MSD Insider 0:00

Welcome to MedShark Insider with Bill Fukui, your expert host on all things medical, marketing, and SEO.

Bill Fukui 0:08

Hello, and welcome to another episode of MedShark Insider. Today, my guest is Dr. Olivia MaDan and she is a plastic surgeon out in Nashville, Tennessee, one of my favorite cities. And today I wanted to have her speak to something that, that I think is unique in the sense that the timing of this podcast, she has a great experience in terms of what a young surgeon needs to be looking for, as they, you know, move into their career, and she has recently become an owner of a practice. So I want to walk through that process of what are young surgeons needing to do today, in order for them to, to maybe sidestep some landmines, or maybe get some pearls of wisdom on really? How can they go out and accomplish and do the things that that you’ve been able to because I think a lot of practices aspire, you know, practitioners are aspiring to do what you just did, right?

Dr. MaDan 1:21

Thank you, Bill. I’m excited to be here. And happy to share whatever pearls and pitfalls I’ve come across. So thank you.

Bill Fukui 1:30

Yeah, so why don’t you do us a favor and just give us a little bit of background? Because, you know, I know you pretty well. But just for our audience, give a little background where you went, kind of how you, you know, where your practice is, etc.

Dr. MaDan 1:45

Yeah. So I’m originally from Charleston, South Carolina, I did my integrated plastic surgery residency at Wake Forest, which is just one state above in North Carolina. And it’s a six year residency, I did not choose to do a fellowship. So kind of during my chief year, which is totally the best year, I was just searching for, where do I want to go? What kind of practice do I want to have? And where do I, you know, what kind of setting do I want to even be in? And it was tough, because I didn’t necessarily have any geographic ties to one location or another. So it was almost more difficult because there’s this whole, you know, nation to choose from, and that doesn’t really help in terms of narrowing down the options, right? So I had been getting the American Board of Plastic Surgeons sends out like a weekly newsletter, and they have like, the classified section where, at the bottom, they’ll have various job listings. And, you know, if you click one of those, it brings you to the whole job posting board. And I found a job posting on that website. And it was a very brief description. And so I just emailed about it, and essentially had a long conversation with my former partner, Dr. Michael Henekie. And, you know, learned about what his practice was like, and what he wanted in the future, and kind of you know, what his exit strategy was.

Bill Fukui 3:38

Okay.

Dr. MaDan 3:39

So ultimately, yeah, go ahead.

Bill Fukui 3:41

No, I was just gonna say, you know, when, when you’re mentioning exit strategies, you know, obviously, if you’re looking to get into a position where you could buy out somebody’s practice, and that’s basically what you did you, you bought his practice. What was what kind of timeframe were you committing to or looking at, in order for this transition to take place?

Dr. MaDan 4:09

So the whole contract negotiation part was, it takes a long time, it just does. You need to set aside months. You know, so I think I had things pretty solidified about what I was doing, where I was going, I would say about March before I graduated. And our graduation, or our last day is June 30th of that year. And I will tell you, the contract was not signed until July 1st, and that was like it was yeah, it was just like it took every single day to get it all, you know, smoothed out and prepared. So it really does take a while.

Bill Fukui 4:54

Okay, so that, that that period, so let’s just focus on that, that, that, you know, um, you know, you know, what was involved with that, you had to hire an attorney kind. of,

Dr. MaDan 5:07

Yes

Bill Fukui 5:07

Give me the background of what you had to, as, not as the seller, but as eventually the buyer of the practice.

Dr. MaDan 5:14

Right. So, and I do believe that my situation is probably unique in the sense of how Dr. Henekie viewed his business and, you know, kind of what he put forth in terms of showing potential buyers. So I would say I probably found the job listing, I wanna say in November of the year before, and then I flew down for a weekend and met with him, saw the practice. I met all the staff at that time, and he had interviewed another plastic surgeon from a different area. And I think that had happened a couple of weeks before. And so it was basically just between the two of us is my understanding. And so he could kind of pick and choose who he wanted to carry on his vision. But he would honestly probably cringe at me even saying that, carrying on his vision, because he never viewed his practice as his baby, which is where I think this whole relationship and Dr. Henekie’s relationship with his practice is very different.

Bill Fukui 6:43

Okay.

Dr. MaDan 6:44

And I don’t know whether it has to do with the name, like a fair number of surgeons will name their practice their own name. And, you know, that tends to instill certain feelings about the practice for you, like it is your child or your baby. And we had a very generic name, plastic surgery affiliates, and he did not view it as his baby, he was ready to let it go, did not, you know, essentially wanted to support me to make this my practice and really built it into what I wanted.

Bill Fukui 7:27

Oh, that’s, you know that, and I will say that that’s probably pretty unique.

Dr. MaDan 7:32

Yes,

Bill Fukui 7:32

I would say that that’s you probably pretty unique, especially. So how long from the time you signed on board and start, you know, walked in the door? I’m an associate with with Dr. Henekie, and how long was that period?

Dr. MaDan 7:52

So from a technical standpoint, I was the sole owner of the practice on July 1 of that year. So once the paperwork was signed, I was the owner. And we did the transaction as a stock purchase agreement. So the stocks would transfer to the company, and I would pay back, or the company would then pay Dr. Henekie, if that makes sense. Yeah. And so the ownership was transferred. And then basically, I offered him an employment contract. So it was very specific, only one year long, with a specific salary and bonus structure. And then things could be renegotiated at that one year mark.

Bill Fukui 8:49

Right. Okay.

Dr. MaDan 8:51

And one of the, probably the most important things that I’ve learned and, you know, partially through Dr. Henekie, because he had an experience where he purchased the practice from another surgeon, right? And it sounded like, you know, this surgeon was essentially taking new patients from him, you know, and it just wasn’t a good relationship. He was never told about, you know, the 401K and kind of the benefits that come along with or that should be with any business.

So we had explicit instructions like every new patient would be scheduled with me unless they were a former patient of Dr. Henekies, or a, like we started off with, as a referral.

Bill Fukui 9:49

Okay.

Dr. MaDan 9:49

From other surgeons in town or from you know, the other patients essentially.

Bill Fukui 9:56

Gotcha. How much have you know, and just to kind of get an understanding of the practice you were, you were basically buying, you know, investing in, at that, when you first started working there, what was kind of the makeup relative to? Was it almost exclusively cosmetic? or was there some reconstructive what what kind of was the makeup?

Dr. MaDan 10:21

It was exclusively cosmetic. I believe he had transitioned out of insurance, maybe about five years before I started. And just to add extra to my whole situation is it was the, right, right in the middle of COVID. So while we were negotiating for this, you know, this whole contract, I think, everything shut down in like May. And so it was just very nerve wracking to be paying this large sum of money for a practice that you don’t even know if you’ll be able to keep the lights on. So fairly intimidating. But.

Bill Fukui 11:03

Yeah, that, hey, you know, if it doesn’t kill you makes you stronger kind of thing.

Dr. MaDan 11:09

Absolutely. And I’m still here, so

Bill Fukui 11:14

No, so, you know, going through that process, what would you say would be, you know, the most important thing that, you know, looking back, what would you say, this, or these handful of things would be the things if, if I’m talking to my son, or my daughter, these are the things you should be, you know, looking, looking at.

Dr. MaDan 11:36

I think you should take into close or close observation as to how the surgeon regards his practice. In terms of what he sees it being worth, many surgeons will overvalue their own practice, because it’s their baby. So you know, the seller needs to have a realistic grasp on what a going price is whether or not you truly get an outside valuation or not. That the price needs to be reasonable and the structure to pay it also has to be reasonable, or at least feasible, how you see how the buyer sees their practice to be growing. And then how I would say have a specific exit strategy in terms of like, in the contract, like, all new patients go to the new doctor, and, you know, this contract is only for a year, we can renegotiate afterwards. And then basically just seeing how things are run and what the overhead is, of course.

Bill Fukui 12:56

So in terms of when you went out there met the staff. So did you keep all of his staff? Did you?

Dr. MaDan 13:04

I did everyone stayed on.

Bill Fukui 13:07

Oh, okay.

Dr. MaDan 13:08

Which is great. That’s what I, which is what I wanted, because they were excellent. And the nurse that we had, you know, she had a baby. And so now she’s the office manager for me. And so, you know, all excellent people that have been there for a long time. So I was a little bit intimidated, you know, when my receptionist has been there for eight years. Like, I’m coming in,

Bill Fukui 13:38

Your’e all new, Ha!

Dr. MaDan 13:39

You know, like guns blazing. And so it was important to me to have a slower kind of transition in terms of ownership. And in terms of the changes that I wanted to make.

Bill Fukui 13:54

Gotcha. So actually, that’s where I was just going to gonna say, What have you changed since since it’s now transitioned to you? What are the things that you feel like, you know, need to change as you’ve acquired, you know, somebody else’s practice so that it becomes yours.

Dr. MaDan 14:16

Right. Um, so I’m trying to say this in a way that’s not sexist or ageist. But basically, you want to put yourself in the patient’s position and who your ideal patient is, and what you would want in walking into an office, how you want it to feel, do you want it to be more like a spa or more, you know, in a different fashion, and then every aspect of that should then reflect that part. I think, and I think historically in the past, not a lot of weight was given to patient comfort. And it and just, you know, I don’t know how to say this, but mostly just patient comfort, like the first, I don’t go in the first time that I’m meeting a patient and they’re, you know, undressed in a gown, like, you know, you have to think about it from the patient’s standpoint. And do you want this random stranger coming in? before they’ve even said hello, like? So I think things can be restructured in terms of even how the patient flows throughout the appointment that can reflect what you want.

Bill Fukui 15:46

No, and I think that whole patient experience because it is, it’s more than just the surgery,

Dr. MaDan 15:51

Right!

Bill Fukui 15:51

Or even, you know, it’s that whole, from the, from the consultation, to even the phone call to, you know, to, it’s they’re, and they form opinions very quickly. They form and, you know, whether they like you or don’t like, it happens pretty quickly, right?

Dr. MaDan 16:10

Yes

Bill Fukui 16:10

So, I would agree with you. And, and I’m gonna be the one to say it, because you may not, but I am gonna say this whole patient experience and, you know, be putting yourself into their shoes. I think because, you know, let’s face it, the majority of our business is built around women, it’s female patients, and you can be a lot more empathetic as a female plastic surgeon than say, if I were a plastic surgeon, you know, I’m probably a little less in tune with some of that.

Dr. MaDan 16:44

Sure, which makes sense.

Bill Fukui 16:46

You know, which, which makes sense. So, I think there’s also not only as being a young, you know, probably very similar in age as many of your patients, you know, not not too different. But also being a woman, I think there’s a, there’s a difference in terms of you, how you interact with them, how open they are with you, right? To say somebody like me or something, it would be different, right?

Dr. MaDan 17:15

Yes. And I mean, I do think that details matter. And, you know, you want to be proud of what you’re putting forth, I think.

Bill Fukui 17:25

Yeah, and I get that, knowing what I know about you, I would say, I get that, I get that.

Dr. MaDan 17:34

Thank you.

Bill Fukui 17:35

So let’s maybe flip this around. sure that what are the things that you’re, you’re telling that they should be looking out for. So those what’s advice on the things that they need to avoid? Or don’t do? Or are there any mistakes or things that you maybe would have done differently? In retrospect, or did everything go pretty much like to hoped?

Dr. MaDan 18:02

Things have gone pretty much like I’ve hoped mostly, because mostly, because it’s been slow, I think that you can get ahead of yourself in terms of, you know, in my mind, I’m spending thousands of dollars, just redesigning the front door of the office. So of course, you can get ahead of yourself. But you need to really prioritize what’s most important, and then kind of set up a three year, five year plan and whether you know, and leave some wiggle room for purchases, but you do not need every single device. You should never buy a device, according to its resale value. It’s just not, not a good thing to do at all. And then, I mean, yeah, I would just say avoiding taking on too much financial burden or too much risk from the beginning.

Bill Fukui 19:05

Right. Okay. So, in your current, now that, how long have you been kind of owner of the practice? How long has it been since since doctor is no longer in the practice?

Dr. MaDan 19:20

So let’s see. So I purchased the practice July 1st, 2020. And my last payment was December 31st of 2022. So, yeah, thank you. Doctor Henekie retired in January of 2022. So he was there just a little bit longer. And yeah, so that was a pretty it we had it set up as essentially bi annual payments that you know, with two balloon payments at the end. so kind structured that the payments were smaller, when I wasn’t busy, I’m building, you know, getting patients together, building my practice and then incrementally getting larger while I’m busier and bringing in more revenue.

Bill Fukui 20:15

Great, great. And it sounded like that timeframe was pretty comfortable for you. You know, it’s not like you felt, you know.

Dr. MaDan 20:25

I don’t know, I think my dad was maybe a little anxious for me. But, you know, it was to the point where I was like, I just need to keep my head down, keep working. And I think I’m going to be fine. So I think he was a little stressed for me.

Bill Fukui 20:43

No, you know what, and I know, your dad so, hahaha, no, and and he only thinks, you know, he’s only keeping an eye out for you. Yes, absolutely.

Dr. MaDan 20:53

Yes, absolutley, And I maybe I should have been a little more anxious about it. But I knew I could do it. So

Bill Fukui 21:00

No, and I think that’s what it takes. And you know what, I think that, that spirit that I can do this, right, I can do this, I think that you have to have that element in you to take on some risks, to take on risks, because this is you can’t be risk averse, and actually do this.

Dr. MaDan 21:27

And I would say a bigger risk would be starting from complete scratch and having to, you know, choose a place to lease and whether or not it’s a shell, and you have to build it out and just the sheer capital it takes to even open your doors.

Bill Fukui 21:47

So was that a thought? Did you did you know when we’re going through this? Did you think about that?

Dr. MaDan 21:54

At one point, there was a thought like that it was not in the Nashville area, it was in the North Carolina area which,

Bill Fukui 22:01

Oh ok.

Dr. MaDan 22:02

The real estate there is just, it’s a different ballgame. So it would be more feasible to do that as a shell and, you know, kind of build out your own place.

Bill Fukui 22:15

Okay, and what what tipped the scale? What was the, was there any one thing that made you feel, you know,

Dr. MaDan 22:24

Well, I got a divorce. So,

Bill Fukui 22:27

Okay!

Dr. MaDan 22:28

That was part of it.

Bill Fukui 22:29

That’s Okay.

Dr. MaDan 22:29

So North Carolina was probably going to be the home state. And then after that happened, I was essentially free and could look anywhere that I wanted to go. So, Nashville is the biggest city that I’ve ever lived in. The real estate market here is wild. And it’s you know, HCA is based here, which is the biggest hospital system in the nation. So I definitely chose a great location for plastic surgery.

Bill Fukui 23:00

No, it’s a it’s a, it’s a great market and a great lifestyle to be honest with you. Yeah. And I have to say, the next time when when I go out there, because I’m out there, yeah, a few times a year.

Dr. MaDan 23:20

Yeah.

Bill Fukui 23:22

Is there any place we can go fly fishing?

Dr. MaDan 23:25

Yes. Definitely. Not that I’ve been yet, but yes, absolutely.

Bill Fukui 23:32

Okay, well, I just had to throw that in there.

Dr. MaDan 23:35

Yes, that’s where we gotta go.

Bill Fukui 23:36

Okay, I just had to throw that out there. But hey, thank you for for sharing all this information. I’m actually going to be speaking at the young surge,- young plastic surgeons luncheon tomorrow. So the timing is really good. And, and I picked up some good pearls I’m gonna share with them.

Dr. MaDan 23:55

Well, good, you can use anything. They’ll be lucky to have you.

Bill Fukui 24:00

Well, I appreciate that. Well, thank you again, and we’ll probably do this in another time. I’d like to maybe have you on as, you know, maybe kind of we kind of touched on it was you know that being a female plastic surgeon, and I started looking into supporting you know, the female plastic surgery organization with the society, and

Dr. MaDan 24:20

Yeah that’s wonderful.

Bill Fukui 24:22

And I think that there’s a lot of good happening there. So

Dr. MaDan 24:27

Totally Agree.

Bill Fukui 24:27

Maybe we’ll have you on for episode with that.

Dr. MaDan 24:30

Would love to. Thank You.

Bill Fukui 24:31

All right. Thank you again, Dr. MaDan.

Dr. MaDan 24:33

Absolutely.

Bill Fukui 24:34

Okay, Bye Bye.

MSD Insider 24:36

Thanks for joining us for the MedShark Insider with Bill Fukui. Join us next week for another dive into all things medical marketing. All episodes can be streamed at www.https://medsharkdigital.com/medshark-insider/