Adding an Associate — with Ivan Wayne, MD (Ep. 224)

Beauty and the Biz

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Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and adding an associate.

I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits.

Now, today’s episode is called "Adding an Associate — with Ivan Wayne, MD".

When you’ve been practicing for a while, it’s almost inevitable to entertain the idea of scaling your practice without working harder.

You figure out how to bring in more revenues without doing more work, while decreasing the pressure of you being the sole revenue generator.

This allows you to go on vacation, share expenses and plan your exit strategy.

The obvious solution is to bring on an associate to fill in the gaps and help you scale. However, that can be fraught with drama if you don’t choose wisely.

In this week’s Beauty and the Biz Podcast, I interviewed Dr. Ivan Wayne, a facial aesthetic and reconstructive surgeon in private practice in Oklahoma City, OK.

Dr. Wayne has been in practice over 25 years and was ready for change and setting himself up for his future. So, he added an associate and then bought and built out a space with 2 ORs so he no longer had to use outside facilities.

We talked about adding an associate that included:

• How he found someone who shared his values
• What to look for when adding an associate so you have a good fit
• How he was able to now focus on the cases he most enjoys

Visit Dr. Wayne's website

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Transcript:

Adding an Associate — with Ivan Wayne, MD

Catherine Maley, MBA: ​Hello and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery, and adding an associate. I'm your host, Catherine Maley, author of "Your Aesthetic Practice, What Your Patients Are Saying", as well as consultant to plastic surgeons to get them more patients and more profits. And I'm really excited about today's guest, who knows all about what to consider when adding an associate.

It's Dr. Ivan Wayne. He's a facial, aesthetic, and reconstructive surgeon. in private practice located in Oklahoma City, Oklahoma, and he's been there over 25 years. He's got a focus on facial rejuvenation, rhinoplasty, revision rhinoplasty, as well as preservation rhinoplasty, which I'm going to ask more about.

So, Dr. Wayne attended the University of Iowa Medical School and completed his internship, as well as residency at the University of Rochester in New York, and he did his fellowship at the University of Florida. So, like everyone else, he's been around. So, Dr. Wayne serves on several committees of the AAFPRS, where he's also a frequent speaker at medical conferences, which was where I met him and trains other surgeons on his innovative techniques.

Welcome to Beauty and the Biz, Dr. Wayne. It's a pleasure to have you.

Ivan Wayne, MD: Thank you. It's good to be here.

Catherine Maley, MBA: Terrific. So, let's just start with why facial plastic surgery, why not some other specialty? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: So, when I was a teenager at some point, I don't remember how old I was. We had these things called books that you read because we didn't have iPads or the internet or anything.

And I read a lot of books and my father who was a, a former professor of French literature and very book obsessed, love to go to used bookstores and. One day he came back with a book all about plastic surgery. And I thought that's kind of cool. It was obviously directed at the consumer, but had information that about different procedures.

I probably was 14 at the time. And I thought this was fascinating. I thought I want to do that. I've always been interested in doing things with my hands. I love to build, to create, to think, envision, and then, and then put it into. Into action by making something. And to me being a surgeon or especially a plastic surgeon, would kind of fit right down that road.

My parents were super excited, yay. Want to be a doctor. And so, they were very encouraging about that. And I happened to train at the Uni, or my medical school was at the University of Iowa, Iowa. And as a medical student, the exposure I got to plastic surgery was the plastic surgery department. And then the Department of Otolaryngology at the University of Iowa was very strong at that time, especially in craniofacial work, left lip and palate, rhinoplasty, pediatric deformities and reconstructions.

And I remember between the two rotations as a medical student, the plastic surgeons seemed like all they were doing was dealing with horrible bed wounds and pressure ulcers and tissue, big tissue flaps. While the otolaryngologist, we're doing these really cool facial reconstruction cases, cases. So, I'm like, I want to do facial plastic.

So, this is cool. That influenced my direction to become an otolaryngology resident, and then to do a fellowship in facial plastic surgery.

Catherine Maley, MBA: Okay, that's fantastic. Were you the first surgeon in your family? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Yes, I, I am and was, yes.

Catherine Maley, MBA: Oh, well, you have a young son. Maybe he'll follow in your footsteps. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Maybe. We'll see. My daughter, more likely, she's the artist in the family.

Catherine Maley, MBA: So interesting. So, everyone's got a journey from fellowship to solo practice. What was yours like? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: So, I did my train, as you mentioned, University of Rochester, Vito Cotella, who you probably know. Of course, of course. He was very influential in my upbringing from early residency to selecting a fellowship.

He's, was kind of a model for what I envisioned doing sometime in the future, you know, have this palace and a surgery center and all these incredible clients and everybody was in awe of what he did and, and still is. I ended up going to the University of Miami for my training, and I trained under very famous Dr.

Robert Simons, you've probably met him once or twice, very strong-minded person about our academy and service, and then Richard Davis is at the university, so I had Kind of a dual fellowship, private practice, saw the boutique side, and then I saw the university side. And I always kind of assumed I was going to at least start out at a university because it made sense.

And I happened to be lucky enough to train in 2000 in

2001, which September 11 occurred in. And that dramatically altered my trajectory because All the job opportunities that I was looking at suddenly kind of dried up and there was a very like narrow pool to pick from afterwards because I think everybody was terrified and people that had businesses at the time slowed down significantly.

So, I had a job opportunity at the University of Oklahoma. I didn't really know anything about Oklahoma or the university, but I did know the chairman Jesus Medina, who, ended up meeting at some meeting during the interview process and everybody thinks he's the greatest and he is the greatest and he was very influential in recruiting me.

I didn't honestly think I would stay long term. I needed a job and I knew I wanted to do something at least to keep my hands working. Having lived for a year in Miami beach and loving the water, it was very hard to leave. But I ended up at the University of Oklahoma and moved in 2002. And that's where I've been ever since.

Catherine Maley, MBA: Just out of curiosity, did you find a wife in Oklahoma or did you have to recruit a wife to Oklahoma? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: No, I met my significant other here in Oklahoma. Yes.

Catherine Maley, MBA: Gotcha. I'm thinking that'd be a hard sell, you know, like, frankly, I had never been to Oklahoma until I met you. And I loved it. It's just not on my radar. How does or did this relate to, or impact your decision on adding an associate?

You know, it was interesting.

Ivan Wayne, MD: Yeah, it truly was. I mean, it's just not, I mean, I knew about the Merr building bombing that occurred. Yes, me too. And I kind of had recollections of reading about the Dust Bowl. And that's about all I knew about Oklahoma, frankly. Do you like it? I do. It is. I have friends on both coasts and I'm on little group texts and I get a lot of complaining coming from the east coast and the difficulty of running a practice and the people and I'm always like, I hate to brag, but I love our patients.

They're so nice. People are so nice. I saw this little meme of life in Oklahoma. It's to pick-up trucks pulling up to a four way stop sign and instead of One of them trying to race across. They're basically offering, Hey, go ahead and go. No, no, you go. And literally they're having a fight about letting the other one goes first.

I mean, that's the attitude around here. It's, it's super positive. It's a great place to run a practice. I haven't had all the problems with recruiting great employees. Staff has been great and people are nice to deal with and great place to raise kids. So.

Catherine Maley, MBA: I will I'll, I will agree with you when I was there, they were the politest people I've seen in a long time because I'm in California, whatever but it was just, you're right, it was, it's a very friendly kind of place, your staff's so friendly, usually I have to train that into people, in your case, they're just really nice people, yeah, I, yeah, I get it. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: It's in the water or something, it's just the attitude around here.

Catherine Maley, MBA: Yeah, so are you still doing any reconstructive and if you are like what's your percentage of recon versus aesthetic because that's always a balance. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Two years ago, before I recruited my junior associate, I was doing probably, by days of the week, about 35 percent reconstruction and the rest was aesthetic.

Now, since Dr. Rhodes has joined me, I, I'm probably down to less than 5%. It's kind of by request, because I've been in Oklahoma City practicing, I'm, I'm starting my 22nd year I, I'm well known, and I get texts from, you know, a doctor will text me, hey, I've got this relative, this friend, what can you, of course I'll see them, I mean, I'm happy to.

I tend to get, you know, the super challenging cases still come my way, and so I do. Enough to, to kind of say that I still do it and then I still like it.

Catherine Maley, MBA: Okay. And talking about your associate, how did you go about that process? He's a super great guy, younger, any, any pearls there because everyone struggles trying to get the right match to come into your practice. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: It's not easy. It absolutely is. I, I think the, the road to partnership is littered with failed relationships and, and not, not with me, but with colleagues around the country. I mean, I, I saw it everywhere that I went. So, Dr. Rhodes was a medical student at the University of Oklahoma. So, I knew him from, you know, I was at the university until 2016.

So, I was aware of him then. He was a resident at OU. Worked with me so I had direct experience. I observed him. I, I was interested because he wanted to do a fellowship and he's got family in Oklahoma City. He's not moving. So, he's coming back one way or another. And I don't know if I was 100 percent on board about bringing a partner on.

But the timing, you know, sometimes the timing forces you to make the decision. And I'm glad that I did because I knew his personality. He's, he's extremely easy to get along with. He's friendly. He's nice to people. He doesn't seem to have an issue with me calling the shots, which is, you know, if, if you want to be the big fish.

You can't join another big fish. So, he seems to be fine with his role and he's thriving in it. I hope he's happy, but I knew him personally. And then Ed Williams was his fellowship director. And of course. He confirmed everything I knew about Dr. Rhodes, that he was A, going to be very successful, he's very nice, and, and everybody loved him, so.

Catherine Maley, MBA: You know, that's another double-edged sword, because, you're absolutely right, the two alphas in the jungle aren't working well, however, you definitely need them eventually to step up to be the alpha, because you want to step down, or step out. So, you know, it's almost like, gosh, can, it, there's just a balance there, and just trying to figure out, Are they willing to put their ego aside for now to learn and grow and be patient? How does or did this relate to, or impact your decision on adding an associate?

And then, like, is there a plan? Like, is that the plan for you two? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Yeah, so, I mean, he's very fortunate that, you know, he started out and all he's done since day one is facial plastic surgery of one form or another. I joined a university and you join a university, that's not always a protected role. I, I did by requirements and general otolaryngology until my, my practice filled up because they had the need for it.

So, he, he is very busy and growing. It, the only frustration I sense from him is I think he wants to do more cosmetic, but you know, it's very hard. You, you're You know, people, patients are needing to entrust you to take their face apart and put it back together again, and he's really young looking, so it'll come with time.

I reassure him, he, he seems okay with that, and, and he's developing his practice. In fact, I'd say he's probably done more cosmetic in the last two years than I did my first two years.

Catherine Maley, MBA: Very good, and remind him of that, because there's a lot of impatience in today's world, and it takes time. to do all of this.

So, so you also have a brand-new building and it was gorgeous and beautiful and any tips on how you pull that off or how you found it? How do you negotiate it? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Yeah, so I had been on the lookout for a building probably for six to seven years prior to when I found this, maybe five years. You know, I, I basically did a lot of driving around and keeping my eyes open.

It's weird how you can drive by things a hundred times in your daily. Commutes and things and not notice it. But when you have your eyes on buildings that come up for sale, what do I need? I mean, I looked at former bank buildings. I looked at there's a there's a big developer on the north side of Oklahoma City who's built out malls and strip malls, and he had a building for sale and How much money he wanted for it.

I'm like, man, I could probably buy the land and build. And so, I started looking at that. I, I talked to a hospital developer about partnering up and, and looked at numbers. And I, I kind of knew roughly the areas that would be good because I'm in Oklahoma. We're about four, just under 4 million, Oklahoma, the greater Oklahoma city areas are a million and a half'ish.

So, I get a draw from a really big area, so I want it to be easy to get to for my local clientele, and then for all the satellite stuff within 50 miles and then a hundred miles of me. So, being on one of the beltway or close to the beltway was important.

Catherine Maley, MBA: The traffic that goes by your office is amazing. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: We have a ton of, yeah, it's a very busy, it may actually be, I don't know the numbers, I mean, I've seen it on, it probably is the busiest segment in our area. So, I mean, my business is not a drive by business, but being able to find us easily and that sort of brand recognition, I think, Does amount to something.

So, the, the group that the hospital development group I had been working with, I knew they had attempted to buy the building that I'm in now. It was an existing building. I had never paid any attention to it. I didn't know what the heck it was. The fact that somebody who's much smarter in real estate wanted to buy it.

They, they low balled the owners. It was a trust told me that if he, if he put an offer in. It's worth looking at. So, I started to get serious and looked at it and 18, 200 square feet. I mean, that seemed pretty big. It, it, it was basically a big open shell with a lab in the back. And then I started the process of looking at it.

I can't remember did I did I hire my architect before I probably in the process because we had a really long like a 90-day due diligence phase to all of our inspections and all that and I'd already, I think I had got my architect selected. Because I've been around for so long, I know people and I.

No, a local contracting company, kind of friends of mine run it. And I said, you know, who would you recommend for an architect? And they gave me two names and they told me the one they really love. And I met this guy and he's, he's kind of an old cowboy driving an old pickup truck. And he was very down to earth and I loved his approach.

And, and I could just tell that within five minutes. I was going to like working with him and his team and it turned out to be great and we had gotten a couple of bids or I got a couple of bids from different firms and you know there are these really bougie kind of architectural firms and it was shocking just how much of a difference there was in the price.

And then I looked at some of the things they had done and the one that I selected had done. Things basically kind of right along with what I'm doing. So, so yeah, that's how, that's how I found the building. You know, it's tough to buy a building because you need a lot of money. I mean, they want a lot of down payment.

Luckily, I've been kind of buying some real estate projects on the side as I've gone along some small rental units and I was able to leverage the collateral there to start the building project to buy the building, which I did.

Catherine Maley, MBA: Any kind of building mistakes you made that you wish you could redo or overdo or I mean, yeah, redo. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: We know we really didn't have any big ones. I think, you know, there's there're so many little minutiae issues with access to parking lots and setbacks and handicapped spaces and buildings a little weird because. 20 spaces are in front and then 60 spaces are in the back. So, we really had to kind of juggle things, but we, we worked at all.

I mean, there's a few things I spent too much money on because it wasn't really hyper focused like, you know, commercial doors with little, I mean, you can spend 5, 000 per door on these little release mechanisms. And I got extra ones I really didn't need, but that's okay. I mean, it's, it's, you know, we, we own it now and the building is nice.

So, No, I was very fortunate. No, the only thing bad that happened was timing because COVID 19, right? Literally, I had almost signed off on the bid to start the project. And then COVID happened, and we went dead in the water for like four weeks. I think I actually started, I was one of the first doctors in Oklahoma City to start working again because I was still doing reconstruction, they let us do cases.

But I didn't know if we were going to have a practice again like a lot of people, you know, I didn't know are we all going to go bankrupt because we have no revenue, but that of course didn't happen. The opposite happened. But because I delayed the pricing went up maybe 40 percent or more, the same exact bid between pre COVID and post COVID.

Fortunately, my company that I selected had really good connections and they got it done really right on time. It just costs a lot more.

Catherine Maley, MBA: Well, it's absolutely gorgeous. Your O. R. was beautiful. You have two suites. It's really spacious. I'm, I'm used to city. Practices and I just I hope you appreciate the space you have because it's really unusual, you know. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Yes, I'm very fortunate that we had so much space to work with and I, you know, I had different options I could have taken over the whole building.

And originally, we were set to do 6000 feet with ours. I checked in with some people who have huge facilities and they said you can never build too big. I mean, that's what everybody told me, whether it's Ed Williams or Vito Quintella or Mike Nayak, who are all friends and who have large, you know, you will grow into it.

So, I thought I'm going to build a little bigger. I'm going to make room for myself and hopefully Well, it's two of us now, two physicians, and I have room for two more for us all to be not stumbling over each other. I think that will be the optimal practice size once we're totally matured. So, we're fortunate, but it works great.

Flow's good. We can get a lot of patients through in a day. You know, I only see patients one day a week. I have six rooms and it just really helps to kind of stack the rooms and all I'm doing is walking from room to room and that's what I want to be doing. So, it's, it, the efficiency is definitely worth it if you can do it.

Catherine Maley, MBA: Well, and regarding marketing, is the is Oklahoma City zoning, are they okay with outside signage? Because you just have such incredible traffic there. Can you put big signs up that say who you are? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: We got one of them up yesterday and then our, our other one is built and a crane's going to attach to the building.

So, yes and yes.

Catherine Maley, MBA: Oh, I think that's. Just the best marketing on the planet. You buy it once and it lasts for a lifetime. So, congratulations. Now that you have all this space though, I think you're you know, surgical is always the main focus, but what are your feelings about the non-surgical side? Are you trying to grow that? How does or did this relate to, or impact your decision on adding an associate?

You don't care. If you do care, how much do you care? Because now you've got the space to put in equipment and, and, you know, non-surgeons. Are you heading in that direction or what's your plan? I'm very well. So, I've had P. A. S. In the past work for me as physician extenders and doing injectables, and they haven't worked out financially for us.

Ivan Wayne, MD: Never busy enough to justify the cost of the practice. You know, there's so many medical spas in Oklahoma City, and it seems like one opens up a month and You know, every two months, one closes. It's just an absolutely saturated business. I talked to people who have successful med spas and they are not like super excited about recommending people do it.

And so, I, I haven't really, I mean, I have branding already in place for it, but it's the people that you need and. I haven't got those people yet. There's a nurse injector who's been in Oklahoma City as long as I have had a great practice and when her plastic surgeon retires, we'll probably bring her in.

I think if I get enough of those people who are just focused on it, because I don't have the time to sell people The services we offer, somebody's got to do it. And focused nurse injector or PA is who you need to do that. And I just haven't found the right people, but I just hired an RN actually last night, who's a former patient of mine, young been out of school for like nine months, she's super enthusiastic aesthetics and I'm like, I'm going to train her from ground zero.

And we're going to kind of go at this from a different direction. So, I'm slowly building that, I have friends, I have a very good friend who's, who's got the oldest med spa in Oklahoma City. And when I talk to him, it's interesting. It, you know, he's, he's kind of, there's some nuances to making money with it.

It's less just like opening a restaurant. It's a very difficult business to be successful with.

Catherine Maley, MBA: I think it's a great idea to either start them fresh, although be careful, usually at the year two or three, just like an associate, they start thinking they're bigger than their bitches and they want to go out on their own.

Or the person who already has a really healthy non-surgical practice and she needs a new home and she knows she doesn't want to run it herself. She knows how hard that is and have her come on and bring everyone with her. Because one thing about facial plastic surgery. It's very difficult to build a relationship quickly because when a woman needs a facelift in her 50s and 60s, she'll, she'll look at what she's done in the past.

And often she's been using fillers and injectables and lasers to try to hold off on surgery. So, it's helpful to build that relationship ahead of time, but I wouldn't bring people on unless they're really good at cross promoting you. In their work, you know, like all arrows should be pointing to surgery, you know, you know, any staff tips on you have a great staff, any challenges there or what's been working for you?

How did, how do you keep them motivated? And how do you find them? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: People come into your lives and people leave your lives and leave your life and you just hang on to the good ones. I, my, my manager, Mariah, who you've met is the most focused, devoted people. She had worked for me in the past. We had a very toxic manager for a while and it took me a long time to figure out where the drama was coming from.

And once I got her out of the office. People started coming back and Mariah is one of the people who came back. So, I, I give people a lot of room to do their job and I acknowledge good work when I see it. I don't, as you know, I don't like micromanaging people. And I very, you know, I, I like to think that I have this sense about people within five minutes, if they're going to work and I can very quickly tell when people are not going to work and, and I've, you know, we've tried.

You know, in what I call it the modification. You know, you have a meeting and you need to do these things and we check with, you know, when people stop working out, they stop working out and that's okay. I mean, there are there are better spots for people elsewhere. People change we all change and sometimes what worked great in the past won't work now and there might be something they'd rather do than be with me so.

Catherine Maley, MBA: What's been the biggest challenge of growing a cosmetic practice in your, in your mind? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: You know, within our practice, probably the social media and the marketing side. I mean, that's probably been the most frustrating thing to me. My practice is largely word of mouth because of reputation and, and I know you're a big fan of it.

And, and You know, I see what young surgeons do who have a lot of time and energy, and some of them are not that young. You know, you look at Mike Nyack's social media presence, I can't duplicate that. I'm just, I'm not big about promoting me on social media, but I've kind of slowly kind of inching into it.

I, I, we have a great person that we've hired who's actually A cinematographer who makes movies. I mean, that's his background and I think he's got a very different visual sense. And I think finally we're getting somewhere with that high creating high quality content. So, that's been the big challenge we've had outside firms.

Those have been absolute disasters. And I know other people have had similar experiences. You, you send them money and, and they just, I feel like reprocess the post they've done for 10 other practices. There's no, there's no unique identifiers. Nothing draws you in. You know, I, I look at my Instagram and Facebook feed and it's like, It seems like every post from all these different med spas and practices are slight variants on the same thing.

There's nothing interesting. I scroll right by them. And I think to break out of that is not easy and I don't necessarily have the answers. But yeah, that's been the most challenging.

Catherine Maley, MBA: Well, I'll tell you the social media that you've done recently is Amazing. You had right off the top, you had two patient video testimonials from deep plane facelift patients who were out six months, you know, on the, just, if I were to critique, I would say do it sooner than six months because they're not as excited.

They like, it's like, that's how they look now. So, the, a lot of enthusiasm isn't there, but it came, it was so heartfelt and you were very natural. And that's what we women want to see, especially when we're going to rearrange our face. How are we going to feel about this at the, you know, how's the end result going to be?

How was the journey? And those were very authentic and very nice. And the women, your Oklahoma women are just darn nice. They're just really nice people. And they're both just, yeah, I'm so thankful for you. And they, and they just were authentic. And I would just keep doing more of that. And same thing with the rhino.

I love when you show, it's so difficult to show how good you are unless you can really prove it tangibly, so when you do a really difficult rhino, rhino case, and then you show what, and you didn't just show what their nose looked like before, you explained the challenges of it, and you could see Oh, my God, there's no bridge.

The nostrils are off that, blah, blah, blah. And then you see them live and then they're saying, Oh my gosh, this was the greatest thing. I just wish you could get them to cry. We love rhino patients crying. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: We had crying yeah, when you cry last week, I mean, just sobbing. And I'm like, are those good tears?

Yeah, we, we try to get you know, I do like the one-week reveals are great. And Luke has been, our media guy has been great. I mean, he loves to film. So, it's, it's natural for it. And I absolutely agree. That's where I'm focusing on. That's, that's what patients want to see. I don't, I'm not really good at that.

And I'm terrible at dancing. I don't think that's going to bring anybody in people when, when it really comes to where the rubber meets the road, and you're about to think about having your nose taken apart or your face taken apart, who do you trust to do it, you know, what do you want that doctor to be, I hope they want them.

They're going to pick somebody like me who's a little bit OCD, a little bit obsessed when I'm doing my stuff, very focused. That's who I am. And I hope it comes across in our videos and our media content.

Catherine Maley, MBA: Oh, it absolutely is. Please keep doing that. Back to the business side, you and I recently were at the Mac conference in San Diego.

And you moderated the best panel I think I've ever seen in my 23 years. And it was called the aesthetic practice think tank. And you had some big, heavy hitters on there and the topics were amazing. Do you want me to refresh your memory or do you want to just regroup or like, or review what, what happened there?

Cause I, I couldn't take notes fast enough. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: So, I created a private Facebook group for myself and colleagues, I don't know how long ago, maybe 10 years ago. Oh, no kidding. Because what, you know, remembering back you leave fellowship and here you are facing this incredibly daunting task of building a practice and challenging patients.

And I remember I'd put calls into my fellowship director or, or to people I trained with and, and they might get back to you that night or the next day. And it's just like trying to get feedback was really difficult. And I thought, wouldn't it be nice if we could just post something and get, you know, just make it easy.

I have this question. What do you do? So, it's interesting, you know, there's like a top 30, you know, members of this group who are like on every post and You can put down a question about a patient. Hey, I had this complication. How would you manage it? Like I had a patient I did a facelift on two weeks ago and he had the weirdest thing happen.

His, his jaw like dislocated the day after surgery and he's calling me and I've never seen this. So, I post the question and a video and I got 20 responses, including several people, very seniors. Like, yeah, I've seen it. It goes away in a day or two. And it did. And I was like, I've been doing this 22 years.

I've never seen it before. So, and then we also have business challenges, you know, hiring people. What do you do about, you know, non-disclosure just, so what I did, Randy Waldman had been aware of this page and likes it and said, Ivan, you really need to do a panel at the aesthetic meeting that I do.

So, I. Kind of thought, all right, I'm going to pick the top five or six topics and I put a little poll and ask questions and it covered things like employee embezzlement. How do you fire patients, private equity, entrepreneurship, adding nonprofit centers.

Catherine Maley, MBA: Private equity!

Ivan Wayne, MD: And, and of course, as I suspected, one hour was not enough because I had some, you know, I'm not going to name names, but I had some big names in our field and there's a lot of big egos, which is not a bad thing, but it's hard to stop talking when, you know, we've got like, you've got like 60 seconds to respond and like 15 minutes later, but it's all good stuff.

So, I just kind of let it roll. And if we do it again, we'll probably do it for longer, but it was just. Top topics that have come up in our in our private group and sort of sharing them for whoever was interested and people seem to like it.

Catherine Maley, MBA: I would say just if you just picked one of those topics because everyone loved to talk about, you have talkers there, so it's even just one topic going deeper than trying to go shallow with five but that was amazing.

It needed a lot more time. Absolutely. And so, you have this Facebook group. It must be a private group, right? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: It's a hidden private group. We just, we want it to, it's just like the same people that I hang out with at meetings, but we're pretty big because people find out about it. We, you know, if you're one of us, we let you in.

It's, it's just facial plastics because I've got some very opinionated members who like to. Talk about facial plastics issues and sometimes we'll mention other specialties. So, I don't, you know, I, I don't want to exclude, but I also, it's our membership and I asked, you know, is it just us? And everybody said, yes, just us.

So, it's just like the people that I would run into one of our meetings, you know, at dinner, we talk about stuff. So, it's, it's, but it's right there and any 24 hours a day, you can ask a question and you'd be surprised. Somebody will answer it within five seconds, literally.

Catherine Maley, MBA: Ah, I'd love to be a fly on that private wall. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Yeah, we're very, yeah, it's, it's, it's like Fight Club and we don't talk about Fight Club, so.

Catherine Maley, MBA: So, I have to ask about preservation rhinoplasty because I've been around for a long time and I swear I only heard about it, what, two years ago, I think when Sam most mentioned it on my podcast. What is with the preservation versus the revision rhinoplasty? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: In a nutshell, there should, you know, it's been around almost as long as open structure rhinoplasty or whatever it is you want to call what I did for 19 years. Preservation, the way I describe it to patients, instead of cutting your bump off, I'm going to bend it straight or bend it and bend it from an ‘outie’ to an ‘innie’.

And that's what you're doing. You're doing maneuvers below the actual surface of the bridge of the nose to release support of cartilage and bone. And you're just kind of pushing it into the nose. It was difficult to learn. I had help from some of my European colleagues and getting started with it.

And Dean Toriumi was helpful. And now I've pretty much converted everybody because I think the results are just that much better to my eye and my aesthetic. It's a more natural result. I've had a hard time convincing people because, you know, we, we spent all this time perfecting a technique and, you know, if you've been doing it 15 years and your results are good and your patients are happy, why change?

And there is no reason to change. I'm just a perfectionist kind of person. And, and with my craft, I want it to be as good as I possibly can. And I've been super happy with. how they've turned out. The patients seem to like it. I mean, they don't know the difference I kind of described to them. And I've only had a couple of patients actually say, do you do preservation?

And yes, I do. And it's not being asked for, but when I became aware of it, I thought I need to learn about this because what if the sweeps the country and everybody you know, the rhinoplasty population is young and very, and very social media savvy. And there are groups on Facebook and people are posting stuff and who, what doctor do you use and what technique and it's, it's an uncontrollable murmur of activity.

And I wanted to at least be knowledgeable about it in case that's the only thing that people want to have done. And that may happen at some point. I don't know. It hasn't yet.

Catherine Maley, MBA: Well, from a marketing perspective, that could be an excellent differentiator for you. The issue is you have to educate patients on the word preservation because most have never heard of it and they wouldn't know the difference.

However, if that could make you different than all the other rhino guys who don't do it and you, you parlay yourself into the expert because you know this innovative technique that others don't or just they don't just don't talk about it. I think that's, that could be a good marketing strategy for you. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: It's, it's on the list of YouTube videos that we're going to shoot.

Catherine Maley, MBA: So, okay, very good. So, we're going to wrap it up, but what advice would you give anyone coming up, you know, who's been in business, I don't know, 10 years or less. What advice would you give them? Or what have you learned that was super helpful for you and maybe today in today's world? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: You mean for a young surgeon coming out?

Catherine Maley, MBA: I don't want to say just a young surgeon, like, just because you've had a very successful track record, and you're doing a great job, and you've grown, and you've had an associate that makes sense, and you've had no major trauma, trauma what, like, what advice would you give others to just ride a smoother path through this world of plastic surgery? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: You know, focus on quality with whatever you do and produce because that's the ultimate differentiator. If I had one, when I evaluate, whether it's a piece of property, a device, a service, I look at, at my, my, you know, I once had, I have a friend who's, who's built businesses and run businesses. And he told me, you know, the value of a business is whatever it would cost you to build the same thing across the street.

So, I always remember that, you know, when, when you evaluate, when you create a valuation on something, don't be too greedy because It's only worth what somebody will pay and they'll pay a little, a little positive on top of what they could do it for themselves. So, quality don't be greedy and then barriers to entry are important for me.

You know, I do facelifts, I do rhinoplasty. There's no med spot in Oklahoma City or anywhere in the world that's doing that. That's my barrier to entry. It's something that's very difficult to learn that limits your competition. Every time a device gets kind of thrown or pushed towards me, I kind of let, oh yeah, anybody could do this.

You can teach your staff to do it in 30 minutes. Right away, I'm not interested because that device will appear in 10 med spas around town, because if it's that easy, why am I going to bother offering it? It just doesn't make sense.

Catherine Maley, MBA: Gotcha. Okay. And then the last question, tell us something we don't know about you. How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: Let's see. I have an alter ego identity called Surgeon Sculptor. It's on Instagram where I, where I do my metal sculpture and metal crafting. That's entirely self-taught. I did, well, not entirely. I took a class in Las Vegas during one of the meetings on some of the techniques, but I have a shop and I go there and it's, it's a great way to unwind.

And I consider it cross training because I do these very detailed welding techniques that are very hard to learn and it's a whole art and I'm not particularly good at it but I get better and it's very refreshing to do something that is highly focused and difficult. And if you do it just right it's perfectly beautiful if it doesn't you throw it away and start over and I can't do that in surgery so it's, it's my therapy and as I have more time sometime in the future, I actually want to pursue that more and have that almost as a side business in a way.

Catherine Maley, MBA: I had no idea. I'm going to go check that out on Instagram. And you can always fall back on that when you're tired of doing plastic surgery. It's great to have a hobby, by the way. I've noticed a lot of surgeons don't. I know I don't either. And you just focus on one thing. And I, you know, when you want to slow down, it's like, well, what would I do if I didn't work?

You know, good for you. You have something you'd want to do. How would others hear about you or if they wanted to contact you, what would be the best way? How does or did this relate to, or impact your decision on adding an associate?

Ivan Wayne, MD: They can email me off of the website WFacialAesthetics.com. That's probably the easiest thing to remember. Or by my email, it's [e-mail] or @hotmail.Com. That tells you how long I've been on the internet. Hotmail, but yes.

Catherine Maley, MBA: I gave up my Hotmail account with my AOL account. Yeah, it wasn't helping my branding. So, thank you, thank you Dr. Wayne for coming today to podcast. I really appreciate it. It's a pleasure. I hope to see you again, again at the next meeting.

Actually, we have one coming up. Are you going to be at the AAFPRS in Vegas?

Ivan Wayne, MD: I will so I'll see you there.

Catherine Maley, MBA: Okay, I'll see you there.

Ivan Wayne, MD: Thank you.

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

If you’ve got any questions or feedback for Dr. Wayne you can reach out to his website at, WFacialAesthetics.com.

A big thanks to Dr. Wayne for sharing his experience on adding an associate.

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

If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don’t miss any episodes. And of course, please share this with your staff and colleagues.

And we will talk to you again soon. Take care.

The fastest way to success is to model other successful surgeons who have what you want, but you can only see their results, not the path they took to get there.

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-End transcript for “Adding an Associate — with Ivan Wayne, MD”.

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