Episode 36: Building an Empire – The Synergy Way

Featuring Dr Mahlon Kerr


Dr. Franco: Welcome back to “Plastic Surgery Untold,” the greatest podcast in the world as voted by us. I’m Dr. Johnny Franco, also known as Austin Plastic Surgeon. We have a celebrity crew again with us and special guest, Dr. Mahlon Kerr. So we’ll give that back to him in a minute because today’s topic is Building an Empire- The Synergy Way. And so we’ll dive into that in just a minute, but, Celebrity, catch us up a little bit. What’s going on in your life? This episode, I can actually see the colors. It looks like you got a nice red festive sports coat on there.

Gilberto: Are you talking about Celebrity Anesthesia or…?

Travis: Me?

Dr. Franco: Well, Most Beautiful Man, G-Berto. I’m sorry. I’m just confusing you guys. You guys are both gorgeous. Thank you. You’re welcome.

Travis: I thought you were having a stroke for a second.

Dr. Franco: It’s just that red is just throwing me off here.

Gilberto: Well, I felt like last time my green jacket just didn’t come across as well as I wanted it to, and so I thought I’d bring the holiday spirit a little more this time with the red jacket and the plaid pocket square.

Dr. Franco: Oh, no question. You’re bringing the thunder.

Gilberto: Yeah.

Dr. Franco: Well, what’s new in your life? What’s going on?

Gilberto: You know, just winding down the year, getting ready for the holidays. And, as a matter of fact, I got in the holiday spirit, and to kinda piggyback on your little anniversary gift from our last episode, I wanted to get you guys a little something. So I…

Dr. Franco: Can we open this?

Gilberto: Yeah, absolutely. If we got some time.

Dr. Franco: It’s a little gift bag. Well, I mean, we don’t got that much time, but, oh, well, I just wanna open a present. Let’s take…

Gilberto: Oh, I know how much you like those.

Dr. Franco: I do like… Oh, dude, this is cool. Yeah. I mean, it’s some “Star Wars” socks. Stance, I love this brand.

Travis: Oh, yeah, man.

Dr. Franco: Dude, this is cool. Awesome.

Travis: Oh, these are awesome.

Dr. Franco: Well, thank you, G-Berto. I didn’t get you shit, but thank you. I appreciate it.

Gilberto: No, that’s okay. No, I know how much you like “Star Wars,” Dr. Franco, and…

Travis: I love this. Dr. Seuss running socks? I’m digging it, man. Thank you, thank you.

Gilberto: And Travis is training for his half-marathon, so there’s a little running theme to those socks.

Travis: Thank you, sir. I love it.

Gilberto: Yeah, you’re welcome.

Dr. Franco: He’ll be able to show those off with his knee-high, like, you know, capris pants that he wears, those scrub pants.

Gilberto: And Producer Donald got something, too. [crosstalk 00:02:05.177]

Travis: First of all, they’re joggers.

Dr. Franco: Oh, did he? What did he get? We’ll have to post a picture of that on our Instagram. Celebrity, what about you? Survived your first couple of weeks in your new house?

Travis: Survived the move, yup, and into the new house. My wife has been posting all about it on her stuff, @yourtrendytherapist, shameless plug number 3,084.

Dr. Franco: You didn’t give her a plug last episode.

Travis: I know I didn’t, man. I’m sure I heard about that.

Dr. Franco: How was the week on the couch?

Travis: It was rough.

Gilberto: Maybe double-plug this week.

Travis: Yeah. She’ll get two plugs. No, so, yeah, just getting settled into the house and everything. And we were talking about something earlier today, how when we first started packing up to move, we were looking at all of the stuff that we had. We’re like, “Man, we gotta get rid of some of this stuff. We gotta sell some of it back, we’re gonna take it to Salvation Army, or Goodwill, whatever.” And we’re looking at it, we’re like, “You know, I haven’t used this in, like, two years, but maybe we could use it for, like, a costume next year or something,” then we’d keep it. And then, like, as we got closer to the actual move, that was like, “I haven’t used that in four days. Throw it away.” Like, we didn’t even care anymore. It was just funny to see how that changed.

Dr. Franco: My favorite is when you sold something on Facebook Marketplace and you said that they had to carry out themselves, and, in the end, you ended up carrying everything out, putting it together, dissembling it, X, Y, and Z. I thought you were gonna go to their house and put it together for them.

Travis: Compliments of @yourtrendytherapist. The wife set me up for that one. She’s like, “Oh, yeah, yeah, no, he can help.” And then I walk in and now I’ve gotta unload an entire back of a U-Haul.

Dr. Franco: Because it was like an 8-year-old and, like, a 70-year-old- man who just had back surgery that showed up at your house.

Travis: His grandpa with back surgery. Okay. Well, I guess I’m bringing this mirror and all this stuff downstairs myself.

Dr. Franco: Well, we got our special guest here, Dr. Mahlon Kerr, who’s actually the founder and CEO of Synergy Plastic Surgery here in Austin, Texas. And so we’re talking about the business of plastic surgery. And maybe we’ll let him introduce himself a little bit and then dive into kind of all the things that go into making a plastic surgery business run to be able to provide care for all the patients here in Austin and Central Texas, really.

Dr. Kerr:Yeah, yeah. Well, thanks for having me. Yeah. So, Synergy Plastic Surgery is our business. We’ve been here for, gosh, a little over 10 years, and, yeah, I mean, just trying to bring beauty to the Austin market.

Dr. Franco: And I think one of the things that’s actually surprising, I mean, I know you, so we’re pretty close in age, and so, you know, 10 years, you know, this actually sounds like a lot. But for the amount of stuff that your practice has done in 10 years, I think most people would think that you have been in practice a lot longer than that. Just to kinda put this whole kind of podcast in context, do you wanna tell us a little bit? Because you started as just you, a single provider, and then where you’re at now.

Dr. Kerr:Yeah. So, in 2010, I thought I was actually gonna stay at the university where I trained and I was gonna do pediatric plastic surgery and cosmetic surgery.

Dr. Franco: I thought I was gonna be a pediatric plastic surgeon, and then I went to the children’s hospital, and boom, and boom, I’m doing butts.

Gilberto: It’s funny because one thing leads to another, and there you go.

Dr. Kerr:I think if it weren’t for the economic downturn in 2008, I probably would be that person now. And what happened essentially was I was offered, you know, a fellowship specifically in pediatrics, which is sort of the traditional track, and was then offered a faculty job after the fellowship would be completed. And then, you know, sorta towards 2009, I basically was told that there may or may not be a job, but there sure would be the fellowship. And, you know, at the point that we’re at, when you think about it, you know, we do four years of college, four years of med school, and then, in my particular case, six years of residency. To be told that you would do a seventh year and then there may or may not be a job at the end of that, it really wasn’t the right choice for me.

And so I’d always been interested in business, had done a little dabble in, like, private-label skincare during residency and figured out how to start a website, and create a company, and sell a product. And so, for me, it wasn’t too much of a leap to kinda get this concept of hanging a shingle. So my wife, Ashley and I moved to Austin and literally did just that. And we came up with a brand, came up with a logo, a location, built out an office, and started the practice with us and a single employee who was like a traditional sort of medical manager. She did our office billing. I think like many plastic surgeons, we started in a very traditional way in that I took a call… I was actually doing all of my cases at the hospital for the first five years that I was here, including my cosmetic cases, which is actually kind of unusual and a little bit of a glitch in the Austin market that ended up getting ironed out. You can’t do that anymore. It’s too expensive. But I had kind of a good deal.

Dr. Franco: And Ashley’s a nurse?

Dr. Kerr:Yeah, yeah. So, yeah, so my wife is a nurse injector, and so that was helpful because in the beginning, she did everything. So she was my coordinator doing the quotes. She was also building her injectable practice and then, you know, literally rooming, seeing patients doing procedures with me, and, in fact, even scrubbing in the OR with me as a first assist. And we went along like that for about a year. We came in with the help of St. David’s, which is one of the sort of large medical hospital groups that’s here, through a form of an income guarantee where essentially they say you’re gonna make this much money a month. We came off the guarantee in three months because we were making more money than they anticipated that we would, and just sort of never looked back.

We had a brief brush with an associate for about a year in 2012. So, Dr. Bekanich who’s currently in my practice was in Florida and was unhappy, wanted to come to Austin. And, you know, at the time, I’ve always been somebody just sort of looking for this concept of, like, infrastructure expansion, giving a good place for people to work and do good work, and just sort of fostering that. So we brought her in. She ended up having a baby and just kinda it was a bit too much, and so she left for a few years and then came back later.

But, for me, you know, we kinda kept along that path for about four and a half years. And in a traditional medical practice we had a five-year lease. Lease was coming due, decided, much like yourself, that it was time to invest in commercial real estate, which I do believe is one of the best things you can do as a physician. And so, ended up buying two condo suites that were in the same medical complex but in different buildings.

And one of them was actually designed to be a true ASC or ambulatory surgical center, has a nice porte-cochère, covered opening, you know, it was totally designed to be that way. And then the developer couldn’t find anybody to buy it and then sort of sold off chunks, and all that was left was, like, 2,000 square feet, which was not enough size for a traditional ambulatory facility, but it actually is a pretty good decent size for a single-room plastic surgery operating room.

So we did that, branded it as a separate entity with the thought that perhaps over time, people outside of the practice could use it. I mean, it looks like our practice, but there’s no outside logos or anything like that. And then built out in-office just a standard clinic in the next building over. And at that point, started everything that has changed since. So, you know, that year, Dr. Blagg, who is my first traditional associate who was actually an intern when I was at [inaudible 00:09:42.849] so I have known him for a long time prior to him coming about seven years. He actually went through and actually did the pediatric plastic surgery. He does not actually do pediatric plastic surgery, but he did spend a year training in it.

Dr. Franco: And we’re gonna dive into that in a minute.

Dr. Kerr:Yeah. So, then, hired him, then hired Dr. Bekanich back the next year. Then hired Dr. Crawford the year after that, and she’s been with us for…I believe it’ll be 16 months right now. And, spoiler alert, I’m in the process of hiring another plastic surgeon who will come into the Austin market probably in the spring.

Dr. Franco: And correct me, but you guys now have two separate locations, one in Round Rock, one in South Austin?

Dr. Kerr:Yes. Oh, yes, sorry, I got ahead of myself. So we’ve had a satellite location in Austin since 2012, and we had a three-year lease on 800 square feet of just tiny, tiny… And we did it primarily for a very business-savvy move which is geolocation within SEO optimization for Google. And so, understanding plastic surgery from a business standpoint is understanding high-level internet marketing, and boots on the ground is required for effective marketing. And so even though that office was tiny…and, in fact, there was nobody there. Like, we would just travel there as a group. So, like, the nurses, everybody would come for the day that we were there. We still got mail there and it became our geolocation for our website, which was critical for us to compete in an otherwise suburb location of Round Rock.

Dr. Franco: And you dropped so many nuggets there, so maybe we’ll back up a little bit because it’s interesting just to hear and see, one, for anybody listening, what do you…? Just so people know, I’ve always [inaudible 00:11:21.915] as a power couple because I feel like you guys complement each other so well. And I don’t mean this the wrong way, but you’re very business, you’re super smart, very, like, to the point, where I feel like Ashley is the sugar. She knows how to make all the magic kinda come together, and that may not be what’s going on at home because I see the faces here.

Dr. Kerr:[inaudible 00:11:42.394] I don’t know. Like, I’m the dreamer and she’s the one that yanks, like, the choke collar.

Dr. Franco: But I do think that you guys are an incredible power couple together. But, you know, it’s funny to see how the transformation…because what you guys have accomplished in 10 years, I think, from any regards, any Celebrity sees a bunch of practices, G-Berto’s been a part of a bunch of practices, I think it’s absolutely phenomenal. That’s why I thought you were an incredible guest for this type of podcast.

But even the transformation, where you went from the traditional starting of taking the ER call, building your practice, and doing, you know, those types of things, which I think is super important. I’ve taken ER call, I’ve done my midnight calls of jaw fractures, and finger pinning, and so forth. But it’s funny how the world has evolved, and I feel like people either evolve or kinda don’t. But you’ve already transitioned to a lot of these other sophisticated…and we call it marketing, but it’s really educating patients about the opportunities that are out there and the quality people that do a good system.

Dr. Kerr:Yeah. And I think, ultimately, marketing is just connecting somebody who wants something with somebody who provides it, you know? And in a perfect world, in fact, this is Google’s biggest wish, right, is that when you type in that search term, you find whoever it is you’re looking for, you know? And so the key is, how do we not only provide that amazing experience but then how do we reach out and connect with those patients that are looking for the services that we provide.

Dr. Franco: And it’s funny that you said that because the number one question on my thing for your business stuff is, how do you expand from just…? It’s easy to control the patient experience, the quality of care that you guys give when it’s power couple plus one. But now that you’ve expanded…because how many people do you have in your practice now?

Dr. Kerr:I mean, probably a little over 30.

Dr. Franco: So now you got 30 people. How do you control that experience? Because I know the kind of person that you are and Ashley is, and you would never want anything but an incredible experience for no matter whose patient it is, whether it’s yours, one of your associates throughout the whole system. And I know you’ve done a lot of things to make sure that experience is quality no matter who they’re seeing.

Dr. Kerr:I mean, I think you try and get it as close as you can, but I think at the end of the day, you have to realize that the physicians that you’re hiring, the nurse injectors you’re hiring, these people that you’re hiring that are part of your brand and part of your core identity, they all have their own sort of unique way of delivering medicine. And so you have to kinda give and take a little bit.

So some things need to be the same. So the approach to, like, you know, when you call the office, you know, how you’re called back, you know, how we vet and educate you before you come into your appointment, those things are all the same. But, I mean, and then how the appointment exists as far as, like, what room is it in, like, how was the flow, that’s the same. But the actual things that, you know, certain physicians or nurse injectors are gonna hit on, those are gonna change a little bit, right? And so I think the goal is that you kind of walk away with the essence of Synergy, but that essence is applied, obviously, in a unique fashion with each person that’s caring for you.

Dr. Franco: Which I think is actually really kinda cool. Because we were talking about this on one of our other episodes is that, you know, someone who comes to see me, someone who comes to see you, personalities mesh with different people. And so it’s so funny because, you know, who somebody’s gonna mesh with. And you want somebody, you know, that we have the same ideas, you know, the same goals, and that it just kinda flows. And it’s some of the nice things of everyone not being exactly the same in the office.

Dr. Kerr:Right. And I think that part of the sales team is they get that initial call, and then their job is to kind of figure out who that patient is, not only the procedure that they want but maybe a little bit about their personality and, obviously, their time frame. And so, all of those things affect sort of where they’re gonna get directed within the practice, and it affects their ultimate experience. But, you know, I mean, the goal is that we get the right person with the right surgeon and we get it within the right time frame, and then that experience sort of feels the same, kinda, even though it might be a little bit different along the way. I mean, that’s the essence of a brand.

Dr. Franco: And it’s funny because it sounds like a lot of things you’ve done are both, you know, challenges and wins because you’re making more flexibility for patients. Because before this podcast, in a previous one, we had Dr. Saxon who does some facial feminization surgery, and we laughed because it’s something I don’t do. And, it’s funny, when you bring more people in, you kind of expand that bubble of services you could provide, it’s just, I feel like especially in a city like Austin in today’s world, there’s no way you or I can singly do every aesthetic procedure out there. It’s just not doable anymore.

Dr. Kerr:Yeah. I think that’s true. I think that, you know, most of us are kind of doing similar things within the group. You don’t have any huge outliers one way or another, you know. And I think that that can be considered good and/or bad. But we pretty much offer everything through the group of, you know, all the different associates and partners, you know, and that’s kind of the goal.

But, you know, to go back to the idea of making the brand consistent, I think that’s probably one of the hardest things, and I think that I’ve had certainly my own failures in that. And it’s hard to go from one location to two. And we’re about to go from two locations to three, and that’s gonna be even more of a challenge. And so, part of that, I think, is developing, you know, protocols and policies, and hiring for the culture of the business, but part of it also is just structure. So I’ve got a COO, so a chief operations officer is gonna start on Monday who’s my first real executive besides me. I’m super excited about it.

Dr. Franco: And what would you say has been your biggest challenge through this route?

Dr. Kerr:You know, that’s a great question. You know, I mean, everything’s been pretty easy. I think the biggest challenge is keeping everybody happy, to be honest with you. I think that, you know, it’s easy to keep the patients happy, but it’s harder to keep the staff happy. So I think managing experience, keeping the staff all happy, and by happy, I mean, like, working well together, right? Because, you know, medical practice is like a big family, right? So families are gonna fight and they have their own issues. And it’s important that while I know that that’s gonna happen, at the end of the day, it doesn’t affect the experience, right? So if Becky and Sally are in a tiff, the patient should never know that.

Dr. Franco: It’s funny because the challenges have been hard of keeping people happy. You and I text pretty frequently, just questions, and so it’s nice to have, you know, someone to bounce stuff. But even COVID has been a challenge, you know? How do you balance the needs of the practice versus individuals and so forth? And just when people are stressed overall, I think sometimes makes it harder to keep everybody happy.

Dr. Kerr:Yeah, the quarantine was an interesting time, and we spent a lot of time on the phone together. And, yeah, I think it was really helpful for me to kinda think about these things and all the things that we were figuring out. But, you know, it’s funny. As you reflect back on that time, I think that none of us really had a sense of how much that was gonna extrapolate an interest into plastic surgery and how plastic surgery was all of a sudden gonna become, I mean, probably one of the better years ever, you know, I mean, minus the fact that we couldn’t work for seven weeks. But, you know, it’ll be interesting to see how this trend in a significant interest in having work done falls out over the next two years.

Dr. Franco: For the plastic surgeons listening to our podcast now, because I think one of the things you mentioned… When I was in Miami, I was part of a big group, and this is interesting. They had a group of three, which in Miami to keep 3 surgeons together for 10 years is a challenge. And, unfortunately, you know, one of them parted, you know, shortly before I left. And I left for a separate reason just because I always wanted to come back to Texas. It was a great experience for me.

But how do you go about…because part of keeping people happy and keeping that synergy the way, you talked a little bit about [inaudible 00:19:50.123]. How’d you go about finding somebody that you thought was a good fit for your practice? It sounds like one of them you knew personally, but it’s always gonna be hard to just call people you know personally and say, “Hey, come join our practice.” And there’s people who I think are great surgeons and I know personally, I wouldn’t invite them to my practice.

Dr. Kerr:Yeah. I think…

Dr. Franco: No offense, G-Berto.

Gilberto: None taken.

Dr. Kerr:Yeah. I think you gotta hire for the culture, right? So, you know, you’re never gonna hire somebody who doesn’t have, you know, what I would say are good hands or is not a skilled or safe surgeon, so you just kinda cut that off, right? Those people don’t even… That’s somebody you’re never gonna talk to, right? And then you need to hire somebody who, you know, I think can be kinda happy and wants to just kinda show up and sort of do their job. And so I think you wanna hire for that in a group setting.

And then somebody who has personality, who gets along with patients. I mean, I think a big part of our experience is, you know, none of our surgeons have poor bedside manners. They all have, you know, I think, charismatic personalities in a positive way, because charismatic personalities in surgery could mean terrible things. Yeah, you know, and it’s just sort of like this new guy who should start in the spring. You know, I mean, just a very charismatic surgeon who, you know, can execute a case. And I think that if you have those two things, then that person can be successful. It’s just putting in the business side of it to plug in and just create interest and create, you know, sales, which ultimately creates surgeries, and then, you know, happy patients.

Dr. Franco: And then could you also have some nurse injectors, PAs… And it’d be interesting to get G-Berto’s perspective because it sounds like that’s probably a similar process when you’re trying to decide to bring in nurses, PAs, mid-levels, someone to that degree into your practice.

Dr. Kerr:Yeah. So, G-Berto, no bad feelings, we do not have any mid-levels. I think I desperately sort of need a mid-level, actually. And so it’ll be interesting to see with this new executive guy what he recommends because he comes from a more traditional versus a plastic surgery background. But we have nurse injectors, we have three. And the concept is that, you know, you would have those sort of med spa services available at every location, right? And the Round Rock location is our original flagship. It is our biggest current location. It won’t be when we move to the third location, but we’ll always have that because there’s great synergy with a nurse injector in a plastic surgery office.

Dr. Franco: I see what you did there.

Dr. Kerr:Yeah. You know, and I think that… Another thing about having a practice that’s heavy with surgeons is that, you know, we’re able to provide those services without necessarily the need for a mid-level because all of our new patients can see a surgeon. And then, you know, they can have that initial contact, that sort of legal H&P done, and then nurse injectors are simply executing order plans, you know, based on the protocols assigned by the surgeon.

[crosstalk 00:23:01.903]

Dr. Franco: Oh, go ahead. Go ahead.

Gilberto: I was just gonna compliment…

Dr. Franco: No, go ahead. Defend your honor. Go ahead.

Gilberto: I was just gonna compliment Dr. Mahlon. He’s got some really, really talented nurse injectors in his practice. So, kudos to you.

Dr. Kerr:Oh, thanks. And I guess my wife, you know…I mean, my wife has this great relationship in the community, as I think I’ve tried to do as well. I would say that those things come in handy when it’s time to look for someone.

Dr. Franco: It’s funny because people forget, Austin is still a small town. And so, you know, either way, if you’re a very quality provider in town, word gets around. If you’re not, word gets around as well.

Dr. Kerr:Yeah. Yeah, I think reputation is really important.

Dr. Franco: And then, you know, one of the interesting points that you made because I think a difference between your practice that has grown and does a large volume versus, you know, other practices or models around the country, especially coming from Miami, there’s other… Because you made one point where patients always get to see their physician. You know, and not saying that they may not see a nurse or somebody shopped on a different day or something and needed some care or something, but they’re gonna have a consult with the actual physician before surgery.

Dr. Kerr:Yeah. I mean, always, of course, before surgery. You know, I mean, I think that the right physician is gonna be the best salesperson you can ever hire because we are architect build, right? So we are everything. We are your interior design, we are your architect, we are your actual builder or contractor. We are executing the vision, right? And so who better to explain that to the patient and get the patient excited about their potential outcome than to have the actual person who’s gonna, you know, execute that operation and sort of realize that dream?

Dr. Franco: Can we roll in? Because we’ve talked about the patient experience, and then you mentioned keeping people happy. So, staff is one thing, but I feel like keeping surgeons happy is a whole other beast of its own. And some of it you’ve done by picking personalities that I think would fit well with the practice, but some of them, that, too is keeping them busy and you alluded to a little bit… Because it sounds like the surgeons that you bring into your practice are people who wanna have a certain busyness but they want a lot of the exterior stuff kinda taken care of. And maybe talk about how you’ve set up a system to keep them busy, take away a lot of the headaches that maybe they don’t wanna deal with. And it sounds like you’ve hired people who love operating, love taking care of patients, but kinda don’t wanna have to deal with the other stuff.

Dr. Kerr:Yeah. And I think that that’s something we’re gonna see more and more common, right? And, you know, the things that attracted…

Dr. Franco: The hospitals have already done this.

Dr. Kerr:Yeah, right. I mean, and the things that attracted me to plastic surgery were actually the ability to have to deal with those things, right? So the concept that, you know, when I started, you know, I became… Basically, my life has been focused on plastic surgery since 2001, so, for 20 years. I’ve been, you know, not necessarily in medical school every day but, I mean, I’ve scrubbed hundreds of cases in plastic surgery. All my mentors were plastic surgeons, I mean, you know, just like you.

I mean, my whole direction in life for 20 years has been that. But part of that was the concept that when I got into plastic surgery, something like 65% of plastic surgeons were in, you know, solo office, basically small business owners, right? And I think that if you fast-forward now, that’s probably, like, half that. It’s probably 30%. And, certainly, I think a lot of people coming out are a lot less interested in sort of that concept of hanging a shingle and starting a business.

Dr. Franco: And if you get outside of plastics, I would love to see that number. I bet it’s even lower than that. Because just from a system, it’s so hard to survive. Most family practices are bought out. Internal medicine, to be by yourself and not be a big group, it just…yeah.

Dr. Kerr:It’s hard. You know, and I think the key is just the infrastructure. And so, you know, you create the kinda infrastructure that you would wanna have, and then that’s also the infrastructure that your friend would wanna have, right? And so then I think it becomes somewhat easy. You know, there are still glitches along the way, and, certainly things that we can work on. But, you know, I think the concept is, you know, build a nice operating room, have nice equipment, you know, build a nice office, have nice exam rooms. Try and hire staff that are competent, which is probably one of the biggest challenges, to be honest with you, to keeping surgeons happy is having staff that are awesome.

And staff that get along with all the surgeons because they’re all a little different, right? So everyone’s pet peeve is different. And so we try as much as possible with the group to do, clinically, the same things. So, you know, we try and have, you know, setpoints for activity levels and kind of the way that we are using binders, or using soft bras or, like, massaging breasts after implants. I mean, we try and be consistent so that not only it makes more of sort of, you know, this homogenous experience but it’s also easier for the staff, right? Because if they have to remember five different ways of doing, you know, breast augmentation sort of post-op, it becomes a little more challenging. And so, I think you gotta find surgeons who are willing to adapt their methods. And, that being said, you know, with every new acquisition to the practice, we learn something new.

Dr. Franco: And some of this stuff, the concepts make sense. And this is why hospitals and other things have made, you know, changes is, even my practice in Miami, it’s nice when you have three or four people because even if you’re on vacation, there’s always somebody at the practice to take care of them. So that’s a benefit to the patients themselves. That’s a benefit to, you know, you or I who doesn’t have to call, you know, several people and be like, “Hey, I’m going out of town for a week. Can you cover for me?” You’ve kinda got that built into the practice, obviously.

Dr. Kerr:Yeah, right. And the more people you have, the easier it is to do, and it creates a seamless experience for the patient to just call nursing.

Dr. Franco: And then talk, too, a little bit, especially since we got Celebrity here, I know we’ve picked on G-Berto a little bit, but you’ve incorporated, as you alluded to earlier, operating rooms and probably some anesthesia into your system, which, again, kinda controls that experience, makes something easy for your team to be able to already have operating rooms there.

Dr. Kerr:Right. Yeah. And I think that, you know, there’s the physical operating room, and then there’s the equipment, and investing in the right type of liposuction technology and so forth that everybody wants to use. But then, you know, again, it’s the staff, right? So it’s having the staff that’s used to doing, you know, that tummy tuck, and they know how to execute that operation easily, and how to get that patient ready and kind of…yeah.

Dr. Franco: And you don’t get stuck with someone like Celebrity doing your anesthesia, and then, you know, it’s downhill from there. Who knows what’s gonna happen? Can I put another quarter in the machine?

Travis: It’s more fun when they’re moving, man.

Dr. Kerr:You know, you can do it with people you’ve never met before, and, you know, that’s the beauty of American medicine, right? I mean, it’s done the same way at every location everywhere. But if you have a staff that’s, you know, dedicated and focused on only plastic surgery, it does make things a little easier.

Travis: I think you hit the nail on the head there. It streamlines the process. I mean, me and Johnny talk about it all the time. It’s just when we’re in there together doing a case, and we’ve got a couple other staff in there that are used to doing our cases, and somebody like Gilberto in the room, I mean, cases just fly by, we get things done. We barely even have to talk because it’s like this seamless dance, and everybody’s got a portion, and everybody’s got their part, and it just works. It works.

Gilberto: Like a well-oiled machine.

Travis: Like a well-oiled machine.

Dr. Franco: And even just some of the equipment because, you know, if we were in separate practices, if I buy, you know, a VASER liposuction and you buy a VASER liposuction, it becomes extremely expensive. If you have three, four physicians, you know, that are all doing this, now it makes it worthwhile to invest in some of these equipment, which sometimes is very hard as an individual provider.

Dr. Kerr:Yeah. I mean, I think it definitely adds up. I mean, probably one of the biggest challenges for us is that our two operating rooms, you know, they’re not connected, so, you know, they’re 45 minutes apart. And so while that’s helpful for the patients and, I think, helpful for the growth of the practice, it means you have to have two of everything, right? And so it just adds up to the cost of that. But, you know, I mean, it’s just like anything. You invest in good equipment and it should last for years.

Dr. Franco: From the flip side, for, you know, people just finishing residency sort of stuff, what questions would you tell those people looking for a practice to join? Maybe two or three questions or things that you would tell them to ask or look for, you know, when they’re trying to join a practice. Any tips you would give them?

Dr. Kerr:Yeah. I think that you need to vet how that practice, how it’s gonna end or how it’s gonna evolve, right? And maybe not necessarily end, evolve would be a better term. Because, you know, you’re either gonna come on as an employee and you’re always gonna be an employee, or maybe you’re gonna come on with the concept that you’d be a partner. Or, maybe in a more traditional way, you come on with the idea that you’re ultimately gonna replace the person who’s hiring you. And I think replace the person who hires you is a pathway that’s, ultimately, probably gonna go away because there’s so many differences between, you know, this person who’s coming out who’s probably 32, 33, and somebody who’s trending down and ending their career and they’re 65, you know, maybe 70. I mean, plastic surgeons tend to stick around longer than they should.

Dr. Franco: And I’ve heard those horror stories, too, where somebody comes on, “Oh, in a year or two, you’re gonna take over my practice.” Four or five years has gone by and that person is not retired, and it keeps being next year endlessly, too.

Dr. Kerr:Yeah. Totally. So, I mean, I would look for similarities, right? So, look for people who are, you know, your age. I mean, that’s part of a huge benefit to us is that, you know, we’re all kinda 40-ish, you know, which is enough so that you worked out the kinks. You know, you essentially have mastery of probably, I don’t know, 40 to 60-odd procedures that we might do in any one given time. And I think that that is, I think, pretty critical if you wanna have a long-term relationship is, you know, you just gotta look for somebody who’s kinda like you.

Dr. Franco: And would you say employment versus partnership, one’s better than the other, or it just kinda depends on situation personalities?

Dr. Kerr:I think it depends on situation personalities. So I’ve done it both ways. I have people that are, you know, essentially associates and may always be associates, and I have somebody like Ross Blagg who was hired with the concept that in a very traditional way, he would achieve partnership over time and has done that. And so, you know, I’m flexible both ways. I think it is helpful for people to have some skin in the game, so I do think that even a minority partnership is appropriate over time.

And I think the key as the business owner is to make that partnership not only affordable but, you know, I mean, really just to make it achievable, right? So I think the bar to entry can be low or it can be extremely high. I mean, these people could buy into practices for millions of dollars and then pay millions of dollars to the real estate, but you could actually, you know, sell somebody a smaller piece of the pie. They can see a reward for that pie, and then they’re a little bit more invested in, you know, the outcome and the care they’re providing. And I think that’s really more the approach that we’ll take over time.

Dr. Franco: And I think you made a great point because I’ve experienced a little bit of it, and I know friends who have joint practices have felt some of this is, you know, it’s one thing to just say, “Yeah, well, you know, we’ll talk about partnership down the road.” You’ll be able to, but without anything kind of structured or some timeline of when that comes about, I think that’s a slippery slope a little bit, would you agree?

Dr. Kerr:Yeah. I mean, like all contracts, you need to understand, you know, what the evolution of that contract is and, of course, understand what, you know, the complete collapse of that contract looks like. And, you know, I think if you have all those terms, then you’re not in a situation where you’re all of a sudden five years in and realize that the deal is a very different deal than what you thought it was gonna be. So I think that that’s probably one of the more important things to vet, you know, as you enter a plastic surgery practice or as you look for a job, so to speak.

Dr. Franco: Sure.

Travis: I did have a question. This one’s for you and Dr. Franco. When you guys are hiring front-office people, whether it’s MAs, receptionists, other nurses, anything besides a physician, partner, or associate, what do you guys look for when you’re hiring those positions, or what advice would you give those listeners?

Dr. Franco: I think that’s the hardest, hardest, hardest thing because it’s hard. I think it’s hard because a lot of it’s trying to find somebody, you know, in a quick interview, you know, trying to find people. And, unfortunately, a lot of these positions people transition to because some of our MAs end up becoming nurses or progressing to other stuff. I don’t know, I think it’s been hard.

You know, I always feel like, you know, the right attitude is the biggest thing. And if you ever read the book, “Blink,” I feel like a lot of times, you get a good feel right away whether somebody’s got good energy, if they’re being positive, if they’re motivated. If somebody’s not motivated, if somebody doesn’t have a good attitude, I feel like you can’t fix those two things. And so, you know, if they’re just trying to learn a little bit more specific about plastic surgery, I feel like we could teach them our way. But the first two, if you don’t have those, deal-breaker.

Dr. Kerr:Yeah. I think you have to be intelligent and you have to be motivated. Because I could teach anybody anything, it’s just they have to be able to actually learn it.

Dr. Franco: Sure. And some of that’s been challenging because even when we’ve tried to interview, you know, just trying to be with COVID right now, we’ve tried to do some of our initial ones either phones or Zooms, which I feel like is its own art of interviewing via some of those things. Because you get some vibe or some idea of what people are doing… If you come for an interview, and it’s your very first interview, and you’re all dressed up, and you look good, it’s like, “Okay, this person at least took this seriously, put some time.” Where you never know if they’re on the phone, you know, they’re probably in flip-flops, you know, shorts, still haven’t brushed their teeth in the morning.

Travis: Not doing the Zoom while they’re driving.

Dr. Kerr:While they’re driving. That’s the key right there. That’s exactly what I was thinking about.

Travis: Oh, yeah, yeah, no, this is going great.

Dr. Kerr:While they’re driving. That’s how important…they didn’t pull over.

Dr. Franco: What other… Because we’ll have to move on here in just a little bit. If you could do one or two other nuggets to either somebody starting their practice or wanna join a practice, what would be one or two advice you would give to the people listening out there?

Dr. Kerr:I mean, I think when you’re starting a practice, you know, I would say look for opportunity, right? I mean, that’s just classic business, right? So you wanna look for somewhere where you’re gonna be successful. And so that may not necessarily be the town that you grew up in, right? For me, it wasn’t. And so I think you have to look for opportunity. And then I think you just have to not do stupid things like name the practice after yourself. Because then, fast-forward 10 years, you might have 4 other surgeons that are working for you. And I wouldn’t also name your location after your geographic location because if you expand past, it becomes a problem.

Dr. Franco: Yeah. No, no, I…

Dr. Kerr:Austin Plastic Surgeon.

Dr. Franco: Yeah, you know, I just narrowed myself down. You know, [inaudible 00:38:14.823] You know, oh, well, [inaudible 00:38:16.504] you know, stuck.

Gilberto: I was gonna say something but I didn’t wanna say anything.

Travis: Don’t wanna touch this one.

Dr. Franco: I’ll just take it, you know? A punch in the face. That’s cool. The one thing I would say from my own experience is just because you start somewhere doesn’t mean that you’re stuck there forever. And I feel like there’s value in it. You know, I spent three years in Miami, I thought I learned a lot, I thought it was a great time. You know, just because you move on, it’s not the end of the world. And a huge majority of people don’t finish their practice where they start at.

I think it’s something like 70%, 80% of people change careers at least once, I think something like first 5 or 7 years. So if you’re not in a good spot or if it was a good thing, take it for what it’s worth and then move on towards your next dream. You just gotta keep working toward your goal, whatever that goal is. And everybody’s goals is different. Some people, it’s lifestyle. I wanna be busy the time I’m there, but I wanna have certain amount of time off, I want certain vacations. I don’t wanna worry about certain things. And so there’s different goals for everybody.

Dr. Kerr:Yeah. And I think on the flip side, I would say that, you know, if you know you’re not gonna be happy doing anything, then it may be worth it just to rough it out. You know, like, if you know you’re gonna move to Beverly Hills, I wouldn’t necessarily come to Austin for three years with the intention that you’re ultimately gonna go to Beverly Hills. You should just go to Beverly Hills and just bust your butt and make it happen, you know, because at the end of the day, that’ll reward you more.

Because I think that there’s a lot of people who don’t spend a lot of time thinking about stuff, right, and then all of a sudden, they’re like, “Oh, crap. I’m gonna graduate in six months.” And then there’s a lot of pressure to get a job, to get a job quickly, and that’s not always the right job, you know? You know, whereas your experience in Miami where you learned, you know, these techniques and it becomes very helpful for you, I think a lot of people are not necessarily going to a huge plastic surgery destination. So they were landing in Kansas and they’re doing pressure sores in Kansas for a hospital, you know, getting their boards done, this idea that they’re ultimately gonna do something else. It’s probably better to just do something else.

Dr. Franco: And it’s really hard to transfer, you know, because most of those patients from Kansas aren’t gonna come to Austin, you know, to get their pressure sore fixed. And so, I mean, they might…

Dr. Kerr:You’d be surprised. My chairman had an amazing ability to attract pressure sores, like a magnet.

Dr. Franco: But it’s such a good point because I think it’s one of the flip sides. You know, and we obviously have a great career and living off that and so forth, but it’s hard for us to pick up and move without starting from scratch all over again. And so, to your point, you know…

Dr. Kerr:It helps you a lot.

Dr. Franco: It does. It does. It’s a big reboot, a big reboot. We’d like to do a little something called Behind the Bovy. If there was one, like, nugget of behind the scenes of running a plastic surgery business, what would be one kind of nugget that people would never think about?

Dr. Kerr:I mean, I think a couple of things, and I see this happen all the time. I think, one, the patient’s being judged the second that they walk through the door. In fact, actually, they’re being judged ahead of time in that you should be nice. Like, a friendly patient, like, I’d charge you less money, you know? And if you’re somebody who’s trouble, and you’re difficult on my staff, then that sends up huge warning flags. I think patients don’t really understand that. So, you know, treat, you know, others as you would wanna be treated.

Gilberto: The golden rule.

Dr. Kerr:Yeah, yeah, totally, which you’d be surprised. And then the other thing is that all things in life are negotiable. And this is something a lot of people don’t realize so I’ll go really behind the scenes is that, you know, the price is not always the price, and it just depends on a lot of factors. And so, you know, I wouldn’t be afraid to negotiate the overall cost of your procedure, especially if you’re looking at multiple procedures, right? So, you know, if it’s just a single one-off liposuction, you got less sort of, you know, ability to change that price versus if you’re talking about a, you know, $25,000 mommy makeover, there’s perhaps some opportunity for negotiation.

Dr. Franco: It’s funny, Celebrity recommended a book called “Never Split the Difference” to me. I don’t know if you’ve ever read that one. If not, it’s a great one. I’ll put that on your list. It’s a good one.

Dr. Kerr:Oh, yeah. It’s a…

Dr. Franco: You know, even for people trying to join a practice, you know, and one of the things that he references in his book is that, you know, if you don’t ask the question, then you don’t know what the answer is. Because, you know, somebody may want something that you don’t even… You’re like, “Oh, sure,” you know? And that may be like, “Hey, I want this extra day,” or “I want an extra two days of vacation a year,” or something that you probably don’t even care about. And he just talks about, “If you don’t ever ask the question, you don’t ever know what the answer is,” and kinda getting to what people really want or need and so forth. So I think that’s a great point from a patient standpoint and even somebody looking for a practice.

Dr. Kerr:Yeah. Totally. I mean, when I hired Ross, it was more important for Ross to have six weeks of vacation than it was for him to make a lot of money. And so we just found a common ground that would work.

Dr. Franco: But if you don’t ask those questions, you don’t get to a point, and then both people can be frustrated and you don’t even…when there’s an easy solution.

Dr. Kerr:Yeah.

Travis: It takes out some of that assumption on both sides.

Dr. Franco: Can we do a quote of the day? Who’s gonna do our quote of the day here?

Travis: I think we both have one.

Gilberto: Yeah. We’re gonna tag-team it.

Travis: Do you want me to go? You first or me first?

Gilberto: You first.

Travis: All right.

Dr. Franco: Mahlon gets a double?

Travis: He gets a double.

Dr. Franco: Okay. Cool. All right.

Travis: This one’s from Albert Einstein, “Try not to be a man of success. Rather, become a man of value.”

Dr. Franco: Ooh, that’s a good one.

Travis: I think that’s good because…

Dr. Franco: I like that.

Gilberto: Yeah.

Travis: I like that because from a business side, not necessarily about building a successful business. In my mind, it’s about building a business that brings value to people. And I think the success ultimately comes from having that value on display and having people receive some of that value.

Gilberto: Yeah, I like it. I like it.

Dr. Franco: Do you wanna try and top that, G, or what’s going on?

Gilberto: Mine’s not so…

Dr. Franco: Okay.

Gilberto: What’s the word I’m looking for?

Travis: Deep?

Gilberto: Deep, yeah. So I think it was DJ Quik who once said, “If it doesn’t make dollars, it don’t make sense.”

Dr. Franco: On that note, we’ll move to our closing here. But I’d like to thank Dr. Kerr for joining us today, our celebrity cast. And as our new tradition that we just started, Dr. Kerr, we don’t actually pay him for being on the podcast, but we do give him a shiny new Yeti mug with our “Plastic Surgery Untold” logo. So thanks for coming out.

Dr. Kerr:Yeah, look at that.

Dr. Franco: Toss you a big old new Yeti there. And so please download us anywhere where you get your favorite podcast, iTunes, iHeart, Pandora now, Spotify. “Plastic Surgery Untold,” greatest podcast in the world as voted by us. Thank you, guys. See you. Bye.

Gilberto: Thank you, guys.

Travis: Yeah.

Dr. Kerr:Bye.

About The Author

Dr. Johnny Franco
Episode 35: Facial Feminization SurgeryEpisode 37: Body Contouring in Massive Weight Loss Patient


Hava a question. Submit it here.


(512) 559-1376


Mon-Fri 8am – 5pm