AAPS Member, Lorne Rosenfield, MD
Dr. Rosenfield has been in practice for over 31 years, is a board member of AAPS, is a professor at both USCF and Stanford, has written several book chapters, and has been voted by his peers as being amongst the “Best Doctors” and “Top Doctors in America”. Learn how you can succeed with your practice with practical advice and tips.
Ep.54: With ASAPS Member, Lorne Rosenfield, MD
Catherine Maley, MBA: Hello and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery. I’m your host, Catherine Maley, author of Your Aesthetic Practice: What Your Patients Are Saying, as well as consultants and plastic surgeons to get them more patients and more profits. Now, today’s distinguished guest is Dr. Lorne King Rosenfield, that is a fancy middle name you have there. He is a board-certified plastic and reconstructive surgeon, and he’s been in practice in the same community for over 22 years. As a matter of fact, he’s also in the Bay Area. So, he’s about 30 minutes away and he lives like a mile from my sister. So, it’s all very family like over here. So, Dr. Rosenfield is the only private aesthetic surgeon to be active as a professor at both UCSF and Stanford University. Now he teaches and he writes scientific papers and book chapters and teaching his innovative techniques to other surgeons. He’s been voted best doctors and top doctors in America by his peers, and is a member of the most prestigious organization called the American Association of plastic surgeons, where only 3% of plastic surgeons are honored to join. Now he does zero advertising and he gets patients the old-fashioned way by earning them one patient at a time. So, they refer their friends, family and colleagues to him. Now, Dr. Rosenfield also founded peninsula plastic surgery foundation to deliver charity reconstructive care to those in need in his local community. So, I want to welcome Dr. Rosenfield to Beauty and the Biz. It’s a pleasure to have you and did I leave anything out?
Lorne Rosenfield, MD: Yeah, that’s an older CV. I know exactly how old it is. Because I’m actually been in practice for 31 years. So, what’s different– and this could be an advantage because it tells you, you know, what, my learning curve and my past and my advancements have been in the last, whatever the years it was, I think you said 23 years and another eight years. So, what’s happened in eight years? Well, as you say, I’m still involved in all the organizations you mentioned. But in addition, I’ve I’m now on the board of the American Society of Aesthetic Plastic Surgery, which is the premier Association for Aesthetic plastic surgeons in America. I’m also on the board of the So, aesthetic surgery journal, which is a premier worldwide Journal of aesthetic surgery. And now I’ve just created a byline called second thoughts about first thoughts, which is about how to be great surgeons become great working right now. I’ve also got a book deal with Oxford press to write a book with the interviews and So, data I’ve collected and collated from Master surgeons as to how they got where they are, what are the secrets to the source.
Catherine Maley, MBA: Is it a consumer book or is it going to be an industry book for the surgeon?
Lorne Rosenfield, MD: That’s a great question, the first book is going to be for the industry, okay. But ultimately, my goal is, with this principle, which could hold across all So, of society’s professions, I would love it to be a consumer book, which will obviously be more expensive and penetrating in the market for good reason. Um, what else I’ve got, as I see a book deal with Oxford press, and I’m working on a meeting I still am, which was, what you were going to be involved in, which is not going to go zoom, which is take advantage because now there’s no barriers, no friction, that’ll happen in collaboration with what I was going to mention. In my traveling professor. lectures I was doing, I became friends with the head of Duke University, and I’ve now become a professor of Duke. Wow. And I’m going to be I’m going to be helping educate the residents, again, remotely, and So, on site at both ends. And so, he’s going to help me with this meeting that we’re going to do next fall or early winter. And so yeah, that’s so, a few of the things have been going on since the last time. I wrote that up.
Catherine Maley, MBA: Okay. Oh, wow, have a lot happening over there. So, can we go ahead and have that conversation that’s still in the air and is the most prominent, which is COVID-19. How have you handled that and what have you experienced now?
Lorne Rosenfield, MD: It’s really interesting. These questions come up by so many people in terms of, I mean, the first thing on everybody’s mind probably no time– probably in our human history have we all been on the same page? Literally globally, in such a fashion. So, it really is an opportunity to either become an animal in a den and be afraid to go out or to, or as I like to put it and take advantage of it and turn lemons into lemonade as best you can, especially from a personal and interpersonal and professional and a lot of ways. I mean, it’s it, I’ve never had such a large pause, I was talking about the positive surgery that we’re supposed to do before we operate to make sure you’re operating on the right hand or that are on the right patient. I always say there should be integrally placed pauses in our life, to stop and look at what we’re doing. It’s just the right path. This is the right direction with anything that we’re working on anything we’re involved in. Well, COVID definitely gave us a pause. And it’s the longest vacation I’ve ever had. And the longest time I’ve ever had not operating. So, I think it initially was a shock to the system, needless to say, and then slowly just because I’m an optimistic person who has to can’t sit still. And that combination resulted in a lot of great things happening. That progressed, all those projects I spoke up all move forward significantly. And some of them are getting off the ground that I So, didn’t even talk about that are additional simply because they’re on my pile of things to do that I never got to we can touch on some of that, as we talk about some of the things I do. I’ll mention it but I think that from my point of view, it really does. COVID really does establish and prove how little friction there needs to be. there needed to be between myself in my office, to telegraph to patients who are interested commitment to safety in our office and operating room. When it comes to reopening these that was the big issue is like what’s going to happen when we go back. And as I mentioned, I was part of the small group, there was a committee, nationally a biceps that we wrote the protocol for returning back to practice. And so clearly, I was living and breathing this for the last several weeks. But what was not mentioned in that list, of course of what you need to do to go back, because that’s all just practical issues related to cleanliness and wearing masks and so on. It’s the genocide crimes that it’s the smoke, and the and the and the unquantifiable parts of your practice that come to life. When you’re stressed like this, I would say it’s easy to be good when you’re when things are good. It’s hard to be good when things are bad. And if you don’t have a substrate and a foundation, especially if we speak specifically of a practice, it may not fly, which is why just like Oh, ah, there’ll be there’ll be practices and clearly, entities that will disappear. Because they didn’t have the infrastructure and anything more than an Instagram page and it won’t last you need you need substrate. So, what does that mean? What I found is that, you know, this advantage that I’ve developed over many years, it’s proven its worth I mean, patients, from the get go have known that this is a safe place to return, to practice and to visit our operating room and our consult rooms. And we’re definitely seeing it as we have increased patients coming in numbers coming every day this in the last couple of weeks now. And that’s what it means to build a practice. I think one patient at a time, as you mentioned, it takes 30 years, not a few days on Instagram, but you eventually have a practice that’s clearly stronger. With a with a sturdier foundation. And you can stand taller. And you know, you can say well, you know, what about the patient who doesn’t know me, who’s never been to my office, it’s easy to say, Well, you’ve got all these, you’ve got all these patients that think you’re wonderful, and they’re clearly coming back. But what’s interesting is that as long as they can get to my website, where they have started teach us as I call it, my body of work by practice philosophy, the differences, as you mentioned earlier about what I do that may be different than others and then the office will present itself through that website or of course, ideally on in person, they’re going to see that it’s real. And sturdier the fact is, is that that’s the way you when you’re patient and I say when I mean it’s honest legitimately, not when predicated on sturdier just fluff and all deference I get a beat on Instagram. But the fact is that having a lot of followers is not the way that’s not the that’s not the same as winning a patient with a win. The body of work in a reputation. And I think, to me, that’s really the piece that matters. Because if you think about it, I’ve spent 30 years building my, my, my passion for, for a balance between safety and results. And I think that, as I mentioned, this is what we what I call, you know, deliberate practice, where one of my heroes is Anders Ericsson, and he was going to come to that meeting, which hopefully will still happen. learning curve, where he proved the 10,000 hours of practice to, you know, to reach expertise. But it wasn’t just practices, Gladwell originally wrote about it and authorized if it was the deliberate practice, just install these pauses in your practice, and they’re gonna act as change agents to better. So, my primary change agent was better with my surgical techniques to realize better and my results in terms of aesthetics, and most importantly, in terms of safety. And that brings us full circle, because then, you know, the point is, is that, as President Bush said, you know, it’s all about the economy stupid. Well, in my case, it’s all about safety in the end, in the end, but patients want, they don’t want to be harmed, they want to be safely taken care of, and come out whole. On the other end, when you ask them what their greatest fear is, that’s always what it is, yes, they want something bigger or smaller or removed or added. But the fact is, in the end, it’s about safety. And, you know, parenthetically, I always say when I give my lectures to surgeons about safety, I say, I know you want to, you know, learn what are you going to tell me that it’s going to make me more money tomorrow. And I always say, that’s not the way to think about this, the way to think about this as if you’re safer, with better results, you’re gonna have more patients in the end than anybody Well, in a much less frenetic, kind of whirlwind way, because it just will happen organically. So that’s how you make more money, just have a better result, it’s safer.
Catherine Maley, MBA: I will vouch for what you’re saying, because like, my book is sitting right here, I interviewed cosmetic patients. And I said to them, you know, we all talk about price. So, it’s all price and when it got down to it, and the real answer was, yes, I’d love a fair price. But I want to make sure I don’t regret this. And I am happy with my result. And I get out of this unscathed.
Lorne Rosenfield, MD: And that’s exactly right. And I was chairing the Safety Committee for the ASAPs for years, for society I created the first checklist, surgical checklist, comprehensive, comprehensive checklist. That’s now the standard nationally, and even in the European Union about how do we prevent errors of omission and commission. When it comes to what we do from one end to the patient to the other, as I like to put it, I tell patients, you will be handled like a fabricator from the moment you come into this office till you are discharged. And it’s not, as I like to put it, it’s not a tagline. I tell patients, I’m not just this isn’t a meme. This is my philosophy; this is our foundational practice philosophy that we will prove to you and my body work will prove to you is real. Because you just can’t say things you can. But if it’s not what substance and if it’s not backed up by both facts and actions, then it’s not real. And I think that’s, to me, the most important piece. So, what happens is now we come to the time of COVID. And you know, understand why it wasn’t hard for me to speak to my patients. And they immediately knew I’m gay, I was all about safety. I’m all about great results, I’m not installing great results aren’t important. As I like to put it, there’s a surface of a balance. You know, Cirque du Soleil, looks beautiful. But it looks incredibly dangerous. But the risks are very low, because they take incredible pains of reducing risks, you get to look beautiful, that speaks to us as aesthetic surgeons, there’s a balance between safety and aesthetics. And you have to struggle with that every day. And the fact is, if your patients already know that, or you can prove it from what you’ve done, then when it comes to reopening your office, the office, it was it was there wasn’t any need to explain I had so many patients say to me, I know if I’m going to go anywhere. I don’t have to think about worrying about going here. Because I know that it’s going to be it’s going to be a safe environment. And so, I think really when it comes down to it, that to me, is the lesson that anyone who’s starting out, needs to listen to and anyone else who’s struggling with where they should be and what they should do at this moment, is the fact that what matters is all the old-fashioned stuff. It’s like that Robert old-fashioned Fulghum book on everything I ever learned, I learned in kindergarten. This is not brain surgery. It’s old-fashioned all the stuff that is alive. Put it, that since the beginning of time, with physicians, it’s about taking care of patients better. It’s about caring about them more, it’s about being beat up around the ball about the right things, you want to get a great result, you want to get a better result, you got to own your skills, and you need to be safety conscious at all times. And that takes deliberate effort. And that, to me is a message that came out of this is that I proved that point right there by old-fashioned COVID, saying, pause, patient, and then the patient says, but I’m not pausing to come to his office, I’m ready to have him take care of me. Yeah, so, I think that’s really the big message.
Catherine Maley, MBA:
To put it in a pragmatic way. Are you going to go over some of the checklists you do? Because you’re talking about safety but how– pragmatically, what does that mean in real life?
Lorne Rosenfield, MD:
You know, it’s an IT that’s an interesting point. And I think that, it’s kind of got a jewel edge, because on the one hand, for patients that know me, and have been in my practice for a long time, they just know, whatever I’m doing is the ultimately the safest way anything can be done, and they don’t have to think about it. From the practical point of view, it’s what everything else you’ve ever heard about, I mean, you need to be sure that your way. Are abide by the three or four main tenants of COVID. I mean, for example, masks, you know, and 95. Initially, I thought, well, I read what’s going on in the hospitals that are in short supply, I busted my rear end, and I got enough of them, that was an easy practice to sell one of my children, but I’ve got, I’ve got enough. And I just start and I thought, well, all the people in the alar are having direct contact with patients should have the 95. And before we started, as in Wait a minute, everybody should have one, clearly, that’s a better scenario, if I’m wearing one and my staffs wearing one, then it is that a way to make my patients should be wearing one. Because clearly, that’s even better than it, it eliminates, as much as possible. Any fear by anybody, these fears a big factor here, and you need to be able to telegraph that this is a safe place, and you don’t have to be afraid, or as much afraid. And so, everybody gets a mask, we obviously have protocol, the way you hear about, you know, organizing patients coming in one at a time and very strict pattern in and out and spending only the time we want to spend with them, which is hard for me because I like to schmooze and talk to patients, which is one of the hardest things to do and hug them. But be that as it may, my staff is on maintaining a rotation. They we, we don’t just clean everything down. on our own, we clean things down with the patient seeing that we’re cleaning things down. You know, it’s just like when you go to a when you go to a hotel, and you see that you see the bathroom with little tickets that say cleaned by somebody. And with a piece of papers on it’s there for a reason. If it wasn’t there, it’s the same outcome been clean. But when you have demonstrable evidence, better yet that you see them cleaning, if you’ve ever watched, or read about the Japanese trains, where they initially, they would have a team go in, they black out the windows, and they would have them all clean the train in like three minutes to be an army go in there and you couldn’t see what’s going on to be three-minute wait. And the public, even though they know it’s well, they’re being cleaned, but they would be frustrated and anxious and impatient. They then decided, the chief said let’s take down the window covers, let’s let them watch. They all watched what was going on. And you know what started to happen to became an event people came just to watch that not to get on the train. They were marveling at how good they were how efficient they were. And they would clap when they came out. They would give them kudos. And that’s what we need to do with COVID. Pay, we need to demonstrably show our patients that we are concerned about this, not just in terms of, you know, saying it, it’s just like everything else I just said earlier, it has to be an action. They see it. They see us cleaning down one after the other all the time. My staff are structured to do that. So, everybody sees that that’s going on. Beyond that, you know, we’re doing the testing that you have to do I think that is mandatory and events of surgery and they shelter in place. Patients people say well, how do you get to keep them to shelter in place? All I do is the same way I say to patients that that smoking I tell them to stop smoking. I say you’re an adult, I’m an adult, if you smoke, you’re going to lose half your face, it’ll turn black and fall off. That’s your decision. I’m telling you now not to smoke before surgery the same way with shelter in place, your choice. You don’t shelter in place; you can get very sick. So, there’s it’s very simple, stay home and don’t go out. So, with all those maneuvers, that is the way we’re dealing with the Drummondville presentation of it and clearly, we have checklists to make sure my staff is doing that. You mentioned that I mean we have a we have a comprehensive checklist. every staff member follows. It is color coded by the staff member; they all pick their color. And then it’s impossible for anybody to not do what’s necessary because it stands out the box is not checked. I have nothing to do with always worried, I don’t want to do any more work on paper, the junk staff does it, they look better, and outcomes are better and happier and everything definitely moves forward. And so, we do that with everything we have. We have some photocopies, think of a new person comes in, you have a floater nurse coming in, she doesn’t know my office, she has to do is look at that checklist and see what the protocols are in following. It’s impossible for her to do the wrong thing of what is most important effort. Because I believe it’s a pulley system that failure is just not human failures, its system failures are what causes most of the problems in the operating room. And in care pre or post.
Catherine Maley, MBA:
I’ll tell you what, this is such a pearl. And I hope the audience is catching this, that is your branding. The way your branding is, you’re not just saying work great. You’re actually proving how great you are in the details. And that I hope that’s the point you How are you different from somebody else, and you have a color-coded system and protocols and checklists. Everyone’s like a Swiss Army Knife of consumer patient can feel that a mile away, you know when someone’s on their game and when they’re just winging it. And that’s why you have that feeling of tasty when you’re with your practice. And that is absolutely priceless. And I hope I hope people are hearing what you’re saying.
Lorne Rosenfield, MD:
And it’s funny to say that shot a few months ago, when I was in practice, the first time I had a patient come in who had done a rhinoplasty on and she had a smile irregularity on the doors of her nose. And she said, you know, I have to tell you I cheated on you. I said what do you mean, she says I went to see another doctor to have a look at the results. And I said you know that I would have given you names of people. I’m not I’m not trying to have you go see other people and see what they think the first person to say got their good ideas, get them. She said, Well, I ended up seeing this guy. And I said What happened? He says, Well, it was really interesting. She says I looked at my nose. And he examined me and he thought about it. And he said, well who did your surgery? Dr. Rosenfeld, and he went, well, then I’m done. Yeah. What do you mean, you’re done? Because he’s Mr. Safety, he’s going to give you the best result you can and then he’s not a minute more. So, I’m not touching you. There’s nothing more to do here. And remember what you told me that I said, Oh, my God, that took 30 years to hear that, right. And that, to me is the brand. That is the one you want. Because that is that is real. It’s foundational, it’s indelible. It’s everything. It’s harder, not the easy route. You know, I always say that, to young plastic surgeons that you have, you have two paths to go down. And I know. And I will, we can talk about, you know, marketing and social media. And I think there is a place, but I’m a firm believer, regardless of what new message there are, to get the word out. In the end, your eye has to be on one ball, you need to be better than the next guy. Technically, that’s, that’s just the bottom line. And I would say, and you may not agree with me, but there’s an inverse correlation, that the more technically adept and with results to prove it, in terms of a better result, with fewer complications, that that surgeon is the lesser marketing, they’re less they’re on social media, I’m actually working on a paper with regard to the Stanford residents, I’m absolutely convinced that there’s a, there’s a, it’s a zero-sum game. If you get my drift between the two. And I think if you look at, I know, things are changing, and I know that I’m not meaning to sound like a mold, but in the end, my final point is, as I tell young plastic surgeons, you only have so many minutes in the day, so many texts in your, in your practice. If you spend it all, on promoting yourself on Instagram, or you spend it on getting better what you do in the operating room, they’re mutual, they’re relatively mutually exclusive, you only have so many minutes in the day. And the fact is, is that I’ve seen it over and over again, you get completely consumed by the latter, you’re not going to you’re going to be you’re going to kind of burn out and edit or at least be the kind of on that curve. You’re going to flatten, flatten and plateau. That’s as good as you’re going to get. And now you have to make up for it with a lot of other less foundational, more ethereal and kinder of anxiety producing phenomenon, which is true full-on marketing. So gotta get good at what you do doesn’t mean that’s the only way. But personally, as you said earlier, there’s a lot of ways that to me is got to the way it’s been since Halstead, and mayo and got to any other surgeon that was better, he was busy trying to get better, it’s a lot of work, honing the skill of 10,000 hours, if you do it multiple times, over and over, takes a lot of time. That’s my success.
Catherine Maley, MBA:
So, that’s where I have a little struggle, because that takes a lot of patience to get that kind of practice. So, there’s some balance there. And in today’s world, you have to market yourself. I mean, you, you don’t have let’s back up, when you first got into practice. Did you do what everybody else did? Did you get into the yellow pages? How did you do it?
Lorne Rosenfield, MD:
In my tops, I have a picture of my yellow– And I bolded it a little bit because it costs too much to bold it too much.
Catherine Maley, MBA:
Those were not cheap ads; they were like 10s of 1000s of dollars a month or something.
Lorne Rosenfield, MD:
And that was about it. There wasn’t a lot. Well, there was probably there was television and radio ads that you could have done. And I actually did dabble in that a little bit and found that I would have like 100 to one ratio under people would call 10 people would come in and I might operate on one of them. That’s an exhausting practice. And you could say, well, that’s one route. And it gets you patients and it does. But when I have 10 patients come in nine of them operate on, I operate on. And so, there are two routes, and I would just say the one is a it has on, advantages and the other doesn’t have. And there’s no way that you can get what I’m just described. By the other route, there’s way too much winnowing, and there’s way too much random shopping. So, I understand that’s the route, you can say, well, how’s the new person going to get started? Yeah. So, to get started, he doesn’t the old-fashioned way. He goes into joint practice, he joins hospitals, he gets on the air calls, he goes out and speaks all over the place. He gets himself known in the community volunteers, he writes papers, he lectures and he gets on committees and he gets himself a foundational body of work and reputation. And the key word, Katherine is it takes time, how long? It takes years and years, a minimum of probably 10 years for you to be able to get that threshold in what I call escape velocity. Whereas when you go on, if you just decide day one, July 1, I’m going to need a static surgeon, as I like to call it, you’re fooling Mother Nature, I train these guys, and they’re not ready to face up to on July 1, I don’t care who they are, there’s no way that that would be really, truly the metric you should be following and understand the forces of the market mandate that you just suddenly say, I’m ready to go. That’s true. If you don’t want to do anything else you were trained to do, you’re trained to do everything else and reconstructive surgery. And so now you’re letting that all be thrown away. And you’re saying July 1, I’m doing aesthetic surgery. And in fact, if you do that, then yes, you’re right, you need to do everything you described. But if you don’t do that, and you say I’m going to build my skills, I’m going to show to speak make mistakes where it doesn’t matter as much when someone comes in with a finger on ice, and it doesn’t take they brought it in on it. But when somebody comes in like you for a facelift, they’re starting from perfect. And with No, there’s nothing that’s an issue, and you better make them better, you better not fail. So, the old-fashioned kind of the map the room for error is Patrick Ichiro. So, all that said, those are the reasons when I first started, I was at 12, emergency rooms, 12 hospitals, I ran all over I gave lectures, I started getting involved with the societies. I made myself known to all the doctors; I took care of every single laceration that could possibly come in. And now I have those mothers coming in for surgery and I’m having the kids come in for surgery. I’ve gotten so old. And so those are from the lacerations I did 1000s of them. So, was it easier to not get out of bed or not go there and do that? Yeah, it would have been. But that foundational base does not happen if you just go straight to passcode. And I know that there’s a lot of argument against that. But I got plenty of surgeons that have followed my advice, and they’re 10 years out. They’re not turning around and watching what’s going on around them and worried what’s So, this guy doing now? Oh my God, he’s got more followers than I do. I need to put out another post. When I go to meetings now, Katherine, half the time ask the speakers on the panels are busy and taking pictures and because they got to post it. And I look at that and I go, oh my god, what the content of your lecture. What about Have you published anything? One of the things I want you to do next time I want you to go on PubMed. And I want you to look at when they wrote a paper last year, what you should do for every single surgeon and doctor you ever see, are they publishing? Are they writing? Are they presenting? Because if you’re not the 10,000 hours clock, left them 10 years ago.
Catherine Maley, MBA:
Well, let me ask you this, because I do think this is also generational, and you have more patients than job, and the others have zero bill, but a lot of the younger people have been told, oh, no, you should be up and running within a year, rather than I grew up on 10 years, it took 10 years to build a practice. Now it’s about a year because they have a lot of bills to pay and all of that. Um, but here’s the caveat to that. It’s also the consumer, in a facelift, patient will So, care a lot about you being involved at Stanford writing, speaking, lecturing on the breast dog 20-year-old patient really does care that you’re on Instagram. So how are you addressing that?
Lorne Rosenfield, MD:
Well, the first thing is to remember that when you talk about, I started that way, so I didn’t have Instagram and Facebook. So, I didn’t have any patients. I didn’t. But you have to work really hard. And I didn’t just do a static surgery. But if we use the model of, I’m not going to do reconstructive at all and I’m just going to do a static surgery, then you’re right. Well, it’s what I call fully Mother Nature, it’s very difficult to pull Mother Nature, she’s going to bite you back. So, you’re going to have the struggles that I see happen when you do that. Because you’re going to save, you’re going to say things that you don’t really need, you’re going to present yourself as something you really aren’t. I mean, let’s be honest, that’s honest, July 1, come on. So, if we start there, it’s really a conversation nonstarter, there’s nothing more to say. But if we try to move forward, then yes, you’re right, then that’s the only way they’re going to build their practice, because they’re not gonna have another way to do it as far as the demographics. And there’s some truth to that the face of patients is unlikely to go to an Instagram doctor. But that’s not always true. There’s statistics to prove, which I don’t believe which I’m going to refute by my research that like a third of all patients, or half of our patients are coming through Instagram, I don’t believe that. I don’t believe it. But there are patients that are cut that are making bad decisions based upon an Instagram page, because that’s a bad decision. I don’t care who you are, how good you are you that’s a bad, that’s a bad way to pick a doctor. It’s a curated, potentially manipulated presentation. That’s unvetted and peer reviewed, and it’s just the Wild West. And that’s just what it is, I can tell you what I’m going to maybe do, but the fact is, maybe I shouldn’t be better when no one else do it. But the point is on social media, but the point is that for those patients, your right face, a patient’s more likely not to go there and the younger patient, that one that’s looking for a deal is likely to go there, you know what the differences should be? Notice the differences, really none. I don’t get those patients now. And I wouldn’t get them if I if I was on Instagram, you know why I charge too much. I don’t I don’t augment them to the number that they want. Because they will they will say this is what I want. See this, I want 620 cc’s I that’s what my wife, this, my sister got, I want that. And the doctor will go ahead because it becomes a retail transaction. And so, I wouldn’t win in that anyway. And I wouldn’t win then. And I don’t win. Now it makes no difference that there’s Instagram or not that demographic would not come to me. And so, I don’t think I’m missing anything. And I don’t think they’re missing anything because they wouldn’t come to me before the visit. The patients that don’t that I think are fascinating, are the ones that are really would like another way and a more voluptuous way to learn about a doctor. And they go on Instagram or some other media site. And they’d have they find me, because I’ll tell you a kind of my philosophy at this moment is, I think about because I’ve had lots of doctors tell me younger guy, so you really need to do it. You need to get on– And it’s fascinating because I thought about it and said, you know what, there’s some truth to this. Because when I first started, which speaks to what I just said earlier, when I first started, what the heck was advertising? What was I going to put on in 1987? What you can I put on Instagram right now, I had no patience, if I put any pictures that weren’t going to be mine, which already starts in a bad press that premise but and whenever I said wouldn’t be real, but the fact is that I didn’t have anything to start with. And I think that I lost my train of thought the fact is that that discrepancy of when you don’t have didn’t have anything to really go on to market. I wouldn’t know what to do with it. But now I run at this point in my career, I’m perfect for social media because I have a foundation of work and I’ve got a reputation. I’ve got results in their mind. I’ve got lots of them. I have great statistics. And I’ve got lots to share. I’ve got lots of reasons to say, this is the place to come to know, ironically, I should be involved in social media. The secret is, and maybe I’ll help me offline. The trick is, how do I distinguish myself, which, you know, is a big piece of the way I think, from all the 1000s of other voices of people that I don’t want to get into bed with? Firstly, because it’s the whole gamut. And I don’t want to become partners, with everybody that’s in that room.
Catherine Maley, MBA:
But on the other hand, look at the consumer point of view, they’re online searching for the best fit for them. And they want to know that you’re more than just a surgeon, they’re trying to connect with you. And that’s where social media has taken over and bond wave a lot of way too far in it. But they’re looking for you as Who are you, as a person, as a father, as a husband as a sports nut? Like, who are you? And that’s why, that’s why this has all gotten convoluted, because I will tell you, there are very many, okay, surgeons are making a killing, with sheer volume of marketing and patients and their results are good enough. They’re not, they’re not perfect, they’re good enough. So, and they can beat you they can they can win that not you. But they can win over a really good surgeon, a really good marketer, can win over a really good surgeon at least in the short term.
Lorne Rosenfield, MD: Well. So, there’s so much loaded in that statement. Number one, what is winning the money what you really mean? If it means money, great, but we know is as old as the hills, that you don’t want that to be the reason when you’re on your deathbed, you want. Because I can tell you, that speaks for itself right there in volume, you don’t want that to be your measure. Because if that’s all it is, and you might as well, there are a lot of other ways to make money in the same fashion, which I would call just wanton advertising 1000 other ways to do that? Let’s bring some nobility back to our profession. It shouldn’t be just about making money. It’s about it’s about so much more than that. And the fact is, you said it as well, I love when you said that their results are just okay. They’re just okay, they’re adequate. They’re there. They’re at the standard of care. Oh, my God, that’s just like, an anathema to me that that’s where I would be, because that’s just who would want to be there. Because in the end, you’ve got to rationalize that that’s okay. But even beyond that, I’d love there to be a study to look at my practices to look at the hassles that go on in the office, what’s the energy that has to go into unhappy patients? What are the energies that go into the So, repeat surgeries in the revisions that go on when you’re in that state of surgery, there’s a lot of hassling that goes on behind the scenes, you may be making a lot of money? But there’s so much there’s so much that goes on behind the scenes, that is personally miserable, and an anathema to me to imagine practicing like that. So yes, you’re right, they can make more money than I can. And they will. Good luck to them. Because I would never want to be in that scenario on that treadmill. doing that. Ever. Can you do both? I’m going to prove that you can, on some level, at this point in my career, I don’t think it would have been honestly possible from an ethical point of view, at the beginning, because it just didn’t make sense to me that I could promote myself with nothing to promote. I have nothing to promote. So, I get that and workplace advertising works. We know that we don’t need plastic surgeons to prove it to me or you. It works. And the question is, is that? Is that, still right? Is that the way we should be spending our energies? Or should we be going and seeing other surgeons and how they do things? Should we be studying the work we’re doing ourselves? Should we be going to meetings? Should we be you know, collecting our own data? Should we be speaking, putting our thoughts together and figuring out what works better? I mean, there’s so much to do in the way of honing your craft and that that’s just distracting, as I said at the beginning, so I think there’s balance there, right? I look at it as one surgeon said to me visiting me from Australia as you’re already marketing, you’re writing your stuff you tell me you’re on the board, presenting your marketing, and that’s true. It is a form of marketing has that added advantage. You know, as I like to put it, if a patient comes in to see me Let’s see from that, Instagram, I let’s say that I had an Instagram page, and they come to me or not, which would be the other scenario. Why should I have you do my tummy tuck Well, my staff will have A chapter I wrote in the definitive textbook on abdominoplasty, and I’m not bragging, I’m just saying I’ve worked like a dog trade number, my kids respond as a deck. Once that bloody chapter done, because I want to see you back. You know what it’s like to write a book. The fact is, that patient has a choice, there’s no more choice anymore. That’s it. $100,000 worth of advertising a month, that works is $100,000 a month. And that says it all right there, there are two paths. But one, on so many levels can be philosophically more noble, more productive, we’re giving back to the community of surgeons and our profession. That’s just, it’s not that I’m better. It’s just that that’s a that is a route, that as I said, at the beginning, that’s the foundational route. That’s been the case since day one. I mean, Facebook and Instagram will come and go. But surgeons doing operating in an optimal operating in an operating room private or in a console room, in private with a patient will not change. That is the way it is forever. And so that doesn’t matter about all the other pieces, you better treat that patient as the best that you can, with the least problems and give them what they want. And that has nothing to do with marketing.
Catherine Maley, MBA:
Well, it does in the sense that they’re not going to even know you, they’re not going to know you exist, if you don’t somehow get in front of them.
Lorne Rosenfield, MD:
And I get it. It’s like fish $64,000 question that I’ve asked people like you and others. How do I do that without marrying the other people that I don’t want to be with? And with all the noise, and a lot of not truthful noise? And so that’s the problem [inaudible] put it you admit it, it’s gone too far, and chose to get on that train that’s going too fast, is that really the right thing to do?
Catherine Maley, MBA:
But if you came in with integrity and transparency, and you actually told the consumer what to look for? Because if consumers are so not educated about all of this, even when they think they are they’ve been online where there’s you know, a two for one booth, you know, it’s so tacky now. And it’s everything and they’re so confused. And so how do you like to take a consumer? How do you tell them that your abdominoplasty, your tummy tuck is 8000 more than this other guy, you have to run into that? Like, how are you proving that you’re worth 1000 more?
Lorne Rosenfield, MD:
Well, that’s a great question. And I’ll tell you what I do. But from my final thought of what social media is the following, I’m going to enter into it. I’m going to go some of the people I’ve talked to are probably gonna listen is that they, it’s about time, Lawrence. And I think that that’s okay, everybody has its moment as to when you’re ready. I think it’s going to be an interesting travel, and I will keep you posted, we’ll do another I will watch another zoom another day. Okay, but I think there are ways of doing it. And maybe it’s almost like I needed to wait for this moment where it’s gone too far. And we have enough data about it, which is always the way I like to think of it, I want enough information to know, before I get on this train, or at least something that’s going to work I have a lot of moving parts off more than 11. Now, as far as your question goes about cost, it’s a fascinating one. Because I’ll tell you what I do in my console. I will tell patients, that you’re paying not just for what should happen for what should not happen. Oh, that’s good. It’s like an insurance policy. And it’s a good insurance policy. And the fact remains that is you’re a real factor. But then you can say, Well, you could just say that. That sounds like a great slogan. And then I go here, I say, let me give you a little more information about how I think and what I do. When I give you informed consent? The normal informed consent is a long litany of every possible complication that could happen on any patient. having any surgery by any surgeon at any location. That’s really a useless, informed consent. Because it covers the surgeon to rent, it does nothing for the patient and they’re signing that anything could happen. You could turn into a rabbit on Tuesdays between two and four and you’re signing it. So instead, I say to the patient, I’m going to give you what complications, what problems I’ve had on my patients operating on a patient just like you doing the surgery that I’m going to do my techniques in my office operating room. And I’ll tell you what they are over the last couple years. I’ll give you those facts. And by the way, Katherine, I do the same thing, my presentation, which is never rarely done. I’m going to tell you what went wrong and how often has gone wrong. And you could say, well, you know, no one’s going to do that. And you’re right, no one will. But I will, then you could say, well, others are just going to make it up. And they’re going to say that, that. No, I don’t have any problems. And it’s interesting because either one of those is possible. But I can tell you patients are intuitive. I’ve had that happen where a patient went off to see another person. And I say to the patient, when you go see other doctors ask him that question. If you go to an orthopedic surgeon for your knee and ask them, what complications Have you had this year? Because it’s what I call Catherine, I need to know their practice bandwidth. what problem are they willing to never want to see? And what results do they always want to see, I need to know that bandwidth, I need to know that that bandwidth for my surgeon that I’m listening to protect he keeps doing what you need to do. Because if I don’t have to cross metaphors, then I’m not getting informed consent, then I’m not really finding out the by the way, I forgot to tell you 20% of my patients have an eyelid ectropion when I do this, but you know, I’m working on it. Well, you tell me that I’m not doing the procedure. But if you didn’t tell me it, I tried Monday morning. Sure, the same way the patient needs to get property from consent, they need to be told exactly what your practice bandwidth is. These are the aesthetic results. I that’s my goal. That’s what I you can expect to happen. And I’m very clear about it. And on the other hand, these are the things I never want to see. And these are the things I do see. And I see when you go see another surgeon, I don’t care if it’s your orthopedic surgeon or it’s another plastic surgeon, ask him that question. So, I’ve had patients come back to me and they say, well, info, I asked the question, one of their doctors left the room. He got upset at me and left the room. The other one mumbled something that made it obvious. Like somebody in court that’s not telling the truth. He was uncomfortable. And that was a deal breaker, Joe, I don’t think, you know, it’s, some are easy. Our facilities are kind of faking it, but it can come through. And so regardless, it’s what I tell my patients, so to answer your question, and then I say here are the results, and you can see them for yourself. You decide. And so, I think that and then I see when you go around this office, and you go see what you see everybody you see all they think do they talk to y’all, they So, take care of you, you tell me if that’s a superior, if that’s a superior eye care delivery, it pervades the entire office, everybody’s on the same page in that regard. And so that’s the way I can I can justify, just like we had alluded about Botox, that’s a good example.
Catherine Maley, MBA:
Tell them about your Botox philosophy.
Lorne Rosenfield, MD:
A book that follows the same philosophy, it’s exactly the same. When I had nurses coming in and doing the Botox. And the premise was, well, you know, you should be in the operating room and you let your you let them do all that. And you’d be busy operating. Well, it sounded good. Until it wasn’t, because I’d have my accountant bookkeeper saying, are you sure you’re actually using, you know, this is really a good idea. So, you’re basically, you’re basically supplying them with the people injecting with a salary, there’s very little profit in there, because they’re chasing the bottom and the lowest common denominator, which is the Groupon pricing. And the numbers keep going down to compete with the little clinics across the street, that are in the hair salons. And there’s little money to be made. And so, I decided, after a couple of problems that I had, in terms of complications related to a couple of treatments that were done with my nurses, no aspersions against nurses, but it wasn’t me that did it, it was somebody else, my name is on it. So, it’s me, I decided, I’m going to start doing them again. I tripled my pricing; I wrote a letter to every single patient. And I said the reasons why this is still a tech, this is still a surgery, of sorts, it’s an it’s an invasive procedure. It requires technique and knowledge of anatomy and the ability to treat a complication if there was an emergency. There’s statics involved that comes with an aesthetic surgeon or anybody else. And that’s why I’m doing what I’m doing. I’m back on board, I’m going to be responsible. And the other thing I do is I give as much as they want as many times as they want within a period of weeks, boosts and all that it costs nothing. So therefore, they get as I like to put it, you’re going to get your money’s worth, but not one TC more, you’re never going to get done. But you’re not going to look, you’re not going to have an undone, and it’s going to give you exactly the right amount by coming back and spending a minute let’s get it just right. It’s I like to say you’re going to hit the bell from below. And so, by doing so, what happened? Well, despite the fact that that I’m doing the cases rather than they are, it was never a problem in terms of or because you still between cases you do whenever they don’t take off. So that’s an irrelevant data point. Number two, I did lose, I probably lost 3% of my patients, they all continue to come to me, they did not leave. Or if they left, they came back. And then thirdly, and the most important thing is the is the non-quantifiable least I haven’t truly gone, it’s hard to quantify number of patients that because you’re getting with that patient, and you’re talking to them, about their Botox and about their skin, about their eyelids and the next, you know, they’re booking a surgery, because they’ve interacted with you, the last four months, three times, that would have been zero times had they gone to the nurse, I am getting surgeries, because that’s legitimate, they’ve got an opportunity to have a mini console every time they come see me. So, and I love to be with my patients, and we develop a relationship. And that’s where it’s cold. As you know, ultimately, your best marketing is your own practice. And as you put it, yes, I’ve got many patients, and it only builds on itself, but it’s only as good as your relationships with your patients. And if you develop those kinds of relationships to come with, with every instance, you visit them as many times as you possibly can, like I’m obsessive about patients coming back for follow up. I mean, I will give them boxes of candy to come in or gifts, because it matters so much to me to see how they’re doing and see how I did. Plus, they come back, they walk in the office, they see something on the wall, we talk again, they see me they think of something they want, that doesn’t come to Instagram that comes from coming back in the office and seeing me, and that builds. And that’s why it takes years. That doesn’t happen quickly, that kind of relationship, where patients do not come to you just this time, and then look for the next best person next time. They don’t ever leave. They never leave. It’s a home for them. And actually, the more borderline personality they are I mean that tongue in cheek those kinds of relationships, the more likely they are to never leave, because they have a safe space. Get them, we’re going to take care of them.
Catherine Maley, MBA:
Don’t you wonder what’s going to happen for solo practitioners?
Lorne Rosenfield, MD:
I mean, is it still gonna be financially possible to go, you know, hit the ground running was solo, like, do you are you gonna have to group up all this Bye, bye? Yeah, practice is probably dead. It is in the Bay Area in any major metropolitan area. It’s that to say that, that that is the case, I think it’s still possible, you know, I hope to get somebody into my practice. But it’s gonna have to be a very special person, because they’re there. I’ve had not that I’m quite looking yet. But I’ve had people come. And we’ve talked. And then they say, Well, you know, I got this job at a Kaiser or an equivalent, and I got a salary. And I don’t have to work nine to five. And I don’t have to try to look for a patient is what I call, you’re in a game reserved, versus being out in the range of it. And of course, that’s very attractive. And also, there’s a mentality and an expectation that that’s what’s going to come anyway, that that’s what I’m going to be doing. Because I think it’s like 75% of all physicians are on salary now. And it’s even hire for a new doctor. On the flip side, as I like to tell anybody that’s thinking about joining me, but what an opportunity to actually be that minority always wanted to be the one that stands out in this business, and you could be the one with your own art, but the reputation office and independent facility that doesn’t, that doesn’t have to answer to some corporate think what went on with COVID, you read all about the corporate missteps of PPS and people getting fired because they don’t want their name besmirched because you weren’t giving enough DPS to doctors and nurses. That’s where we’re going. And it’s not a pretty place for quality of care. Don’t get me started on that, and show if you can have your own bubble. And you can, as I like to tell my patients, we’ve got our bubble, I can control everything horizontal and vertical, it’s mine. And you can do that kind of work. in that environment, it would be very successful, because you’ll be even fewer people like me. So, I have I have some a modicum of optimism that they will exist, there’ll be fewer and far between. and the ones that do survive are going to have to be better. You talk about being better, you can’t be average, and you’ll never survive against people that are in institutions, being fed patients, whether they’re good or bad.
Catherine Maley, MBA: So, what kind of mindset are you going to need from 2020 on? Obviously, you’ve got to have that growth, mindset, creativity and thinking outside the box, or thinking in the box and just becoming a– you’re getting a JOB like, is that–?
Lorne Rosenfield, MD: So, that’s fascinating. So, this first happened, Catherine discovery If I said to my wife, I don’t want the terminal years of my practice to be, you know, looking like 10,000 Leagues Under the Sea. So, if the short answer is that this goes on a long, long time, I’ll just do something else. Because it’s got a lot of fun. No one can say, this is fun, right? It’s rude. And so, anybody that says, Oh, yeah, it’s good. We didn’t even talk about zoom calls and console. They’re not. They’re not good. They’re not better. They’re worse. Okay, so anybody that says, Oh, yeah, it’s better, I’m getting close with them. And there’s nothing like being in person. I mean, how could anybody possibly refute that, especially in our field, their body language, what they’re wearing, just the touch, just the whole environment, being an artist, being in my office and seeing the office, by my staff, there’s no comparison. So, zooming is never going to replace it, in terms of the intellectual evaluation of it, but the bottom line is, is I thought, if this continues, I’ll do something else. But in that vein, when I’m asked, I’m an optimist. I don’t think it’ll go on for years and years, and hopefully, I’m ready to find I’m flexible and nimble, I’ll deal with it for now. But I suspected that it won’t be interminable. And I love what I do too much. And I’ve worked too hard to not reap those benefits. But I’m also diversifying, I did that, in a way. When I established a foundation when I could have been doing basket weaving, I needed to establish that I needed to do something with my staff. So, I started the foundation to do charity, reconstructive care, which turned out to be a blessing, because now I’ve got that as a as a side kind of filler for my or and keeping my staff busy. They feel entirely empowered emotionally. It’s an incredible gift. Oh milling, about, about, you know, doing that. I mean, I was the chair of the board for the operation access, which So, was the organization that’s these patients I got so involved, just recently stepped down, but I’m going to diverge of I’m working on several things. And why that diversification? One, because I don’t know where this is going to take us. We have we have our as I was just talking to a chief of a program, prominent program yesterday, you know, he says he started up as well. And I said, you know, but this is the first wave. these are these are selected population patients, these are ones that at least fearful, they’re already on your books, or they’re thinking about coming, whatever the reasons were, don’t get too excited. And it’s good that they’re coming back. But it’s the second one that matters, what’s that one going to be like, because there’s a lot of fear in the community. And I think that’s going to be the So, chest plus, in tandem with that, you know, we’ve got this COVID going on. And if there’s another, there’s another peak, which could happen and that and everything gets shut down again. That’s like, that’s like losing another leg. So, I think that it’s uncertain right now, there’s no question the uncertainty is real. And you wonder how optimistic you are, it’s uncertain. So just like I said, in two ways, I’m trying to diversify both because I want other things to do. And I got to prepare for retirement. And so, I’m working with a malpractice company, to become a consultant for them for the with my checklist, and give it to it’s something I’ve always wanted to do is, is to finally be able to penetrate the market beyond my aesthetic colleagues where I’ve done a good job. And I’ve had a very hard time getting get into university settings or hospitals. Well, if you go to the doctors, practices where they’ve gotten a practice, and you say, you could get a discount in your malpractice if you start practicing more carefully. Bingo. So, I’m working with them right now. And they’re very interested in it. And I’m, so that’s going to happen. I’ve also established this learning curve, where I’m going to be for education of residents, and we’re going to do this meeting, which is going to be as you just put it with something else you’re talking about, like this whole– what you’re doing now is independent of associations and meetings, it’s my own meeting, it’s we have control over it. And obviously they’ll be they’ll be it’ll be financially worthwhile because it’s gonna deliver a lot in an unfettered, transparent way. And the way no one else can do it, for a multitude of reasons. It can’t be done in the, in the mainstream venues. And so, and I’m going to do, I’m going to start, we didn’t talk about it, but I’m going to start some social media and podcasting and Shawn because I do think that’s going to feed into everything else I’m doing. It’s all one big thing. It’s safety and aesthetics. It’s else, my balance between the two suffused with truth, and honesty, integrity, and it all sounds motherhood apple pie, but it’s real. That’s what it is. That’s how you’re gonna, that’s how you succeed. So that just diversification is going to be another piece of how I’m going to deal with what’s coming up specifically related to practice. It requires a lot of communication, right? I’m sending emails out every few weeks to my patients, to make sure they’re up to date with where we are, what I’m thinking, what the state of the state is, reinforcing the safety commitment we have, and based upon a foundation of work reputation, not just saying I’m going to wash my hands, they know how I feel about all that. that’ll continue. But it shouldn’t take that same to that doctor yesterday, it could take a lot of hand holding a lot of talking, because I had a patient on Friday, whose mother was going to come in on Friday, she got Thursday yesterday, for a facelift, taking care of the daughter, the mother coming in to get a console, we haven’t, we have a protocol where we have the patient call us. They’re in their car in the in the parking lot. And they we tell them, it’s time to come up. The mother, the daughter called mother, we thought they were coming up, the daughter called back a few minutes later and says she can’t come out of the car. by car, she’s afraid. She’s been in shelter in place for two and a half months. And she’s This was her first time out. And she’s afraid to go upstairs. So, if you don’t take pause and respect that you’re missing the boat, in terms of the market, the market is afraid. There are lots of them that are ready and not afraid. But there’s a lot that are. And I would say all of them are to some extent, for good reason. And so, you need to respect that. And you need to you need to work on that you need to be able to require a lot of talking a lot educating, a lot of hand holding, and a lot of demonstrable evidence that you are with them in terms of what you’re doing to protect them. But some of it is impossible. I mean, we’re just dealing with something that’s hanging over all of us and you can’t make it go away, you can’t turn off the light is gone. So, there’s a limit to what you’re going to be able to do. And you have to be careful. You don’t want to be crass. You don’t want to suddenly sound like a, like an insensitive plastic surgeon that wants to just get you in to do your Botox. It’s a dance. It’s a very delicate dance, which hopefully will make people better. It should make people better if there’s one thing I tongue in cheek say they’re going to be safer now.
Catherine Maley, MBA: Right?
Lorne Rosenfield, MD: All those guys that were just safe, they got to be safer now, because if they aren’t, it could be catastrophic. So, the benefit of this is that people are going to up their game hopefully when it comes to dealing with something, they didn’t think a lot about.
Catherine Maley, MBA: For overall, I got the feeling that it made all of us pause. So, it’s more quality now than quantity. It’s just making all of us just stop and think before we act and bend and all the things we’re doing. Yeah, I’d like to wrap it up now though, because I think we’re going long. But um, how can people learn more about you, especially surgeons who are interested in following your ways? Because it’s different and I’d love it. It’s one way not the only way but?
Lorne Rosenfield, MD: So, for now, it’s my website, drrosenfield.com. I try to put up some blog posts up there for people to see what’s happening new in my world. And then they can obviously email me @drrosenfield.com and definitely ask me any questions or get me on. I can get them on my list of where people are interested in what I’m doing. And I’m ultimately as I alluded–plan on doing some platforms with So, a podcast, both on the professional side and on the consumer side that I’m working on right now, which wouldn’t have come without this pause, as you put it in. So that’s going to come and eventually, I could share that with you on your website. And but I think your point made one last question you mentioned about that, this gives us positive people are going to slow down and they’re going to be more careful. And they’re going to, they’re going to have all the prior kind of goals you might have had that were misplaced. I’m more of a realist. As soon as things go back, so just normal. We know that we’re creatures of habit, and the path of least resistance, which is great, because I’ll be standing out again, I think you got to have links to this. It can’t be something that’s for convenience, or it’s thrust upon you for the moment. And the minute, that string goes away. You go back to your old ways. And I think that’s the lesson here. Try to hold on to this. Don’t let goals or whatever you were thinking that knew better. And you paused and said, Wait a minute. I would going down the wrong track, write them down and put it on your wall frame it, because the likelihood is that as soon as we go back to so to speak normal, you’ll have forgotten all of them.
Catherine Maley, MBA: Those are beautiful words of wisdom. Thank you Dr. Rosenfield, and thank you, everybody. Please do me a favor. If you got a lot of value out of this, please subscribe to Beauty and the Biz. I’d love a good review if you feel so inclined. And then if you’ve got any comments or feedback, please give them to me on my website is catherinemaley.com or you can always DM me on Instagram at catherinemalrymba. And with that, have a great day and we’ll talk again.