Transforming Patients and Yourself — with Nicholas K. Howland, MD (Ep.192)

Transforming Patients and Yourself — with Nicholas K. Howland, MD

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 consultant to plastic surgeons to get them more patients and profits.

Now, today’s guest is Dr. Nicholas Howland and he’s a young for certified plastic and reconstructive surgeon practicing in Draper, Utah at the largest private practice group in the area, and he knows all about transforming patients and yourself. And we’ll talk more about that, but this is what I find really interesting. He was born in Utah and before pursuing his medical career, he fulfilled a two-year church mission to St. Petersburg, Russia, where he was the lead interpreter and coordinator for volunteer efforts in the world-renowned Hermitage museum. You have to Google it. It is the most unbelievably huge ornate building I’ve ever seen. So, we’ll talk more about that.

So, Dr. Howland went to medical school and his residency at the University of Texas Medical Branch in Galveston, and he’s presented at over 20 local and national meetings, as well as published several abstracts, journal articles, and book chapters, all before he learned about transforming patients and yourself.

Now, he has a great introductory video on his website at Howlandplasticsurgery.com. He actually has two and one is, and I think everyone should have an introductory video (remember, he knows about transforming patients and yourself), like get to know me kind of thing, where he’s talking about cosmetic surgery that he performs. But he is, or was also, talking about taking call at six different hospitals in the area.

So, we’ll have to dig into that and see if he’s still doing that. So, Dr. Howland, welcome to Beauty and the Biz. It’s a pleasure to have you.

Nicholas K. Howland, MD: Thank you Catherine. Thank you, and thanks for calling me “young”. I appreciate that.

Catherine Maley, MBA: Sure. Well, I’m getting up there now. Now you’re, everyone’s looking pretty young to me. So, how did you, you’re in the middle of Utah, and transforming patients and yourself.

Oh. First, I have to talk about the Russian thing. I happen to be reading. I love Russian spy novels for whatever weird reason, and I’m in the middle of one right now. Now it’s winter and the way it’s described, I’m literally freezing reading. This book is so, intense in Russia. How cold is it?

Nicholas K. Howland, MD: Well, it depends on where you’re at in the country.

I mean, you go, if you go south to like Rusto Nanu, which is on the Black Sea, it’s a tropical climate. But where I was in St. Petersburg, we I lived in St. Petersburg for about one out of the two years. And then the other year I lived in a very small town called Petroski, which is, here’s St. Petersburg, here’s the North Pole. And Petroski is this little lake town, right? A little closer to the North Pole than St. Petersburg. And I was there in the middle of winter and the coldest I ever saw was 40 below, and I remember it was 40 below because you know what? 40 below and Fahrenheit. No, it’s 40 below and Celsius.

That’s where the two graphs meet. So, 40 below is the same in both Fahrenheit and Celsius. And you walk outside in that kind of temperature and you immediately take a breath and every bit of moisture in your body immediately crystallizes all of the moisture in your nose. Any tears on your eyes, everything just immediately is frozen.

But I, I loved my time there. I, I spent two years there for a church mission. And we loved the people, loved the country. The history is incredible and fascinating. And I, I still haven’t gotten a chance to go back there, but that’s on me.

Catherine Maley, MBA: But if you were interpreter, that means you spoke Russian and you must have spoken very well and fluently if you were in charge of that.

How in the world, I don’t know, one person in America has said, Hey, I think I’m going to learn Russian, especially in terms of Transforming Patients and Yourself.

Nicholas K. Howland, MD: So, while I was there, I had been there for about a year and a half, and this was in 2003. And in 2003, St. Petersburg celebrated their 300-year anniversary as a city. And president Putin, he was still president at the time.

He put in billions of dollars into renovating St. Petersburg for this celebration. So, they, I mean, they repainted the whole city. They restored a lot of old churches and buildings and one of the things that they were anticipating was several hundred thousand, if not over a million visitors coming through the Hermitage Museum in a period of about a month.

So, it was just going to be packed for this whole month-long celebration of St. Petersburg. And they needed English speaking interpreters to be stationed throughout the museum to be able to tell people like, Hey, the Rembrandts are this way, or If you want to see Michelangelo go this way, or The bathrooms are that way.

And for whatever reason, the church missionaries got put in charge of that project and I got tapped as the lead for that project. So, I had to over several months give, we had over a hundred missionary volunteers who spoke Russian, but also, English. And then we had over a hundred native Russians who spoke fluent English.

And so, I had a group of over 200 people where we organized and trained them on the museum so, that throughout that whole month they could be stationed throughout the museum and guide people. So, every day for about two and a half months, I was taking little small groups on private tours throughout the museum so, they could acquaint themselves with it.

Taught them what we were going to do during this big celebration. And that’s really where I developed a, a really strong love of the arts. I mean, you spend, so, The Hermitage is the second largest museum in the world.

Catherine Maley, MBA: Do you have any idea how many square feet It’s, cause this thing is massive, and I’m sure that’s helped since transforming patients and yourself.

Nicholas K. Howland, MD: Oh, I’d have to go look.

I mean, it is, is it like football fields like. Bigger. Yeah. I mean, it’s, it’s composed of five buildings. The Winter Palace, which is where the, the czars used to live is one, is the kind of recognizable building. It’s, it’s like a, like a green color. It sits right on yellow Square. And that’s kind of the entrance that everybody recognizes, but it’s actually five massive buildings that host some of the most incredible art in the world and some of the most recognizable art in the world.

And walking through, just over and over, I really developed a love of art and the classics there.

Catherine Maley, MBA: And, and just out of curiosity, is it a dangerous city? Because this book makes it sound like everyone’s a spy and you can’t trust anybody and everyone’s ripping you off. I mean, is it, is it what, what is Russia?

Like, just your observation and how it relates to Transforming Patients and Yourself.

Nicholas K. Howland, MD: Russia is a city as, as a country that’s really been damaged by its history and by its leaders. There is, since the Iron Curtain came down, there still has not really developed a middle class. It’s a very kind of two class system, especially in St. Petersburg where you have the ultra-wealthy and then everybody else.

The people that are, are great. They’re, they’re, they’re kind, they’re loving and they’re great people. They’re a little untrustworthy because of their history and how they’ve been treated. But once you kind of get in their home, they’ll give you the shirt off their back and would do anything for you.

I, I, I love it. What’s, what’s interesting is my brother, He served a church mission to the Ukraine. And so, he and I with world events as they are today, actually having friends who are, are now at war with each other. And it’s, it’s a hard thing to watch especially when you know and love people on both sides and you have to your heart goes out to these people who really are at the mercy of, of leaders making, you know, choices that we may or may not agree with.

Catherine Maley, MBA: I wouldn’t mess that. All this, my lord. So, back to our vanity world how, how did you become a plastic surgeon? Did you grow up with plastic surgeons (before transforming patients and yourself) when you left the church?

Nicholas K. Howland, MD: First of all, I’m going to, I’m going to correct you right there because my approach to plastic surgery is a little. It’s not about being Vanity.

I do not believe that plastic surgery has anything to do with vanity. I think plastic surgery, I think it can, and I think there are people who utilize it that way. But for me in my practice, plastic surgery is one of the most self-empowering things that a person can do for themselves when it’s done for the right reasons.

And so, you and I talked a little bit about this when we met in Miami, which I have my own podcast called The Naked Patient Podcast. And that’s what we kind of talk about on there is removing this social stigma of plastic surgery being this horribly vain thing that that people only do to kind of satisfy their own vain desires,

Cause I don’t think that’s what it’s about.

Catherine Maley, MBA: Hmm. Okay. We don’t agree on that. But carry on because what, whatever. Prompt somebody to want to look good and feel good. I’m all for that because my opinion is we’re all just trying to be happy, period. We’re all just trying to figure out what the heck we’re doing here on, on earth and how can we enjoy it Today I want to buy a new car and that’s going to make me happy.

Tomorrow it’s plastic surgery, the next day it’s a boyfriend or husband. Like, it’s just, we’re always bopping around. So, I love that we, we can do whatever we want. That’s the greatest part about being human beings. You know, we, and we, we ebb and flow, you know, so, yeah. However, we get there, it’s become super-duper popular, and how that all relates to Transforming Patients and Yourself.

Nicholas K. Howland, MD: Yeah, absolutely. Well, well I’ll tell you how I kind of came to that belief. Cause that really is the mantra that kind of drives me in this practice. When I was going through medical school and then residency, I remember. I, I had a, a dinner with this. He was a, a friend and we went out to dinner with some other friends and he was asking me, you know, what I was going to go into, this was around third or fourth year of medical school.

And I told him, you know, I think I’m going to do plastic surgery. I think I really love plastic surgery. And he didn’t ask me another question. He just looked at me and he says, Ugh, what a shame. And I was like, I’m, I’m sorry. And he says, I just, it’s such a shame that healthcare has become the way it is, that you’ve got to go into such a vein and, and horrible profession in order to make any money these days.

And I’m like, hold on a second. I really like plastics surgery. And that was the start of it. And then even later, we, I got into residency and my mom would call me pretty regularly. and she would say, did you do good plastic surgery today or did you do bad plastic surgery today? And in her mind, if I was doing cleft lips and pallets or you know, even massive breast reductions, she would, she would justify then I was doing good plastic surgery.

But if I was doing rhinoplasties, breast augmentations, facelifts, I was somehow doing bad plastic surgery and that was coming from my own mother. So, I had to reconcile that somehow in my life. I had to make that make sense or else, I mean, I, I, because I wasn’t going to agree that I was just doing this profession to make any money and that there was a good and a bad side of it.

And that I was choosing the bad side because I knew I wanted to go into cosmetics. So, for me, the way that I reconciled that is I just realized that they’re not different. For I, I think, and I have seen a breast augmentation change a woman’s life just as significantly as a cleft lip or cleft palate change some kid’s life in Guatemala.

And that may sound like a really harsh comparison, but that is true. And that’s because plastic surgery is such an individual thing and it can be so, self-empowering for that person. That thing that, that’s why I believe it’s not about vanity. So, when you do it for the right reasons, it’s taking that whole vanity thing away and it becomes about empowerment.

And that’s why I love plastic surgery. And that’s, maybe that’s just how I reconcile it in my mind, but I truly believe that, and that’s the approach that I take with me.

Catherine Maley, MBA: So, at family reunions do you guys talk about it? Are you the black sheep? Are, is everyone okay now? Like, how’s your mom doing?

Nicholas K. Howland, MD: Oh, listen, she’s, she is, heard me tell that story countless times. and Oh, yeah. Yeah. She, and she knows, but she, I think has come over to my side where she feels like, you know what, you’re, you’re right. I, plastic surgery really can change lives and is more about, can be about self-empowerment and not about the way that we have pushed this as a society.

And that’s not just, you know, social media and influencer’s, faults. We as plastic surgeons have pushed this as a vein profession and something that, that’s not empowering. And you know, I think that we have a responsibility as plastic surgeons to, to improve the way our field is perceived.

Catherine Maley, MBA: So, when you left Fellowship and it’s time to go out into the marketplace, what were your choices and how did you decide what to do and then what did you do before transforming patients and yourself?

Nicholas K. Howland, MD: So, for me, I had gone to a meeting in, I think it was in San Diego or Dallas. And it was, it was actually about the business of plastic surgery. And they had some guys talking about how to, how to run a business because you don’t get a lot of that in training. And I’m trying to remember who it was that gave this talk.

He’s, he’s, he’s out in California. Really like him. Doctors. What’s that? Doctors? Yeah. He’s a plastic surgeon in California. I just, I can’t, I’m blanking. What’s that? Paul?

Catherine Maley, MBA: Nasa, the guy, he has a program now. Everybody wants to do what I do. I’m a consultant, plastic surgeon. He’s the business of marketing and now everybody wants to do that, in terms of Transforming Patients and Yourself.

Nicholas K. Howland, MD: No, I’m blank. I’m blanking on his name and he’ll, you know, I’ll come back to it. But he had this idea that he used when he went out into practice and he, he wrote a letter to every board-certified guy and said, Hey, I’m coming out there to practice. I’m not necessarily looking for a job, but if you have an opportunity, I’d love to hear about it.

And he said he got two responses back. He got one guy that said, there’s no room for you here. And he got another response from a guy that said, sure, as long as you stay on this side of town. And I heard that story and I thought, I’m still going to do that., I think, I think that still sounds like an opportunity and.

Salt Lake City is still kind of this underdog or, or at least perceived underdog in plastic surgery. We, at one point, were the number two or number three spot per capita in the country for plastic surgery. Right. And it’s kind of, it always kind of shifts, but, but Salt Lake is always up there near the top.

We have a ton of plastic surgery here and a lot of plastic surgeons. So, I was training in Texas. I had gotten divorced and my ex-wife had moved here with our two kids. And so, I knew I was coming to Utah. And I did what this guy had suggested. I wrote a letter, I looked up every board-certified guy, wrote a letter, said, Hey, I’m coming out there, let me know.

And in two weeks I had 14 offers. Nice. And a lot of them were older guys looking for me to buy their practice. You know, they wanted me to pay them. One 2 million to buy their practice. And those ones I wrote off immediately. But then there were a few that were from guys looking for partners and the contracts they offered were different.

And the one group that I found that I ended up joining is, is a kind of a hybrid practice model. So, our group is called Premier Plastic Surgery, and there’s four of us in the group. And we office share, we share expenses with of our nurses. We have the same office manager, but within that umbrella of Premier plastic surgery, we all have our own individual pc.

So, Hal Plastic Surgery is its own entity within Premier Plastic Surgery. So, I’m the sole president and employee of Hal Plastic Surgery. I do my own marketing. I run my own social media, but I’m also, under this premier plastic surgery group through which we buy our implants. We buy our products for our med spa.

And as a and as a group, we also, save a little bit on our malpractice because of that and. So, I get a lot of the benefits of a group practice, but I still get to enjoy the freedom of an individual practice where I’m doing my own marketing and I’m creating my own brand. And that’s all independent from this group.

And I’ve loved it. I, I don’t think that there’s a model that, that I have seen that works better in my, in my opinion.

Catherine Maley, MBA: Alright, so, how do you divvy up the expenses? Is it done per surgical hour or whatever? Cause this is one area where you can get into trouble when you’re working with a bunch of surgeons when transforming patients and yourself.

You’re using the OR more than I am. Why am I paying for, how have you worked that out? Because it can be troublesome, as it relates to Transforming Patients and Yourself.

Nicholas K. Howland, MD: So, the surgical center side runs a little bit differently. So, I’ll get to that in a second. So, on our clinical side with Premier plastic surgery, Everything is split uniformly down the middle.

We all get a bill a stack of bills at the end of the month, and we’re splitting those bills 25% across the board. And on the surgical side though if I’m, I’m an independent contractor with Premier Plastic Surgery, so, I go into the surgical center and I have a contracted pricing as an owner with the surgical center that I pay when I use it.

And so, it’s really based on my use. Your kind of still eat what you kill, and that’s it. A couple years into the, into my practice, I was offered the opportunity to buy into the surgical center as well as the medical spa, which I did. And so, I now am one of the four owners of the surgical center as well as the Med Spa.

Catherine Maley, MBA: So, all four of you are the owners. Partial owners of the Med Spa and the surgical center. You don’t have outside surgeons coming in? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: It gets a little complex there, We, we are in a building where there are nine plastic surgeons in this building, and only four of us own the Surgical Center and the Med Spa in my group, premier Plastic Surgery.

Three of us are the owners. The other owner actually is an independent private, or, sorry, a solo practice, but he’s in the building. Hmm. And so, that’s where, that’s where it gets a little convoluted,

Catherine Maley, MBA: Okay. As long as you got a good accounting system, you know, taking, you’re tracking all of this, you know. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Oh, yeah. And so, with, with the four of us owning the surgery center nine plastic surgeons in the building that, that use it. Plus, we bring in some orthopedic surgeons. We bring in some podiatrists, some urologists. I mean, there’s probably about 17, 18 surgeons. That use the, or we’ve got four ORs. It’s a quad, ASF surgical facility.

And works great.

Catherine Maley, MBA: So, what would you say gimme the pros and the cons of working in this, this hybrid practice idea, I think is almost your best bet no matter how you look at this, because you still have the freedom to do your thing. Because one of the biggest issues I have seen after 23 years is one guy wants to be the alpha and the other guy has to be the number two.

And it just, the egos don’t usually mesh well that way. So, in your case, you don’t need a line in the jumble. Your ha you’re all for doing your own thing. And so, what would be the pros and the cons of. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah, I’ll tell you exactly what the, the hardest part for us right now is, and it has nothing to do with our model.

It has to do with o only one of those owners of the four of us is actually the landlord of the building we’re in. Gotcha. And that’s where any problems that we run across come up is when the landlord makes a decision that favors the landlord and not the partners of the practice. And so, the solution to that, which is something we’re working on, is having a building where everybody shares equal ownership in the land, in the building.

Because otherwise the practice model runs almost perfectly. I mean, I, there’s, I don’t need to be the Alpha and nobody else strives to be the Alpha because they have their own practices and brands. My brand is Howland Plastic Surgery, premier Plastic Surgery. Is this. Nice group model that we put up a billboard for and, and we’ll put some ads in a magazine here and there so, people know, oh, that’s the group I go to.

But the brand I’m building is Howland Plastic Surgery because, because I’m the brand.

Catherine Maley, MBA: One of the issues also, that comes up is Premier Plastic Surgery is, it’s not a little practice, it’s a very big established, you’re the largest group in Draper, Utah. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: So, we’re the largest group in Utah outside of the university.

Catherine Maley, MBA: Okay. When leads come in, they don’t all say Dr. Howland, they sometimes just say Premier, like, I need to, how do you divvy up leads that come in arbitrarily. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: We have a front desk staff that’s very well trained to be diplomatic. They also, know the surgeons who kind of like certain things. So, a couple of the partners.

Don’t like liposuction. And so, if somebody calls and they don’t know the surgeon that they want to go to those two, those doctors that don’t like liposuction aren’t recommended. And we’ve all kind of created our own little niche in terms of what we like and the front desk staff know which surgeons prefer which cases.

And, and, and that the other thing I’ll say to that, that was one of my big concerns coming into a group. I had had a friend who joined, a guy whose wife ran the practice, and it was a year in before he realized, oh my gosh, she’s giving every single lead to her husband, obviously. Yeah. And so, that was a concern for me.

And I, I asked the office manager Hey, how do we divvy this up? And she said, you know, you’d be surprised. She said, most people who call here, Aren’t calling saying I need a plastic surgeon. Most people who call are calling because they looked up Dr. Howland or Dr. So-and-so, and that’s specifically who they’re trying to get an appointment with.

It is few and far between. For somebody to call up and say, I want a tummy tuck, Kuya got Gotcha. And that’s getting even more prominent in today’s age of social media. People are looking up year before and after’s, they want to come to you. Nobody’s looking up a group practice before and after’s not looking at the surgeon and then calling up and saying, well, gee, the group looks good.

Send me to somebody in there. No, they, they know the surgeon. They’re trying to get in to see.

Catherine Maley, MBA: That’s why there’s such a debate about what to name your practice. I, in today’s world, you’ve got to get your name in there somewhere. Like you’re the brand. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Absolutely.

Catherine Maley, MBA: And I, and I, I hear you. Like, I know when you’re ready to actually, you wish it was something else, but at the moment to grow this thing, it takes your name. How does that relate to Transforming Patients and Yourself ?

So, I, I don’t know what the answer is there, but I do know things work better when, when you when you brandish your name and people get to know you well.

Nicholas K. Howland, MD: …And I’ll tell you what, I’ll go, go back to those guys who were trying to sell me their practice at the end of their career. For whatever reason, among doctors that, especially plastic surgeons, the idea that your practice is worth anything when you retire.

That’s gone. plastic, this is, you are not a dental practice. Nobody’s staying committed to the plastic surgeon they go to when he retires, and they’re going to go in and see the guy he brought and replaced you. No, like you are the brand. The only thing that’s worth any money at the end of the day is the building you’re in and the dirt it sits on.

And so, that’s why that landlord issue is so, important for, for me, is I know at the end of the day, my practice is not going to be worth a thing because it’s me. I’m the brand. So, I better be invested in the real estate and the building if I want to have anything to take away from my practice. At the end of the day,

Catherine Maley, MBA: I certainly agree about the real estate and I would also, keep an open mind to the med spa.

That’s your best bet for reoccurring, predictable revenues because asthma, your name is not on that as much and it’s much easier transfer over and a doctor will buy. Something like a predictable revenue stream from a med spa than they will from another surgeon who has patients that may not be a fit for him at all.

So, I think that’s where your next best asset is. The med spa. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah. That I would absolutely agree with.

Catherine Maley, MBA: So, are you still doing how much cosmetic, how much insurance? Where, what’s the point? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: That’s, that’s kind of morphed over the years? You know, I, I still followed that old model. You know, we, we talked earlier where about me taking call and I, I did that old model where you just take, call everywhere you can.

I did a lot of hand trauma and a lot of facial trauma and built up my cosmetic practice slowly. And that still works. When I say slowly, I feel like it built up pretty quick with social media, but, The I, I only in the last year have stopped taking any insurance other than some passion surgeries that I really enjoy doing.

And so, now my mix is probably a 90 10 mix of cosmetic versus insurance cases.

Catherine Maley, MBA: Oh, interesting. And does anyone else in the practice do insurance or are you pretty much cosmetic all the way there? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Pretty much cosmetic all the way. We will be bringing on another junior partner here shortly. Especially since I’ve transitioned out.

He’ll ideally come in and take some insurance cases and that, that’s kind of the model we’ve followed. Where the new guy comes in, he practices that old style of eating, what he kills, taking what insurance he can, and then growing his cosmetic practice until he’s busy enough where it’s time to take on another junior partner.

Catherine Maley, MBA: What I’m noticing after doing this for decades is the patience. Has dwindled to a, a lot less because in the before you’d have to grind like that for years. And now it seems like there’s, the patients are, there’s no patients now they’ve got, they want it now. They want it now. Sure. So, they do all the, all the recon and the, and the e n t and all that for about a year and say, okay, I’m, I’m done.

I’m not doing this. And that’s been, it’s, it’s problematic because on the one hand you’re saying, oh yeah, insurance is great. And on the other hand, nobody wants it because you can’t make any money. You know, that’s, I any advice for that for people coming out saying, I’m not doing, I’m not call, you can do this without doing call.

Can you enter the marketplace? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yes, you can enter the marketplace without doing call. And I see guys do it all the time. How, how do they do? I, they establish a social media presence as, as quickly as possible. They provide good results and they treat their patients well.

Catherine Maley, MBA: …And they take out a massive loan to cover office staff lasers or like I, is that what they’re doing? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I’m not sure if they are. I, for me, I didn’t have to do that. The way my, you know, the way that this was set up is I took out a, I established a line of credit and I think I dipped into that line of credit twice. I bought a computer and a white coat, because that’s all I needed. They had everything for me.

Here. Desk was here, furniture was here, the nurses were here, everything was here. And I needed some help with that first month for cost of living. After that I was, I was earning enough to, to maintain my cost of living and to pay my bills. But I think there probably are guys who have to either take out loans or take out a line of credit if they’re not doing any type of insurance cases or their contract is different.

I, you know, I have a friend who joined a cosmetic practice, doesn’t take any call at all. His contract was a guaranteed salary. And then he, anything that he earns past that guaranteed salary, he gets to pocket a percentage of it. And I, I think a lot of those contracts exist where it makes sense to do that and not have to take call.

I’m partial to the independent contractor contract. I think when you’re, when you’re giving a percentage of those cases away to a partner, golly, that sure breeds a, a, a difficult relationship. Right. Especially if you start earning a lot and you’re like, why am I paying this guy a percentage of these cases?

So, for me, I just think doing that independent contractor agreement and saying, I’m going to, I’m going to buckle down for a few months until I’m busy enough is the best way to go.

Catherine Maley, MBA: Well, I, I hang around mostly with the more mature surgeon who’s trying to figure out how to exit profitably. Mm-hmm., and they’ll, they’ll guarantee a salary for about a year and, and that’s not going to, that’s not an open wallet forever because he took the risk.

And that’s what they say to me. I took all the risk. I’m the one who put down all this stuff at the bank. I’m the one who had to go through hell to grow this thing and this guy walks in and says, oh, oh, what do you got for me today? You know? And so, there’s some resentment already before everybody even starts. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Exactly.

Catherine Maley, MBA: Exactly. Yeah. So, I always say it, all of this in writing when everyone’s still happy. You know, just like a divorce, like do it when you’re still in love. Cause there’s just so, many ways to go sideways on that. And I don’t know how, you know, they want you to buy their practice because they want to walk away with some money, but you’re saying, what am I buying?

And that’s why I think you’ve got to own some land here because at least you’ve got the land in the building. And the rest is just gravy, I guess, you know? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah. So, one of the things, one of the things that we have done in our group that I think is, is, is helping so, two years in, I bought into my into the surgery center in the med spa.

And the reason I did that is I was, that wasn’t supposed to be an option for me until five years. But one of the partners retired earlier than everybody thought. And when he retired, he said, okay, I’m out. Buy me out. And they hadn’t really thought that far ahead. And so, they did an evaluation and they ended up paying this guy out.

And I’m sitting there going guys, you’re all about the same age. I’m not about to take out a massive loan when you all retire, to pay every one of you off. So, we either figure this out or else I’m going to be fine in another practice. And so, what we did is my, my buy-in for the ownership in the surgery center, in the med spa was assuming the loan that they took out to pay that guy off.

And the way though that we structured future buyouts is we had an insurance guy come in and we all now have a, basically it’s a, a universal life policy that will have a set cash value amount at our retirement age. And when. Want to retire, that policy becomes your buyout. You’ve got the cash value of it, which we set really high, and you can then retire and say, great, I will take my cash value policy and I will now walk away.

And so, older guys in the practice have to put in more money for their premiums because they’re older and closer to retirement. For me, my premiums towards that policy are not too significantly high, but I know that I’m going to have a nice cash value nest egg at the end of retirement, and I’m not going to have to worry about having somebody buy me out.

Catherine Maley, MBA: What happens though, if you wanted to leave earlier? Is there a clause that says you get the piece of whatever you’ve put in already or do you lose that if you…? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yes, you can. Yes. If you leave early, you can take your policy. And it’s because they’re, they’re individual policies under an umbrella.

Catherine Maley, MBA: Gotcha. Now is there, by the way, let’s just talk about staff for a second. This, I’m surprised you don’t have any staff issues because usually on the morning there’s a dictator, at least there’s some clarity, like everyone gets it because there’s this one personality you’re dealing with. But when all of you are working solo or the staff still has to work together as a team. How does that relate to Transforming Patients and Yourself ?

Yeah. How does that work out? Like who do they listen to or…?

Nicholas K. Howland, MD: Brittany, her name’s Brittany.

Catherine Maley, MBA: Office manager? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah. Get, and we had, so, it’s now Brittany. It used to be Stephanie. And that is one of the biggest lessons I’ve learned in five years is find, I, I am, I cannot manage. People around the clock. I’ve, I’m like most surgeons where I want to come in, do my cases, go home and not deal with drama, not deal with, you know, nurses arguing or not doing their job or staff having issues.

And so, you’ve got to find an office manager that can run that ship and you pay her every cent she’s worth because, or him because it will make your life. And so, for us, that’s, that’s Brittany. She does, she does everything. She manages each partner’s individual day-to-day stuff that they need, and she manages all of the nurses and any staffing issues that we have.

And we have regular meetings with her where she says, here’s where we’re at, here’s what we need to do. And she makes life a thousand times easier.

Catherine Maley, MBA: I would just make sure she doesn’t burn out. Because that’s a lot of responsibility. Oh yeah. Yeah. I would, wow. I would, I would take good care of her, those people. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Well, well, and we’d take very good care of her. And those people are hard to find. We, we had, like I said, we had Stephanie and then Stephanie moved out of state and we needed somebody else. And we went through we went through two more before we were able to find Britney, who has been fabulous. God.

Catherine Maley, MBA: Yeah. That’s why I say hang on to her, because especially in today’s climate, it’s been very difficult to find good people. That’ll stay, you know? So, yeah. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Well, that’s, that’s been my mantra as one of the owners as you, you pay your good people what they’re worth. And we have very, very little turnover.

And I think it’s because we, we keep our good people and we pay them what they’re worth.

Catherine Maley, MBA: So, in your five years, just gimme one mistake that you made that you wish you hadn’t, but you learned from it. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Okay. This one is, I, I still don’t think this was a mistake, but, it’s not a mistake. It’s feedback, you know, but I definitely learned a lesson from it.

And so, I came, this one’s a little bit topical based on Utah and the culture here. So, that two-year church mission I served was for the Mormon Church, the Church of Jesus Christ, the Latter-Day Saints. I grew up that way. I grew up here in Utah. I’m no longer a member of that church. But a large part of the community here in Utah still.

And so, a lot of the marketing around here, not just plastic surgery, but marketing in general will oftentimes cater to members of that church. In Utah. It’s a very common phrase to hear people say the church, and you’re just supposed to know that they’re talking about the Mormon church. I remember when I moved to Texas and I said something like, oh, I’m a the church.

A friend of mine was like, what church?? What are you talking about? But here in Utah, everybody knows what you’re talking about. So, I had this idea for a billboard that I thought was brilliant. The Salt Lake City, l d s temple was undergoing construction and was under all this scaffolding. And that temple is a huge part of the Salt Lake City skyline.

Like if you, if anybody shows you a skyline of Salt Lake, that granite temple with the six spires and the big golden angel on top is going to be part of that skyline. And so, when I was growing up a, a thing that parents and church leaders and people would always say to me is, your body’s a temple. Your, your body’s a temple.

Don’t do anything to your body that would, would, that would damage it. Because that’s a temple. That’s the house of God. And so, I, as I kind of reconciled plastic surgery in my mind, and I’m going through residency, It’s really bad to tell somebody, Hey, you need plastic surgery? Go, you’re looking, you’re looking a little rough.

You should get some plastic surgery. Like that’s a terrible thing to say to somebody where temple is not looking so, good. Exactly. But I think it’s just as damaging to tell somebody, Hey, you’re going to have to deal with those size, size H breasts. Or sorry, you can’t have any plastic surgery because your body’s a temple.

I think that’s just as harmful. So, the billboard was a picture of the Salt Lake temple with under the scaffolding and the billboard said, God’s remodeling his temple. Isn’t it time to remodel yours with how? And plastic surgery underneath. Oh my.

Catherine Maley, MBA: Oh, my goodness.

Nicholas K. Howland, MD: Still, I think hilarious and brilliant. I still will take credit for that.

Catherine Maley, MBA: What was the blowback and our house, how quickly was the blowback? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: For the first couple days, I, I knew I was going to get some, some of the church blowback, like people are very sensitive about the religion. I, I knew that was coming. And so, for the first couple of days though, it was mostly positive. People were laughing, people loved it.

And I was really happy. And then somebody who had a pretty sizable following on Twitter, got on Twitter and went on a rant about how I was body shaming women. Oh, okay. And I tried to rep reply, be like, no, no, no, you’re, you’re missing the whole point. This is the opposite of that. I’m saying it’s bad to tell somebody, get something done.

It’s just as bad to tell them they can’t. Like, this is the opposite of body shaming and. It just, its people clung onto that negative image. And I started getting one star review bombed, and people started coming after me on, on social media. And I spent days where I just was, was up looking at every comment.

And I had this, I, I was trying to respond to comments and I finally realized I can’t respond to comments. These people are just here to, to make a mess and to be angry. And I molded over for several days and I finally the local news came and did a story on it. And I, I finally, when, when the local news came, that’s when I was like, you know what?

We’re just to appease people. We’re just going to take the billboard down. I heard all

Catherine Maley, MBA: PR is good PR, no? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Until you get one star Google review.

Catherine Maley, MBA: Phone ring with people who wanted plastic surgery. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I have seen a lot of. Patience come to me specifically because of that billboard. Right? A lot of people saw it and said, oh my God, I love that guy.

I want to go see him.

Catherine Maley, MBA: He’s got a great sense of humor. I think he’s probably real. Like, look, I, I would just look at the numbers. The numbers tell you everything, you know. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Well, I would say, I would say I’ve probably had just as many looks at that and say, I don’t want to go to that guy, And so, the I to this day, wish I wouldn’t have taken it down.

I, I had a friend call me the night before. I had already made the decision to pull it, but she called me the night before and she said, here’s what you do. She said, you get on the news show tomorrow and you say, Plastic surgery is about self-empowerment. That’s what I believe. That’s what I practice.

And I am proud of plastic surgery and I’m not going to be shamed into taking this down because we need to take away the shame from plastic surgery. That’s the whole problem with the world today. And I wish I would’ve done that. I just, my, my two, I was only two years in practice. My Google reviews couldn’t have handled that probably.

Catherine Maley, MBA: But How long, how long was it up? How long was the billboard up? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: A week. One week.

Catherine Maley, MBA: Oh kidding.

Nicholas K. Howland, MD: Yeah. And those are expensive, right? Yeah. I mean, it’s here, it depends on where you’re at here in Utah, but billboards run anywhere from one to 3000 bucks a month. But don’t you have to sign a contract? Yeah.

You’re on a contract and so, we just changed the ad. Oh good. It was a, it was a, it was a digital board and so, we just changed the look of the ad and put something else up.

Catherine Maley, MBA: You know what, but you were a little new, so, maybe that was a lot of critique for, you know, still being pretty fresh at this. I still, I think it’s very cute and it’s a good idea.

I think you could have gotten some good PR from it if you had, could have gone on to do the empowerment. But I will tell you, the media loves the negative, so, they could have turned that around on you. So, like, you think you’re want to talk about empowerment and there’s a good chance they would’ve Gotcha.

You know, so, you’re, yeah. But actually I, I worked with this practice I won’t say who, but he was also, religious, but he was more Christian and he had Bibles in each exam room and I told him, look, you’re either talking religion here or you’re talking. Body transformation, but you can’t do both at the same time.

This is, it’s making me uncomfortable. And I, I’m Catholic, like I, I love God, but this is not the time for us to be talking about Bibles, you know? You know what I mean? Like, I, I was in Utah and I went to the, the church and I was fascinated with it that they were marrying on a Tuesday afternoon.

There had to have been 50 couples getting married, and they were all under what, 18 or something. But I was fascinated with it. So, good for Mormons. You know, they’ve got everyone, they’re, they’re clean living, no drinking, no smoking, I mean, good for them. I don’t know how you get people to do that, but you’re the most productive state I’ve ever seen. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Well, I feel, I feel very blessed to have been a part of that culture. Yeah. You know, people will ask me all the time when I’m telling I’m from Utah, if I’m Mormon and I actually will say, even though I don’t belong to the church anymore, I will say I am because those are my people. Those are my culture.

I’m very grateful for the, the le the lessons I learned for the values that I have because of that. But I also, love being able to speak both sides here. Like a patient comes into my office and if they are a member of that church, I’ve, I’ve been there. I know what those thoughts are and what they’re dealing with.

Somebody who’s not a member. I know what that’s like mm-hmm. And so, I can speak to that too. So, I feel like those experiences in my past have given me such an advantage here to be able to speak to both sides of the coin with my patients.

Catherine Maley, MBA: For sure. So, let’s talk more about marketing, because I love that you’re only five years out. How does that relate to Transforming Patients and Yourself ?

There’s no way you are marketing like your father’s generation did. So, how did you enter the marketplace? It sounds like you, you went to so, well, you, well, you tried the billboard result. Well, you found, you forget that one out. But did you go into the print ads or did you go straight to social? How, how did you put your marketing?

Nicholas K. Howland, MD: Well, I didn’t, I didn’t have a lot of money and so, I I do, I still think billboards work. And I still do billboards. My, my face has been on the side of I 15 for ever since I got here.

Catherine Maley, MBA: Do you keep updating it because you look dramatically different than you? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I do. I do. And yeah, it’s, it’s changed, my appearances changed quite a bit, especially just in the last year.

Catherine Maley, MBA: But do you want to talk about that? Because I almost didn’t recognize you when I saw that introductory video on your website. I thought, that’s not the guy I know! How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I know I need a different, I need a different one. I’ve lost 60 pounds in this last year.

Catherine Maley, MBA: And good for you. Any, any weight tips, weight? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I went through I did the 75 hard challenges.

Catherine Maley, MBA: Love, love, love, love, love. I listened to him. I just listened to him this morning. I love Andy Sela. He’s my main. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah, it was a great start for me. And so, I now at least have a, a, a base to work with, you know, and I got down to a weight that I’m happy with, and now I’m working on kind of building some muscle.

And this last year was a real journey for me. I kind of got out of a toxic relationship and r really focused on myself a lot this year and on learning to love me, and it’s changed every aspect of my life. Both my self-worth, for me, my ability to be a dad with my kids and even into my work life, my ability to be a good surgeon and a good boss and a good leader.

All of those things have changed just by me focusing more on myself and taking care of.

Catherine Maley, MBA: For those of you who don’t know, 75 hard is program put together by this internet kind of guy named Andy ela. And he’s in St. Louis? No, he’s in Missouri somewhere. Maybe it’s St. Louis. And so, he, he, it’s, he’s all about mental toughness and he’s another one who lost like a hundred pounds.

And the thing is, is for 75 days you learn discipline. It’s all about discipline and getting to know yourself and controlling yourself, controlling your emotions. No drinking, no every very disciplined diet you have to read twice a day. You have to exercise outside twice a day for 45 minutes no matter what.

And I think, and I think about him all the time because I’m very disciplined. I exercise like a, like I am disciplined. I even take the darn cold showers. I’m waiting for them that to make me a multimillionaire. It hasn’t yet, but I’m going control my mind more than I let my, you know, I’m going to control my brain and I’m not going to let control me.

So, this 75 hard I. I just never wanted to go that far. But, but I intermittent fast all of that, I just, it is brutal, wasn’t it? Like, didn’t you, I mean, it’s a game changer, isn’t it? For 75 days, you’re so, gosh, darn disciplined. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah. You’re, you’re locked into it. And for, for me, I thought that no drinking was going to be the hardest thing.

But it actually was the water. You’re, you have to drink a gallon of water every day, and as a surgeon, you don’t, you don’t normally scrub out to go to the bathroom, Wow. So, when you’re drinking a gallon of water a day though, you have to. And so, that was one of the hardest things for me. But it was such a good, it, it’s, it’s a way to develop habits.

You know, doing anybody can do anything for 75 days. It’s not going to suddenly just change you, but it helps you create habits that you hopefully continue to stick with to this day. I walk for 45 minutes every morning. That was my outside workout that I would do every day, would be a 45-minute walk outside and every morning I still, I get up and I take that walk and that’s kind of where I meditate and get my day started.

Catherine Maley, MBA: Oh, so, interesting. That’s good. So, back to the marketplace. So, you have the billboard and you’re doing social media? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I, the billboard, I do. I, I started doing a lot of Instagram and Facebook and I started by posting a lot of videos of my cases. That’s become more difficult to do as a, as a marketing ploy.

The algorithms have started pushing those down or shadow banning those people for showing graphic content videos. When I started doing that, they, they didn’t, and those became wildly popular. People want to see surgery and action. You can still do those and you can, and videos still get a lot of traction, but you just have to be careful how you’re posting them when you’re posting them and making sure you’ve got the appropriate kind of filters on there.

Like, Hey, this is a graphic content video. For me, I’ll tell you the secret to my own social media is you need to be interesting. And so, the only things you should be posting are things that are interesting about you. And because again, remember the whole. The whole point of, you know, my belief in my success is you are the brand.

And so, take five things that are interesting about you, the brand, and that’s all you post. So, for me, I sat down and I thought about this and I, because at the time I was throwing anything at the wall, I was doing literary book quotes. I was doing stock photos of people having plastic surgery and saying, BBLs are great.

And just, it was, nobody was stopping and liking it. Nobody was commenting on it. Nobody cared. It didn’t engage you. And so, The five things I came up with for me that were interesting. I’m a plastic surgeon. That’s pretty interesting. And so, I post plastic surgery content, whether it’s before and after’s or videos or education.

I post that. I’m a single dad with two kids. That’s unique and interesting. I love to hike, so, I post about hiking. That’s unique and interesting. I love to travel, so, I post anytime I’m traveling and I love cooking and I love wine. And so, I post videos of me cooking or, or wine that I’m enjoying, and that’s it.

I don’t post anything else. You scroll through and that’s all you see on my feed. There’re no stock photos, there’s no book quotes, there’s no hang in there posts. It’s just those five things and I if, if you don’t have an engaging post, don’t post it. I am a firm believer in posting only engaging content.

Sometimes that’ll be more than once a day. Sometimes that’ll be twice a week.

Catherine Maley, MBA: And you do it yourself or you have a team that does it? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I have, I, it’s a mix. I’m the one who finalizes and posts everything. I do have some content they call them content curators because I actually get the content and then say, Hey, I need you to create a before and after, or make this into a TikTok.

Be, and I’ve tried bringing on people who could run the whole social media. Nobody has your vision. Nobody is going to take it and run with it the way you want to. And so, you’re constantly just like, Ugh, why’d they post this? Why’d they say this? I, you, you just, that’s got to be a thing that you do. I, it’s, it’s a good, and it’s a blessing and a curse.

It’s good and bad.

Catherine Maley, MBA: I do know some surgeons though, who have a marketing team, but they meet with them every week. They go over the content. The, the best part is they’ve got that videographer in there all the time, taping or recording the. You know, the day in life of a plastic surgeon. And then if you can get a good editor and somebody who understands social media well it’s the Gary Vanerchuck thing.

One, one video becomes 96 pieces of content Right person to do that. Cause that certainly makes your life a lot easier. And it’s really engaging content too. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Yeah. Those, those are hard to find. We’re, we’re slowly kind of building that team, but that’s kind of, we, we started from the bottom. And, we’re slowly building that team.

Catherine Maley, MBA: Now I saw your Facebook and I didn’t see YouTube and I didn’t, and Instagram was private. Is that just me? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: You’re looking at Howland Plastic Surgery. You need to go to Dr. Nicholas Howland. Hi, the Catherine.

Catherine Maley, MBA: I, God, I, I’m like, there’s no way he’s doing, cause it said, you know, I’ve got a lot of videos. How does that relate to Transforming Patients and Yourself ?

And I thought there’s no way he put that under private. Why would he do that?

Nicholas K. Howland, MD: Ok, Dr. Nicholas, how’s the Instagram as well as the TikTok? My YouTube channel is sparse. We’re starting to put my podcast content onto the YouTube channel. And we’ll use that more.

Catherine Maley, MBA: So, let’s talk about your podcast. Cause I know a lot of surgeons who have started one and they usually get to.

Four and say, this is way too much work. I don’t want to do this anymore. And so, I always say, you know what, before you even jump in, decide are you and commit, are you going to do it or you’re not going to do it because you can’t do it once a month. It’s got to be consistent; it’s got to be interesting. And thank God I have all you surgeons to, you know, interview because it’s a lot of work to pound this out every week.

So, for sure we’re probably with yours. And I love the name of yours to make it patient. You, you’re, you’re very, you’re very good at inline. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Well, listen, this, this came about really just in the last six months. I had a patient who was talking to me, she’d been through three rounds of body contouring after losing 300 pounds.

And after the last round of surgery, her husband pulled her aside and said you’re still ugly and I miss you when you were heavy. And that. That was a blow to her. And she was talking to me on the phone about this and said, you know, I just, I’m struggling because I’m feeling guilty about my bariatric surgery.

I’m feeling guilty about my plastic surgery. She said, but I’ve never felt better about me in my life. And she says, I don’t know how to deal with that. And I said, that’s actually more common than you think with weight loss patients. Let’s, we should do like an Instagram live or we should do an interview or something.

And literally it just kind of hit me. I was like, hold on. This just needs to be a podcast where we talk about that human element of plastic surgery. There’s surgery, podcasts all over the place where you can talk about what to expect and what surgeries do, what and how the pain was. I want to dive past that.

I want to get into the actual emotional side of plastic surgery. Did it change your life or did it not change your life? Wasn’t it. Empowering, or wasn’t it? And I want to hear both sides. This is not a rah rah, Dr. Howland podcast where people come on and talk about how great I did. No, I want, I bring on complications, I bring on patients who I know are not happy with their results.

And that was, that was how it started. And so, I brought in patients where we were going to talk about their plastic surgery and then it’s kind of morphed into everybody who comes on as a patient of mine. But really, I just want to hear good stories. And sometimes it’s plastic surgery adjacent.

Sometimes we don’t even talk about their surgery. Like I had my sister on who has had plastic surgery, but she has this really cool story where she met her fiancé during Covid. They dated for 18 months online, and then he moved around the world to meet her and get married. Oh. And they meet before they got married.

They, the first time they met was for two weeks in Hawaii, and that was March, 2020. Oh man. And then the world shut down and they, he lived in Australia. She lived in New York, and so, they dated online for the next I talk to you.

Catherine Maley, MBA: Boy, I’ve been to Australia. That’s a 24-hour airplane. Airplane ride. Wow. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: So, they, they only had met for two weeks and then they dated for 16 months online and decided it was worth it.

And now they’re married and they just had their first kid.

Catherine Maley, MBA: Oh cow. That’s a great story. We love stories. I mean, I, I’m a marketer and the first thing you learn is stories are everything. We remember stories. We were, we were told stories. As kids bring on the stories and bring the emotional element that one of the biggest issues, I see in practices is they’re so, logical about the surgery.

Now this is what’s going to happen and this is what, but nobody’s talking about the emotional side. Like, why are you having this? Anything going on in your life? Like, what’s prompting you to do something about it now? And then grab the story afterwards. So, what do you think, you know, has this transformed your life? How does that relate to Transforming Patients and Yourself ?

Has it been a game changer? I, that’s what we all want to know.

Nicholas K. Howland, MD: Yeah. And so, that’s, that’s all we talk about. And I don’t do hardly anything other than set aside. I set aside a block of time once a month to go down to, there’s a, a podcasting studio. And they’ve got, it’s all set up. I pay a small monthly fee where they’ve got cameras set up recording equipment.

I schedule my people; I knock out five or six interviews in half of a day. And then we release and they, they do everything. They cut it for me, they edit it for me. They upload it to all of the podcast channels for me. They even will create small snippets of clips from the podcast that I can use for content on my social media.

And it, for me, I, I think it’s helping my practice from a business standpoint, but it, I don’t care. I don’t this podcast. Does not need to make money. For me, it’s hell, it’s a, it’s helping me become a better surgeon because I’m connecting more with my patients and I think it’s very cathartic for my patients to come on and talk about their experience.

That’s what makes it worth it for me. If this thing blows up and becomes the next Joe Rogan podcast, awesome. It’s not going to, but it might be the best when it gets to that point., if it, if it also, only gets my patience to come on and that’s it. I, I’m still happy. It’s still worth it for me. And so, that’s the other thing I would tell anybody looking into doing a podcast, you have to go into it for the right reason.

If you’re And that reason cannot be to make money cause the podcast. This is not a money-making endeavor. No. The podcasts that make money are few and far between.

Catherine Maley, MBA: So, how difficult is it? How do you ask a patient, do you want to be on a podcast? Cause most of the surgeons still have trouble asking for before and after photos

So, how are you, how are you getting them to agree to full on podcast? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I, let’s say a connection. You, you, you build a connection with your patients that’s beyond the money surgery exchange. And so, if I know somebody has a unique story or if I am, am talking with a patient and they tell me that emotional side, I’ll just like, Hey, I would love for you to come share that on the podcast.

And sometimes I get stuff that is just completely unexpected. Like, I had a, a gal come on my podcast just last week and I saw her in my office for her three months, which is when we do their pictures and we then turn them loose and we see them every year. And I came in to see her after she had gotten her pictures and she was just sobbing and I, what’s, what’s wrong?

And she said, you know, I just, you need to know that this is like the culmination of this long road I’ve been on. I lost all this weight. I was in a very abusive relationship and this has just really helped me see the me that I knew existed. And it was really beautiful. And I just said, I would love for you to come share that.

Will you come tell me that story on my podcast? She said, absolutely. So, she shows up and that was all I knew about her. I didn’t know anything about A lot of my patients that come on there might be friends or they might be somebody who I know their personal life or they might be like locally famous and so, we’ll put them on.

I knew nothing about this. And she came on and started sharing her story. She was in a very physically abusive relationship. She decided to leave the relationship and the day she decided to leave was July, 2020. In the middle of Covid, she put her two kids in the car. She went in to tell her husband that she was leaving and he shot himself in front of her.

Oh my God. And I had no idea that was coming. And so, I’m silent on this podcast and she, nothing. But she goes on to tell the most beautiful story of healing and kind of learning who she was and forgiving him and raising these two boys and becoming an advocate for suicidal awareness. and plastic surgery for her was, was like putting a bow on the present.

She said like it was the cherry on top to finally see all of the work she had done on the inside. And it was such a validation to my message that plastic surgery is empowering, that I, I couldn’t have asked for a better, a better messenger to come on the podcast and share that. And that’s, those are the stories that I look for.

Catherine Maley, MBA: For lead generation then. Would you say social media is your best lead gen piece or podcast is your best lead gen piece where from I would always word of mouth and social media is a very close second. Can you track it? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: So, tough. It’s, it’s hard too, for sure. I, one of the things that I do is I personally engage with all of my messages on Instagram and social media.

So, you’re, you’re not talking to a nurse or a coordinator, you’re talking to me. And that’s a helpful way of tracking. But other, otherwise, and, and there are algorithms built in where we can see if a patient, you know, got to my phone number or website through Instagram or through TikTok. But otherwise, it’s tough to say, yes, this is exactly where this person came from.

Catherine Maley, MBA: Right. Do you find, though, on Instagram, I find I personally just working with practices, I find that the Instagram people are have more sticker shock than others. I don’t know if it’s because they, they’re online a lot and they think like, you know, Boobs or two for one. And like, I don’t know if it’s that kind of thing, but do you find that, that they’re more price sensitive than somebody who came to you from word of mouth, let’s say? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I haven’t, I’ll, I’ll have to look at that. I haven’t noticed that where I’ve said, oh, these, that’s the way it’s going to be. Utah is a little bit unique in that we’ve managed to keep our prices really competitive across for, for, in terms of across the rest of the country. Mm-hmm. And so, we get a lot of out-of-town patients who fly here because it’s cheaper to fly here, stay here, have your surgery here, than to actually stay home locally.

And I think that’s a, a, a unique part of Utah that’s allowed that to happen and allowed plastic surgery to be what it is. For sure.

Catherine Maley, MBA: I didn’t realize we are way over time, so, let me just ask you gimme, gimme. So, well we’ve learned a lot already, but give me one thing that we don’t know about. You already, we know you like hiking wine.

All my favorites of the 75 hard. So, what don’t we know? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Oh boy. I, I, I kind of bear it all out there. One thing I would tell you that, that you don’t know is I. And it, this, this last year, as I said, has been sort of a journey. And so, I have an entire half sleeve of a tattoo planned and I’ve started part of it.

And this is kind of one of my newer tattoos that’s, oh, let me see if I can turn it for the camera. Oh my gosh. And this is actually the skyline of Salt Lake that we were talking about. Mm-hmm. And there is the Salt Lake Temple right in here and the Wasatch Mountain Range. And I’ve got more coming along this arm.

And that’s all kind of a homage to this journey that my last year has been for myself.

Catherine Maley, MBA: All right. So, where are you going with this? It’s going to, so, far it’s one, one body part. Is it moving around? How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: Is it, is it, it’ll all be just that left arm.

Catherine Maley, MBA: Oh. Why do people do that? Why don’t we put them all in one spot?

I don’t understand tattoos. I have enough freckles to deal with. I can’t have any more spots on me, but well, so, you put them all in one place. How does that relate to Transforming Patients and Yourself ?

Nicholas K. Howland, MD: I, I, I am I, I think individual people put them where they, where they want. Yeah.

Catherine Maley, MBA: So, interesting. All right, so, just to wrap it up, do you have any words of wisdom for the new people coming out or trying to figure out where they fit into this marketplace? How does that relate to Transforming Patients and Yourself ?

Any, any words of wisdom there?

Nicholas K. Howland, MD: Yeah, just be authentic. Just be you, you are the brand. Be you, be authentic, and you’re going to be successful. I mean, you’re come out, you’re a board-certified plastic surgeon, you’re well trained. There’s, there’s very little difference between board certified plastic surgeons.

And so, the thing that’s going to set you apart is you be authentically you. That’s the only thing that’s going to set you apart from everybody else.

Catherine Maley, MBA: Oh, what words of wisdom. That is so, darn true. So, how can people learn about you? Because I, I understand the website is Howland plastic surgery.com. Mm-hmm. What was the Instagram?

Nicholas K. Howland, MD: Go to Instagram. It’s @DrNicholasHowland is the handle. Same for TikTok. Same for Facebook. Those are the handles that you’ll find most of my content on. Listen to The Naked Patient podcast. I, I think it’s actually the naked patient colon beyond the operating room, but it’ll, it’ll, it’ll come up if you just look up the naked patient.

And come, come see me in Utah. Let’s go skiing.

Catherine Maley, MBA: Oh, wow. Have you gone up this year? Okay. Yeah, you’re in the right place, that’s for sure. Alright. Thank you so, much. I really appreciate you being on Beauty and the Biz.

Catherine Maley, MBA:  Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on transforming patients and yourself.

If you’ve got any questions or feedback for Dr. Howland, you can reach out to him at, HowlandPlasticSurgery.com.

A big thanks to Dr. Howland for sharing his experience on “transforming patients and yourself”.

And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, 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.

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-End transcript for “Transforming Patients and Yourself — with Nicholas K. Howland, MD”.