How a Small Surgery Practice Competes in Manhattan | with Stephanie Romeo, BOAC #72

0:00Dr. Stafford Broumand: You can do a boob juggle wig, yeah. Because now it's not under the muscle. They've put it over the muscle. I've been with Sempoli Park Plastic Surgery, specifically with Dr. Broumand, for 18 years at this point. I started with him at 21. I started at the front desk. And then he was like, can you do patient coordinating? I was like, sure. And now I'm running his office. Once you're there, do they have the same aesthetic as me? I want to stay a B cup, but this doctor is thinking that C and D cup breasts are more attractive. or they want to give me this over-pulled facelift when I really want it to look good now.

0:35Dr. Stafford Broumand: I never want to be like, it's like a car, because I hate when people come in and think it's like we're a car dealership and they think that handling a price is like normal. I have patients who, if they do have a question about a quote, I will reconfirm because I'm like, I'm just reminding you, the quote has your full name on it, the actual procedure, the cost of it. Nobody wants somebody looking over their shoulder at work and then all of a sudden it's like, oh, you wanted to have a facelift on? It's like, I mean, I guess. So when you look at an aesthetic office, specifically cosmetic surgery, and there is high turnover, it's like, why?

1:08Dr. Stafford Broumand: What is that surgeon doing that's making these people not want to stay?

1:20Stephanie Romeo: Welcome back to the Business of a Clinic podcast. I am joined today by our guest, Stephanie Romeo, who is the practice manager of 740 Park Plastic Surgery. It's great to have you here. Thank you for having me. I can't believe we've known each other for so long, which is crazy because you don't look old enough for how long we've known each other, which I guess is testament maybe to the practice, maybe not, maybe just genetics, but all of it would be great to have just a bit of an introduction to you and your background and everything. Sure.

1:54Dr. Stafford Broumand: So I've been with Semperi Park Plastic Surgery, specifically with Dr. Brumond, for 18 years at this point. I'll be completing my 18th year in December. So I started off, I finished school, I was looking for something to do. My whole family is in healthcare. My dad's a psychiatrist, my sister works, she became a dietician. My brother got his doctorate in psychology. And so we all followed this path. And I was like, what am I going to do? I don't know. So I found a headhunter. She sent me on a bunch of interviews in Manhattan. And I came across Dr. Brumann's office. And I thought, all right, I'll just start here.

2:29Dr. Stafford Broumand: He honestly was like the sweetest person. He reminded me of my dad, which was like the first thing I said to my mom was like, I could see myself working for him. He gets it. I can see he cares for his patients. It's everything that I wanted to be a part of, especially as a 21 year old. I think I interviewed at 21. So I started with him at 21. I started at the front desk and then he was like, can you do patient coordinating? I was like, sure. And now I'm running his office. So over the last 18 years, we have progressed. Initially me thinking, I'm going to start here. I'm going to get my feet wet, just see what I want to do.

3:05Dr. Stafford Broumand: But 18 years later, I haven't left him and we're just rolling at this point.

3:09Stephanie Romeo: That's incredible. And I guess a few questions from that. First, you said you started out at the front desk, then went to patient coordinating, and then went to practice management. What are the differences between those roles and how did your own role and experience change within each of those domains?

3:26Dr. Stafford Broumand: Yeah, a receptionist is the person who greets you in the office. The first voice that you hear, they're taking all of your appointments, scheduling new patients, just like the front of the house. So it's like your standard, you walk into the office, somebody is greeting you, that's your receptionist. For the patient coordinating side, we do a lot of plastic and reconstructive surgery. So all of those patients need to go through a process in order to prepare for surgery. It's paperwork. It's making sure they have all of their labs and their tests and everything is covered to safely perform that surgery for them.

3:58Dr. Stafford Broumand: And then the follow-up on the back and making sure they have the follow-ups that they need. They're happy. We've taken care of everything that they actually need. So that's a separate role. And then now I am physically running the office. I'm doing everything from helping billing during our 401k plans, doing our standard like in and out of what's going out of the office.

4:18Stephanie Romeo: And so with let's start with those first two roles of when you were yourself and then I guess subsequently have hired for your receptionist and subsequent patient coordinators as two different people. How many people are working now as the team for that?

4:33Dr. Stafford Broumand: Yeah, so we have a receptionist, Jen. We have a patient care coordinator who's Amanda J. We actually have a full-time aesthetic nurse with us now who's Tamara, who's fantastic. And then I have a medical assistant who's also our surgical tech that's full-time, and then myself along with Dr.

4:51Stephanie Romeo: Brumond. It's fabulous. And so when you think about the roles of the receptionist versus the patient coordinator, let's say, what about it do you feel requires two different skill sets or two different roles between them? Or how do you split that journey to make it consistent for Stafford and for everyone between, let's say, a receptionist who is, you said, handling the new inquiries and leads and booking patients in versus someone who is then handling that journey throughout? out?

5:19Dr. Stafford Broumand: Yeah. So for our office, the receptionist really is like the person who has the warm voice who you want to hear, who's extremely accommodating on the fun end to all the patients in that face to face interaction with our patients. And then on the back end, she's telling Dr. Bumund, you're running five minutes late. This patient's five minutes behind schedule. We still have to maintain what we have going on in the office and then doing all of those things as well as keeping everything organized, scanning in all of our documents. Nothing can get lost in a medical office. The patient care coordinator, after we've met with the patient, we've booked them, they're ready to go and they're ready to rock and roll.

5:55Dr. Stafford Broumand: She knows more about what actually needs to happen. She's a little more versed in the post-operative care, the pre-operative care. She knows exactly like when we like to see our patients after surgery. She knows anything that's potentially like a red flag that we need to be allured about like right away. So we have something like that. Our nurses, obviously, and our medical assistant also do all of those things. And all of the roles in our office are really, they're very interchangeable at this point because everybody has been there for so long. Jen, our receptionist, is the newest member to our team.

6:28Dr. Stafford Broumand: But everybody else, our medical assistant has been with us for, I think she's pushing 11 years. Amanda Jay, the care coordinator who started as a receptionist, who's now doing this role, has been there for about six or seven and Tamara's since COVID, so six years. So like we're all extremely familiar with each other. We all know Dr. Brumond. So when we go to do something or a patient calls in or there's a question, one of us knows exactly what's going on. So that's the biggest point between the receptionist and the patient care coordinator is just the understanding and the knowing of our patients.

7:03Stephanie Romeo: Makes so much sense. And I guess with such an intimate team, there's a lot of kind of knowledge transfer that needs to happen or be recorded. How do you guys handle that internally?

7:13Dr. Stafford Broumand: So we have an EMR system. So everything gets scanned into the system and everything is noted. It depends on what it is. But for something like if somebody comes in, they have a cyst or a mole that they don't like, everything gets sent out to pathology. So there's a work order that's written up. It gets sent out. We have a book. We follow quad A guidelines. So it has to be recorded in one out and have to record when it comes in. And Dr. Reuben has to sign off on it. Could you just explain that a little bit?

7:38Stephanie Romeo: Yeah.

7:38Dr. Stafford Broumand: So we have a full surgical suite in our office, which means that we can do everything from a basic mold removal to a local procedure all the way through to a full facelift in the back as long as that patient falls within a certain medical set of clearance. So we follow and maintain those guidelines very carefully.

7:59Stephanie Romeo: And so is that the type of stuff that's coming under your wheelhouse now as clinic manager versus, let's say, a patient coordinator before? Or is that something that is a shared thing to basically follow along and make sure all of those steps are taken correctly?

8:16Dr. Stafford Broumand: So it is definitely under my umbrella, and I do the majority of the paper check for everything to make sure that if there is a change within a year that we do that. If there's a manual change, I'm making sure that we're doing that. But every single person on our team has a specific role in order for us to maintain that certification. So Tamara has certain rules that she needs to fulfill as far as making sure her paperwork is done properly. Amanda does all of our autoclaving and cleaning of the instruments. Everything has a certain way that it needs to be done. And so we all take on an individual that's specifically for us, and then we follow through.

8:57Stephanie Romeo: It seems like it's a huge amount of process and kind of due diligence of the work that you're doing. And you've been there now 18 years. So I'm assuming you were a lot of what set up precedent of how things must be done, correct?

9:09Dr. Stafford Broumand: Yeah, so it's gone through a lot of changes, especially COVID came with its own set of rules and regulations. And like, what are we testing? What are we not testing? What is the protocol of if someone comes in contact with somebody? It changed. And as the landscape of medicine changes, we also have to follow how those changes affect our patients. And in the end, it's just maintaining the safest environment possible for everybody. So everyone is up to date and it's definitely it's a process to have that quad A. But when a patient comes in and they see it, they know we follow and we do everything the same way that your ambulatory center at Mount Sinai and what they're following.

9:50Dr. Stafford Broumand: There should never be a question of, is this safe? Should I be doing this here? It's like, no, you can be doing this here because just like the ambulatory center, we have the same exact guidelines that we're following and we follow them to a T.

10:02Stephanie Romeo: It's amazing. And so with that, is that all recorded in your kind of patient management system, your EHR? Or is that something that you're like, how are you tracking each of these things? Yeah, it's different.

10:14Dr. Stafford Broumand: So Quad A sends out packets of information. There's a very large monitor that we have. And then each year, as things kind of change, we insert the new changes, make sure we're following it, making the proper changes and then notating. So it's separate.

10:29Stephanie Romeo: And then I'm imagining it as almost a task list of things you need to check off each time to do it. Is it done on paper? Is it done electronically? Is it done? And how have you managed to get everyone to do this? It's quite complicated. I know it's not too many patients.

10:43Dr. Stafford Broumand: At this point, everybody follows the same protocol. So we don't, there is no deviating from it. We take intake on every new patient. We read through it. Amanda or our nurse will re-go over that intake. We're going to make sure that you are healthy. There's no cardiac history. There's nothing that would stop us from doing surgery in the office. As soon as there's something that's marked, somebody usually highlights it. It's circled. And then we ask the patient in the room as far as what they meant by whatever they wrote down. And then by the time it gets to me to talk about whether it's money or just the procedure of how to have surgery, I will address it with them and say, based off of this, I really have to double check with anesthesia.

11:24Dr. Stafford Broumand: I have to double check that you can be cleared for this surgery. Sometimes it comes down to their own physician and mother or not. Based off of their entire medical history, can I safely do this here?

11:36Stephanie Romeo: Makes so much sense. And I guess with that, they're going under anesthetic. What's the longest procedure that you guys run in the clinic? It must be eight hours.

11:46Dr. Stafford Broumand: Yeah. So if we're doing a full face, upper, lower eyelids, back rafting, lateral brow lids, we can shortest for that would probably be about six, six and a half hours. We really try not to push beyond that seven, eight hour mark, because at some point we need to have a cutoff because the patient's been under. We are in ablatory settings, so all of that is considered when we make a surgical plan for them. But yeah, it can be a full day.

12:12Stephanie Romeo: So it makes sense why it needs to be. It's not just in this little aesthetics clinic. It's a really reconstructive surgery, aesthetic plastic surgery, but not minor procedures, actually quite intensive, which makes a lot of sense. And what have you seen in terms of that transformation of the clinic from the time you started to now in terms of where Stafford was 18 years ago, how he's developed, how procedures have changed or operations have changed within that to grow or change the clinic and clientele? Yeah.

12:43Dr. Stafford Broumand: So when I first started, Dr. Roumand had a focus that was reconstructive. A lot of our referrals and our patients were coming from our breast surgeons, our cardiac surgeons, general surgeons. So we were tackling all of these massive surgeries.

13:01Stephanie Romeo: So what type of surgery, just to question in terms of it, what would be a reconstructive surgery or what types of things would be within that for each of those buckets?

13:09Dr. Stafford Broumand: So breast reconstruction for breast cancer patients, we do all the reconstruction. Usually it's tissue expander all the way through implant nipple reconstruction. And then you have our general surgeons who, if they had a patient with a very large hernia, they can take care of the hernia part. But then there is studies and data that show if you place the muscle back over, if there's a mesh placement, if there's not a mesh placement, they're just closing it, that it has a better survival and functioning rate. So we were doing that. So instead of it just being like a standard tummy tuck where we are coming in because our muscles have separated, whether it's pregnancy, weight loss, I'm putting that back together and addressing skin.

13:50Dr. Stafford Broumand: There is an actual functional problem to that. And then for cardiac, we do open heart surgery. Not like... What? Yeah, I know. If I could do it, I probably would jump in there. But the cardiac surgeons call, they have realized when Dr. Vuman closes for certain types of patients, especially patients who've been radiated, who have a history of breast cancer, they have a lower infection rate. They did a really large study. Actually, he presented, gosh, this is a long time ago, in a cardiac clinic about what he does just to show the numbers and the actual cyanide data of the rates dropping with aplastics coming in to do that closure for them.

14:28Stephanie Romeo: Wow. So it's almost the different technique or approach that is creating kind of a lesser recurrence of infection or these types of things that...

14:37Dr. Stafford Broumand: Yeah. So usually the cardiac surgeon will go in. Obviously, their main concern is the heart. And then if they run into something that's not normally seen or there's something that's just different, they'll call in plastics and say, we need you to actually come in and close. Do you have the time to do it? And he would go in and close it for them. That's amazing. So that's where he started, when you started with him, that was the predominant? That was a lot of it, yeah. And then we started to make the shift to more of the plastic side. Obviously, the insurance landscape has changed over the last 18 years.

15:10Dr. Stafford Broumand: I think everyone at this point is feeling it and seeing it on every aspect. I feel like I'm looking at my kids' pediatrician bills, like, because we have a high deductible plan. And I'm like, wait a second. I'm like, I, yes, I filled out that survey. I'm like, but it should be quoted separately. But now I'm getting, so it's like, there's just all these things that I think people are realizing insurance is changing. And we feel it too, as medical providers. And he's always done cosmetic work. It just was the difficulty and the camaraderie of the hospital that is appealing to doctors. So we started to make that switch.

15:47Dr. Stafford Broumand: We are now at this point 90 % cosmetic, 10 % insurance based. And now we're pulling to continue through with obviously adding, and I told you we have an aesthetic nurse now, and a medical assistant who are doing everything for non-surgical lasers, skin pen, everything that we can offer our patients is there now.

16:06Stephanie Romeo: It's fabulous. And with that shift, were you always at 740 Park in terms of the actual address? It's probably one of the best buildings in New York City, so it's fabulous. But when you joined, was Stafford there yet?

16:18Dr. Stafford Broumand: Yeah, so he opened that practice in 98. And his journey to me is fabulous, which is just who he is. I think for a surgeon to come in and say, I don't want to work in a hospital. I don't want to be employed by somebody. I want to be a solo practitioner. I want to open my own thing to not only do that, but to then say, I'm going to open it in 740. I'm going to find the most elite building in Manhattan. I'm going to put myself there and I'm going to thrive. It really is amazing, but it just goes to show who he is. He's a go-getter for sure. And he is so detail-oriented and specific that he was like, it has to be this building.

17:00Dr. Stafford Broumand: And so we're here and I don't think we're ever going to leave. I think the only other option is always that we talk about when we throw around is like, where do we expand to? Like, how do we get this even further? What is our next point?

17:12Stephanie Romeo: What are some thoughts on that? I know Tamara has been with you for a while, but an aesthetics, I call it aesthetics. Let's say, as you say, aesthetic nurse, the lasers, the non-surgical elements of it as one nurse and practitioner within the same space. What are the next potential expansions?

17:28Dr. Stafford Broumand: What is taking on potentially another person into our space? It's hard. And we talk about it all the time because there's so much trust that you need to have in that person. So not only do they have to be skilled and talented and able to see what as an aesthetic provider, that they're not sending out a patient who Dr. Vorn is like, oh, my goodness, I can't put my name on that work. And they're coming out of this office. but you have to trust that she actually is going to do what she's supposed to be doing placement of product is where it's supposed to be she's not obliterating fat that shouldn't be killed with certain types of lasers so it's definitely been a process we talk about like how do we find this person because we are when it comes to hiring so specific and the amount of trust that we have in tomorrow is so high there is nothing that she could do that i would be like whoa whoa i don't know if we need to do that it's like she's i think we need this laser i'm like i agree i think we need to bring this in and like all of a sudden we have the conversation we bring them in we're testing it and she is on the machine in 30 40 minutes she's like i got this i with talking to the people who are teaching her how to use it and to find somebody else like that with that same aesthetic Like she's in the OR with all of our cosmetic patients and she's looking at somebody's boobs and she's like, no, that's not what she said during her consult.

18:54Dr. Stafford Broumand: I think she thinks she wants to be a little bigger. I think she wanted to have a little more of this, a little less of that. And so she is so aware of the body and aware of what Dr. Ruman sees and then also what the patient sees. That's our expectation. And it's going to be a difficult spot for someone to fill.

19:12Stephanie Romeo: Do you think it might be something that comes from internally? You bring someone in to observe, because I can imagine Dr. Brumond has such an eye and is, as you said, so specific on what he wants to do that being around him. Tamara was with him for six years or so before starting this part of it. Do you think it's something along those lines of kind of training in that kind of Stafford way?

19:34Dr. Stafford Broumand: I don't know. I think Tamara has her own way of doing anything. She consults her own patients and she does what she needs to do. And we do have staff that do that. I had a receptionist who came in out of college and she was like, I just want to see what I want to do. And then while she was there, she was like, I think I really do want to become a nurse. So she stayed, she left, she went back to nursing school. And I was like, whenever you're ready, I was like, you let me know. I'm like, and you'll come back. And she did come back. And a lot of our patients were like, wait a second. But we value those relationships because we do value the people that we hire and we know what their worth is so it's always nice to have somebody come back or to train that way but I think there are so many talented nurses and PAs and and people out there that we can find them and they we will find somebody when we're definitely ready to do that but it's just a matter of the right time in the right space.

20:35Stephanie Romeo: How has the aesthetics let's say the nurse of the non-surgical aesthetics been for the clinic? Has it changed any dynamic? What things have you noticed? How did you make that shift? And when did it happen from it just being Stafford to being these two things?

20:52Dr. Stafford Broumand: Yeah, so we had a few other nurses before. Initially, we took on a nurse to do a lot of the medical side. So it was more of like the post-operative care, just a lot of hand-holding through that, and then circulating through our operating room and just making sure that what we needed a nurse of actual like RN, what like everybody thinks an RN to do, was doing. And then we realized that our patients were looking for a more comprehensive approach to like what we do. And we would say, oh, we know this lovely dermatologist and she is wonderful and she has all of these things. We have some things, but we don't have like everything here.

21:30Dr. Stafford Broumand: And we realized like patients don't necessarily want to, once they're in our office, they want to feel like they're taking care of. They trust Dr. Rumon. They trust that he is going to be offering them the appropriate things and something isn't going to be done to the side of like it being a little scary. So bringing her on was really easy because our patients were already looking for it. They were like, okay, so I've had my facelift on, but now I'm hearing like, I should do a CO2 laser. And Dr. Rumon's like, you're talking like when CO2 lasers like first came out and it was like it's a lot we're like we can do this for you and then we're like nope we actually we have to bring stuff like that and we have to evolve with where our space is going and she was she's been wonderful.

22:14Stephanie Romeo: It's amazing and what kind of is that patient journey from let's say in general I guess a few different questions one how do people find you if they've never heard of the clinic or they've not actually attended different, they've not actually embarked on a plastic surgery or medical aesthetic journey? Two, I guess, is along those lines, is it more that the patients are driving to come back in for aesthetics? Like, how do you have that switch over? And three, more generally, how are you keeping that life cycle of the patient?

22:56Dr. Stafford Broumand: Yeah, we are really fortunate to have wonderful patients who like to refer back to Dr. Ruman. So whether it's we, it can be as something as we saw somebody's child when they were two because they fell. And you're talking now 30 years ago that Dr. Ruman happened to a laceration for. And then she's like, I'm done with my kids now. They're all grown. And now I'm looking for whatever it is that she's looking for. And she's like, his scar healed so well. I don't even see it. Everybody's like, I can't believe that he had this big cut on his face when he was two. And they come back or we have a mother who had something done and now her child is coming in here for something.

23:34Dr. Stafford Broumand: And we still have a nice steady flow of other doctor referrals. Our network that we work within is really strong. He works internationally. We have a very large international patient database that refer back to our office. So that's always the nicest way to have a patient because people already have the trust. They already either know it or they know somebody who's had something done that they've seen. So the trust is there. The aesthetic space is changing. And we have Instagram and TikTok and influencers. And to go into that space, because we did go into that space, it has to be very specific.

24:10Dr. Stafford Broumand: So everything that he puts out is really just to inform people of who he is, what he does, what can be done. And like when you look at something on TikTok, what's airbrushed? What's not? What's realistic for everybody? Because I think as a society, we're losing a lot of that. What are we actually attaining because that was done appropriately and medically? And this is really what they look like versus the doctor who's posting something that's completely AI generated and no doctor should be doing that. But you never know what you're actually saying on these platforms. But a lot of people are finding their doctors there, which I think is a wonderful place to start your research because these influencers are doing some homework as far as like whose credentials, like who has the port certification, who have I seen go to this person.

25:01and there is that word of mouth part of it but it's a double-edged sword I think for Instagram

25:07Dr. Stafford Broumand: and like educating people to certain things because I think as much as you do your research and there's like a whole separate side to to finding a doctor and it's something that we talk about because I at first was like I hate this I hate that like we are now looking to Instagram to find our doctor because what are we who's double checking who's fact checking that like all the things all these things are what I should be looking for and a lot of the times the questions are great it is it's like are they board certified where did they go to school do they have a an accredited facility in their office who's taking care of you what's the post-operative care look like and you have all these things but then there's the other side of it where it's like once you're there do they have the same aesthetic as me i'm i want to stay a b cup but this doctor is thinking that like c and d cup breasts are more attractive or they want to give me this overpulled facelift when i really want it to look good now like in the next six months i want to be able to walk out of my house and not feel like i'm like overpulled because that was a big thing for a long time where women were walking for two years of being overpulled to just let everything settle And so there's all these other steps that, yes, it's you should definitely double check to make sure they are board certified and they do have all the credentials that you're looking for.

26:29Dr. Stafford Broumand: But then it's do I get along with this doctor? Do they hear me? Do they understand exactly what it is like that I'm looking for? Am I going to leave the surgery happy? So it's a great place to start now because I think people are doing a lot of research and they are finding these wonderful, great surgeons. But it's just trying to make sure that you understand, like, just because somebody is putting themselves on a video and like saying something, can they actually execute it and do it?

26:59Stephanie Romeo: Do you find it's such a visual thing, actually, especially with aesthetics, it's even called aesthetics, but that it lends itself to Instagram to have before and afters or have these shots or have this stuff? I know Stafford's or Dr. Brumont's style is more to have him talking about general procedures and such and him as the forefront, which is also a thing of branding as the clinician. But do you think that it is a good medium to explore for the aesthetics of it, seeing more repertoire of someone's work?

27:31Dr. Stafford Broumand: Yeah. You if you look on like websites because everybody has a website now and we went through that process of redoing this entire website because before I like Google and where you rank all of that, like played a part in how people find you. Some people on their website don't actually have a before and after gallery, right? So you can click on somebody who is very well known and they do not actually have a before and after gallery and says you have to come in order to get those photos. We have a healthy mix on our website. We do put some before and afters on our Instagram, but it's not necessarily like the forefront of our stuff.

28:07Dr. Stafford Broumand: I think people definitely want to see it. It's probably the most viewed page on our website is going to be that before and after gallery. It's going to give somebody the idea of what you as a provider can actually give to them. But obviously, it's not the most important thing because you do have a lot of providers who still do not have a for and after gallery on their website. But their work and the amount of people that they're touching is enough for them to continue having an actual amount of business.

28:33Stephanie Romeo: It makes a lot of sense, I guess, because they're so famous in and of themselves or have such like Stafford, such a big referral network that it speaks for itself. People have seen it in person or in real life. You mentioned that kind of questions that people get or you get a lot from Instagram or people looking are what is aftercare like? Could you elaborate on that a little bit and why it's so important and what you guys do and look at with it?

28:58Dr. Stafford Broumand: So I think a lot of it has to do with the fact that a lot of our patients are women. and whether they're active women in their 20s or they're mothers who are taking care of young kids or they're women that are a little bit older and they have like their own social calendar already going on and it's trying to figure out where exactly all this is going to fit for them. Men have it too, right? So like I have a gentleman who has a football game that he really wants to attend and then a work trip and all of a sudden like life is starting to happen but you want to do these things. And you don't want to take time away from your family or you don't want to take time away from these things.

29:34Dr. Stafford Broumand: So it's like, what am I realistically looking at? What do I actually have to block out? Because if it's, someone's going to tell me it's six weeks, I'm going to be like, all right, like, where can I find that time? And you do want to recover properly and you do want to do all the right things for yourself to give you the best outcome. So I think it's always like the first question, how much time off am I going to really need to take?

29:54Stephanie Romeo: So it's more so time off. So they're looking for almost the quick win answer of how much time off. It's not necessarily about the care that you guys are providing as a clinic throughout that after portion.

30:04Dr. Stafford Broumand: Yeah, it's definitely like a self-concern question.

30:08Stephanie Romeo: And is that really something that differs between clinician to clinician? Isn't it that if you get a boob job that is a specific type of boob job where you have to take the muscle, go underneath the muscle, you use this type of implant, et cetera, isn't it the same recovery from every doctor? Yes or no, right?

30:27Dr. Stafford Broumand: You have a new implant that's out it's motiva you have the preserva now technique that literally is hitting the market everybody is talking about it it's on the internet you can do it awake you can do it in

30:37Stephanie Romeo: a week oh away so wait and do it awake yeah you can do a boob job awake yeah because now it's not

30:42Dr. Stafford Broumand: under the muscle they've put it over the muscle so now you're talking like technique and a lot of that like for a facelift it's technique it's we use a very special type of like adhesive we don't use drains. We don't have the head wrapped for more than usually eight hours, depending on the patient. But there are things that we do to minimize that recovery for patients. And I've had a patient walk out. And every doctor is different. Like somebody can look at my patient. She doesn't have to be wrapped. She's bruised and she could take a shower in a couple of days. But am I telling my patient you should go walk around town?

31:23Dr. Stafford Broumand: You can. I don't know if I would, but some people are like that's her downtime it's the two days but for me downtime is when has the majority of my bruising gone down the majority of my swelling when do I look like me enough that I can face you and somebody is not like oh something is really different so I think the version of downtime too like differs from when people are explaining things and I sometimes it's like how much downtime for like physical activity which is different than when can I go get lunch with my girlfriend. So it's a big conversation.

31:56Stephanie Romeo: Do you think that's almost like a marketing ploy people use that's unrealistic? Like someone claiming, oh, it's only 48 hours downtime, when as you said, it's the specificity of what that downtime looks like?

32:06Dr. Stafford Broumand: I have patients who can do it. It depends. Yes and no. I and Dr. Ruman always err on the side of, I'd rather give you the longest possible timeframe. And then if you happen to meet that patient that can walk out after 72 hours and feel okay about it, great. I had a patient who literally was taking a walk down the river and the Hudson five days later. She put a scarf on and she was like, I'm great. This is fine. She's like, nobody's going to look at me. She's like, nobody cares. And I'm like, you're right. So did she have a four or five day recovery? I don't know.

32:42Sally: Now a quick break to tell you a little bit about Coherent Healthcare, the company behind the business of a clinic. Coherent helps fast-growing healthcare providers engage, support, retain, and nurture their patients from intake to discharge. As you get bigger, your patient body grows enormously, and it becomes much more than just another hire, just another front office team member. It's no longer a people problem. You need technology that can scale with you. Coherent helps you do that by keeping every patient on track. In short, we're the agentic CRM and patient support platform for outpatient hands-on health care.

33:16Sally: To learn more, visit us at coherenthq.com. Now back to the episode.

33:21Stephanie Romeo: Yeah, it's really interesting. And then all the stuff kind of pre-operation, like what is the procedure internally, let's say, to if I'm a lead and I come in and I say, hey, I'd love to come in considering to get, I don't know, a breast lift. I just had kids. Walk me through that journey. Like how do you guys handle that? Yeah.

33:43Dr. Stafford Broumand: So when somebody calls in, so there's a range of like where they are in this process. Some people are like, I'm ready to come in. When do you see patients? These are the days I have available. And then their consult is in and you're done in five minutes and you've gotten all the demographics and then all the information. And you're like, great, we'll see you on X date. You have other patients who call in and they're like, I just had a baby and it was last week. And I'm like, OK, so maybe we should take a step back. I'm like we can always have a conversation with you but you're going to have to come back in in an x amount of time in order for us to really evaluate to see like where you are and what we actually need to do I think conversations are always positive and if that's what you're looking for and in the six seven months that it takes for us to get there for you to actually be ready to start talking about scheduling something and you're like actually I'm happy with like how everything ended up being that's great but the conversation is always open to everybody and it's always there, but everybody is a little different.

34:42Dr. Stafford Broumand: Some people just want to know basic information. They want to know how much is it going to cost me? And can I actually afford this to even want to pursue the questions of when can I do it? This is where I am. And everybody calls and I can be on the phone with somebody for 40 minutes and I can be on the phone with somebody for five minutes. But it's just making sure that they understand that if they come to our office, everything is done extremely professionally. It's done safely. We know exactly what we're doing. We're never going to do something that is not appropriate for you. And it just depends on where that patient needs to go in that conversation.

35:18Stephanie Romeo: And for let's say the patient who says, I'm thinking about it, what's that seven months between, let's say, when they first reach out to when they might be ready to convert, what do you do in the interim? Are you just waiting for them to get back in touch?

35:30Dr. Stafford Broumand: Do you ever send them, you know, not nudges, but conversations for it? It depends. I am not. It's hard because as much as I'm like, I don't sell something. In the end, I have to provide a patient with a quote of services and we have to we're booking them. Right. You have to want it. It's. I hate it. I never want to be like, it's like a car because I hate when people come in and think it's like we're a car dealership and they're like, they think that like haggling a price is like normal but does that happen often no it's not like haggling in the same sense of like a car but some people do that and it's a service but I guess I think at this point like if I can talk about the person who cleans my house and like you are like all right you said 150 but I can do it for 130 and everybody's comfortable with like having these conversations or like you go to get your car examined and you need new tires and you're like the guy down the street said he was going to do it for 900 there is something we said that like it is transferring over into our space and it's fine and it's natural for it to happen but

36:43Stephanie Romeo: we still have to to it's different i don't know makes sense so yeah so you were saying though So, which I agree, I don't, it's this thing which I believe is actually enabling people to do what they want to do and checking in, you know, in a way that is non, as you said, not pushy car salesman, but the opposite. Being like, hey, you were thinking about this. Can I help you? Is there anything I can answer as further questions? How are you feeling on it? Do you have that type of flow within the clinic to follow up with, let's say, leads that haven't yet converted?

37:17Dr. Stafford Broumand: So we do that. We will check in. if patients are like, oh, I was thinking about this date, we'll mark the date and be like, hey, we're just touching this. If you are still considering this, like, we need to start prepping you for surgery. We need to start getting like certain things done. A lot of patients will be like, I think I want this date. And I'm like, I'm happy to mark that for you. And if somebody else calls me for that date, I will call you first and let you know that this date is now, there's the potential that you're going to lose it. And I never want that to feel like a pressure, but I also need people to realize like there's only one surgeon here.

37:49Dr. Stafford Broumand: And there's only one OR. So if there isn't like that firm commitment, there is potentially you're not going to have it. And for a lot of people, it's either like, oh, no, that's not OK. Like, I'm definitely going to do it now. Or it's like, OK, I can relook at these dates and like we can circle back. And that's fine, no matter like what it is, because nobody wants to feel pressure. Nobody wants to feel like they have to do something. It's cosmetic. It is your choice. We are not here to tell you like you have to do it right now. The only person who's telling you like right now is our breast cancer patients.

38:18Dr. Stafford Broumand: Like there is a need and like we have to take care of it right now. There is no choice for you. So very delicately try to find that line of where somebody doesn't feel like I am a car salesman and I'm calling them and I'm cold calling them. And I'm like, you have to do all of these things and you have to give me this deposit and you're going to lose it. I never want. I don't ever want to feel like that. So I don't ever want to do this to somebody else. And I think that's probably why we are so successful in the way that we close, because somebody can come back to me two years later and they're like, OK, now I'm ready to do this.

38:52Dr. Stafford Broumand: And for a facelift patient, sometimes it takes that long because it's your face and you're like, oh, gosh, is it really now? Do I have the time? Is it the right time? It's like, don't. We're here. We're not going anywhere. We've been here for a really long time. He's not leaving.

39:06Stephanie Romeo: So it's really almost the patient coming back then. It's not an active kind of nurturing throughout that time period.

39:13Dr. Stafford Broumand: Sometimes it depends on the patient and it depends on the feeling I get from that person. Do I think that they need to be asked? Do you have any further questions? Because some people are scared to ask for a secondary visit or something. And at this point, for me, it's reading people and just trying to gauge where their comfort level is and things. and there are patients where I talk to them and I'm like, I can tell you are really hesitant about this and that's okay. You digest this, let it simmer. And when you're ready and you think you want to actually come back, let's have an actual discussion about what it is that we want to do.

39:54Dr. Stafford Broumand: There are patients where I'm like, you're so hesitant. I don't even know if I want to give you the price quote right now because I feel like you're just, we're not there to digest it or they're just like their body is not where it needs to be and they need to really, you stopped nursing two days ago. And I'm like, we really need to wait to see exactly what that procedure looks like for you.

40:13Stephanie Romeo: And so when you're face-to-face with them, it's really immediate. That makes complete sense and seems easy to do. What if it's been a few months? How do you track kind of the inbound information, inbound leads?

40:28Dr. Stafford Broumand: Our system does a lot of it. We have a lot of automated emails that go out just from website inquiries. If they are clicking for a rhinoplasty, they'll get one email. And then a few weeks later, they're going to get another one. Just a gentle reminder, if they haven't, I also reach out. And if they haven't reached out, they still get some small little nudges from the office. Our patients, I feel like, especially in New York, do not want to be inundated with phone calls and with emails. And the last thing I want to do, especially when it's coming from like a medical office, is to be that person.

41:00Dr. Stafford Broumand: So I think it's just finding the right time to just throw. And it's literally like two lines in an email. Hey, I hope you're doing well. I'm just checking in and just making sure you don't have any other questions for me. That's it. There is no pressure. I just want to know that like we're good.

41:15Stephanie Romeo: We completely agree. We do a lot of patient follow up. It's our kind of bread and butter of what we do. And that's how we find it. It's how do you make sure this is really non-obtrusive, but you're just reminding them that you're there to serve and help them in their journey. And a lot of times with automated, just purely automated emails, especially with things as sensitive as plastic surgery, you don't want someone to say, hi, Sally, are you still considering getting a breast lift after your children? Like, yeah, coming up as very personal things when you're sat right next to someone or whatever, it needs to be very discreet and very friendly and demure in a lot of ways to just give them that invitation to write back in.

42:00Dr. Stafford Broumand: Yeah. I don't even like to, I have patients who I'm like, if they do have a question about a quote, I will reconfirm because I'm like, I'm just reminding you the quote has your full name on it, the actual procedure, the cost of it. So when you go to pull and open that PDF on your phone or wherever you are, all of that information is there for you. I know you've already confirmed that, yes, I can email this. You've told whoever it is. She can email it to me. But I still want to make sure you understand exactly what it is that you're going to open and then the space that you're in to open it. Because it's the last.

42:32Dr. Stafford Broumand: Nobody wants somebody looking over their shoulder at work. And then all of a sudden it's like, oh, you wanted to have a facelift on. It's like,

42:40Stephanie Romeo: where do you go from there? Also, you want facelifts done and you're expecting to pay this price for it. We're in New York. I don't even want to think about what the quotes are for a full facelift at the time. You're showing that is something that you're even considering spending on. It's a very personal. It's both your body, your livelihood and your personal finances all being shown at one time. So it makes complete sense. And what other procedures? So we started with this with saying, I'm a lead. I call in. I come in for a consultation. Then what has to happen thereafter?

43:17Dr. Stafford Broumand: So they actually come in for the consultation, fill out paperwork in the office, fill it out at home. It's totally up to you. Amanda, our medical assistant, is usually the one who brings them into the treatment room. She'll talk to them, get to know them a little bit. She'll go back in with Dr. Brumond. He will introduce himself. He'll have a conversation with them. If they do need to get undressed, he will then step out for them to change. He'll examine them. He'll go back in after they're dressed, make sure all questions are answered, and then they're introduced to me. And then I will give them exactly all of the breakdowns, what it takes for us to get you to the operating table, the days that we operate, what are we actually looking at logistically, and then we'll send them on their way.

43:59Dr. Stafford Broumand: And then if they want to proceed, they have to pay a deposit. Yep. And we have patients who in that moment are like, I'm ready to leave the deposit. This is the date I came in knowing I wanted to have it done. I'm like, OK, great. Otherwise, there is a lot of usually a lot of back and forth, either phone calls or emails talking about whatever questions that they ended up having, dates, logistics. Then we pick a date. 30 days out from that surgical date is when they start to see all of our information. So they get a surgical packet that's emailed to them or hardmailed to them. They have to read through it, sign consent forms, make an appointment with their primary care doctor or cardiologist, depending on their medical history, do a full blood panel, health and physical, EKG if it's breastwork, mammogram within eight months, depending on their age, EKG, chest x-ray, and then we get cleared.

44:45Dr. Stafford Broumand: And then they'll start to see all the emails two weeks before surgery, reminding them to stop any NSAIDs. And I go through, but I'm like, smoking recreational drugs, like all of these things that are a conduit indication, so please stop them now. And now we're in this whole GLP-1 world where we have to remind patients, if you are taking it, when to stop it, you have a clear liquid diet, and then we continue to prep them. With GLP-1s, is it something you guys are offering at the clinic? It's a problem with the patient. So typically a patient that comes in already has in mind that they potentially want to be on it.

45:21Dr. Stafford Broumand: And then we have to send them out for blood work. So we obviously do not carry it in the office. so there is a bunch of blood work that needs to be done. It has to be sent back to the office. Everyone has to check it, and then we can go ahead and then start prescribe it to them, but I think it's, yeah, we're in it. How is it decided among you guys when you bring in a new treatment

45:44Stephanie Romeo: or a new line of service? Let's say GLP-1s being weight loss, I guess it's part of aesthetics, but it is a different animal or let's say a laser from tomorrow. What's the process of making a decision to bring on something new?

45:57Dr. Stafford Broumand: So usually one of us will say we see a need for whatever it is. The laser, we were back and forth with a CO2 laser. We didn't end up with a CO2 laser. We got something else. It's ultra clear and it does a very large variety of different things. But we try to see, is there a need for something? We have Morpheus, we have all these things. And then we're like, there is a clear hole that we need to fill because we have patients that are coming in that need it.

46:27Stephanie Romeo: And it's so is it that the patients are asking, is it a patient led thing? Hey, I'm asking for a CO2 laser. I'm asking for GLP ones. And then enough people have questioned that you're like, OK, well, look to do this.

46:40Dr. Stafford Broumand: Sometimes it's led because we're like, oh, we really should. This would be like the ideal procedure to be offering. Instead of us offering out, what would it take for us to actually bring in here? Do we actually want to bring it in here? because there are certain things that we'll never bring into our office. It's just not something that we're going to do. And then it's who has to perform it? Does Dr. Rubin have to do this? Because there are certain things where it's like, is it worth his time? But is this something that we think is going to be beneficial for the practice? Because in the end, that's what we're looking at.

47:10Dr. Stafford Broumand: And then things like the GLP-1 where everybody was talking about it. Dr. Rubant has, again, a very large network of friends who are starting to take a look at it and offering it into their office. And then it's a conversation of logistics. Can I safely do this? Can we take this on as a practice? Can we properly watch and maintain these patients? Because, yes, he is an MD, but what does this actually mean for us? How many more patients are we going to have to see in a day? Because at one point I had our nurse and our medical assistant injecting every single patient. They were coming in. We still have patients who don't want to inject at home and injecting them.

47:53Dr. Stafford Broumand: And we offered like a very full service, like weight loss kind of situation where it was like, we're going to monitor your bloods. We're going to check on you. We're going to see how you're doing. We're going to make sure that like side effects aren't like totally gnarly for you and then follow you through. I think at this point, because they're so widely offered that people aren't really like looking to their plastic surgeon necessarily for that. But yeah, it's just it depends.

48:18Stephanie Romeo: With those types of cares, it's very different than the one off facelift or not to be fair. I think probably plastic surgery leads itself to one off over time, but multiple procedures. But with GLP-1s or let's say Botox or the lasers that are more high maintenance, high frequency, how do you manage those patients and those flows?

48:39Dr. Stafford Broumand: Yeah. So our Botox and filler patients, we typically will, if it's a first-time patient coming in, we'll tell them they should come back in 10 to 14 days for a quick follow-up. We want to make sure everything looks okay, everything's settled the way it's supposed to settle, everybody's happy, we like how it looks. And from there, we'll say, you should really be coming in at this point. Amanda, who's our patient care coordinator, is really good at making notes. And when patients are like, oh, can you just remind me that I need to come in here? Oh, like right before. And she will then reach out to the patient and say, hey, don't forget, like you really are due for this.

49:11Dr. Stafford Broumand: Like, why don't you come back in? So we have, depending on the patient, if they're okay making the appointment right then and there, we always suggest that they make it so it's on the calendar. And if they have to reschedule, you reschedule. It will flow with whatever schedule you have at that time because it's two to three, four months later. Or no one knows. Or we will take it upon ourselves and then do the follow-up for them.

49:33Stephanie Romeo: And when you're managing the clinic, like what are your own, let's say, metrics you're measuring to say we're doing great, we're doing less good, we're doing fabulous, we want to do this, or we need to change this part of our procedure? Like what things are you looking at? Yeah.

49:49Dr. Stafford Broumand: So I have my Excel spreadsheet that's literally covering, I think, from 2006 all the way through at this point, because I think I pulled some old data from before me and I have everything grouped out. So I have like all of our surgical numbers, all of our injectable numbers. Each time we add something in, like it has its own category and I'm reading it and then it gets sent to Dr. Brumann and it's a monthly thing and it's a monthly conversation. of, okay, so like in inductables, this is typically what we're doing. We're either crushing it or like, why? Why are we seeing a drop here? Or why did we all of a sudden have a massive influx with patients here?

50:27Dr. Stafford Broumand: Did we put out like a special? Did we do something that's like different? So we were looking at obviously numbers is obviously always a great way to look and see how you're doing. And then it's also a patient feedback, right? So we are always talking with our patients. Somebody is always in contact with them. I want to know, are you happy? Like, how do you feel things went and a lot of the times someone will tell somebody because at some point during their journey they've made a connection with somebody that's comfortable enough that they're going to say i really didn't like when this happened or i didn't like when this was like whatever or i really liked this this was a really wonderful experience can i have x y and z again whether it's the nurse that i sent them home with the anesthesiologist the bra that they left in.

51:10Dr. Stafford Broumand: It's just, okay, so I know these things are working for people, but I had an older bra, and patients were like, I don't know, it's uncomfortable. I'm like, nope, then let's change it. We don't have to use this one. Let's find a different one. Let's find a better one, and we'll just keep moving.

51:24Stephanie Romeo: It's so great. It's something I've been personally working on and very excited about, something we call patient voice reporting. So a lot of what we do is also data viz and transparency and basically getting the data out of the patient management system into ways you can actually work it, see it, visualize it, understand it. And because we are messaging Bayesian body all the time or through this system, using a mixture of AI and just straight coding, we have something called the elephant in the room and patient voice. So like, what is the sentiment? How is the analysis? Exactly what you said. What are the thematic things that keep coming up?

51:58Stephanie Romeo: Hey, I couldn't make my deposit. The deposit link wasn't working. Or for, let's say, if you were running a larger practice, like, oh, the booking link is really confusing because I don't know what to book. Why would you know what to book if you're booking an aesthetics appointment or whatever? And shout outs, and we call them trumpets and bellows. So like happy things and constructive criticism of the bra would be a great example of this. And we're able to filter and get that data and make it really transparent. And I think it's very interesting, the use of the spreadsheet. So are you currently pulling things manually from?

52:32Dr. Stafford Broumand: So our system has, I can pull like thousands of different pieces of data that it'll just pop it out for me. And then I'll look at it. I need to double check it and then I'll pop it into an Excel spreadsheet.

52:44Stephanie Romeo: Into Excel. And then you use Excel as kind of the place you can manipulate and work with the data easier. What management system do you use? A Nextech. Nextech. Cool. But it's a very interesting thing because it seems like a lot of clinics we talk to are just having to run things on Excel. and you think there's a better way to just visualize this data, get the insights and work with it. How much time does it take you usually? Not that long at this point.

53:07Dr. Stafford Broumand: But I think like when you, for me, I am visual and I like to see, I have my monthly reports that I need to pull. I just like to see them sometimes, print them out, physically look at them. And then it, for whatever reason, it makes me feel good to put them in and be like, okay, I can look at the last five years and I'm like, ooh, I did really good this month with this. What did I do different? Or, gosh, why are we seeing a downturn in consult numbers? And a lot of the times it's economic driven, obviously. The market's down, things are changing, and all of a sudden patients are a little more hesitant to be spending on things like this, especially with my Botox numbers.

53:43Dr. Stafford Broumand: There are certain things where it's an easier give up than other things. And it's just trying to catch the trend and see what can I do better if I do see something like this happening and to maintain a more even flow.

53:56Stephanie Romeo: At what point did you notice, let's say, the Botox example, and what types of things could you do to try and counteract it?

54:01Dr. Stafford Broumand: Yeah. So right now, I think in the aesthetic space, filler is being looked at as not necessarily like a negative, but I think we've gotten to the place where people are so over full and so balloon-like. and it's like a common thing to see that patients are shying away from it. So now it's more about like bio-stimulators and good skincare and like what are all these other things that we can be doing? But what we've lost is the actual proper education, which is why I'm like Instagram is so good because you can see that there are things and like trends where it's like we've taken it so far with the lip filler.

54:37Dr. Stafford Broumand: It's why do we want to look like that? And now people are like, I don't want to look like that. So how do we take it back and how does that change what we're doing? and then it's how does it change what people are asking for because they're seeing it and then they're seeing like there are other options so it's just making sure that patients are aware of all of the options and that when it's done appropriately within our space that it doesn't have to look like that it can look like this none of our patients have walked out of the office like that which is why like for our instagram like just having that educational piece to it and seeing Dr.

55:09Dr. Stafford Broumand: Ruban as like a human is really important, I think.

55:12Stephanie Romeo: Yeah, it's so true. People are looking kind of nuts. And that was an aesthetic choice that was happening. And now it is going towards that like Korean skincare. You know, everyone's like, oh, I have friends who even fly to Korea multiple times a year. And I'm like, why? You've all the same things here. But it's a really interesting trend. But yeah, filler, it's not that filler is necessarily the enemy. That was an aesthetic choice that was being made.

55:35Dr. Stafford Broumand: That overfull, overplump look, that's what was being put in. But as far as when you look at just trends in general, it really is just managing, trying to see, okay, so during the summer months, obviously, an IPL and other certain types of skincare treatment. IPL is an intense pulse light laser. We really shouldn't be doing it on tan skin, on skin that's going to be exposed to the sun. It's going to just contradict everything that we're doing and then potentially cause an issue. So, like, there's going to be a downturn, obviously, in the amount of patients coming in for that. So, like, what during the summer months should we be offering?

56:16Dr. Stafford Broumand: Like, what should we be telling patients? It's obviously sunscreen and, like, proper skincare. And then how do we make sure that, like, once September, hence that everyone's done being in the sun and not the beach, like, we're able to recapture those patients and say, okay, now it's time. Like, we really got to hunker down. Let's get the skin, like, where it needs to be.

56:33Stephanie Romeo: It's really interesting. It's a great point. It's how can you actually use this data to drive those decisions and create kind of an ebbing and flowing of different offerings for different seasons that make sense and go along with that, especially, as you said, even social seasons. Facelifts in the fall are probably not going to be as popular, I would imagine, in New York or in the spring in these kind of high.

56:55Dr. Stafford Broumand: yeah it goes around like the school schedule like all of a sudden it's okay so school started this year the last week of august for new york for at least my kids and then i know private school so i think started september but everybody is very aware of like i either need to do it right before that if they're away for the summer that's a great time to do it and it doesn't matter like how uncomfortable we may be if we're wrapped and covered but like that was like the appropriate time to have something done. And then like Botox right before everybody is going to do the pickup line. And then we see a little drop because now everybody is back in and just trying to get their kids acclimated with this new schedule and like in class and like doing the things that we need to do as parents.

57:35Dr. Stafford Broumand: And then all of a sudden it's like by the time like the end of September, October hits, it's like, OK, we're good. Now I can take time to do something for myself.

57:43Stephanie Romeo: And so you see those trends. Do you try and balance it also with like segmentation? So let's say people who are in their 20s who might not have kids trying to bring them back in early September or anything like that?

57:55Dr. Stafford Broumand: Yeah, I try not to push people to do things outside of when it's appropriate for them. And there are definitely times where we're busier than others. And I have those conversations with patients as far as the ease of getting onto the schedule. But yeah, you try to, you figure it out. You offer, as we do every once in a while, a special for something and it's usually when tomorrow brings something new in for the skin our new laser we did we do hair transplant in the office but depending on like where it is and I'm like oh men are usually starting to take a look they're noticing the hats are off it's not winter anytime they're trying to do something okay let's take a look and see like where we can slowly insert this.

58:37Dr. Stafford Broumand: I think the importance of just like the overall office makeup is really important for patients because I don't think people realize. I think they realize when I'm like, I've been here for 18 years. And sometimes a lot of times the women are like, what did you crawl in here? And I'm like, but it speaks a lot to who Dr. Brumand is because he has staff that are staying with him and where we're in a time where loyalty is no longer an important part of job stability in the medical field it's something that really still needs to remain important because once you have somebody who can who knows the tool that you're going to need the instrument oh my god if I said tool he'd be like that's the instrument that you're going to need and we can already know exactly what he's thinking and where he is in his thought process without him actually having to say something, it's a really amazing experience for the patient because everything just flows.

59:33Dr. Stafford Broumand: I get all of our emergency calls directly to my cell phone. If somebody has a problem, it comes. I and Dr. Ruman will get the alert. And usually I'll text him and I'll be like, I don't think you really need to jump on this right now. I have no problem calling her. I'm going to give her a call. I'm going to let you know. And then I'm going to talk to her. I'll be in touch with you. Just make sure you have your phone around you. So if there is a problem, you're available for it. This person has a laceration. Can you do it now? Can I tell her it can wait till the morning. There are all these things where I don't have to call him and ask him anything.

1:00:02Dr. Stafford Broumand: I'm already like, this is where I'm at. This is the conversation that I've already had with the patient. And here we are. And it goes from me doing that to Amanda in the operating room to Tamar already knowing you're not going to like that. This is not even we need to change the plane of this. This side has to match better with this side. So when you have all of these people in your office that can do that for you, I think the process for the patient is then unlike anything else because things don't get lost and things aren't so easily missed. It's just a three-word conversation sometimes. Sometimes I'm literally finishing an email and Stafford will come in and he's, oh, can you?

1:00:37Dr. Stafford Broumand: I'm like, yeah, I already did that. Don't worry about it. And he's like, oh, okay. I'm like, okay, don't worry. Yeah, it's done. So there are all these things that show he's a wonderful person and he is the most talented surgeon with not only an incredible background, but he cares about people, he cares about his staff, and then he cares about his outcome and we all stick around for it. So when you look at an aesthetic office, specifically cosmetic surgery, and there is high turnover, it's like, why? What is that surgeon doing that's making these people not want to stay? It's not like we're in finance where it's like we're jumping and we're trying to get this large increase in pay.

1:01:12Dr. Stafford Broumand: Usually the nurse has already left the hospital system where she wants to go into it, but back into it. But like there's all these crossovers and reasons why medical professionals are in this specific type of setting and not in a hospital setting that loyalty matters, like tremendously.

1:01:28Stephanie Romeo: Let's say a few questions on that. One, when you have to bring in someone new, how do you onboard them and stuff?

1:01:35Dr. Stafford Broumand: Yeah, it's a team effort, really. Hiring, I do the initial interview, they always meet with Dr. Brumond. And then there's always like a conversation. And the conversation is always about are we disrupting the flow of our office by having this person come in? Do we think the vibe and the mesh is going to fit within our office? And do we think that person is going to be happy in this environment? And as much as we try to make our environment as positive as possible, we are a family and you have four women, three women that have known each other for a very long amount of time. And Dr. Rouman, there are so many conversations around hiring.

1:02:13Dr. Stafford Broumand: And then it's how do we properly onboard them? How do we make them feel comfortable? Like, how do we make sure that we're doing the right things? And they understand that, like, we flow a little differently. And like, we all like jump in where we need to. But that's the person that we're looking for. So it's a give and take with how we do that. But yeah, how often do you have to hire someone? Sounds rarely. It's rare. We hired Jen because Amanda was going on maternity leave for her. and I needed to bring somebody on and Mary, our nurse, who was our receptionist who came back, actually decided to go back to the hospital.

1:02:48Dr. Stafford Broumand: So it was like a very specific time where I was like, okay, we really do need to bring somebody on because we're not going to function properly without an extra person here. So we do and we did. And I hope that she's happy. She's been here for six months. I don't think she has any intention of leaving. Watch us airs. But yeah, it's rare that we have somebody who runs for the hills from the office.

1:03:09Stephanie Romeo: Or is it sometimes that they're not a good fit, that you've hired wrong and you've had to just, you know, start again? I have definitely, yeah.

1:03:18Dr. Stafford Broumand: And it also goes to, I like to give people the benefit of the doubt and I like to see the positive in everybody and what they do. And I have high hopes that we've never had somebody steal from us, but you're not going to steal from us. We have a full boatload of narcotics in the back. You really have to see a trusting approach to all these things on top of doing your due diligence of who they are as people. But most of our receptionists, I will say, stay for multiple years, if not transition into a different role. And we have been really lucky in the people that we get. And what do you do when people have to go on vacation?

1:03:53Dr. Stafford Broumand: We just cover it. So the rest of the team just comes in slots and it's what you're saying. Everybody just flushes it.

1:03:59Stephanie Romeo: Finding the place, which is a really, it's the most necessary mentalities that no one's above anything or below and that team effort of just taking it on.

1:04:07Dr. Stafford Broumand: Yeah. And we all can do pretty much everything. So as much as if Tamara's out and Amanda's here and I'm like, I need you to at least explain to her X, Y, and Z, there's never anything lost. Somebody is always there to explain it, to do what needs to be done. And obviously, no one's injecting to Mara's patients, but it's covered because we've all been there for so long.

1:04:30Stephanie Romeo: And you were mentioning about potential expansion. Is there thoughts to have another clinic or be in a different state or? To some level, I think a lot of our patients have taken to Florida for whatever reason.

1:04:44Dr. Stafford Broumand: And he likes to go there. So when he's down there and he's vacationing with his family, people are like, why don't you see patients down here? We're here. Everybody's here. Wouldn't it be so easy? So we have started conversations of like, how do we do that logistically? What does that look like for us? And then we've also looked at other smaller spaces in Manhattan to just open a satellite for Tamara and a couple of their nurses. And they're all interesting ventures because I think now with like Manhattan, we have so many med spas opening up and closing down. And it's a completely different space than like what we're used to.

1:05:18Dr. Stafford Broumand: and it's a beast that is definitely something that like would need to be tackled completely differently than how we look at like our practice because I think it's the competition is higher like the price point is definitely more important and there's like all these other nuances that we really have to look at that we continue to look at even for our practice because we do have an aesthetic nurse but yeah we're always talking and looking but there's always conversations about it

1:05:45Stephanie Romeo: Yeah, it does really venture into a different animal because you're trying to do something that is actually higher volume, higher throughput. You know, it's a different experience than that nudge, that let's say really gentle approach or client led approach. You have to be almost proactive, whether that's on marketing, whether that's on patient engagement, follow up, etc. That every dollar you're spending is kind of converting. And so we see it as a real difference. We do work with both surgical practices and we work with the high throughput aesthetics practices, MSK clinics, dental practices that are more of this kind of, I'd say, the high street service offering.

1:06:22Dr. Stafford Broumand: And it's intense. And I think I look at like what doctors have to do now, like in a hospital with like the amount of patients that they need to see in their day. Everything is like it's timed and it's like very specific. And it's not the way that we operate. everybody, if you need that 45 minute phone call, like you're going to get the 45 minute phone call. If you need the extra 20 minutes with him, you're going to get the extra 20 minutes with him. And we're going to figure out the rest of our day. We really try to take the patient into consideration, understand what it is that they need in order to be like fully comfortable.

1:06:52Dr. Stafford Broumand: And when you're in those settings, like it's not so much about like patient comfortability, it's about we need to get this done and it needs to be like, we got to do this in order to see a reason as to like why we're here.

1:07:03Stephanie Romeo: While still maintaining some essence of real patient care and a really great experience. We work with someone who considers themselves like the Soho house of aesthetics. That's what they want to create in their environment of that really bougie feeling of coming into the med spa and feeling treated, almost being greeted by, I love if you go to sub 40, you get given water as well, but that type of very bespoke servicing or other clinics that we work with have defined a real niche and brand. One of them is really has a brand around also helping with gender affirmation and such as an Aesthetics Med Spa.

1:07:42Stephanie Romeo: And it's a very interesting thing. How do you differentiate, as you said, with spas opening up almost on every block?

1:07:49Dr. Stafford Broumand: Yeah, we're in Manhattan and you literally turned between like Lex and Third Avenue. There's three or four of them in the 70s. They're here and there are a lot of them when you look at like mom groups, they're doing decent work. They do have some really positive patient experiences. They have some, everyone has not so great experiences within their clinics, but you, they're there and the competition is different. The way that you brand yourself and you market is like completely different. And you have to find that specific thing that you're going to offer somebody that's not like anybody else.

1:08:22Stephanie Romeo: So I think that Dr. Brumond has done a very good job of that and that we see also a lot clinician-led marketing tends to work quite well to have that kind of voice and whatever and I think that Dr. Ruman's focused on aesthetic including on the arts including in everything in his approach could lend itself very well to having that type of

1:08:43Dr. Stafford Broumand: different niche to break through the audience of why to go he and he definitely has differentiated himself, I think, from the beginning, as far as being like a very like small, like compassionate, like warm, caring place for patients, that it translates through everything else. And then if we do eventually do something like that, it will then translate. And then Florida is, it's just him, but it's like him and a staff member. And that obviously always translates. So

1:09:16Stephanie Romeo: So it's really exciting. Thank you so much for joining. Thank you for having me. And really interesting. Thank you.

1:09:23Sally: Thank you so much for joining us on this episode of The Business of a Clinic. We hope you had a good time. We hope it was helpful. If you can think of anyone who should join the conversation, feel free to nominate them, send them our way. We'd love to invite them to participate. If you like what you saw, give us a like, share, comment. We hope we'll see you again next time. Thanks so much.