Busy Without Advertising — with Scott R. Miller, MD (Ep. 228)

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 how to stay busy without advertising.

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 "Busy Without Advertising — with Scott R. Miller, MD".

On average, the “experts” say a plastic surgeon should spend 6–12% of their annual revenues on marketing to include advertising, Website/SEO and content creation.

For example, if you are a $1,000,000 practice, your average advertising spend of 9% would equal $90,000 per year or $7,500 per month.

Of course, that doesn’t take into account what advertising stage you are at. Because there is a big difference in ad budgets if you are getting a new practice off the ground, or a 10-year-old practice ready to uplevel, or a busy and mature practice with an established track record and reputation.

This week’s Beauty and the Biz Podcast guest was with Dr. Scott Miller, a board-certified plastic surgeon who has run his solo practice in gorgeous LA Jolla, CA for the past 27 years. He also manages to keep busy without advertising.

We talked about how he grew up in Las Vegas playing tennis and then found his way to medicine, and then to LA Jolla.

He laid out how he has kept the majority of his staff for over 10 years, and how he runs a busy practice without advertising, even though he’s in a very competitive area.

Here’s a hint for his success: He’s thinking about his patients above all else ;-)

Visit Dr. Miller's website

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Transcript:

Busy Without Advertising — with Scott R. Miller, MD

Catherine Maley, MBA: ​

Hello everyone and welcome to "Beauty and the Biz" where we talk about the business and marketing side of plastic surgery, and how to stay busy without advertising. 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 special guest I've known for a long time, it's Dr. Scott Miller, who manages to stay busy without advertising. He's a board-certified plastic and reconstructive surgeon in solo practice located in absolutely gorgeous La Jolla, California. and he's been practicing there for the past 27 years. Now, Dr. Miller, who keeps busy without advertising, teaches courses on plastic surgery, instructing surgeons in endoscopic techniques, and advanced concepts in facial rejuvenation and enhancement.

Now, he acts as an attending surgeon at Scripps Memorial Hospital in La Jolla, and is a voluntary clinical instructor of plastic surgery at the University of California, San Diego. Dr. Miller speaks at medical conferences and has authored multiple textbook chapters on facelift advancements, along with other numerous medical articles.

Dr. Miller, thank you for showing up on "Beauty and the Biz". It's a pleasure to have you.

Scott R. Miller, MD: Glad to be here. Thanks for having me.

Catherine Maley, MBA: Yeah, I'm glad we finally figured this out. So, tell me something. I happen to know you're from Las Vegas. How did you get from Las Vegas to absolutely gorgeous? For those of you who don't know La Jolla, California, it is the highest end, the most breathtaking views I've ever seen. How did or does this factor in with you keeping busy without advertising?

The weather is magnificent. It's, it's San Diego, but it's just a really prime area of, well, what makes La Jolla so special? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah. I mean, I think you hit on it. I think for me, it has. It has the benefits of being its own town with its own identity with its own character And yet it's got like everything you'd want in a bigger town So, you have you have sort of a small-town big town at the same time, right?

You know you go out and you see friends and you walk around and you see people, you know And yet at the same time you have access to the

You have a civic identity, which is really important to me. I spent some time in Orange County, and I just didn't feel that so with all respect to my friends and colleagues in Orange County so, yeah, I just love San Diego, not to mention, you know, the weather's a gimme. You know if you're going to work hard and you want to be able to work hard, play hard, then you have to have the weather to allow you to do so.

And so, it's nice to not. I haven't checked the weather in 20 years. So, just plan on it. And on the occasion, we're disappointed, but for the most part it's reliable and we can plan what we want to do, which is really helpful when you're working hard and have the occasional day off. I want to take advantage of it.

Catherine Maley, MBA: Oh, for sure. So, how do you get to La Jolla from Las Vegas? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, so I mean, it's, you know, for me, the first of my life's broken up into, I guess I'm getting older now, so it's 1 3rd 2 3rd instead of half and half, but the first, the first chunk of my life was pretty dominated by tennis. So, I was a tennis player.

Tennis was what I did. I was at all the hotels. I go from one. I play two or three sets. I get somebody and I get to another hotel and play two or three sets against somebody. So, that was most of my youth. And then you know, we were going vacation to California. And of course, anybody who's. Not from California when you're on vacation to California, you're like, it's like the beach, the beach.

So, it was always such a pleasant thing. So, when it was time to pick a school and go through recruitment and whatnot you know, the California schools had a big advantage when it came to my choices. So, I went to UC Irvine for college. And yeah, it's funny because I started out making fun of all my friends from California who acted like there was no other place to live in California.

I'm like, California is great, but there's a whole world out there. And then I did college and then I went to medical school at UCI because you know, the known is Sort of better than the unknown. Sometimes there's good medical school. They wanted me and worked out pretty well. And then I stayed there for internship and resident residency.

And at some point, along the line, when it came time to decide where you're going to put your stake in the ground and have your practice, you, you kind of looked up and realized I'd become one of them. And I really do love California. I love all it has to offer again, whether it's conveniences or people or population, it's just a really convenient, fun place to be.

It's been a great place to raise a family.

Catherine Maley, MBA: Wow. Well, you picked the right place. So, what was your jump from fellowship to solo? Was there a journey there or did you go straight, straight into solo? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: So, you know, it's a little bit interesting and I'll save you the longer convoluted tale, but I really tried hard when I was finishing up my plastic surgery fellowship.

To have an open mind. And, you know, I did not want to be closed minded. I wanted to look at all opportunities. Again, I wasn't originally from California, so I want to keep an open mind. And then I then did a fellowship with Bruce Connell. And during that year with Bruce, I think what happens is you.

You learn a lot. You also gain a tremendous amount of confidence in what you can deliver and knowing what you can deliver and the level at which it's at. And between those two things, I sort of stopped looking for opportunities and started just deciding where I wanted to be. And that's, so then that's kind of when I finished my year with Dr.

Connell. I had actually inadvertently started building a practice. It wasn't my intent. I was just doing some cases on the side and, and, you know, doing cases that, that he referred to me during the fellowship and doing cases as a clinical faculty at UCR, I mean, UCSD. And so between, cause I was driving back and forth from Orange County where he was and San Diego.

And so, I sort of inadvertently, you know, I had people just. Calling me on a pager. I mean, it's not the way a normal person starts a practice, but I had people calling me on a pager and saying, Hey, you know, this is Tracy. My friend Holly said you're the one to go to. How do I get a consult? So, it was a very sort of ramshackle, unofficial start to a practice.

But then once I finished, I said, okay, this is where I'm going to be. And what I quickly found out is that it's all about the patients. It's not about having the Taj Mahal of offices. It's about the patients. And if you have the patients, you can find the space. So, I had a reasonable flow of, you know, calls and consults and cases.

So, I had no shortage of people who were happy to let me use their facility and do my cases out of their surgery center. And then from there, shared space for a couple of years. With someone. And then that worked out well, but they were going to stay in practice and I think we both wanted to be solo. So, kind of around 2000 two, decided to kind of like take my own shingle.

It was always, I always had my own practice. It was just a matter of whether I was sharing space. And then in 2002 is when I moved into my own facility.

Catherine Maley, MBA: Gotcha. And but you stayed in the Scripps office building, right? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, yeah, I've been ever since I finished fellowship. Like I said, I shared space here and then kind of moved into my own space and it was amicable because originally that person was going to retire and then and I was going to take over and then they decided they didn't want to retire and we both.

Preferred to be in solo practice and had sort of a patient flow to where that was reasonable. I run a, I run, and so did he, a fairly lean practice. So, the, the pressures to share space and staff weren't as strong as they might be in more of a high maintenance type of practice.

Catherine Maley, MBA: Yeah. And then what, how do you feel about being in the building? How did or does this factor in with you keeping busy without advertising?

Looking back now, do you wish you bought your own place with your name on the building where thousands of cars see you? Do you have a feeling for that? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, I, well, I think I do. I mean, I think from a business standpoint, I absolutely, I, and I knew that then, so I can't claim ignorance. But if you have to look at the community, you're in and what buildings are available in order to do that, I'm right here in the La Jolla University town center area.

I get patients from Orange County. I get patients from, you know, deep south into San Diego. I get patients from east and obviously we have people flying in as well. So, I can go. My catch area if you want is so wide that it would be really hard For me to be in a difficult to access area. And so, or at least it seemed that case, the places where you could buy five, 10, 15, 20, even 20, 000 square foot buildings were not the places that I thought I should be.

And so, I just made the decision like that, that wasn't worth it. I wanted to optimize the practice situation, particularly early on. You can imagine rather than have this great. Office building and business proposition, but not be accessible or whatnot. So, yeah, the buildings where I am are all.

You know, 80, 000 square feet and up. And that just wasn't a practical thing to, to work towards. But I think that's a great idea. So, I would never negate that for anybody. Like I said, to me, the other thing you have to do is look at your community. So, I have a lot of friends in L. A. and L. A. is really different.

In L. A., people go, are you on Rodeo or Spalding or Bedford, right? That's L. A. In, in San Diego, people kind of say, oh, are you. With, with or by Scripps or Sharp or UCSD. So, I was on clinical faculty at UCSD. Their hospital is right next door. I've been attending at Scripps. I'm on the campus of Scripps. And that just made for a much easier identity.

Again, particularly early in practice. At this point, it probably doesn't matter. But at this point, I'm also set and settled, so.

Catherine Maley, MBA: Well, I'll bet there's a lot of cachet to the name Scripps. And everyone knows where it is. And it was probably a really good play on your part. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Exactly. It's just, and again, in our community, you know, I had, I had young, you know, young kids when I was starting out, and all you have to do is go to a four-year old's birthday party, and you'll find out right away what people are looking for because they ask you, you know, like I said, they ask you, oh, oh, are you with Scripps or UCSD or Sharp or something?

That's the question we get here. Again, I think the question is different in L. A., different in Orange County, and probably different all over the country, so I think you have to know kind of your community as well. Thank you.

Catherine Maley, MBA: Right. And then regarding reconstructive versus cosmetic, did you jump right into cosmetic? How did or does this factor in with you keeping busy without advertising?

Were you doing half and half? And what do you do now? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: I do pretty much exclusively cosmetic with the exception of a variety of dermatologists that when, when they make a hole, that's kind of beyond their capacity. And as long as patients, we don't do any third-party billing. So, as long as the patients are okay with that, and we have a reasonable population here that, that is okay with that.

So, I'll help them out in those cases. But other pretty much we do exclusively. Cosmetic surgery. And you know, while that was always my, obviously I did a fellowship for a year with Bruce Cannell, I didn't do that so I could do free flaps. So, I had an open mind starting practice on sort of whatever it takes and, and definitely willing to hustle.

But that was always my dream and it actually came to fruition much quicker than I expected. Because of variety of circumstances. As I said, when I finished the fellowship, I sort of found myself in practice. Well, I found myself in practice as I was still waiting to get hospital privileges. So, I was doing cases out of surgery centers and office-based surgery centers while I was still waiting for that.

So, by the time all that came through, I had developed, you know, inadvertently a pretty decent aesthetic practice. And at that point you It doesn't. I took some call early on just again to hustle and to be available. I worked a half day at a wound care center, but at some point, you have to say that it's not fair to your 7 a.

1. case patient to be up at 2 a. m. doing a facial fracture. And so, and there's a lot of people who need the other work. To get going. So, leave that to them and you do what you're best cut out to do and that you prefer to do probably. Exactly. I think if you stay in your sweet spot of what you're good at and what you enjoy better things are going to happen for both you and the patient.

Catherine Maley, MBA: Now, the challenge with a plastic surgeon is you were very heavily trained on face and body . Yes. So, You, I, when you were, when I knew you, oh my God, I've known you for 20 years or something, but you, you, I felt like you were more body. As I've watched your career, it feels like it's moving more towards face. How did or does this factor in with you keeping busy without advertising?

Was it always like that? And I just didn't notice it or how, what's happening with that face versus body? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah. I mean, my passion was always facial aesthetic surgery because I think it's the, in my feeling is that it's the pinnacle of our art. It's the most precise. I think if you could do that well. You can carry that over to the other venues of breast and body.

I don't know that it always goes the other way. I'm sure I'd get some pushback on that, but that's how I feel for me. So, for me you know, at the same time when you start practice, look, most people's first bunch of patients are going to be the patients their age or around their age. So, I'd say my practice was sort of 50 50 starting out, which is, I think, unusual when you're 34, 35, 36.

And then, but over the years that the face parts gone up and up and up both by natural referrals as well as by inclination. And then I would say in the last decade, we've been very, very intentional about that because again, that's what I want to do the most. And if I've got calls for both, why wouldn't I book more of what I want to do?

And I think what happens is the more you do of that, the more your office is cut out for that, the more your office and staff and system is tailored for that. And it goes the other way too, you know, so if you're doing a ton of big body cases, you probably have all the systems and, and, and protocols and everything set up for that.

So, this just works best for us. It works best for our patients. 85 percent now. I mean the breast cases, the body cases I do are just because I'm doing something else. It's either a previous patient or I'm doing something else and they want it done at the same time. And the breast cases I'm pretty selective for, you know, I just honestly try to do things that I enjoy and that I know I can hit a home run.

And if I don't think it's one of those two, there's plenty of people out there.

Catherine Maley, MBA: I didn't know it was even that much. That's amazing. And I just think that's so logical. As you get older, you decide or you, you have preferences. And it's like, why, why kill yourself doing 10 procedures, you know, little procedures versus like two or three really good facelifts a week or a month. How did or does this factor in with you keeping busy without advertising?

I mean that, God, that just makes a lot of sense to me. If you can pull that off, you're just, you're working smarter and less hard. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Exactly. And I know that there's other people who say, who find, you know, find from a business perspective, you know, oh no, knock out five breast dogs and that's great if that's their thing for us.

And I enjoy doing, still doing, you know, straightforward breast augmentations. But for me, I enjoy, you know, surgeons like to do surgery that, so I enjoy coming in and getting settled in, in the OR and having one or two really juicy cases that appeal to me and that. That I enjoy. It's just an efficient practice for us.

You know, there's not a lot of, there's not a lot of changing for post ops because it's your base. We've got it kind of down, like I said, just as if a breast or body focused practice probably would as well. But for us we feel really comfortable with what we produce. We have a pretty good price point.

And so, it all works together to make a practice that's just incredibly satisfying for me and for my patients.

Catherine Maley, MBA: Well, I call the facelift patient the long tail patient because if you have one of them, they're obviously a more mature, usually financially, you know, sound and they care about your skill and expertise. How did or does this factor in with you keeping busy without advertising?

They are not shopping around for the cheapest or shopping around for the best. And the first thing people do, especially in your kind of area. They don't go online. They talk to each other. Who did you go to? You know, who you, who's the guy to go to? They can be your absolute automatic marketing machine. How did or does this factor in with you keeping busy without advertising?

So, I love where you're going with that. It just makes your life a lot easier. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: I think you're absolutely right. And I think that's partly too, is I don't want to be, I'm not. I enjoy my patients. So, as much as I said, I enjoy surgery, which I do. I enjoy my patients. I enjoy seeing people. I'm an extrovert.

People energize me. I enjoy the give and take with my patients. They give me a vacation and restaurant recommendations. And you know, I really enjoy the dialogue back and forth. So, I enjoy having relatively sophisticated, intelligent, bright, fun, funny people as patients that I interact with. I mean, I interact with my patients and my staff is a patient.

huge chunk of my life. And so, I want to enjoy that. So, I don't, I'm not trying to be sort of the surgeon who walks in and walks out and doesn't take questions and doesn't want to discuss things and stuff like that. So, that clientele really lends itself to that, the face clientele.

Catherine Maley, MBA: Okay. So, you mentioned that you have a lean machine there. How did or does this factor in with you keeping busy without advertising?

What is it made up of? Because oftentimes, when you go facial, or like, concentrate on that, sometimes you want to also do the non-surgical to develop that relationship. So, when they are ready for surgery, they choose you. What's your feeling on that? And if so, then do you need to bring on some other staff who can handle that and be revenue generators? How did or does this factor in with you keeping busy without advertising?

How did you set that up? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, I mean, I think there's different paradigms and again, not to judge anybody else's paradigm, but you know, I, I didn't, I don't have an MPA. I didn't, I didn't go to business school. I didn't take any extra courses. I just try to be smart and reasonable. And I did early in my career do a lot of reading of adjacent and ancillary fields.

To try to gather as much as I could. Books like yours weren't out then, and there wasn't a lot of, you know, I had to read, I read some of the dental literature actually had much better stuff at the time. And just general business stuff. So, and then I had to sort of extrapolate on what, how that would mean to plastic surgery.

But the bottom line is, you know, I have six. Full time employees and then three anesthesiologists that rotate through our surgery center and that's enough for me, right? So, I'm not I hold no illusions that I could be managed 25 people and so I try to keep it relatively lean and simple I think we're really lucky in what we do is we have a reasonably healthy margin in what we do And so I really don't need to then try to make an extra 10 In nickels and dimes and dollars when I have when that means making my machine much more complicated and more difficult to run if it means I'm going to sit in the office for an extra half a day, right, or more doing administrative duties because I'm running this big machine so that I can what have a 10 percent bigger gross and that's gross, you know, then you then you have overhead and then you have taxes.

It just doesn't to me. I'd rather have the extra, you know, half day off and I do So, so that to me is kind of how I've kind of made it work for to have a good, I don't really like work life balance. Work life integration is a better way to put it, especially when you're in solo practice, you know, you know, it's just, I live 10 minutes away and you know, it's, it's just, it just makes me unable to not feel like I'm missing out on anything with the kids or the family or the social life.

And at the same time, commit fully to my patients and my practice.

Catherine Maley, MBA: I hope everyone caught what you just said, a 10-minute commute. I would recommend keeping your commute as simple as possible. There's too much more you have going on to become a successful plastic surgeon. Your commute should not be part of the aggravation. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: No, exactly. Exactly. I mean, you know, I say sometimes if you want to wind down, you can sit in the car an extra five minutes if you want, but, but who needs to sit in traffic or lose 30 minutes of your day. Each way gets to and from work. I mean, I just think that, and, and when you, you know, I just can't tell you the conveniences of being, being so close to the office, being able to pop back and pop in.

I mean, yesterday I finished my case a little early, ran home for an hour, hour and a half, and then came back because I had patients starting at two. So, you know, you just can't, I couldn't do that if I. I lived in the valley and had an office in Beverly Hills. So, for example,

Catherine Maley, MBA: Traffic in California, dear lord.

Scott R. Miller, MD: Yeah, yeah. So, again San Diego, we, you know we have rush hour traffic still, you know, as California, but we don't have too bad of off hour, you know, traffic. So, that's kind of nice. And I mean, there are, I'm sure people come here from other parts of the country and think we have horrible traffic, but if you go a little north of here, you see it gets significantly worse.

So, yeah, we're really fortunate that way.

Catherine Maley, MBA: Well, I know anybody who's been to, I'm in Northern California, so whenever I'm in Southern California, everyone knows the horrendous trip between San Diego and L. A., you know? Everyone's done that, and as a tourist, you're like, oh, how long can that take? Oh, it can take a long time. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: It can take hours and hours. Well, my kids, you know, obviously, I had three kids, and they all participated in all kinds of activities, sports, and other things. And the number of times I've driven back and forth, mostly to Orange County, occasionally to L. A. and Pasadena. The crazy thing is... If you pick the right time, it could take an hour, hour and a half.

That's the crazy part. But if you pick the wrong time, it could take four and a half hours. So, you get a little strategic with that.

Catherine Maley, MBA: Yeah. So, back to staff. Does your staff appreciate that they have Fridays off? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, I think they do. I hope they do that. There's always a little hedonistic, hedonistic adaptation.

So, they probably appreciate it in theory, but then get kind of used to it. But yeah, I think yeah, I mean, I think they do on the whole. I think I have a really great dedicated staff. We're all on the same page of Not trying to we don't try to melt the practice of the patients. We're here to serve Obviously you have to set up a paradigm where that keeps you in business, right?

You can't you I don't want to be too, act too altruistic about the whole thing. It's a business but on the other hand, If you set up the right you can really focus on t why I went into medicine You can really focus on the patient care, and for the lack of a better… Less can just happen because you're right in the right way and for the right reasons.

And I think I have a staff that's all-in kind of lockstep with that, including their lives. So, yeah, I think they do appreciate that. They have a weekday to sort of get things done. All the things that we all need to do in our lives. I know. And I don't think we do any. Less, we just make us more efficient on the other days.

Catherine Maley, MBA: Oh, I have never heard of this before, quite frankly. Usually, the doctor will take the Friday off, but the staff still has to work, you know? That's a really, that's a really big perk that you're offering there, especially in San Diego. Like right now, today we're doing this on a Friday, and I'm, they have to be appreciating this, I hope they are. How did or does this factor in with you keeping busy without advertising?

Nobody else is doing that. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah. Yeah. And I mean, I think it comes with the commitment to, you know, we see patients on Thursdays and, and tuck them in. You know, you have to, you have to plan your week and get everyone tucked in and, and then, you know, I try to call all the patients on Friday too and just make sure everything's so, I guess in that way it falls a little bit on me to kind of check in with the patients.

But I think I appreciate knowing they're all tucked in and they appreciate the, the call. And so, I kind of make, I give myself. You know, per some of your systems, I give myself. That's my job. So, I actually get a list of all the patients for the week and I call them all on a Friday or Saturday and make sure they're all checked in doing well and get make a note on it.

And then we look back at the end of the month and just like all the employees have their jobs and we look at whether they check, check, check, miss that one, check 80%, 90 percent completion, whatever. And so, I get it. in our little group meeting one of my kind of key roles I would say, because we f does make people rea of them.

And we're really is like going on a trip w and you don't do it unless you're committed. And once you do it, you're committed. So, we really, you know, there are interests are very much aligned with our patients.

Catherine Maley, MBA: I guarantee those patients are paying you back with reviews and testimonials and word of mouth referrals. How did or does this factor in with you keeping busy without advertising?

No, no surgeon usually It is making those phone calls. They just they make them the first year or two and then it's delegated to staff or some nurse. And I know that makes a huge difference. So, and you probably know that, right? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, I mean, we've gotten the feedback that it does. And it also helps with my staff too, because, you know, you kind of have to walk the walk, right?

You can't, you can't tell them how important patient care and how important all these different areas are, while you kind of. Blow everybody off and go along their own way. So, so it's a, it helps with them to set a better example.

Catherine Maley, MBA: Oh, absolutely. So, all in all, what would you say is the biggest challenge of running a solo practice? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: I think it's just, it's the main thing is you know, I would say, what's the biggest challenge? That's a good question because I think that number one, I'm comfortable being available. You have to be comfortable being available. Now I have great colleagues in town and I have great relationship with them.

And it helps that I don't try to do everything on everyone. So, you know, I don't have, I don't look at it as a competition. You know, obviously, if, if you do a great job on a patient, that patient's going to likely refer people to you, but more importantly, that patient's going to feel great about plastic surgery and have good things to say.

And some of that's going to trickle to everybody around you. So, I think that, you know, a rising tide lifts all ships. And so, there's a number of other colleagues that I have a great amount of respect for. And so, I have people who will do me favors and everything, but I try not to call on that. And I take first call.

Unless I'm out of the time zone, in which case I have a nurse who takes first call and then she would call me. And I only call colleagues if I really have to. We also arrange the surgery schedule when we're going out of town to try to accommodate for that. So, we would be very unlikely which it is anyway again, because of the way we tuck them in.

So, but I do think that just. Having that phone with you all the time, you know, being available used to say major announced phone, right? But that's probably the biggest thing you know financially fortunately for me hasn't been an issue because we've had a pretty thriving practice So, it's never been that close to the bone where that's been the issue, you know I also don't live beyond my means and I think that's one really good piece of advice I got from a senior plastic surgeon when I was starting out in practice, you know is you if you live Within and even a little under your means.

Then you'll, you'll set yourself up to make better decisions, both for yourself and for your patients. And so, I've never had a situation where either professionally or personally, I would have things cut that close to the bone that I felt I had to do anything I didn't want to do. So, so that hasn't really been a big issue, although I think it could be.

The other thing is just being, you know, I love the autonomy. But at the same time, you do get sometimes decisions. You know, sometimes you're just like, Oh, can't something just take care of itself, you know, but no, but at the same time, I have to admit, that's why I couldn't manage, you know, 24 people or 25 people because I am a micromanager and I accept that in myself.

I've tried to get better at delegating and I've got some great people to do that. But, you know, I want to have a say on the paint color and I want to check the new faucets that we put in. And that's just who I am. And that's okay. But I think that could be a burden for some people.

Catherine Maley, MBA: Well, “know thyself”, as they say.

Scott R. Miller, MD: Exactly, exactly.

Catherine Maley, MBA: All right, so you've been in practice 27 years. Have you been thinking about an exit strategy? What are your thoughts about that? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, I know it's interesting. So, I have thought about that a lot. I try to think ahead. I try to, I try to think ahead. I try to look for opportunities, but I try to look for the opportunities that, and this is off the topic, but I try to look for opportunities that.

That somebody's not doing not the ones that everybody's already done. Okay, but so on that same token, you know, of course, I look ahead and I kind of go, okay, what's the plan? You know, what's the plan 10 years out? What does that mean? I want to do five years out reverse engineering. You know, a couple years ago, I had a friend who he had been in the military.

So, he's a little late starting in practice. And then he had some health challenges. And he was revamping his whole practice, renaming it, getting his name off a bit, genericizing it adding all the med spa components to it. And his goal was really to create something that was a little more transferable, right?

So, that he had something he realized he felt like he didn't have enough of value to leave if something happened to him or if he wanted to retire. So, I talked to a couple of people I know and friends and whatnot, and I kind of evaluated, is this something I should be doing, right? I think you always want to be humble and teachable.

And, and so I looked at that. What I came up with, again, for me, is that I could invest a ton of money up front, and a ton of time, and a ton of stress, trying to sort of... Revamp, restructure, remodel our practice and create something more sellable, quote unquote, versus you know, I'm fortunate enough to have plenty of cases.

Like I said, I don't work Fridays. So, and I, and I still don't, don't want to, but like, if I really versus, you know, throw on a breast auger every Friday morning. And put that in a separate account. And then somebody else said this, I didn't think of this, but he said, throw on a breast auger every Friday morning or Thursday afternoon, put that in a separate account.

And then, you know, 20 years from now, just lock the door on the way out, access that account and you bought out your own practice. So, I'm not saying that's for everybody. And I've certainly, you know, I certainly won't be. Refusing offers when the time comes, if there's a good opportunity, but I decided that it's more important to have and live and experience and work within the practice that I want while I'm practicing than to turn it into something less comfortable so that one day maybe dot, dot, dot.

Catherine Maley, MBA: I don't think there's any one answer, but I do love your philosophy on. I want to enjoy my work since I'm there. Only four days a week. Yeah, exactly. I mean, you've got that set up just the way you want it and it's working for you and the staff's happy. You're happy. Why not? I mean, why change? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Exactly. I mean, you mentioned the staff.

I've had incredibly good luck with, you know, staff longevity and we have patients come in and they recognize Who's been with me since I started practice? Katie, Christine, who's been with me over 15 years. Katie has been with me well over a decade and, and the most of the people that have left him to you out there.

You know, most of them it's because of. You know, marriage or pregnancy, or, you know, we're in a military town, so if they're married to somebody military, the military person gets transferred, so, and that happens, so I actually have a, a decent number of plastic surgeons around the country who appreciate that I've hooked them up with really good employees, because when I have an employee going to another town, you know, I'll call ahead and try to find something for them when they, because they're, they're relocating, but you know, I think that that all goes together too, you know, I, I shared space with somebody, I saw the challenges of that.

I then looked around. I mean, I see brothers who can't get along. I see, you know, father daughters, father sons that can't get along. No fewer best friends that can't get along. I mean, the number is, is, I mean, I, I don't know what the success rate is, but it has to be 20% or below of people that, that joined together and, and probably there's another 20% on the other end that end up in horrible.

Divorce slash acrimony slash legal action. So, that's just not something that to me is, is worth it when I weigh the pros and cons. Again, I run a relatively lean practice. So, when I shared space, what we found is in very short order. We had one receptionist who was overwhelmed because we had two busy surgeons in the same office.

We definitely both needed our own patient coordinator. We definitely both needed our own nurse. And in the office, and since we were both busy surgeons, you know, I guess we could have figured out how to do the OR time, but I was working five days a week at the time, and three days in the OR, and he was working three days in the OR, so that was going to be a long jam, and, but we had two, we fortunately had two ORs, so we had two ORs, two OR teams, we had two nurses, two patient coordinators, and shared a front desk person who was overwhelmed, and there wasn't a lot of savings there, you know, I mean, rent, I, you know, just not to break it to anybody, but like, if your biggest issue is rent and I'm in California and we pay obscene rent, you know, thanks Scripts Realty, but having said that, if your biggest issue is rent as a cosmetic plastic surgeon, you need to rethink how you're doing things.

And I don't mean that to be harsh, but I, I feel that way for myself.

Catherine Maley, MBA: That's really a good point. Let's talk about competition. I can't, LA Jolla, I don't know as well, but you know, Newport Beach has something like 150 plastic surgeons. Yeah. How far are you from Newport Beach and is that a competitive area for you, or do you have your own local competition that you have? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, I mean, both, both. You know we certainly have a ton of people here. I think the joke was at one point between my building, the building next to me, there were probably 25 options to get a blepharoplasty, you know, between the, the ENT and the plastic surgeons and the, and the ophthalmologists and oculoplastic surgeons and whoever else thought it was a good idea to, you know, do that.

So, yeah, no, I mean, we definitely have, have that just. On Scripps and then UCSD is next door and then Sharp is 10 minutes down the road and then there's other Scripps campuses and UCSD campuses further south. So, and then, yeah, even though Camp Pendleton separates us from Orange County, there's no question South Orange County, I get patients from South Orange County and Newport Beach and some from L.

1. And I'm sure they get patients from here. So, I think especially when you're kind of like, you know, whatever niche you're in. Right. But if we're in the higher end facial aesthetic niche, if you will, then it suddenly becomes like a handful of people and you have people, people are definitely can go where they need to go to find the right fit for that.

And I'm a big advocate of that. So, by all means, I think that's smart of them to find the right fit. We definitely get people from up north who want to slip over here. I mean, I think there's people that want to get out of their personal middle you sometimes to have their surgery. And we've got a really good set up with Torrey Pines Lodge and retreat and whatnot, where you can recover and, and privacy and luxury and whatnot.

And whether they're from here or whether they're from up north or anywhere else in the country. So, I don't look at it as a competition as much as a collegiality and I've got great friends and colleagues, but I certainly there's people when they weigh their choices, there's choices in town and out of town that they're going to consider.

Catherine Maley, MBA: But you also haven't taken that for granted. I saw on your website, and I don't know why everybody doesn't do this. It says, why choose Dr. Miller? Like, it literally says, why choose us? And you're very specific about your core, your four core values. And it's, it's just, it has a whole section of why us? How did or does this factor in with you keeping busy without advertising?

And I think you have to be so logical and emotional with patients. Because they buy, well, they're logical to begin with, but then they buy emotionally. But I think you have to spell it out. Why you? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: I do think so. And I mean, we might add a section. Why not? Why? Why don't choose us too? Because I think there's reason to choose or not choose a practice and you need to find the right fit.

And, you know, I want patients where we're the right fit for and I'm confident there's enough of them that will keep us going and thriving. But, you know, I think that's I want patients that are happy, you know, before, between and after and then refer other people. We don't do any other practice. Marketing really so-so. I think that absolutely I think, you know, we have this as you mentioned the passion for performance and the four is quality, integrity, safety and service.

You know, we want to do excellent work. We want to have integrity and do what we say we will do. We want to safety is always first and we don't cut any corners. You know I'm very lucky that my wife has a master's of public health and she's an RN and she's not in the office all the time working, but she oversees our surgery center and our certification and, you know, we don't cut any corners.

You know, we do the same. We provide, create an OR and recovery room atmosphere and safety setup. That is what we would want if we're all having surgery and many, Okay. people in the office have kind of, you know, and the we want to serve our Pati said, we pick the right p go broke. But at the same we're here to serve and a and you know,

when I wrap to feel like I, you know, Contributed something to someone somewhere. That's really important to me. So, so yeah, I think that's, that's kind of a really important part of what we do. We, we kind of, I think I really believe in a core value of respect and respect involves what I like to think of it as care because it's a nice acronym care, but you know, it's kindness, appreciation, reliability and enthusiasm.

You know, I think personally, I think Kindness shows appreciation for people's feelings, appreciate, appreciation shows respect for people's feelings, I should say, appreciation shows respect for people's time and effort and choices. Reliability shows respect for people's commitments, you know, and for yours.

And enthusiasm shows appreciation for their own opportunities that you've been given so, so if we, you know, we kind of look at it each day is like, hey, look at all these great people we get to meet look at all these great people we get to serve. And if you keep that attitude. And again, I don't want to be polyamorous within the right paradigm.

Then, then we try to we, we find that works really well for our practice. And then we try to express it, as you said, on the website, is that this is what we have to offer. You know, there's certain looks you might want to achieve, you know, that, that might not fit with our, with our aesthetic. So, look at the pictures, talk to us, and we'll give you an honest impression of where, where, what we see, given your concerns.

Where we're trying, where we think you should go, listen to where you're trying to go and see if it's a good fit.

Catherine Maley, MBA: That's why I think your marketing is spot on, you're attracting that niche market that you want the most of. And frankly, you picked the right demographic because you want to work with a group who's least likely to be affected by the recession or the economy or whatever the heck is going on out there, or last affected by them. How did or does this factor in with you keeping busy without advertising?

So, you have a minute to regroup if you have to. Did you make up that CARE acronym? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yes. Yeah.

Catherine Maley, MBA: Yeah. All right. You have another really fun thing. You say you have a really great short PR intro video. I highly recommend everyone check it out. It said Miller cosmetic surgery dot com. Usually doctors want to talk about all of their degrees and the training that they've had.

And you talk to the patient about what they care about. And you said. I think you said something like this. I use my hands, my head and my heart to, you know, give you what you want or, but you said it very eloquently. I thought that was, I mean, talking right to that patient who cares way more about that than the price. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Oh, yeah, thanks. No, I appreciate that. That's actually something I originally sort of just spit that out when I was making a message to my staff in the middle of COVID and just kind of how we're going to get through this. We're going to use our, our head, our hands and our heart. You know, we're going to, it's going to take some thinking.

It's going to take some work and it's going to take some perseverance to get through this. And then, like, then I kind of thought about it and apply it more towards the practice, too, which obviously relates completely to a surgeon who has to have the vision, the skill and the will to get the work done, you know, you can have somebody with a lot of skill and no vision.

You can have somebody with a vision and skill, but no will, you know, as a friend of mine. Said once, you know, like you need somebody who's going to stand in there until the job is done. So, yeah. No, I appreciate that you, that you noticed that.

Catherine Maley, MBA: You have all sorts of them. You're really, maybe you're a copywriter at heart!

Scott R. Miller, MD: There you go!

Exactly. Exactly. Yeah. Yeah.

Catherine Maley, MBA: So, regarding social media, is that your thing? Are you doing it, not doing it? Where are you at with that? How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: Yeah, no, I mean, I think I don't do it. We, we have, we have an Instagram site. I think we put really useful things on it, but because of that, we also don't put a ton on it because, you know, we post when we think we have something to post.

And so, we try not to waste people's time. It's got to be either really helpful and knowledgeable or we think it's really funny. But basically, you know we don't, we don't dwell on those things and overwhelm on those things. We're really not doing it. It doesn't have any pictures of me. Going for a run or lifting weights.

Nobody wants to see that. Trust me. And so, we basically try to look at it as a, you know, it's an engagement tool, but it should be a constructive engagement tool. It should, people should get something out of it. We're not looking at it as to replace. We think you should be engaging in you. IRL real life social life as much as possible and checking in for really good pearls and bits and pieces of information that are useful for you.

So, we try not to, I've always felt that way, whether it was back in the day with newsletters and things like that. There's a, there's a balance between regularity, which you have to have for people sort of tune out, right, but also substance. And I think if you, I know for me, if I'm getting newsletters and I'm not, you know, if four out of five aren't like incredibly substantive, then I'm just, you know, unsubscribed.

So, we try to find that balance.

Catherine Maley, MBA: I just want to suggest that if you just, just try it, do a couple jogging, you playing tennis, you playing with a dog, just try and watch what happens. We women eat that up. How did or does this factor in with you keeping busy without advertising?

Scott R. Miller, MD: And I do the 10. I'm pretty comfortable with my again. I have a pretty decent background in tennis. So, yeah, I drag my son who also played college tennis out there and I've always been to the tennis one.

But like I said, nobody wants to see me on the driving lane.

Catherine Maley, MBA: We're going to wrap it up now. Yeah. Can you tell us something interesting that we don't know about you?

Scott R. Miller, MD: I mean, the tennis would probably be the easiest one. Like, again, a whole different life. Were you pro at one time? Well, I don't think there's a kid who plays sports who doesn't at some point, you know, except for my daughter.

Cause she was a, she's a springboard and platform diver in college. So, then you don't think you're going pro because there is no pro, which is actually quite good because then it clarifies that you better pay a lot of attention in school because there is no pro you get no delusions where you can rationalize ignoring school.

But I don't think, you know, yeah, I was a young kid who six plus hours a day. Playing tennis. I mean, I would go get dropped off at, you know, before I even had a license. You know, I would get dropped off at the age of 1213 at Caesars Palace. I'd play for two hours, then I'd pitch a ride over to the Desert Inn, play for two hours, and then maybe get, the person I finished playing with would gimme a ride over to the Hacienda and I'd play another hour, and then hopefully get a ride home at some point.

So, that was my, that's how I grew up. I didn't miss Thanksgivings. I played on Thanksgiving. I played on Christmas. I mean, we. We played tennis all the time. I, it was a, it was kind of the golden age of Las Vegas tennis. If you will, we had a guy named David Pate who became, who won the NCAAs and, and with top doubles team in the world, we had several other players.

Obviously, everybody knows about Andre who kind of broke through about four years, four and a half years behind me. So, we had a lot of great players come out of that little. Shell because we were all going to the hotels and just playing against each other over and over and over. No academies, no fancy structures.

So, that was the whole first chunk of my life. And I got to play with, like, You know, every athlete, every tennis player, every celebrity. So, unfortunately, there was no iPhones, you know, no, no photographic evidence that it ever happened, but it's all, you know, I have it. So, anyway, that that's the main thing.

And then the other thing is that, you know, I was fortunate enough to meet my wife, although, you know, We don't really know when and where because we met so young, and we were friends for a long time before we started dating, but, but at some point, we met, and at some point, we started dating, and I'm fortunate to have a life partner who is there's no BS, there's no errors, there's no there's just a true partner and we love each other and tell each other the truth and make each other better.

So, and we have three great kids to show for it.

Catherine Maley, MBA: Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on how to stay busy without advertising.

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

A big thanks to Dr. Miller for sharing his recipe for success on staying busy without advertising.

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.

So, you continue to jump from one thing to another, hoping to find something that will work for you too, but it rarely does. So, try this shortcut instead. It’s guaranteed to move you forward. I compiled my intellectual property to grow cosmetic revenues, everything I’ve gleaned over the years into one playbook of the most successful practices and what they do to win.

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-End transcript for “Busy Without Advertising — with Scott R. Miller, MD”.

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