Over their career facial surgeons will generate a lot of money. Whether they accumulate wealth is another matter. This chapter is intended to provide guidance on money management and fiscal responsibility, both within the practice and in one’s personal life.
■ A Stereotype to Be Overcome
In “Why Doctors Can’t Manage Money,” investopedia.com noted, “Doctors are one of our most esteemed professions. They’re held up as geniuses, seemingly unable to do wrong. Except when it comes to money.”
The fact that doctors are not looked upon as good managers of their affairs makes us targets to industries that prey on the medical profession’s lack of business training. Physicians are usually so busy taking care of patients and practicing defensive medicine that we don’t always pay attention to financial matters, at least not until we learn by being burned. Hopefully, this chapter will go a long way in helping you avoid being indoctrinated by fire.
The Investopedia article goes on to say, “A common stereotype [is that] doctors… rack up debt, spend too much of their income and fail to save for retirement.”1
In the same article, Dr. Jim Dahle contends that the stereotype stems from “a lack of financial literacy, poor financial discipline and a lack of long-term perspective. In addition,” he said, “there is a bit of a culture within academic medicine where you don’t talk about financial topics.”2
As is the case with most issues, balance is the key—knowing when to spend, knowing when to save, knowing when to invest, and into what. This chapter emphasises the wisdom of investing in one’s practice.
In addition to his academic responsibilities, the chairman of my residency program managed a very successful private practice. Thankfully, he did not hesitate to share financial matters with his residents. The following is one of the “secrets” he shared: “The doctor who brags about a low overhead could be penny wise and pound foolish.”
Dr. Hicks was referring to the fact that a surgeon should not skimp on essentials necessary to be productive and accommodating. Good business practices call for surrounding oneself with a competent staff. This includes medical and paramedical personnel, to whom the surgeon can delegate tasks such as prescreening patients, assessing laboratory tests, application and removal of dressings, and basic wound and skin care.
The other part of the equation is to know when enough is enough. For more advice on this matter, I recommend the book Parkinson’s Law.3 It is a brilliant dissertation by Dr. C. Northcote Parkinson, a 20th-century British economist. His law states, “Work expands to fill the time available for its completion.” To this, I add, “Work is not necessarily synonymous with productivity.” I include another corollary to Dr. Parkinson’s law: Being present is not necessarily working. Work is measurable, either in profits or in reduction of stress for the owner/manager of the practice. If an employee or associate is not rising to either of these criteria, that employee is a drag on the practice.
■ The Office Makes a Statement
In Chapter 3, I discussed the strategic location of one’s practice. That includes the assistance of an architect schooled in the design of medical/surgical facilities and a professional interior designer. Their charge must be to design and decorate the facility with tasteful décor that creates an inviting ambiance and provides the considerate privacy expected of an elite facial surgery practice. The elite facial surgery clinic is careful not to offend anyone who enters the door. Extravagance is not only unnecessary; it can be interpreted as poor taste. In that regard, a visitor should not be faced with anything that they might find offensive, for example, school colors and memorabilia of the surgeon’s favorite sports team. And the practice setting need not be expansive to impress.
■ On the Matter of Compromise
Many young doctors enter practice with large debts hanging over their heads, usually in the form of “student loans.” Debt often forces compromise and limits opportunity. Though they may not be the best option for building an elite practice, practice settings in which income and benefits are guaranteed appear more attractive. In these cases, the surgeon is often required to provide services that are not related to aesthetic facial surgery. The public perceives any doctor who performs plastic surgery to be a “plastic surgeon,” regardless of the parameters that exist within the medical profession. And surgeons who perform services outside the facial region will find it more difficult to establish themselves as a “facial surgeon.” The bottom line is this: the sooner one dedicates oneself to facial surgery, the sooner one will be on the way to establishing an elite facial surgery practice.
■ The Facial Surgeon’s Consulting Team
An elite facial surgery practice should have an elite team of trusted consultants. It is never a bad idea to check with the local Better Business Bureau, state bar, and accountancy and financial planning oversight board to see if the consultant you are considering is in “good standing.” You should also ask for references of other clients represented by the consultant. And follow up by speaking directly to several of the references provided. It is also a good practice to ask for references outside the medical profession. And do not limit background checks to one’s consulting team. It is a good idea to check on anyone you hire. There is a reason I began this chapter with the stereotype assigned to us physicians.
While you will want to contact business individuals outside the medical profession, make sure the attorney and accountant you hire are experienced in dealing with issues that pertain to medical practices. A facial surgeon needs a consultant who knows about a “fee for service” business model.
As indicated with the décor of the practice, a facial surgeon should exercise prudence when hiring consultants. Accountants and attorneys charge for their time, including research and preparation for meetings, usually in 20-minute increments. A facial surgeon might not always get the best advice from the most expensive consultant. You should know what each increment costs; and keep a diary of when you consult with each advisor. Subtly, let the consultant know that you are doing so. One way to do so is to ask, when did we “go on the clock?” And in the case of face-to-face meetings, write the answer down, in front of the advisor.
During the interview process, you should also insist that anytime the consultant’s fee schedule changes, you are to be notified at least 30 days in advance. “Memorandums of understanding” specify contractual agreements between the facial surgeon and each consultant.
Here, I share the advice of my Scotch-Irish father—a man reared on a dirt farm during the Great Depression of the early 20th century. He was only able to obtain an eighth-grade education in a one-room schoolhouse. Yet along the road of life, a member of what journalist Tom Brokow called America’s “greatest generation,”4 my father acquired the wisdom of the ages. As though it were yesterday, I recall the day he said to me, “In some cases, saving money is as profitable as—or better than—earning it. You may not be required to pay taxes on money saved.”
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