What to Watch Out for with New Associates (Ep.157)

What to Watch Out for with New Associates. With Michael Persky, MD

Catherine Maley, MBA: Hello, welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery and what to watch out for with new associates and if you should work until you drop. 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. And today I have a very special guest that I have known for a very long time, and we’ll be discussing whether it’s wise to work until you drop.

And it’s Dr. Michael Persky. Now he’s a cosmetic facial plastic surgeon in private practice in Encino, California, which is Southern California and has been since 1985. Now he specializes in rhinoplasty, blepharoplasty, facelift, laser skin resurfacing, as well as a variety of non-surgical solutions.

Now, Dr. Persky is a frequently invited speaker, both nationally and internationally at facial plastic surgery and multi-specialty cosmetic surgery conferences, and he’s a medical consultant on numerous national and local TV news segments, as well as a featured medical expert in LA daily news. LA times and LA magazine, Dr. Persky welcome to Beauty and the Biz. It is a pleasure to have you.

Michael Persky, MD: Thank you, Catherine. It’s a pleasure to be here and it’s always an honor to be connected with anything that you’re involved in. So, thank you for inviting me. It’s, I’m honored and privileged to be here and I hope we’ll have a great session.

Catherine Maley, MBA: Oh, I know we will. So just to let the audience know, I have known you, you were also one of the very first surgeons I ever met at a conference and it was the Newport Beach Facial Medical Conferences. Those were just the greatest conferences. I just love them. And that was a very long time ago.

So just give us a quick synopsis of how you ended up in private practice. Did, were you still working in a hospital? Did you join your practice? What was your journey? Also, share with us about what to watch out for with new associates and if you should work until you drop.

Michael Persky, MD: Well, my journey began at UCLA pre-med and met in medicine. And my baseball career did not pan out as I wanted to. So, I medical school, Emory university did my residency training at county USC in head neck surgery, facial plastics in, in the last Couple years of my training, I was offered a position with two practicing facial plastic ENTs in Encino, California, and I in 1985, I went into practice with them and, and did primarily ear, nose and throat with some facial plastics as most young doctors in head and neck surgery training do after about five years, I went into practice by myself, going in with them about two years in, I had to buy in a small fee. And then when I went out into my own practice, I just established that by myself. We’ll discuss later my thoughts on what to watch out for with new associates and if you should work until you drop.

Catherine Maley, MBA: But let me, let’s just back up when you were with them, were you brought on as an associate (because I assume you don’t want to work until you drop and I know you have some good insight on what to watch out for with new associates). Then, you stayed for a couple years and then you were offered a partnership or how, what was the agreement?

Michael Persky, MD: The agreement was, I was paid a salary per month. And anything above that, that I brought in, they kept which is I, I found was the, the usual agreement. They kept a whole, the whole thing. Well, I, I was paid my salary at the five or $10,000 a month, which was ridiculous in 1980 5,000, but I, I don’t remember.

But soon after, after the first year I bought in, I think for $50,000. And then I was an independent practitioner where I kept what I brought in and I shared one third of the expenses of the practice, which was pretty steep because I had two established doctors and, and I was young and starting out and most doctors and surgeons who start out don’t have.

Big of a practice and that big of an income flow to get things going. So, I did take out a loan to establish myself, which for me was imperative since I didn’t want to work until I dropped, so I had to get the ball rolling early on.

Catherine Maley, MBA: So, was it helpful to be in a practice with two other surgeons? Were you at least able to live off of their name or their reputation or patients that they attracted, but didn’t want and gave them to you? How does that all relate to what to watch out for with new associates and if you should work until you drop?

Like, what were the. Pros and cons of that?

Michael Persky, MD: The pros were again both of them were, were phasing out of their ENT portion of their practice. So, I saw a lot of patients there and from E T patients, I was able to Gain some facial plastic patients, whether it was a patient who couldn’t breathe and wanted a, a rhinoplasty or someone who had a mom who wanted a facelift and young physicians can offer their services at a lower price than established physicians.

And some patients who are looking for a deal we’ll, we’ll go for that.

Catherine Maley, MBA: And then, so you’re, you were mainly like 100%. Like EM, ENT, no cosmetic or, or what was the ratio at the beginning? And what is it now?

Michael Persky, MD: I guess probably 90% ENT and 10% facial plastics. And that continued to grow over. The first five years when I went into solo practice after five years, it was probably 75% ENT, 25% facial plastics.

And then after 10 years it was a hundred percent. Facial plastics and, and no more ENT.

Catherine Maley, MBA: Gotcha. So, to back up again, how did you. Untangle from the other two surgeons and go out on your own. What was that like? Any thoughts on this in relation to working until one drop and what to watch out for with new associates?

Michael Persky, MD: So, at five years, I, I had established myself. I had a flow of patients. I had an income flow and just felt that it, one of the, one of the physicians was older.

He was having trouble meeting the overhead. Every month, we were loaning a money and the other physician wanted to go out on his own and I wanted to go out on my own. So, we just split up at that point. And I established my own practice.

Catherine Maley, MBA: And then did you open a practice nearby? So, you didn’t, so you could assume that your patients would stay with you.

Michael Persky, MD: Actually, we had a very, very large office space, probably 5,500 square feet, and I just lopped off. 2000 of those square feet and kept the area and, and just re

Catherine Maley, MBA: Oh, okay. That’s a great idea. And then how did you divvy up staff? Did you want to bring your staff with, did you want to start over, how did that work out in regards to what to watch out for with new associates and if you should work until you drop?

Michael Persky, MD: That was one of the things. The first year I was in with the other doctors, I shared staff, but there was always a problem with hello, doctor’s office. May I help you. And which doctor do you want to see? And they have their allegiances to the established doctors. So, AF within a year I had my own staff.

I had my own director; I had my own receptionist. I had my own medical assistant. So pretty much it was a transition from shared to our own, even though we were in the same space, we had our own practices.

Catherine Maley, MBA: Okay. And do you wish you had done it sooner or were you happy to get that experience with what to watch out for with new associates and if you should work until you drop? And get all that credibility under your belt.

Michael Persky, MD: Well for me, I was naïve. I was the first to go to college of my family. I was the first obviously to go postgraduate school. I didn’t take a formal fellowship. My fellowship was being in practice with these two established surgeons who were probably doing the most rhinoplasty in Los Angeles at the time.

And so, I spent. First year, pretty much watching them, observing them and learning. So that was a good experience. I think most of the physicians today are coming out of fellowships. They can learn from their mentors how to run a practice, which is very, very important. I had no idea. So yeah, I, I would do it differently today now that I know about what to watch out for with new associates and if you should work until you drop.

I would definitely. Doing a fellowship and not only learning the surgical and medical skills, but learn how to run a practice during that year.

Catherine Maley, MBA: For sure. So, any staff pearls, the staff can be a challenge, you know, hiring them, firing them motivating them any, any pearls that you learned that work really well (when learning what to watch out for with new associates and the importance of having an exit plan so you don’t have to work until you drop) for you to put together a staff that stay put and.

Michael Persky, MD: Things have changed a great deal over the last three years post COVID with staff. I, you know, I just read an article the other day about staffing and, and not only in medicine, but everywhere criteria today to have hire somebody is that they have a pulse it’s, you know, the great resignation people don’t want to come to work.

So, it’s very hard today to find good staff (or compatible associates for that matter). I think that one must interview them personally. I, I interview all my staff with my wife. Because it has a good insight into things. I don’t, I used to, for many years just trust my medical director, the office manager to hire staff. And then I was, I had the final say at the final interview.

But I think today it’s important for us to look at people from the start all the way through and, and see them in the interview process a few times before deciding on them. If I have a small practice, that’s more like a family feel. So, we have to get a good feel for the person’s ability to communicate with our patients and just be a good person.

And then also qualified in what they’re being hired for.

Catherine Maley, MBA: Okay, so now we’re going to back up because a long time ago we were at a conference and I ran into a very pretty young woman who had, she had just gotten out of, I don’t know if it was fellowship or what, but she was, we were talking at a conference and she said, I’m really looking for a practice to join. Lead us into your thoughts on what to watch out for with new associates and if you should work until you drop.

I don’t, I don’t know what to do. I don’t like, I don’t know where I want to be. And sure enough. I said, well, And then you walked up and I introduced the two of you and take it from there.

Michael Persky, MD: So, it was in San Diego and it was probably 13, 14 years ago. And I was Dr. Shar who is an incredible physician surgeon and person as well.

And you had introduced us at, in the exhibit hall and we began to talk and she told me the things that she wanted to do. And I’m a native of Los Southern California, and she was coming in from the east coast and she wanted to split her practice between Beverly Hills and an outline Los Angeles area.

And I, so I advised her to just stay in Beverly Hills. She doesn’t. To that two-hour commute to the, the outside area. And but after a day or two of the attending conference together, we, we spoke and, you know, we actually talked about, we, we met at the new beauty exhibit magazine and they were asking thousands of dollars to advertise.

And I, it clicked that well, here’s a young doctor coming. She trained with a physician Vito Quella back east, who I always admired his aesthetic sense and his results and particularly facelifts. And she was an expert. Under him in facelifts. And I particularly didn’t want to do facelifts. I always thought facelifts was the greatest one-sided operation.

If you could just do one side, but I, so I wasn’t my favorite thing to do. And I said, why don’t you come into the practice and you can do my facelifts and I’ll, I’ll stop doing those. And you could build your practice in the meantime. And she was. A new mom and raised in a family. So, it worked out good for the both of us that she came in and was able to establish a practice.

Seven years later, she went out on her own. And today she has one of the premier practices in Beverly Hills.

Catherine Maley, MBA: That’s amazing. And then you brought, you had another associate at one time, didn’t you? Having associates is important so you don’t’ have to work until you drop!

Michael Persky, MD: Yes. So, then I was by myself again, which I’m comfortable with and for about three years. And then I was contacted out of the blue by Dr. Ari Hyman, who was at the time, a fellow with Dean Tomi. And again, I always admired Dr. Demi’s nasal work. He’s the premier nasal surgeon in the world, and he had good things to say about Dr. Hyman. Dr. Hyman said he was moving to California with his wife and was interested in establishing a practice.

And again, I said, okay, come on in. And., I saw his work. And once I saw it, I, I say, you know what? You could do all the rhinoplasties and the facelifts. And you know, I’ll just do eyelids and, and other things. And eventually after. A few months I just decided to stop doing surgery and he did all the surgeries.

He was with us for about two and half years and very successful. And now it has it built out his own practice and surgery center. So, I’m back by myself again and actually I’ve been interviewing new young doctors coming out of fellowship programs, perhaps want to join me. The thing is I have a large patient population over the years that I’ve been established since 1985.

And so, patients are always coming in or asking me for surgery. And so currently there’s, there’s an opening there for a young doctor to come in and. You know, I’m probably at the stage of my career four or five years, I’m going to be selling my practice. And so, at this point, the new doctor who comes in has an opportunity of pretty much coming in and getting a Southern California facial plastic surgical practice.

Catherine Maley, MBA: So, in the past, you were not looking at an exit strategy when you hire these associates. And now, now you are like, how are you going to vet? Because that’s really big deal to try to hand your practice another surgeon. But you have to stay put, like, how do you think that’s going to work out? What should other surgeons watch out for in regards to new associates and in your opinion, should they work until they drop?

Michael Persky, MD: Well, it, I mean, it’s interesting.

So, I actually put. Some feelers with some of the fellowship directors this past year and at, we had about 12 interviewees come in and I narrowed it down to two.

Catherine Maley, MBA: And now what were you looking for in them? What were you looking for in a new associate for your end-goal of not having to work until you drop?

Michael Persky, MD: Once again, I think they have to be an excellent physician and surgeon and a better person. So, we, it, we have to be like-minded.

I’ve established my practice on being a good physician and, and having relationships with my patients and, and long-term relationships. And so, I need a person who is warm yet. Very like top, top shelf quality surgeon with great results. Cause I, I, I only, I, everything I have built over all these years is, and the only thing that I really have is, is, is my reputation.

Mm-hmm. But when patients call me, they know they’re getting the best. And so, I’m only going to settle for the best. So, I, I had two of the best based on. Their fellowship directors’ recommendations. They, you know, they said, this is probably the best fellow I’ve ever had, which is again, I heard in the past from the other young physicians who came in.

And so, one for her, her husband is, is moving somewhere else and she, it would’ve been way too long of a commute for her to come in. So that fell through. And the other young physician currently is actually, we just spoke this week. He’s deciding whether or not to take out a large loan. Establish his own practice and build it from scratch or come in with me and for, to come in with me.

Initially, the young physician still needs to take out a loan because our, our deal is different from all the other deals out there. How so? So, banks will give young physicians. Bigger loans. If they show I have to buy this, I have to buy that and I have to buy that rather than I need to support myself during that first year until I build my practice big enough to, to be successful with Dr. Persky.

Catherine Maley, MBA: Mm-hmm. Do you think you can build a practice in today’s world? You think you can build it in a year where you it’s self-sustaining so you don’t have to work until you drop? What about when dealing with new associates? What should others watch out for with them?

Michael Persky, MD: Well, again, it depends on the young physician. Both doctors, sender and Hyman were very active on social media, Instagram, particularly. I think they’re before and AF and again, it’s got to be great results, great surgeon, and very active on social media and willing to work hard.

Now it took Dr. Sun. Longer because she was pretty much in the office two or two and a half, three days a week while she was raising a family. and Dr. Hyman was, was quick within and, and this, so Dr. Hyman came in in August of 2019, and we all know what happened later in 2019 and early 2020. So, during the three, when we had a, we closed for 10 weeks in March of 2020 during his first year.

So just as he started. See patients and, and, and, and bring in some income, we were shut down completely. And he was still able to establish his practice well enough within two years that he was able to go out and, and establish his, his own practice.

Catherine Maley, MBA: So, regarding marketing of a surgical practice, when there are two surgeons there, do you market separately to reach your goal of not having to work until you drop and so that you can have good associates?

Do you do your social media platforms? Is there any crossover? Because it seems to me you would have a different patient demographic probably than he does, you know, is just starting out. How did that work out for you when pondering what to watch out for with new associates?

Michael Persky, MD: And again, I’m different than most surgeons again, because I’m not doing surgery anymore. So, I, his success or her success is my success.

Their success enables them to diminish my overhead in the practice. And my success brings patients to them. So, with both physicians, we took out advertisements in local magazines together, you know, here’s and I promoted them and I spoke with my patients and I, I introduced them to all my patients. And so, it was a combined effort on my part.

Their part because they’re, you know, they have, they, they actually have a double benefit. They’re, they’re getting my promotion and then they will promote themselves on their own to, to carry on.

Catherine Maley, MBA: So, do you, when, when you bring a new associate on board then, is it it’s pretty much two people kind of running their own practices, but sharing staff and overhead? How does that all relate to what to watch out for with new associates and if you should work until you drop?

Is that the point?

Michael Persky, MD: Yes. Yeah. So, during the, the physical space, the equipment and staff, I, I found that when physician, the young physician gets busy enough, then we have to bring in more staff and the staff it’s more than just a, a medical assistant at that point, they need to bring in their own. Type of coordinator, director who really fine tunes, their surgical patients.

Catherine Maley, MBA: Gotcha. And then the new person coming on board, though, this is going to be treated differently because this is your exit strategy, more or less, right. It’s important to know what to watch out for with new associates so you don’t have to work until you drop. You want this person to stay put, buy in and literally take it over and you walk away.

Michael Persky, MD: Yeah. So, in the I, again, I, I basically in the past, I. We had an agreement that was oral year to year.

Oh, going forward. I’ve now spent a great deal of time and treasure, as they say, having a very fair. Contract. So, for me, it’s all about, and this is what I told the attorneys that I dealt with. I, I wanted something to be very fair and I wanted it to be protect both myself and the new physician coming in legally.

So, we’ve established that. And so, yeah, it’s, this is going to be a little bit different, but basically the same setup. So, it’s Fu you know, I, I know. From my experience that a young physician could come into my practice and be very well established in a competitive Southern California facial plastic surgical environment within two years.

Nice. And then have a career going forward for as long as they want to practice. Okay.

Catherine Maley, MBA: Well, anybody hearing that there’s an opportunity out there in Southern California. It’s absolutely beautiful where he’s at. So. Think about that regarding marketing. I don’t see, like, let’s just talk about social media and how that relates to what to watch out for with new associates and if you should work until you drop.

I didn’t really, so you’re not doing any at all right now, or are you going to start doing it again now that you’re on your own?

Michael Persky, MD: I’m- No. I- So people say, well, Dr. John Joseph was a good friend of mine and we’re in actually in the same building. And both of us have around the same time we stopped doing surgeries and, and, you know, we share the same experiences and thank.

He actually gave a great talk at Miami cosmetic surgery. Dr. Diane asked him to speak about his background and you know, I think our paths are very similar. Thank God. We’ve had good careers with excellent results on our surgical patients. No real complications. Thank God. All the patients that went to sleep woke up and they’re…

And it’s not that there’s, you know, any wiggle in our, in our dexterity, because we’re both still doing very fine work on cases and no drug problems or things like that. But at a certain point in our lives, we real like for me, The epiphany came one morning when I had an anesthesiologist show up in no surgery center and I had to cancel the case after he had put the patient to sleep because the alarms were going off and he said I said, is everything okay?

And he, well blood pressure’s 80 over 40. And I, I looked and the, and the circulating nurse said, doctor. So, the anesthesiologist, the blood pressure cuff is on the anesthesia table. So, this guy had just come in, drugged out and had to cancel the case. The mother was in the waiting room. She had flown down from, out of, from San Francisco.

And ER, nurse had explained to her So, you know, there’s just, at this point of my career, I’ve had a lot of good things happen. I don’t want anything bad to happen. I, I just couldn’t live with the severe complication or even, you know, patient death, which. Again, I’ve heard of a, a few in Beverly Hills, just in the past week.

So, with, from good surgeons that I know.

Catherine Maley, MBA: Yeah. You want to go out on a good note for sure. So, is it because you’re down in LA? How important was PR for you to grow your name or differentiate yourself from the others and how that relates to what to watch out for with new associates and if you should work until you drop? When so many others are after the PR as well. And do you have any tips and tricks about PR are you paying for.

Do you just happen to know somebody? How, how does that game work?

Michael Persky, MD: Well, I remember when I first started out, there were some practice consultants who said it doesn’t matter about the skills of a doctor. If you have a good staff and a good PR, we can, we can make you successful. Certainly, that’s true. It will cost you money to do it like anything else.

And I think for me, I, it never sat well with me. And I always felt that we built R PR. Word of mouth, one patient at a time. And one patient tells two patients. And, and again, avoiding that bad patient because one bad patient will tell 10 or 20 patients. So, it’s all about stay for me. It was slowly building things along the way.

I never found magazine advertisement to be good at I’m old. Yellow pages. we’re our, our go to in 1985, we’ve stopped those we’ve stopped those pretty shortly after that. I, you know, I, I, I started on real self when it was new and probably, I was one of the first five physicians there. I think that’s helpful to, and then Instagram today, I think is the best place for young physicians to build their practice PR wise.

And, and it should all be about education. Educating our patients is most important. I, I, you know, I see physicians doing a, a dance and dressing up and, and I think that

it diminishes our profess. Although, you know, who knows that maybe the, the young Instagram crowd is into that. So, I I’ve been turned off by that. One of the things that I did early on the really, the only time I paid for PR was I was one of the first physicians to bring in the technology of a, a fractionated CO2 laser.

And at the time the technology was so expensive that I spent 25% of. That caused me on PR with a Beverly Hills PR firm. And they got me on some of the local and national news, and I spoke about the technology and that led to a few other relationships, but it was very expensive. And so, you know, I, it, everybody has to make their own decision.

I think, I think that if you have deep pockets paying for PR is good. I think that you. Definitely have been a great influence on so many physicians and everything that you have to offer from your books and your services. I’ve learned so much from you over the years and you know, I, anybody who’s watching this, this is definitely the person to talk to about building your practice.

I mean, you, you’re just such a great consultant and. and so, yeah, I that’s…

Catherine Maley, MBA: Thank you for that. Yeah. We’re, I’m also looking at an exit strategy because I don’t want to work until I drop, but I don’t need any new associates with my firm, so I don’t need to watch out for anything that has to do with them. Like we’re all getting a lot older here and just trying to figure out where is this all going?

So just to wrap it, A lot of people are trying to understand the surgeons. Now can’t just be surgeons. Like, even though you just went through like 14 years of hell to become a surgeon. Now you have to start with business school with marketing school, and you’re trying to figure all that out now. So is there any.

Quick way for people to understand the business and marketing side of classic surgery. Did you do listen a certain podcast? Do you read certain books? And if you do, are they on leadership, business, marketing, social media, any tips there?

Michael Persky, MD: Well, again, I, I, the nice book sitting right behind, and again, this was not.

Catherine. I, I have to say that I was contacted about this. I didn’t, I didn’t know what the setup was going to be. There was no mention, I haven’t even spoken to you. I spoke to one of your assistants. I didn’t even speak to her. It was an email. I had no idea what we were doing. There was no mention of plugging you or doing it.

Oh, you don’t have to. I, and I’m not plugging you because anything, again, my reputation’s everything to me. So, I, I, I. It can’t be bought. So, the book behind you, I think is a great place to start. I think that anytime I’m at a meeting, I, I, I think the meetings are important to, to attend one or two, at least a year.

I stay on the more. Clinical side, but there’s always the administrative side. And whenever I see your name there and that you’re lecturing, I think it’s important to come in and listen to see, hear what you have to say. And, and for young physicians, it’s, it’s hard to take in both the clinical and the administrative portions of these meetings.

I think that it’s good to have either a spouse or an assistant attend. So that they attend a hundred percent of the administrative portions and hear everything you have to say. And then again, become very facile in Instagram. Instagram is very important in building your practices. I think real self is good too, but you know, again, there’s cost to, to that there’s cost to everything there’s cost to, to Instagram.

So, you have to have a budget that you’re willing to spend starting off, but I think The, the blueprint should be around a great consultant such as yourself.

Catherine Maley, MBA: Thank you. And so last question in regards to what to watch out for with new associates and if you should work until you drop. What’s one thing that we don’t know about you that’s pretty darn interesting?

I happen to know that you love dogs and you love the beach, but what else?

Michael Persky, MD: My wife is such a good editor. and then she tells me I need to be a better editor. Sure. I probably shouldn’t share the few things that you don’t know about me that I, that I would normally share. So, she’s going to be very proud of me that I’ve done that. Okay. You know, I just think that, you know, we’re all in the same boat life short.

I think that we have to help people. And be honest and truthful. And again, it, it it’d be nice if we could just you know, have, have some conversations and listen to each other and, and get along and not be so wacky.

Catherine Maley, MBA: And on that note, I hear you by the way it has just been a pleasure to know you, Dr. Michael Persky. I just, I think you’re one of the nicest surgeons I’ve ever met before and your after photos are excellent, and you certainly know your stuff as it relates to what to watch out for with new associates and if you should work until you drop.

I’m going to miss you at the conferences if you stop going. Because hopefully we’re back out again. I finally, you know, I, I, I sat on the sidelines for two years, like everyone else.

So now the meetings are starting again. So, I hope to see you short.

Michael Persky, MD: We will we make for the opportunity to speak. And if anybody has any questions, they’re always welcome to, to call me. I’m always open to talk with people.

Catherine Maley, MBA: That’s a really good point. If they want get a hold of you, especially if someone’s looking for a really great opportunity to join your practice, where, how would they do that?

Michael Persky, MD: I, they could contact me My email, [email protected].

Catherine Maley, MBA: That’s easy enough. And is it your website DrPersky.com?

Michael Persky, MD: Yeah, it’s [email protected].

Catherine Maley, MBA: DrPersky.com. Okay. Gotcha. Thank you so much. And everyone that wraps it up for us at Beauty and the Biz and this wonderful discussion on what to watch out for with new associates and if you should work until you drop.

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.

-End transcript for “What to Watch Out for with New Associates. With Michael Persky, MD”.