughout your training to really think about what works and doesn't work for you as a person, and um, and figure out, you know, what what might be the best environment for you. And then remember, you know, most plastic surgeons don't stay in their first job. So if you don't get it right the first time, you know, think long and hard about what works and what doesn't work, and and then hopefully the next choice you make is is the right one.

Speaker 3 49:30

That's uh that's awesome advice. That's that's yeah, that's really good advice.

Speaker 49:35

I think just you know, the exposure is really what's key here. You know, we're so um in most residencies, you know, you're just you have exposure to academic medicine, academic surgery. So, like Ashley said, the real life landscape is so different now and it's still changing. And so, you know, just kind of taking the initiative to expose to have that exposure during your residency um it speaks volumes and can be really helpful in making some of those decisions and talking to people, you know, just ask questions, like she said.

Speaker 4 50:12

So um, I don't know if many of our listeners know that you guys uh host a podcast together called Lipstick and Lipo. So um we we kind of wanted to ask at least the one question about that. So thank you for the other on all the major topics. Shameless plug, I guess, for you guys. Um so has podcasting changed the way um either of you thinks about educating patients or mentoring young surgeons? I know we kind of touch on those topics separately, but how is podcasting affect that or changed the way that you guys think about that?

Speaker 50:49

Oh gosh, it's it's so funny because I don't think it actually like what you guys get on lipstick and lipo from the both of us is what we give our patients every day in the office, right? It's like very real, candid conversation, except we're just talking to each other, which makes it fun.

Speaker 2 51:07

Yeah.

Speaker 51:08

Um yeah, very fun. And so, you know, we we sort of this idea was born during COVID when you know we were all stuck at home and we were trying to find a way to still um educate our patients, and we're like, oh, this is great. Well, we get to see each other every week. It started as an Instagram live.

Speaker 2 51:25

Yeah.

Speaker 51:26

Um, and we get to like hang out with each other over Instagram, but then we can just talk about really cool plastic surgery topics um and answer questions that you know patients are afraid to ask or they're curious about or they're nervous about, you know, um, when they're starting their plastic surgery journey, and it's now really evolved into um, you know, a YouTube channel and Spotify, and you know, we're on Apple um podcast. So um, but you know, you guys get the they get their the real versions of us that you know our patients would see in the office, which I think is really um neat.

Speaker 1 52:04

Yeah, it's like an adjunct, like it's not like anything new or novel, but for people who like to watch or and are more visual or who like to listen, or for those patients who are really anxious and you know they need to be extremely overeducated coming into surgery so that they feel prepared. It's just like another tool for us to help educate. And in a world, you know, where people are watching short form videos for education, you know, for everything else, I think it just fits in that it's another tool, another modality for people to educate themselves and get to know us. And honestly, it sets our patients up for success because they are hearing, you know, more than once, you know, what we're recommending, what we're saying, they're becoming confident in their plan and their preparation and their recovery, and you know, all that information helps. And it's a fun, exciting thing for us to do. And um, and ultimately, I really do think it it benefits the patients, but we have a lot of fun doing it too. Exactly.

Speaker 3 53:17

Yeah, you guys are so good at it, and it's any anyone listening needs to needs to listen to these conversations because I think it's so important for I I mean, you guys probably have these conversations, and then um anyone else could gain so much insight and knowledge just by listening to them. So it makes total sense, especially when it's uh people like you who are friends and have gone through similar life experiences together. Um so I think that that's really cool. And then kind of again, switching gears a touch, and we're getting towards the end of the podcast. So I I I want to ask one more kind of important question, and then Omar is going to wrap this up with a couple of rapid fires. But this you could probably do a whole podcast on, but I think it's important for people because no matter who you are, everyone has their own interests outside of medicine, outside of plastic surgery, outside of our job, whether that be a family with two kids, Ashley, or or you know, whatever your outside hobbies might be, um uh family time, etc., building a family. You we talked about the grind of private practice. How do you guys both balance what's important for you outside of work? Like, do you ever say, oh gosh, I'm working really hard now. Maybe I should have stayed in an easier job. Yeah. Or how do you how do you how do you find time for what's important to you, family and all these other things?

Speaker 1 54:44

I think it's just balance. I mean, I, you know, for instance, my brother had a big medical procedure yesterday, and it's there's no question that those are the things that are non-negotiable for me to be at. And so I knew I had a full operative day on that day. And so I have the flexibility to take some of those cases, move them up on my schedule, and then last week I just grinded like extra crazy so that I could get that done so that this week I could be there for my family. And so I, you know, am creative about my scheduling, but for me, there's non-negotiables. The kids' birthdays, I'm always taking off to spend the time with them. Um, vacations, you know, that's our that's our time away. And we really do, you know, just you know, kind of distance ourselves and we're available if needed, but I have partners I can trust and I can really spend quality time with my kids and you know, doing entertaining and having fun with family and friends. And I feel like I have actually pretty good balance. It's like work hard, play hard for me. I work like an animal when I'm working, and you know, on the weekdays I just go, go, go, go, go, and I go to bed and I wake up and do it again. But then that allows me to really dedicate my weekends to my family, and that's that's what's important to me. And so, yes, it's a hustle, but I can balance it in a way and I have enough control um that I always do what's important to me first.

Speaker 3 56:24

And what about you, Smyra?

Speaker 56:26

Yeah, I mean, I I echo a lot of that. I think, you know, in solo practice, um, you know, the the sort of misconception is that you don't have flexibility, but I have more flexibility than I've ever had in my entire life. You know, yes, I work hard, I hustle. Sometimes I, you know, open up my laptop at the end of the day, you know, um, but uh, but I can make my schedule the way that I want to. If I want to go away, I don't need to get approval. If I want to take time off to do or, you know, start my day later um in the morning or have a later, you know, there's so much flexibility. And I think that allows me to make time for the things that are important to me on a personal level, you know? And so, yes, I'm working harder than I ever have, but I have more flexibility to do what's important to me and prioritize that. Um, and I don't think my practice is, you know, I'm not sacrificing anything professionally in order to do that. So um, I mean, even little things like I'm starting to, or I have interests, I'm not starting, um learning how to play golf, right? And so I'm like, okay, well, I can like start, I can end a little bit early on a Friday to go out on the golf course. Like, it's okay. I would never be able to do that when I was in my previous job. So um things like that uh I think are are sort of invaluable and um prevent burnout, you know? Um, because you can do the things that you love and still have the career that you want.

Speaker 4 57:59

Yes, when you're on your own bus, right?

Speaker 58:01

Yeah.

Speaker 4 58:03

All right. So we're gonna we're gonna try to wrap this up. So thanks to both of you for for all that. Um and this is gonna be very quick, like a 10 second, 20 second answer. Um, so and I'll just give them both to you and you can uh you can take turns answering these. So, what's the best advice you received in your career, whether it was early or late, and then the worst advice you received?

Speaker 58:25

Oh gosh, I think for me the best advice was um as a resident, so when I was a chief resident, that I don't need to make my like wife career decision for the next 20 years, right? I'm just making a decision for the next few years. Hopefully it works out, but if it doesn't, then it's okay to change. Um, that really helped me a lot because you know that's not how our brains usually work when we're in training.

Speaker 4 58:52

True. All right, and then the worst.

Speaker 58:57

The worst, I think, for me was most medicine.

Speaker 1 59:00

I don't have answers. Keep going.

Speaker 59:02

Go see. Yeah, no, I mean, I think it's not necessarily rapid. I know. This is hard. This is hard. Well, I would say I'm gonna change this a little bit because it's not really advice that I received, but it's sort of um, you know, a lot of people have opinions, you know, and I think in residency we we value the opinions of our mentors. Then, you know, you're sort of you just put your head down and you do what you're told, right? And so I think um when you're early in your career, that same mentality is like, oh, well, they think I should do this. And then at the end of the day, you have to realize like, you're your own person, you're the only one living your life. Um, and so like you sort of have to tune out the noise. And there's a lot of noise out there. And this is really where, as Ashley said before, you have to really dive deep into like who you are, what your motivations are, what your goals are. And um, this isn't the time to sort of please your mentors and all the people you have been trying to please for the years before to become a plastic surgeon. So it's weird. Yeah, yeah, exactly.

Speaker 1 1:00:07

I mean, I still care. Isn't that weird? It is. I don't know. Um, you know, I would say the best advice was like a I can, I don't know if this is advice, but I had like a very vivid conversation with my program director when um when I was pregnant with my son and about uh to deliver my son, and my son had a lot of medical problems and um he had open heart surgery when he was born and brain surgery when he was three months old. And he said, This is gonna be the hardest thing that you've ever done in residency. And I was like, that's weird that we're having a conversation about this because like your job is to like train me as a plastic surgeon. And he was like, No, Ashley. He's like, he's like, life is the hard stuff. Like the things that you have to overcome in life are the hard stuff. He's like, this is just your job. And so, you know, less so advice, more so like big picture thinking that like, even though plastic surgery is so much of who we are, it is not everything that we are, and our life and the people that we love around us are, you know, the ones who love us back. And so I think that the way that he created those priorities for me has never left me. And I think about that all the time whenever I'm facing anything hard in life, that you know, this is the hardest thing that you're going to do as a plastic surgeon. And so um it was just very, very meaningful conversation. Um, and you know, the worst advice, I hate to end on a bad note, but like um, you know, I had a lot of naysayers. Like when I was a medical student, um I would say I had more people who were negative about me wanting to be a plastic surgeon than those who fully supported me. And it created a lot of self-doubt. And, you know, when I would put out there into the universe to different people and different um, you know, surgeons that I was shadowing, and I won't name names, but they would say, like, oh, well, you know, that's the hardest specialty to get into, and you know that you're never gonna have a family if you do that. And and I had so much self-doubt because in that vulnerable position as a student, I really looked to those people, you know, to inspire me. And and there were many who didn't. And and it took me a lot, a lot of years to get their voice out of my head and to prove them wrong. And and boy have I. Um, but but you know, I would let that stuff roll off you and and try to find that self-confidence in who you are and what you want to be, and and only you know how hard you work to achieve your dreams, and and no one else can tell you what you can and can't do. And um I wish I wouldn't have let it get to me like I did, um, but I'm glad I left that a long time ago.

Speaker 3 1:03:06

Well, sometimes when it gets to you, it gives you the motivation to do all the great things that you've done. Um, but it it it kind of summarizes a lot of the things that we talked about, you know, pushing through the doubt to perhaps make the leap in your career journey as well. You know, like this you're comfortable in academics, jump to something else that could be equally fruitful, equally rewarding. And and I can't say how much I'm grateful for this uh conversation that we just had, how much I learned and and how much I'm looking forward to releasing this so that other people can learn. A huge shout out to ASPS, YPS, uh Dr. Smitta, Ramanatham, and uh Ashley Amalfi. And if you haven't listened to their podcast, you have to check out their podcast. You can actually that podcast, you can actually see them. This one we can just listen, but and and thank you to my co host Omar. This has been a ton of ton of fun. So um, I'm looking forward to listening to it.

Speaker 4 1:04:06

Yeah, thanks so much, ladies.

Speaker 1:04:08

Thank you guys so much.