Episode Transcript
[00:00:00] Speaker A: I think the issue in medicine in general here is how do I make money? Still do the right thing and not work your butt off. And you don't have time for your family, hobbies, friends, et cetera. We owned our buildings. That is number one, you got to own your real estate. And then also you have to make sure you have good contracts with insurances. And then the other thing I can say is you've got to delegate. You've got to have somebody who can help you. So you've got to have someone also with a good relationship who can tell you or stop or let me take over. Let me do this. You've gotta have some help.
[00:00:35] Speaker B: Welcome to skin deep. I'm Dr. Ana Chacon. And today we have a very special guest joining us. Get ready for some expert insights you won't want to miss. Tell the audience a little bit about yourself.
[00:00:47] Speaker A: I moved to Miami eight years ago because my ex husband and I moved around due to his job. So it's interesting, I did all of my training in Alabama at University of Alabama, Birmingham. And then I was 30, I was pregnant with my first child. I was just ready to get out and it was great. His first job was in Indiana. So I started practicing for the very first time there in Fort Wayne. We were there for five years, then we went to Richmond, Virginia, five years there, had a second child, and then we decided to move to Miami to follow his career again. And we planned to be here temporarily, but then we fell in love with it and I wasn't super happy with my first job.
And since we decided we're going to stay, that's when I opened sort of my own practice and joined my current partner. Actually, she joined, I joined her and then she joined my llc. But she, she's been here a long time. Mercedes Gonzalez. And now we're together and I love it. I do adult derm, she does pediatric.
[00:01:44] Speaker B: So you've been basically at a private practice since starting residency? I mean, since leaving residency.
[00:01:51] Speaker A: Yes, I've always been in private practice. And because we moved so much, I could never really start on my own.
I never really wanted to do that anyway. Since I had young kids, it was very convenient to join a current practice. And then with each of them, I eventually became partner. And both of those practices in Fort Wayne, Indiana and in Richmond, Virginia were incredible people. And I was just lucky. I worked for a year and became partner. And it was really an incredible opportunity. So you kind of get the best of both worlds. Sometimes you just want to go to work and go home you know, certain stages of your life, you don't want to make those administrative decisions, but then at some point you're like, I really would like to have a say in how things were done. And so then I was able to do that. And now she and I both make those decisions. I don't know if that's a good thing or not, but let me tell you, it's tough, but it's nice to be in control.
[00:02:40] Speaker B: I know. I told my staff that I never knew the hardest part of being a doctor would not be the patients. Actually, that's the best part.
It's the administration that's hard.
[00:02:54] Speaker A: It is.
[00:02:55] Speaker B: And how do you balance now having your own practice and home by the water?
There's a lot of work worth having kids and stuff.
[00:03:04] Speaker A: Well, I am part of an mso, which has been helpful because some of those things, hr things like that, are handled by them. And I would say that is helpful because I don't have all of that on my shoulders. And the other thing is I have a partner, so it's not just me.
I cannot imagine if it were just me for multiple reasons. I want to share the overhead. Clearly, financially it's good, but. But I need somebody to bounce things off of. Should we do this? Should we grow in this way? Should we spend money this way? Those are. It's really nice. So I, I, I really enjoy having help with that. Plus, she's an amazing person, which is also nice.
[00:03:39] Speaker B: Yeah, I know. I, I feel like I bounce off a lot of ideas. Off with you in Mercedes.
[00:03:45] Speaker A: Yeah. Which you're welcome to. I can't imagine doing it by yourself.
[00:03:48] Speaker B: Yeah, it's a lot. Do you feel like you stop working or how many days? I, I shouldn't, I, I'm just going to get jealous. But how many days a week?
[00:03:57] Speaker A: Let me tell you, I never wanted to work on Fridays. So I'm. From day one, I went into these practices saying, I will not work on Fridays. My number one priority was kids, and I started working with kids. I never was in a practice without children, so that was important to me. So I worked Monday through Thursday. Let me tell you, I worked my butt off for a while. I would see 50 to 60 patients on those four days.
And I was still trying to survive and support my husband as he grew his career. And then it just got easier and easier to say, okay, now I'm only going to work to two or whatever. So now I work when my kids are in school and I still don't work on Fridays. It's like my day now. It's like an admin day. I'm about to go sign charts and I'm going to take care of stuff. I'm still working. I'm not seeing patients. And of course, I've got other. Other jobs, too, which we can talk about.
[00:04:48] Speaker B: Yeah, no, that's awesome. I know. It's kind of having your own practice. Like, it's. It's a little bit weird because my accountant took two days off for Christmas. No, sorry. Two weeks off.
And then I also know somebody that he doesn't, you know, he's. Celebrates the Sabbath and doesn't touch his cell phone for, you know, two full days on. During the week. And I'm like, how do you do that? You are really not a doctor, because.
Impossible. It is impossible to do that. I mean, it would be impossible for me. They would think, you know, I got run over by a car or something like that. That's what my staff would think if I took those same steps. But right about the population of Miami compared to Alabama, because we don't have an easy patient population. We don't at all. You know, and I work in multiple states. How did you find that different and how did you adapt to it?
[00:05:43] Speaker A: I don't know. In my opinion, people are people. And, yeah, it is a little different here.
I think there's a. Maybe a little bit of entitlement, maybe, but for the most part, people are people. I don't really have a problem getting along with anyone. I feel like, you know, that this skin disease people have skin. Skin disease is the same. The issue for me is I don't speak Spanish. So I came here with this big goal of trying to do that, but clearly that was not a priority because people look at me, they speak English, and it just made it easy. I hire people that translate, and that's the hardest part of dealing with this population. And, you know, for the most part, I'm really happy, and I love my patients.
[00:06:21] Speaker B: I think it's been wonderful, awesome, awesome. And I believe you told me that you are fully booked or you're not accepting new patients.
[00:06:30] Speaker A: Yeah, I really only see new patients if it's family members or, you know, sometimes I do have a few slots, like one or two a week. You know, I really just want to take care of the people that I have, and I want to be available to those patients. And as you know, you can't plan when your rash is going to be. You know, we plan our cancer screenings, we follow up for certain conditions that we have. But when you have something you're worried about, a rash, a cancer, you know, you have to have those appointments available. I'm trying really hard to do that.
Also, you know about our space. We're building out a bigger space.
[00:07:03] Speaker B: Where?
[00:07:04] Speaker A: The Greenery Mall.
[00:07:05] Speaker B: Oh, I didn't moved in there yet. Or you are.
[00:07:09] Speaker A: We have not moved in there yet. This. Now that is the frustrating part about Miami, let me tell you.
Oh, my God.
But we'll be there soon. And when I have more space, I'll have more rooms. I will be able to accommodate more people.
[00:07:24] Speaker B: Yeah. I do regret not getting into that industry earlier because they're really reaping the profits, you know, like we're talking about with. Talking about people that just happen to become millionaires overnight and even have a degree with the construction industry here. Yeah. And it was pretty. I do have a space in Coral Gables, but. And people actually sometimes say it's too small, but you can't find anything else like it.
[00:07:53] Speaker A: No.
[00:07:53] Speaker B: Yeah. I have someone actively looking and every space that they find is not as good as mine.
[00:07:59] Speaker A: Yeah. I mean, and think we have to have a lot of parking. We're high volume. We need parking. And then I see so many Medicare patients. I need easy parking and my patients don't know how to download a parking app, you know, so that is the hardest part about this city.
[00:08:13] Speaker B: Tell the audience a little bit about what an MSO is and what's the benefit of partnering with that versus trying to do it the way I'm doing it, which is extremely, extremely hard.
[00:08:23] Speaker A: I'm not necessarily saying MSO is best. A management services organization is someone that helps you with sort of the back end stuff. This is how I see it. I don't know the definition. Okay, let me preface what I'm going to say with that. But I see it as a group that helps you with sort of the back end things so that you can practice. And that's what you get to focus on, is the patience, which is a true thing. But you have to pay them a certain percentage of what you bring in and then you have to decide whether or not that is worth it. And Almost always those MSOs have contracts with insurance companies that are much better than what you can get on your own. So that really is the largest advantage. But in the previous practices I was in, now they were in different states, which is very. Is the wild, wild west. Let me tell you. Either way, when you have partners, you still have other people to help you make these decisions.
I can't imagine what it would be like to just have one person. You are a machine, Anna. You have to be. Because to do it all on your own is very hard.
And it's overwhelming, I'm sure. But I just feel like in my personality and in my life and the other things that I wanted to pursue, like my other businesses and then I have children, I just did not want to take all of that on. Now some people love that I'm just not that person.
[00:09:42] Speaker B: I think it's just been difficult and I think our audience, at least the patients in Miami are shocked at how close some of these networks are. Like Medicare Advantage, I think has been closed. United has been closed for over five years. I don't know any doctors that can get into United.
We apply and we get a rejection. Usually the same day or the day after that their panels are full. And I think that's why it's important to have this podcast. So patients, when they make an appointment, they realize that it's not necessarily us that doesn't want to take their insurance. They don't want to take us on.
[00:10:20] Speaker A: Exactly. They don't understand that about. And that's a Florida thing right there.
[00:10:24] Speaker B: Yeah, I know. Because in Alaska they'll never do this. We've had patients walk out of our office after making an appointment, leaving their credit card and signing our cancellation policy because we're not in network and they don't realize we cannot be in network.
[00:10:40] Speaker A: Right. We've tried. They kick us out, don't they?
[00:10:43] Speaker B: They do.
Some people think it's the only way to work in South Florida. As a dermatologist, you either grind it out every day like I do and offer something unique like telehealth or availability or good pricing, good self pay pricing or great service. Or you join one of these monsters and get into networks that you otherwise would never been crisis of being on.
[00:11:10] Speaker A: Exactly. And there are disadvantages to both and advantages to both, of course.
[00:11:14] Speaker B: Right. Tell everybody about. I was curious about your line. It's a fashion. Is it sunscreen and fashion or.
[00:11:23] Speaker A: First. First of all it is sun protective and secondly, it's meant to be a little cute because let's face it.
[00:11:29] Speaker B: Yeah, it is.
[00:11:30] Speaker A: You're out on the boat, you don't want to wear your husband's ugly old fishing shirt to protect your skin. No, women want to do that. Right. We want to look fashionable, we want to look a little sexy, we want to feel good. And that's why I did it. I did it because I love the sun. I know I'm not supposed to Say that, but I'm super fair. I have had a battle with the sun all my life. But we moved to Miami. My oldest son is obsessed with fishing. My youngest son, all he wants to do is go on the jet ski and wakeboard. I mean, we're on the water all the time. We take the boat out just about every day, or at least three or four times a week. We are in the sun all the time. So there's this conundrum. What do I do? Right? I'm telling my patients to protect themselves. However, I'm out there all the time. But what I was doing is covering up with random sun protective shirts, pants, things that I could find with different companies. And there just wasn't a lot out there that made me feel good and make me look good. And so that's why I created it. So I can do all of these fun things that I love and. And still cover myself up and protect my skin, but look beautiful in the process.
That's what it's about.
[00:12:39] Speaker B: Your designs, they look very local, inspired.
[00:12:42] Speaker A: They are. They're all designed here in Florida. The designer is here.
My partner and I went to her and said, hey, we want vibrant colors. We want it to feel like Miami and Southern Florida and show us what you have. And she came back with all these fabulous ideas, and we picked the colors and. And then we said, hey, we want this crop top. We want it to zip. We want this to cover the belly. You know, the one we have that has the peplum bottom, we want this, that. And then she drew it out and she did it all. So we're working with a company called the Knotts Project that did all of that. You know, we have the crop there, which is the little wrap top, which goes over any bathing suit. We have swim shirts. We have swim tights. We have super cute shorts.
We have stuff now for men. But listen here, we are not a men's company. This is for women. The only reason we have men's stuff is because the women wanted their men to match.
[00:13:37] Speaker B: Oh, my goodness.
[00:13:39] Speaker A: We also have these adorable little girls bathing suits.
We did the bikini tops and the bikini bottoms because people want matching stuff, right? So they're like, wait, we need a bikini top to match this cute wrap.
And so that's what that is. Now, most of that is swimwear, right? So it's meant to get wet, so it cannot be loose. So all of it is fitted. And then we also have those loose cover ups. So for those that don't really want to wear really tight, fitted things, that's okay. We want to cater to all women, ages, sizes. We do have a little bit of skin care, but that skincare, as you know, is something that we as dermatologists can get and we private label it, but it is created by dermatologists.
However, we have our own proprietary sunscreen coming out. I'm so excited. It's coming out in about a month. We created it ourselves with a chemist. Wow, that's going to be hours.
[00:14:37] Speaker B: How was that process? Because I was quoted something very expensive. And of course, in the skincare industry, I feel like there's a lot of competition. You know, there's. Every celebrity wants to come out with the skincare line.
[00:14:51] Speaker A: Yes, yes. We specifically wanted sunscreen because you are right. Skincare, there's a lot of great companies and it's hard to create something that's better. There are things, of course, and as. As we read the research and anti aging, you know, things we know what could be better. But my passion is preventing skin cancer. It's just what I love. And so we wanted to do sunscreen. And I wanted sunscreen that everybody could use that I could slap on the face of my kids, that doesn't burn, that I could put on every day, that soaks in and doesn't leave you white. You know, it's not too goopy. It's not like diaper paste. You know, it's very important for our company in general for us to be sustainable. All the fabric is made of recycled bottles, but the bottles for the sunscreen is made up of bamboo and sugar cane. We have no chemical sunscreens. I don't like any of it. You know, we have the zinc, the titanium, that natural stuff right out of the dirt, modified to go on in a cosmetically elegant way. So, you know, that was my focus, was the sunscreen. So who knows if we'll end up doing skincare. Maybe, maybe not. Maybe we'll just support someone else, because that's not our passion right now.
[00:16:04] Speaker B: And how did you meet the designer and the chemist? Yes.
[00:16:08] Speaker A: So the designer literally fell out of the sky from God. I'm not even kidding you. Because we had. We had a wonderful designer initially, but she kind of had her own line and was really busy with that. We had someone else who is also a beautiful designer and seamstress, but we weren't in a place where we could really have the money to do it. And then finally we met this woman. I think we just literally googled fashion, seamstress, designer, and found her. And initially we didn't Want to pay the money, which was problem number one.
And we realized, you know what? This is not what we do. I'm a dermatologist. My partner is a psychologist. We've got to pay somebody who's worth it to do it. So we forked over the money, and it's been the best thing we've ever done.
And she's now, she's not only the designer, she is our opera, like we call her, our chief of operations. She everything for us.
Yeah, yeah. Helping us with the marketing team. She's helping us organize, helping us do do shows, trunk shows, things like that. So then it just grew from there. The chemist, we also, we just searched for.
Oh, I don't even know. Gosh, to be honest. You know, laboratories that made skincare and skincare products.
[00:17:27] Speaker B: Yeah.
[00:17:28] Speaker A: And we just made cold calls. Hey, this is what we want to do. This is what we want in our sunscreen. These are some examples of what we like and what we don't like about them. How could you change that?
And they helped us with the formulation. So it's just about cold calling, research. Just call, call, call, call. You'll find somebody who can help you.
[00:17:48] Speaker B: Looking back in your experience working in South Florida, what were some of the things that you liked and didn't like about your former and current practices?
[00:17:57] Speaker A: It all depends on where you are.
You know, I do only medical dermatology, which means I really have to accept insurance.
But then I also need to make a profit. And so I think the issue in medicine in general here is how do I make money?
Still do the right thing and not work your butt off, and you don't have time for your family, hobbies, friends, etc.
[00:18:22] Speaker B: Me.
[00:18:24] Speaker A: So I will help you with that. I can help you right now. You need to reach out to me. Let's work together.
But I feel like in each of the places, I learned something. For example, in Fort Wayne, we owned our buildings. That is, number one, you got to own your real estate because then you're paying yourself rent. There are tax advantages there.
Now, in Richmond, we did two. We owned one, then we rented some. We had four offices in Richmond. But that was something that I noticed was very important because it's a nice way to earn income. And, you know, obviously real estate appreciates.
And so that's something I've not been able to do here in Miami. So I'm still working on that. I do regret that I was not able to do that before. And then also, you have to make sure you have good contracts with insurances you know, there were times when I, you know, my old practice, I had to see almost 60 patients.
[00:19:22] Speaker B: Right.
[00:19:23] Speaker A: In order to.
Not even to make money, but to just cover the cost of myself because I was an employee. That's insane. That's not quality healthcare.
I was three hours behind because I like to talk to people. I like to ask, how was your vacation? How's your sick dog? How's your granddaughter? I talk to my patients. They are so important to me. And so I was behind, and so I can't run a factory. It's not going to happen. So then there's this happy medium of I want to spend time with my patients, but I've got to pay my staff.
I got to pay for college, you know, and anyway, so that's really something that I think is like a continued struggle. Right.
And then the other thing I can say is you've got to delegate. You've got to have somebody who can help you. My office manager, her name is Yani. We've worked together forever. She came to me when she found out I was opening my own practice, reached out to me, and I thought, oh, my God, of course I need you. And she is incredible.
She knows me so well at this point. But I can tell her one thing and she gets it done. She has helped me determine what to take off of my plate. And she'll come to me and say, no, no, no, that's a little micromanaging. Let me handle that. And then she does. So you've got to have someone also with a good relationship who can tell you no or stop, or let me take over. Let me do this. You've got to have some help. And so you've got to be willing to delegate and find that. That person or team.
[00:20:51] Speaker B: And I think people don't realize how hard it is, I think, to be profitable in medicine, because I was telling my staff the other day, did you ever think it was going to be this hard for me to get paid? They're shocked.
[00:21:03] Speaker A: Yeah, of course.
[00:21:04] Speaker B: Shocked because you spend. I mean, I could say that my education easily cost over a million dollars. Yeah. And so it's basically. It's been a journey that I've worked on, really a lifetime, including, you know, Carrollton, where I went to school, is unaffordable now. It's as much as Brown is.
[00:21:24] Speaker A: Yes.
[00:21:24] Speaker B: I'm not sure I would ever do that with my kids, to be quite honest. What my parents did, I'm not sure I can do it in the future. I'm not even sure I Can have kids right now with how busy my practice management operations are.
Right, Management. It's not necessarily that I'm seeing patients all the time. It's I'm managing a lot of stuff. And Brown University, one of the most expensive medical schools in the world, which eats up most of your years of fertility and youth.
[00:21:55] Speaker A: Right.
[00:21:58] Speaker B: You're bouncing all over the country. Because I couldn't get in here for residency. I was just in Los Angeles. I couldn't have been farther away, you know, and Miami has not been with all the non competes. When I left Cleveland Clinic, I had to get jobs usually in other states and do a lot of telehealth to be able to afford my medical office, which I do. Did you say that you own the place in the greenery? You guys do?
[00:22:26] Speaker A: No, we don't. We're leasing. We have a 10 year lease there.
So we are working on finding a place that we can purchase that is very high on our list right now.
[00:22:35] Speaker B: It's almost impossible what I did in Coral Gables and it's insane the value of it now because you know, you could get a very, very nice lease and a very, very nice even purchase at Sunset or Coral Gables or Merrick park or Ball harbor or Aventura. But with the assessments and the fees, those monthly fees, they're going to kill you.
[00:22:58] Speaker A: Yes.
[00:22:59] Speaker B: With these monthly fees. So having a standalone building is very difficult.
[00:23:04] Speaker A: Yeah.
[00:23:04] Speaker B: And then how about research? So you do research for another company. And that's another thing I'm starting to see a lot in medicine is okay. To all the research companies that are out there. You cannot get one single dermatology study without a board certified dermatologist. Absolutely airheading that study. You still can't put a nurse practitioner or a pa. They haven't taken that away from us. Okay.
[00:23:27] Speaker A: Thank God.
Yeah.
[00:23:28] Speaker B: That's the only thing left that they say for dermatology studies.
We no longer need a dermatologist, so.
[00:23:35] Speaker A: That's right.
[00:23:36] Speaker B: We still have that as something that can, you know, drive value to, you know, being a dermatologist. And some have been taken away from dermatologists. What would you have to say to dermatologists like myself that are. I've been doing research, I think for a little over a year now who don't know the management, operations or how to lead your own company or sometimes what falls behind this?
And you know, dermatologists get approached a lot. And another thing in South Florida is that there's fraud in research.
[00:24:10] Speaker A: Yes, there's a lot of that.
[00:24:12] Speaker B: Yeah, there's People that invent patients. How can you stay out of that? Or how can you know that this is a good company? In fact, we saw me and another dermatologist were approached by a company. I think it's in either Cutler Bay or Palmetto Bay, because I always confuse the two. And we saw the owner posting a video on TikTok with a Bentley, and we said, wow, if only we could come up with a company.
[00:24:39] Speaker A: Exactly.
[00:24:40] Speaker B: That does research. So people with Bentleys can't just use your title.
[00:24:45] Speaker A: Exactly.
[00:24:46] Speaker B: Because it's your liability.
[00:24:48] Speaker A: It is. It's all on you.
[00:24:50] Speaker B: So what do you have to say to those dermatologists that are being approached right and left by these companies?
[00:24:56] Speaker A: Well, I'll tell you. I've done research. I did it years ago, and then I didn't do it in my initial job here because, again, it was too much to handle. I literally wanted to go to work and come home. But since I've been on. On my own and with Mercy and I have a little more time because I'm not working as much with patients. You know, seeing patients, that's one of the things that I do on Fridays or in the afternoons. I joined a company, so I did not start my own, but my friends with Gastro Med, they started a company called Research Associates. They are GI doctors. And they started initially with those, and then they got other studies. They did some studies with rheumatologists because some of those diseases are linked. And then clearly, according, you know, just kind of thinking about diseases, you know, acne vulgaris, Crohn's disease, certain things like that. There was one study, I believe, of a biologic, and they needed a dermatologist. And I said, no, no, no, no, no. And finally they said, look, we will do the work for you. We just need you to see the patients. And I said, okay, fine, I'll do it. And when I realized I didn't have to do a lot of extra work, that's when I did it. I did it. So this goes back to find someone to help you.
I'm one person. I cannot see patients all day, run a company, you know, the new Bella Soul clothing company, deal with my children. You know, we have life as well, and there's only so much you can do. So I said, look, I'll do it if I don't have to do a lot of extra work.
So this company has an incredible CEO who runs it so smoothly, and she literally says, here's what you have to do, and I do it. I cannot take that on. I have too many plates in the air already. So that's why I did it. And it is the best thing ever because, you know, like, I do what value this brings to your practice. I have patients that don't have insurance or cannot get approved for certain medications and they're in these studies and now their skin disease is clear. It is so worth it, even for them now. Yes. You will make more money if it's your company. That is true. I'm not in it for money. I can't. I, you know, I need to sleep at night. I provide the service for my patients, you know, and it is a nice source of income on the side because medicine doesn't make the money it used to. People don't realize that that could be a whole nother podcast on its own.
So it's an extra, you know, an adjunct of income, but it's not a ton of money. But it's worth it to me. It's worth it because of a. It's contributing to research which, you know, evidence based medicine is the way we've got to, we got to stick with that because the way medicine's going now, lots of MPs pas doing things without SMDs, it's not as evidence based and they're not well trained in some cases. Right.
So that is why I wanted to stick with it so that I can contribute to research.
You know, we learn more every day and our patients are benefiting from it.
[00:27:44] Speaker B: Thank you, Kristen. I have to.
That's fine. I know.
[00:27:47] Speaker A: Go and look, if you want to do this again, I'm happy to. I think this is really fun and I'm so proud of you for doing this. This is super cool. So you go. I love it. Thanks.
[00:27:56] Speaker B: It's very informal and it's always great to catch up. And this is, you know, hopefully our audience gets something. I'm sure they'll learn a lot from this because it's more about the management and business minded side of medicine and we also have influencers and things like that. So, anyway, thank you so much.
[00:28:14] Speaker A: Good.
[00:28:15] Speaker B: Of course.
[00:28:16] Speaker A: Have a great day, babe.
