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From Hospital to Large Practice — with Jeffrey Spiegel, MD (Ep.168)

Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and how Dr. Spiegel went from hospital to large practice.

I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits. Now, today’s episode is called “From Hospital to Large Practice — with Jeffrey Spiegel, MD”.

Dr. Jeffrey Spiegel, a board-certified facial plastic surgeon in Boston had a nice set up in the hospital that became like a cocoon of comfort and certainty….until it wasn’t.

It started with an itch to grow and a frustration with the lack of control over his own fate, so Dr. Spiegel took action. 

He read the Harvard Business Review, My Book 😉, and lots of others on management, marketing and economics. 

He talked to others, scoped out a great location in Boston to set up shop, hired consultants and opened his own 9K square foot practice plus multiple OR suites surgical center.

His private practice occupies the first floor, and a separate business for his surgical center is on the second floor used by him and other surgeons who practice nearby.  (Check out the 3D Image.)

⬇️ Click below to hear “From Hospital to Large Practice — with Jeffrey Spiegel, MD”

We talked about the pros and cons of building out your own surgical center, what it’s like working with your wife and the challenges of staff.

Dr. Spiegel also has more of a demand for his services than he can handle. So, he’s looking for additional providers to join him. Feel free to reach out to him if you are a surgeon or an injector looking for a new home.


From Hospital to Large Practice — with Jeffrey Spiegel, MD

Catherine Maley, MBA: Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and how Dr. Spiegel went from hospital to large practice.
I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits. Now, today’s episode is called “From Hospital to Large Practice — with Jeffrey Spiegel, MD”.

So, I have a very special guest today who went from hospital to large practice.

It’s Dr. Jeffrey Spiegel and he’s a board-certified facial plastic surgeon in private practice in Boston. Now Dr. Spiegel completed his internship in general surgery and residency in Otolaryngology at the University of California, San Francisco in my neighborhood. And then advanced training was done through Harvard Medical School.

Now he’s a full professor and chief of facial plastic and reconstructive surgery. At the Boston University School of Medicine with dozens of award-winning research projects, scientific papers, articles, and book chapters behind his name. Now Dr. Spiegel (who went from hospital to large practice) performs more than 1200 facial plastic surgery procedures per year in his onsite surgical center.

And that includes facial feminization surgery. And we’ll talk more about that. Dr. Spiegel, welcome to Beauty and the Biz. It’s a pleasure to have you.

Jeffrey Spiegel, MD: Hey, thanks Catherine. It’s great to be here.

Catherine Maley, MBA: So, tell me this, everyone. We always like to start out. How did you end up in private practice? Was it a long journey?

Did you jump right in? What was your, what, what’s your story in regards to going from hospital to large practice?

Jeffrey Spiegel, MD: Ah, well, it’s funny. It was never my intention. I expected to stay in academics my entire career, but It sort of was a necessity to go into private practice. So, what happened was I was at the university Boston university, Boston Medical Center.

My practice was thriving. I, and I kept progressively outgrowing the resources. I would outgrow the amount of office space allotted to me. Outgrow the number of support staff I could use outgrow. The number of patients one could see outgrow the or time. And I was constantly going to the administration and the chairman and the CEO of the hospital to, to get more resources and justifying it and not to make it an exception, right.

Everybody’s supposed to be sort of equal there. I would pay for all these resources on my own. So, I’d say I need a patient coordinator cause I have a lot of patients coming from outside of the state. We’d have to go through a lot of hoops and trials and, and we’d get it done. And it would come directly out of my paycheck for that person’s salary and benefits, et cetera, and that, and that kept going on for years and we kept growing and growing.

And then the hospital decides we’re going to hire a you know, a podiatrist. So, everybody has to give up operative time and I’m already booked out eight months, so slowly but surely it became a necessity to move off. And I did, I, I sort of bought my own space and built it out and I continued to work through the university until eventually they said, you know, it’s, what you’re doing is, is too busy, too complex for, for us.

And why don’t you stay affiliated in the professorship side and, and run your own organization. So that’s what I did more than a dozen years ago now.

Catherine Maley, MBA: Okay. And then how, if, I mean, you’re on a major real estate there that put the cost a little bit, huh? How did that affect your success in going from hospital to large practice?

Jeffrey Spiegel, MD: Oh yeah. It’s initial office that we had. We’re our location after leaving university and the first location we rented thousand square feet of space of which a thousand was.

On street level and a thousand was basement level underneath where we had sort of administrative things. And now we have a building that we work out of just shortly down the road from where we were before. And we use just under 9,000 square feet.

Catherine Maley, MBA: For those of you who haven’t seen it, you need to go to his website, I’ll give it to you later.

He has a 3d video of his large space that does amazing facelifts and facial feminization surgeries and it’s pretty impressive, especially coming from a hospital setting.

Jeffrey Spiegel, MD: Oh, thank being in the middle of Boston. I mean, that had to cost that, well, fortunately we it made it made sense for us to do it this way. I was I’ve always been uncomfortable with the idea of. Not controlling my own fate.

And so that was the reason to go into private practice. Right? So, at the university, like I said, they could say, we’re going to reduce your operative time. We’re going to reduce the number of clinic rooms you have access to. And I didn’t have much recourse, but now that’s not an issue. Now I, I can control my own or time can control my own schedule and.

When we’re not leasing, we’re not, someone’s going to someone can’t come to us and say, you know, at the end of your lease, I know you did this big build out, but in eight months, we’re turning it into a Chick-fil-A. You have to go. Right.

Catherine Maley, MBA: Good job. So, regarding going from a hospital to a large practice you did a great talk in Miami recently about having your own surgical center.

And so many of the surgeons are on the fence. Should I, should I, should I, you know, should I still beg for time at a surgery center or hospital? Or should I build out my own now that you have both sides to that coin, what are the pros and cons of each.

Jeffrey Spiegel, MD: Well, the, the cons of the surgery center are, are very straightforward.

They are. You own it. You have to deal with it. And there are regulations and regulations and regulations on the regulations. You know, we have three ring binders filling shelves with all the things we need to do to maintain. And we use quad ASF certification. You need to get every electrical outlet, checked, everything needs to be of a certain standard and, and protocols and drills and reviews.

And, and I think the other thing is you have to take it seriously and recognize that, you know, if you’re at a hospital and you’re doing a procedure, a serious procedure and something starts to go wrong and it could be as simple as. The instruments you like to use breaks. They usually have something else.

They have access, but now you need to have all that redundancy within your own four walls in order to be safe. And, and you have to kind of run through that in your head. If something terrible happens, what am I going to do? And, and we’ve had a, a couple of times, even, you know, which I also spoke about that meeting in Miami, where we have procedures, we’re doing where something starts to go awry and it’s.

That we did something wrong necessarily. I was just, this is something that can happen in a rare case. And now I have to go to the closet and take out the equipment that I never use, but I have it in case that one time occurs and it does so that those are the cons. Oh, and then also it’s very expensive.

You need to have staff space and equipment you know, beds, if you want a surgical microscope, like I have that’s, that’s a six-figure purchase. The pros of course are what I hinted at, which is that you, you control your own destiny. I have the ability to operate more or less whenever I want.

And I’m busier than ever, but I’m not booked out eight months because I can. Add on a day, I can say, let’s go upstairs and, and do it this way or that way, or stay longer or, or start earlier, or and on the flip side for your lifestyle, if you say, oh, you know what, on Tuesday have to take my kid to special assembly at school at eight in the morning, let’s start the, or at nine, you can do that.

That’s not really possible at the hospital.

Catherine Maley, MBA: So, in looking back now, are you glad you did it in regards to going from a hospital to a large practice?

Jeffrey Spiegel, MD: Oh my gosh. So glad. Yeah. So glad. That being said, there is probably something in the middle, which is even better, which is if someone in your neighborhood has a surgery center so my surgery center has three ORs, so we call it Newton surgery and we have a website for it.

Newton and there’s three ORs. And there are a number of other plastic surgeons in the area who had the same problems. I. And they come and operate here. And that’s what we focus on is plastic surgery and facial plastic surgery. So, it’s a nice experience. And the person coming in for a facelift is not in the waiting room next to somebody, you know, with a bleeding, open leg, or who’s there for, you know an appendectomy or a hand surgery or something, or, you know, an eye surgery, something that makes them feel kind of like they’re in a place for sick people.

Catherine Maley, MBA: Right. Has that been difficult or challenging to manage other surgeons’ expectations in terms of going from a hospital to a large practice?

Jeffrey Spiegel, MD: It, it can be, except that I think when you’re one of them, you kind of get it. Right. So, I, I know more or less what they want, which is, you know, seamless, quiet, smooth. And you know, no drama, everything predictable, reliable, nice experience for their patients, not having the nurse in, in the PACU say, I’ll get to you when I get to you.

I got somebody else over here who needs my attention. You know, one on one. So, everybody who’s coming through our center gets one on one attention, and it’s great for the other surgeons in our neighborhood who use. You know, I’d certainly love it. If somebody across the street had what I have, then I could go over whenever I feel like it too.

Cause we bend over backwards to make it available. It’s not, you know, these things aren’t necessarily aren’t necessarily money makers for plastic surgery or suites, but they are tremendously good for quality of life and for allowing you to operate when you want to. So, in that way, they, they they’re really good for your bottom.

Catherine Maley, MBA: It does seem like if you’re going to look at this as a profit center (going from a hospital to a large practice), you’re, you’re going to be disappointed. It’s much more about what you just said. The quality of life, the freedom actually in the opportunity costs everyone forgets all the hassle. They went through trying to find space elsewhere.

The patient’s hassle because they have to pay differently with you than them. And it’s. All of that adds up. And I think it also is the hassle factor. As you get older, you just don’t want to hassle with all of that. So, if you can make your life easier too. But how did you know how to do it? I just was talking to a surgeon and he just spent millions doing the build out and guess what happens?

He doesn’t know that they have to have two lobbies. So now they’re back under construction again, and yeah. And I thought, oh dear, well, how does that happen? So, any pearls about who you need to work with to make sure you’re dotting your eyes and crossing your Ts?

Jeffrey Spiegel, MD: Yes, you, you need to, so I’ll tell you what I did.

What I did is. Researched and found a consulting group who walks you through the process and who, you know, helps whoever is the resource on your end to make sure that you’re going to be qualified and certified. And then the next most important part, perhaps the most important part is to find an individual who is of that personality, which means like the we’ve had two people running our ORs.

From construction time until now. And the, the woman who ran it for construction, she was recently out of the military where she was in like the military health Corps and. Regulations following the rules, checking off boxes, adhering to standards. This is in her blood and it was, you know, very comfortable for her and it didn’t feel like she was, she wasn’t stressed out at this.

She, she understood the idea of the final inspection and getting things done according to code and the, the woman we have running it. Is similarly skilled at keeping all those kinds of things in the front of your mind. But the, the consulting firm is valuable because they have experience and they are there to.

Say, okay, you’re going to need a checklist for this or that. And they send it to you and you don’t have to build it from scratch or things like that. Now we’ve also simplified things quite a bit, and I think we’ve educated our consulting firm on a lot of best practices and, and there’s a lot of new technology out there.

That’s very helpful. For example, something as simple as a blanket warmer for patients in surgery and after surgery, you have to have a temperature. And so, you can spend a lot of, you know, man hours logging that, or you can go on Amazon and get a remote-control app, logging the temperature out a report variation by weekly, monthly, yearly.

You need for your inspection. So, few you can do to simplify your…

Catherine Maley, MBA: How is the situation with the staff the surgical staff versus the office staff. Are you having any issues in regards to going from a hospital to a large practice?

Jeffrey Spiegel, MD: No, we have, we’ve created a separate corporation for the, or it’s a, and this was it. It’s separate in the following ways. It’s a separate business entity.

It is, has separate management and has separate signage and it even has a separate door. I decided that was critical, LLC –

Catherine Maley, MBA: As well, separate LLC, completely different profit center, in regards to going from a hospital to a large practice?

Jeffrey Spiegel, MD: It’s a completely. Business and that that’s critical for number one, having other plastic surgeons feel comfortable using it because, you know, Dr. Smith doesn’t want to have his patient walk into the operating room at Dr. Spiegel’s office. That seems weird, but it’s okay. If Dr. Spiegel happens to have his office in the same building as the surgery center that you use. So that’s, that was a, a big part of it there, and then The staffs get along very well.

But what is challenging with staff is the transition as you get busier. So, when you’re first opening this up, you’re going to be operating somewhere hospital or, or some other entity. And there’s this moment where you want to switch to your site. But if you’re very busy, like we are, you may not feel comfortable, kind of turning it on and off.

You might not feel comfortable that, you know, 30th of the month you’re done at the hospital. And the first of the next month, you’re starting at your center full speed, full time. Cause you kind of have to ramp up and see how comfortable you are. And so, you have all this staffing complication as far as, when is your staff full time?

How many of them were per diem in the beginning? And there’s a tremendous expense at. You know, five people on full-time staff doing nothing until you’re busy.

Catherine Maley, MBA: Yeah. So, regarding the other side apart from going from hospital to large practice procedures, the admin side, I know you gave a talk on staff and it was really good. And you had talked about how you had addressed a staffing issue that was occurring during COVID.

Do you want to just touch on that light?

Jeffrey Spiegel, MD: Well, COVID was very unique time. Of course, we didn’t we didn’t furlough anybody from here. We kept everybody on full salary throughout COVID. But we did have challenges, people not wanting to do their work remotely, you know, and, and fortunately, remote work is.

A thing of the recent past and hopefully not future in, in our field. I know in a lot of fields, people don’t want to go back, but of course, what we do, you really need to be on site. For most positions. We still have some administrative type roles who can work from home part of the weekend and do, and we’ve had no problem with that.

But in general, I think the biggest staffing, no staffing is the biggest challenge for all of us in all of our offices, especially in 2022, where finding good staff is harder than ever. And quite frankly, a lot of staff have a different idea of what work is then what the physicians and maybe other types of healthcare workers.

Have as an idea of work. So, I’ve had staff say to me you know, I don’t understand why in the summer we have to have the office open on Fridays. Wow. You know, or, you know, why can’t we just shut down if the weather’s nice. Well, you know, cause it’s a doctor’s office, you know, and the weather’s nice. You can still go get a cup of coffee somewhere and that’s just a coffee.

Catherine Maley, MBA: I, I hear you. I know you had said you were losing some staff, I think, to the hospitals and you had to up the wages and is that oh yes. The point or the case or…? How has that affected your success in the realm of going from a hospital to a large practice?

Jeffrey Spiegel, MD: Well, during the last, you know, year or, or so there’s been a tremendous shakeup as you know, and a lot of people left the job market and a lot of people decided that because of that, they could be Paid more than the position traditionally was.

So, there’s been a great realignment in in salaries and benefits for staff at all levels. And with or staff and nurses in particular during the COVID times when, when nurses were in such high demand at the hospitals, they were getting paid ridiculous sums. So, I guess they weren’t ridiculous.

Those were the sums necessary to recruit these people. You know, multiples of what had been standard salaries for those positions up till a few months before. And you either adapted or you found yourself closed.

Catherine Maley, MBA: So, I’m just, I’m hoping this ends soon, because it doesn’t make any sense in regards to going from a hospital to a large practice. Physically, emotionally, logically I agree.

Business wise, it doesn’t make any sense that so many people don’t need a job. So, you have to overpay those who will actually work. And it can’t last. We we’re not built like that here in America and I, I hope it’s over soon.

Jeffrey Spiegel, MD: Oh, I agree with you. You, you would hope so. And it’s the big question, right?

Where did everybody. And why is it that people no longer need to work? Right. And, and how is it that everybody, how is it that restaurants, for example, have raised their prices by 70% around us and, and yet you still can’t get a table right. All of that doesn’t seem to fit together, but the economists will explain it to us next year.

Catherine Maley, MBA: Ah, dear God. Yeah, I hope so. So, on my, my tip, my HR tip is when you’re looking at people and they have that two-year vacation on there. They’re always going to say they; they took care of their mother. You know, they had a sick mother just as a tip off that they, they definitely had have been chilling, you know, good or bad.

It’s just something. Yeah. That’s right. Yeah. So not tell me that’s a good. I’ve been looking on your “from hospital to large practice” website and your Instagram. How, how involved is your wife in your practice?

Jeffrey Spiegel, MD: Very, yeah. And I feel very, very lucky about that. My wife is also a doctor. She has two doctorates actually. And, she does a ton of the administrative work for our office.

She is very, she is, she’s a great chief operating officer. Nice. Everyone gets things done. She. You know, we, we have meetings, we talk about things and then she’s really the one who is outstanding at, at motivating our team and helping them stay on deadline and making sure that things move forward.

So, you know, when, when you have a spouse or family member who works in your office, typically, you know, that their incentives are aligned with yours, that they. The organization’s success and they’re not going to suddenly say goodbye, which is, which is a, a big problem in, in today’s world. Again, a lot of younger people in particular feel that if they’ve been at a job for two years, they need to move to enhance their resume.

Otherwise, someone will think their stale. And for those of us who are hiring, when we see people who’ve been jumping around every 18 months or two years, you think, gosh, you can’t keep a job. But there’s just a different alignment here in values. Yeah.

Catherine Maley, MBA: And so, she’s not part of the going from a hospital to a large practice procedure, she’s all on the admin side?

Jeffrey Spiegel, MD: I was thinking, no, no, no.

She also does the majority of our aesthetic services. That’s what I thought. Fillers, lasers. She’s outstanding. She’s been Rated one of the top 25 people in that field in the United States. And she’s tremendously skilled at all of that and is a huge asset. So, I’m just, I’m just lucky.

The, the problem of course, is that for anybody else watching this, that’s one of those, well, you know, gosh, I didn’t marry someone who does that or is good at that. So, it seems like an. An unfair advantage perhaps it is it is.

Catherine Maley, MBA: Did you see that coming, like when you were dating her, did, did you OK?

Jeffrey Spiegel, MD: No, I did not.

I did not expect it at all. Never anticipated it and frankly, I was at the university full time at that point. So, the idea of having an office. On my own, never was a dream. Although I, it it’s been a very good experience. There’s this seven-year itch concept that people have of the famous movie.

But I think people get that professionally too. I think you get this kind of boredom or complacency after a certain number of years. So, after enough time at the university, I kind of. I’d already advanced academically to the limit I could. And I, my practice had grown to the amount it could there. So, it was either stay here forever and just kind of chug it out or take on a new challenge.

So, opening our office and in the surgery center this has been the new challenge it’s been great.

Catherine Maley, MBA: And then do you have plans for adding how many revenue generators that relate to going from a hospital to a large practice do you have and do you have plans for adding a partner, an associate, any of.

Jeffrey Spiegel, MD: Let me, let me say it to whoever’s watching here. You want a job?

Come see me. I, I can’t, I can’t move. We’re so busy. We get thousands of patient inquiries a year. We cannot see them all. We cannot do all the procedures and I would be. Extremely happy to bring on another facial plastic surgeon, a person who’s more interested in body, plastic surgery and possibly even someone who wants to do in aesthetics and injectables because we are already, already swamped.

Cause right now it’s basically within the SPI center, which is the practice. There’s just the two of us. My wife and I and then the surgery center have me and the other doctors who use it, but I’m, I’m still the primary user I use the most hours.

Catherine Maley, MBA: Okay. You heard it here? Yeah, please, for a, a new going from a hospital to a large practice position in a great city.

I love you are tomorrow. Okay. So, if you need so out, this is great. Sure. So, let’s see what happens now. Let’s talk about marketing because you haven’t, you seem to have had an unlimited patient supply. So where are these patients coming from and how did you pull that?

Jeffrey Spiegel, MD: Predominantly it’s word of mouth.

The, what happened was early. I think what happened for me, which was. A benefit was early on in the days of the internet. I had a patient come to me for a procedure and they wanted to get a break if they’d make me a website. And it’s like, who has a website who needs a website would need that? What is that?

I’m in the yellow page in the university listing. But I said, oh, what the heck? You know? So, so they made me a little website. So, we’ve had our website out for a very long. And it gets a lot of traffic and it, it has gotten a lot of traffic for a long time. And then what happened early on again, in the days of long before anybody did SEO or had any company doing SEO for them, or even before it was a field?

I had a patient who was a computer person and I did her surgery and she was. And then a couple months later said, oh, everything’s gone bad. I said, oh my gosh, come back to Boston. She was from out of town and I’ll take a look. She came back and I looked pretty good, but alright. Yeah, I see your thoughts.

And I fixed everything for her adjusted for her. And then she was so happy and then a couple months later happened again. I’m not happy. She came back this time. Like, gosh, everything really is perfect, but I’ll do a. Stitch here a little shot there, make you happy. She went away in it just as you thought she was happy.

And then two months later unhappy again. So, I said, listen, there is nothing left. And I was, this is 20 years ago and I’m like, all right, this, this is on me now. I’m not getting that you have some sort of body dysmorphia or just cannot see it, or it’s something else. And you know, I eventually figured out that she was unhappy that the guy she liked didn’t care for her any more than before, even after she had changed her appearance, but she thought it would.

And so, a bunch of mistakes there, but I wouldn’t fix it. I said, there’s nothing left to do. You need to seek help a different way. And so, she made a website which was something like, I hate Dr. This is before. You could go online and leave a bad review for someone anywhere. There were no review websites.

And so, if someone was looking for me, they found this site, which was like a, a site to trash me and She put up pictures of herself before and at each stage of the surgery and talked about how she went to see me and I offered to fix it. But then eventually I didn’t. And that led to me getting very, very busy because people would look for me, find her sight, read it in morbid curiosity and be like, oh, well, she actually looks really good.

There’s something wrong with the way she’s seeing he. I’ll go see that guy. And so that actually helped me grow quite a bit. So, it’s sort of funny. So that was a big boost and it’s been primarily word of mouth ever since we do close to nothing in terms of advertising. We have a, a social media presence across multiple channels, which I think is necessary as a means of proving your existence.

If you if you think about your own behavior, if. Someone says to you, there’s a great restaurant in Marin county. You, you ought to go to this restaurant and you go, what’s it called? And you look it up online. If they didn’t have a website, you’d be like, there’s something fishy there. I’m not going. And if they, if you go on Facebook and they don’t have a page, even if it’s ignored, you’d be like, that’s sort of funny.

And then if you go on Instagram and they don’t exist, you’d be like, well, they must not be that trendy and, and so on and so on. So, it’s, it’s kind of just proof that you’re the real deal and that you are a contend. I don’t think you need to be like some of the clowns out there. And there are some internet clowns who are, you know, making videos all day of, of dancing or acting or singing or things that are kind of entertainment rather than medical.

But, you know, if that’s what they, like, I, you know, good for you, but I don’t think you necessarily need to be that person, but you do need to exist. That’s proof of some that existence.

Catherine Maley, MBA: There’s such a balance between educating (especially when it comes to going from a hospital to a large practice) and entertaining, and then you need some kind of a call to action. Like you’re not doing this just to spend your afternoons doing this and videotaping and coming up with ideas.

The whole point is to. Ingratiate yourself and, and get somebody to know you so well that they’re willing to come see you. And they trust you so much that when they, when they actually finally meet you, they think you are a celebrity. That, that’s how, I mean, there’s a point to all of this and it’s getting, I think everyone’s losing their focus because like, for example a lot of people now are doing Instagram and it took a minute, like, you know, cause it’s not surgeons, aren’t naturally actors or entertainers, you know, you’re much.

Jeffrey Spiegel, MD: Yeah. Well, so most are well you’re right. Not, not, not necessarily. So, you’re right. Yeah.

Catherine Maley, MBA: But then now you’re used to like, OK, I’ll show, like I’ll take pictures with my patients and my staff, and now everything’s real and that’s video. And I don’t know if you’ve noticed, but if you try to go to social media now, there’s not going to let you just scroll.

They’re going to make you watch all these little videos and frankly, they’re. Freaking addicting. I can’t even do it because I’m lost for 30 minutes watching things. I don’t even who cares, you know, I don’t need to do any of that. I, I get mad at myself, but then I think if this is where we’re heading and now like so many doctors, I know now have videographers on staff.

Now they have to have like creative marketing directors. because you have to come up with some idea. You had a really cute one a couple years ago and it was so cute. It had a really cool music vibe to it. You were all in the, or all of you and all like people would at a time or something. That was so cool in relation to going from a hospital to a large practice.

Jeffrey Spiegel, MD: Oh yeah, I remember that. And what you said is right, and, and in marketing, there’s, there’s different types of marketing and. You, when you hire a marketing firm, which we haven’t, but I’ve read up about this on my own. There, you have to think about how are you going to differentiate your yourself or your product or your service.

And sometimes you try to differentiate it on something that you think is the case and it, it doesn’t work. And famously there was the Pepsi challenge, the Coke versus Pepsi challenge. And Pepsi tried to say, oh, you know, in blind taste test people preferred our taste. Okay. Nobody cared enough because Coke was great and Pepsi was fine and nobody cared or burger king used to try this.

Our French fries are better than McDonald’s no us for improved taste, but people liked McDonald’s French fries, McDonald French fries. Yeah. So, they were trying to distinguish themselves. On quality of the product. Now McDonald’s, you’ll notice, never does this in their advertising. They’re the segment leader in fast food and they, they don’t distinguish themselves on this.

All of their advertisements are, have a nice day. It’s McDonald’s. You deserve to have a nice day, you know, it’s, everyone’s smiley and happy here happy. And what they’re doing is creating a feel so that you associate their. With a feeling and they’re not making claims about we’re better. And, and a lot of times what happens with plastic surgeons is especially young ones is you get out and you have this need to compete.

And this sense of, you know, probably a little bit of a sense of am I really capable of this? And so, it’s a lot of what I do is better. I’m the only one who can do this. Everybody else is bad. I’m better, better, better. Really anybody who’s in practice and succeeding is delivering a nice, solid, you know outcome.

You, you don’t stay in practice if you’re doing bad work. And, and so saying something is so much better is often not really the case. And so, you might want to think about that when you go on social media and you just want to distinguish kind of the feel like people who come here are happy. Or this is a fun place, or I like mountain biking or whatever your thing is.

And then people might say, oh, I relate to that doctor. She likes mountain biking. I do too. And, and so it doesn’t necessarily have to be, you know, we’re the only one who knows this magical stage, right? It can be, this is a nice fun place with pretty normal people and, and people who are looking for a nice fun place with pretty normal people will find that to be a good.

Catherine Maley, MBA: Well, I think a typical facelifts and facial feminization cosmetic patient, they actually a typical, not the, the ones who have researched every, every CD on the phone. Yeah. But the typical one, they really just care that they like you. Like, I, I think, I don’t know if they just assume that you’re a surgeon. You’re probably good at that, but.

It goes beyond that. It’s about, it’s way more about personality and do I connect with him and do I like him, you know? And do I like his staff and I guess that’s fine because you’re right. If you, if you’re a surgeon practicing in today’s world, I don’t think you’re going to last long if you’re not a good surgeon.

So, and if you’re a board certified of there’s a good chance, you’re a fine surgeon. It’s just the other part. You’ve got to work on the marketing part and the people skill that’s right. Become a really big deal. So, regarding differentiating yourself, you mentioned that, and then I thought like big that, that, how, what are the challenges of that for going from a hospital to a large practice?

Jeffrey Spiegel, MD: Well, I suspect we are the world leaders in this. We’ve been doing this. 20 plus years with a tremendous volume and a lot of academic output. And we see a lot of patients for this. It fits me. Personality and professional interests. Well, in that the type of surgery involves a lot of cranial and bone surgery, which I enjoy.

And I like the impact it has on people’s lives, where it’s, it’s a very meaningful, fundamental change. And I also like. The questions, it answers in appearance. Meaning if you can understand how a person is perceived a certain way, like why is that? You can look at a face and know their gender. How do you look at a face and know their age?

How do you look at their face and know who you’re seeing? I haven’t seen you for several months, but I recognized you immediately, when you came up on the. And, you know, you weren’t wearing the same dress at that time. So, it’s something in the face that you use to identify a person. So, these kinds of fundamental questions appeal to my academic interests.

So, it’s been a, it’s been a nice fit. And then I think what happens is from qualifications stand. People see that you do this and they’ll say, oh, wow. Well, if you can help that person who looked male, look female, then certainly you can help me with my nose, which has above or help me look younger or, you know, whatever it is.

So, I think it’s qualifying in some ways.

Catherine Maley, MBA: Well, I have seen different aspects of that. Sometimes it can be a little polarizing and I will tell you there, like I know a surgeon in the UK and he was a, a plastic surgeon and then he started doing lots of transgender or little transgender. And because of the word of mouth, he got from that he became a hundred percent.

Transgender, because number one, he actually said, these patients are amazing. They’re so appreciative. And I think he liked that way more than just working with the cosmetic patient. So, he just went full on transgender and he’s been busy ever since. So, but I’ve also seen other practices that have dabbled in both and that.

It, it hasn’t gone smoothly, you know? And I don’t know if you have to, I don’t think you have to put your, you know, flag in the sand and say, okay, I only work with transgender, but it is, it is, it can be polarizing, you know, you’re just trying to figure out like you have mature women who want to face.

facelifts and facial feminization rejuvenation, you have that young 20-year-old who doesn’t know what the heck they want, but they know they want to re and then you have the chance drag. And I’m just saying like, we, we, human beings are not all alike. We have the same innate human needs, but they come out so differently and represent differently that how do you manage, you know, so like three huge, different target markets.

How do you manage that in relation to going from a hospital to a large practice?

Jeffrey Spiegel, MD: Well, that’s very difficult to do. And, and it poses an important point, which you said, which. You have to feel comfortable. I think for the most part, giving things up, you go, you, when you first practice learned everything, I that’s, you groove, I’m seeing of amount of rhinoplasty and I’m getting comfortable with it.

Maybe, maybe it’s okay to stay there and, and give something up. Transgender surgery, I would say is not something or gender confirmation surgery is not something to, to dabble in. In that the it’s a, it’s a little bit different technically. The patient needs are very specific and it requires you know, I think a, a certain degree of.

Of commitment. If you have that commitment, the it’s not hard to do to get your office ready in that you simply follow the golden rule. Right? Treat everybody as you would want to be treated yourself and you’re going to succeed. And I think the best thing about being in practice, you know, after so many years is.

You can be yourself. I do you know, I like comedy. I like music. I like joking and singing. And you know, eventually you realize you can’t, you said doctors, aren’t actors a lot of the time and you’re right. And, and I’m not interested in acting a role other than being myself. So, I joke with my patients, I, you know, sing during their surgeries when they’re awake and.

You know, it just helps me enjoy my day and my, my work and my life. And I think that’s very important. So, you just find what you’re comfortable with and that’s a great, that’s going to be the way it sits me ultimately.

Catherine Maley, MBA: Okay. There’s something else you do. That’s very unusual. You have other doctors on you, you videotape, you know, conversations with other surgeons.

What’s that all about? Cause that’s very interesting.

Jeffrey Spiegel, MD: Well, There’s a few parts to that for the main thing, is that every starting during COVID, when we, we here in Massachusetts were shut down for essentially three months where we were you know, the office was closed, could not be open March to June, 2020.

And during that time period, my wife said, maybe I’ll start. Talking to people online and we’ll have a conversation. And she did she called it one on one at 1:00 PM, I think. And so, you know, every nobody was working, so 1:00 PM was fine time to have a little conversation, sort of like what we’re doing.

And they did this and it was a nice way to. Kill the time there was no there were no medical meetings going on, so you could kind of share ideas, talk to people, have conversations. And that went nice. Then when everything reopened, of course, most plastic surgeons and cosmetic surgeons got very busy.

So. 1:00 PM was not a good time for anything. So, for the last couple years, she’s been doing a nine-minute interview program at 9:00 PM on Wednesday nights on Instagram. So, you go to at Dr. Spiegel, Dr. Spiegel and there’s every Wednesday night, she does this live program where she’ll interview someone usually from a geographically diverse area.

We’ve had people from Australia all over the place and they are people in aesthetics, whether they’re… Physician a surgeon, a nurse injector, someone specialing in antiaging medicine, someone who is an industry person. We should have you as a guest, in fact. And she’s been doing that for a couple years.

She told me that I’m now have, I now have to be a host twice a month. It’s lot of work. So, she wants to share, share the load. There that’s one disadvantage of having your spouse in your practice your office manager, otherwise wouldn’t tell you that. So. So I’ll be doing more and more of them, but yeah, it’s nice.

We, we get online, we share ideas and it’s, I think a nice way for colleagues to learn things, but also for patients to see you know, these people you might think of as competitors are actually very friendly and they’re, they’re not out, they’re not cut through at people. They’re out there sharing their ideas and trying to advance the.

Catherine Maley, MBA: I thought that was the nicest part. I thought, see, all surgeons are not fighting with each other, some actually get along and work together. And there’s plenty for everybody. And you know, that kind of mindset.

Jeffrey Spiegel, MD: Plenty for everybody. We have too much. Remember that part where I said, please come join us. I want to reiterate that.

Catherine Maley, MBA: I’ll tell you that’s a great opportunity. Your large practice office is gorgeous. I’ll just say it one more time. You have to see the 3d tour of his large practice office. It’s this huge diagram. And he, and you can Move the, the arrow. So, you can walk through his office. Can I walk through the office? Yeah. Later. Yes. And it’s 9,000 square feet on a really killer street in Boston.

My Lord that had to cost money since going from a hospital to a large practice. So, you’re not even from Boston.

Jeffrey Spiegel, MD: Are you? Well, I’m from new England originally from Connecticut. So, the, the Eastern half of Connecticut thinks of itself as a suburb of Boston and the Western half is a suburb of. Okay. Good.

Catherine Maley, MBA: So, so tell me, let’s talk about the going from a hospital to a large practice mindset. What, what has driven you to go from academia, where you are in a nice, safe cocoon to 9,000 square feet in killer real estate in a very competitive arena and not just enter that world, but really build a little kingdom in that world.

How, what, what did you need to, to get to that? What did you need to learn to think, to do and how it all relates to going from a hospital to a large practice?

Jeffrey Spiegel, MD: Ah, great questions. You know, there was so much to learn and I’m still learning every. I started off just aggressively reading. I read Harvard business review. I read and bought Harvard business review summary books, which were great.

I read your books. Thank you. I read books by authors about six Sigma about lean techniques, about management, about time tactics, about market. And you know, most plastic surgeons are, you know, have a lifetime love of learning and are spent the first 30 something years of their lives in school and intensively reading and studying.

And so, it’s natural as a, as an interest. And like I told you earlier, when you get. Little bit of a, of an itch in your current position, you think, well, let me learn something new and if that’s an interest for you, I also read basic economics books. I didn’t really study economics in school. I regret that.

I think that it’s a fascinating field and I wish I had read more. So, I read books you know, fundamental, basic economics books by Thomas sole and the. And I find them very interesting. So, you, you take all that together and then you trust yourself. You say, you know, doctors are, for the most part are pretty capable people with good executive function and good understanding of things.

And, and so you can take what you read and then you take a chance.

Catherine Maley, MBA: Right. And half of success coming from a hospital to a large practice is also failing, but I don’t call it failing. It’s just feedback. You try something yet. It doesn’t work. No problem. You try something else. That is, that is how you do success.

Jeffrey Spiegel, MD: Oh, we just had a, we just had a huge failure.

We, we were changing we, we were changing some company who works with us on our website and I thought I found a real secret because there’s something called white label. Which I didn’t know about. It turns out that a lot of the SEO companies you hire are really sort of a front or a face and they off, they offloaded the SEO to a white label group.

So, I thought, fabulous. I’ve discovered this little secret of theirs. I’ll hire the person to actually doing the work. Exactly. Yeah. That didn’t go well for us, you know, we didn’t get the, not having that, that middle man there. Limited their responsiveness and their ability to, you know, perform where we needed them to.

So, we’ve undone that. And that’s a mistake that I learned. I, I thought it was such a great business innovation, but it was the opposite. So, we’re, we’re constantly, you know, one step forward half a step back, but going forward. For sure.

Catherine Maley, MBA: Of any last words of wisdom in regards to going from a hospital to a large practice? And by the way, everyone, remember, there’s a job opening there for you in Boston.

Yeah. Right.

Jeffrey Spiegel, MD: That’s my words of wisdom

Catherine Maley, MBA: For anyone who wants to get out of the hospital and into a large practice, I’ll level their practice, because I have to tell you something, not every plastic surgeon thinks like you do. Here’s my theory, a majority of them are so sick. The, the learning, like, I think they’ve had enough of it and they finally got to their practice, they set it up and I think they’re, they just exhaled and said, this is, this is all I want, I just want this.

I don’t need to be the lion in the jungle. And they don’t want to learn anymore. Like they, they just kind of, but they’re just, they just want to coast. And then there’s this other group, like you who are still thinking and striving and learning and growing in the “from hospital to large practice” market. And how else can I do something or how else can.

Grow this thing. So, but so not there, there are all sorts of different personalities out there.

Jeffrey Spiegel, MD: You’re right. And, and both are great. You know some people are, are never satisfied and always looking to, to change and other people, and perhaps they’re much luckier are completely satisfied with where they are and have hit that spot where they’re super, super comfortable and, and pleased with their physician and, and what could be better.


Catherine Maley, MBA: So, no words of going from a hospital to a large practice wisdom?

Jeffrey Spiegel, MD: No, just I think, you know, exhale, like you said we’re, it’s a good field. People will come do good work aim for singles. I was always taught when you first start out. I think anybody watching this video is already interested in learning. And growing. So, you know, read things and don’t believe everything you read.

There’s a lot of things that when I go to the conferences I hear, and I go good for you that, that works for you. That would never work for me. Never. We’ve tried that certain thing we; we hear about fabulous results doing this or that. And we come back excited and we try, it’s a total fizzle. So, you know, try things, but don’t feel bad about trusting your own guts.

Catherine Maley, MBA: I’ll tell you as a consultant for the last 22 years, I have seen one doctor will say this absolutely does not work for me yet. I know for a fact it works beautifully for some other doctor. And then you say, why is that? And there’s all sorts of reasons why, but it’s true. Like, I, sometimes it works for that group and sometimes it doesn’t work for another group.

So, and I, you know, isn’t there a 50, 50 to life. Like it’s always this on the one hand, it’s this on the other hand. Cause then I feel like I live in that world because they’ll say to me, oh like they’re like a, it’s a fact, it’s an absolute fact that Facebook ads don’t work for example, yet. I know for a fact that they do work somewhere else.

So, it’s like, well, I don’t know, you know, I don’t, I never even know what they, then I say, well, you know what, try it. If it doesn’t work, you know, stop. But I will tell you before you close your mind to the opportunities, think it out first, think, you know, be rational, think about it. But I just like to try things first before, especially when it relates to going from a hospital to a large practice.

Jeffrey Spiegel, MD: I say no, that’s a good point.

And you know, I do have one last word of wisdom, which. Which is you have to decide who you’re going to be in a way, and it’s your choice. So, for example, there are the doctors who are the on Groupon. They are the doctors who are not they’re the doctors who are moderate priced. They’re the doctors who have.

Astronomical prices you think? I don’t know. Didn’t know there was anyone in the world willing to pay that for that service and it’s okay. And if you think about it, who do you want to be? Would you rather be Hyundai or would you rather be Rolls Royce? If you’re a car manufacturer? Well, Hyundai makes a nice, solid, reliable car there do not have the posh or the brand name of rolls.

Royce Hyundai makes a lot more money each year than rolls Royce. They sell a lot more cards and they’re worth a lot more as a comp company, but maybe your ego is I need to be rolls Royce in that case. Fine. Just understand what comes with that. You can’t be both. You can’t be everything to everyone.

Catherine Maley, MBA: And you better back it up.

If you’re going to charge five times more than the other guy (especially going from a hospital to a large practice), and you better be able to logically and emotionally be able to get that patient to that punchline, you know, like why are you five times more? And if you can back it up, go for it, but it, but you just, I think you better answer that question for yourself first.

Jeffrey Spiegel, MD: Totally right. Rolls Roy and the Hyundai will both travel you from place to place in safety. Rolls Royce’s experience is nicer in some ways on the road, more bells and whistles, but you know, like I said, there’s pluses and minuses teach.

Catherine Maley, MBA: I’m going with the Aston Martin. I think that is the coolest car just saying. Yeah.

Jeffrey Spiegel, MD: So super car, not quite as reliable as some others though. So, there’s always a catch, right.

Catherine Maley, MBA: I’m just saying it’s cool. So, if anybody would like to get ahold of Dr with your job application, please. I email, he’s at And Spiegel is spelled S P I E G E L. And what is your email?

Jeffrey Spiegel, MD: [email protected]. [email protected].

Catherine Maley, MBA: Oh, that’s easy enough. Easy. Right. Thank you. Thank you so much for this wonderful discussion on going from a hospital to a large practice.

Okay. Thanks everybody. We are going to wrap it up now for Beauty and the Biz. A big thanks to Dr. Spiegel for sharing his insight on going from a hospital to a large practice.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at, or you can certainly DM me on Instagram @CatherineMaleyMBA.

If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so you don’t miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

-End transcript for the “From Hospital to Large Practice — with Jeffrey Spiegel, MD” Podcast.


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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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