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Ep.52: With Bruce Moskowitz, MD & Grigoriy Mashkevich, MD

Ep.52: With Bruce Moskowitz, MD, Grigoriy Mashkevich, MD

Today’s guests are two surgeons who joined forces to start their own practice in the most competitive area of the world – Park Avenue, NYC. Hear what’s worked for them, and how they’re keeping things together at the epicenter of the US COVID-19 pandemic.

Bruce Moskowitz, MD | Grigoriy Mashkevich, MD

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Episode Transcript:

Catherine Maley, MBA: Hello and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery. I’m your host Catherine Maley, author of Your Aesthitic Practice: What Your Patients are Saying as well as consultant to plastic surgeons to help them get more patients and more profits. Now, today’s guest this is very special because I have two surgeons on and who they joined forces to start their very own practice couple years ago in the most competitive area of the world, and that is Park Avenue in New York City. It’s Dr. Grigoriy Mashkevich and he’s a double board certified facial and reconstructive surgeon. And then it’s Bruce Moskowitz, MD and he’s a board certified [inaudible 00:45] plastic and reconstructive surgeon. And then they both lecture and write and they’re very active in their medical societies. Now together, they formed a brand-new gorgeous practice on Park Avenue. And they’ve called it Specialty Aesthetic Surgery. So, we’re going to learn more about it. So, welcome to Beauty and the Biz, doctors.

Dr. Grigoriy Mashkevich:  Great to be here, thank you for having us on.

Catherine Maley, MBA: Sure. So, the first thing we have to talk about, what everybody wants to talk about next COVID-19. Give me an update on what’s happening in New York because you guys got hit a lot harder than some of the other states.

Dr. Bruce Moskowitz: Well, in mid-March, Governor Cuomo shut down all non-essential businesses and put a complete stoppage to all elective surgeries that were not critical to ensure proper PPA and make sure that the during the shortage that hospitals had enough supplies to take care of the overwhelming number of patients that were affected by COVID-19. So essentially, all our business except for the functional side of our practice. Certain Mo’s closures like melanomas and invasive rapidly events and squamous cells. They were done but even beta cell carcinomas have been put off until all electrosurgery can be resumed, which still hasn’t begun yet.

Catherine Maley, MBA: Oh, you’re still closed down, huh?

Dr. Bruce Moskowitz: Still closed down. We’re hoping that in the next few weeks, as the hospitalizations have gone down, that New York City can achieve what are some of the boroughs, I’m sorry, not boroughs but some of the surrounding counties are now able to perform elective surgeries.

Catherine Maley, MBA: So, there’s no estimated time of restart?

Dr. Grigoriy Mashkevich: So, let me jump in a little bit. So, credit has to be given to the governor and what they’ve done in New York. And there’s actually a website with very specific metrics for openings. So, New York City, the county of New York is still lagging behind in hospital beds that they need to have in order to safely resume regular activities. But we’re just a shade under 30%. If you look at that, so I think we’re doing well, we’re not that far away. I think Bruce, probably in a couple of weeks or so.

Dr. Bruce Moskowitz: I agree. Even the hospital where we do sort of a functional basis. they anticipate within a couple of weeks, the resumption of elective surgeries.

Catherine Maley, MBA: So how did you handle this whole staff situation? Because you’ve got some staff did you furlough them? What do you do?

Dr. Grigoriy Mashkevich: So yeah, well, we’ll take turns obviously but it’s interesting such unfamiliar terms, all of a sudden, we had to learn on the fly and with the whole application process for the government forgiving us loans and everything else. But as far as employees go, I mean, Bruce and I fairly rapidly decided that it’s incredibly important to keep everyone employed. There’s a sense of loyalty, it took us a long time to find the right people. And it just didn’t seem right to either let people go or the furlough despite obviously having some economic hardships. And so that was the number one decision that we’ve made. And we’ve stuck to it. And I think Bruce and I were both incredibly proud about having made that decision. And we will talk about what we’ve done in the meantime as far as office staff and all the projects but I think for sure that was a critical decision at the very beginning for us.

Catherine Maley, MBA: I bet they appreciate that too. And if they don’t, they should. That’s a big deal. Are you keeping them busy while they’re furloughed? I mean, I assume they’re working at home or are you keeping them busy?

Dr. Bruce Moskowitz: Well, I can jump in here. There’s been a smattering of cases that are emergent, some post offset required visits. So, typically either one person in the staff, just Greg and I alone would see them during those hours. And they’ve been extremely busy as have we in taking care of all the back end of the office and trying to emerge from COVID pandemic even stronger as a practice and moving forward. So, we had a lot of projects that needed to get done. And the staff has really jumped in and done a pretty incredible job.

Catherine Maley, MBA: That’s great because this really was a good opportunity to take care of all those things nobody ever has time to do. Anytime the staff says, I can’t get to that this was a good time to get to it. Right. So, tell me, we have to talk about your practice. So, what does this do to join forces and open up a practice in the middle of the jungle? What was the thought process there?

Dr. Grigoriy Mashkevich: Bruce, you first

Dr. Bruce Moskowitz: Okay, well, Greg and I have worked together both attending resident and as colleagues for God knows how many years, well over a decade. And we complemented each other’s practices quite well, and with a lot of mutual respect and a lot of crossover between the patient both from a functional and aesthetic point of view. And we kind of figured that we could do what we do in an ultra-specialized way to give patients what we thought was the best of care.

Catherine Maley, MBA: And you thought New York City was the best place to do that, like was there any thought at all about going to, like let’s say a suburb that might have been less congested?

Dr. Bruce Moskowitz: Well, both of us have established practices within Manhattan, merging them was a little easier than starting from scratch or deciding that we’re not going to make it here in New York, we’re going to go out to the suburbs. So, we both had established practices that we’ve kind of melded together both functionally and aesthetically into a practice that really blends what we do best. And I think we get great results for patients.

Catherine Maley, MBA: Is that one of your differentiators? I believe that is like, that’s why you’re calling yourself specialty aesthetic surgery, right?

Dr. Grigoriy Mashkevich: Right. So, I’ll jump into this. And just to echo what Bruce has said. So clearly, we had the lots of mutual admiration, I’m a little bit younger so Bruce had been a mentor and then subsequently a colleague. There was a little bit of a sea of change at our hospital with a takeover from a different institution. And that presented an opportunity to reassess and to look forward. And it just made a whole lot of sense to take two practices that had a lot of complimentary pieces and put them together. And yes, it made it a whole lot easier having been in the in the geographic location, Manhattan in this case and it made no sense to go elsewhere. And clearly, we had some anxiety about moving up down, and it’s worlds apart even though it’s not that far away. So, the challenge of growing and practice in a different part of the city is still there. But clearly, it needed a little bit easier having established practices. So, I think a lot of factors just came together. Both Bruce and I had been looking or started to look and just so happened to we’re doing it at the same time. And I think we haven’t looked back since. I think things are moving in the right direction for us and we’ll talk more about that. But that was the– sort of like the basis for forming this partnership. And yes, the word specialty in the practice designates what I think most intelligent consumers in New York look for. They look for people who are highly specialized in their respective fields. And we reflect that in what we do. It’s a little bit of division of labor, if you want to call it that way.

Catherine Maley, MBA: So, you didn’t just start a practice in New York, you literally started from scratch, like you got to build and you had to get it out. And I mean from scratch, and I’m fascinated to hear how was that journey and did it take longer than you expected? And did it cost more than you expected?

Dr. Bruce Moskowitz: I’ll jump in here. I think that it took us probably six, eight months to find the appropriate spot and then negotiate a lease. And it was a complete gut renovation of an old prewar building [inaudible 09:30]. It was completely dilapidated. It was rented by an old [inaudible 09:38] OBGIYN group. And we saw through it and we had a very good architect and designer, which we collaborated with and we created an office that had great flow. It could satisfy all our needs in terms of examination rooms, waiting space and bs with proper flow to– we can see patients all at the same time, separately have other doctors if we so choose, we can pre op patients in a room, run a case, moving through recovery out and still keep turning the room over and over again if need be. So, we’re very, very fortunate to find the right space at a fairly reasonable price because it was a dilapidated building. And I think we were over budget, a little more than we expected to be. I mean, I think that we expect it to be 20 to 30% over, we’re probably 50% over that all said and done. But I think that the investment of time and money has been well worth it. And our trajectory has been going up and up each year.

Catherine Maley, MBA: So, what were some of the mistakes made that others could avoid?

Dr. Bruce Moskowitz: Greg.

Dr. Grigoriy Mashkevich: Well, not necessarily jumping into specifics but we’re not in the construction business, we’re not in the negotiating business, we had to rely on a number of professionals. And at times managing different components of this project was probably the most challenging thing between the designer and between the contractor, the building and their rules and their regulations and the long documents that require the review. I think we ended up surrounding ourselves with quality people. And that’s probably the most important thing is to have professionals who know what they’re doing, much like what we’re doing in the practice, can guide us through what is something that we don’t normally do for a living on specific things like ordering certain items online and then learning later that they’re not as useful as we thought they would be. They look really shiny and beautiful like exam chairs, that we got a great deal on, spent very little money in the grand scheme of things. And then they came in and they were just like, too wide, too bulky to just unusable for what we do for what I do specifically for sure. And so, we ended up reinvesting and then repurchased these. But I think, if you look at the financial side of things, the percentage of incorrect mistakes and what it cost us was probably like a reasonable small number. Bruce, wouldn’t you say? I don’t think it was an overwhelming figure to worry about.

Dr. Bruce Moskowitz: I think we’re very lucky, we didn’t have any major state setbacks. I think that picking your architect is a critical piece here because after [inaudible 12:37] building a medical building and it’s a little bit more often that because we also have [inaudible 12:45] billing and everything, clothes, certain things were grandfathered, certain things were not. So, we didn’t proceed and make mistakes and have to pull out new stairs and new doorways or anything like that. So, finding the architect was critical. The designer we had known for a long time we knew would do a good job there. And it was very, very– I think, if someone’s going to embark on a project like this, you have to be willing to give the time. Both Greg and I were— notice in our work, was almost like working two jobs.

Catherine Maley, MBA: If you can hear my dog, I’m sorry. In speaking of working together, how in the world because there are so many decisions that need to be made, like everything from everything, they’re just 50 decisions to make every day. How do you manage that? Do the two of you have boundaries or somebody’s good at one thing and they just– how do you manage the decision making?

Dr. Grigoriy Mashkevich: Well, I’ll jump in now. So, look, there’s no question that sometimes visions differ. And that’s a healthy thing on some level, that puts checks and balances in place. And if you think something’s tremendous but the other person thinks that is completely awful, then then you put brakes on and as a reasonable individual for the most part. I think compromise takes over. Look, I think we haven’t had any major disagreements, because we understand that if let’s say one’s idea is a little too– either radical or it doesn’t fit the other person, then there are other things to worry about. But I would say, Bruce, for us it’s not been an issue for the most part only because I think we have a clear vision. I think there is definitely a complimentary part to the whole experience. We want each other to be successful and as far as day-to-day decisions. I think it’s much easier to have a consensus than not, that’s been my personal experience. What do you think?

Dr. Bruce Moskowitz: I want to echo what Greg said, I think that we complement one another in a lot of different ways, someone’s good at one thing, someone’s good at another. But I think one of the main things is, which I’ve noticed and I’m being I’m older than Greg and I’ve seen a lot of partnerships folder not doing nearly as well as what we’ve done is the fact that we know how to compromise. I know that there are certain– it’s like an [inaudible 15:18] of anytime, you have learn to compromise, you can’t win every battle, you can’t be ingrained in every position on every little thing.

Catherine Maley, MBA: Here’s what I have learned because I’ve worked with quite a few surgeons who tried to work together, it seems you’re absolutely right about being able to compromise being reasonable and having values that are similar. So, you have to– it seems to me, the ones who are heading in the same direction and they have that same vision, they do the best, right? I also from what I’ve seen when you work, you also have your strengths and weaknesses, and you’re very good at staying in your own lane, I think that’s really helpful too. And you don’t have to die on every mountain, you do let a lot go, not everything can be that important.

Dr. Bruce Moskowitz: Even as simple as sometimes seeing a patient in the office, work together, there’s a great synergy we have together, we often do consultations together routinely. Patients get two for the price of one during the same consultation when they have someone come in for blepharoplasty then they’ll talk to you about their chin. In otoplasty, whatever I bring Greg in. And if they have complex issues, it’s almost like being in a small little Grand Rounds room with them, with the two of us talking about ideas and giving them suggestions. And it’s worked out very, very well for the patients and for us.

Catherine Maley, MBA: And then for staff, do you find that one of you is better at managing staff than the other or do you both manage? Because that can also– a lot of personalities in one office can be a lot, how do you handle that?

Dr. Grigoriy Mashkevich: So, this is a very good question, Catherine, because I think our practice is reaching an inflection point in which considering an office type manager, it’s critical, it’s becoming critical. We’re not there yet and so some of the management falls on the shoulders of Bruce and I and it’s been challenging, no question about it. This is not what we went to medical school for. But you know, managing staff can be interesting, let’s put it that way. We are fortunate in many ways, we have very good staff, and they work through issues themselves also. But things do show up on the radar here and there. And, I think what helps is that we tend to be on the same page about things and issues in the office. And I think it also helps for staff to see that both surgeons are sort of sending the same message in their direction. I mean, Bruce, correct me if I’m wrong, but I think if anything comes up on that sort of a What do we do here, we first talk about it or send emails.

Dr. Bruce Moskowitz: Always.

Dr. Grigoriy Mashkevich: And then there’s a unified answer coming out. And I think that helps send the message a little bit as well when, say a staff member with whatever issue that’s been brought up is seeing that both surgeons are on the same page, it avoids that triangulation where they go to one, get one answer, go to the other then other person gives them a different answer. So, I have no issue pulling back and saying, hey, look, let me think about this. We’ll talk to Bruce first. And so, I think that’s been very helpful. But clearly that’s an area that at some point, as we grow will probably require a middle person, I would imagine.

Catherine Maley, MBA: Oh, speaking of that is there a plan to grow? Like would you ever want to bring on more surgeons or just grow in patient flow? Like where are you going?

Dr. Bruce Moskowitz: We want to grow in every dimension. We want to bring in other people, other complimentary, physicians, staff members, procedures, but we also want to grow in our volume as well.

Catherine Maley, MBA: Gotcha. Are you still doing your own injectables? Or do you have an injector or how are you handling the non-surgical side of your practice?

Dr. Bruce Moskowitz: Well, our patients want us to inject. And for us, we’re both experienced injectors, we do a very large number of injections in the office both cosmetically and with our facial paralysis practice. And dystonia practice, we do a large amount and doesn’t take very long to do injectable. So, at this point, I don’t think my patients over the years would accept a nurse practitioner or a PA during their injections. And they’ve grown accustomed to me and I’m sure the same for Greg. Correct me if I’m wrong, I don’t think they would be very forgiving,

Dr. Grigoriy Mashkevich: Loyal patients, I’ve thought about it a number of times. And we don’t have the kind of practice where we market and market and market and try to get everybody through the door and maybe get someone who pays less to see another person in the practice. And all the patients that I can think about who show up every three months, every six months, we talk about their families, we talk about– I’ve gotten to know them so well. I can’t even imagine breaching the subject of hey, I’m sort of busy doing facelifts or other surgeries, you might end actually having my nurse practitioner injected. And maybe at some point that will become a thing but it’s hard for me to envision that transition really is. So, we’ve stuck to this formula where we just have loyal patients and the base is growing. And we’re just doing everything ourselves at this point and most of the things that ourselves, but is it outside the realm of future growth? Of course not. But at least we haven’t gotten to that point yet.

Dr. Bruce Moskowitz: If I can just add a little more to it. I think in New York City, there’s still– it’s a different market than other places in the country. I think if you go down to Florida or Texas, people will accept a nurse practitioner or a PA doing injectables. I think that most New Yorkers would not accept that. We’re a little bit more of an old fashion doctor centric office and that there aren’t a lot of physician extenders in these cosmetic practices and I’m aware of in Manhattan. Would you agree with that, Greg?

Dr. Grigoriy Mashkevich: Yeah, I think so just quickly thinking about all the other offices that we’ve had relationships with over the years, even dermatology practices, I mean, sure, here and there and that’s a completely different world, you can’t really compare cosmetic surgical practice to a dermatology practice. But just thinking about that, thinking about colleagues, very few if any seemed to have extenders and for sure, if one has one is just one, it seems to me just thinking about it. So, I think I think clientele is very intelligent and they want the best and then the best to them is having an MD after their name. So, definitely the demand is to have a doctor do the injection. And we’ve followed that, in our practice.

Catherine Maley, MBA: I don’t think there’s any set rule, but I do think as long as you’re comfortable with that, I hope you’re charging for that, for that privilege of having a surgeon doing their injectables because where you’re at and you’re such– on unique area, like Upper East Side. It’s a very different kind of patient out there. So, I would say if they’re not going to you, they’re at least going to like a top cosmetic dermatologist, that’s probably your biggest competitor because then they think of you as surgery and maybe somebody else doing the injectable. But I highly recommend, I think you’re doing the right thing, stay exclusive and charge for it. So, regarding marketing, because I love to talk about marketing, when you first– it’s a huge challenge to leave a functional practice, go onto Park Avenue and say now we’re functional and cosmetic. How did you introduce yourself to the world?

Dr. Grigoriy Mashkevich: It’s an ongoing process, Catherine, you were involved in the early stages. And we have continued to grow and expand the base social media base, we retained a PR company six months ago or so a little less. And it’s starting to sink in that there is so many components to it. And not a single one is a home run. That is almost like layer. So, you have to layer and layer and keep layering and the website and the social media and presence here and presence there. And I think it’s all adding up in a place like Upper East Side in New York City. It’s going to take a lot of layers before it becomes a thing that sort of feeds itself. And I think we’re both noticing it. We’ve had some frustrations early on with like simple Google ads and other campaigns that you cannot possibly even measure an ROI. It’s just a difficult sort of thing to say, hey, how much do we need to spend before we actually make a profit? But I think once we decided to branch out and do other things, to me it’s starting to make sense all of a sudden. You have to really have multiple fronts happening. And for the first time since we open, Bruce, and I’m starting to get a sense of this growing momentum as we answer various media queries and are expanding our social media presence. It’s starting to feel like a real thing for the first time. What do you think?

Dr. Bruce Moskowitz: I agree, I think that you have to have a lot of tentacles in a lot of places and the layering aspect of it, description is really appropriate here. I think when we started, we probably didn’t pay as much attention to that as we should have but that was understandable given that we’re building an office from scratch, total gut renovation, finding staff, getting a culture within the Office together with policies and just getting to know one another and making a collegial atmosphere within the staff in between ourselves to make sure it worked. Now that we’ve established all that, now it’s time that we’re really branching out social media and PR and other things. And I think that even despite the COVID crisis in New York City, I think that we come out of it, we’re going to certainly be stronger far more savvy. And we’ve accomplished a lot of the back-office things during it, both in marketing and otherwise a compliment the marketing. Just our audience post op instructions, redoing them in a packet, how we want to approach patients for photographs. It’s a gigantic list of tasks that we almost are accomplishing during the six or eight weeks that we’ve been completely shut down.

Catherine Maley, MBA: Okay, regarding social media, I’ve seen you guys on Instagram and how much of your time is being spent on social personally?

Dr. Bruce Moskowitz: Personally, not a huge amount of time. I think that our staff is finally– we have a couple of young millennials who are really, really smart and really savvy and motivated. And they’ve pushed us in a lot of ways to do a number of different things that gives them enough feeding material for the Instagram and Facebook post. I think what we’ve been reluctant to do, a lot of plastic surgeons around the country is to cross a line of being what we feel comfortable with personally and invite everyone into our private lives in a way which we’re just not that comfortable that a lot of surgeons do, that just isn’t us. So, we’re trying to be true to ourselves as well.

Dr. Grigoriy Mashkevich: Yeah, Bruce, look, there’s no secret sauce. And I think in terms of personalities, we are on the same page about this. I see it and part of me thinks well, why not do this, why not take pictures of myself with my dog walking or skiing or whatever and it’s just not me. Look, I am okay with a certain amount of that exposure but not as much perhaps. So anyway, but to go back to the social media, we’ve initially sort of struggled with the decision whether to outsource it or do it internally. And I think we’ve been very fortunate and having staff that sort of repurposed itself during this break. In fact, during this break, we have done quite a bit on that front. And to be honest with you had it not been for this pandemic in a way I’m not sure we would have gotten to it to this level of detail and effort that we’ve given it so and so. So, it’s becoming a much more organized effort which hopefully will be on autopilot once we become busy again, when the restriction is lifted. So, I think that doing it internally has helped us tremendously as well. I am starting to enjoy it. It seemed like a black box to me initially, I’m younger but I’ve never been on social media posting. But as we sort of discovered this new avenue to grow within the practice, it’s gotten– I’m actually getting them feeling engaged in shooting videos of myself describing various topics and I think it’s great, like I feel very comfortable with that. So, we’ve been doing that.

Catherine Maley, MBA: I really think you have to get used to it. And I do think it’s our future and I came kicking and screaming too, I thought this is silly but it is the new world where patients not that they think they’re your friend but they want to know who you are. They want to know you’re a surgeon and a dad and a skier and a what else to do. But what I say is if you’re not comfortable with that side, at least have your staff filming a day in the life of a plastic surgeon just you are the content. And that’s one of the issues. The challenge is you’re trying to keep your job so at least let the staff videotape your job. No, that’s not to do that on. Yeah?

Dr. Bruce Moskowitz: I’m sorry to interrupt. But it’s interesting because we’re not comfortable with it. But I have some very close friends around different businesses. Some are international like textile companies and she’s got an enormous social media presence. She does her social media shoots in St. Barts and all around the world and they’re very, very chic. And she follows one of our competitors and it drives me nuts. Because he’s the exact opposite personality type of what I’m like and I’m not comfortable doing it. And she’s been trying to push me to do it. I’m just not that comfortable yet getting there. But maybe that is the future. You may be right, Catherine.

Catherine Maley, MBA: I just think– I don’t know, what else are we going to do? Because when you look at marketing, you think, okay, there’s SEO, which is– SEO is dead as they keep saying. And they say, well, you have to do PPC, well, in New York do you know your PPC budget has to be to make a difference? I mean, that’s insane. Then said, Okay, well, let’s go to PR, you know, so then tell me about PR, has that been a fruitful channel for you?

Dr. Bruce Moskowitz: I think we’re gonna reap the rewards of the PR channel over the next few months. I think it’s a little too early, I think if you’re going to go into PR suggestion, we’re learning is that you have to make a long-term commitment to it. It’s not like you can do PR for a month and expect to reap the rewards of that.

Catherine Maley, MBA: I will tell you what I do know about PR because I used to do a lot of it, you’re paying for their Rolodex. I said that to somebody once and they had no idea what a Rolodex was so I have to stop saying that. Whenever you call the darn thing, a phone book, you’re paying for their connections especially where you’re at, you’re in a very good place for that. You need somebody who can pick up the phone, call a station manager and pitch an idea. But then you have to be available and run down there and deal with it. So, PR is another one of those polls in the pond. And if you can get it great, but I wouldn’t hang in there forever. I would just say to them, who do you know? Who can you literally pick up the phone and call? Because I think that’s way more important, just saying. So, what do you think has worked at best? Like all the marketing channels, do you have a feeling for–? How are you growing this thing? By the way, do you do know I used to take 10 years to grow practice? Nowadays you have about a year, like everyone’s got ADD now and they have no patience. But it takes a long time to grow practice and grow your reputation and your brand. And so, you should give yourself a break. You’re doing very well for what two years or so on. But is there anything in particular you’ve noticed that’s working better than something else?

Dr. Grigoriy Mashkevich: I have an old school answer, Catherine, word of mouth.

Catherine Maley, MBA: Thank you.

Dr. Grigoriy Mashkevich: And not to downplay all the other things that we discussed, it’s clearly important to be out there and to grow the practice in many different ways. And we’re doing it, we’re totally committed to it. But at the end of the day for me and for Bruce as well, I’m sure loyal patients come back and they say, Look, you’ve treated so and so. We’re here. And for me that’s been driving force behind the new patients for now. We certainly have seen the other avenues pick up as well. I don’t know if we can give you a one particular one that stands out the most. I think we’ve tried them all. And perhaps the issue, the limiting factor is not being able to or at least not willing to spend insane amounts of money on a particular Avenue. But I think it’s all adding up slowly. Bruce, I’m not sure if you’ve experienced any particular–

Dr. Bruce Moskowitz: I feel the future is going to be very very successful based on the groundwork was laid. I do think that there’s one critical thing, it’s that Greg and I are good with patience.

Catherine Maley, MBA: Mm hmm.

Dr. Bruce Moskowitz: Patients like us and we’re honest. And we’re good at what we do. So, I think it’s built on that. And I think all the other things are complimentary to that.

Catherine Maley, MBA: For sure, I would if you never thought about this before, it’s never been more important than a while patient experience. Because I don’t believe they’re going to be as many patients. I know everyone seems to be so optimistic and say no, no, they’re all coming back. I don’t know, maybe, maybe not. We don’t know. But boy, the ones who love you hang on to them. But then they owe me I would have strategies built in for them to review and refer you and talk you up at every opportunity. All right. So, what do you say you tell me what you’ve been doing in your spare time? Have you? Because this is the one time in our entire lives all of us, ADD people have had to sit still. And I know I’ve gotten a lot out of this. kicking and screaming of course but did you learn anything new or grow during this time or just chill or get to know your family or what happened?

Dr. Bruce Moskowitz: You want to start Greg or would you like me to?

Dr. Grigoriy Mashkevich: I have thoughts about this but don’t you start?

Dr. Bruce Moskowitz: I think that I’ve never been so exhausted at the end of the day. During this pandemic, just working on the back end of our office on everyone, thinking about it day and night, literally sitting at a screen and zoom meetings with Greg and the staff and our PR people occasionally and whoever it might be. I’m exhausted, I’m putting in enormous amounts of time in the back office and I think I’m very satisfied and proud of it. It’s taught me a lot of I can do more than I thought I could do. I always thought it was just good Doc, I’ll have the right people let them run with it. And I realized that we’re designing certain new fonts for certain things in the office and packaging and marketing materials and small videos and redesigning of our website. There is so much that we’ve accomplished and I think that it’s pretty incredible, given the meager skill set that I thought I had going into this but I’ve learned a lot.

Dr. Grigoriy Mashkevich: Right. So, just think about the fact that we literally in the last two months while given an opportunity to really reassess office practices, reassess everything from start to finish. Everything aside, we started a brand-new skincare line and a lot goes into it, selecting a product, finding a vendor, thinking about packaging. We’re almost there, it’s going to happen. But I think something like this would not, absolutely would not have been possible during our routine existence, Monday through Friday, the way that it had been before the pandemic started. So certainly, the downtime actually presented an opportunity to work full time on everything else. And look, I think, at the end of the day, Bruce, the goal here is to have a practice that functions smoothly that has everything in place for us to walk in, do the work and walk out and feel like we dedicated our time to something that we love doing and not have to deal with everything else peripheral. So, we’re solving the peripheral problem. The last two months have been incredibly exhausting, I completely 100% agree with Bruce on that. It seems like it wouldn’t be. Now, I have spent more time with my two teenage kids, we’ve had dinner every night together which I don’t think has happened up until this point like this. And so, there’s been enough of that time but I’ll tell you, everything else has completely consumed the existence and there’s so much to potentially to look. Both of us obviously have done a lot professionally. And, I think we expect in many ways not perfection but at least a high level of achievement within everything. And so now all of a sudden, the clinical side of things moved aside and we’re presented with spreadsheets and instructions and HIPAA forms and thinking about like a filter for the office and everything else. And all of a sudden, we’re like pouring all this energy into these projects. And so, it just goes to show you how much stuff gets set aside because we’re busy clinically. And all of a sudden, once that has been cleared, we’ve been given an opportunity to– And I’m excited, I really am I. I almost wish we had another couple of weeks of this which probably will happen but a lot is getting done, really a lot is getting them.

Catherine Maley, MBA: Well, I know so many surgeons who they call me often and say I’m ready to leave the hospital, I’m ready to usually leave somewhere and start on my own. What advice would you give them before they jump?

Dr. Bruce Moskowitz: I think there’s two different ideas here because Greg came right out of his fellowship to a faculty position at a hospital. And I had the best of all worlds. Whereas I was in private practice geographically located at the hospital. So, I was never employed there. I’ve been in private practice since I started in 1992. So, I’ve been doing this on my own for a long time. But I think from my perspective, it takes an individual who wants that autonomy and is willing to trade off– it’s a big personal sacrifice in terms of time and a lot of time’s money. But it’s worth it for me because of the autonomy it brings me. If I want to work, I work, if I don’t want to work, I want to take more vacation, I can do that. I want to take Friday’s off and get out in the country on a three-day weekend in July and August, I do it, I don’t have to ask permission from a hospital administrator. So, it’s been definitely worth it for me.

Catherine Maley, MBA: So, you would recommend– well for you, it was a good move. It’s not for everybody, is that the point?

Dr. Grigoriy Mashkevich: It’s a very interesting discussion because coming out of fellowship training, these discussions happen a lot more often. Because the decision is that you jump into a fully cosmetic practice and do small things on the side somewhere to sustain it and then grow from day one rapidly in that direction. And there are risk takers who’ve succeeded tremendously doing that. I would say, these are probably exceptions. If you look at every single person who’s done plastic surgery. A lot of plastic surgeons, regardless of their subspecialty field end up doing a mixture of things and maybe even do a lot of reconstructive stuff up front. I am not personally someone who takes a tremendous amount of risk if I can avoid it, okay? That’s just not the way I’m built. When I finished my training, I already had two little kids, I had a family so I had to think about them as well. And so, getting a job first and getting established sort of allowed me to grow my practice, have a loyal patient base, diversify. And we can talk about that during this pandemic. Because of what I do for a living, I’ve actually been able to work, let’s say part time whereas a fully cosmetic surgeon could not. And so, there’s something to be said about having that diversification that allows you to sustain this major move which is– it’s not a cheap investment to open up a cosmetic surgery practice on the Upper East Side in the city. And you need to have an income flow. And I personally I’m risk averse in that sense. And so, for me it worked out. And so, my advice would be, look, there’s no shame in having a diversified practice, spend 5, 6, 7 years whatever it takes in a setting that will shelter you and protect you. And then go ahead and go for it and people are not going to hold it against you. I think that’s one of the biggest misconceptions that once you have that label that you’ve done or you’re still doing a little bit of medical stuff that you’re no longer that go to person and I don’t believe that to be the case. I think patients understand when your results are good and word of mouth works and your practice will continue to organically grow. So, my advice would be you don’t necessarily have to jump into this private practice cosmetic surgery all or non-setting, you can spend a little time sort of developing and diversifying before taking that next step.

Dr. Bruce Moskowitz: Look, check over Greg Who said I had a colleague of mine who is probably a year older than me, I met during my residency. And he had a fifth avenue practice right near the Guggenheim. He was in practice probably 20/25 years extremely successful cosmetical we practice with a high-profile clientele, celebrities, politicians, extremely successful. Once the last downturn took in 2008/2009, he had a full shop, now is at a much smaller Avenue working in Connecticut. So, I think diversification is a key and it’s worked well for Greg and I. And I think it’ll keep us moving forward in the future and allow us to really grow.

Catherine Maley, MBA: For store. I’m torn on it because I’ve seen what happens in certain practices because what happens is the managed care side of their practice takes so much more energy and paperwork and time. And it can take away from cosmetic and as long as you can keep a good balance with that. I agree, it’s great when there’s a downturn, you still have something to go to so like everything is a balance.

Dr. Bruce Moskowitz: We have a lot of energy.

Dr. Grigoriy Mashkevich: I think we’ve drawn lines, Catherine, I think you’re absolutely right. That’s the biggest challenge, the waiting area and the back office and just sort of thinking about, is it worse to continue one versus the other? But if you do it intelligently, you can shift and mold it and move it in the right direction for yourself. But I think having that diversification for me has proven over the years to be just a tremendous asset, I think. And not to mention that I enjoy the other side of the equation which is that we construct a part, that’s part of my fellowship training and so as Bruce’s and so there’s a reason why we went into it. And I thoroughly enjoy these reconstructive cases as well. Now my practice today’s 50/50 or so, maybe even slanted more towards cosmetic but give or take and it’s fine. It’s totally fine, it’s working, it’s doing okay.

Catherine Maley, MBA: Good. Okay, any last words of wisdom? Anybody want to throw anything else out there for–? Anybody needs anything? All right. Well, I love your practice. I think it’s beautiful. I think you guys have done one of the best jobs of combining two egos and two personalities and two skill sets and merging them together to create one great practice. I think you did a lot of things right. I’m not even criticizing anything other than the managed care, I struggled with it only because it keeps your attention. I just struggled. But beautiful thing, you’re off to a great start. And if you’ve done all this in just two years, I see good things for your future. All right. Well, thank you so much for being on Beauty and the Biz. And everybody, if you’ve appreciated this, please subscribe and give me a good review if you feel so inclined. And then if you’ve got any questions for me or for the doctors– how can they find you by the way, where can they find you online?

Dr. Bruce Moskowitz: They can find us at [email protected] or they can individually query us as well if they need to.

Catherine Maley, MBA: Do you know what your Instagram is? Is it specialtyaestheticsurgery probably? Okay. And then you can also reach out to me, I’m at catherinemaleymba. And with that, thanks so much for joining us. Take care.

Dr. Bruce Moskowitz: Thank you, Catherine.

Dr. Grigoriy Mashkevich: Thank you.

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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