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Ep.42: How to Persevere Through Chaos with Special Guest Robert Kotler, MD

How to Persevere Through Chaos with Special Guest Robert Kotler, MD

Get the inside scoop from a seasoned veteran who’s performed a mind-blowing 10,000 surgical procedures with over 30 years of practice experience. Dr. Kotler explains the importance of “less is more” and how specialization can keep you afloat during these troubled times.

Robert Kotler, MD

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Catherine Maley, MBA: Hello, and welcome to Beauty and the Biz where we talk about the marketing and business side surgery practices. I’m your host, Catherine Maley, author of Your Aesthetic Practice: What Your Patients Are Saying, as well as consultants with plastic surgery practices to get them more patients and more profits. Now today’s episode is very, very special. I have a theme for it. This one is called How to persevere from chaos. And I have a super special guest to help me out with this topic. And it’s Dr. Robert Kotler of Beverly Hills, and he is an icon in our industry. So, Dr. Kotler he’s a facial cosmetic surgeon. He’s been in practice over 30 years, and he’s performed more than 10,000 surgical procedures. Now he’s been ranked among the top physicians in the nation based on patient reviews. I’ve never seen anybody so good at patient interaction as I have Dr. Kotler. Now actually, in the nation, we’ve got 720,000 active physicians, and only 5% have received that honor. So that’s a pretty big deal. But also Dr. Kotler was raised in my hometown of Chicago, I still haven’t lost my accent, and he doesn’t seem to have one. And he did serve in the army. And then he found his way to Beverly Hills, which I find to be a trip to Chicago and Beverly hills are very different. And that’s where he specializes in only five facial cosmetic procedures. And there’s a hint there. That’s what sets him apart as a super specialist. And now Dr. Kotler, he’s a teacher, medical writer. He’s author of books for the consumer, which are excellent. And he’s also invented several products. One of them is the commerce stealing demo. And that’s to give the consumer like a sneak preview of his technique of micro droplets, permanent non-surgical rhinoplasty, which I find fascinating. And non-surgical this one’s interesting. He’s also the inventor of the real non-surgical talk, clear flow nasal airway that is an FDA cleared and patented medical device that gives you clear breathing after nasal and sinus surgery. And I can attest to this one because I even used it for my own rhinoplasty many years ago. And it was a super big helter in recovery because you can actually breathe. So, for those of you who have been around for a while, he was one of the first surgeons to be on a reality show called Extreme Makeover. And boy, was that a popular show, it was just so interesting, because that’s when plastic surgery was just getting the consumer market like in a big way it was going to go mainstream. So, I’d love to hear from him about his experience from that and how it affected his practice. But first, we’re going to welcome Dr. Kotler and by the way, did I leave anything important out Dr. Kotler?

Robert Kotler, MD: No, I think my So, mother, may she rest in peace would be very proud of your summary of my professional life. Thank you very much great to be with you, Captain. I don’t know anybody who understands our industry better than you do. You’ve been indefatigable and helping everybody. And I’m glad to be a part of this. I’m glad to share my experience.

Catherine Maley, MBA: Well, thank you so much. And I’m so glad I finally got your attention, because this is the perfect time for us to talk about chaos, and how you get through those Muddy Waters. So of course, we have to address the big deal going on right now, which is the COVID-19 situation that has completely taken over the world. And so, Dr. Koller, can you just give me your view on what’s going on? And how it’s affected you and where you think you’re going to go with this?

Robert Kotler, MD: Yeah, you’re right. I don’t think anybody could have foreseen this, how the infectious disease has now turned the world upside down economically, medically, etc.? Well, there’s no question that, in speaking with my business friends, who’ve also been around a while, we’re gonna I think we’re gonna face a recession, I think there’s gonna be a very unsatisfactory environment for elective surgery, because that is the history. And yes, I’ve lived for at least at least two of those. And it’s no fun. Because what we do for patients, as important as it is, takes second, third, fourth, fifth place, compared to, you know, you need to pay your rent, you need to have food, you need to get your kids through school. So, I think unfortunate, it’s gonna be a little rough ride. And that means everybody’s got to think more and work harder. And then what do you do? And then the I know, the question is, what do you do? Well, you know, frankly, you’ve got to figure out a way of keeping in touch with the pool of potential patients. And I know we’ll talk later about social media and all the other means, and you’ve got to position yourself, I think this is probably the single most important concept, how you position yourself in the community. How do you position yourself? These are the other doctors who do the same thing you know, for, for patients, sometimes it’s confusing, but if they look at people’s resumes, they say, Well, yes, graduated from a good school, board certified, took a fellowship. Those are all kinds of equivalence in their minds. So, what would separate doctor a from Dr. B, in terms of being more attractive to at least consult with what’s what is it about your practice factor A that makes you different from Dr. B? And I have some thoughts about that. I think the best single thing you can do is you must differentiate yourself by either doing a limited number of procedures, and thereby excelling them, because results count, obviously. And you’ve got to be able to tell the world that that’s what you do and why you do it better. This is a basic principle. And again, they should keep an eye on what’s happening in the world because people have choices. And every day we have to make decisions about what car do we buy, or clothing that we buy? Well, what makes one stand out against another? Why do some people like Levi’s, for their, for denims, and others want to buy designer denim, perhaps a greater cost, right? And you have to do that by essentially doing something better, or something more sophisticated, something that brings a highest level of patient satisfaction. And we’ll talk about this later. But I think a lot of physicians, and this I shouldn’t say physicians like but the surgeons in our world, maybe need to stop doing certain things that someone else is doing better, and somebody else is doing it better down the street, I think you’re serving the patient best. And they appreciate that, by referring to patients, we can’t all do everything at the top of the totem pole. It’s impossible. We can’t master all the possible hazmat procedures. So, I think it’s better to focus down on the ones you like to do the ones that you know, you get the best results with say, because the is you mentioned the reviews, and thank you very much. But the truth is reviews are so important because the bad ones if they’re in the majority, or even a significant proportion, that’s the worst news you can have. So, you got to do procedures that you could be successful. And you know which ones do the best at and you know which ones maybe you’re not the best hard to give it up. I understand. You trained you learned it, but maybe it’s not you guys. I’m working off a much smaller menu now than it was even five years ago.

Catherine Maley, MBA: You know what I see coming, though, because I saw it the last time, we had a recession and the surge is panic. And they went back to reconstructive and insurance and they went back to taking the medical cases, because the cosmetic got hit really hard. And they panic. And now they try to do and that’s doing both is definitely not the answer, either. I’m not sure what the answer is. But you’ve been through both of those the medical transition to cosmetic cash patients. Can you just give your rendition of–? Wait, how do you balance those? Can you balance all this?

Robert Kotler, MD: Yeah, I think that’s a great question. I think the first question is, where do you practice? If you’re practicing in a relatively sophisticated area? I mean, the larger cities, I think it’s impossible. If you’re the only city or a general plastic surgeon, and your service areas, three counties in Missouri, and you’re a long way from Kansas City or St. Louis. Well, you’re there’s going to be a need for your services. And you have no choice, I think. So., I do think it’s a step backwards. I agree with you. I think that once you once you switch from train a to train B, you should try to stay untrained. And likewise, those who’d like reconstructive surgery, hospital base, they’re best off not trying to make that transition. in difficult times. They are two worlds. It’s like riding two different horses. I remember one of my teachers told me that he reserves Saturday to see all his major cancer reconstructive surgeries, because if patients were sitting in the waiting room, seen those people and they’re sitting in the waiting room for routine sinusitis or some other problems, they’d run out the door saying, oh my god, you have two faces missing that that patient have a sinus problem like I do. Yeah, that was good advice. Yeah. So, it’s very difficult today, we all did it. Looking back in the in the earlier days in the 1980s, early 1990s. But I think it’s just impossible. I don’t you should you should not take this step back unless there’s absolutely no alternative.

Catherine Maley, MBA: Okay, because even the alternatives that it used to be was insurance even that, is that really a good alternative? Like let’s say you decide, you know what, I’m shying away from cosmetic, I’m gonna stick to the safe business, the safe practice of, you know, insurance-based procedures. I don’t think that’s any safer because

Robert Kotler, MD: Well, it’s a different world too, because now the hospitals is most likely you’re going to be an employee of the hospital. And that’s another trend that that’s fairly recent. You know, and an is that good. I think for some it is good, but that hospital paying you, they’re not paying you to do cosmetic surgery because cosmetic surgery are not good cases for hospitals. So, you’re going to be doing only reconstructive surgery. So now you’re an employee and you must listen to your employer, and that’s another strike against making that step back away from cosmetic procedures and try to elaborate reconstructive. As I say in the past, it was possible today, I think, much more difficult.

Catherine Maley, MBA: I probably get calls every week from surgeons trying to leave the hospital and get into cosmetic. It’s more of a mindset shift for them than anything and by the way, you came from Chicago and so did I. How in the world did you get from Chicago to Beverly Hills?

Robert Kotler, MD: Well, it took me a long time because I am from Chicago. going, I went to medical school medical school in Chicago did my residency there. But I did my internship out in California and I kind of fell in love with it. And I said, someday, I’d like to come back here to California. You know, if you come out in the middle of winter, it’s looking pretty good if you’re a Midwestern, so, but the route was long, because I wasn’t my own man. When I finished my residency, I went on active duty in the army, because I had been reserved officer for seven years. And I was called up to do the two years active duty. So, when I finished that, finally, I was a free man. And my wife and I agreed, we’d like to try Southern California, having lived in Northern California in San Francisco, and I had this on my relatives were here and, and we liked it. And we said, okay, I think we’ll, we’ll end up settling here, and I use a fellowship that I took here. I was in the early days of cosmetic surgery fellowship. And it was very valuable. But I used that time to look around because I didn’t know what was going on, where people practicing what is their need. And I knew I couldn’t open a purely cosmetic surgery practice that was impossible in those days, because they’re very, first of all, they’re extremely strong, nationally recognized practitioners here. So, I did combine my reconstructive work in general, head neck surgery for the first seven years of the practice started the practice from zero. But at least I had a little sense after being here for a while I worked for an HMO for a short period of time just to buy more time and get a little income, that I felt I could, you know, to get the practice going. And because I had this excellent residency and cosmetic work, as well as did alive in the military, and then had the fellowship if at some point, I would like to do that work, but I couldn’t tell myself or anybody else, how long it might take, and it took seven years.

Catherine Maley, MBA: What was the competitive landscape like, then and now?

Robert Kotler, MD: Well, you know, interestingly, there were only a handful of cosmetic surgeons that that were quite successful. Let’s put it that way. They were and they were good. There. I could read off a few names at some of the doctors might know, but they were good. There were some general plastic surgeons that were doing great work. And there were some redneck surgeons doing great work. I apprenticed myself to one of those after my fellowship. So, I really wanted to learn as much as I could, and the quality was very good here. But there, I would say there were 10 or fewer, that had a very strong reputation. That’s not many. Well, then when I moved into the building that I’m in now, and I moved in the building in 1990, there were three of us in the building who are sort of, you know, serious cosmetic surgeons, there are now 26 names on the roster of surgeons who do cosmetic surgery, that admittedly summer only or part time, it’s an advantage. They have some Beverly Hills practice. And this is may not be the norm for anywhere in the world. Assistant Beverly Hills, I’ve got a laughing because all those names on the roster, you think they’re like 5060 office suites in their art, there’s a limited number, but everybody’s kind of piling in and piling up or time. I’m sure all those things are practical. So, there’s no question that competition is still the major economic limitations, supply and demand. And the supply is very plentiful, there’s no question. And we continue to have you under practitioners come into the community, some have left. But by and large, the community is larger than ever here. And that is the supply of patients totally elastic, will continue to expand and expand to have surgeons recently busy. Now we’re going to find out, because now it’s going to get a little bit it’s gonna get tougher. Oh, is it work that’s here, it may be the same in New York and I don’t know, in Houston and in Miami and other major centers, but supply and demand is always the number one rule of economics.

Catherine Maley, MBA: Well, I know I get a call a lot of times that the doctor wants to move to Beverly Hills. And I think could you go anything? Could you go anywhere more competitive? And they said that that’s where the market is. And I think do you have 10, Beverly Hills sustained? And all of these plastic surgeons who I think are under the illusion that everybody’s reached, there–

Robert Kotler, MD: Sort of illusion that they’ll because it First of all, there’s a limited number of ultra-wealthy, there 10 million people in Los Angeles County, for example. Now, yes, there is a big thirst for cosmetic procedures. In Southern California. There’s no question, Los Angeles, area, Orange County, Newport Beach, for example, all the way down to San Diego. unquestionably a stronger interest perhaps in other parts of the country. Nonetheless, there’s only a finite number of people. And as I see it, here’s what happens. There’s a broad span of socio-economic qualification, the first people to fall off from the pool or fall out of the pool of those who’d like to have cosmetic surgeries or those lower incomes. Now, the fees of the fees have been actually relative to other costs. Good, reasonable and affordable for a lot of people. But now they won’t be affordable for some segments of that when the economy has difficulties. And we saw that before. And yes, the exposure through extreme makeover, Dr. 9021 on all these other programs was great. It opened the public’s eyes to what could be done and through competition. The seas have been pretty stable. generally, less than the general rate of inflation. But that said, when things get tougher, a fair segment that came into the market will leave the market say that was the ultra-rich will still have it. But there’s only so many of those to go around. So that’s our experience here. And, and that if they became popular, because it was seen as recently affordable, that a lot more people entered the pool, who in tough times probably will not be in the pool of prospective patients.

Catherine Maley, MBA: And then as times get tougher, what happens is, a group of your competitors will start price cutting, and it kind of dumbs down the whole thing, because now how do you market because you’re a really good marketer, and you were really good way before when it was still traditional, like magazines, TV, radio, and then you’re really good marketer now, with all the new digital things going on, but how do you compete? How do you compete with price? Or how do you do it

Robert Kotler, MD: Another way? I think competing for prices by price is very difficult, because not you cannot everyone, first of all, as the same cost of doing business, I think it’s easier to compete on price. If you have a lower cost of doing business, meaning your staff salaries are lower, your rent is lower. If the doctor thinks he can just come to the Beverly Hills and open up shop, wait till you see the cost of rental here, you know, it’s very expensive, the tenants pay a premium to be here, just as retail shops pay a premium to be on Rodeo Drive. The difference is I will tell you that many of those shops I rode with Dale drive are not big moneymakers. Because the rents are so high that the companies feel that they have to be there, you know, whether it’s leave with john or, or any of the high-end boutiques, just like they might have to be on Fifth Avenue or something in New York City doesn’t necessarily mean though that the profit is there. And this is a difficulty. Here, there’s average weight, the average wages are higher. And people here have a limit on what they can spend on a procedure. And therefore, if the limits become less, because their budget is tighter, then they’ll be out of the pool, even for low end for low-cost providers. But certainly, if you have a high cost of practice that that’s gonna be difficult, whether you’re in Beverly Hills, or Pasadena or in Houston, or wherever you are. So, my thinking about this and discussing with others is how do you how do you reduce your overhead? One way, frankly, that we’re seeing is doctors are sharing office space more than they used to? And it’s good way to do it. Secondly, you know, if you got any family members are looking for a job? Well, the answer is come down to a family business and work that we need you. Some, some practices are actually literally family businesses. And I happen to think that’s a good way to do it. If your family members are interested in, they have the skills and all that you know.

Catherine Maley, MBA: So, you’re saying watch your overhead. See, there’s so many different ways to play this, a lot of the surgeons just spend a ton of money on the office and the audience and the staff looks great. And they’re either in the 90210-zip code or one of those kind of zip codes, their So, presence looks like it’s five-star celebrity driven. But there’s a cost to that. And you have to the overhead on that is unbelievable. And are you able to it would be okay, if you’re able to also charge accordingly. You know, so patients were willing to pay double or triple for procedure. And because of that, because of your cache and your audience, and all that is there. That’s a part that I find so interesting, what when five-star we’re all tightening up, and everyone’s freaking out, and how does that affect you? Because if you’re double the price of your competitors, because you offer a more elegant patient experience, do you feel the pressure to discount that, like, drop your prices yet? You’re still stuck with that kind of overhead?

Robert Kotler, MD: You know, yeah, you’re right. This is really important. You and You certainly understand that because you’ve five-star heard the stories and discuss it with your own clients. And that’s a problem because what happens now, patients shop by price. Look what’s happened with Amazon, look how many retailers it’s put out of business, because you can buy a cheaper on Amazon, you can shop it in 10 minutes, you can figure out who’s got the best price. And rather than go from store to store to store with nobody has time for that. So, people and people do shop for cosmetic surgery as if it’s just another commodity. Now again, I don’t come up from with all the particulars at all geographic parts the United States, but the internet is the great equalizer. It gives everybody the same information. And our experience has been there are people who said to us well, yes, we’d like to be a patient here, but we just use Dr. So, and so in another town 10 miles from here. Look what he’s charging. Well, we say okay, I mean, again, from a practical standpoint, if we lowered our fees to matches, it would be $1 going in at $1 going out because our cost of practicing error is higher. sell some people also sell their price is their selling points that Oh, we’re really inexpensive, okay, they will attract a certain following. One of the negatives, though is often many of those people are not necessarily the ideal patients, there is somewhat of a correlation between the behavior and one associated behavior, personal behavior on the part of a patient and the socio-economic group in which they reside. I think every physician has been in practice long enough knows that Medicaid patients are different than those who self-paying, right. And this is a reality that you can’t deny. It’s a different attitude. There are people look for insurance to pay for everything. And they come in and say, well, cancer bill insurance for this, and Won’t you go insurance and that becomes kind of a scene, the world that you enter into, some doctors will do it, because they feel they have no choice is that the doctor you want to be when you basically said, you know, put in a position by patient to want to game the system. And everybody views it differently. So, there’s a lot of there’s a lot of factors here, that this is not a simple matter of opening up your door. And all of a sudden, the phone starts ringing with high quality patient generally is someone who values quality. And there’s another flavor to this, I think the patients that shop by price, often because they’re not particularly sophisticated. And they’re not looking at the other elements, which is service and quality. You know, there’s always three elements that every business transaction, price service and quality. But if they if they disregard the quality issue, and even the service aisle, well, they’re treated, and they shop on price, those are the ones that seem to always be somewhat dissatisfied. And that’s a problem because you cannot have too many dissatisfied patients in practice. That is to eat a chiller. Just like you can’t have too many bad reviews. Right? Right. Because these people become the voice to the public. And when they sit in the waiting room and complain, what’s that going to do with somebody there for consultation to see you? It’s a turn off. So, you have to be very careful then. So quality is still number one. And then how does one build a quality practice that that attracts quality people. And that’s So, not easy. And it takes time. It takes time to build referral chains. After all, one satisfied patient doesn’t necessarily lead to 10 new patients the next week, and worked out what patients will talk about having had cosmetic surgery, some only reveal it to their own sister.

Catherine Maley, MBA: Would you say that’s changed a lot? Or do you think that still I know it used to be really hush, I wasn’t San Francisco with the society grow here. And it was very hush hush and there were only two facial plastic surgeons who do facelift and hushed it was just super under the radar. But nowadays, do you think it’s easier? Are the patients more readily available to chat about it?

Robert Kotler, MD: My sense is younger patients, the people that are in their late teens and early 20s who have it again, remember those are the ones whose parents are subsidizing it. And therefore, they’re going to come from the higher socioeconomic. They are much more open about because they’ll go to school with each other say they’re looking each other. They know what’s going on. They know everything they know every doctor; I’m amazed how sophisticated these young people are because they’re clannish, and they interact with each other texting and emailing and sending pictures. But that’s a small sliver of the population. So, the other part of the population isn’t necessarily they’re open about and by the way, why do some people use the internet to research for cosmetic services where they could ask some people around or even as their own doctor? Well, do you know anyone who’s good at doing yellow facelifts whatever. The reason is, they don’t want anybody else to know, the anonymous route is to use the internet. But that’s a different kind of patient. So that’s different than that going to lead to referrals, you can often your best work leads to zero referrals, because that patient is not part of a talkative network, the talkative networkers will lead to other patients. And that’s why you have to be very good at satisfying that patient. Because if you don’t satisfy the networker for local experts, if you will, remember, there’s always some people that are looked to as the experts that the mavens so to speak, if you don’t satisfy them, that’s the end of that referral chain. There’s nothing better than a good referral chain, and nothing worse than the end of a referral chain. Because the patient was unhappy.

Catherine Maley, MBA: I think the biggest question is, and you mentioned quality, and I’m going to, this is where I spend most of my time, because if it’s quality, but that’s so intangible, how do you prove quality? And your you do a brilliant job of that with all but you know, people don’t understand the effort that goes into that. So, I’ll say to doctors, well, if you’re getting a consumer book, have you done any speaking or writing? Have you done any talking in the community? Have you got any PR all of that equals Quality, you know, like tangible proof? But tell me how much work that takes you to do. But what did you put into that to become the most quality practice that I think I know?

Robert Kotler, MD: No, thank you. I appreciate that. Well, first of all, it’s a team effort. And I know you’re you always been very strong, and the importance of the office staff. And it’s absolutely true, you’ve got to find the best people. Because like everything else in life, it is about people. And there’s a certain personality who is ideal for these types of practices. There are other personalities who are not at one end, or the extreme, the ones you want, are people who are positive, they dress properly, they act professionally, they are a good greeting for you. A Hello, this is our office, and I’m glad to be working with Dr. Smith here. And it comes out for the minute they answer the telephone. Now hard to find. And sometimes you have to approach them from other practices, but they’re out there, they’re out there, and you need the immediate happy smiling face at the desk. That’s number one, because that that suggests a warm environment. And we’re all looking for that, rather than you know, the old practices. And there’s still something like that you walk into the waiting room, and there’s an opaque glass sliding window. And you know, there’s somebody behind it, because you hear the staff talking, you know, they don’t even open it when the door opens. And you’re sitting there waiting, waiting for someone to please open the sliding glass window. That means it’s absurd means you have to have somebody there.

Catherine Maley, MBA: If you’re in the people business to put up barriers like that, it’s such a no–

Robert Kotler, MD: Exactly. And I think people now realize that, but so you have to have good staff and people obviously care. How are you? Mrs. Smith today and the Sorry, it’s a rainy day. And so, we’re glad you’re here. And there’s nothing like saying to somebody, welcome. Thank you for coming in. Frankly, one of the things I like to say to every patient that comes in at the end of the consultation, thank you for coming in to consult with us. After all, they’re they’ve taken time out of their life. It’s flattering if someone comes to see you. They’re putting their life’s history in front of you. They’re discussing very personal things. And we should say thank you, we don’t say thank you often enough. And even getting back to employees. I think, again, you have to study the basics of psychology, what makes people happy, what makes employees happy. It’s not just money. That I think is the truth. It’s respect, its appreciation. And the greatest thing you can ever do is to say in front of the patients, how good your staff member is. And frankly, that says two things, it says that you appreciate what people do, you’re a decent person, if that’s what it says that patient to say that it also says to the employee that they’re valued. And I so, can tell you that the answers come from, from the books, the textbooks of psychology, and human behavior, nothing’s better than a compliment. It works. And when people do nothing but complain about their office staff, either so, the office staff is really bad, you have to replace them. Or there’s something wrong with a doctor who doesn’t have a sense of appreciation and thinks that he’s the only person in the world that is about one man or one woman show. And that’s another that’s another failing that comes across the patient. See, I mean, patients come in and they just go sometimes they’ll discuss their consultation about ever interested in the doctor’s name, I never asked them. But they’ll say well, I went to doctor so and so. And all he did was talk about himself and how great he was. He didn’t ask me any questions about why, what so, my thoughts are? Why am I happy with a certain part of my appearances? And what would I like to have? It’s like, okay, we’re going to do this. And let me tell you, I’m the greatest. I’ve done that and this movie star. And that was, I mean, I think that’s not going to work much anymore. Patients are getting right. Yeah, it’s a failing on the part of the doctor to understand that most people are interested themselves not interested in you, but there isn’t what you can do for them. Right. And this all this– over 100 years ago book was written about how to win friends and influence people by Dale Carnegie. And everybody should read that, because that’s the basic of, of human interaction. And the emphasis is on the man person that someone else, the what the comments he made the book was that someone told him once he that was, I met somebody that was really a very interesting, interesting person. And it was, and then DLS Well, why were the interesting you said, well, because it just they just asked me a lot of questions. So that person was interested in someone else rather than themselves by asking questions, and then really talking about themselves in that they were considered interesting. It’s all there. It’s all in the books. And if we don’t read the history books, we make mistakes in, in political matters. If we don’t read psychology books, and human relations and business books, we will not do as well. I do think you have to be an eternal student. I appreciate your comments that you made about my career because I man must admit, I’ve learned so much and want to keep learning. And I have a cousin in the restaurant business and we were talking one day with another cousin. And I said to the senior, you know, cousin who’s very experienced a good businessman, he said, God you know everything about the restaurant business. Why? Tell Larry, a few things he needs to know. He says, know everything. Are you kidding, I’m still learning? That is a smart man. And that’s why he’s very successful.

Catherine Maley, MBA: Now there’s a tip, never stop learning, never stop–

Robert Kotler, MD: Never stop learning and read the classics, if you want to, if you want to learn about being a better executive, which I think we have to beat, then you have to read the classic books about, you know, being a good executive, whether it’s jack welch, who just passed away, or some of the other experts that that really tell the story. It was a book by Robert Levinson, I think his name was called a great place to work, what makes some offices and businesses popular where people want to work there, you’d like to have an office, by the way, we’re your sought after, by learning? prospective employees, they if they hear that a spot is open your office, if you have good office reputation, they’ll be they’ll be you know, calling you. And that’s what you want. But you learning? You’ve always been a strong advocate of that. And you’re 100% correct. And but by the way, back to your question about how do you do all these things, it’s time, you have to give up the time to do it. And that time is subtracted from your personal life, because you can’t subtract time from taking care of the basics, right? That’s a given. So, what happens is, and this is the dilemma of every branch, every professional, every business person in the world, it takes more time to do everything today, because it’s more complicated. Everything is more complex, you do have to study the human relations, to manage your office and to understand patients, you have to study marketing and advertising. If you’re going to, you know, put your name out into the world, whether through the internet or social media, you really have to try to keep up. It’s stimulating. It’s interesting. But it takes time and money, by the way, because I’ve been a lot of doctors and you mentioned are spending a lot of money on advertising on the internet and social media well, and you have to do that, you have to put out a massive effort. And there have to be many columns to support that your structure, many columns of reaching out to the large pool of patients.

Catherine Maley, MBA: So, let’s talk about the good old days just for a second, because when you used to get a lot of PR from these reality shows, and they were so new, and you were at the cutting edge of you know, we do have to think, who changed all this, like those shows really change this to mainstream. And it started I forgot about Dr. nine to one Oh, but that was a good one extreme makeover, the ugly salon or whatever that was called. Yeah. And then people were willing to talk about it at the watercooler. And it was taking away the stigma of this and, and I just think that helped us a lot. But then of course, the Kardashians jumped in and, and they brought it to a whole different level. But you know, there’s always a good and a bad to everything. And that helped a lot because it just opened up the world to anybody who wants a little good and who has the time and the money. And there’s polarity of options available. But now it’s gotten really confusing, because there are too many options. And then there are too many people who could, it doesn’t have to be a surgeon, it can be in other specialties. But anyway, let’s talk about the good times when you do have that PR from those shows. And how does that change your practice when you get that kind of regular exposure?

Robert Kotler, MD: Sure, by you, you said it perfectly, it opens a country’s eyes, that it wasn’t just for the rich and famous that, you know, a good share of the population good to have it done. By the way, it spawned financing by So, banks and credit companies, you know, and just as it was always done with orthodontia, you can pay it over time. Well, that’s great. You know, people use credit cards as a way to finance it. But the most important things– it showed that you know, real people, if you will the average people, the average Americans, this looks good. And now patients are happy. And it’s not $100,000 there’s a you know, for a procedure, there was a lot of misconceptions. A lot of people thought a nose job was $100,000, isn’t it? They just didn’t they didn’t know. Now where it entered their homes through the television. Yeah, I can tell you my personal experience was that it was first of all, it was really enjoyable and positive experience because I felt that I was participating in something that would help educate the public and the public would be better educated, we would all benefit from it. All surgeons benefited from it, not just those who are out of programs. And I give the producers a tremendous amount of credit because I think they did it did it very well. Now what happens to the individuals on the program like myself, yes, it has a very positive effect. Yes, the phone rings and people come in. However, when that program ends, the phone isn’t going around as much so because you’re no longer regularly in front of the eyes of the public. And I feel Dr. Robert Ray credit because he was kind of the backbone and the cement of after 90210. It was really many of us were like all in terms of Hollywood lingo, you know, supporting actors. But he had a very interesting personal life. It was a grabber people want to watch after Reagan to be up to next week, and he lifted the boat for everybody. And that was good everybody, I think benefited as you said. But don’t count on that, to make you rich for the rest of your life, because it’s like a narcotic, you get a good, you get a good practice high. But if you don’t keep taking the narcotic, it goes away. And you can’t necessarily have a new TV program every year. So, they run their course. And you enjoy the ride, as we all did, and I think the whole industry, but then at some point, it just Peters out. Now, what’s taken its place to some degree is the growth of the internet. But that is a two-edged sword, as we’ve discussed here, because getting your message out to the internet is a lot more difficult than being featured on a weekly national television program.

Catherine Maley, MBA: I the internet changed almost overnight as well, because it was the next best thing. So now it was PR, then it became the internet, then it became we need a really good website. And then you had to change your website because it can’t look old. And then it you know, SEO like done, you have to make sure people can find your website. And you know, you really got a huge education on that because you were there, almost pre internet, you know, and now you had to develop your website, which means you have to develop your copy and what you’re looking feel like what is your branding? And how, how do you stay so open minded to all of this? Because that’s a really big, huge, huge change.

Robert Kotler, MD: Huge? Well, you’re right how well you said it. And this is the course, again, very parallel to other two-edged kind of freeways, you know, if you will, in the entire world, I mean, everybody who is almost any kind of business would say to you that today, it’s much more complicated, and much more difficult, by a power of five, or 10, or whatever. And if you want to still be productive and have an enjoyable practice, you just have to do it. If you don’t, you’ll just fall by the wayside. That’s just the way it is, you know, the quality of the work, of course, is very important. But that alone isn’t enough. And you’ve got to be, you’ve got to be seen as a caring and concerned physician. And you should be of course, and but there’s some who don’t behave that way. You know, and so those who don’t will suffer. So, I think what it does, it’s, it’s a little easier to figure out what needs to be done if you’re willing to do it. And that’s the hard part. And the execution is hard. And what if you don’t hire the right people to do your website? Or what if Google changes its algorithm as it did, you know, a year or two ago and everybody suffered. I mean, it’s, it’s very frustrating. But if you believe in, if you believe that this is what you want to do in life, you trained a long time, you’re prepared, I think you have no choice. But to figure out how to prosper just as a business person today has competition in the form of Amazon Prime and all that which is very, very, very threatening to their success. It is a difficult world for everybody. My speaking in Chicago, my family had a manufacturing business. And there was a time when it was a it was a very good business. And foreign competition. Basically, knocked it off, just ended. It’s a four-generation family, four generation family business, my grandfather started work very hard. My father joined him the classical American story wiped out by foreign competition. And that happened, there’s so many businesses there, you couldn’t compete, there was no way. You know, there was just there was just no way because people buying products had price limitations. And if they could get it for free for less money, it was made wherever it wasn’t trying to Mexico fail good enough to not be great, good enough. And that’s it. And that’s, that’s this is the feature of our society today.

Catherine Maley, MBA: Well, I noticed, as soon as the surgeons settle in and say, well, I’ve got a great list, I’ve got me SEO and life keep turning it upside down. And then I happen to know the Google algorithms happened. And then social media happened. And so now, you have to be a great surgeon and a really good manager of people and a great leader of the practice to have a vision so your people know where you’re going. And then you’ve got to have a killer business acumen to figure out the numbers, you know, and most surgeons go to business school. And so, on top of that, if that weren’t enough, now, you also have to be the marketer. Because with social media, it’s social. And they do more than being a plastic surgeon today is, is more than many hats, you’re wearing more than many. Because if you’re going to do social media, the patients want to see you in surgery, talking to patients and talking to your fan. Now they want to know about your family. What are your hobbies? Where’s your dog? It’s like, I don’t know how, I don’t know how you compete in today’s world to be good at everything. You need a team but now you actually need you. And that’s so that’s added another complex layer to all of this. So how were you at with all this social media? Are you leaving you out? What do you think?

Robert Kotler, MD: No, I yeah, we I to be honest with you. I don’t think personally I don’t think I’ve been as participatory is as good as others because others use the social media more to reflect their social life or their personality or they’re a bodybuilder and they have a bodybuilder following. And so, for me personally, I like to, I like to kind of limit the exposure to things that I think are dignified and professional, I think people would hopefully be more interested in my professional capabilities, rather than my skiing ability or something, you know, but everybody’s got to have a different, everybody does have a different view. And I think you have to be comfortable, I don’t want to do anything, frankly, that I’m not comfortable with. I’m not a guy that dances around, you know, there’s a polka in the operating room, I’ve seen some really bizarre, unprofessional behavior to the operating room, for example, all designed to grab patient attention, or prospective face, that’s not me. But for others, it may be fine, and it may work, they may bring it so, may bring your face, I think you have to be you know, the, to the old self be true that bright line from Hamlet, you have to be yourself, be comfortable with who you are. As soon as you try to be somebody else, it’s probably not gonna, it’s not gonna work. I think at the end, you have to think about who you are, in general, what is your own sense of dignity? What is your sense of self respect? Will it translate to perhaps not have these many patients get in touch with you through Instagram or something? It may, but maybe you’ll be a little stronger with your website? So, I think there Yes, there are various tentacles that are that are important. I don’t think anybody can be super strong and all of them. But boy, did you say it? Well, when it usually has to wear so many different hats today. It’s daunting. And also remember it can be expensive. We talked about expenses, because it just is when Google algorithm changed and everybody was scrambling to get remembered their websites back into a reasonable position, you can’t do that yourself, you need experts to help you. And then what if that expert doesn’t do it? Well, now you’ve wasted dollars in time See, so it’s, yeah, it’s hard. Now, is anything any easier for our brethren who are in the non-elective world, I think they’ve got, as you alluded to, before, working for hospitals and being under the thumb of hospital administrators. And that’s what’s Let’s be called, I was speaking to a hospitalist a couple weeks ago. And that whole concept of a hospitalist being your doctor, and you wave goodbye to your personal doctor, when you go into the hospital is absolutely contrary to sound medical care. But that’s what’s happened. You know, the hospital world has basically co-opted the physicians. And, you know, we could talk about that alone is a separate story, but it doesn’t apply to our industry, but the lessons are there. It’s about supply and demand. Why? Because we turn out so many doctors today. 22 and a half times as many physicians graduate today, there’s when I graduated medical school, the population, the Ice Age is not two and a half times what it was. So, what that means is this law of supply and demand starts to work against physicians, and the insurance companies and hospitals and all that. And so now there is a lot of young people do that will open up a practice, whether it’s internal medicine or general surgery, they find it to be very daunting, and it is so think about that as a challenge and then think about in the cosmetic world, or isn’t just a matter of opening the practice and getting patients from the hospital internist. Now you got to get you have to draw your population of the general public. Yes, it is very hard. But it’s not as I say, it’s not that easy for our brethren anymore. And the hospital has told me that even in the last few years, it’s become very difficult to enjoy the work because they’re under pressure from the hospital to discharge patients and put out 15,000 different diagnoses. So, the insurance company pays better. I mean, it’s just become almost bizarre. That world, it’s so there’s no, there’s no easy places, though refuge. Right? You know. And so, I wish we all I wish, I wish there was some of these better, but I will say one thing, I think that for all those who are listening in, you have to have good advice. And you have to spend time thinking and talking to people, what are your colleagues doing? How what’s working, what isn’t working, and then having consultants with the type of experience that you have as a totally unsolicited testimonial, just so everybody knows that Kevin, you get your hand on the pulse, you know exactly what’s going on. And it’s really important. And the nice thing about working with consultants is that they understand your challenges and your dilemmas you’ll get answers because they know what’s working what isn’t perhaps in parallel situations because you have a national you know; they have an A you have an AFL following Catherine it. And, and even you know, like I was talking to my accountant and accountants know what’s going on. They know that they know the problems of physicians. Yeah, because it’s good to have an accountant as a lot of physician clients because they’ll tell you what those guesses what their what their gastrointestinal gi specialist clients, what they’re facing, so it’s not easy for physicians. I think the bottom line is it’s those guesses just become a much more challenging and difficult world for those guesses all physicians today. And even though there’s a flight from insurance in that world, it doesn’t lead to doesn’t necessarily lead to having this specialty as its own challenges.

Catherine Maley, MBA: Although there is something that keeps brewing for me that I watch, I watch some of the surgeons that still have their eye on that one hit wonder they still want that surgery, and they’re not thinking long term as impatient for Life mentality. And I know you live off of, you know, you are a high-quality referral practice. And I feel like I’m talking to myself most of the time, because there’s so many fun shiny objects out there for surgeons that are not just running scared, but they’re also maybe bored. And they’re like, Oh, we try this. Now we try this and they jump around is very short sighted. And when I talk to them about waste, I can everybody slow down here for a minute, rather than throw all your money at Pay Per Click running after those 1000 leads that are going to create five surgeries for you. And now you’ve got your staff dealing with the 995. Who needs to get to the papers? Neil, why don’t you take such better care of the five patients that you got that? How do you get those five, talk to the other five, talk to the other five and exponentially remember that haircut? shampoo, you’re those two, those two friends until those four friends no 16 or both? analogy, you know, they say from an 18-hole golf course. But if you just double the like if you’re on a golf course, and you have a contest with a person, and every dollar you double it each 18 holes, and it’s something. Yeah, it’s a ridiculous amount of money. Wow. How did you get that mindset where Wait a second, I better take care of the patients I already have to grow internally rather than chase all the shiny objects to grab that? That one hit wonder, how do you get–? They need to hear that and they can’t hear from me anymore because I think they’re sick of me saying it.

Robert Kotler, MD: Well, I think in a way, it’s that? kind of common sense. In other words, if you if you can make somebody happy, and through not necessarily just the surgical route, but how they were treated, how they were handled, that’s the closest thing to return customer. And Dale Carnegie said he’d never been in a business that didn’t have returned customers. Well, that is a problem. In cosmetic surgery, you can turn out a nice nose job, but for gal who say 25. And she may come back to you for 15 years for her neck or something or not bring your kid in? Well, that’s another generation you have to wait for. Right? So, this is the problem. So, what’s the next best thing? In next best thing is to treat the patient with the best care you can possibly get. We’ll talk about some specific because they’ve got a sister, that cousin, and they’re there, they’re glad to extol your virtues and praise your work. If they will. They may not. But let’s say that they do. That’s the closest thing you have returned customer, because that leads to perhaps a chain. But it’s not just what you do surgically, I think this is work. And that’s just the machinery that you buy. It’s what was the total experience. For example, if you let’s say you’re an excellent surgeon, your work is good, you have few complications, but you never see the patient after surgery, you don’t like to see the patient, some doctors don’t. They don’t want to, or they’re afraid they’re gonna hear complaints. So, the staff sees the patient after surgery. And maybe the doctor wastes from the hallway. Well, that’s not good. Because the patient said, you know, it was kind of crazy. I want to die, never saw after surgery at some questions. And I didn’t want to ask the staff I want to talk to him. They didn’t give me any time with him. And then I went back another time and I had to ask for time with him and he was rushed and he’s looking at a clock you know, I don’t have any clocks on the walls of my office I ordered wristwatch, and no idea what time it is. I’ll kind of my staff to knock on the door if I’m running an hour running late. My point is that it’s about the human being. And I want my fellowship was So, was a Dr. Morey Park, Dr. Murray parks was one of the giants of the early Facial Plastic Surgery world here in Los Angeles, I was very fortunate to have my fellowship with Him, particularly out of the service because I really did have a lot of a lot of surgical experience. He said, If the patient likes you, they’ll like your work. At first, I didn’t get that. It’s like, Well, what do you mean, what if it’s not a great result? If they’re still gonna think this is the greatest place in the world, they have cosmetic surgery. But he was right, because it’s a subjective experience. And another one of my great teachers, Dr. Howard diamond, who is the most prolific rhinoplasty surgeon ever in New York, said that when I was visiting with him, he says, you don’t have to get a great result every time just don’t get a bad result. In other words, stay within a reasonable range of outcome and behavior. And you’re going to be okay. So, the office that doesn’t have good staff where the doctor doesn’t see the patient after surgery and didn’t spend very much time before surgery, didn’t ask a lot of questions, but sat there and talked about himself how great he was and his three sports cars that he just bought, you know, he’s gonna be at a disadvantage. He will be the disadvantage and his, his, his practice in the eyes of the patient is going to be diminished and there’ll be less apt to sing his praises publicly through public reviews, or through So, personal referrals. And there’s so many other little things you can do that says we are a good practice and here’s why does the doctor ever call personally to do a follow up after surgery to see if the patient was a little anxious after surgery and maybe a little more swelling or bruising whatever that Little phone call. Ally, this is uh, you know, Dr. Smith just want to see how you’re doing is the swelling going down? What’s going on? Right? And what’s wrong with that? What does that tell the patient? You care? It’s all about do you care? There’s a great line from a Harvard professor in the 1920s. I use it in my book that I wrote for patients understand, he said, the secret of the care of the patient is caring for the patient. That’s it, you’ve got to care for that person. You want them to know by what you do, and not you believe that you are 100% on their side towards getting a great result, and avoiding their unhappiness? What if the patient has some complaint? And they’re a little shy about complaining about you need to know. And so, it’s always a good question. They asked them when they come back from a post out visit. And she looks like to me, you look great. And everything’s going well, any questions or concerns that you have? Because by me asking someone open ended questions, you’re inviting them this year, something you may not even thought about? Like the patient would say, well back to be honest with you. And I really, we had a lot of pain and the pain medicine you gave me didn’t work. So, what about that? Well, there is a way to know and that is you certainly either you your staff calls a patient the next day. How you doing? pain medicine, working? Everything. Okay, right. It’s that all these little things? Yeah, they take time, but the bonuses are huge. Because the bonuses are you are seen as a superior doctor. Does your office call the patients that have appointments? If you’re running late? Do you know because let’s say you start day starts late, whatever it is, you call them, let the knob Sorry, just want to give you a heads up? Often patients complain that they went in, say an hour and a half to the office before the doctor saw. And then comes the room looks at Yeah, sure. Yeah, you need to have your religion on ccrs, we’ll get you scheduled. What are the chances that the patient’s going to schedule their–? I think it’s next to zero. Again, little courtesies to the patient. Maybe I, we have a survey form, we asked if we have a survey form, we give the patient’s couple weeks after surgery, you know, how was your experience with pain? How did it was the surgery center? Okay, we’re gonna see, we’re happy with the anesthesiologist. Did you feel you’re well cared for? Did you? Did you were all your questions asked before surgery. Are you happy with the offices care after surgery? Why shouldn’t you do that? Why shouldn’t you know, you know, you know, surveys pop up on the internet and everything. Big companies want to know, they need to know they need to know, not necessarily about your personal experience with them. But they’re asking questions. So, I think those are the kind of small things you do that endear you to the patient that say not, yes, I’m a good surgeon, technically, but more than that, we wanted to and we hope we did give you the very best care, because when you read some of the bad reviews and stuff like that physicians, there’s something that comes through pretty clearly, it’s nobody seemed to care about me. Right? Not just I was unhappy with my result. Yeah, you’ll see some of that we’ll all see some of those, you know, but often they sent around this office didn’t care. The service wasn’t good. I had to wait too long. Why should patients wait too long? Can’t you schedule appropriately? Right? allow more time for the patients than you think. But if the doctor is in a hurry to pack as many patients as he can, so he can, you know, go home or do something else? I think that’s I don’t think that’s good. I think you’re judged by the whole experience, not just the result. And clearly, when Dr. Park says is the patients like you that like their results, he was right. And with their diet, when Dr. Diamond said, you don’t have to get a great result, don’t get a just don’t get a bad result. What he said by what he meant was that every case is going to add a plus, but you’ll still get referrals because the patient will be happy by sometimes, they are happier than you might be as a surgeon. What would you say to yourself? See, I wish I could have done better maybe I should have, you know, tighten the neck of them or maybe did this and yet the patient’s expanded say, so it’s perception. And the perception comes not only from the surgical result that comes from the respect and appreciation the patient was given from the doctor from the staff treated well. Can we get you a glass of iced water or Mrs. Smith? If it’s you know if it’s a rainy day in everybody’s running late. Well, thank you for coming. We appreciate the appraisal rain to come here. What does that say? That’s a that says that your perception? courteous, you’re appreciative of them. You’re thanking them for coming in. I’m amazed sometimes I go in a store. They don’t even thank you for shopping with them, right? Here’s your–

Catherine Maley, MBA: I can’t even go the drugstore anymore. There. I’m not capable because I’m so attuned to customer service. And they hired just the dregs of society basically at like those kinds of stores like your Walgreens, or you know, I just I almost can’t I can’t even participate anymore. I just order online because it’s such awful. This. Nobody looks at you. Nobody says thank you. The only times I say you’re awesome, and they don’t even understand why I didn’t say that right.

Robert Kotler, MD: Well see this is this is because this is The grand design of big business in the United States, you know, because this is the big drugstore chains, the services terrible, horrible I, you know, when I was given the opportunity I always like to prescribe I’ve had stripes under a patient to a small neighborhood pharmacy is rare as their as they are because they have become that and people want the fact they’re still in business means people are willing to pay more for service because they deliver, they treat you well, they have your perception ready, and you call up on some of these other chains. And of course, they’re closed for lunch between 12 and two. It’s almost comical. And by the way, the pharmacists are under terrible pressure to sell a lot of prescription in a short period of time. And that’s why here’s a small detail again, that would patients appreciate. We order that are their prescription medications, routine pain medicine lallana by appointment at a time before surgery, okay, we folded in their pharmacy, so makes it easy. I say, look, we’re going forward in it. So, they’ll pick it up, but I want you to bring the prescription so the surgeries are because I want to look at them and make sure they filled it right. So, you see what I’m saying to the patient. two things. First of all, there are mistakes that are happening, and that we know. Secondly, I care that everything be right. And I personally need to check and make sure the pharmacy gave you the right stuff. If I were a patient, I would think to myself, this guy’s good. Right?

Catherine Maley, MBA: Yep. And the details are the differentiator, you know if this is going to–

Robert Kotler, MD: Exactly differentiate, yeah, yeah. Yeah.

Catherine Maley, MBA: –just by offering more care, and more service than somebody else’s.

Robert Kotler, MD: And good service, and why service because it comes from being a physician, a physician is an essential part of our life. And why should a physician be as good as he can be? Who wants to hire somebody who isn’t as good? As So, they can be? Or should be? Right? So, the point is, so it’s those little things as that call to the patient. Another thing is sometimes a patient a little skin rash, or something, I have—procedure and you say, Okay, now we’re going to do medicine here. And I want you to take it for two, three days. But if it isn’t working, you must call me. So, in other words, oh, here’s a prescription go back. No, you must call me. And with lab tests, we order lab tests, if you have taken nasal culture or something like that. We say them okay. It’s Tuesday, we should have the results by Thursday night, probably Friday morning. But call So, the office three o’clock on Friday. If you haven’t heard from us, we will call you as soon as we get the results. But if you haven’t heard from us, why because you have to have a failsafe system, a fail-safe system. So that the thing so that your request is fulfilled, and the result is known and action can be taken small thing, but the patient is saying themselves. Yeah, that’s right. That’s true, because they hear stories about the doctor orders a test, and either overlooks the results or ignores it and they never hear back and then there’s a problem. What if it comes back that there’s a serious staph infection going on? Right? That’s why in our office, I have to sign off on every lab test that comes in. Now, it’s not like internal medicine where we have, you know, many lab tests performed every day. But when we do, I’ve got to know the result. Personally, I have to see it as a sign off to put it in the chart. And I will call the patient personally to discuss it. By the way. I don’t leave that to the office staff. Because there are there are nuances. There are questions that have the answer. And I want them to understand too, that I’m on the case. I’m on the case. 100%. And this is good medicine. Yeah. is a good business. Yes.

Catherine Maley, MBA: Yes, it is. So, wrap it up. I didn’t realize it was so late. We had been on for a while into, you’ve probably been through what like three recessions at this point? And I’m sure you’ve had a whole bunch of other things that happen. And the last question would be then, what kind of advice would you give anybody in this industry that can be tumultuous at best? What would you tell them?

Robert Kotler, MD: Well, I think you always have to look at your overhead costs. First of all, I think your accountants and advisor would fail-safe say the same thing, because you never know when bad days are coming like now, you know who would’ve predicted this, I think the fail-safe fallouts not going to be good. So even though times are good, say for a rainy day, and secondly, you have to be efficient in your in your work, you know, you have to you have to just develop efficiencies. And again, you have to have really good people, you must find good people, it is really hard. I know that takes so much effort and time we– I could spend an hour talking about that alone. But who could help you and to know, run the best possible practice you can generate? The one advice I would say is, if your employees are better than more employees, I’d rather have three good employees than five average employees. Because first of all, the three employees will do a better job. And secondly, the more people you have in our office, the less efficient everybody comes. There’s too much, you know, often there’s too much inappropriate conversation. It’s just I found better to have fewer people who will work harder and better than more who won’t be motivated and sometimes it takes what happens is the lowest common methylator has to become the standard in the office. And that’s not good.

Catherine Maley, MBA: Yes, I found a surgeon, several surgeons have said to me I was happier and more profitable when I had an office of five. And when I had 20, there was so much chaos. And nobody knew who was who was doing what. And it was he spent more of his day managing those 20 personalities, and it was a train wreck. And he is much happier now that he

Robert Kotler, MD: Just did. That’s right. I would I would absolutely agree. And then again, he has to look at your marketing and advertising. But again, if you will focus more on who from the minute that patient calls you if you will absolutely improve your you’re conduct your office’s behavior, your office’s style, so that you booked, the high percentage of patients will be your patients, that’s the best thing you can do. I think that’s your it. I mean, you’re, it sounds rather mechanical to talk about conversion rates and things like that. But the truth is that if people will take the effort to come to see you, and are turned off, because you know you’re wearing a dirty lab coat, right? Or you’re not washing your hands in front of them, or your office, they have greeted them like they were bringing in the Coronavirus. And you don’t get the chance to serve that patient regardless how great a surgeon you are, then there’s your problem. Okay, you know, I mean, the aim should be 100% of people that walk into your office should become your patient. And that begins with a phone call. And you the problem is nobody’s going to have 100%. But that’s what you should aspire to. And that means you gotta watch every detail. You got to check everything, unfortunately, it is very, very time consuming. And you got to look at your emails that go out to patients, in response to say they come to your website, what messages are you giving out their typos, right? Does it look sloppy? Does it look or does it look professional? Is it meaningful? Is it easy to read, right? All these things matter? I know, it says a zillion thing. But if you’re not willing to do it, then guess what? It’s zillion thing going to be tough. Well, everybody detail after detail after detail, which by the way is the theme in surgery, or to surgery, it’s a succession of details, any one of which have not done well impacts negatively on the outcome.

Catherine Maley, MBA: I’ve noticed the most successful practices; they are into the details of a surgeon the pain when the staff calls them micromanagers. Or he’s really difficult. And he’s real picky. And that’s usually the sign of somebody who’s managing well and running a real business. And quite frankly,

Robert Kotler, MD: I couldn’t agree more. Again, if you just if we all get in the habit of reading more but written by business people one businessman road, I know everything that goes out of my office. I know that’s hard, because when you’re when you’re a surgeon, particularly Remember, you’re not in the office a lot of the time, or you’re with patients a man or owns a business as an event a man or woman owns a business, because they can walk around all day and look at everything and talk and ask questions. There’s, there’s a theory of business management called managing by walking around look and see who’s doing what I have to ask you about debt credit for that. He was very good at that. And he practices; walked around and he kind of kibitz and joke with some of the people in his in his little factory there and how the Chicago Cubs doing and the answer was terrible. And he knew that was going to be the answer. But you know, his stats like that, and I liked him and, and I saw a great model. And but he had a small business. It wasn’t it was easier to do. You know, he had 20 employees at one time, the business, that family business grew to be a lot larger. But just as you said the profitability wasn’t as good. That’s just how it works. But the Times have changed too. So yeah, that’s the challenge.

Catherine Maley, MBA: Most surgeons would prefer to hide out in new or you know, it’s where they’re comfortable. That’s where they’re skilled, and I get that. But if you survive and thrive in today’s world, you have got to become a businessman as well. And I know that’s tough, but that’s the reality. So that’s why I’m spending a lot of my time now in business and leadership and marketing. And not just oh, gosh, I am staff, you know, I’m trying to that’s why this is about the business and marketing side. But anyway, we got to wrap it up got Dr. Cutler, you are just a pleasure. You and I definitely think alike. Actually, there was another thing that that I heard and understanding is that they won’t sue you if they like you.

Robert Kotler, MD: Well, that’s generally true. generally true. Don’t count on it. Yeah, I think again, I think that is true, most reasonable people. And most patients are reasonable. If you play the odds that most people are good and decent. You’re fine. They’re all going to be the screwballs the outliers, you tried to pick them up at your consultation. So, you’re out is it really worth taking care of this patient? If you listen, you say if you watch listen to them, it kind of comes out it’s actually spends all his time saying how great he is. You’ll never get the message. No, thank you. It’s a pleasure to help and I hope they were helpful to you to all your listeners and your devoted fans.

Catherine Maley, MBA: All of you. If you enjoyed this, I sure wish you would subscribe to Beauty and the Biz so you don’t miss any more sessions that we have. If you would give me a great review, I appreciate that as well because it helps us to share and grow the community. If you want to share this with your colleagues and staff that would be greatly appreciated. Please send me your comments and your feedback. You can leave a message at my website at, or you can always DM me on Instagram at catherinemaleymba. And with that, I’m going to say goodbye, Dr. Kotler, I’ll talk to you soon. Good luck, everybody during this tumultuous time, and we’ll talk again soon.

Robert Kotler, MD: Yes, everybody, thank you, stay healthy, stay good. And let’s keep up, but stay optimistic.

Catherine Maley

Catherine Maley

Catherine is a business/marketing consultant to plastic surgeons. She speaks at medical conferences all over the world on practice building, marketing and the business side of plastic surgery. Get a Free Copy of her popular book, Your Aesthetic Practice: What Your Patients Are Saying View Author Profile.


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