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Ep.93: Manish Shah, MD, FACS


Beauty and the Biz with Manish Shah, MD, FACS

Dr. Shah shares his wisdom from over 16 years in private practice, with over 10K surgeries in total (including 2K facelifts), and performing an average of 75 eyelid procedures and 50 rhinoplasties annually!

Dr. Shah’s Website

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Welcome to Beauty and the Biz – Where we talk about the business and marketing side of plastic surgery.

I’m your host Catherine Maley, author of “Your Aesthetic Practice – What your patients are saying” and consultant to plastic surgeons to get them more patients and profits.

⬇️TODAY’S GUEST⬇️

Today’s guest is Manish Shah, MD, FACS.

✅Dr. Shah is a board-certified plastic surgeon in private practice in Denver, CO and has been for
the past 16 years.
✅Dr. Shah has performed more than 10K surgeries, including 2K facelifts. He averages around 75 eyelid procedures and 50 rhinoplasties per year.
✅He did an aesthetic surgical fellowship under Dr. Sherrell Aston at the Manhattan Eye, Ear and
Throat Hospital, and has since become a member of international, national and state medical
societies, while serving on several various committees.
✅Dr. Shah was awarded the Marquis Who’s Who in America as well as the “One of the top 10
Most dependable plastic surgeons of the Western US” award by Gold line Research for Forbes
Magazine.

Transcript:

Catherine Maley, MBA:
Hello everyone and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery. I’m your host Catherine Maley author of Your Aesthetic Practice: What Your Patients Are Saying as well as a consultant to plastic surgeons to get them more patients and more profits. Today’s guest is Dr. Manish Shah and Dr. Shah is a board-certified plastic surgeon in private practice in Denver Colorado CAD competitive there and he’s been there for the past 16 years. He has performed more than 10000 surgeries including 2000 facelifts he averages around 75 eyelid procedures and 50 Rhinoplasties per year. He did an aesthetic surgical fellowship under a name called Dr. Cheryl Aston at the Manhattan Eye, Ear, and Throat hospital and he has since become a member of international national as state medical societies while serving on several of their committees. Dr. Shah was awarded the Marquis who’s who in America then with another one called one of the top 10 most dependable Plastic Surgeons of the western United States by Goldline Research for Forbes magazine. Dr. Shah welcome to Beauty and the Biz.

Manish Shah, MA FACS:
Thank you Catherine. It’s nice to be here.

Catherine Maley, MBA:
I’m glad to have you, this is something I found interesting about you when I looked at your CV online I can see that you worked in hospitals to get started like everybody then you also did a Lifestyle Lift center where you were the surgical consultant. You also partnered with another surgeon in a practice and you went solo. You have covered the gambit and I would love to hear your insights on the different business models then any lessons learned that should help others.

Manish Shah, MA FACS:
I’m happy to help out. I’ve learned a lot in the years when I came out of training I was 34 years old and I moved here to Denver with my three young children at the time and started with my practice. I got a call from the chief of General Surgery at the university and they needed somebody to become the local chief of plastic surgery at the level one trauma center I was still collecting board cases at that point and it was an ideal situation. When I’d come out of my program in Chattanooga Tennessee we had been at the 99th percentile for hand trauma facial trauma and it was perfect. Like perfect lock and key fit for me. Therefore I spent three years at an academic level one trauma center doing clinical plastic surgery, I got all my board cases and I did a tremendous amount of work while I was there. At that point somebody else came in and took over who is more of a permanent fixture in the vein on the facility and I went off and started to develop my little private practice. It was around that time I found out about lifestyle effects. She’s one of the local skull base surgeons who recommended me for the position it was a great thing. I learned a lot of great business pearls. I learned a lot about how to run a practice how to market patient care issues of the female financial management of a business etc because when I came out I got lucky I’d gone to a fellowship with Aston and Baker which was a business-oriented fellowship. We had our clinic which was great. We learned how to start the process of building the business. Then we got to watch what they did over the years. No it was night and day difference between us is fellows. Those gentlemen had been in practice for 30 plus years at that point. When I got away from Lifestyle Lift I joined a group practice and doing nothing but cosmetic surgery at that point. We had an amicable breakup in 2015 and for the first time 10 years into my practice I was full-time in my practice. We have skyrocketed because of all the things I learned in those first 10 years through this other subsidiary practices and then I’ve been using it for about six years and we’ve had a glorious run and we’re looking for the version I think 5.0 my practice and I’m going to be starting a major expansion in about 18 months and it’s been good but a lot of things have gone wrong and a lot of things have gone right to get me where I am today.

Catherine Maley, MBA:
What personality do you think you need today to run your practice because it was invaluable you got mentorship from the big guys and learning how to run the business side of plastic surgery, that’s a tough part. Everyone’s got the surgery part down. It’s the other part. How do you run a practice and life If they would have given you a good education on patient attraction, conversion monitoring numbers I mean they were a business?

Manish Shah, MA FACS:
They were an extraordinary juggernaut. The problem with their business model was they were mushroom structure. They had all these people at the top and there was such a top-heavy structure. The first thing that I learned was you don’t have a mushroom structure for your business you’ve got to keep things relatively lean and mean until you can develop new service lines. And either market those service lines aggressively and you price them appropriately. Then you get the messaging out and today’s with today’s marketing structures including social media it gets muddy because there are many places you can put messaging out you have to know who you’re looking for. You need to put your message down the pipelines that are aimed directly at those kinds of clients. it does take time to figure out what your ideal client is at this point. I’m moving away from a certain procedures and embracing other ones for both longevity neck discomfort like new things that happen. As you get older you want to do the procedures you love to do then you recognize you do them you do them more efficiently and you do them faster not because speed is an issue but when you’re talking about dollars per hour and the number of cases you can do in a day where you’re not tired at the end of it that you lose your edge you start thinking about the things that are important to your practice. I for the longest time I’ve been trying to develop a facial based practice and I made about 90% face and for a bird certified plastic surgeon I’m unusual light because I don’t do a ton of breast I do a lot of butt work and I do a lot of faces or it’s the middle of the body sort of doesn’t come to my office but face work. I’m over 100 Rhinoplasties a year. I’m doing a tremendous amount of surgery but the things I want to do took me a while to get there. I teach at the university and I am one of the four preceptors for the offer rotation cosmetic surgery, I guess elective we get chief residents from the University of Colorado division of plastic surgery coming through with us and I get them for two months every year. I get multiple residents throughout the year and one of the things that they tell me is the best part of this is they learn much about how different it is to be stuck in residency stuck in the mindset of the ivory tower that when you come out and you have no idea of what to do you don’t know anything about contracts nothing about finding your suppliers or about how to hire we talk about all that while we’re operating because we’ve got to kill the time somehow. they learned much about business with us or at least with me because it was one of the things that I never got a lot of them. When I learned it I recognize I can save these young surgeons much of a hassle if I could tell them the right things to do upfront and they can customize it any way they want to because we talk in generalities but we talk about the right things because they don’t know and they’re not taught any of this stuff. I think it’s the most valuable part about rotating with us people in the private sector is that you can learn some of these things.

Catherine Maley, MBA:
Today for somebody to enter the marketplace what personality or mindset do they need? Should they go solo? What would you recommend them do?

Manish Shah, MA FACS:
I will give you the first piece of advice Dan Baker ever gave to me and he’s like go where you want to go the money will come. I think that’s still the case and would still say go where you want to go. Make sure that you’re where you want to be for the larger picture of work-life balance. I steer them away from er call because it doesn’t get you anything. It’s more time off your ability to focus on your daily practice to work on stuff at the night. Unless you’re a reconstructive surgeon that’s fine, could do it but for guys like me it was a waste of my time. Half the time I didn’t even charge I’d go repair some kid’s bite and I wouldn’t charge about it. But it is the hustle you must be willing to hustle. You must be willing to say yes to every phone call yes to every referral it still doesn’t change. Some of these uncertainties can get extraordinarily busy because they’re good with social media. The results are good. like it The proof is in the pudding and they can do a lot of teaching and they’re comfortable in front of the camera. I’m in-between generations where I’m still not sure I want to waste my time on social media but I know you tell me you got to do social media and we do it we have an Instagram channel and I do YouTube but I took Brad calibrates says the mindset of pick something you love to do and go all in completely all in you. You market it, you talk it, you teach it, your social media is about it and then you can be considered authoritative and I think that’s the goal. It doesn’t I don’t care there are other surgeons in my community to do as many Rhinoplasties or more than me I have a particular flavor I have a particular aesthetic and people come to me for that I do things that no one else in Denver does. I do ultrasonic Rhinoplasty. I do preservation on Class II because I love the operation. I go teach myself, I go to all the conferences my first two meetings this year are both international meetings focused on Rhinoplasty and that’s my hustle. I would recommend that to any young surgeon. Yeah and I think solo practice is perfectly fine. I would still bet this is one of the few practices you can do one of the few specialties you can be in where you can still be a solo practitioner. When I was in a group practice nothing ever got done because all it took was the down vote of one of the partners and then everything was dead in the water. I had many great ideas that I could never launch because my hands were tied by the corporate structure of a have multiple partners. when I got out and I could do the things I wanted the way I wanted to I took the bits and pieces that I’ve learned from everybody over the years and I hybridized it into what I consider my type of practice development model. Of course you and I have spoken over the years and your information is invaluable. We bought your books and gave them to all of our staff members and everybody has tried to use the important components of the book that match where we’re going with our practice. You need a personality of perseverance that you have to persevere, you can’t come out thinking anything’s going to be handed to, you can’t come out thinking he’s going to make half a million dollars off the bat. You can’t, you have to be you have to expect you’re going to be working hard even in today’s market. But when you’re young and you’ve got all that a time on your hands when you’re in the first six months of practice that’s when you build your resume. That’s when you tell people this is what you do. That’s when you teach clients who might find you on Instagram they might find you on YouTube you’ve got time get a camera video yourself and be out there showing people this is what you do.

Catherine Maley, MBA:
[Inaudible]…you want to be solo because you want to do it your way. Most surgeons and entrepreneurs like me are on what do they call them unemployable? We’re with others we want to do our own thing but the thing about surgeons or anybody when you do your own thing and you are in your little world you do not mind setting with other people or mind mapping because you have staff that’s around you who say yes to you unless you have somebody who is honest and says let’s think about that. Or you have a wife who doesn’t have any clue what’s going on? Or she does but helpful to have somebody else bounce things off of otherwise you’re in your head and we all know you can get far with your mind. You can and you have to change your mind to get somewhere else. I would be careful with that. I think that’s why the meetings and the conferences are important. We have to everyone’s got to compare notes and find out what are you doing? What are you doing? And what do you think about this idea because you can waste a whole lot of time money and effort trying to wing it because you have a brilliant idea? And I could have told you two years ago that brilliant idea has been tried. Here’s how it works the best that’s why I think you need an outside consult.

Manish Shah, MA FACS:
Agree and I think that’s an amazing point. I think the reality is even if you are solo you’re not an island unto yourself. One of the biggest lessons I learned was that what I thought a patient wanted had nothing to do with reality. It had to do with the fantasy I had in my head about how I would position myself, how I would brand myself. It didn’t make sense until somebody said why don’t you try this and it made a lot more sense because I can’t look at a patient with my eyes I have to look at a patient with their eyes. Those were things I learned through trial and error. But talking to smart people like yourself taught me a lot. There’s a lot of stuff in there’s a lot of stuff you can get from your partners there’s a lot of stuff you can get from your colleagues. I have an extraordinarily good relationship with my colleagues in town and I don’t feel uncomfortable calling them, I don’t feel uncomfortable referring to them if I’ve got a question. I made that a policy from day one. I think it was what my parents taught me was like take good care of your people in your world. they’ll end up taking good care of you and we have a good congenial atmosphere here in Colorado I’m sure. It’s not always that way. In other market spaces. We’re a competitive market but the mindset is the pie is getting bigger. It’s not getting smaller and we don’t have to share the pie. We can cut a slice that we want and people we right I mean anytime a young surgeon comes into town or calls me from a different part of the country I’m like come on I have no fear about bringing a young surgeon and if they accelerate past me they were the better person and that’s and that’s what they deserve. But we do everything differently and it’s okay to be separated but not isolated. What you’re saying like you don’t want isolation I love going to meetings I loved. One of my favorite meetings was the first time I ever went to the CS 2015 I spent the whole time in the practice management side of things. It was the most eye-opening education I had for five days. I barely went to any of the surgical meetings I’ve seen them 100 times what I mean there wasn’t anything new there. But there was a lot of stuff about management and team and ethos. That’s where I first heard about Jim Collins and get the right people on your bus right? you don’t get that from anything. You can have the wrong people on the bus like you’re saying and they will not guide you the right way and they may not be. Luckily I’ve surrounded myself with people who are willing to complain to me. Not that wasn’t always the case. But it was nice. It’s nice to have people stop me when it’s time and say that’s not the angle we should be considering? Have you considered this in the end? It’s my decision. It’s my business my name. But I do listen to people.

Catherine Maley, MBA:
They always say a good leader listens to their people let them be part of the practice of the growth of the practice. It’s a great mindset to have. They often see it differently than you do and can’t hurt to see all the sides of it. Let’s talk about staff for a second because that seems to be tripping up people who have been in practice one year or 10 years or 20 years. Do you have any pearls of how you have hired the right people or how to avoid hiring the wrong people any tips?

Manish Shah, MA FACS:
In the last position we opened up was a front desk position full time and we had 1000 resumes from indeed and it was impossible to find people we ended up hiring three different people each one quitting within six to eight weeks where we fire them because they were nothing made sense no matter what the hoops who made them jump through in the resume process nothing. I would say hiring is still if you ask most people I think hiring is the hardest job in the world because you’re trying to marry somebody who you do not know of and who’s putting their best face forward into your way of doing things. We tend to have younger employees who don’t necessarily have a lot of years under their belt they’re bit more malleable. We try to pick people who have science backgrounds fit into the mindset of the practice. We love sales backgrounds but it’s rare to find somebody who’s had both sales and science together who would fit an aesthetics practice. I use things like your book when I was trying to look at things like what do I need in the salesperson and we tried to get them trained as we 2019 and 20 we’re big years first stuff we spent a lot of money on ups up to training everybody for everything like my office managers getting financial accounting she understands when we get the PnL from the accountant she understands it but the point is like I want her to understand that like an a professional accountant will understand it our sales team gets routine sales training reviews you with our online resources. My medical people get upskilled because they’re under my license I can train them to be laser text I can train them to be injection people and we expand when we get the right person we’ve run a small ship for 16 years. I’m sure most of your clients and most of the people you’ve talked to you who are busy surgeon they had a record 2020 and I don’t know if that’s going to be the case for 2021. It’s been great far. But when you’re hiring you have to take a lot of time to hire and you do not fire anybody until you’ve got another person in the chamber ready to fire out ready to bring forward for what I mean it’s hard to find the right stuff. We’re lucky I have a pretty decent team but it’s taken a long time and I’ve kept most of my staff for a long time until I change practices and hire new people.

Catherine Maley, MBA:
Do you have your nonsurgical side, your Med Spa side and your surgical side? Are they as important? That mindset is changing on this. Some surgeons say I started a Med Spa because I want to build that relationship early. They stay with me for surgery or they’ve had surgery. I want to keep them and build the lifetime value of a patient. Other surgeons say I’m sick of the Med Spa stuff. I don’t want to compete with them anymore. I want to do surgery. Do you have a feeling for that for your practice? Or where are you trying to scale? If how are you going to do it?

Manish Shah, MA FACS:
We are scaling we’re stuck in a small space right now and the lease is up in 2022. I’m probably going to triple my space. come November of 2022. I’m still deciding whether I want to build an operating room or not but I’m not saying I’m adding on it. I’m adding on a young attending. I’m adding on injectors, I’m adding a full-time esthetician and our goal is to scale because I want multiple service lines working for me because I don’t want to do the injections anymore. I am good at Botox and Dysport. I’m great at filler but what I can do it one day a week. My money is in doing consultations. I I’d rather spend time doing six consultations each with a five-figure value if they move forward and a good sales team then making 10000 in a day of injectables and Botox is and whatnot the numbers are the same. The time I spend is the same but the return on investment for my time is greater. But it’s a lot easier for me to hire people and have them going I believe you’re the surgeons that take the form of view of you to want them early because it is a lifetime value. There’s great data on you get a patient young whether it’s with acne care for a teenager or you take good care of them you have a chance to be exposed to their parents who are aging and will need things down the line and then when you do things like surgery doesn’t fix everything. People still age if I do a facelift I still need them to maintain the face. If they’re going to buy a Ferrari they still have to polish the wheels. I don’t mind having that, it’s a great way to do I don’t want to do it myself. Like I start at the beginning of my practice I did the lasers and I did the chemical peels and I did all the micro-needling because I love doing it but in the end it was a service I was adding on it was when I was younger. I had the time to do those sorts of things. For the last five years I’ve had no time to do any of those things. Because I’ve had no time even to get all the consultations that I want to be done in a week done. to me it’s best to have multiple service lines and slowly expand them. Somebody’s got to make money when you’re not in the office. When I’m operating there’ll be an office that can either lay fallow or it can be generating money for me which then frees me up to have bit of quality of life. I can put all that cash away. if I want to take a three-week vacation or if I get sick I don’t feel weird as the like you said the unemployable I don’t feel weird taking time off for the longest time. That’s the downside of being on your own. You’re the one generating income in the beginning right and if you’re sick it’s up to you don’t get to get sick. I’ve probably taken I think January was the first time since I graduated high school that I took a day off from work because I was sick with what I thought was pre COVID before COVID was an issue January of last year in 2020. but it’s like I don’t feel uncomfortable. I’ve got plenty of cash coming in, everybody’s doing a good job there’s room to grow. It’s we don’t have space for it.

Catherine Maley, MBA:
If you want my two cents I’m going to give it to you anyway for after 21 years of doing this having your own or suite on-premise is a game-changer. How you scale you sit still and let people come to you. It’s convenient and private for the patient. They’re more comfortable with it and you don’t have a coordinator on the phone constantly scrambling to find time for you and shuffling around with the bag and no does he have all the supplies? I would say go for it.

Manish Shah, MA FACS:
But we’re about 90% in the having the art side of things. Yeah we’re looking for the right space because that adds another 2500 square feet to have that space at least for one operating room at least in Denver for sure.

Catherine Maley, MBA:
By the way are you a big fan of buying lasers? If how do you decide what’s the right one? I will tell you I watch practices do this constantly and I don’t know if it’s a great salesperson but let’s say they have an aesthetic practice. For whatever reason they decide to get a hair restoration machine. It’s a whole new market and they have to learn how to market that thing. It doesn’t happen. It’s not like why wouldn’t you stick to the women? They’re 85% of the revenue probably more in most practices and that astounds me like why wouldn’t you buy something normal that women like skin, I don’t know, Fraxel machine or something? I don’t mean practical I mean a fractionated something that a lot of people have that problem that you could have the solution to? It’s easy to find them because they’re already in your practice.

Manish Shah, MA FACS:
I own my laser but it’s a laser that I’ve loved for 15 years and I’ve learned that I’ve used this device hundreds of times and it’s got great ROI. I got a killer deal on a brand new from the company because I knew I’ve been wanting it for a long time and they wanted to they wanted another they want to open the market up bit more. I buy technology I have had a long time to watch and we’ve got one nonsurgical device for fat loss. You’ve got IPL. We love the Venus concept company. we have a good number of their products. But we are careful about what we buy and why we buy it and we take a long time. Before we purchased I had been I get approached a nauseating number of times by device companies. Everybody wants me to buy their latest legit and I can’t do it and I don’t want to do it and I have no space for it and hurts my head to think about how I would market it. I stick with the things I know work like you were saying and I can use them. The majority of my patients whether there’s a pain and they’re no longer having acne but the scars need a laser or if somebody’s too busy and they want to do some skin tightening. We’ve got skin tightening devices and they’re afraid of surgery. We’ll use our ND Yag fat melters or whatever it is we have technologies for a basic grouping of patients that we can run at a profit and let it pays for itself. That way if I can’t justify the paying for itself part of it because I don’t have a market and the startup is this steep then I’m probably not going to do it.

Catherine Maley, MBA:
Okay, can you give me one business mistake you made that others can learn from and avoid?

Manish Shah, MA FACS:
The business mistake, I still am not sure the ROI on this, I hired a PR person and it was great. PR now is digital placement rather than true magazines because no one reads magazines anymore. The problem with digital placement is it flashes in and flashes out no one ever sees it again but with a magazine it’s hard and it sits on your coffee table and somebody can flip through it. I learned a lot of great things about access and writing and Q&A like this through the PR person but I wasn’t sure I got great ROI on it was quite expensive. I would say be careful before you before you trigger the use of a public relations expert because the markets different and I think I’m probably seeing more of my colleagues getting far more ROI and far more traction using things like properly performed social media properly created post good content attractive before and after which don’t cost them much of anything unless you’ve got a social media expert helping with a lot of it. But you can do a lot of this stuff yourself and get far more return on investment than anything else.

Catherine Maley, MBA:
PR has become a do-it-yourself you but it’s going to cost you are there it’s going to cost you money or it’s going to cost you time. But the old PR business model I don’t know I don’t know about that anymore. Does anyone even care even if you got on a morning show the thing I would say is do it especially nowadays they’ll let you do it they’ll charge you for it? But if you’re allowed to take the B roll that’s recording that they do have your video and you’re allowed to put it on your website or anywhere you want for your marketing purposes. That would be the reason because then it at least it grows legs. But if you’re on the doctors let’s say you can’t even take that V roll if I’m not mistaken. Like they’re funny about their stuff that it has to be on their website. You need that. I don’t know that PR thing? I would understand the details before I invested in that one.

Manish Shah, MA FACS:
Yeah and I think your content or your assets. The more content you can create the more your assets are growing. There’s nothing like a bit a busy YouTube channel of great education because people are looking if you keep telling people that you do something that they’re looking for you’re going to get a phone call or you’re going to get an email or you’re going to get a chat or an SMS message. But if you don’t let people know you exist especially in the way people are looking for you or looking for somebody like you then you’re going to you’re doomed to be bypassed for business and they’ll go to somebody down the block who talked about it and put something up and said, Hey I do this procedure and these are my results. I can teach you about it. And you’re now familiar to them because they saw you on video or they saw you on Instagram I saw you saw your results on your Google business page. Then they found you. It’s convoluted. I think that’s one of the things that I think is the hardest about marketing is how do you track everything. Because you can do things in many different spaces. Then a patient comes in and they don’t remember where they saw you. They’ll tell you I saw your website. Your girlfriend talked about me at a cocktail party and you remember the name and you remember the part of the name and you found me on the internet and then you went that way. But I would love to thank you girlfriend for referring you to me by talking about me. But you never get a chance to do that. that’s the hard part. I think tracking is a big part of knowing how to spend properly on your marketing.

Catherine Maley, MBA:
There. gratefully there’s a lot of technology available. My goal in life is when I consult with a practice is to get a dashboard going your numbers at a glance. It’s impossible to do with one app you have to have there everyone’s using three different software to get the regular numbers you need not including all the other numbers like QuickBooks and all that I’m talking the marketing numbers right? There’s you often have a CRM that knows some of it but then you use another like the app to use to tell you where the lead came from online. You oftentimes have to use another back-end thing to do the drip campaigns or the marketing campaigns that you want to do and it is it’s gotten complicated.

Manish Shah, MA FACS:
That’s been the hardest part. As a solo practitioner we scour the internet looking for companies that have these ideal unicorn products and still nobody’s come up with the thing that does it all because they attach it to an EMR and we’re like Okay if you’re not an EMR practice we’re old stuff. We’re an old-style chart practice. I’m going to have to go to EMR with my new young attending coming on because that’s what they understand. But we love charts. But regardless we do have a practice management software that we use we use practice plus by nextech which was the former Superman and we use my med leads above and my PCC she loves my Medicaid she loves seeing everything in one space and she loves the recall capabilities we do constant contact for certain kinds of things and inside my med these they customized campaigns for me for grip purposes and they work if you can put a lot of stuff on autopilot but you need smart people at the helm of the autopilot like running the mimed leads to get the best out of those things. But I agree it’s hard to find an ideal product.

Catherine Maley, MBA:
Before they sold my leads. I used to write their scripting for them. drip campaigns? They sold for him and he was trying to grow it he had a nice exit out of that.

Manish Shah, MA FACS:
Yeah, It’s a good product.

Catherine Maley, MBA:
If anybody who can follow the leads and make some sense out of them and the staff can understand it. Kudos to them. Personally, that’s all I want to see. I want to see your marketing plan then I want to see where the Personally from and are coming from there. That’s what I liked about like mimed leads we’re not supposed to promote anything. But what I like is if there are no bodies involved it will tell you because it tracked it that it came in from a directory from who knows all the different websites. That is good information to have nowadays the patient says I found you I googled you and that’s not helpful because then you find out when they come to visit you. My girlfriend mentioned it to you and then I went to your social media and then led me to your website. it’s gotten convoluted. all you can do is the best you can do. But you’ve got to know some of these numbers to figure out where are you supposed to be putting your money for marketing? do you have marketing knowing you of course have a marketing plan? But what I think would be interesting about you is you have a Rhinoplasty target market but you also have a facelift target market right? Do you have different marketing plans for each of those target markets

Manish Shah, MA FACS:
I have different marketing plans for each one of those markets and part of my part of this new practice expansion in 2022 is splitting up into two brands under one roof. One brand will be the mart will be the Rhinoplasty practice separates assets, much more easily trackable hardcore focus on one procedure Rhinoplasty and then all the science and data that goes that a patient could ever want about it. That’s like one brand than I have anything else left on the face I plan to get rid of all the bodywork I’m going to be moving that on to the young surgeon and let them have a completely open practice while they’re the associate and then when they if they choose to come on board as a partner a couple of years later they can do anything they want. But my goal is to brand myself as two entities. One entity is my Rhinoplasty practice which I don’t think I can sell when I retire. I don’t worry about that. But I can keep the logs of patients for future Facial Plastic Surgery. Attending that I want to buy the assets later on. But then I’ve created a private labeled name for a facial practice. Again using the model from Lifestyle Lift not doing what they did but using the concept that later on when I’m in my 70s and I decide I want to retire I built up something that has nothing to do with my name that could be easily transferred as a saleable asset to somebody else lock stock and barrel operating rooms the works for later on. That’s how I’ve come up with two different concepts and we launched that full-time end of 2022.

Catherine Maley, MBA:
I struggle with that because social media has forced you personally to be a personality and patients always say Dr. Shah they don’t say Lifestyle Lift that I struggled because I don’t know what the real answer is. When you’re young I would say use your name when you’re older getting ready to exit? Yes, I hope you have a different name? I don’t know the answer for that.

Manish Shah, MA FACS:
I would go with you on people do need to know your name. Because in the end when they’re searching the smartest thing you’ll ever do is watch your analytics and look at your search terms and understand that. I spent probably several hours a week trying to go into the world that you live in every day in the world of the marketing people to try and understand the psychology of what is the patient? What are they thinking? What do they need? What makes them happy? What’s the fulfillment for them? And then how does that translate in the tech side of things with social media Google search capabilities search engines results pages optimization like Facebook ads and Google ads and pixels and all those things that you are completely blindsided by when you come out and no one teaches you this stuff I’ve had to teach myself every single bit of it by learning it on the internet like going Philly and going to all kinds of big people who are in the search space and trying to understand things from their point of view. I can understand the framework that makes me as a Cosmetic Surgery Specialists exist. Like if I did the wrong thing I would be relegated to page three then the statistics show that 82% of contacts occur in the first three search results. If you’re 12 and you’re on page two and you’re wondering why your phone’s not ringing it’s because Google doesn’t think you exist they don’t think you’re important for that particular procedure. I’ve learned and how do I make Google the number one search engine in the world followed by YouTube the number two search engine in the world? How do I make them know that I exist? I provide them the authoritativeness and I think that’s the thing one needs to learn is no matter what you’re doing make sure that the world knows that they’re you’re an authoritative person you’ve earned it you’ve done 1000s of hours of operating you’ve slept little, you eat, breathe, and sleep plastic surgery or whatever procedure you love to do. But if the world doesn’t know that you do love it or you that’s your thing. They’re going to bypass you and the biggest place to be found I still say I get more leads from my website than anywhere else. Yes back to what you’re saying. I got it from the girlfriend. But if you look at the numbers it’s every contact page gets filled over and over and over again because they find their way and they funnel their way to the website. That’s our biggest asset that is your greatest asset. It’s portable you can take it with you wherever you want to go and I tell all of my young all the chief residents like I don’t care if you go into academic medicine it doesn’t matter. Make sure you’ve got your name go buy your domain with your name on it. Because you never know when you’re going to get fired. You never know when you’re going to get a change of heart and want to go out there. And I said keep the rights to your photos keep the rights to your stuff that you do get the patients to sign off on. Before and after consents even if you’re working in a university practice you’re doing those patients keep them to the side you never know when you want to use those things later on in life and you need to have everything that has to do with you. Because in the end, it’s these two hands in your name that care everything else like you were saying it’s not about a lifestyle lift. In the end, it’s about the surgeon’s inside lifestyle if they did all the work and no one knew anything about them. Right man, it was all about this big company. What else I

Catherine Maley, MBA:
think change much is that surgeons talked to you at conferences about branding. And I used to hate that because I thought oh you’ve got too much going off on that tangent like branding. You’re not Coca-Cola but what I thought branding was you become credible when you educate the patient there’s no need to promote. First of all, it’s not time to promote you directly when somebody doesn’t know you. All they want to know about is how do you feel about the downtime for Rhino. And I based my whole career not here but my whole career in life was on marketing versus selling. I’ve always done that with education and if you surgeons would do the same thing. That’s what the patients are looking for when they go like that downtime for Rhino they’d love to see a YouTube video with you explaining downtime for Rhino. it can be that simple. And a lot of you I think it caught up because you think but then what would I tell them during the consult? Frankly, they’ve heard much at this point it for you to tell them one more time the way you would tell them is completely different than anybody else. I promise it would be a good discussion.

Manish Shah, MA FACS:
I agree 110% I think the greatest thing you can ever do as a surgeon especially now again going back to social media it’s hard to know what the truth is. It’s and I think patients appreciate a genuine take on what’s going on. I don’t think a lot of patients want to get sold on anything. and it’s rare, it’s extraordinarily rare in my practice that somebody comes in and says what would you recommend Dr. Shah? I’m like I don’t recommend if they ask them like I don’t recommend I go what’s bothering you? Let’s address what’s bothering you. Like what are your top three concerns? Let’s address those and I’ll tell you what I think looking at you and talking to you and understanding your life this is what I’d recommend for you. But I wouldn’t recommend that for your next-door neighbor you could look the same but I would tell you she’s a homebody and you love to play tennis three seasons out of four. We have different you’re a different human being you’re going to need a different pathway unless you’re willing to be like your homebody neighbor and then I could do more aggressive things on you. Education is the most important thing and it’s the first step towards being genuine. Then being genuine leads to authoritativeness because I don’t think people are tired of being taken for a run on everything. people are I think people are tired of being commoditized. Does that make sense? The Groupon generation and all that stuff I think they’re tired of they love that. They love the special but I don’t think they want to be treated as anything but special. They want to be educated and they’re always looking for information. I’d rather spend the time upfront giving good education than having to break somebody of their bad education by reteaching everything.

Catherine Maley, MBA:
I think you’re much more credible when they show up that I love when they show up saying Oh you look you’re taller in real life or I’m Good I feel like I know you from watching you on social or on YouTube or reading all your blogs on I think it’s such an easier way to have a conversation. The keyword you keep saying is genuinely, authentic. You don’t need to be someone’s best friend. But they do want to feel like you’re approachable and they can talk to you about what bothers them. But what I also noticed you have a Hispanic element to your practice I noticed that your website switches between Spanish and English. How do you speak Spanish?

Manish Shah, MA FACS:
I don’t want my patient coordinators fluent in Spanish.

Catherine Maley, MBA:
Because that’s getting to be more popular. I get that but you have to have somebody in there who speaks Spanish and if that coordinator walks out the door now you have to find somebody who’s good and speaks Spanish. What are the pros and cons of offering a completely different culture different language? what do you think? Is it working or?

Manish Shah, MA FACS:
Interestingly enough I guess because I’m a person of color I have a diverse practice far more than anybody else in this community. I have my patient practice manager she’s a northern European, my PCC is Guatemalan my search tech as the Titian is half Japanese. We have this wonderful mix in our office and it creates an environment for a group of patients that are becoming a much larger force in cosmetic surgery if you’re looking at anything again on social media about bodywork those Hispanic women love their curves and that allows African American women to love their curves. It brings a lot of patients that would never have felt like they could come in and do this out of the woodwork. we offer a service and we offer access to people who in a lot of ways would not have felt would have would not feel comfortable with the general population of plastic surgeons in Colorado and probably the surgeon themselves because for whatever reason they’re not as culturally in tune they have a harder time understanding and delivering again delivering that outcome that patients are looking for. I live in Denver, I can throw Penny in any direction and hit a Spanish speaker. When I hire such a large number of people that are already fluent Spanish speakers pop up on my radar. I don’t think it’d be difficult for me in my community to do that. But it may not be something that you can do in other communities that are not necessary. What I say as diverse what I mean? It’s been an absolute boon I had much success with it and they don’t mind that I don’t speak Spanish. They love the fact that Brenda speaks Spanish and we don’t have communication errors. We do have Spanish consents from the ASPS. we tried we do it in such a way and we try to deliver what we can in our way of doing things. It’s been financially extraordinarily rewarding.

Catherine Maley, MBA:
How do you build rapport with the patient if you can’t talk to them are you using tools to educate? Are you showing them pictures?

Manish Shah MA, FACS:
I do use tools but when I’m consulting with somebody who does not speak the language and because I’ve got a lot of patients that don’t speak English as a first language they might come in and Russian will be their first language they’ll bring in one of their family members and I will translate through them it’ll take we’ll give them bit more time during the consultation. But in the end the pictures don’t have to have a language associated with them. when I show them before and after’s or I do my teaching on one of my teaching apps that we use here in the office everybody understands once it’s been explained to them.

Catherine Maley, MBA:
Okay. I want to talk about mindset because I think that’s getting to be more important than ever because the world has turned upside down and it’s going to continue to every time you think you have your bearings something else happens. Even in marketing when you figure out like let’s say you want to do Facebook advertising when you figure that out the other day they changed the rules again and you’re like, Are you kidding me? I did try to keep up with all of that. If you don’t have a growth mindset I don’t know how you’re going to win this game because it will wear you down trying to be this is how I do it. This is how I’ve always done it I’m not going to make a change. I hear that in some of the surgeons and it doesn’t even matter how old they are certain people do not want to change. I would say the keyword in today’s world is adaptability and also resilience. How do you handle the ups and downs of life and business and this industry? How have you been doing it?

Manish Shah, MA FACS:
I’ve taken a page out of the book from the business world they talked about things like being agile and they talk about being lean. We plan what we do by thinking in in Agile terms we think about running a lean business we talk about I don’t take any money home that I don’t need to take home I’m not sitting there driving a Ferrari. The secret is not to get ahead of yourself and put your money back into your business like any good business. Why do stock companies buy back stock? Right they know that in the end, they can resell it for a higher profit. We put our money back into the company we’re always reinvesting in ourselves whether it’s through training whether it’s through technology whether it’s through expanding market share whether it’s trialing an error in new marketing concepts that come across my table but you do have to move you cannot be stuck. Because in the end as search algorithms change as you said Facebook changed like that whole Apple privacy thing that made Facebook ads I don’t know completely disempowered overnight you end up thinking you’re spending all this money and then you wonder why your returns and your lead numbers fell off the cliff within one month because it’s as simple as if you find the right tap you turn it up and the leads come in. But in the end, it doesn’t matter how many leads come in if you can’t manage the leads in-house, your external marketing is too powerful for your internal services. You have to have balances in those things and the way you’re going to have balances in those things is if you’re thinking about what’s going on in the outside and then you got to look at what’s going on inside your house. I mean your house your business house and even your home and understanding that all those things can affect you. Some days are going to be good days some days going to be bad days. But in the end, you made it you committed yourself to build this business and you got to stick with it. But being agile I agree with you on is being on your toes and thinking it’s a 24 hour a day business I’m always thinking about this business. It doesn’t matter where I am or what I’m doing. I’m always thinking about something related to the business.

Catherine Maley, MBA:
Are there any particular books or courses that you follow? or read or resources that are…

Manish Shah, MA FACS:
I’m not going to say this because we’re in a podcast. Yeah. But I found your book the best simplest black and white things a young surgeon could take and implement extraordinarily quickly with a low cost of caught the barrier to entry from a cost standpoint and start thinking about what it is to build a fee for service elective business and that’s what I do. When you’re running an insurance type practice it’s a completely different mindset but you still If you want to do all the deep flaps for breast reconstruction then you better talk about the flaps you better do the operation your oncologists in town need to know that you’re the one that does these cases and you build up but it’s different the same concepts are the same whether you’re a cosmetic specialist or whether you’re doing reconstructive surgery in the end patients need to know I.e through education that you do these things and you’re the system is I know it’s how sounds strange it’s derivative it’s you do the same certain things. People will find you and then you will have a successful business. But in the end, you still have to be a decent human being you have to show the care you have to be there for them when they need you and you have to deliver in the end. It doesn’t matter how good you look on paper it doesn’t matter what degrees you have on your wall. In the end, did you meet the needs of the person who was sitting right in front of you? Or was sitting on that table in the operating room? Did you meet their needs? It’s one patient at a time that he knows how you deliver and you’re always on? In my opinion, the time I get a good night’s sleep is when I’m on vacation.

Catherine Maley, MBA:
I don’t know what a vacation is yes. Let’s be nice. Is there anything? Is there any one piece of advice that you would want to leave the audience with for either growing a practice or growing a mindset anything like that?

Manish Shah, MA FACS:
When my growth started triggering it’s when I decided what I was good at and when I decided what I was good at I then asked all these things that I’m good at what do I have the most fun with. Then I took those two pieces of information and they have been my guiding star ever since. I use that to determine what I want to grow into. I use that to determine how I want to use my time and it is been rewarding both emotionally professionally financially. From a standpoint of being able to support my family all those things I decided what I want to be good at. I’ve never looked back and it’s blossomed I’ve had growth in the surgical procedures I’ve want to do that are that it’s extraordinary. It outstrips the market if I had the numbers I still don’t have access to that AMM thing. I’d love to see but my EMR can’t plug into it and I don’t have access to but I hope I hope to get a new EMR plugs into and I can take that data and use it. There’s like you said there’s lots of great stuff out there that surgeons can use to know where they are and get benchmarking. But you have to do those things you have to look like every year in January I look at the whole year behind. I look at all my numbers and I calculate for myself a spreadsheet to know where I am I look at what my surgical dollars were I look at how many micro-needling is that we do in 2020 and where we went up to look where we went down. I use that data to then have a conversation with my team and say Hey last year we dropped off by 20% of this I don’t understand why to let’s talk about what we can do to build this back up to pre-2020 levels and I said we did great in this. Or it’s time that we did many it’s time to bump our prices because we’re starting to capture market share let’s think about how to be more efficient. That you don’t have to be running through all the chintzy leads and wasting all your time. Because everybody is a lead when they come in. We don’t know if they’re hot cold or warm until you’ve spent time with them. We’re trying to find everybody’s efficiency of time matters. I’m trying to do anything I can to make sure that when my patient care coordinator is on the phone by the time she’s on the phone with them they’re 75% ready to go because otherwise you waste time and we made our new our new little trial. I don’t know if it’s going to work or not but we put our prices on the website. We’re going to see if that’s effective at getting people who want to kick the tires not coming in. I’m not for everybody. You can be okay with not being for everybody. I think when you’re young you’re like I have to do every surgery I have to take every console that comes across and do something for them. All the disasters in my professional career have come from that mindset. I stopped that mindset a few years ago.

Catherine Maley, MBA:
Those pricing models getting more popular on the websites and I do know in real life they get a lot more leads but you better have a back-end system to qualify those leads automatically. So your staff isn’t going through 1000 leads when five of them were legit or many of them were legit. But I see the value in it but I’d rather say prices starting at.

Manish Shah, MA FACS:
We don’t there’s no actual number because, in the end, I have to see the patient and determine how to customize the price when we give them ranges or starting assets depending on what the procedure is.

Catherine Maley, MBA:
I think a real cosmetic patient they do want to know what are we talking about? Here we talk 5000, 10000 I get that. But when you get into that looky-loo Price Chopper patient that’s the one I’m trying to avoid the one that he’s $500 more or you’re $500 more what are you going to do about it? I don’t like that patient. I like the one that they care about the price we all do. But they also care about your credentials your reputation and you as a doctor and a person and I like that patient a lot better. But it’s worth a try everything’s a test.

Manish Shah, MA FACS:
It is and we’ll see what happens with the data and decide if we want to keep that page up. Or if we want to pull it down. It’s a matter of somebody turning off some code. it’s not it’s not hard to do it’s a great way to do a B testing on the process and see if it works. But the one thing that I think you are probably a big fan of this concept is that your staff have to qualify you anyways. when patients ask does he discount my staff for already training like no he does discount he’ll do a special once a quarter of something so you can wait till the special comes around. But he doesn’t discount his services because he’s trained. He does X number of this he’s a professor of surgery and on. And if you want this is what it costs.

Catherine Maley, MBA:
Today he charges a fair price for his experiences and credentials. That’s what they do. I love the fair price because that’s what the patients are looking for. Some of the patients use negotiations this sport and they wanted a darn deal period. But otherwise, I think the majority want a fair price and they are okay. Tell us something that we don’t know about you already something fun?

Manish Shah, MA FACS:
It’s funny when I’m a big fan of electronic dance music EDM

Catherine Maley, MBA:
Really.

Manish Shah, MA FACS:
I see I’m a drummer. I’m a drummer by background. But back in the 1980s is when I fell in love with analog synthesizers and drum machines. I’ve been slowly building up quite the studio in my basement and that I’m an empty nester and my kids are off to college I have time to go ahead and produce my electronic music. that’s one way you can be a bit you can be a band of one nowadays with computers doing all the work. Yeah, that’s the one thing that a lot of people don’t know about me.

Catherine Maley, MBA:
And are you a great skier? If you live in Colorado do you have to be to live there

Manish Shah, MA FACS:
You don’t have to be a ton of people who love to ski. I have not had a lot of time to go off on the weekends especially raising my kids. But now that they’re off I have more time. But by the time the end of the workweek comes I’m tired. It’s like I’d rather sleep in on a Saturday and wake up and take the dog for a walk or go cycling around the neighborhood or something like that. But yeah I mean it there is an absolute cornucopia of amazing outdoor activities that are in our footsteps. it doesn’t take long for me to get up the mountain and go skiing. Yeah, when I want to I go.

Catherine Maley, MBA:
Before I became an entrepreneur I used to go to Lake Tahoe every weekend. I had a lot more time. I learned to ski and time I was 20 when I learned to ski and it was awful I’m still not great. But I then thought of running up there every weekend. nauseates me but I used to go all the time. It’s I don’t need to hurt myself. I’m fine. I Steve been there done that.

Manish Shah, MA FACS:
Again that’s the thing. It’s when you’re young and your brains their brains different about getting hurt. think about that. When you’re in art when you’re in my position. I can’t hurt my hands. I can’t break my wrist. I have a colleague who had he was doing longboarding on one of those skateboards and he took a digger and he’s older than I am. I mean he had the longest rehab for a shoulder and he NXT is an extraordinarily busy practice. I can’t imagine it wasn’t financially quite the hit for him and his team because he’s got a large practice and I got gastritis thinking about if what that what if that happened to me Why? Do what I do? I’m like no I’m not letting that happen to me.

Catherine Maley, MBA:
It sounds like you’re setting up other profit centers good for you. We’ve got to go. But where can people learn more about you? What’s your website URL?

Manish Shah, MA FACS:
My URL is https://drmanishshah.com. And you can find me on Instagram at the face surgeon where I showed before and after’s and talking about facial surgery and show pictures of my kids and my synthesizers now and then.

Catherine Maley, MBA:
It’s great, your site’s great. Your Instagram is good too. Dr. Shaw thank you much for joining us Beauty and the Biz, I appreciate and I hope to see you at a meeting someday.

Manish Shah, MA FACS:
Yeah no, I’m hoping to go I’m off this Istanbul for a meeting

Catherine Maley, MBA:
I lived in Istanbul for one year when I was younger and silly and I long story but I was there for one year and it was the longest year of my life and I love America. I meant to live in America with choice and women’s rights.

Manish Shah, MA FACS:
No, I haven’t. It’s not for everybody.

Catherine Maley, MBA:
But it was beautiful parts of it were beautiful. But I would love to go as a tourist and try it again. Because that was a long time ago like 30 or 40 years ago. Anyway, I’m sure it’s gorgeous. Thank you so much and everybody thanks for joining us. If you would do and subscribe to Beauty and the Biz and give us a great review. I’d appreciate it. If you’ve got any feedback or questions for me or Dr. Shaw please leave them at my website at www.CatherineMaley.com or you can certainly DM me on Instagram at CatherineMaleyMBA. Thanks much and we’ll talk soon.

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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