What Happens When Plastic Surgeons Work Together Will Surprise You

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:05):
Welcome everyone. Let's talk about plastic surgery today is it a group effort, team effort? A lot of times we see in the media it's sort of a solo craft, a lot of practices out there are not group practices. Today I have Dr. Hector Salazar back to join us about what it's like being a part of a six doctor practice where collaboration, consistency, and care go hand in hand. So welcome back to the podcast, Dr. Salazar.

Dr. Salazar (00:36):
Thanks so much, Monique. I'm always happy to join our conversations and get more content out there with our podcast series. For all patients that are interested in either having surgery or just are curious about plastic surgery.

Monique Ramsey (00:52):
Let's talk about this six surgeon plastic surgery team, and why do you think it's so effective?

Dr. Salazar (01:01):
When you start to touch a little bit on the topic, normally what tends to happen, I would say the norm in plastic surgery is that tends to be a solo practice. That's the most common outside of the academic world, right? I mean, when you hear at U-C-S-D, U-C-L-A, all these different academic programs, they're going to have a large department where there's going to be five, six different plastic surgeons, seven plastic surgeons as part of the university or the academic program. But normally in the private world, plastic surgeons tend to be lone wolves, tend to be a solo practitioner practice with some ancillary staff and some administrative staff. That's a great majority of plastic surgeons. I really don't know why, if you ask me why that is, because if you go and think about internal medicine doctors and they have 10 even nephrologists, you'll have a team of eight and a gynecologist like eight or nine.

Monique Ramsey (02:02):
So the effectiveness, I'm going to put this out there and see what you think in terms of a plastic surgeon. You guys are incredibly detail oriented and that thank goodness.

Dr. Salazar (02:12):
That's how you want.

Monique Ramsey (02:14):
That's how you want it. But then if you're super detail oriented, you want to do things your way.

Dr. Salazar (02:19):
Exactly.

Monique Ramsey (02:20):
And then in a group practice, can you do things your way? And so tell me a little bit about, because you've been in private practice by yourself too, right? Yes. You've been part of a large health system, so you've seen all three sides. And now part of this, our group. So tell me what is the differences and what do you feel about the benefits of this group?

Dr. Salazar (02:45):
In the world of plastic surgery, remember all doctors are scientists first, then they're physicians, so they're doctors, but everything is based in science, the medical part. But then when talk about plastic surgery, then you're talking a lot of attention to detail and even some artistry, right? So then you're dealing with a scientist that's a doctor, that's a surgeon that has some art in the work, a plastic surgeon does. And when you have a team, then somehow you have to group or you have to bring together all those different minds and then try to have a certain standard of care for the patient patient experience. But at the same time, you want to be able to respect that individual. Why? Because what makes a certain plastic surgeon, a great plastic surgeon, is having a fundamental base of plastic surgery plus, and that plus is what that individual surgeon is going to be bringing to the table. And I think that that's what La Jolla cosmetic allows to flourish. Physicians that come in and practice here and patients benefit from all those different techniques. Patients benefit from knowing the entity where they are getting their care and everybody loves it.

Monique Ramsey (04:17):
So talking about with that basic level of that, you all share that mindset of putting the patient first, patient safety. How do you guys come up with, if there's something new and you want to look at that, how does the group, do you all talk about it? How does that kind of knowledge sharing, whether it's something new technology, a new technique, what do you all do in terms of sharing that information and information, helping each other all be better and bring a better result to patients?

Dr. Salazar (04:55):
Number one, we all, and I know that probably our audience knows about this, but just all of us are American board certified plastic surgeons. So that gives and brings a seal of warranty in terms of safety. So we all care about safety and of course we're not going to be jumping in and trying crazy things or things that are not been approved by the FDA or so on and so forth, but also that collegiality and at the same time, high standard of filtering new technology. Then if we want to evaluate some new device or if we want to implement a new technique, we all have to be in agreement if it's going to be performed under our La Jolla Cosmetic umbrella, even though maybe not all of us are going to use that device or not all of us, but we all have to be in agreement that it's a safe device and that provides good results.

(05:54):
And not only that, Monique as well, not only for new techniques, sometimes we are professionals. We are constantly learning, improving, evaluating our own practice, and maybe we have a challenging case, let's say breast revision case, a patient that has been operated three, four or five times. So if you go to a solo practitioner, that solo practitioner is going to be him himself and the guy, so that's it. So he might going to go and read a couple of books and read a couple of articles and look back at his own cases and put his ideas together and then deliver. But it's rare that he's going to be consulting or sharing or brainstorming with someone else. The way we can do it here is I can say, let me discuss that with my colleague as I'm having a cup of coffee and let's share what a plan I have for this or that challenging case. And then you're going to get two or three other suggestions or maybe a confirmation of what you're thinking is great. And that only benefits the patient. And of course when I say that, of course, HIPAA laws are always respected. So we would never share pictures or information of a certain patient with another doctor if we haven't asked that patient.

Monique Ramsey (07:28):
Right. And I think that collaboration and brainstorming has got to be great. It's not like you need it necessarily every day, but it does to be able to turn to your left or turn to your right and have five other great minds near you who can say, oh, you know what? I had a case like that five years ago. And it's not something that the consumer, the patient who's out there looking for surgeon would ask or even know. But it is a really nice benefit. And so how do you keep care and the results? I guess that you guys are getting so consistent that the patient has the same experience, whether they see you, they see Dr. Brahme, they see Dr. Riedler. How do you as a team, like a medical department in a way, ensure that that experience is the same across all surgeons?

Dr. Salazar (08:23):
I think our ancillary staff is key. So you know how we are structured in the sense you have a group of doctors, you have all your plastic surgeons, and then you have all the clinical team and the clinical team, you have nurses, you have medical assistants. Then on the other hand, you have the administrative part of the practice, which is it starts from people that greet you when you come in, people that answer the phone and our team of coordinators. So we have all agreed and established protocols of not only medical protocols, but also administrative protocols and patient care protocols. So patients will always have a very similar experience in terms of uniform experience, in terms of high quality, a beautiful smile when they walk in, which is something that sounds trivial, but you go to other doctor's offices and you are not greeted with a smile.

Monique Ramsey (09:35):
It's crazy, isn't it? You go some places and you're like, what's happening?

Dr. Salazar (09:40):
Am I making you guys uncomfortable by being here? I'm so sorry. I don't want to bother.

Monique Ramsey (09:45):
Well, or even to bring yourself as a patient, and if you feel like there's something that you're embarrassed about or you want to change about yourself to have the courage to make that phone call, you want somebody who's nice on the other end of the line to have the courage to walk through the door because it is a little bit intimidating. But then you get into our office and it's not intimidating. Everybody, like you say, has a smile. Miriam at the front desk, all the nursing staff, the coordinators, everybody's so sweet and really helps you feel

Dr. Salazar (10:22):
At ease that you're at home.

Monique Ramsey (10:23):
Welcomed. Yeah, at home welcomed. And if you look through all the reviews, you see certain words over and over, I felt cared for. I felt like it was home. I felt like I was with family. And that's something that I think all six of you surgeons fully embrace.

Dr. Salazar (10:43):
Absolutely.

Monique Ramsey (10:45):
And the team around you embraces that too.

Dr. Salazar (10:48):
And that is part, I would say part of the uniform experience that everybody is going to get, having access to their clinical staff right away, making a phone call being answered that same either as you're making the phone call or in the next 10, 15 minutes requesting for an appointment and being able to be seen if not the same day, the following day. And we know how that even if you want to go and see your regular doctor has become practically impossible to, I mean, I have a problem. I want to be seen. And yeah, we have something right now is October something available in February for you? What do you prefer? A Tuesday or a Wednesday? And here with us is that patient experience is immediate, it's present. And everybody enjoy that, that come to our practice. The most important part is that you feel connected to your surgeon, that you feel that him or her have, I mean that they're understanding exactly where you want to go, and very importantly, if something goes wrong that you know he or she is going to be there for you and throughout the journey.

Monique Ramsey (11:57):
Now, another thing that I want to bring up is something about each of you has your own maybe lead nurse that you work with all the time. And we joke in the office that you guys kind of share the same brain, you know, get to know each other really well. They get to know your style, your technique, your foundations for care. And so tell me a little bit about the day-to-day and that partnership.

Dr. Salazar (12:26):
We have well established teams within the office, so it's very consistent. The fact that I work with a certain person since we, let's say spend the entire day together and exchanging information, seeing patients, evaluating patients before or after surgery, and we share exactly how things went in the operating room because it's not going to be the same nurse that you see in clinic that the one that's going to take care of you in the operating room, right? We have specialized nurses for the operating room in surgery. The information flows back and forward. So up to a certain point in which they know exactly how I react to certain things. It's invaluable for patients that they have, that we have that extension of the physician through the nurse in terms of evaluating pictures, answering questions, things come up in the recovery that you are not planning.

(13:28):
And then they can actually, I mean you as a patient, we're not planning, but then you have questions, oh, does this look normal? It's hurting a little bit over here. What should I do? And the doctor might be seeing other patients or the doctor might be operating. And it's important that that flow of information is constant. And let's say that I am operating and I'm in a case that it's going to take about five hours and I'm in the operating room and I'm operating. I cannot leave that patient. And let's say that a patient calls in because she might think that she has an infection. A nurse takes a look at the picture, and then the nurse identifies that as a potential infection and says, you know what? We need to evaluate you as soon as possible. And the patient says, okay, I can be there in an hour and I'm operating and I cannot leave that room for the next five hours.

(14:26):
The nurse evaluates the patient in the clinic and she says, you know what? Let me have a set of eyes of a board certified plastic surgeon. Dr. Salazar is locked in for the next five hours, but let's ask one of his colleagues, are you okay if Dr. Brahme or Dr. Swistun or Dr. Smoot or Dr. Briester, if they can come in and take a look? Patients would get that huge benefit and say, you know what? We might need to star you on antibiotics and you don't even have to wait for the next four or five hours for that to happen. And then we'll take some pictures. Dr. Salazar will evaluate you afterwards, and so on and so forth. If that's needed, I'm going to an extreme situation, but that's a benefit that you wouldn't have if you would be going or having surgery with a solo practitioner.

Monique Ramsey (15:17):
And to that point, what, how do you as a surgical team sort of approach after hours care or handle after hours concerns or even on the weekend?

Dr. Salazar (15:29):
That's also a very valid question. So what happens is if it's after hours, the patient calls the office, answering service, gets a hold of their doctor, and then we get connected and then we talk. And then this is the modern era. So if I need, I can ask patients to send me some pictures. We can connect through FaceTime if we need to. I mean, we have to do a Zoom or something right away for us to be able to take a look. We have of course, the keys to the office. So if it's three in the morning and I really need to come and see the patient, we'll meet here. I mean, we don't have to go through the ER or anything like that if the situation is not that alarming. But we can just see each other over here, evaluate, take the dressings down, make sure that everything's good. And even God forbids, you need to perform some surgery. You have the mechanism. We have our operating rooms quad, a accredited real deal operating rooms, and we always have an anesthesiologist on call and then we can perform surgery right away.

Monique Ramsey (16:36):
I think it's always good to think about, okay, if something goes wrong, what happens? 98% of the time things are not going to go wrong. But to me as a consumer, I'd want to be reassured that just in case what's going to happen, what does that look like? And even, let's say something came up and you happen to be on some wonderful wine tour in France.

Dr. Salazar (17:01):
There you go.

Monique Ramsey (17:02):
Dr. Salazar or at a Formula One race. What would happen if you're out of town and something needs to happen?

Dr. Salazar (17:10):
So normally, and here's what normally would happen with other plastic surgeons, solo plastic surgeon practices, what would normally happen is if the doctor is out of town for any reason, he will ask another doctor from another office to cover for him. And again, to the benefit of our patients, if we happen to be on vacation, if we have to go to a national meeting, if we hope to like a state meeting, and if we have to leave town, the patient will be taken care of, number one by the same office. All the nursing staff that she is familiar with or that he is familiar with are here the same medical chart, the same electronic medical record,

Monique Ramsey (17:57):
Yes. Just gonna say.

Dr. Salazar (17:57):
Right, all your information is here. Most likely the same anesthesiologist or one or two of the anesthesiologists already took care of you. And then you have, of course, if one of us is out of town, you have four to five other potential physicians that will be covering for the guy or the girl that's out of town. So then you will be very well taken care of.

Monique Ramsey (18:24):
And having that familiarity with the staff around the patient

Dr. Salazar (18:30):
Makes a big difference.

Monique Ramsey (18:30):
They're not going to be gone necessarily at the same time. And they can also help having that medical record and sharing it with the doctor who's covering.

Dr. Salazar (18:38):
So again, that care being delivered in a uniform standardized way, that's going to the benefit of all patients. And as you're saying, 99.5, 99.9% of the time, it's not needed. But if it's needed, it's there.

Monique Ramsey (18:58):
And I think also looking at how La Jolla Cosmetic Surgery Center has been around since 1988, so 37 years and counting. And what I see also, and I think this is so interesting, is that patients who might have been Dr. Lori Saltz's patient a long, long time ago, or Dr. Wheeler's patient or Dr. Rourke's, patient doctors who have been with our practice a long time, they retire and then they're like, oh, you know what? I'm ready for a facelift, or I'm ready for this or that. And they come back to La Jolla Cosmetic Surgery Center, not because of the doctor, because the doctor's not there anymore, but they know that the care and that infrastructure and that they're going to be taken care of in a safe way. And that the surgeons who we have on our staff, let's say the six of you, that you're vetted.

Dr. Salazar (20:00):
What you're saying is quite remarkable Because yes, I mean, there's a lot of tradition in this practice. I mean, it's a very prestigious place, and patients come back looking for, and they know that it's going to be a different surgeon, but they know exactly the quality of care that they're going to get.

Monique Ramsey (20:21):
Yeah, exactly. Well, I think on that note, I think we've covered all the benefits of a team approach and the underscoring sort of the philosophical and ethical framework that you all work within. And you're all such incredible people, and you're such incredible surgeons, and it's a pleasure to work with kind wonderful people that you're also proud of to show the results. You want to feel proud about where you work and what kind of results are coming out of that practice. And so having six under one roof, the benefits are so strong that knowledge sharing and helping each other out with different ideas and techniques and being able to cover each other with care of the patients. So for all the reasons that we talked about today, is there anything we left out?

Dr. Salazar (21:26):
No, I think we discussed it all. You, it's a very, very, very good atmosphere, and patients enjoy all those benefits. And I think we offer the best of both worlds, meaning we are a brand, but we are not a manufacturing, plastic surgery manufacturing company. And that's really important that if it's not a cookie cutter style plastic surgery, every patient's an individual, every patient has different needs, and we have different solutions, and we have six surgeons with minds of our own, in which in the sense of the practice does not impose of like, oh, no, no, you cannot use more than seven sutures per centimeter.

Monique Ramsey (22:15):
But, no, it could be.

Dr. Salazar (22:17):
That happens. That happens in branded places. That happens in other places in which, no, no, here, we don't do tummy tucks, we only do liposuction, and that's it. And you better take care of it with liposuction because, hey, but I know how to do tummy tuck. No, no, no, no. You cannot do that over here. So it happens. So I think that patients are never going to be having that problem over here. They're going to be fully evaluated by their physician, their certified plastic surgeon, have a unique plan and a plan that it's not going to be limited by certain manufacturing money making making company.

Monique Ramsey (22:55):
Right? Like you said at the very beginning, it's a patient centered practice. It's patient first and caring for that patient and what's best for him or her. So thank you Dr. Salazar, and for everybody listening out there, thanks for listening. And if you have questions about scheduling, about financing, I want to see before and afters. We've got tons of 'em every day. We're putting in new pictures, and we have even more pictures when you come for a consultation because some patients say, I don't want to be online. But I'm happy to share my before and afters in the consult room. So we're here for you and just let us know what you need and we'll be there to help. And thanks all for listening, and we'll see you on the next one. Bye

Dr. Salazar (23:44):
Bye. Thank you.

Announcer (23:48):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the Ximed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, theaxis.io.