An MBA helps shape a successful plastic surgery practice for Ben H. Lee, MD, MBA

Going back to school to earn an advanced degree in business helped make Ben H. Lee, MD, MBA, a good businessman—and, interestingly enough, an even better plastic surgeon.

“In one of my first lectures in medical school, I was made aware of the fact that the average life expectancy in the United States rose dramatically after the industrial revolution because of improving economic conditions, not because of anything doctors did. I realized that I could have a broader impact on society as a businessperson-physician. I decided at that time that an MBA would be the most practical avenue for me,” says Lee in explaining why he did it.

Lee, who practices in Englewood, Colo, obtained his business education from the University of Colorado soon after completing his plastic surgery residency. An important lesson he learned at business school was that change is to be expected because change is constantly occurring—in the market as a whole, within individual organizations, and among the people who make up both.
Says Lee, “They teach you that if you don’t change in response to change, your business dies.”

Cognizant of that simple formulation, Lee structured his practice to be organizationally nimble. For example, much of the day-to-day decision-making originates in the trenches rather than from on high.

“My employees have the authority to do whatever needs to be done around here,” he says. “They’re empowered to address problems on their own, and they do so with the confidence that I’ll back them up and support their decisions. But this isn’t a situation where everyone is off doing their own thing. Built into the culture of this practice is the concept of teamwork. They achieve that by regularly meeting as a group, informing each other about needs and issues that have to be looked at. As an illustration, we’re experiencing tremendous practice growth, and it’s been hard to keep up with the workload, so I was considering hiring an additional employee. However, without me directing them to do so, my staff decided to meet and explore possible solutions that would bring about increased productivity and avoid having to hire anyone extra. I wasn’t even aware that they’d taken that initiative until they told me about it afterward.”

So dedicated are Lee’s empowered employees that, at the close of many a day, he finds himself practically pleading with them to quit working and go home.

Efficiency Minded

Clearly, obtaining that MBA was a good move for Lee. Among other things, he learned how to find ways to eliminate time-eating and effort-wasting activities from his practice. Consider as just one example what he’s accomplished with TRAM flap breast reconstruction cases. Instead of the 4, 5, or 6 hours it typically takes to complete these, Lee is in and out of the operating room after 21¼2 hours. And with the time savings resulting from this surgical efficiency, Lee can accommodate a much heftier caseload.

“This month alone, I’ve got bookings for 50 major cases,” says Lee, a solo practitioner supported by a staff of a mere three employees.

The efficiencies that permit so lean a practice to handle so much work came about after Lee analyzed his own workflow during surgery and uncovered opportunities to refine various processes.

“My starting point was the charting of all the junctures where delays in surgery were apt to occur,” he says. “I identified the factors—including people—responsible for causing or contributing to those delays. From there, I redesigned my workflow to allow me to be more productive.”

Over time, Lee has learned that achieving efficiency requires taking actions that might at first blush appear counterproductive. For example, if the personnel whose job it is to prepare the operating room between surgeries aren’t able to immediately perform their cleanup chores, Lee never hesitates to grab a mop and get the room turned around himself.

“I don’t look at that kind of thing as be­neath me,” he says. “I have a vested interest in moving my cases forward, so I’ll do whatever’s necessary to ensure that they can.” For Lee, efficiency of surgery doesn’t mean galloping through a procedure.

“It means only that I’m not wasting time and effort, not that I’m performing the surgery itself at a faster pace,” he clarifies. “That’s an important distinction, because a goal of mine in breast reconstruction is to have the one side look exactly like the other—and that demands moving at a careful pace, no rushing." Patients, of course, benefit from Lee’s surgical efficiencies by having their time under anesthesia appreciably shortened.

Flying High

Although Lee is in practice by himself, he nevertheless shares a luxurious 4,000-sq-ft office (featuring fully equipped aesthetic skin-care facilities, state-of-the-art exam rooms, and a certified on-site operating room) with renowned plastic surgeon David Knize, MD. “It’s a genuine honor for me to be in the same offices with Dr Knize,” says Lee.

Lee provides services across a sizable swath of geography in and around the Mile High City, thanks to having privileges at several hospitals (Rose-Health One and Porter Adventist in Denver; Aurora South Hospital in Aurora, Colo; Skyridge Hospital in Lone Tree, Colo; and Littleton Adventist in Littleton, Colo). His closest hospital is Swedish-Health One in Englewood. Ser­vices include facelifts, brow lifts, blepharoplasty, rhinoplasty, mentoplasty, otoplasty, Botulinum Toxin Type A, breast lift, breast augmentation, breast reduction, breast reconstruction, abdominoplasty, liposuction, arm lift, buttock implants, body lift, laser surgery, and medical skin care.

His practice is dominated by cosmetic cases, the reverse of the situation just 1 year ago when reconstructive work was his mainstay. Despite the turn his practice has taken, Lee is one of the area’s few plastic surgeons who are still accepting Medicare and Medicaid patients.

“My business model has been and remains the open-door policy—take all comers. That’s how you build volume,” he says.

To be precise, the business model Lee uses is patterned after that of high-flying Southwest Airlines. One of the distinctive elements of the Southwest Airlines model is its requirement of putting employees first, ahead even of customers.

“Southwest Airlines understands that if you hire the right people, train them well, and treat them well, they’ll turn around and treat the customers well,” Lee explains.

This model stands in stark contrast to the much-better-known and widely lauded approach taken by the Nordstrom department store chain, he adds.

“Business gurus often point to Nordstrom as the textbook example of ultimate customer service. They love to tell the story of how, in one instance, Nordstrom took over a former Sears Roebuck location where an elderly woman—unaware of the change—came in to return a set of tires she’d bought at that Sears some time earlier. Nordstrom graciously took back the product and gave the woman a full refund, even though it wasn’t Nordstrom’s responsibility to do so. That’s truly excellent customer service, obviously, but if you look at what’s happening out there today, you see Nordstrom being clobbered financially—in part because of that kind of customer-service strategy.”

As evidence that his business model works, Lee offers that 90% of the prospective patients who drop by for an initial consultation decide to go to surgery with him.

“I’m the one who’s responsible for closing the sale, but it’s my employees who work hard at facilitating it by interacting with the prospective patients and helping them through the process,” he says. Notably, none of Lee’s employees function in the role of patient coordinator.

“I’ve eliminated that position from my organization. I want the new patient to deal directly with me. I feel that’s central to developing the person’s trust.” Patients like utilizing Lee for many reasons, one of which is his accessibility.

“I freely give out my home phone and cell numbers to patients and other surgeons. I don’t try to hide from calls.”

He Took the Long Road Home

Lee’s office is located in the Cherry Hills district of Englewood. Cherry Hills ranks near the top of the list of the nation’s most affluent communities and is a scant 2 miles from the home where Colorado-native Lee spent his entire childhood.

“Like Jimmy Stewart in ‘It’s A Wonderful Life,’ I thought I was going to leave home to bigger and better things, but somehow I wound up back in the same place I started.” Lee says a career in medicine was preordained for him by dint of his Asian ancestry.

“In Asian families, having a child grow up to become a doctor is a really big deal,” says Lee, whose immigrant parents perhaps would have flipped out had he instead opted to become a car builder or metal fabricator, two of his favorite pastimes today. “My parents insisted I become a doctor, and that’s all there was to it.”

The University of Colorado at Boulder conferred an undergraduate degree in molecular and cell biology upon Lee in 1986. From there, he attended the University of Colorado at Denver’s School of Medicine and went on to receive his MD with highest honors. Following a surgical internship at the University of California, San Francisco, he trained in head-and-neck surgery as an otolaryngology resident at Duke University Medical Center in Durham, NC. It was there that he first developed an interest in plastic surgery. Afterward, he undertook formal training at Duke in plastic and reconstructive surgery, then trained in hand and microsurgery at the Kleinert Institute of Hand and Microsurgery in Louisville, Ky.

Weighing his options, Lee decided at that point to enter private practice. He considered setting up shop in the South, but his wife pushed for Denver. Her wishes prevailed, and he opened his practice there in 1998. A short time later, Lee teamed with another plastic surgeon in a shared-office arrangement that continued until September 2004.

They Are Not Expendable

Lee hints that he might like to write a book one day for physicians that would spell out everything they need to know about running a business.

“It’ll be a very thin book,” he jests, “because, basically, everything you need to know about business was already taught to you in kindergarten: Be nice to the other kids, and share your toys. That’s really what business school education comes down to. But if you do those things—treat people well and look for ways to cooperate with others—you’ll be on the right path for success and greatness.

“I went to business school to learn more about balance sheets, cash-flow analysis, and the like. And while I did learn a lot of metrics, the most important things taught were those things I already knew intuitively or from everyday routine experiences.”

The chief misconception held by physicians with regard to business is the notion that employees are expendable. In Lee’s view, they’re anything but.

“Employees are your most valuable asset. Unfortunately, most practitioners don’t see them in that light. Think about it. You wouldn’t let anyone take a baseball bat to your $150,000 laser. You’d get pretty mad if anyone even so much as tried. And yet, if someone screams at your employee—hitting that employee with a figurative baseball bat—you’ll see that as no big deal, even though that employee contributes more to the success of your practice than the laser ever will.

“Plastic surgeons need to start seeing their employees as the very heart of the practice, as money-makers for it. As such, employees need to be treated very well.” Another misconception: The assumption that “going with the flow” is the safest course for a private practitioner.

“Many plastic surgeons are striving to convert their practices to 100% cosmetic, but there’s risk in that,” Lee cautions. “Sometimes when you follow the crowd, especially on something like this, you can be led right over a cliff.

“After 9/11, my cosmetic volume dropped significantly. The only reason I did OK during that time was that I’d hung onto a lot of insurance work, even though my practice was becoming more and more cosmetic-oriented. But the plastic surgeons who followed the crowd and had little or no insurance business found themselves struggling.”

Of course, Lee is no stranger to financial pain. When he separated from the plastic surgeon with whom he first shared office space, he was obliged to walk away from a skin-care ancillary the two had started—a venture pulling in $400,000 a year by the time they parted company. Lee, however, has since launched a similar ancillary of his own.

Now, Lee is in the process of enlarging the space that houses his in-office operating room. Upon completion of construction, he’ll end up with a roughly 5,000-sq-ft facility. Glancing at the future, Lee confesses he cannot predict the shape of his fast-growing practice 5 years hence.

“All I know is that 5 years from now, things will have changed from where they are right now. That’s inevitable.”

Rest assured, though, that Lee will be prepared for change, ready to react and make the most of whatever may come. That, too, is inevitable. n

Rich Smith is a contributing writer for Plastic Surgery Products.