Starting Over at 45, with Brock Ridenour, MD

Starting Over at 45 , with Brock Ridenour, MD

Catherine Maley, MBA: Hello, and welcome to Beauty and the Biz. I’m 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. And I’m very excited about today’s episode. I have with me, Dr. Brock Ridenour, who’s made the jump into private practice, now he’s a board-certified facial cosmetic surgeon running a very successful private practice in St. Louis Missouri. Now, this is the interesting part before making the jump into private practice, how he made the jump into private practice, and why he made the jump into private practice. He was the former director of the division of facial plastic surgery at the prestigious Washington university in St. Louis for more than a decade. So, I want to talk more about that now, Dr. Brock Ridenour. He’s authored several books, chapters, and articles, and as a member of Professional medical organizations, as well as frequent national and international speaking on facial cosmetic surgery and rhinoplasty. And that’s why I’ve, I’ve known him for years. He’s been on the podium forever and we just kind of travel or travel around the world together. Now he works with several industry pharma companies and vendors of laser devices and is a strong supporter of many, and I repeat, many charitable causes throughout St. Louis. So, Dr. Brock Ridenour, I’m so glad to have you on Beauty and the Biz. Welcome.

Brock Ridenour, MD: Oh, it’s a pleasure. I’m glad that you’re asked and I hope I have something.

Catherine Maley, MBA: I know you do now. Here’s something that I’m really interested in because I get the call quite frequently of the surgeon who’s in the university setting or academia and he, or she wants to make the jump into private practice for a long time and their list of complaints that they have, but they also have that fear hesitation on certainty.

So, Dr. Brock Ridenour, could you please explain your journey from university to making the jump into private practice? What was that like and how mental was it? And then w what happened when it had to get practical?

Brock Ridenour, MD: That is a great topic. And I agree with you. I think there’s a lot of people that are. In that position that chose to be in that position for a variety of reasons.

I like, I think that I chose that position because at the time I was sort of altruistic, I had some research interests. I wanted to kind of put my stamp on, uh, uh, on medicine at a, at a place that I think had some, you know, like you said, it was a noteworthy institution that had some resonance in the world, you know?

And, uh, but after a while, uh, I started to figure out that my real interest was in cosmetic surgery and I wanted to be a great practitioner, not just a great academic. And I knew that, uh, you know, from my experience there that it’s very difficult. In a university that is so large and it’s, you know, they have a lot of bureaucracy and it’s very difficult to have your chairman or whoever it is that chair providing oversight to your career to understand how quickly things evolve in cosmetic surgery and how you have to react.

And you have to have, you know, certain channels for marketing and media, and you need a piece of equipment or you need a better environment in which to encourage these people to come in. So, after a while, I, I became aware that those things were very difficult to obtain, and I knew that I needed to go into private practice, but it’s still a very difficult job because you know, most people have very little business experience.

Uh, I didn’t even know how to, you know, Uh, software to do my bookkeeping, you know, when I was in an academic institution. So, uh, it took some soul searching. I wish I had done it sooner. Uh, my advice to people is that, uh, it is not as hard as it looks. And now you have a lot of wonderful people out there to help you, uh, to get started.

I think when, uh, I made the jump into private practice, my career jumped off, you know, cosmetic surgery was still in its infancy relative to what it is today. So, you didn’t have the assurances that there were, you know, all these folks out there to show you how to market and to, you know, make yourself identifiable in the community and to begin to set up, you know, where do I find an accountant?

Where do I find, uh, you know, um, you know, a medical supplier or, you know, where do I, you know, what kind of, how do I get a lawyer to set up my, my corporation? And, uh, so it’s, it’s challenging. Uh, but. You have to kind of, I think, make the decision and that you’re ready to leave based on all the right things.

And for most people, that’s not the problem. They know they need to leave. They just have this fear that’s been put in them that outside of this institution, you won’t be successful. And I think the academic institutions do that a little bit to you because you know, it’s to their advantage to hang on to you for as long as possible.

Um, and so, you know, because most academic institutions are built like a pyramid where the guy at the top makes the most and the people at the bottom make the least. And I think, you know, they want to obviously have people develop careers in that, uh, vein. But once you decide that it’s not right for you, for whatever reason, you’re not going to become chairman, you’re not going to become, you know, the Dean of the institution.

And you want to jump into private practice on, uh, you know, the art of cosmetic surgery on patients. You have to just decide that I’m going to do it and make a list of the things that you need to do. Uh, generally, am I, do I want to partner, do I want to come on as a, as an associate with somebody? Do I want to start my own business?

Do I want to join a large group? Do I want to join a large multi-specialty group? Think about what suits your personality. I mean, for me, I know. Uh, I I’d like to run my own show. And so, I mean, that was my problem with the university. That’s why I started banging heads because you know, in a university do run your own show.

I mean, let’s face it. There’s a larger institution. That’s much more important than you are as an individual. So, I had to figure out, you know, how I ran my own show and, uh, but for everybody it’s different. I mean, for some people you want to come on as a salaried employee, for some people you want to start your own business for some people, you know, you want to join a large multi-specialty group, that’s promising you, you know, a certain salary and lifestyle.

And, uh, I think you pick that. And then you, you make a list of things that you need to accomplish in order to head in that direction.

Catherine Maley, MBA: Dr .Brock Ridenour, I don’t do decide you practically speaking in regards to making the jump into private practice. Do you have your wife answering the phone or do you hire coordinators or do you immediately get an injector or how did you figure that part out?

Brock Ridenour, MD: Well, that is difficult. I think, um, setting yourself up, uh, was, you know, I was in my, like in my mid-forties, I think when I decided to leave. So, I didn’t really have an opportunity to start up. Slow. I took a chance, you know, I took a big entrepreneurial step. I found a bank that believed in me. I took out a big loan.

I opened a 6,500 square foot office by the way. Oh, well, thank you. I, you know, I, I just decided it’s now or never, I had sort of reached that frustration level that I decided, okay, I’m going to do this. Um, but I think for younger people, you know, there’s so many avenues for finding your place and, uh, you have the opportunity to start small and yes, you know, there, you know, and, and to them, you know, to do traditional growth, you know, traditional growth, Catherine, as you noticed.

It’s where you see more people and you provide more services slowly over a period of time with that com building a staff comes building, you know, adding people on increasing your overhead, hopefully staying ahead on the profit margin as you do it. And then you get to a point where, you know, maybe growth doesn’t make sense, and you look at other ways to make your business, you know, uh, flourish a little bit better, you know?

Uh, but for me, um, I was kind of all in a little bit because I felt this midlife crisis coming on, where I hadn’t done all the things that I wanted to do in this medicine and in aesthetics. And I thought I had, you know, ability to make the jump into private practice, and I thought it was being unused. And so, it was scary. Um, you know, you, but once you get into it and you start doing it and meeting with people and understanding what’s going on, it, it becomes more manageable.

And, uh, and you know, the fear starts to slide away and then, you know, it gets exciting.

Catherine Maley, MBA: Right, Dr .Brock Ridenour. Um, you, you could have bought a little red car and instead you bought a huge building. And the beauty of that is it almost forced you to decide and commit because you were definitely burning the boats, you know, put your, your, uh, your name on the line at the bank.

And it has to work. And quite frankly, I don’t think I’ve known any surgeon unless he was doing something weird. Nobody has ever failed. I mean, you have a service that every, you know, everybody wants it at this point. Um, it would be really difficult for you to actually fail. Even if you’re not a good business person, even then you’ll figure it out.

I really haven’t known anyone. Who’s like, oh my God, I have to go bankrupt now. You know,

Brock Ridenour, MD: I, I agree completely. I think that fear of failure, I think exists in all of us to some degree, but you’re right. I think as a physician, if you are at all reasonable and have a pretty good work ethic, failure’s not, what’s going to happen.

You may not know. Do it the best way you may not get it. Perfect. You may have to take a few years to evolve, but failure is unlikely. I agree. I encourage anybody that thinks they want to do this to just do it. I think more than anything, just figuring out what fits your personality. You know, am I a solo act in my group back to my working in an institution or, you know, am I going to be a, a person that sort of finds my own way right now, along with that comes staff and staff challenges.

Catherine Maley, MBA: And I would say, Dr .Brock Ridenour,  that’s probably the biggest challenge of running a private practice. And especially right now, I don’t know if the Midwest has incurred the same crazy HR issues that others are having, but what’s the scenario there. Um, are you having trouble finding good people, keeping them motivated?

Brock Ridenour, MD: Well, I think that’s probably the, you know, the single greatest is, is human relations, HR. Staff finding good quality people, uh, and retaining them is, uh, is a very difficult thing to do in general. And I think in today’s environment, uh, where there’s very low unemployment, where people are trying to find out what it is that really inspires them and makes them happy.

Uh, it’s a little bit more difficult. I have actually benefited from that. I think because a lot of nurses have left the hospital systems and are less interested in working in those environments and have a certain degree of burnout. And, uh, our applicant pool when we post the job has been extremely good still, as you know, I mean to take somebody out of, you know, the ICU or the emergency room and teach them their aesthetic businesses.

And, uh, time education, uh, it’s risky because you know, people then become quite good at what they do and then they have other options available. And so, retaining those people is always difficult. You know, legal avenues are not really, always the best to try to nail somebody down because you know, it ends up being restrained a trade anyway, most of the time and, you know, different states have different laws and eventually they’re going to set up shop somewhere else if they want to work, join somebody else if they want to.

So, you know, finding those good people, uh, nurturing them, uh, is really important. Having them have a sense that they’re part of a greater. Something been themselves, you know, that, uh, the, the, you create an environment they want to be part of and they feel good about that. They can say I work in this place and I’m proud of it.

And the people in the community hopefully go, oh, yes, I’ve heard of that. Or they have a good reputation. You must be a quality person as well. That’s kind of what you hope happens. Um, I think, um, in a recognizing people for small things every day is really important. Uh, Meeting with them on a regular basis to get their feedback about your management and your, you know, how am I as a manager?

How is this as a place to work in, instead of it being always the other way around, you learn so much, uh, in that process, I’m not singling out, you know, Talk to somebody, you do it in private, you do it. One-on-one you, you’re doing it in constructive ways. I think are all very helpful at the same time. You also have to be pretty good at recognizing the toxic individual or the person that doesn’t share your values, the person that’s not on time, the person that seems to be dishonest or, or to talk badly about other people, or doesn’t share your sense of quality and how you want to treat people and getting rid of those people quickly, you know, um, making decisions that this is, you know, before you dragged that on into some lengthy process where, you know, everybody in the office it’s miserable, that’s also, you know, something that comes, you know, Uh, you know, but you get to the point where you get pretty good at that, because you know that it’s essential for your business to survive, but you have the right people that are, that are there, you know, um, regarding the managing of people.

Catherine Maley, MBA: What I have learned, Dr .Brock Ridenour, is it seems to me, the surgeon is better off being the visionary and the leader. And then having that manager, that’s a buffer between him and the staff seems to work the best, but I love that. Um, it all comes from the top and dribbles down and you have to set the tone and the standards and the values that you expect from everyone else that just gives staff so much clarity.

Okay. Here’s where we’re going. Here’s what he expects from me. Um, it’s super helpful. And then are you also meeting with them or are you letting you know the manager here?

Brock Ridenour, MD: So, uh, I agree with you a hundred percent, um, that, uh, having a, somebody with good interpersonal skills and, um, you know, has that emotional intelligence as a manager is just so critical to making things work well, uh, because Hey, they have the time to do that as it needs to be done.

But it also, like you said, gives you a little bit of a cushion whereby you’re not, um, you can focus on. The business as a whole or on technical thing, your purchase of equipment or something that needs to be done, or, uh, teaching in all those different things, the human resource part of it, uh, having, having somebody with that skill set is just really, really important.

We have a manager or an assistant manager and they both, uh, do it and work together extremely well. And that has made my life so much better from the standpoint of knowing that people are being cared for. And it doesn’t require my constant attention. Uh, but you’re right.

Catherine Maley, MBA: That position has helped you stay focused on your core skills, Dr .Brock Ridenour.

I just don’t understand why people or other surgeons don’t do that. They tried to do it themselves. They’re trying to be the surgeon, the manager, the leader, the HR director.

Brock Ridenour, MD: When does, you know, and more and more, you know, with, you know, sort of the legal climate, HR is a more challenging. Um, area that you really need to at least have some outside help with, if not, you know, having somebody that knows it intimately, but, uh, I agree you can’t, there’s a tendency, especially early on, you don’t want to pay all these people.

You don’t want to, you know, incur this big overhead, but, uh, that is money well-spent because like you said, I think you’re way more productive and way more focused on improving your services and what people are coming to see you for where you, if you don’t have enough time for that and being thoughtful as to how does this.

Office, is it running the way that it should, are we providing the right type of services? Are we charging the right price? Are we, how are we, you know, pero health, what’s our intake in our uptake process. Are we streamlined our rate? You know, if you’re not doing that. Um, and instead you’re worried about somebody’s maternity leave.

Um, you know, I think it distracts from, you know, your growth after you’ve made the jump into private practice and the big picture.

Catherine Maley, MBA: Dr. Brock Ridenour, do you know your numbers? Like are, do you have a pretty good handle on the numbers business numbers?

Brock Ridenour, MD: Yeah. Yeah. I, I look at it, uh, a lot. Um, you know, I think, um, Yes, I think to understand what’s working and what’s not working, you have to sort of have an idea of what your inflow and outflow is.

And you also have to benchmark certain things. I mean, I didn’t do that early on. I wish I had done it all my life, but, uh, somebody sort of educated me on the value of looking at how. This provider doing relative to similar sorts of providers in this part of the country, you know, versus this. And that’s not going to be your only decision matrix, as far as this employee, a good employer to, you know, there’s so many other intangibles in and around that, but you should definitely know this person’s oh, wow.

This person is in the 90th percentile. This is a really important individual in my practice. They’re doing really good things and what are they doing that we can mimic, or the other providers can mimic, uh, to, to sort of reproduce that. Um, uh, so benchmarking, I think can be very helpful, even knowing kind of like, where do you fall in line with some of these large vendors, you know, You, uh, a low Botox user or a medium or high Botox user.

And it’s just sort of, maybe Botox is really that important to your practice, but maybe 10% increase in that area because you’re under treating people or you have providers that are, that are not using the, you know, the, the sort of standard dosages or other things can kind of bump you up a little bit where now you can afford that, uh, that employee, that, you know, the manager person that you think you can’t afford.

So there, you know, without having some sort of understanding of, of those numbers where they’re coming from, it’s very difficult, I think, to do your best in terms of maximizing your return on investment.

Catherine Maley, MBA: Dr .Brock Ridenour. I liked the benchmarking idea a lot in relation to making the jump into private practice. And I also like always comparing numbers to something because otherwise they’re just standalone numbers.

And, um, I love looking back at the same quarter last year. Um, although the last two years has been so screwy, it’s hard to say, but, um, I love comparing numbers.

Brock Ridenour, MD: You know, year over year numbers are really, really important and also looking at your seasonal productions and things to try to understand where, what procedures I’m doing in this time of the year and what time of procedures am I doing?

And, uh, and also trying to keep a finger on the pulse of what, what you’re missing. What are people asking for that you’re not providing that you could be providing if you learn a little bit more about it? So that’s also something that I, I, you know, when I hear people asking, what about this? What can you do for this over and over again?

And I feel like I don’t have the technology for that, or I don’t have the skill set for that. Uh, if I think that you know, that I can accomplish that, then I, then that’s a good way to that’s your next little step in your businesses adding that particular service?

Catherine Maley, MBA: That’s a good segue into talking about lasers, Dr .Brock Ridenour.

Um, you’re a facial plastic surgery practice, so that means you’re doing space up neck up and, um, and then a lot of you are not doing body. However, there’s so much nonsurgical body technology, but then you’ve got a building full of very expensive lasers. Do you have like a checklist in your head that. I buy a laser win and then.dot dot.

Do you have any kind of requirements for that before you invest in such a big-ticket item?

Brock Ridenour, MD: Yes, I think so. Uh, although it’s still largely subjective. I wish there was a way to do that in a way that is just perfectly, you know, analytical and quantitative, but there has to be some gamble in there a little bit.

So, you know, I started with the things that you can charge for, um, like a fractional CO2 laser, for instance, I mean, a lot of people need it. It goes very well with your surgical, you know, cases, uh, you know, people aren’t going to be happy if they have a nice-looking jaw neck line, but their other skin quality is poor and they have wrinkles.

So, it’s a natural fit with a surgical practice. Um, and you know, the. The price point for the procedure is, is good enough that if you do, you know, I don’t have to do hundreds and thousands of them to get a return on investment. Um, so they start with those sorts of devices, you know, an ablative and a non-ablative sort of resurfacing device, I think is, is a good starting point for most people.

Um, I have veered into some areas where in retrospect or, or a little push, but for the most part, I’ve made pretty good decisions. Um, I got into CoolSculpting when it first came out. I had the second machine in the Midwest. And so, part of that market-leading for a minute.

Catherine Maley, MBA: Yeah, Dr .Brock Ridenour. That, and it lasted a good year.

Brock Ridenour, MD: You know, I, you know, I made my money back in three months or two months or something and it was, uh, you know, it was very profitable for me for a while. And then it becomes a tight market, you know, where they’re on every street corner and you, you know, you can’t really charge a premium for those services and it becomes commodity driven and you have to have a lot of people come in and it’s different.

But if you see a technology that is, you know, that it has promise. Um, so one of the things I did was, you know, I, the people behind it or have extremely high quality, I called some people that had done the clinical trials on it. And they said, yes, this really does work. I think it’s a good investment. Um, I looked at, you know, the adverse events in the studies early on and things like that and thought that, you know, that were fairly low complication rate.

And then it’s, you know, you know, people would be looking for a non-surgical in a way to control weight or fat, you know, localize that upon study. So that became, that was a real easy decision there, market leader, getting out in front of everybody else, uh, in an area that you thought can’t mess really right.

You know, weight and body image. And so, uh, that’s how I got into got into, you know, the cool sculpting, uh, –

Catherine Maley, MBA: Some of the things that you love, you don’t have to name the brand, but just something that you bought that you realized it just fell flat with your patients or with you or with the staff.

Brock Ridenour, MD: That’s a great question.

See, probably some of the RF technologies, you know, I had, uh, you know, the ones that were going to Blake Peoples glabella, you know, with that turned out no matter how well we have bladed the nerves that they sort of recovered in a year, but didn’t, that was not a cost-effective device. Didn’t really kick Botox or a run for its money.

Uh, I have the sort of cannular based RF that they still pretty good, you know, especially, you know, the, the ones that sort of simultaneously, you know, pull the skin and monitor the temperature. But, but they’re, they’re not, you know, they really didn’t supplant, you know, the procedures that came before them, you know, you know, traditional liposuction or other methods of skin tightening, things like that.

So, some of those are after viruses. Uh, you know, I had a couple of different microneedle RF devices, uh, prior to the ones that I have now. I still think they have a place of value, but they weren’t, as you know, th that I, I’m not, I don’t find myself, uh, recommending those the way that I do, uh, You know, a Fraxel dual, for instance, you know, just earn still Liam and erbium is still a great way to condition the skin.

And I, I do like my Pico laser, you know, for skin and, uh, you know, again, that’s, you know, that’s the next step laser kind of thing. That’s where you have to have, um, you know, I think when you have a lot of foot traffic, it becomes easier to make those sorts of decisions and internally market them to the proper people, the people that want the no downtime, textural improvement, uh, you know, we have St Louis A.

Little bit, um, was a little monotonous for a number of years, but it’s, uh, it’s now, uh, a city of color and we have a lot more people of color and we have to have devices that manage. You know, darker skin types and Asians can type some. And so, some of those things you add as, as the need arises and the demand increases, he Ray have to balance it all with these tremendous costs that go with not only the device itself, but the warranties and the maintenance that goes on ad infinitum.

And, you know, I, you know, I probably have, I’m trying to think of how many devices I actively, I wonder warranty, but, you know, it’s, it’s, it’s quite a few. And, um, so you have to get that return of investment right away. You know, I think that’s something you really want to look at. Can I make this work and give yourself maybe six months to sort of get to that breakeven point?

In which case, then you have some time for the, make a profit to have your warranty pay you no money for that. And to, you know, allow for the fact that something of better quality may replace it as things age. And fortunately, you know, CO2 lasers stayed pretty strong as well as the, you know, the non-ablative devices.

That really haven’t been a lot of changes. Uh, a lot of those devices, I do also own a device for vascular problems, but you know, that is a harder device to make money on and. Well, it’s, you know, a lot of people have facial redness, but it’s really hard to, you know, to get people to engage on, you know, they want their wrinkles traded there, you know, you’re saying, but you have this terrible realization inflammation.

They don’t see it the way that we see it a lot of times. Um, but I do have a VBM prima that I use that has added value to my patients. So sometimes you buy a laser because now, you know, when I have a surgical patient that, you know, gets some additional, you know, telangiectasias after surgery, I can treat it.

If I have patients that I bruise with injectables, I can treat it. If I have a bruising, we use it. I mean, literally every day, just to eliminate people’s bruises so that they feel better about our practice and what we’ve done. So, you know, it’s a device. You know, I, if I look at the return on investment is never what I wanted to pay, but I still am happy to own the device because I think it adds value to my patients.

So, there are some times you do that.

Catherine Maley, MBA: So, given all of that, Dr. Brock Ridenour, how do you scale and or grow a practice? So, you start with you, then you add your nurse injectors. I also noticed you have a fellow. Is it time then to add an associate or start looking for a partner? Like in your case, the obvious one would be, you know, why wouldn’t you bring in a plastic surgeon and then you have very strong boundaries, your neck up he’s neck down, you know?

And do you have any plans for expanding this or have you filled in your 6,500 square foot building?

Brock Ridenour, MD: Well, we have used it up pretty well, but at the same time I have added an associate that’s just out of her fellowship. She’s also a facial plastic surgeon. Uh, she’s now, you know, she’s, uh, an employee at this point in time, but we’re hoping that she developed some wants to have some ownership and who knows, maybe take over.

And then that would be the ideal circumstance. But I don’t think you have to have that as a. Uh, deal breaker in terms of, you know, bringing somebody on, uh, I think that in my case, the reason I brought on somebody of a similar, uh, training is two things. One is that I, I don’t need more patients. Um, you know, I’m at a point where I really am having difficulty maintaining or keeping up with the amount of patients that I have coming in.

So. Yeah, it’s a good problem. So, uh, you know, partly she’s here to help me with that volume. The second thing is that, uh, she has an interest in hair and that was a service where we’re not doing his hair transplants, regenerative hair medicine. And, uh, that was one of those things that, you know, patients kept bringing up to me, you know, what do I do with this thinning hair?

What do I do with this? And yes, we’re doing PRP and things like that. And, you know, uh, sort of the standard sort of things, but now we’re more expansive. We’re analyzing their scalps. We’re doing genetic testing. We’re, uh, treating them with variety of custom made topicals that are made of. According to their genetic profiles and we’re doing hair transplant.

So, um, you know, that, uh, that’s a way of scaling is, you know, bringing that other person in that is adding, but it’s not directly competing against you, but it’s adding some services that are not being provided that could be done in the office with the present staff without additional people. I mean, that’s the whole concept of scaling is, uh, making right, making more money without increasing your overhead or.

Relative to the overhead where growth requires just this constant sort of linear buildup. And it does require, you know, like you said, when you first started out, you add an aesthetician, you get some people that can act as a physician, extenders or nurse injectors, you, then you get a management position to kind of hold it all together and to help you grow.

And then you add on, you know, some. Some folks to help you market to understand how the world works outside of your own little vision. And, uh, and then when you get to that place where you’re kind of, okay here, I’m sort of there. Then, then you want to try to scale upwards and scaling upwards either requires what we just talked about, bringing in a plastic surgeon, let’s say somebody has a non-competitive thing that basically, hopefully you don’t have to expand your staff, you know, proportionate to what you already have, maybe one person or another person, you know, an extra scheduler or somebody comes on to support that individual.

And then you have, like you said, all these complimentary services that you are not offering prior to that. So that’s what great idea. And certainly, I’ve thought of that. The reason I probably haven’t done that is. And I may someday, uh, it’s more just because it requires a little bit different equipment, little bit different, kind of.

Uh, set up and, um, and then you get kind of a different clientele, different kinds of bandages and hailing and those sorts of things. But but I do think that’s, that’s one of the obvious choices is to get somebody that is in another sub-specialized area, what we do. Um, and that’s what I did with the hair kind of thing that was, you know, big draw is I wanted that service.

I think it’s really important, especially to millennials and I wanted to get this, get that off the ground. And that was something where I literally didn’t have to add anybody, but our heritage, you know, so, um, that is a very big-ticket item when you can get, it makes different kinds of marketing and advertising efforts than before.

Catherine Maley, MBA: It’s well worth it. It’s well worth it. If you can manage it.

Brock Ridenour, MD: I agree. It is a whole different arena and, uh, there’s a lot of specialized places and, uh, you know, you’re competing against some of these behemoths, but, uh, there’s a lot of people that want it locally and want it from a quality place they know, and recognize and know that it’s, you know, hopefully they have faith in us that we’re going to provide those services at a high level, which we are, you know, where we wouldn’t do it.

If we didn’t think we were doing it at the highest possible. So, um, and then, you know, the other way to scale up is, is, you know, when you get busy enough, instead of killing yourself and doing this more and more and more of the same procedure, you can sit back and say, okay, I am going to raise my prices and if a few people drop off it’s okay.

And that that’s something that was always been extremely hard for me because. In a modest beginning and I want it, I want it to be accessible and that sort of thing, but it just plain makes sense. You know, you can’t treat everybody, raise your prices a little bit, make a bigger, you know, make, may improve your, your bottom line without, uh, you know, giving up your entire life, you know, which is, you know, Treating it like a commodity and doing hundreds of men stuff.

And I’m not, I’ve never, I won’t be the kind of doctor, you know, even if I think I do similar quality work, I’m not going to be the Birkin bag doctor. And in our work, you charge this really outrageous, you know, high price, uh, because it, it takes a certain amount of it doesn’t fit my personality. You have to have a lot of ego there to pull that off, but you know, that is something people do, you know, to scale up is okay.

Now my operation costs five times as much, and there’s a certain group of people that are attracted to that issue.

Catherine Maley, MBA: Now it’s a different market though. It’s a different

Brock Ridenour, MD: demographic. And, uh, but, uh, but I think, you know, some, some increase in price when you get busy enough, makes sense. I mean, that’s just, you know, that’s how you want to control the pace of your practice and make a little bit.

Catherine Maley, MBA: So, doctor Ridenour, give us one business mistake that you’ve made that you learned a lot from, because everything always looks so great. When I do these podcasts, everyone’s doing great. They have all the patients they need, but something always goes sideways, you know, somewhere in there. So, give us just one.

Brock Ridenour, MD: Okay. Sure. I think probably the single biggest emotional heartbreak I had was with an employee that, um, I saw certain characteristics as well. You know, I had concerns about, but didn’t act quickly enough with that individual to make a decision that these signs were enough to terminate this person’s employment.

And so, I let them persist for a while and then we got into the COVID epidemic and, uh, she got into some financial hardship then sort of made this decision to, uh, Sue me for a toxic or hostile work environment. And that occurred because, you know, I sort of made the mistake of allowing myself to be vulnerable with that because I got.

Pretty angry at her, you know, uh, because she was not showing up to the zone meeting. She wasn’t, you know, um, making herself available, uh, in the hours that she had prescribed, um, bunch of different things. So, I lost my cool, uh, to a degree. And then, you know, was, had to work myself through some sort of that employment lawsuit, also all that ends.

Well, you know, once we get by those things, you learned such a valuable lesson. And one of the things I would say is you cannot trust people the way that you would like to many times you need to treat them with respect. We try to have a family sort of environment, but I will never have that. Level of the, again, I think you have to always, I mean, one of the things I liked about, uh, the last meeting I saw you out, I believe in probably Miami or something was known, they had a section on all those employment issues and people should really pay very close attention to those, you know, how to, um, you know, the, the HR and that’s why you shouldn’t be your own HR person either.

And I wasn’t, but, um, you know, I, they were telling me that she needed to go and I was the one that sort of allowed that to continue because I thought, oh, you know, she’s got all these other good qualities, you know, but, so I think, you know, that labor, uh, issues are always the most challenging, I think. And, uh, I, uh, allowed myself to be kind of.

Made vulnerable to that and makes me very mad, you know? I did that by simply not taking care of a problem. That was, that was there. I recognized it and didn’t act on it. So that was one of my big folk paws. And I wasn’t like a big decision that cost me a lot of money or cost me a reputation or anything like that.

I made; I did no wrong. I promise. And I feel strongly that I wouldn’t even, I didn’t even require a nondisclosure at the conclusion of it because I know I didn’t do anything wrong and I feel free to talk to you about it. But just to tell people that you have to be very careful with your employees. And occasionally, you know, I love the people that work here and many have been here 10 years longer, but, uh, it’s, it’s a challenging landscape out there.

You have to be big. Learn how to walk around those little minefields a little bit. Other than that, Yeah. Other than that, you know, the occasional bad purchase, you know, the device that, you know, is it didn’t get as much as I thought it would. Uh, and I’ve been very fortunate. I really have, I haven’t made too many blunders, but starting earlier, but how does it have, that’s probably my biggest regret spending five more years at the university then than I wanted to.

And, uh, and then trying to play catch up, you know, trying to grow the practice quickly, work, work, work, work, try to build up to some point where you’re ready to retire. I think it’s just like investing. You start at a young age, you know, that’s why I say get after it. If you’re, if you know, that’s what you want to do, don’t be afraid.

Just your, your biggest mistake will be hanging on.

Catherine Maley, MBA: That’s such a great Pearl jump sooner than you want, and it will work out and will work out, like it can when you make the jump into private practice

Brock Ridenour, MD: Yeah, it will work out when you jump into private practice. Yeah. And if anybody, anybody that sees this, that wants to talk a bit about it personally, I’d be happy to fill their phone call and tell them about my experience in the endeavor.

It’s a little challenging to jump into private practice, you know, sometimes the university, they turn on you a little bit. They’re mad at you. They don’t, you know, they wouldn’t forward my patient phone calls after I made the jump into private practice, you know, all those little petty things, but you know, you survive it, you get by, it’s not hard to make the jump into private practice. And a matter of fact, it’s so much more fun being in charge of your own existence after you’ve made jump into private practice and working with the people that you choose and want to be with.

So, I mean that first year was not rough at all. I thought I thought it would be, you know, just scraping by, but I’ve made more money in my first year in private practice than I got paid in theater.

Catherine Maley, MBA: Interesting about making the jump into private practice. That’s how that’s great. Um, so let’s switch over to marketing because you definitely had to come up with patients that first year, but that was a long time ago, and now it’s a lot more challenging, a lot more technical.

It’s got a lot more of everything. So, um, how competitive is it in St. Louis after you made the jump into private practice?

Brock Ridenour, MD: And it’s getting increasingly competitive after I made the jump into private practice, but I think that’s great. Uh, I, in a way, you know, sort of rising tide lifts all boats. I think that I’ve learned a whole lot from my, you know, my bigger competitors, um, because he’d watch what they do, what they do well, what they don’t do well.

And, and, you know, again, I do think that we live in an environment now where there are in a maybe, you know, Southern California, things are a little more challenging for sure, but, you know, and some of the big markets, but there’s also lots more patients that are willing to spend money as well. So, I don’t know.

Uh, but yeah, St. Louis is really, uh, the number of people doing this has doubled or tripled since I’ve started in probably the least tripled. And there’s some very good quality doctors in town, but I think they’ve only made me better. Um, and so, uh, but you have to find your niche in that environment. You know, who you’re going to be.

I think we’re a, we’re a luxury practice in the sense that we have really good patient care, which I focused on after I made the jump into private practice. We try to do high quality work. We try to only use the best equipment. We train people. To be, I like to think by aesthetic nurse practitioners are better than most doctors, um, in the sense of, uh, their education on those devices, their understanding of their endpoints and treatments they’re experienced.

And so, people, I think, respect us for that. I don’t try to be, like I said, I’m not going to try to be the park avenue guy. That’s just not my style. Uh, you know, I want the, I want to make a profit. I want to get, I want to, I do all those extended deep plane. Everything’s, you know, I do all the same surgeries I do.

And I think I do them well, but you know, again, I, I don’t think that I’m that person, you know, that’s just not my style. If you have a staff that is working together, that is well-trained that answers the phone. Really well, the very first time they call you, they don’t say, I don’t know, let me check on that.

Let me get somebody, let me do that. They know, you know, they know what they know about all these devices. We do. They know, you know, you know, approximate cost things they can discuss with anybody. They are, you know, kind of try to be very caring for the people, meet their needs. I think if you do that, you know, you’ll survive.

You’ll do well. And, um, you know, that’s kind of a, you know, kind of how we position ourselves as, as experts, you know, we’re, if we’re, if we’re do it, we’re an expert at it. And we try to stay expert on it. We don’t buy a piece of equipment and go to a weekend meeting. That’s just not how we do it. I mean, we will, uh, we will go to the people that know it the best way we’ll watch, you know, every webinar video.

Yeah, we will make the trainers come back. If we feel like we have any missing pieces, uh, I will read the literature and the nurses will read the literature and we try to do it really, really well. And we don’t hurt people. And that helps also, I mean, you know, not trying to really avoid, uh, any untoward effects or, or, you know, we all have our complications, but you know, try to be a safe environment where people are trusting.

It’s really important. Um, and then, you know, we, we, we try to educate, we send, you know, what I do, like, you know, monthly emails on that are, you know, kind of like what we’re doing, what’s going on, but also. You know, educating, continuing to educate people, you know, what is, what is this, why do you want to treat, you know, the broken capillaries and redness in your skin?

What does inflammation, how does it damage it? What is the Dawn of time? You know, what is rosacea what’s melasma what are these things that, uh, you know, that, that, how can you treat, uh, always trying to give them some added value in those? Not just saying, oh, we got a special on lip filler, but you know, we do look filler.

We do it, you know? Well, but if we’re going to do something on the lip filler, you know, I have a little blurb in there about, you know, kind of discussing, you know, what are, what are some. Things you should discuss with your provider about how you want your and which fillers do, which things and you know, those kinds of things.

I liked staying in touch with people, uh, you know, through email, but not, not so much that, you know, it’s imposing on. You’re giving them just this never-ending cycle of you in our next deal or whatever. Uh doesn’t you know, not that anything’s wrong with that. I mean, a lot of people do respond to that, but, uh, for me, it’s more just, uh, You know, we do like to have occasional promotions, you know, certain time of the year, you’re going to be outdoors.

You’re going to be this, or you’re going to be locked up in the winter or this procedure is a great time to do this. Um, I think those things are, and you know, it’s going to help that person. That’s already been thinking about it, you know, make that decision. Um, and you know, people, they love some value. I think that’s important, but we don’t, we don’t want to also do it so often that it’s just people sitting around waiting for the next thing to see what comes up.

You know, if they’re going to jump on it or not, you know, marketing wise, when I first started out and made the jump into private practice, I held open houses. Uh, I did those sorts of educational forums where people could come in and learn about, you know, uh, an operation or a procedure. I would try to educate them on, you know, what I do, why I do it that way, why they might benefit from the procedure, never, you know, pushed a year.

And it was just an opportunity to learn about it. I gave lectures at the art museum of beauty through the ages. You know, we always have been very charitable schools and events and, you know, donate little things, Botox. So that always gets your name into the community. We did those sorts of things. Um, let’s work the best.

Uh, one worked the best.

Catherine Maley, MBA: Yeah. Like what, what is working now after you decided to make the jump into private practice? Actually?

Brock Ridenour, MD: Well, what works now for us is, uh, We do a lot of internal marketing and we have enough foot traffic. We have, you know, televisions up running kind of little videos on different, you know, procedures or products or things that they might be interested in.

It definitely helps bring those subjects up while they’re waiting in an exam room for a short period of time. Um, we do, uh, you know, monthly emails that I think we get a lot of response to. Uh, we do, we do have a company that handles my corporate Instagram, and then we have Facebook. And then we have where we assist our other providers and our nurses and handling their own accounts that are sort of, you know, also riding our plastic surgery accounts.

But it’s, you know, so-and-so right in our plastic surgery and, um, A lot of people really enjoy those because, you know, they, they really, um, sort of relate to the, to the nurses, speaking to them, you know? And so, I think those have been really, uh, very good, uh, individual providers have grown their own practices, extremely well doing.

Um, you know, they, you know, we have people that are, you know, sort of our aesthetic nurse providers, us, a couple of them that have full schedules, you know, and, uh, they’re hard to get into and part, they, they drive that through her social media.

Catherine Maley, MBA: Um, but I like that they stand in your name because you don’t want them thinking that they’re going to go off on their own and take, you know, 2000 patients with them.

They need to stay under your umbrella.

Brock Ridenour, MD: Yeah. And that, that’s something I insist on anybody that inside the office that has their own social media accounts of whatever it has. And I think there is a tendency that people do get feeling sort of empowered and poorly. Um, and the other thing is we’re all trying to drive.

You know, we always tag each other, so there’s cross talk and, you know, you gain from other, other people’s posts a little bit, and it keeps it more interesting for our clients too, because they see the variety of sort of different sorts of things. Uh, we try to post a lot of before and after pictures, I think that’s really important.

I mean, people want to see what can you do for, and they want to say that it’s natural and it’s well done. I think before and after pictures, that’s hard when you’re young, because you don’t have a lot of patients yet, but every one of those pictures is extremely valuable. I can remember when I. First started out and I really couldn’t provide them patient a before and after picture for a facelift.

So, you know, somebody had to step up to the plate and they eventually did, you know, for whatever reason. And sometimes you have to, you know, we start out, uh, you know, incentivize people in different ways to be that person. And, uh, because you got to build, you’ve got to build a portfolio and that’s really, really important.

Um, and so early on, you know, that that’s a little bit more challenge. I, you know, I have literally. No, no. I, or like can scroll through before and after pictures –

Catherine Maley, MBA: I looked at your before and after photos after you jump into private practice, Dr. Brock Ridenour. They’re very good. And, um, I would just say just more of them because that’s what we women want to see.

Especially when you’re working with the face millimeters, make all the difference and we want to see, what are we talking about here? Like, I need to know that I’m going to look fabulous. I love, we all love the photos I noticed on your website. You have this page called social on the wall for social wall.

Brock Ridenour, MD: You know what I’m talking about?

Catherine Maley, MBA: What I’m assuming the point was to keep them on your website versus have them go off onto a tangent or what was the point? I like it.

Brock Ridenour, MD: Yeah. Um, so those reviews and comments and things or –

Catherine Maley, MBA: Testimonials?

Brock Ridenour, MD: Yeah, well, right. So, the social wall is just a, it’s just a way to, if you don’t want to go through Google or you don’t want to go through a real self or you don’t want to go through all the different other sort of, uh, places where those things are Yelp or wherever they’re stored, they automatically pop up on our website.

And so, and cause I think just like with photographs, they want to see, not just that you’ve done three and you don’t want to show them a hunter and either you want to show him a good number, then you know that you do this on a regular basis. And I think with the reviews, you want to see, uh, you know, the timely reviews you want to say that.

Been on the last little bit, not like a review from two years ago. And so, I think that was sort of the point of that was to show people that we’re constantly getting reviews and we’re constantly getting positive feedback from our patients. And, and, uh, if there’s something negative, it goes up there too, but we haven’t had –

Catherine Maley, MBA: No, I liked it a lot.

And then, you know what I would suggest after one makes the jump into private practice, um, now that you’re not so demographically limited, you know, I would definitely start adding more photos of different ethnicities, gender generations just everyone’s welcome.

Brock Ridenour, MD: Yes, yes, absolutely. I a hundred percent. Um, you know, it’s, uh, I remember the first time, uh, on a real self.

That, uh, one of my African American patients posted her before and after. And I probably got, I don’t know, 10 calls in the next two weeks from African-Americans looking for rhinoplasty and that shouldn’t have surprised me, but I, I kind of was like, whoa, you know, I’m sorry. I realized, you know, people want to be represented.

They want to see, you know, something that is similar to what they, they, they look like or feel like or identify with. And so, I’m in the process of that. It’s, it’s challenging because, you know, it was just challenging to get photo permissions. That’s a whole another thing, you know, because people are afraid that you’re going to, you know, kind of put them on a billboard, even though our plans are very.

Very small. We just want to put you on our website, you know, rightfully so with privacy issues these days they’ve got concerns, but yes.

Catherine Maley, MBA: Yeah, we’re running out of time, Dr. Brock Ridenour. Let me ask you this. How did. All of this, this ease for you after you made the choice to jump into private practice and your leadership in managing business, it doesn’t just come natural. Unless you came from a family of entrepreneurs or you had a great mentor who taught me the ropes.

How did you get to this knowledge to thrive after making the jump into private practice?

Brock Ridenour, MD: So, no, I, I came from a family of teachers, you know, and so nobody was really running a business. I didn’t have a lot of experience with that. I think, uh, you know, knowledge, I was just voracious sort of, kind of sponge early on. I went to, you know, I, I was a very much a believer in multi-specialty training and sort of learning and, uh, you know, George Brian out there and started those early multi-specialty group meetings and things.

And I, I got myself involved in that and learned a ton. Yeah. You know, skincare and, and laser technology from the dermatologist, as well as just good surgical practice. You know, a lot of the older plastic surgeons, people that were really quite frankly, you know, uh, the most experienced and many of those procedures early on.

Uh, so that’s kind of, you know, just talking to people and getting involved in little things, you know, participating and maybe a small study or doing something in industry where you get connections and you learn from people, um, and you know, from your vendors, you know, talking to your vendors, don’t take everything they say is as accurate, but they still are valuable sources of information.

And then my wife was very helpful because she has really good sort of skills as far as emotional intelligence on how to treat people, how to. Work with staff, how to do you know, how to develop people. Um, and she always has been really good about insisting that I nurture and help people grow. Um, The business part, uh, you know, I have had a friend or two, I rely on one of my college roommates, Stanford business school graduate has helped me with just real simple things, you know, but they weren’t simple to me, but just, uh, concepts and ideas.

And then I’ve had good help from the St Louis community and the business community, my CPAs, my bank people, and those folks that really helped me a bit. And then, you know, you have to work at it as well. You, um, learning from other doctors, that’s where I probably have learned a lot, you know, just like what you’re doing with this.

You know, some of my doctor friends are just really better at this than most, you know, why don’t you do that? You know, oh my God, there are those teach about in a real estate and other things like that that are just my head. You know, I think as you get into business, you have to, by nature, put a little bit of effort into it and grow and learn and just keep being inquisitive and asking and, and learning and talking to your peers.

And it’s really good. I do read like the Harvard business review. I get little tips on there. You know, they’re really small little, like a paragraph tip like that. It’s really, really helpful, you know, about managing personnel or sort of tidbits about how to run a small business, which is what.

Catherine Maley, MBA: That’s the whole point if you, you know, a lot, but you who are considering making the jump into private practice can always learn those little pearls that, you know, small hinges, swing, big doors, you just, as long as you stay open to hearing it, I think what happens is we get so darn stuck in our ways as we’ve gotten older.

And I have to force myself to stay open and listen and say, how could this work for me? Half of the things I have learned that I have taught you surgeons, it came from another industry. I love something from another industry and say, how can we use that thing open to it? Um, so last question. Tell us something we don’t know about you.

That’s pretty darn interesting.

Brock Ridenour, MD: Wow. I don’t know if there’s very interesting. Uh, –

Catherine Maley, MBA: Well, we don’t know anything.

Brock Ridenour, MD: Uh, let’s say I grew up in a little suburb of New York city called Mount Vernon, which is famous for Denzel Washington. Who’s my age, but we didn’t go to school together because his mother was, was concerned about him being at the high school that I went to.

So, she sent him to private school to keep him out of trouble. But otherwise, I might’ve known Denzel was of let’s see what else. Or be smooth, you know, the comedian, uh, he’s on like a or B or smooth JB Smoove. Maybe you saw Larry David a lot is real funny guy. A lot of NBA basketball players that are famous.

We had, uh, uh, David Chase that produced the Sopranos is from, there were a bunch of people anyway. So, it’s a small little Polish right outside the Bronx in New York city is where I grew up. Lot of people don’t realize I’m from there. They think I’m kind of a Midwesterner because my parents were, and I don’t have an accent because my parents weren’t from there.

Yeah. So, and then I, uh, you know, in high school I was really, I played football, tennis, baseball, and then, uh, in college I was on the, I was technically a division one athlete. I, uh, Swim team at Yale. And, uh, I’ve lived in Los Angeles very shortly after I graduated college, my friend and I wanted off there with no money and no jobs.

And we thought like everybody else, uh, you know, got, got a couple of kids, got three dogs, I’ve got a.

I have a two right now I have a three weirdest bridge to go together. I’ve got a Portuguese water dog, a Belgian Malinois, and a, uh, kind of a midsize poodle. They looked like a crazy, crazy little show together. You know, I like doing things outdoors. You know, I love skiing, uh, gotten into cycling a little bit.

Yeah.

Catherine Maley, MBA: I had no idea you did all of that (not to mention making the jump into private practice in the first place), and I will never forget you have three dogs cause I’m a big dog lover, Dr. Brock Ridenour.

Brock Ridenour, MD: So –

Catherine Maley, MBA: If other surgeons wanted to talk to you on making the jump into private practice, Dr. Brock Ridenour, which I, you know, only if they have a quick question. Um, I do know your website is www.RidenourPlasticSurgery.com. Would that be good for them to go?

Brock Ridenour, MD: And if you, if you just do [email protected] It’ll get to me and where my first name, period, last [email protected] is my email and, uh, happy to, to help. If in any way I can, I don’t know that I have that much to offer, but, um,

Catherine Maley, MBA: You have plenty to offer to help others make the jump into private practice! Thank you so much.

Brock Ridenour, MD: I’m flattered.

Catherine Maley, MBA: Well, I really appreciate your time. I know we went over, but thank you so much on explaining your process on making the jump into private practice. I appreciate it then everybody, if you would, and if you haven’t done so already, please head over to Beauty and the Biz and give us a good review and subscribe. So, you don’t lose out on any of their episodes. And if you have any feedback for me, you can always leave it on my website www.CatherineMaley.com or you can certainly DM me on Instagram @CatherineMaleyMBA.

Thanks so much. And we’ll talk again soon.