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Ep.49: COVID-19 Update with Dr. Bitar

COVID-19 Update with Dr. Bitar.

Dr. Bitar shares insight of what’s in store for the industry, how to survive the crisis with minimal effect on your practice, and how to rise above it all when the dust clears.

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Beauty and the Biz

Ep.49: COVID-19 Update with Dr. Bitar

Catherine Maley, MBA: Hello and welcome to Beauty and the biz, where we talk about the business and marketing side plastic surgery. I’m your host, Catherine Maley, author of Your Aesthetic Practice, as well as consultant to plastic surgeons to get them more patients in a more profit. Now, today’s episode is a very special interview with Dr. George Bitar. And he is a board-certified plastic surgeon. He’s also founder and medical director of Bitar cosmetic surgery Institute. And he’s got two office locations, one in Fairfax and one in Manassas, Virginia. And in case you don’t know, it’s in the Washington DC area, which is super competitive. Now, interestingly enough, he came to this country from Lebanon when he was 16 years old. And I’d love to hear more about that as we talk today. Now, Dr. Bitar managed to receive a medical degree from George Washington University School of Medicine, where he now serves as assistant clinical professor. He did his general surgery at the Albert Einstein Medical Center of Philadelphia. He did his plastic surgery residency at the University of Virginia plastic surgery program. And then he went above and beyond. And he received additional training with prominent cosmetic surgeons in Rio de Janeiro, Bell, Melbourne, Johannesburg and Beverly Hills. Now he then launched his own plastic surgery fellowship program that was endorsed by the American Society for Aesthetic Plastic Surgery. Otherwise, we always call it ASAPS. And it is only one of 26 practices in the entire US that has that type of a ASAPS endorsement. That’s a big deal. He’s received numerous honors and awards for his research, he’s a speaker and member of several medical societies. And he does medical missions and volunteer work in the US and abroad. Now, if that weren’t enough, he has a beautiful wife, and we’ll talk about her later, and he’s got two great kids, and he’s an artist focusing on watercolors and photography that you can see on his website. But I’m not going to tell you that right now. Because then you’re gonna go to the website. So, I’ll tell you that later and I’ll put it in the show notes. So welcome to the podcast, Dr. Bitar, how are you doing today, and–?

Dr. Bitar: Thank you so much for having me. It’s a great honor and privilege. You know, we’ve worked together before at conferences and our own practice where you came in to help us doing things up. So, it’s so much fun to be here with you and to share some of our experiences with your audience.

Catherine Maley, MBA: Thank you so much. Now, of course, there’s only one conversation going on right now. And it will be for the near foreseeable future. And that’s COVID-19. Can we get an update on COVID-19 and your practice and where you’re at right now?

Dr. Bitar: Sure. I mean, I think that in the Washington DC area, I’m happy to say that as of the time we’re doing this podcast, the numbers are not stable, they’re still rising, but they’re rising at a very, very slow incline. So, my feeling is if we have not clicked or close to meeting, the governor of Virginia where I’m at has agreed to open up this area on May 1 to for surgery. So, we have been doing surgeries in the last week in a limited fashion. He agreed to open up the offices of non-essential medical practices, which have cosmetic surgery practice is non-essential. On May 15. We’re going to be opening up shortly after that. But we’re really never close. Catherine, we have patients who have operated on, who are doing post office who are seeing patients who need to be seen and we have some of the staff members taking care of patients who need prescriptions, have questions to be answered, have upcoming surgeries that need to be pre op. So, although we have slowed down our practice a lot, but we never closed.

Catherine Maley, MBA: And we’re just the mixed profit into this. Are you able to do injectables and lasers?

Dr. Bitar: No, we haven’t yet. I mean, as of March 20, when we close, we haven’t done any injectables yet, because you know, the injectables and any type of skincare has a close proximity between the patient and the provider. So, we’re waiting to you know, we’re opening back up close to May 15, we’re probably gonna open up on May 8, which is a Monday, but then we’re gonna have more protective gear, we’re gonna have mass, we’re gonna have gloves, we’re gonna have patients being put in rooms and spaced out. So, we’re working on a whole new system of practicing medicine, unfortunately, but we need to do it for the safety of the staff and the patients.

Catherine Maley, MBA: Speaking of staff, by the way, you have a pretty darn big staff, and we’ll talk more about them later. But right now, how do you handle that?

Dr. Bitar: Well, you know, I have to say that we always say in our practice that we may have over 20,000 patients, but we only have 37 staff members, our staff members are very valuable to us. And, you know, they’re like our family away from home and my wife is the medical is the executive director of the practice. I’m the medical director. So, between her and I, the staff has become our second family over the year. Obviously, it was very painful for us to have to furlough a lot Have them when we had to close our practice, we had no more for anybody. And it was just by the orders of the governor, we had to close. And now slowly, slowly, we’re bringing people back. So, it’s very exciting, it’s very rewarding for us to see them back. And we’re happy that they were able to survive last month, it’s been tough, but, you know, they were able to do what they had to do to, you know, survive. Now we’re bringing our patients back slowly for the job. We’re doing a lot of Virtual Console, a lot of virtual postdocs, a lot of virtual pre op. But there are certain things that you need to see people in the office for like, if somebody needs to have breast augmentations, you need to come and try on implants, you cannot do that virtually. If I need to do a type of rhinoplasty surgery, I need to examine somebody and we’re being very careful with the gear with testing people. But this hospital has given the green light to open for rhinoplasty is next week, and we’re planning on doing. So, you know, the staff is essential in terms of keeping the patience and the practice sort of, on common ground.

Catherine Maley, MBA: A question about the staff? Do you have any issues? I’ve been on a lot of the medical webinars and the legal was on there. And they were talking about what a staff doesn’t want to come back? What if they’re not comfortable with the safety of the practice? And how do you handle that? Because I didn’t see a good solution for that.

Dr. Bitar: I feel that it’s our responsibility as the practice owners to make it as safe of an environment as possible. There are some people who are you know, by nature, risk takers, or some people by nature are the ones who take zero risk. And there are some staff members who probably are influenced by their husbands, their wives, and their parents, they don’t go to work. So, there are lots of variables, I think, on our end, what we can do to mitigate the risk factors is to create a safe environment to decrease the load of people coming into the office. And there are some staff members who can do virtual consults and virtual patient encounters that we got to keep doing it virtually such as our patient care coordinators. You know, we’ve learned a lot in the last few months about virtual consoles, and how efficient it can be. And the fact that a lot of the things that we did by bringing patients in the office may now be able to be replaced by a Virtual Console. And quite frankly, interestingly, our rate of bookings for a virtual console is close to 100%. But I don’t want to jinx myself, but people who booked virtual consoles are booking. And I think the reason is, is because the ones who do go on Virtual Console are serious, they’re not doing it for fun they’re doing because they want to have surgery, they understand the risks, they have the finances and so our staff is very happy to help them and because they’re motivated, we’re able to go a lot virtually before we had to do in person and handholding Are you charging for the console? We do we charge for the console I they can call our office and our staff can give them the financial information.

Catherine Maley, MBA: That probably helps you that during the COVID-19 crisis, I was recommending that you just build a list right now, build your brand and let anybody talk to you. But now that things are settled, I would say now it’s time to go back to charging for a consult virtual or live because you can’t afford the no show rate.

Dr. Bitar: We were talking before for regular consults, I don’t see a reason we that we should change our habit. In virtual consults. We’re still giving the patients our time we’re still giving them our expertise. We’re still giving them our– how we’re showing them what we can do for them. We’re giving them valuable advice. So, I feel that if they are serious, then that should not be a big deal to them. If they’re not serious. They probably Welcome to virtual consult in the first place.

Catherine Maley, MBA: All right, I got a tip from Reema, your lovely wife on the platform that you’re using. It’s a nice easy platform. It’s called doxie me or something?

Dr. Bitar: Yes, about me. I learned about that about two months ago and we started using it. The nice thing about it has a virtual waiting room, you can see who’s waiting, you can have the patient care later. Or the nurse depends on for doing a consult or a follow up. You have one of the staff members there you have the patient and myself or Dr. [09:10] my partner there you have the other patients who are in line they understand when their time is gonna come because I’m in the waiting room, you can show them before and after photos, you can show them you know you have a nice, very clear screen that if I want to raise my iPad and show them things on my iPad, I can we can give them virtual consent to sign through it. So, it really does a lot and it’s not that expensive. There’s like a $35 to $50 a month version that you sign up on and you can upgrade that so you can have a little bit more you know, more bells and whistles at a higher rate. But as far as I’m concerned, it’s been very effective in terms of having patients in the comfort of their own home. My staff member in their home and myself Sounds like my own home, talking about what we would normally have done in the office. You know the patient, if I’m doing a breast augmentation call, so they can just lift up their shirt, I can examine them, if we’re doing a face consult, it’s very easy to see. If I’m doing a rhinoplasty consult, you know, if they say they’re having difficulty breathing, and I know they’re going to probably need some type of airway procedure. And when I go back to the office, I’ve examined them on the pre op, I will because I never want to offer that anyone after just having seen them in a virtual console, I have to see them in person, you know, called the old fashioned but virtual can only go so far you need to be there. Same with the patient. Patients need to know that you’re serious enough and they that you care enough about them that you sat down and talk to them and answer their questions face to face, which is what we’re going to do. But for all those reasons, I think virtual costs are probably going to be here to stay at, we are going to see a change in the way we practice medicine based on not only COVID, but on companies that do virtual consults and videos upping their game, because now they realize it’s gonna be a lot more than that. And things that were difficult to do or more cumbersome are going to become more streamlined and easier to do you.

Catherine Maley, MBA: What I don’t want to gloss over are those two big features that doxy has that zoom, like what we’re doing, we’re using zoom platform I always have, but I don’t have a waiting room doxy has a waiting room for you. Because what happens is that everybody has the same login. So, a patient could have jumped in on a zoom call, while you’re still on a call with–

Dr. Bitar: That’s a good point.

Catherine Maley, MBA: That’s ridiculous. And most of you we’re not doing virtual consoles and converting, you are just doing virtual consults and saying, okay, like there was no closing end to it. And with doxie, you literally can have them signing forms if you want.

Dr. Bitar: You kind of hit the nail on the head, I think because I have a lot of international patients. So, I have patients with Saudi Arabia, from France, from Beirut, from Nicaragua, and, you know, you used to use the Virtual consult. Like, WhatsApp or–

Catherine Maley, MBA: Go to webinar.

Dr. Bitar: –call me on, you know, Instagram On Facebook, I mean, whatever they could get their hands on. But it was not professional. I mean, the way I looked at it was just a way to keep the interest of the patient and the practice. But that was more like a stepping stone. Now, with doxy is that we consult, I’m booking patients, as soon as I hang up, they go to my patient calculator, they give them the price, and to give them the service, we’re very busy with the restrictive [inaudible 12:38] in the hospital, we’re booking a lot of patients. So, we’re running out of space. So, if patients want their surgery, they want it right now and they want to recover during this time of COVID, then they better book soon.

Catherine Maley, MBA: I’m glad that you have it was called embrace Virtual consult, I don’t think now that we let that out of the box, I think it’s going to become mainstream; I think many patients are going to demand it because it’s more convenient for them and for you. But it’s I mean, a busy person, I could do a console any day virtually then go get in the car flip over there and traffic, I love it. But I think you have to put some parameters around it. Because in the old days, you couldn’t do a console unless you live far, far away, like a virtual. Um, but I don’t think it can be far away anymore. But I don’t know, I don’t know what the answer is yet. I think you have to test things. But I used to say you have to live at least like 25 miles away, or 50 miles away. And now I think you have to know–

Dr. Bitar: I can tell you that you have to remember something that is very important in terms of the psychology and that people do Virtual Console, you know, virtual consoles. 20 years ago, were on the phone people would call in I mean, I did the international debate fellowship around the world. I operated the LASIK company, I had patients calling me when it was midnight, my time and it was 12 o’clock their time and all that stuff. So initially, there were the phones and then there was Chi. But now we live in the generation of Instagram, where people want to see things instantaneously. You know, you post a picture on Instagram, if you don’t get your 100 likes in their first hour, then boom, it’s gonna flop. So, people are very attuned to that. So therefore, that same psychology and that same mind frame is 26 year old, you know, successful woman into her office, even half an hour away from me, who wants to have a nose job she’s thinking, you know, why can I send my pictures back to be on Instagram and somebody can do my nose, but yet I cannot go live with Him and for Him to explain to me how to hate my rhinoplasty and or now that we have the privacy with having a patient calculator in the room, you know, she can easily think of her talk and I did today consults on breast implants, tummy tucks Brazilian Butt Lifts, you know all in one day. So, you know a woman can be the presser on or even her own office and take her clothes off and I have a chapter on with me in the virtual room so to speak with which is my nurse or my patient calculator. And that would save us time and to save the patient time to save her driving and hour and a half to work. I mean, to be honest with you, if I would do all the consoles from now on virtually, I’d be very happy. Because a lot of the time in consoles is wasted, putting a patient in the room changing their room getting their husband to take the kids in the stroller outside then calling the husband back in when they want to try on things. So, there’s a lot I mean, I’ve learned that was a wakeup call for me, I learned that there’s a lot of wasted time in our consoles, and I consider ourselves to be a very efficient practice. So, I think, number one virtual concerts I hate to say, number two, not everybody wants a Virtual Console, so we will be able to see them in person. But you’d be surprised that when we go back to life, as it was before, Corona, you know, BC and AC Now, when we go to the Beastie times, you’d be surprised. My bet is, I would say more than half of people under 25 years old company for rhinoplasties Auto classes breast augmentation, liposuction I got I want to have their concept done virtually even though they come into the office, and I’m going to offer it to them.

Catherine Maley, MBA: I think they’re going to demand that for sure. I’m not you might suggest doing like tier pricing. If you really– actually get such a good close rate for your virtual, I would actually, I’d stick to that. But if you don’t, some of the practices, I do suggest charging less for virtual more for life to get people or sometimes the other way around, they’re trying to still get it in life. But if you’re having such a good conversion rate, what the heck dude.

Dr. Bitar: I was gonna say so if you don’t mind, this podcast should be only broadcasted to people about 150 miles outside of my radius, so they don’t get [inaudible 16:28]

Catherine Maley, MBA: Turn this off right now. So, this is a really good time that you mentioned the hospital. Amongst all of this, you literally just opened up your own alarm–

Dr. Bitar: My staff, it’s like we send the bride to the altar, all dressed up and the groups that are up at altar, you don’t have a beautiful office setup. In the Fairfax office, we have a 2700 square foot beautiful office that we do everything right now with the surgeries. We do pre off the post office consultations, even seminars. In the last year and a half, we build a surgery center right next door to our office, they’re only separated by a corridor. And so, the new office is 3700 square feet. So, it’s about almost time and a half existing office. It’s got two beautiful operating rooms. And the way it was designed is that we’re going to move all our surgical business to the office next door where we have the operating rooms, we have exam rooms, we have the patient care monitor rooms, and it’s got a nice recovery room and the way outdoors, it was on the ground floor so people can go from the back door straight to the lobby. And we’ll keep the medical services and the skincare in the existing office will separate the nonsurgical from the surgical services. And I mean, the setup is gorgeous. It’s beautiful. Of course, I’m biased, I built it. But I couldn’t wait to start on March 30. And then, you know, we got an unwanted visitor coming to town.

Catherine Maley, MBA: Dear, Lord. I saw you, if anybody wants to look on Instagram, you did a great tour of the office, the new surgical center and it’s gorgeous. And it’s beautiful. I couldn’t believe the timing on that. But whatever. So, what’s the plan? When can you use–?

Dr. Bitar: The plan is we’re gonna be opening up on May 18. And we are going to do all the injectables and preamps and postdocs in the office because we’re already operating right now and the hospitals are the people that now I’m seeing it half empty office, they’ll be coming back to a you know, fully staffed office next week or so. And, you know, we’re still trying to figure out our surgeries in the office because we have two operating rooms that are you know, that are meant to do general anesthesia. And so now we have an entire geology group that we’re contracting with. Our problem right now is that it’s very, very difficult to buy things to make the office days for Coronavirus patients, let alone operating. You know whereas you have to have gowns and masks and gloves to see somebody up and post off when you’re operated. You have to have certain filters for the anesthesia circuits and boxes, you know that they have to put above that patient intubate zone with this. You have to have the negative air in the operating room and you have to have the air circulating we’re going to be getting up the air filters that also killed the particles in the air because you know Coronavirus, very aerosolized virus. And quite frankly, for the safety of the staff and the safety of the patients. I’m not in a rush to go operate in our new center because God forbid if any problems right now, and we don’t have the wherewithal and the materials to fix it. I’d rather keep the surgeries in the hospital where they have worked out those kinks in the last month and a half. And then when we get a little safer the next two or three months I don’t know, that operate in our office because our office was ready to be operated on in a pre COVID era right now I have to assess everything the safety of the staff the way we you know, clean the surfaces that how long does it take from one patient to another to bring them back into their home, after we’ve done the PG surgery, what kind of surgeries we’re doing. I mean, I can tell you that we have a protocol where I have eliminated certain surgeries that I’m not doing anymore. For example, we’re not doing any surgeries over four hours right now. I’m not doing anybody over 65 years old. I’m not doing anybody with a history of smoking, vaping or asthma. We’re not doing anybody with a BMI over 30. We’re not doing anybody who has comorbidities like hypertension, or diabetes, or we’re not doing anybody who has a combination of those. I was testing everybody for COVID, sometimes one test with rhinoplasties. I like to test to be negative before I put on them. So, I mean, we’re being extremely cautious. But there are people who want to have this medic surgery, we want to offer it to them, we have delayed it already. And we’re going to have it on a delayed anymore, because–

Catherine Maley, MBA: Talking about the test. Did you find one that’s user friendly, you can get the results right away? Or how’s that working out? Because the testing has been a big issue.

Dr. Bitar: Yeah, I mean, and I think it’s gonna continue being a big issue. The bottom line is, we don’t have one great test, and we have a test, it’s not going to tell you all the information you want to have is going to be the swab that’s going to tell you, whether they have antigens or not, you’re gonna have antibody tests, some of them have like 15 to 30%, false negatives, some of them have false positive, some of them are not very specific. Some of them you can all do the test by the time it comes from a fake company. So, there’s a lot going on right now that I’m hoping in the next month or two would be sort of like, you know, sorted out, and we’ll be able to have a better testing what abundant testing is preferred. As of now, the hospital where I’m at Fairfax is thankfully, providing our patients with pre op testing, and we don’t offer to anyone unless they are negative, we are bringing testing for the staff that 15-minute antibody test that is rapid that we can visit to the office, as you know, as we make our way back to the office. Um, I mean, we have to always be careful, you know, as a surgeon, and the people who are watching this, or surgeons in the era of HIV anyway, people we can test for HIV. So, everybody had HIV, everybody had hepatitis, and you just take your precautions.

Catherine Maley, MBA: Regarding staff, are you testing them regularly?

Dr. Bitar: We will, I mean, we haven’t brought them back yet. But we will when we bring them back, and we are going to test everybody, we’re gonna have a questionnaire for the staff and the patients every time they walk in the office and make sure that we take everybody’s fevers with temperature, we get them in like a nine-point form, you know, have you been exposed to somebody with COVID? Do you have a coffee receiver? Do you have a sore throat? Do you have any symptoms that are related to COVID? So, I think we’re gonna try to do our due diligence. But as you know, there’s no perfect way of screening people you can have been exposed to somebody yesterday, and then today, you’re not showing any symptoms, but you’re still, you know, a carrier, kind of like a pregnancy test. I mean, we’ve tested people who are negative, and then turns out that after the surgery, they end up being pregnant, because, you know, the they had sex, like 24 hours before the surgery and the pregnancy test, the morning of the surgery was not accurate. So, it’s kind of like we are working in an environment where you don’t have all the answers.

Catherine Maley, MBA: For sure. So, let’s talk about the patient for a second. With these new requirements. You have, let’s say if there was 100% pie, how many what percentages? Have you just kicked out with your new rules? And percentages what’s that doing to your patient flow? Because you can’t see all the patients you want anyway, how are you handling the flow and as a decrease dramatically or not at all?

Dr. Bitar: So, you know, we have now the patients that were on the books before this all happened my I can tell you that at least about 30% of them have been put on hold or we may have offered them a smaller surgery. You know personally sample somebody who was going to be doing a rhinoplasty and the breast augmentation, I mean, just do the breast augmentation. And wait for somebody who’s going to be having a rhinoplasty and facelift I mean, just do the rhinoplasty and wait on face. So that’s number one. Number two, we may have to retest them, you know, they may have been negative, but they may have you know converted recently, they may have booked for a liposuction case, but now last month have gained a few pounds and are no longer attended for. So, we’re assessing everybody we’re turning down the surgeries. We Those were the old ones, the new ones, the ones are now coming for Virtual Console. They are being screened by the patient care coordinators before I even do the console. So, by the time I’m doing the console, they kind of like if somebody calls and says I’m 79 years old, I want to have a facelift she’s not getting a Virtual Console right now. We’re saying you know what, right now it’s not safe. We’re gonna have to wait or if somebody says I insist, I mean, I read about that to be that he does lower body less what I’m not doing lower body strength now because in my hands, it’s a six-hour case, you know, and maybe other plastic surgeons are faster than me but if I feel that a case is going to take me longer, I’m going to keep them to the hospital overnight. I’m not doing anything also anybody in the Whereas I used to do, for example, in breast reduction and a tummy tuck at the same time, I’m not doing those combinations at the same time right now. And, you know, I do a lot of webinars, we just did a Dallas rhinoplasty course with Dr. Rodrick. This weekend, we did a staff webinar last week we’re doing every day, there’s a different webinar. And you know, the plastic surgeons ourselves are confused as to what is the right thing to do. I don’t think anybody claims to have all the right answers. I mean, we are taking the information that we have, we’re trying to make the best decisions to protect ourselves, our staff, our patients, you know, but anytime you see a webinar and you get somebody who is quote, unquote, an expert, I can guarantee you can get somebody else who’s going to be you know, drilling holes in that person’s statement.

Catherine Maley, MBA: I feel for you guys, but it’s never been more important for you to have a business mindset. And it is now because the math has changed so much for you. And you can’t have that kind of overhead and 50% of the patient flow that used to happen. You’ve all got to figure that out. And I don’t have a good answer. I have plenty of answers. But you know what I mean? You have to really look–

Dr. Bitar: We’re living in an irrational, I don’t say irrational world right now. You know, people are gonna put off Botox, after surgeries. But you know, you’d be surprised how many people we have seen in the last month and a half in virtual console that are want to have their surgery yesterday, you know, I’m young, I’m healthy. I’ve been sitting at home, I’ve been making money because I’m an IT consultant, I’m a lawyer, I have my own business, I’m selling things online, I had a woman that I did a consult with was a virtual fitness instructor. So, all her work before this was on online anyway. And these people want to have surgery right now they feel it’s a great time to recuperate. So, you know, it’s not for everybody. And a lot of people are going to say, you know, this is not the time to have cosmetic surgery. But there are other people say this is the best medicine friend of mine, who’s a surgeon, who I opened on last week, because he was not operating himself. He’s like, well, if it’s my time to have my surgery so–

Catherine Maley, MBA: So, let’s switch over to marketing, because one thing you guys really have down is marketing, branding. You know how to brand– Like you are the top tier and branding is. And I don’t know why more surgeons don’t get this. But you’ve also put in the work to make that happen. Dear Lord, I mean, if some write papers, you write 10 times more papers, if some have PR, you get 10 times more PR. Like you’ve really, just so you know, from a marketing perspective, I applaud you for putting in the effort because it really does differentiate you from all the competitors in a wildly competitive arena. So how did you know to do all of that? Where did all the marketing come from?

Dr. Bitar: Well, I mean, apart from maybe my Lebanese background, I think, if you come from Lebanon, do you have that entrepreneurial spirit in you. Partly because I had good mentors along the way. And partly because cosmetic surgery is a desire, it’s not a need.  I mean, you don’t have to have a facelift, you don’t have to have a tummy tuck. So, when people come to me say, Do I need a [inaudible 28:00]? You don’t need a facelift. Nobody needs a facelift. But you got to do it because you want to do it. So, my dad is a pediatrician and he practiced pediatrics for 52 years. And God bless him, he was wonderful, Dr. Welby type of pediatrician that everybody adores. And my practice couldn’t be any further different from what his practice was.

Catherine Maley, MBA: But did you do that on purpose?

Dr. Bitar: No, no.

Catherine Maley, MBA: –say I don’t want to do that. I want to be something else. Because I love Dr. Welby. That was a great most people have no idea what you just said.

Dr. Bitar: Yeah, Dr. Welby, when he has only two patients a week, then he can survive. But that was nice and 1960s. But you cannot practice the medicine that my father does. Well, the practice where they go house calls 82 patients a day and they spend with the whole, you know, extended family seven hours discussing a kid’s problem. We can’t do that right now. That’s unrealistic. But I guess the point I’m trying to make is if you want to be successful as cosmetic surgery, I think you need two things really. One is you need to know what you’re doing because I like I mean, I’m a dental surgeon performing gallbladders. I’ve done open heart surgeries to remove tumors from brains. I’ve been hip replacements, the hysterectomy is liver transplants, I’ve done that all and you have a very hard time judging whether a liver transplant surgeon is good or not, except by the results of the health of the patient. That’s cosmetic surgery. If somebody walks out of an operating room in the recovery room, the nurses are judging whether you do a good job or not by seeing the patient in the recovery, let alone right now we have social media we have you know, online reviews. So, your work is out there for everybody to see and criticize. And for every one person says something nice, you know, to other people who want to criticize so you know that the somebody has a nice cosmetic outcome they want to keep it to themselves. If I had a penny for everybody, I had the great results on who refused to give me consent to show their photos I’d be rich, whereas the people who don’t have a good result or the one or 2% are not happy, they’re gonna go to every single Yelp You want stuff and write about. So, with that being said, I think number one, you need to know what you’re doing. And number two, as you mentioned, there are other pastors in town. So, if somebody is paying out of their own pocket, and they’re doing something essential, it’s very different dynamic than if somebody is having an open-heart surgery or their battery removed, because they have a gallbladder that needs to be removed, they gotta go to their medical doctor, the doctor says go to Dr. X is going to take out your gallbladder. That’s it, that’s the end of the discussion. But if you are 18-year-old girl who wants to have a rhinoplasty, you are gonna go on Instagram, you’re gonna see every single person in the world who does rhinoplasty, you’re gonna compare, you’re going to send the messages to an average, you know, researchers for about six months to a year, before you realize, so if you don’t have something that separates you from the rest, you know, you’re not, your people aren’t going to come and knock on your door. And a lot of doctors who start out as plastic surgeons wanting to be fully cosmetic surgeons end up covering the emergency room, because that’s the easy, you know, that’s the easy path. Nothing against that, but I’m saying if you want to truly be a cosmetic surgeon, you got to put the effort in, you got to create the 18-year-old reason why people will come to you and other 100 officers in your market, you know, get nice results, you have a nice office, are your staff, you know, responsive? Do they portray a good image of you do your results, you know, speak for themselves? Are you 18-year-old know, did you just do one of those facelifts five years ago, you have constant results on your website, when people come to your office, your office nice and clean. You know, when they deal with you and the hospitals, the nurses have nice things to say about you, all that is part of the brand, and you have to work at it every single day, nothing, nothing is nothing is taken for granted.

Catherine Maley, MBA: You’ve done so much in that area. And you have to if you’re going to be in the middle of Washington DC, you have to do that I don’t see how you could have survived without it. But you went above and beyond, you really did do a lot for that. Um, where is your I want to talk about your wife for a second because actually, I’m going to do some podcasts on this, like how to work with a spouse. And it can go both ways. Sometimes the surgeon is those facelifts wife and the doctors video business person. But I have noticed the ones that work the best and a doctor that you have your different personalities, usually, usually I’m just going to generalize. The wife is the fluffy, the fluffy one, you know, like the more people skilled one to keep staff happy and fuzzy. And the doctors more focused and clinical. And so, like there’s a good guy, bad guy kind of thing, or one of– more business related and the other one’s more marketing. How does that work with you? Because you have a great team? You know, you’re a good team together.

Dr. Bitar: So, we are like completely against all the stereotypes. I can tell you that right off the bat. I’ll tell you for starters, that when I met my wife, she said that when she was five years old, she wants to be the first female astronauts. I don’t know, too many girls and astronauts when they’re five years old, okay. Secondly, she’s also from Lebanon, like me, oh, I immigrated from Lebanon with my family when I was 16. And I came to the states and I went to college and that school here and basically that my career here. She, on the other hand, grew up in Lebanon, but came to the United States by herself to study Electrical Engineering at UCLA. So, she left her whole family half the world away. After she did her undergrad, the American University of Beirut, which is an excellent University, got a degree in electrical engineering and then came and bit a masters and a PhD in electrical engineering at UCLA. And, you know, on one, The Teacher of the Year awards, I mean, I can brag about my wife a lot but–

Catherine Maley, MBA: But how did you meet if you’re now– if she’s on the west coast and you’re on the East Coast? How did you meet?

Dr. Bitar: We had mutual friends in LA because I had a medic fellowship in Beverly Hills. So, I knew a lot of people there. And one of these people happen to be living in the same dorms as her and the, the common denominator was that we were both of Lebanese origin. And he told her I know this guy, he told me no, he’s girl and he hooked us up together.

Catherine Maley, MBA: Ah, a referral.

Dr. Bitar: Yeah, it was a great referral. But going fast forwarding to now us working together. I mean, I think my wife is a very hard worker. She takes the practice very seriously. And I think the way I compared her handling the practice is like somebody learning, either somebody growing up with English or somebody learning English as a second language. He learned plastic surgery as a second language. As a result, because she came from an engineering background she brought literally when she started with me the practice when she joined me, I hadn’t practiced in 2002. And then she joined me as the Executive Director 2010, we were eight years into it. But she went about every single book about managing classic 30 practices, read them, you know, and she was great at data analysis and data mining. So, she already came with a very different set of skills that she applied. And so, we kind of look at the practice, right, very difficult in a different time, but I want to make my patients happy. I want to spend time with them. I want to you know, give them free stuff here and there because that’s what doctors like to do. To make your patients happy, you know, she wants to look at the staff, whether they have used up their time, whether they go into overtime, whether things that we did for marketing a year ago are still pregnant, you know, whether that vendor who is doing our internet is too cost effective, we need to move to another vendor, you know, whether our 401k for the staff is with the right financial company. So, she does all the things that I hate to do, quite frankly, and that I was never good at. And I like to focus on taking care of patients being the creative person, you know, and So, we have an office manager that runs the day-to-day activity, girls have been gentle Rima, and me, I think we have a very good grip on the practice. And whenever we’re interviewing somebody who comes into the practice, I tell them, you know, when you walk into a practice where that is run by a husband-and-wife team, you may have a concern that you know, what if these two guys fight one day, what’s going to happen to my job? I think that’s a very legitimate concern. Let me reassure you that we’re never going to fight one day we fight every day.

Catherine Maley, MBA: You’re very consistent.

Dr. Bitar: Every single day, every single thing we disagree on and find it out. But the nice thing is, you know, we fight it out based on facts, and based on mutual respect. So, it’s not the fight for the sake of fighting the fight for the sake of trying to come up with the best solution for the practice. And we made this work for 10 years through government, government furloughs, through the recession, you know, and now through COVID. So, I think we have a very good system. And I think we love our staff. And, you know, I feel that we go above and beyond for them, and they go for us as well. So, I think it has worked out for us. But I think the key is we’re both very hard workers, you know, we’re not sitting sometimes, you know, Sunday night until midnight, trying to figure out employee bonuses or annual marketing campaign, or we’re going to be installing a new software for our before and after photos. And she wants to work out the kinks before we introduce it. So, we have, you know, it’s a busy practice, as you know, we have a high volume. And we do a lot of services, from skincare, to injectables, to lasers to all surgeries, we do facial surgery, rhinoplasty and body surgery. And we have a very robust non-surgical practice, you know, therapy machines, the fracture the laser machines, full scope, we have more cool stuff, anybody that you do have for booth got machines, we have XLS, we have [37:24] emsculpt. So, our skincare, our injectable, our laser, our non-surgical and our surgical practice, are all you know, working full steam. Now, of course, we’re just going to change things, we still really don’t know how it’s going to change things, we’re going to go and dip our toe in the water before we type in. We are, you know, we are an aggressive practice, we’re not going to basically sit at home and just don’t do anything. I mean, we’ve So, done a lot of consults with our patients and the office or the patient wanted to be seen had been seen. You know, so I think we’re very proud of the fact that even in these times, I feel that we were able to, you know, take care of our existing patients who already have surgery with us and manage the people who were on the books, but have not had surgery, and be able to service the ones that want to have surgery in the future. And do it to them in a professional way as we can.

Catherine Maley, MBA: [inaudible 38:18] bonuses, and that’s actually going to be another fence to jump over because they haven’t been working. A lot of the staff count on those bonuses, like you know, they spend the money before they get it because they know they’re going to get it as well without the patient flow. That’s a whole other complex. How did you fix that? And when we’ve been off work for two months, or who knows how long?

Dr. Bitar: I mean, look, I have a simple philosophy. I mean, I think if the practice does well, the staff does well, if the practice doesn’t do well, the staff doesn’t do well. It’s as simple as that.

Catherine Maley, MBA: So, do you bonus as a team or do you have–?

Dr. Bitar: We have a bonus structure that is based on two tiers, what the team does and what the individual does. It’s sort of demoralizing if you feel that you are working very hard, and the team is not and you have to suffer because of them. And the reverse is true. I feel if there is a collective bonus, then people push each other because they feel that if you’re not going to be working, and I’m not going to get my bonus, I’m not going to have that. So, it is partly motivational and partly it’s to keep a successful business. I mean, we’re not a charity, we’re a business, we have to make profitability. We do a lot for our staff and our patients and you cannot have a luxurious practice. If you are not making the money. It’s very simple. So, I feel that our bonus structure creates a competitive if you will, but also a progressive environment in the practice. And over the years and quite frankly, I think staff members will couldn’t put up with it went elsewhere. For sure. Meaning So, we did not have to fire them. I think among the staff, the staff feels somebody is lazy and they’re not pulling their weight. They make it just uncomfortable. For them, and they just need it. I mean, we don’t do it on purpose. I usually find that about it in retrospect, because I’m too busy operating stuff. But let’s say we hire a front desk staff person. And you know, she’s nice, she’s smiling. She’s, and then three weeks later, I find out that she left. And I say, Well, why is that? Well, you know, she wants to take our lunch break, he was more interested in doing her nails than taking care of the patients, and the rest of the staff would not have that.

Catherine Maley, MBA: I like when they self-policing. And that means that you have built a culture and not everyone fits into your culture.

Dr. Bitar: And I tell everybody that I interview and I interview everybody who would bring– that this is not an easy place to work. If you want as a comment, take two-hour lunch breaks and take your like three-hour hair dressing appointment afternoon. And I say, you know, my wife and I are very, very hard workers, we probably work harder than anybody in the practice. But we do expect you to pull your three-hour way. So yes, I mean, it’s a culture. And, you know, some people may tell you, oh, I don’t want to go work for the guitar Institute with their very, you know, they’re very hard on their employees and their rights. I mean, I don’t dispute that. But for the right person, it’s very rewarding. The patients get treated very well. And at the end of the day, I think if you ask our staff, would you have your family member operate on this institute? They would say yes. versus other places that may you know, they may be making money they need to have any time but I’ll never have my stuff. I never have my mother copies on here, because I don’t trust the doctor. I don’t trust the aftercare, but I work here because of the monies. But I don’t want to ever hear that.

Catherine Maley, MBA: That’s so true. So good for you, good for you. I know Reema is so good with numbers. Boy, when I had a question, she had a number for it. She was amazing. And I’ve noticed though the most successful practices know their numbers. And they know them daily, not yearly, they know them daily, weekly, monthly, quarterly. They compare it against last year, they know what’s going on.

Dr. Bitar: I mean, look, you cannot– that the because you cannot assess something you’re not finished or something you don’t know you cannot know where you are if you don’t measure your success. So that’s number one. True. But also, I think the numbers are more than just numbers. They tell you the trend. And I’ll tell you a very two examples. You know, one day she came to me and says we need to have booth coffee in the practice. I said, but the cool scarf is going to cannibalize our liposuction. And so, you know, our numbers for liposuction have been going up for the last 10 years and this year, they flattened out and next year, I’m afraid they’re gonna start coming down because other people will have pool slot machines are taken away from us the business. Fast forward eight years later, right now we have four pools of machines, and we don’t want liposuction. So that was a decision made on numbers. Another decision was I did a lot of acid breast augmentation with ceiling implants. I love paid in advance; they were easy to put in. And she came to me one day said we need to do silicone implants from the armpit. I’m like, this hole is small, I can’t put the silicone and binding I can put it underneath. But you got to learn how to do it. So, I went to learn how to do the color funnel. And now six years later, I do 99% of my Preston classroom, the armpit was silicone. There you go. But what that did is it kept our implants that are our first augmentation numbers going up because when she told me that it was the year that was across the data, com implants were on the rise stated implants were on the decline. And that’s the year that they intersected. So, knowing your numbers is important and testing cosmetic surgery as a business, you know, you can you can translate that to if you’re a car maker, and everybody else is making electric cars, and you’re still stuck on the fossil fuel cars, one of these days you’re gonna be buried alive. And people who did not adapt to you know, watches that were digital watches, you know, they went by the wayside and swatch game and ate their supper. So, I mean, like any business, I think you need to know your environment, especially in cosmetic surgery, whether people are asking for it are very well informed, they are highly motivated. They are they care for their books; they have the money to spend, and they’re gonna do their research, and they want the latest and the greatest and the best for themselves. Nobody’s says I dream of being operated on by a mediocre plastic surgeon.

Catherine Maley, MBA: Have you added any new marketing avenues after COVID? Or do you think you’re going to market any differently after or now?

Dr. Bitar: That’s a good question. I think one thing that we have started doing recently that has been very successful that has brought us a lot of new concepts as our live Instagram. And whereas we had done maybe one or two live Instagram in the past year apart when I go to a conference or when an event happens. Now we made the commitment to do a live histogram every Friday and Saturday depending on the guests. So, four weeks ago, we had Ashley I Canetti who was on The Bachelor, and she’s a patient of ours and I did the model lift on her so she appeared on our viewership went up the roof, but she has over a million viewers and then we had one of our patients as well that I did a model lift and the rhinoplasty on was an actress and the producer Rebecca Franklin, game we talked about rhinoplasties about you know, model lift That’s what very well. And then I invited my friend to be on the podcast, Dr. Ramsey deer, who is in New York. I go back to the presidency. I’ve known him for over 20 years. So, he thought we talked about pace less about lipless rhinoplasties. You know, the situation in New York versus DC. And it was a lot of fun. And quite frankly, because he’s sitting with his kids, I’m sitting with Mike, it was an excuse for us to talk to each other for all one hour uninterrupted. And last week, we got, I was interviewed by a major net spot in Lebanon. And they wanted me to talk in Arabic, but because we have not international to do it in English, but I could have easily done it in Arabic, and French, but because we had a lot of hours that our patients or our viewers wanted to listen to this episode or the English or the subtitles. Well, it’s just when you’re doing it live, it’s just too much of a hassle. And then this weekend, I had Paul Nassif with me who don’t need any introduction, Paul, I go back a long way a great guy, you know, from botch to having a very successful practice to having a, you know, a new baby on the way to, you know, practicing in Beverly Hills. It was a lot of these Lebanese too, anytime we had, we had a question whether you like the tutor Kabuli more and yeah, you know, so Kabuli that and now, next week, I’m gonna have Matthew Schulman coming on our Instagram Live. I don’t know if you know, Matthew, Doctor, doctor in New York. So, he he’s big on Instagram match Omen, and he does a lot of body contouring. So, because we did a lot of facial podcasts, or Instagram lives, I want to do one on body contouring because I also do a lot of press and I mean, I’m Brazilian Butt Lifts. And he was on a recent ASAP seminar. And so, he has new techniques I’m bringing him on. So, you know, partly plastic surgeon partly reporter partly having fun.

Catherine Maley, MBA: How many hours a day are you spending on marketing, you and social media and branding you, what kind of time would be putting in on that?

Dr. Bitar: It’s difficult to say because also I’m doing a lot of things academically, I mean, I was at the rhinoplasty meeting Saturday, and I had to present a PowerPoint presentation on vinyl final. So, I had to sit down and all my photos in order, I had to do my research. So, I spent a lot of time on that we had a new chapter coming up in a book on PRP for hair transplant, sorry for hair growth. So, I had to edit that chapter, I have another chapter coming up with the break in New York and a male connector on lift on men. So that hasn’t come out yet. It’s coming out. So, I do a lot of talk lectures. You know, seminars, we had a huge conference coming up next year for the Association of Plastic Surgeons of Lebanese descent, which I’m going to be the chairman of 100 plastic surgeons from around the world. But now we’re gonna have to postpone it a year to 2022. But we won’t have any sponsorship money. You know, the it’s going to be a big conference at the Ritz Carlton in DC. And that’s a pretty expensive conference with 500 plastic surgeons from around the world so that I was working a lot on that until the last minute when I realized that, you know, we cannot keep asking the big sponsors for money when they don’t have the money. You just have to say, Okay, we’ll postpone it a year. No, I mean, those things as well as the patients that I’ve already operated on that I’m seeing virtual consoles, our staff and their issues. Researching COVID we have a fellowship at Ace that fellowship and I was interviewing for the 2022 we just hired a fellow for 2021 2022 years. So, I was working on her paperwork. You know, so there’s a lot going on. And even though we’re not operating at full speed right now, but the work of hiring anesthesia team, the work of finishing up our new surgery center, taking care of our patients doing those live histograms, it just all takes time and I have two kids at home so I like to spend some time with them. We’re doing board games and we’re going out you know their scooters on the bike we swim in the afternoon when the weather permits. we you know we do family baking sessions with my wife is like her new hobby now is doing some baking at home. So, we’re also spending a lot of time with the kids. My parents live close by so we’re also spending time with the family. It’s a hodgepodge Catherine.

Catherine Maley, MBA: Do you? Are you like Tony Robbins who sleeps for hours and?

Dr. Bitar: I see five or six hours, I beat him.

Catherine Maley, MBA: I need eight. I’m a loser, I need eight. So, is there any advice you can give anybody who’s dealing with this? Because a lot of the surgeons– some of the med spas aren’t gonna make it some of the practices who don’t have the math right aren’t gonna make it. Are there any thoughts about that and what you can offer?

Dr. Bitar: I can tell you that my advice is going to be a very simple advice. You know, when I started this practice, I called it an institute for a reason I wanted there to be the three, you know the three steps of that tool to keep it sturdy. The first step or the first step. pillar of our practice, if you want is patient care. I mean, as a doctor first as a pastor, the second most important thing I do, and the thing that I get trusted by people’s lives to do is to do their surgery. You know, some people may be Cooper’s medic surgery, but we just put a picture of a lady to the right or five on Instagram, that’s her life was changed by the software, I saw that that was amazing. I mean, literally, we have people that I’ve done breast reductions on that, you know, were depressed and didn’t want to go on with life anymore. And now all of a sudden, you know, there’s bouncing their staff, we’ve had people that plastic bypass surgeries and lost 200 pounds and have all that loose skin. And now when you do their lower body lift, they can, you know, go through life with pride and with dignity and being able to have a new sense of purpose. That’s my first goal is to, you know, give to the patients who trusted me, what they came to me for, which is a cosmetic surgery, sometimes it is to boost your ego to boost your self-esteem. Sometimes it is really life changing. And the spectrum is wide. As you know. The second pillar of our practice is basically being a part of our community, we’ve done a lot of fundraising, I was the Man of the Year for the Leukemia Lymphoma Society. 2006, I raised the most money in the country for looking at a former because I had a very good friend of mine, who was a fellow in my fellowship program, who died from leukemia. So, I did his honor. We both started our practice. And three months later, he called me up said, George, I have leukemia, and two months after that he died. Basically, I did the fundraising and his honor, we’ve done a lot of work with the air organization with the Hoop Dreams and BT with cancer societies. You know, five gay runs. And so, I think it puts for the staff, it puts with a patience is good for our soul. It’s good for our soul and spirit. It’s like, you know, yes, because medic surgeon, I love what I do. I’m an artist, but I also want to feel that I am a valued member of the community. And I think we have achieved that. And this is a lot of work with charities, 11 on and stuff that’s kind of like, in the background. But it’s also you know, I left Lebanon as a teenager, I found out I help in some way, I never went back. But I like to help. You know, the people of Lebanon, grab extended families there, there’s a lot of misery over there. There’s a lot of help. And I can, I can talk to you a whole hour about that. The third pillar is the educational aspect. So, we try to do seminars, we are educational on Instagram, when we post things on Instagram, they have to be educational, they have to be well thought out. And they have to also be entertaining. I mean, I’m not catering to classical, catering to the public, but also the public are savvy, they’re knowledgeable and they want to get something out of your post other than just a picture. They want to have an explanation. They want to have a, you know, a call to action. They want to have a pros and cons of why do I do this? Why do I not do this? We also have a fellowship and a stats fellowship, as you mentioned, and that requires a lot of work. We have to have our fellow you know, knowledgeable to operate at conferences. We did a partnership with Hopkins with UVA so our federal goes to Hopkins and UVA gets their didactic because we are in private practice. They’ve got a lot of surgeries out of us. But in terms of getting resident meetings on Wednesday morning, presentations and guest lecturers, they need the university program to get that and we have provided that for them. We also write a lot of articles and chapters and books and present at meetings. I mean, this year I think I had like about seven meetings that I was supposed to go to for example. I went to two of them and other I think five Council. I went to one in Toronto and one in the back. I had one in Vegas. I did that Dallas rhinoplasty virtual one this weekend with Dr. Rory. But that was kind of came up last minute. Okay, but I was going to go to Monaco. Do one in Monaco, one in France, the French society. One in London was a high end, you know, vendetta and one in Lebanon. But it’s all you know, it all got canceled. You got to do it. So that’s like a long answer to your question. So, when you said what should people do? My answer is stick to what you do best right now, I don’t think it’s time to start a new venture. Right now. Take the things that you know how to do because you’re gonna have limited staff, you’re gonna have limited finances. So, I think the last thing you want to do right now is try something that is not trying to so if you are a facial surgeon don’t decide you want to go and learn how to do a new way of breast augmentation for putting new money into the practice doesn’t make sense. You know, do your facial surgery and do it right. If you are a mess. You know right now is not the time to go by $200,000 machine, you know, take the machines that you have and make the most of them. If you’re a surgeon who does a lot of breast augmentation, you know whether you want to do Instagram sessions on breast augmentation, you want to get testimonials and you want to have a, you know, an afternoon social for your breast augmentation patients and thank them Whatever you have to do, but right now, it’s not the time to decide, oh, I’m going to do a new technique and because you know, I want to have a new source of income. I think that would be very stupid. Now, as we move forward if you want to increase the or diversifying your practice when you figure out what’s going on, I’m all for it. I mean, I’ve diversified my practice every year. So, I don’t like to stand still, I like to keep moving. But also, when you’re dealing with limited finances and the patient trust right now being shaky and COVID in the air, you don’t want to– the book I’ve read all the books by the guy who wrote The Great. He wrote Good to Great — I’m blanking on his name.

Catherine Maley, MBA: Oh, my God, I have the book sitting right here.

Dr. Bitar: But when he wrote the book, and the last he said, you know, first throw bullets and then Cannonball. Right now, to go buy huge machines, do the things that work and then expand to doing the, you know, the things that may end up being big game changer.

Catherine Maley, MBA: Is it Tom Collins?

Dr. Bitar: I think Tom Collins, you’re right. He sounds like a drink.

Catherine Maley, MBA: Maybe [inaudible 56:13]

Dr. Bitar: Yeah. So, I read all his books.

Catherine Maley, MBA: I need to reread those. It’s been a while.

Dr. Bitar: He and Malcolm Gladwell, I think, my favorite. But I’ve met a lot of business advice from you know, Good to Great. He’s a draw the three circles, you know, what you’re good at? What you are, you know, what you like to do? And what’s your business denominator and where that intersect to it. So, I gave up on reconstructive surgery, I give up all the cosmetic surgeries, I don’t like to do it I’m not good at and I think that I’m good at and I like to do, and that have profitability, because we’re not a charity.

Catherine Maley, MBA: I agree. On a personal note, we’re gonna wrap it up now, I really am fascinated with how does a kid from limit on who came here at 16 end up where you ended up? Because the only thing I’m one of those ignorant Americans who came from Chicago, and I still have the accent, although I left 40 years ago, I never understood what was going on over there. I still don’t understand. But I did see that movie Beirut, only because I love Jon Hamm, I think his name is.

Dr. Bitar: I never saw it because I lived it.

Catherine Maley, MBA: Cool. It’s not pretty, it’s a real tough movie to watch.

Dr. Bitar: My guess is probably it’s even a watered down from reality.

Catherine Maley, MBA: What the heck was that like?

Dr. Bitar: I mean, look, I grew up in Beirut, where Beirut was considered to be the parents of the Middle East, you know. So, I was born in 1968. So, I’m 52 years old now. And the war started in 1975. So, I was like six or seven years old when the war started. And then I came to the states when I was 16. So, I’d have 10 years of war. And, you know, when I first came here, and I came here as a freshman to University of Missouri, in Columbia, Missouri, so it could not have been a very different environment from the war room to being a freshman, I can’t I started college at 16. And so, it was an interesting, interesting transition, to say the least. But I think Lord taught me a lot of things. I mean, it taught me number one hoppy read resilient, you know, because it was not a sprint, it was a marathon, you know, day after day, you go to school, you don’t know where you’re gonna finish your class, you don’t know where the bombs gonna fall on your class. Number two, it taught me not to take anything for granted. Because, you know, we lived in a very uncertain environment. I mean, it was like COVID-19 multiplied by millions. We live in a place where you didn’t know whether you’re going to get killed or shot any day. And I was taught at least three times in my life. Luckily, people shot at me, we’re not bad to where we’re bad shooters. And you know, I almost got kidnapped once. And so, there are a lot of things that at this point, they’re not relevant to this conversation. But what is relevant is it teaches you how to appreciate life and how to put things in perspective. You know, so I don’t sweat the small stuff. I pay attention to detail, but I know that I’m going to overcome this and I tell my staff, I survived 10 years before medical school to residences and fellowships, I’m going to get you through this. And I tell them that they believe me, because you know, it’s, it’s true. So, you know, I’ll tell you a simple story. When I took the LSAT because I had to come to the States, I had no choice. There was like a spring of 1985. And I was immigrating here, like two months later, so I had to take my essay to be able to enter college. And we went to the University of Beirut, and we arrived there at like 730 in the morning, and the test was going to start I think, like 830 or something. And during that hour between the time, we arrived and the time the test was going to be given there was a lot of fighting going on outside and the so, sound of the bombs and artillery was getting louder and louder. And then we entered into the classroom. And the time, noise of the bombs and the war going on outside of the classroom was so loud that we had no matter A professor, he was one of the Americans who are left there before they were evacuated and said, Look, if we open up those packets for an STD, you have to take that test. Otherwise, we lose accreditation from the States. If you don’t want to take it, that’s fine, you can leave now. But once you open it, it’s a four-hour test, you have to take it. I remember about two thirds of the class left. But I was one of those people who have to take it’s I have to say, and the one thing I do remember is because it was a classroom with big glass windows, because two thirds of the class left that people who are sitting next to the windows are moved inwards to be away from the windows. And then the teacher had to write the instructions on the chalkboard because we couldn’t hear him out. We could read what he was writing. But if he was saying something at the front of the classroom, we couldn’t hear him. I wasn’t like sitting in the middle of the car, I couldn’t even hear him. And I took that test for four hours under those circumstances, not knowing what was gonna fall outside of the classroom and kill all of us. So, you know, but the irony is I finished that exam, I came to the States, I got accepted based on my TOEFL exam test of English or foreign language. And I never knew my CT scores, because they were advanced to that state. And then they went back to level I think, years, I never found out but I was accepted anyway, so I didn’t bother finding out.

Catherine Maley, MBA: Okay, that is an insane story. If I didn’t know you, I would say you’re making it up. And nobody lives through things like that, that’s insane. I can’t even imagine–

Dr. Bitar: I can tell you if there’s about 50 stories like this. I say it because it’s an SET exam, you can relate to it, I can relate to the fact that I was when I was 10 years old, swimming in a beach. And there were Syrian soldiers. And I thought they were like fish flying next to me because it was like water, it turns out there were Syrian soldiers on the hill, using me for target practice and shooting at me. And I ran out of the water and they started shooting sand and the sand was flying next to me and I have to run for shelter. Like I said, luckily, they were like that. I was 10 years old, but there was like no good reason, it just felt like it.

Catherine Maley, MBA: I don’t even know how you’re rational right now. That’s insane, it really is.

Dr. Bitar: Life went on.

Catherine Maley, MBA: I mean, America has been good for you.

Dr. Bitar: It has been great for me. It has been great for me and my family.

Catherine Maley, MBA: I mean, at least there’s that, you know, like you went through hell. And now you’re hopefully in heaven.

Dr. Bitar: The interesting part is my generation did not have PTSD. We all felt like, you know, this is life. I have lots– I mean, I’m very good friends with all my high school friends and to vote. You know, I can tell you this interesting story when I was in high school for three years at the time. I was 13. At the time, I was 16. I had a band. We formed a band. And we played in the schools and university auditoriums of universities when the best time during the war going on. The battle is called quaking bush. And we call the quaking bush out of a character and a novel by john Knowles of Deputies ever came across the novel, john Knowles was a very prolific writer, but he wrote this novel called a separate piece about two guys in the northeast England and New England dawns, why World War Two was going on. And we could relate to them because there was a war going on in Europe where they were having a separate piece of New England. And our man was our separate piece from the war. Anyway, so we formed this band, we played for three years, it was a great time. And then we literally got added all over the world when High School finished. And like about eight months ago, I saw one I kept in touch with four out of the five band members, I was the manager and the songwriter, I never, I was never gifted enough to play a musical instrument, you know, those who can do those who cannot manage.

Catherine Maley, MBA: Well, they need something to play and you did the song, so you’re in.

Dr. Bitar: And the management. But anyway, so I saw it on Facebook about eight months ago, and one of our band members who was a drummer, our drummer ends up being a CEO of a company in Malaysia. And at their big bank, when he’s playing the drums. He kicks out the good drummer and he goes up on his own, you know, company’s end of the year, and he plays the drums I see on Facebook, I said, Ramsey, you know, this reminds me of our baking questions, because what are you waiting for? Like, what do you mean, what am I waiting for? Let’s get the band together. And so, we ended up so we ended up doing a picture on social media to find the other two members that were missing. And we found one guy who is a head of Credit Suisse in Hong Kong. He was our keyboardist. The rhythm guitarist is a big banker in London. I’m here, there was the bass guitarist, it’s an architect in Texas. And he was the last one. And the drummer is in Malaysia. So basically, oh, and the lead guitarist was the only one that we thought was going to become a musician and actually becoming a musician. He has his band in LA. So, I organized for this July next month, we’re supposed to have a 35th year reunion in July. And everybody– In LA, we’re gonna get a hotel room and the guy who’s in LA was gonna get us a studio to record an album, 35 years later and then COVID it.

Catherine Maley, MBA: Oh, got it. That could be your second career.

Dr. Bitar: So now we’re now having a WhatsApp group and we share songs and we share old stories. So, it was fun, like 35 years later, you know, it’s like my wife told me if that’s not a midlife crisis, I don’t know what it is.

Catherine Maley, MBA: If plastic surgery doesn’t work out, you can move on back to the songwriting, good for you. Well, thank you so much for sharing, how can people learn more about?

Dr. Bitar: I mean, I have my– my email is [email protected]. And through our–

Catherine Maley, MBA: And bitarinstitute is the website, now I’ll tell them.

Dr. Bitar: But my email is [email protected]

Catherine Maley, MBA: Gotcha.

Dr. Bitar: And, through our Instagram at thebitarinstitute on Instagram, I have my personal Instagram is drgeorgebitar, but I keep it for personal things. I don’t put before and after photos and stuff. And I never like to put my kids pictures on Instagram. So, people sometimes go on Instagram, they don’t think I have kids, but I do, but I don’t put them on Instagram.

Catherine Maley, MBA: That’s awkward. I need to do a podcast on that. Like, when is personal– What’s the boundary there between personal and business?

Dr. Bitar: I mean, look, the bottom line is that the people, including the fans, and the followers, they push you to show pictures of kids, it’s like almost like a very strong parent that’s pushing in that direction. And you don’t have to resist because I’ve had a lot of people impersonating me on social media. I mean, yeah, I even had a guy who basically, I had to, I was like, sitting in a coffee shop watching. It was Tucker like two years ago, there was a guy sitting next to me and my son and this guy who impersonated me said that I’m sitting with my two sons. He was like to hit on some woman online and made it look like the two kids are my sons. And she had I mean, crazy stories online. And I didn’t even post that picture. He I don’t know he was somehow on the internet, but it’s just very unsettling.

Catherine Maley, MBA: You know fishing? Like I get a lot of crappy stuff. Because they think they think I’m– the Nigerians, I guess, that [inaudible 01:07:15] doing it or whatever. They show–

Dr. Bitar: This guy was like hitting on a woman and– He’s got to be tired. She called her office, he said there was something wrong when this guy– doesn’t get the picture of a white guy, but he has an African accent. He’s using my photo. But he was telling her that he lives in London but yes, he is– He has a practice and– he is trying to impersonate me but he lives in London.

Catherine Maley, MBA: Wow, it’s so crazy. All right. Well, thank you so much for being on the podcast. I really appreciate it. And say hi to your wife for me.

Dr. Bitar: I will. She loves you, Catherine, you know that and she gives you her regards. And you know, if there’s anything else I could be of assistance, please reach out.

Catherine Maley, MBA: Well, I will have you back because you have many facets to your life in your practice. So, we have all sorts of different topics to talk about. And with that, I’m going to call it a day. I would love for you to subscribe to Beauty and the Biz. If you enjoyed it, please give us a review. If you have any comments or feedback, I’d love to hear them. Please just DM me at catherinemaleymba, or you can always leave me a message on my website, Alright, thanks so much. Talk to you again.

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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