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Going Solo in Medicine: Interview with Dr. Klausner

“Follow your own piper, make your own beat, find your own rhythm.” – Dr. Klausner

Dr. Klausner is the founder and president of the Center for Cosmetic Surgery which is a facial plastic surgery practice in Naples, Florida. He is also a triple-Penn Alumnus, having studied undergraduate, med school, and residency at Penn*. As a medical student, he searched for a specialty that combined office practice with surgery. This led him to specialize in otolaryngology and facial plastic surgery. He first worked as an employee in a large, multi-specialty group practice in Illinois before considering opening his own clinic. Today, he is a “Top Doctor” owning and managing a successful, trustworthy practice for 20 years. Through this interview, the Penn Innovators in Business Network asked Dr. Klausner to share some of the lessons he learned through his path of establishing his own practice and transitioning from working for a multi-specialty clinic to his private clinic…

Walk us through your career path. From undergrad to where you are now, how did you navigate your journey? During your undergrad what extracurriculars do you believe helped you stand out on your medical school application (e.g. clubs, internships, research, scholars program, etc.)?

“My perspective on admissions is interesting as while in medical school I interviewed people for Penn Med. Then when I was a resident, I was involved in admissions for the residency program. I’ve seen the whole thing evolve from what competitive schools are looking for and there’s no real formula. People think there’s a formula. Instead we look for something applicants do consistently and have a certain amount of measurable time involved. We see a lot of people have long lists of activities. But when asked: ‘How many hours a week did you do this?’, there are a lot of activities they aren’t super involved with. We want people that can stick with it. It’s consistency; it’s devotion; it’s finding activities that you really like doing. For me the activity that I loved and might have been noticed by admissions was being in the Penn Glee club. I was able to be academically successful while rehearsing several days a week, regularly pulling serial all-nighters before shows, and travelling with the Glee Club many weekends.”

How did you decide to go into plastic surgery and otolaryngology (i.e. a specialty focused on medicine and surgery of the head, neck, ears, nose, and throat)?

“At first, I wanted to be a trauma surgeon. In high school I was an emergency medical technician (EMT). We would pick up people from accidents and then drop them off in the trauma bay. I wanted to be one of those guys that received the patient. When I did trauma rotations, my goals changed. The hours were unpredictable. 50% of patients that I dealt with never would come back for follow-up mostly for socioeconomic reasons. Thus, I started looking at specialties that dealt with all ages and combined office practice with surgery, and had long-term follow-up. I became interested in otolaryngology and facial plastic surgery. Plastic surgery is challenging but it’s rewarding. You can take someone with a defect on their face and put it back together and make it look nice, and make them happy. Or you can take someone who’s unhappy with something that they have and put it back together. I also can see all ages from newborns to people over a hundred years old. I still get called into the pediatric ICU to see newborn babies, and I have people over 100 years old coming into my office. So that’s how I ended up in facial plastic surgery. It was a combination of interesting office practice with a challenging surgical practice involving all ages.”

Why open your own medical practice? How should students navigate the challenges that come with starting a clinic? How do you recommend handling the business side of running a medical practice?

“Each specialty has a different avenue towards becoming an entrepreneur or an employee. My role models were independent entrepreneurs. They have their own practices. I wanted to be independent like them. The process is tumultuous and continues to morph. You have to negotiate one step at a time. It is just like climbing a mountain; things can change daily. In private practice you don’t have the financial resources that a large place like Penn or a big health facility has to take care of patients. You have to ask yourself: ‘Are you a super involved, detailed person? Do you mind working for yourself until two o’clock in the morning? Can you deal with everything from paper jams on printers to nosebleeds from a nose surgery to a wound dehiscence?’

My journey first started at a large, multi-specialty group practice in Illinois. I was an employee. As an employee, if you want to change the brand of Kleenex that you have your patients blowing their nose on, it becomes an unbelievable affair. These kinds of episodes made me want to be self-employed.

Being on your own starts with finding space, partnerships, and employees. You are an employer. You have to learn about employee tax, liability tax, health insurance, etc. Even after practicing for 20 years independently, it is challenging. I work seven days a week. That doesn’t mean we see patients seven days a week. Roughly 40 to 50 hours is spent on seeing patients and conducting surgeries. The other time is spent completing administrative tasks. The challenge is trying to create a work-life balance, as most entrepreneurs will tell you the work is never finished when you own your own business. Having your own business is good and bad. It taught me to be even tougher and more resilient.”

What are mistakes to avoid?

“You learn much more from your mistakes than you learn from your successes. One of the biggest mistakes was listening to people tell me you can’t do it. When I was coming out of training, there were ‘experts’ lecturing us at Penn and beyond that it is better to be employed. Relatives and other people were saying: ‘You can’t be independent’. Ultimately, you have to do what is right for you. The same thing is true for surgery. In this field, people make judgment calls. You learn business by listening and experiencing. However, you can’t be taught most of the stuff that you need to know. It’s true of medicine, perhaps more than anything. There’s so much information. There’s more information being added to the information pile every week today than the entire body of information I assimilated during medical school. As you go through medical school and residency training, what you really have to do is be an efficient information acquirer. You have to learn where to look, how to assess what’s meaningful and what’s meaningless. It is a continuous, lifelong journey.”

Are the profit margins higher when owning an independent practice compared to being employed?

“The profit margin isn’t necessarily higher when you’re out on your own. Some people can’t make the plane fly. It’s easy to lose money in practice if you’re not managing your supplies and if you don’t bill correctly. Also, unpredictable events can occur: you can get sued or have a catastrophic outcome. Revenue also depends on the specialty. If you’re a pediatrician, it’ll probably be easier if you’re employed because of the dynamics of what you can do in your office and what you can bill for because it’s not a procedure based specialty. You could only bill for an office visit, which doesn’t pay very much. No other industry in the world has its pricing fixed. Our pricing is fixed by the government and by the insurance companies. Most insurance companies pay you when you bill for something based on a percentage of Medicare. I think otolaryngology, which is a procedure-based specialty, is in a position to stay independent. However, profit margins are variable since the market continues to transform.”

There are a lot of celebrities who had plastic surgery and the outcomes make their face seem less natural. What were these results? Was it a miscommunication between a doctor and the patient? Was it an actual surgery? Or was it the actual desire of the patient?

“The answer is all of the above. But most of the celebrities that you see are driving their own self-image. Many that go to extremes may have a form of body dysmorphic disorder. I think part of that is driven by the psychology of being a celebrity. Those folks often bring me videos and photographs from public appearances. They see the imperfections and want to correct defects that they see in the filtered medium of cinema, TV, internet, or print. My job is to try to set realistic expectations. I always tell people I want your nose to work, and I want you to be able to breathe. If you get a facelift, I want you to be able to smile and swallow. If it’s so tight you can’t do natural expressions and you can’t swallow, what good is it? Aesthetics means ‘of form and of function’. Facial surgery is basically like being an architect. The trick to being a successful commercial architect is to be able to create space that’s livable but also aesthetically pleasing. This is similar to doing any facial surgery, whether it is cosmetic or reconstructive.”

*Specifically, Dr. Robert Klausner studied molecular biology as an undergraduate, then medical school at Penn Med, then internship at HUP before doing his residency in otolaryngology-head & neck surgery in the University of Pennsylvania Health System.

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