Hello and welcome to this episode of Beauty and the Biz with Edwin Williams, MD.
Dr. Edwin Williams says,
“I have less headaches with 75 staff then I did many years
ago with only 5 staff.”
How is that possible you might be asking.
Or, you might be saying, No Thank You!
Either way, Dr. Williams is full of pearls and worth listening to.
I used to run a course called the Master Academy of Surgeons where Dr. Williams was the professor and together, we taught the business and marketing of plastic surgery to surgeons who were interested in scaling their practice and setting themselves up for a profitable exit.
So, I interviewed him to share his pearls that have catapulted him to 1 of only a few private, big, profitable and well-run practices today.
Here’s a sampling of Dr. William’s pearls:
This is a “must see” if you struggle with inconsistent revenues, staff issues that keep you up at night and you’re bordering on burnout from being the surgeon, manager, marketer and all the other hats you wear.
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➡️ Robert Singer, MD FACS – Former President of The Aesthetic Society: https://www.catherinemaley.com/podcast/ep-86-robert-singer-md-former-president-of-the-aesthetic-society
➡️ Grant Stevens, MD FACS – Former ASAPS President: https://www.catherinemaley.com/blog/ep-44-covid-19-update-with-asaps-past-president-dr-grant-stevens
➡️ E. Gaylon McCollough, MD FACS – Former President of AAFPRS, ABFPRS, AACS: https://www.catherinemaley.com/podcast/ep-88-e-gaylon-mccollough-md-facs-past-president-abfprs-aacs
Interview with Edwin Williams, MD
Catherine Maley, MD: Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery. I’m your host, Catherine, Maley, author of Your Aesthetic Practice – What Your Patients Are Saying and consultant to plastic surgeons to get them more patients and more profits. Now, today’s is a very special guest.
It’s Dr. Ed Williams. He’s a facial plastic surgeon. And since 1999, he’s been in private practice in upstate New York in a cute town called Latham, which is in Albany and which happens to be the capital of New York. So, he also has locations in Manhattan, Saratoga, and the Virgin islands. So, he’s grown has main practice.
Into 22,000 square foot facility with four surgeons, 75 staff, a surgical center hair center, and med spa. Now I’ve known Dr. Williams for years. He has shared the podium or I’ve shared the podium with him at medical conferences, since he’s well-known for his business acumen in running a successful.
Eight figure practice with lots of moving parts. Now, as a matter of fact, I used to run a course with him called the Masters Academy of Surgeons where Dr. Williams was the professor. And together we taught the business and marketing side of plastic surgery to surgeons who were interested in scaling their practice and setting themselves up for a profitable exit.
So, Dr. Williams have served on many medical society committees. He’s also past president of the American Academy of Facial, Plastic and Reconstructive Surgeons. He’s also an author of his own consumer book for rhinoplasty, and he’s got another book and he’s got his own podcast and consulting services for surgeons. And it’s called the White Coat Entrepreneur, which I think is a brilliant name. Anyway, welcome to Beauty and the Biz Dr. Williams.
Edwin F. Williams, MD: Well, thank you, Catherine. And just a couple of minor corrections. So, I went to practice in 92, but I built, I built facility in 98 around that timeframe. And we’ve got actually five core physicians and we have one joining us in July full-time and another one in July 23.
So, we’ll have, we’ll be up to seven. So. But I’ve made every mistake out there. So, I like to, I like to share, and I love this stuff as you know, because you, and I’ve spent a lot of time teaching together. And mainly because I learned, you know, what every juncture, right?
Catherine Maley, MD: Well, so it’s a long story, but could you just give, like, everyone loves to hear, how do you get from like residency, fellowship, private growing? Like, what was your journey to get where you got to.
Edwin F. Williams, MD: Well in the beginning. So, you know, I don’t want to bore you with residency stories and, and you know, and fellowship, but I, I wanted to do a fellowship. I was interested in rhinoplasty and so I did a facial plastic fellowship in Chicago. I wanted to come back east because my family was on the east coast and I was just scared.
And obviously I’d, you know, be out in the Midwest or out in the west, somewhere skiing, but my family was here. And so, I looked for a town. I basically was pretty, pretty neurotic. I got a map out and found out, went to the library. No one does that anymore, but I found out where their plastic surgeons and facial plastic surgeons back then, and.
I needed to have a town where I could be involved with a residency program. And you know, for some reason I knew from day one being in, I felt, I felt very secure in my training, I guess, too, which is important because you know, sometimes I encourage people to take a stint in a university for four or five years where they just get, you know, work their ass off.
Blood and guts all over him and, and really become better surgeons. But I just, I knew that I wanted my autonomy, I guess. And was willing to take the risk and whether it was brilliant or, or, or crazy. I’m not really sure, but it, it worked for me, but things were definitely different back then.
I mean, we really didn’t have, you know, aesthetic. There was no non-surgical, so we had skin cancer and sewing, lacerations and trauma. So, I went out on my own and, you know, I went to a town where I didn’t realize this, but there was an eight-person plastic surgery group that. Probably, I think it was the oldest in the country at that point.
And they had it out for me. So, it wasn’t easy. It was not easy to start at all. They were, I mean, there was some goofy things like the bylaws in any of the major hospitals you had to be in practice for two years in good standing before you could get on the call schedule. Well, how do you start, you know, as a young person and, you know, I walked the ERs every morning and every night.
I did it, you know, it would go at the beginning of the shift and go at the end of the shift. And you know, slowly the phone would ring. I go visit 10 dermatologists and one or two would send me patients, you know, and they take a tray and you know, they would be happy, I guess. But a lot of people are not really, you know, we weren’t really interested in, in, in the new guy there, there wasn’t Instagram and there wasn’t marketing at all.
Really. There wasn’t, there weren’t even websites. I mean, you know, people have fax machines, so it really does sound like dark ages, but, you know, it’s the same, no matter whether it’s 20, 22 or whether it’s, you know, 1990. 30 years ago, it’s really all the same stuff, because I talked to a lot of young folks who so I, I believed in myself, I, I grew up in a small family business.
I, my, my, my dad was the only one who was educated. From college from high school that is of seven. So, there were no professionals in my family. It was really blazing a new educational trail, if you will. And then you know, I started to get a revenue. I lived very conservatively in the early years because I knew my end game was to continue to just reinvesting in the practice.
And I, it’s interesting when I was in practice 10 years and I remember meeting with the financial people and I think they were kind of shocked how little I had in security assets, you know? Because I had it all invested in the business and real estate and everything else, but and then eventually started to, you know, took care of the businesses, started to take care of me.
But that was, you know, years later. So, I don’t know. That’s kind of the short version of it. Yeah.
Catherine Maley, MD: How did you get what possessed you to build a 22,000 square foot facility I’ve been there? It’s gorgeous. It’s beautiful. But what, how, how, how long were you in practice before you decided to do that? Cause that was a big jump.
Edwin F. Williams, MD: I started in 1992 and I broke ground in 97. So I was, I was definitely on the fast track. Again, maybe it was reckless. I’m not really sure, but you know, the, the, the building of the real estate was probably one of the best decisions I ever made. At the time my wife will tell you, I lost a lot of sleep over it.
I get up in the middle of the night and pace. So, I was 37, 30, 8 years old, but I, when I made that you know, and I made that decision and it’s, it’s like, you know, when you commit to something, you have to make it work right. So, I did it at a young, at a young age. And so yeah.
Catherine Maley, MD: So, was the intent to grow your practice to fit a 22,000 square foot facility?
Or were you just going to practice on one floor and rent out the others? Like what was your thought process or your business model?
Edwin F. Williams, MD: So that’s a good question. So., I wanted to maximize the real estate. I knew I wasn’t going to occupy it by myself, if we meaning put a surgery center in and my practice was over 50% of the building, you get more favorable interest rates because it’s owner occupied.
Okay. My plan was to slowly grow, to rent out the other space to help cover the mortgage, and then to slowly grow into the building. And we now We now occupy the entire building. So, and that’s just really the last, you know, a John Wayne said once there’s no such thing as a shortcut to a 20-year success.
And I, I remind some of the younger folks, because I didn’t have money. I didn’t have family money. I wasn’t, nothing was given to me except you know, add a boy and a kick in the ass. But I. My plan was, and we did, I mean, just this past year, we finally have taken over the entire building. So that’s kind of cool.
But that was my plan. I needed something to, if I, if I figured if I made it just, you know, if I had help with it, I could always grow into it. And that’s really what I did. I rented out actually I rented out half of the building. Initially there was a. Laser. It was called gimbal vision. They laser vision center that went in two or three years after I was in the building.
And that space was empty. They took over the space and they went, you know, they went bankrupt in two years and left me with a whole build-out. So I was, and that’s when I first broke. Nurses and nurse injectors and started our rejuvenate center. So that was in 2002 or three. I was one of the first people in the country to have nurse injectors back then, but I figured, okay, I got to take over this space.
I got to do something with it. And I realized by separating the business model, by having them separated, you could have your own team. Strategic planning. And you’ve heard all my, you know, my stuff on outbreak and how to escape your operations. But I knew that I could be more successful if we focused just on that.
And so that was actually grown separately on its own parallel track. But in the beginning, it was just kind of coincidence the other floors in the building. I rented out. I did have one plastic surgeon just took us, took space by had family. A woman who does hair extensions and all kinds of things like that.
And some of the space one was a laser hair removal. They were there for about three or four years. Then they went bankrupt and left us with space. So, it wasn’t all rosy. You know, the surgery center was one of our, is one of our tenants and we’ve had a couple, we’re doing great with the surgery center now, but we’ve had a couple of rough years for that too.
So, I don’t want to paint a picture that. Rosie. I mean, anytime someone sees reward, they’ve usually taken risks somewhere. And honestly, the first conversations I have with people that I bring on board, you know, colleagues, associates who end up eventually being partners is you know, what we have is not.
So, unless you want to write, you know, write me a big check. I get to make the decisions. But I talk about risk because it’s, I G gosh, I get weekly, Catherine, I get phone calls. How do you bring someone on board? And I both know 95% of us fail at that. Or maybe that maybe it’s a hundred. I don’t really know many people.
I mean, I don’t know anyone. Who’s, who’s got this many people on board and they’re all about. That’s the challenge you have is when you bring really good people. Cause I’m not, I’m not looking for the biggest group. I want all rock stars and with rock, you got rockstar personalities, you know, but I always had this vision and that’s why we’re right here by the airport of, of building a destination practice.
And we are, you know, the, the percentage gets, you know, larger and larger that people come from a distance now, but that was always kind of my vision. You get a bunch of rock stars, each specializing. In one place, and then you have an economy of scale that we have now. I mean, when you were here last. We certainly we’ve completely renovated the building now, but we certainly didn’t have the team.
I mean, I’ve got an accounting team. I got a full-time CFCP CFO. I got a full-time person here as far as business development. In addition to Susan Sullivan, she just does operations. So, we’ve really built now with an economy of scale, which allows us to do things at a higher level. And I learned that from a buddy of mine who I went, you know, it was in about 90.
About 2005. I went with, he ran a publicly traded company. I learned a lot of lessons from him and I was hanging out at the track cause they sponsored a zip Saratoga Raceway. They sponsored one of the races and I met his management team, his CFO. I met his person who was in charge of examinees merger, acquisitions his HR person.
Wow. Imagine if I had a team like that, how effective I could be. And Amy, you know, realize the benefit of having an economy of scale and helping your talent and building a team that was a real Tiffany for me. And so, it was a long process, but it didn’t happen over. Well,
Catherine Maley, MD: I think the doctors, you know, I talked to an awful lot of surgeons and they like what comes first?
You know, they’re, they’re very risk adverse naturally and void because the whole point is to run your practice like a business and a business has people in charge of the profit centers and you’re not running the whole show, but number one, you have to let go of control. You never do. You still have to manage it or leave.
And then number three, you’ve got to get the right people. And then, but then the doctors are thinking, how am I going to pay all these people? Like they’re not even revenue generators. They’re like, they’re important people for business. And until you can figure, like, look at that and say, but they’re leaving you more time to do what you need to do to grow the practice.
Can you speak on that? Like how did you scale without fearing you can’t pay for all of
Edwin F. Williams, MD: this. Well, I did it slowly, but, but you’re, you’re absolutely right because I talked, I, you know, I, I talk about this on my podcast too. I think the physicians are almost set up for failure here by the very nature that they made it through plastic surgery or facial plastic surgery, and at the top of their game, they have an ego and you can’t build a very successful team.
If you’ve got an ego, it’s just that. Right. You look at the best CEOs you look at like Jim Collins work great by choice. You’re built to last or a good-to-great, which is probably my favorite book. And I reference it all the time is level five leaders have humility. And they realize the importance of the team.
We learn going through our training that we learned to be individualists and we learned to be independent. We learn not to lean on people. We go to the emergency room in the middle of the night and someone’s bleeding all over and, you know, God forbid you get somebody to help you. So, you learn how. You know, open up the instrument pack with your feet and you know, and so we learned to survive as individually individuals and then, you know, people cause I, I get friends of mine call me all the time.
So, it’s like, I want to bring, I want to bring on a plastic surgeon. I know done this. How do you do it? I said, you got, you know, you got, you got several hours. First of all, there aren’t enough hours for me to be on the phone. Cause I could tell people that are just not coachable, right. 30 to 40% of physicians I talk to are not even talking.
And they don’t realize it and they don’t want to hear it, but if their ego gets in the way, if they’re not willing to give things up, they’re not willing to share equity play by the same rules. This is another big one. I see all the time, you know, you know, Dr. Joe Smith has been in practice 12 years.
He starting to do well, you know, but he wants more time off. And so, we want to bring someone up. Well, no one, no rock star is going to come on and take all the junk you don’t want. And by the way, your practice now is a lifestyle business. You know, I don’t know if you know, differences you probably do because you’re a business person, but a lot of physicians, when I say that, they’re like, what do you mean?
I said, are you growing a business to have a business, to have assets and have profit, you know, re an ROI. No EBITDA, do you have income at DIA? Do you have profit at the end? It’s worth something or do have a light lifestyle business? Are you living? Off your business. And I dare to say, most physicians say savior in practice for 12 years in a very successful, you know, they they’re over expensing things there.
And so now they bring someone else on board. You have to live by those same rules, right. That you can’t expect them to come on and be partner. And by the way, you’re living, you know, you’re living off the business and, and it’s, it’s hard to break that mindset, especially someone. And by the way, I’m no, we’re no different than any other small business people.
You know, how many small business people, their businesses, a lifestyle business, They have no real intention to grow it, to sell it or to divest it. In fact, so many small business people get to that right age. And all of a sudden you realize your businesses don’t risk anything because they haven’t set it up to sell it. I don’t know if that answered your question. I know.
Catherine Maley, MD: Well, talking about scaling, they only way you can get out of being the only service provider. Cause that’s the problem. You’re the service provider and it takes you to be that. So how does, how do you scale? Well, you open up different profit centers, which is what you did, or you bring on partners, but do you bring them on as a partner?
Are you better off starting off? I don’t know, an associate and seeing how it works out, like what you’ve been through a lot of that, like what, what’s your best bet to bring somebody else on?
Edwin F. Williams, MD: So, the first there’s two kinds of two parts to that. I have, as you know, I’ve got a, a chief operating officer, someone who runs in, in the problem, cause I actually got buddies of mine who were trying to do the same thing with law firms.
If you are still a technician, which I am. That takes a lot of your time. Unless, you know, there’s some people that don’t want to be doctors and surgeons. I still really enjoy, you know, I still really enjoy that part of my life and you can’t do that. And then by the way, here’s the other thing is we devalue the importance of running the business.
You know, we want to five o’clock in the afternoon, you know, when we’re. I mean, I’m talking to you in the middle of the day. It’s noon, but I put this in the schedule a month ago and I’m going to make time because this is a priority. Most of us, God forbid we take time for meetings during the day. Now the other option is to run your family.
Ragged, you know, will not be present in home at night or on the weekends, which you know how I feel about that. Right. We’ve talked about it. I don’t even want to do, I don’t even want to have a phone call after, you know, after six o’clock at night because you know, I, I. BN on, on my, a game. So that’s the first part of is you.
And this is where there’s two parts to this too, because so many doctors, they bring your spouses in to run the business because you’re too damn cheap to pay a real, a real operation person. Am I right? Yeah. Okay. And then the other, or they just don’t want it. They don’t want to spend the money to bring someone in.
You’re never. So, I live my mantra. What I live by is if there’s somebody that can do something 80% as well as I can do it, it’s time to move on in surgery included by the way. So, you know, and that’s what I struggle with right now because you know, I’m 62, I’ve worked very hard to be in a position where I don’t need to work.
I’m there. But walking away from surgery is really hard. It’s really hard. But if you do, it takes you a long time to get good at it. So, making, having a discipline to invest in. And, you know, have the conversations, being able to hold them accountable, respectful. They, so that they, you know, you don’t just go out and here’s the other problem.
Doctors say, I need a COO. Okay. And rather than really vet the heck out of it, slow to hire, which is, you know, Jack Welch, they go out and they hire someone and it doesn’t work out in six months and they’re cause they’re a freaking hot mess and they didn’t. Do it correctly, doctors solve problems. How do you solve a problem?
You solve it quickly. You know, we’re used to being, being surgeries. That’s not higher. So, you have a, you know, you have a couple failures there, but if you have that right person, then you can go to the next. Does that make sense? So, and rather than, you know, and I, you know, what blows my mind because you know this, you and I had this conversation.
I have a lot of friends in real estate. I have a lot of friends in insurance. They a ton of money on personal and professional development. I spent a ton of money on personal and professional development. I know you do too. Okay. God forbid, doctors spend a few dollars. I have a guy that’s on a retainer. I meet with them once a month.
I have, you know, all the different things I can do and you do the same thing, but physicians don’t value this stuff. They think it’s beneath them. And I know I’m preaching to the choir, but this is the single most important thing is that is switching your mindset. Back and forth from being a surgeon to a business person and realizing that you can’t do it all.
So, when you bring that person on again, and to me, if you look at the ideal team and you’ve got a person who’s in charge of developing, growing our business, we have someone now you met, maybe you’ve met Monique. She’s a. She’s got her BS in neuroscience, in an MBA, and she’s smart as hell. That’s her job.
And so, if you start to say, okay, what could I achieve too? And then no, you have to do it slowly. But rather than a, an old timer told me, say, if you take care of the business, it will take care of you. And that’s kind of where I’m, where I’m at instead of going out and buying a new Mercedes ed Williams.
Gets jacked up or here’s a better one. I’m going to go buy a, you know, some new piece of technology that conveniently price is priced around a hundred thousand dollars. Okay. You know what? I get excited when I hire a rockstar on our team. So, I invest in people, but again, back, go back to Jim Collins. I invest in the people and make it a place where they want to be. And it’s a win when we win versus, you know, buying more tools.
Catherine Maley, MD: For sure. While we’re on the subject of staff, you are very good at setting up a culture. And when I consult with practices, I think the culture thing confuses them. Like, what do you mean? What’s it going on? What’s culture? That that’s, so it becomes so important, especially for somebody like you, who isn’t afraid to add 75 staff.
Now, most of my is cringing right now it’s managing 75 staff, but the, the, the mindset. Change that, or the mindset shift you have to make is staff is not an overhead expense staff is an asset. You speak to that.
Edwin F. Williams, MD: Yeah, I can. I can, you know it, it is a mindset because most of us say, okay, I’m making all the revenue and you, all people are taking it from me. Yeah. Right. So. Investing in the people now, the late herb Keller, who’s the CEO of Southwest for many years who founded Southwest and he’s got an amazing and fascinating story says there’s three roles of the CEO.
And I, I recite it so frequently and my team gets tired of hearing it. But number one, people have to see your vision for me. It’s. Putting a world-class practice together and a destination practice with super specialized people. Okay. Number two, how you make money? You got to tell your people how to make money.
You know, my, my management team, there’s four or five of them. They see the numbers; doctors won’t take their class. They are afraid to show the numbers to their people. Okay. And then third and probably the most important thing is create the culture. That is the number, the three most important things that the CEO vision, tell your people how you make money and then creating your culture.
Now, I got to tell you, when I read a lot of Verne Harnish’s work habits on, you know, creating a culture 15 years ago. It’s I can understand why most physicians have a hard time getting this in their head because I did too. That sounds kind of corn. I mean, what do you mean I got to, you know, create, so how do you create a culture it’s by every single day, everything you do is deliberate and intentional.
I’ll give you an example. Our culture here is, you know, we have our motto. The Williams center taking care of each other and you, and we do that and we live and we live it and we breathe it and we talk about it. Okay. At the huddles in the morning, if somebody, you know, is an example of our culture, we should…we, you know, they bring it up.
My managers do, do you know yesterday, Brianna you know, so-and-so broke down in the north way. She drove up there herself, used her AAA card and got their tire fixed because they don’t have triple. Okay. That’s a true story. And, and, and, you know, we just want you to know Brandon, you know, I mean, that’s exactly who we are and I just want you…kudos to you.
So, it’s and then we will hire people. And so again, our, our motto is Williamson or take care of each other. You and our part of our culture is we have a culture of winning and accountability, brutal honesty. In reality and having the difficult conversations with people in a structure or whether it’s coaching or whether it’s my Mo my monthly meeting with the managers, where we talk about these things and.
Because I know that they’ve done their coaching and when I asked them and I get the whole structure, you know, but I’m just jumping around. But if, if, if my manager knows that I’m going to say, who did you coach this month? And she says, Brit. And I said, okay. And you know, what is she struggling with? You know, what does she think that we should do as a business?
Where does she think we’re leaving money on the table? What’s the biggest frustration they know I’m asking those questions every month? Do you think. And not coach somebody that month. And so, what do I mean by winning an accountability, that’s the winning and accountability, you know, you help us grow our culture and put it to the bottom line?
You’re going to get rewarded. And we, and now, because we have an economy scale and we have a very significant, you know, profit EBITDA at the bottom of. We handed out some huge bonuses this year and or 2021. And that’s because it’s tied to profitability through. So that’s, that’s our culture you show up.
And when you know, you know, you let me hold you accountable you. And by the way, people are not part of our culture. They don’t last. And there’s a guy by the name of Ray Dahlia. Who’s a, he just wrote a book called principles and I read it over the Christmas break and I, I couldn’t put it. Guys we’re in hundreds hundred, most influential people in the world, UK, we’re the fifth largest private companies in the world.
And wondrous wealthiest people. You probably know who he is. Yeah. So, and Bridgewater, not Blackstone, but he, but anyway, my new mantra is if, if people aren’t, aren’t part of our vision. Okay. And they’re here for just a paycheck. Get rid of them. And that is your culture. So when, when people know that if they deliver, they’re going to be rewarded and it’s talked about on the, you know, at the interview, it’s talked about at the huddles, it’s talked about at our meetings with brutal honesty, which is you can’t do at four o’clock in the afternoon.
So, the mindset change really for the physician is to become a deliberate, deliberate, really become a business person. But I got to tell you a culture is a really hard thing to wrap your head around because it requires being brutally, brutally honest with each other. We’d let them, we all have things we struggle with, right?
We’re not good at everything. Let’s talk about it. Let’s, you know, let’s do an assessment and find out what Catherine’s struggle. And build it. And but that’s it, you know, I read this once and I, I believe it now, when people start to refer to your culture is almost a cult. You when you’re there.
And, and, and I do believe that now, because I think our culture now is, is stronger than ever. We, we, we ha I mean, it’s kind of corny, but we’re like a place to work. People want to be here. I’ve had people say to me, Take a job at the front desk and say to me, I just wanted to get my foot in the door there, but it’s, it is probably the most difficult thing to do because it doesn’t come naturally to those of us who are individualists and performers and have learned to do it ourselves because we don’t understand how important that team is.
Catherine Maley, MD: Well, talking about the team. We have to talk about how you’re motivating them and especially with bonuses. And one thing that gets all kind of alluded is when you have the closer the coordinator who is the closer, she had that position happens to become this us and them kind of thing. Like, like she’s bringing it and nobody else’s, but it takes a team to do that.
You have been very good about building the team culture. So, people are not. Directly compensated for their productivity. They worked together as a team, but then they don’t know what their bonus is going to be. But then I think to myself, but you know what, that’s not the right culture for you. If I’m money motivated.
And I come in and I want to know if I sell this for you, what do I get? Like, then I wouldn’t be a good fit for your culture. Like, can you talk, speak on that because that’s…
Edwin F. Williams, MD: No, no, I can, I can absolutely speak on it. So, first of all, any problem or challenge you have in one business has been solved in another industry already?
What can we agree? Right. So, all I did was steal ideas from other people. Right? Okay. So, you made reference to performance models. I believe so. Our senior PM. Have a performance model that is a very nice base salary and they are tied to the increase in the profitability of the business that they are involved with.
Okay. Our highest-level people who are crossover all the businesses, like for example, Susan and our CFO, they had the same thing, but overseeing all businesses. As you come down, the position in the skills become different. Our patient concierge. For example, if you, by the way, the, the, the personality of the salesperson is very different than a personality of a nurse.
Can we agree on that? Yes. Nurses in the culture of nurse nursing is not to want their handout. Okay. In fact, I’ve had nurses who you’ve come to interview and they were somewhere else and they were used to getting tips. I won’t hire them. I mean, because they’re not part of our culture, you know, there’s medical team is when you’re delivering care is different.
However, the skills that it takes to sell, and if you want more sales, you hire more and better salespeople. They will chase a dollar.
Patient concierge having a nice base. And then they get a small percentage, which they know that number by the way. So, this is different nurse injectors. We’re going to talk about them too. A very small percentage of, of what they see over a certain revenue number okay. For the year and that’s distributed quarterly and we hold back some and we give it at the end.
My point for telling you is that a big part of the salary is not. The percentage piece, because then it becomes a fee-split if ever questioned by an OPMC. The other problem is I have had made this mistake where I have patient concierge or patient care coordinators who are like, you know, I generated a hundred thousand dollars this week and we that’s here’s a correction.
Okay. No, no, no, no, no. I had this, I had one of our patient care and I said, no, We did as a team, everybody from the front desk. So, and the minute they start to feel that they’re indispensable, you need to get another one. And that is what we do. That balancing act. We never get anyone become indispensable so they know what they know, and they have the other, we actually just introduced this issue.
We started to notice that the patient concierge, we coming a little too individually. You know, on their own. So, then we put another layer in for them to cooperate with each other, and it’s not a ton of money, but it’s enough that they know that if the phone call comes it’s, that’s not Patty’s patient that’s, you know, it’s, our patient is part of the team.
Nurse injectors. What I, what I indicated to you is that we pay them. I have found, and I, and I listen, I’ve got people been living for 20 years, 22 years, you know, so, and we have a lot of longevity in our staff here, which it, you know, I mean, that’s the biggest, I hear this all over. I don’t know what you’re doing there.
I can’t keep people. You know what the problem is. They, they hire people too quickly. They train them and they expect them to solve the problem with the, everything. And what they did is they hired the wrong person. They dig hired too quickly. So, if you get that right person, you bring them on their part of the culture names, you know, when, after they started to become trained and we want you to understand, we pay attention to the numbers and we, we see what you’re doing and whatever, and they, we don’t tell them exactly what, but they do get quarterly bonuses and they know those numbers they’re tied to their productivity.
The manager. I do see all the profit loss of balance sheets or the business I’ve learned. You can’t show everybody because you know, hourly front desk person, or even one of the nurses, they see these numbers and they think they’re huge numbers. In reality, they don’t know what the expenses are. Oh. So, I’m very transparent with our, with our partners.
I’m very transparent with the management team. We even had someone who is are running all our marketing and we had to, we just decided that, you know, she wasn’t someone, we wanted to see the numbers because, you know, in her mind, it’s like, oh my God, I’m worth a lot of money. You know? It’s. I can’t say I have the answer for all of that, but what we are doing works and I am, I am absolutely opposed to an arrangement where, you know, the nurse, by the way, it’s illegal, you know, I can pay an MD 20% of gross on injectables, 35% of net gross on surgery.
But, and, and, and it blows my mind when I have arguments with colleagues of mine, that they disagree with me and they say, no, cause it’s not Medicare. It doesn’t matter. Go look it up in the American college assertion, revenue sharing with a non-physician is unethical. And, and, and instead in New York, it’s considered minimum medical misconduct.
And let me tell you, you do not want OPMC banging at your door. They’re worse than malpractice. So, I don’t profess to have all the answers, but I do know what we do work. A part of is, is it comes with the conversations. It comes with the conversations and then sit downs. And if there’s one thing I do better than we ever have done, excuse me, in the past is communication.
Every time we have a problem, one of the businesses starts to run off track a little. I realized the communication has been. Whether it’s the managers meetings and I’m not rolling up my sleeves and digging up, or, you know, digging, digging, digging deep enough. But I, I’m sorry to go on, but it’s not like a one size fits all kind of thing, but I, I do believe, like I said, our, our managers received some half the bonuses this year.
And I can talk to you about this offline a little bit more, but I have no problem with that because they’re the ones dealing with the headaches. They’re the ones dealing with this one called in. And so, the way we deal with that, cause this is, this is the, you know, a nurse comes and says, you know, I, I know that cause they all talk right.
So, let me ask you something. So, are you, you know, are you looking, does that mean you’re interested in patient condition? Well, I, I, I, you know, it’s a different position. The different skillset is you. If there’s a position you could apply for that position. But you know, we all think we’re valuable, but, but the reality is sales drives.
Sales and marketing, you know, I mean the old saying, right, CEOs all hate marketing. They know that half of the marketing works, but, but is a very integral part. And one of the things that’s changed and said, you know, you and I worked, I’ve realized how important, how important marketing now, you know? And having.
Good marketing. And you know, you’re very ethical, but there’s a lot of, and I’m going to say this because I’ve known you for a long time, and I know you’d be a very honest person, but you know, they’re, especially in the digital space, there are so many unethical people out there trying to profess to be, you know…
Catherine Maley, MD: And promising you so many patients every month, you won’t even be able to take lunch.
And I’m so tired of the, over the over promising and under deliver, because then that affects all of us. I know that it takes persistence to grow a practice and it’s not an overnight, then it’s not a one hit wonder. And if you can try that, but you’re going to end up doing it. You have to get the fundamentals in place.
Edwin F. Williams, MD: In 2015, I realized that I had too much responsibility on my plate for my other associates and partners. And if I wanted to build a team, I needed to get more professional in my marketing. Well, I made an incredible mistake. I hired and I got to tell you a call cost us multiple. I don’t even want to tell you what it cost us.
Multiple. Okay. Six figures. Oh my God. There’s this group that was going to take over everything, including social. And they profess themselves to be incredible, like really incredible. Okay. And they were an incredible disaster here later, our revenue dropped 25%. They had totally locked up on everything.
They totally over promised and under delivered and I don’t know he did, you know, all I know is they were an incredible disaster.
Catherine Maley, MD: Oh, how long did it take for you to figure out that things were going sideways? Because it’s not even just the money, it’s the time that you’re losing.
Edwin F. Williams, MD: Actually, you make a really good point.
So, we had, so, and I, you know, these are people that you and I’ve shared the podium with. Hmm. Okay. And I’m, I’m disgusted at how they took advantage of us. They didn’t. So, the first we had someone who’d been with for 12. And again, you know, someone I like actually, and I had, I had to come to…Jesus…conversation with them in 2015.
And I said, you got one year. And by the way, I’m not afraid to spend money. Okay. I’m not afraid, but I need, and we put, you know, we put someone on hold, holding them accountable and see whatever. And, and all, they were interested in selling us more shit, selling us more shit in bigger programs and whatever.
And the reality was they didn’t deliver it. And at the end of that at the end of that year, I had a, another “come to Jesus” conversation because when we got rid of them, it took us six months to get our website back to get. And I actually hit that on the phone with them. Okay. And I said, Robert, you and I are going to be on the podium in about three months.
And I’d hope not to take this out on the podium. Well know what a freaking shyster you guys are. Okay. And I don’t need to say last names, but you can do dues do the math. So, then we ended up going to another. Group that was recommended by, you know, a consultant. I have a ton of respect for, and they were, they did a nice job designing website, but they didn’t, they didn’t know SEO.
And that was another year of a slow screw we got. So, then I think we were, we were right to go with someone begged who had, I was like, Let’s throw some serious money at this. We brought these people on and it was, it was an incredible disaster. So, I can say and it was, we. North of like $300,000 for a year.
And our numbers were down today. They over, they over delivered. We actually took, we hired someone, brought them in house. They, and they cause we had this big operation, but they locked up and they were just not getting their work done. And they had put a bringing new. And you know, what I realized was I talk about this with professionals.
They knew how to sell. But they didn’t have to run a business. So, they were having their Shera terror turnover, you know, when they were, you know, we’re in, we got four offices all over the world, you know, who I’m talking about. Right. And so, we, you know, they were having a turn on their account executives and people, and the numbers were not changing.
The SEO was terrible. And, and here’s the other thing I learned about it is everybody. It was what I called the blame game. The last one did this and they have all their broken links. And the last two years we, we brought it all pretty much in house. We realized that social media has to be done in. How can somebody represent me?
Okay. People don’t just want to say, buy your shit, buy your shit. And then outsource things like SEO or some of the things that you do. But now we have it all. We don’t have anything independent on one are dependent on one person, but I didn’t realize how important it was to her. And I have, I’ve got responsibility, a lot of doctors here, but we, we ended up bringing someone in house who just did the Saratoga hair transplant site.
And honestly, the next month. The ladies were going growing, you know, and it was because this, these people had a so locked up. And when I see them at the meeting, I can’t even look at them because what I really want to do is, is make it public so that the exploiter take advantage of someone again. But I’m like, you know, We lost two years with those clowns two years.
And it was at every meeting. It was like the same thing over and over. And I wasn’t at the meetings, but my team was. But so, I realized the importance of marketing, but I realized they’re not, not everyone is as ethical as you are. Well, this is you because you see these people at the meetings and they’re on the podium and then they’re selling themselves and, you know, you know, the quality of.
Catherine Maley, MD: Well, I definitely know the difference between sales and marketing and actually executing what you, what you sold in marketing. You know, there’s a really big difference there. And I’ve also this thing about outsourcing. It’s getting so much more popular to outsource because you can’t be everything to everybody.
So, you hand it off to the experts, but if you hand it off to the wrong experts, well, look what happens. You lose time and money, and then you’re jaded. And then. Well, no wonder you’re a control freak because every time you let it go, right, all hell breaks out. But there’s the accountability you got to hold everybody accountable.
So, somebody’s office needs to hold that person accountable and make sure that…
Edwin F. Williams, MD: …That have now. And I think that, you know, we have this economy of scale where we can, we can put the resource, it. But the but the average person out there, one person show guy’s been in practice or one been in practice 10, 12 years need to find people like you, where they can outsource this sort of thing.
And, and with someone who who’s honest, because you don’t have the economy of scale that we do, or the revenue to work with that we do now, you know, but I got to say this, that it has been, you know, that’s been one of my biggest challenges since I’ve been a PR you know, part of it is. I’m not I’m I rather like fly under the radar.
You know that about me. I’m not really wants to see my name all over things, but so I, I’ve never really enjoyed, you know, as I say to people, you know, my generation got on the podium and spoke and did humanitarian things. Cause it was the, it was the right thing to do. And you know, a lot of younger people, it’s all about the photo op for Instagram, you know, It’s but it made me realize we can’t ignore you can’t ignore the marketing thing.
You, you just can’t. I mean, if there was someone, you know, if you could solve that, but one of the challenges, if physicians are not willing to put the, but the re the appropriate time and resources into it, either bill. Right.
Catherine Maley, MD: Well, you know what? Scott horror. So, thanks to the social media. It takes the surgeon to market themselves.
Like you need the surgeon to be the, the material and that’s not helping just know you’re a surgeon and you’re a content maker and you’re a you know, a marketer and a leader and a visionary. And dear God.
Edwin F. Williams, MD: Well, one of the things that we do now is I have, we have a room that we completely fit up. It’s got, you know, five of these it’s really cool marketing rooms, got the five and the desks do up and down.
And we have a bank of interns and, you know, and, and you know, so we have someone over them, but the bank of interns, they work 15 hours and their job is to take the content for the doctors and get it out there. But. Basically, to my dock. So, you guys can’t expect them to do people. Don’t just want to see buy my shit, buy my shit, buy my shit.
Right. They want to get to know them. They want to get to family. They want to see your personality. They want to see the real side of you and that your. And getting that content out there in a respectful way. And it’s not going to happen overnight is, is got to be an organic homegrown method where the doctors involved you and, you know, and, and, and shame on these incredibly terrible people who told us they could take our social media.
You can correct me if I’m wrong. If the doctor’s not involved and you’re not getting, you’re not going to be able to make up content and grow someone in.
Catherine Maley, MD: Right. It’s so inauthentic. You can see it from a mile away. There’s no personality, no emotion to it. So, tell me, we all do it for other practices, but it’s not, it’s not, I don’t call that marketing.
I call it something you don’t want to do.
Edwin F. Williams, MD: Just one piece of it, but social media be social. Okay. People don’t again, don’t just want to see my, my, my one partner yen. He couldn’t, he couldn’t understand why his Instagram wasn’t grown. Right. And we said you know, people don’t just want to see breasts, dog breasts, dog breasts, dog.
They want. And by the way, when you’re just throwing, you know, funny stuff out there all the time, there is some people are going to click off because they don’t want to get that shit showing up in her feed. Right. So, you, you know, understanding, but we realized no, that has to be done in house. And one of the things I, you know, I say to my colleagues here is like you guys, without, I used to say this at the APRs meetings, we, you know, PR firms, God bless them.
The firms we had over two years and they would, they would come to me because. And I used to talk to my colleagues and I say, guys, you can’t expect the PR firm to deliver us for us. If we’re not giving them content. Well, they’re not improving our whatever. We’d give them nothing.
Catherine Maley, MD: Well but that’s, that’s the secret, the successful practice figures out how to outsource what they’re not good at, so they can have time to do what they now need to get good at, which is if you’re going to do social media and you’ve got to, you got to figure that out.
Now you need new skills that you didn’t need before. That’s for sure. So, I know you have to go pretty soon, but would you just tell me like three nuggets that like all the years that you’ve been at this. What, what things have made the biggest difference for you? I know like that one, like staff is not an overhead expense.
They’re an asset. Another one might be. That…
Edwin F. Williams, MD: That’s, that’s, that’s a really important one. Okay.
Catherine Maley, MD: And like patients for life, I think you, you feel strongly about that as well. And then, well, at the med spa, you can’t do this one-off thing as well as you used to.
Edwin F. Williams, MD: Well, you know, we quote you Catherine, because it, when people say, yo, you know, my patients don’t Crow across town there, they got there’s one, they just laughed.
Right. Yeah. And so. We actually, there’s a we’re now we are now. Well, here’s another Pearl. W we just went through this exercise about a year and a half ago. There’s a book called the customer of the future. I’m trying to remember the author’s name. Oh, no, it’s phenomenal. The woman or the customer of the future.
And basically. I’ll summarize the book in about 30 seconds here, but what we are now is patient customer centric, as you could possibly be. And I talked about, which is what’s brilliant is because this book was written before COVID and then it happened. And as I was reading, it is more relevant now with COVID than it ever has been, by the way, they’re not comparing you to your, your competitor down the street.
The customer’s comparing you to Amazon. Okay. The frictionless customer experience. And so, we’re obsessed with the customer experience. Now we thought we were product innovation. We all thought we were innovators to patients. Don’t give a damn about Dr. Williams credentials. You feel right. So, one asks one, Pearl would be it, you know, it’s all about, it’s all about the people and the culture.
And it’s all about your customers. It’s not about you. And then just, you know, changing your mindset, I think is a big one or adopting the mindset of understanding that are you trying to grow a business or are you growing a lifestyle around you? And if you want to be deliberate, you have to put the time in the energy, in the work and spend that.
The resources on doing that you know, physicians are very cheap on wanting to invest in their business, but they have no problem going out, buying brand new Mercedes, for sure. You know? And you know what I’m talking about because you deal with it every day, you know, try to get, you know, $5,000 out of a doctor, you know, but, but they have no problems.
Do you know what, you know, what I, to what I worked for watch? Oh, I got friends. Who’ve got these fancy watches. Like I got to worry about the damn thing. So, look, I appreciate you letting me chat with you. It’s always an honor Catherine and you know; I have a ton of respect for you. What you’ve accomplished.
Catherine Maley, MD: How would they get a hold of you? If somebody does want to talk with you or get into your world, how would they do.
Edwin F. Williams, MD: Go through, I have a website that has a bunch of podcasts on it, and it’s www.DrEdwinWilliams.com and then just shoot us an email through there. You know, through that website.
And again, it’s always an honor talking to you. I, I, you know, you’ve been in the industry, you know, it as well as anyone. And I know you can help, you know, help people out because you’ve been there. My recommendation to someone younger as far as you know, is to outsource, you know, invest in your team and then.
And outsource the things that you, you’re not going to be good at because you can’t do it all. And try to be very deliberate on what you’re doing as far as running a business and making a business.
Catherine Maley, MD: Thank you so much, Dr. Williams. It’s always a pleasure. I hope to see you at a meeting coming up soon.
Edwin F. Williams, MD: All right, Catherine.
We’ll see you.
Catherine Maley, MD: Thank you everybody. Thanks so much for joining us at Beauty and the Biz. And if you feel so inclined, we’d love a review at iTunes. That’d be great. If you’ve got any questions or feedback for me, please leave them on my website at www.CatherineMaley.com or feel free to DM me on Instagram @CatherineMaleyMBA.
Thanks so much. And we’ll talk again soon.
This concludes this episode of Beauty and the Biz: Interview with Edwin F. Williams III, MD (Ep.139)
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