Eva: Okay. So I'm here with Jeanine DiGennaro and Richard Reish from Long Island Plastic Surgery Group. And what city is that in?


Dr. Reish: Well, we have nine different offices.


Eva: You have nine offices. All on Long Island?


Jeanine: Eight.


Dr. Reish: Eight.


Jeanine: Currently eight.


Dr. Reish: Eight different offices.


Eva: Are you trying to grow faster?


Dr. Reish: And six of them are in Long Island. We have a very nice office in Park Avenue in Manhattan on the Upper East Side and we have an office in Brooklyn as well.


Eva: That's a lot to manage. And so do you go to more than one office?


Dr. Reish: For myself, I just predominantly spend most of my time in our Park Avenue office in Manhattan and then I go once a week or once every two weeks to our Garden City office in Long Island.


Eva: So on Park Avenue, is it like the size of a closet?


Dr. Reish: No. Actually, we have a very nice office. They really designed it well to maximize space efficiency. It's really a beautiful office and it has its own operating room. It's a quad A certified operating center. That means it meets the highest safety standards for the entire country and we see a lot of patients in that office, and do a lot of surgery there as well.


Eva: If you had to sum up how you want the office itself to make people feel, what word would you use?


Dr. Reish: Welcome.


Eva: Welcome.


Dr. Reish: Yeah. We like patients to feel like they're getting individualized treatment and that when they come in, they're not just a number, that although it may be busy, I really try to make every single patient feel like they're our only patient at that moment. And when they come in, they know... From my perspective, all my patients get my personal cellphone number. They text me, they call me, weekends, night times, holidays, it doesn't matter. It's really a full 365-day year job for me.


Eva: And I think it's also a brand decision to be that way. And it's a challenge and a commitment to extend that through all the providers in all the locations. So Jeanine, you're the marketing director, how have you thought about doing that and enabling your team to be able to do that well?


Jeanine: Well, Dr. Reish is incredible. I feel like he came on board and really, really marketed himself in a way I've never seen before. So I think that it's an anomaly.


Eva: It's easy and it's natural for him.


Jeanine: It's very natural for him. I don't think it comes naturally to everyone. I think that surgeons are specialized in what they do and the fact that somebody could be such a talented amazing surgeon and also have the capability to market themselves is pretty incredible.


Eva: Definitely a unicorn.


Jeanine: Yeah.


Dr. Reish: I'll tell you, it was interesting. When I first started off in practice, mentors, other people told me, "Do not give patients your cellphone number. Whatever you do, do not give them your cellphone number. You're crazy if you're gonna give them your cellphone number. They're gonna bother you, they're gonna call you, they're gonna text you. It's gonna ruin your life and there's no point to it. And you're making a terrible decision." And, you know, I just... I don't know. For me, it wasn't even a... I didn't even think twice about it. It's just natural. It's just, I don't want someone on the weekend or in the middle of the night to have a problem and have to call the person on call or call a nurse, or God forbid, go to an emergency room without speaking to me.


Eva: Has anyone ever had unrealistic expectations of you because you've given them your phone number?


Dr. Reish: Shockingly, not really. That's what... And a lot of people are surprised to hear that. I get some patients that'll, you know, text me several hundred times over the course of a month, but it doesn't really bother me that much at all. Usually, patients are pretty good about not calling me in the middle of the night unless they have a serious problem. And then when they do, I'm happy that they have my number because we've saved a lot of patients a lot of time and problems by just having them be able to get in touch with me very quickly. They can... If they're having a problem, I'll just say, "Send me a picture." They can send me a picture and immediately we have an answer instead of waiting, and waiting, and waiting.


Eva: Do you rely on Siri or do you do everything with your thumbs?


Dr. Reish: No, I do it all with my thumbs. So...


Eva: My hands hurt. I was curious if yours do too. I keep trying, but she's just not that smart. Okay. So Jeanine, how long have you been working with this practice?


Jeanine: So I started at Long Island Plastic Surgical Group about eight and a half years ago.


Eva: And it's the largest practice in America. Is it the largest practice in the world?


Jeanine: It is the largest longest running private academic plastic surgical practice in the U.S., perhaps in the world.


Dr. Reish: It is.


Jeanine: And yeah, you ask if anyone else comes close. Not to my knowledge.


Eva: No.


Jeanine: Not to my knowledge. It's a very unique organization.


Eva: Yeah. It's hard. So it's admirable that you have the size you do and are able to stay as organized as you are, and market yourself so well. I'm curious what the size... like, what kinds of challenges the size has compared to solo or small groups that people just would never know unless they were on the inside?


Jeanine: Sure. I think for us it's communication. I think the larger that we get, the harder it is to keep everybody looped in and communicating. And it's something we're always working on.


Eva: What kind of tools do you use?


Jeanine: Well, internally, we have a lot of meetings. I think, you know, something I've always said is marketing isn't what makes a practice successful and it's really marketing working in tandem with the surgeons, with the reception team, the phone room, the coordinators, making it a cohesive experience for the patient. So we do a lot of meetings often to make sure we're all on the same page and we will change our process as needed when we start to see that things are slipping or falling.


Dr. Reish: Yeah. I always think Jeanine has an incredibly difficult job.


Jeanine: Thank you Dr. Reish.


Eva: She does.


Dr. Reish: Because normally a marketing person, they're working with a solo practitioner, one or two physicians, two surgeons and it's pretty easy to find the middle ground there. When we have 22 surgeons, each of whom has their own idea often about certain things it is very difficult balancing act that Jeanine is placed in.


Eva: Is she empowered to lay down the law and say, "This is how we're gonna do it?"


Dr. Reish: Well, yeah, I mean she's very skilled at it. Jeanine has a way of guiding people into a certain direction without being overbearing or, you know, it's a very political way that she does it.


Jeanine: Thank you. I think what I've learned... I appreciate that. I think what I've learned is I always hear everybody out. I always respectfully listen and I know that doctors are scientists, right? So in the end, they really respond to data. So if I'm presenting something, I'm gonna back it up and most of the time, I get to move forward with what I present. Every now and then I'll be told, "No, we don't actually think that that's a good strategy or a good use of our time and money." I mean, when I first started, I had a physician who wanted us to invest in the yellow pages.


Dr. Reish: I was just gonna say that.


Jeanine: And Dr. Reish, it went against everything I felt as a marketer. So...


Eva: What year was this?


Jeanine: It was 2010.


Dr. Reish: I've heard that same person say that more recently than 2010.


Jeanine: So do you know what I did? I tapped into my friends. I come from media. So I started working in national media. I worked for "Rolling Stone" with "Open" magazine, "Condé Nast Traveler," and I worked as sales support. So when, you know, we would pitch to Sony or Levi's, I put the data together to help the salesperson make the pitch. So I called up my friends in the media industry and I said, "Can you please run some MRI numbers for me?" Which is a national survey and "I wanna see over the past six years, the readership and usage of the yellow pages." And it was a decline. And that was what I had presented that this is a medium that is falling. And for that reason, I wouldn't advise proceeding and that was the end.


Eva: It wasn't just the data. It was actually the source of the data that made that so compelling. So it was a double whammy of supporting your opinion. It was really smart.


Dr. Reish: I completely agree.


Eva: So what is your source of truth for data these days? What tools do you use or tool?


Jeanine: So it's interesting. I think for data, what speaks volumes, we pay very close attention to patient flow. We have eight locations. There's overhead going into every location and we wanna make sure that we're achieving the goals that we set, and we do meet monthly the management, and we review patient flow to different areas of business to different locations. And we adjust our strategy accordingly. In terms of tools, I'm always looking at Google Analytics too. I feel like the health of our website really backs up how well we're marketing in general and I'm always paying attention to web increase, where they're coming from. We wanna make sure too that when the traffic is increasing, the conversions are also increasing because it's great to get people to your site, but you wanna get them to pick up the phone or submit an email. So... And I do review that data monthly with our digital team.


Eva: Have you ever noticed how much time it takes between something you see in the website data and the effect it has on the real life behavior of the people coming in? Does that make sense? Is there, like... My impression was always that, like, we get this big spike of traffic in January, but the patients don't actually show up until February or March.


Jeanine: That's interesting. To be...


Eva: So it was always trailing by a month or two.


Jeanine: To be honest with you, I never overlaid our traffic with our patient flow. I can't honestly say that I've done that. I know that the website itself is monstrous. It's been in place for so long. It has a lot of credibility with Google, but I haven't... That's an interesting question. I can't answer it.


Eva: We should write a paper. Let's figure that out.


Jeanine: We should. I'm gonna do that when I get home.


Eva: Okay. So you have 20, about to be 22 doctors.


Jeanine: Correct.


Eva: How do you... I mean, I would love to hear from both of you on this. You're younger and newer to the group, and you're trying to herd the cats. How do you manage egos and disagreements when they come up?


Dr. Reish: I think the nice part about our practice is that it's been in place so long, it's so well established. There is no one boss. There is no surgeon that says, "I'm gonna tell you, other doctors, what to do and I'm the boss." And this and that. You know, we are governed by a board. And so everything has to be looked at as what's best for the group, what's going to be the best decision that's going to have the greatest impact in a positive manner in our group and not necessarily only for individuals. And sometimes that can, yes, create some problems. But I think for the most part, it's shocking how well we all get along and how well it's run.


Eva: And in spite of that, you market yourself, you do a lot of marketing on your own because you like to do it on Instagram and on RealSelf. Is there anywhere else that you use or is it just those two?


Dr. Reish: The ASPS Match website as well.


Eva: The Match website. Does that ever create any conflict or is everybody okay with you just being out there and doing your own thing?


Dr. Reish: I do my own thing. I just always think of it as, I don't... If someone is gonna get mad or jealous of what I'm doing, it's probably because they're not doing that well themselves. And so I don't really let it affect me at all. I'm sure.... Yes, I mean, I'm very busy in our practice. I'm sure there's some people that are probably not that thrilled about that, but it doesn't bother me at all.


Eva: What are some learnings you've had from that work that you've been able to share with the rest of them to actually help them grow?


Dr. Reish: It's interesting, we've given several talks on the topic. It's all about commitment. There's no secrets. You just have to work hard and I've created a formula and a model that works extremely well for me. I'm able to through RealSelf, through Instagram get patients to come in from not just New York area, but all over the country, all over the world. So we'll have patients that literally on a Saturday in like, Park Avenue office when I'm seeing patients, coming from multiple different countries that... just for that Saturday. And what I try to tell people is if you market yourself the right way, you increase your net, the zone where you can catch patients from. And when I first started in the group and I think probably still to this day, a lot of people don't believe and a lot of people are on the outside of that. Other physicians don't believe that. They think, "Oh, he's stealing my patients." You know, and I just... I look at where these patients are coming from and I just sort of laugh on the inside because I know that that's just not true. When I have patients coming from the West Coast of the country, from, you know, New Zealand for a rhinoplasty, it's really remarkable what sort of social media, what RealSelf has created and that we can get patients from any part of the world. But it's no secret how you do it. It's just hard work.


Eva: We know.


Dr. Reish: Every single day I do this. So my...


Eva: There is not a scarcity of interest. There's a scarcity of confidence.


Dr. Reish: It's very true and there's a scarcity of dedication as well because I give talks on this all the time and I tell people exactly what I do. It's no secret. I just.... every single day, I'm on RealSelf.


Jeanine: But it's a change to the mindset. It's something you have to take into consideration as you're moving through your day and, you know, I think for some of our younger physicians, it's easier to do. But I think for some of the older physicians who aren't active on social media platforms, it's harder.


Dr. Reish: It can be hard for them, but if you want to, you can still do it.


Eva: So give me a day in the life of you, the marketing you.


Dr. Reish: Yeah, yeah. I'll tell you exactly how I do it. So...


Eva: You can throw the surgery part in there too, but I'm really interested in how you make this happen on a tactical level.


Dr. Reish: That's what a lot of people ask me and they say, "Is it you or do you have people doing this for you?" No, it's all me. What I do is this is, every morning I get up very early. So my surgeries all start at 7 a.m. So I'll get up probably around 4:30 or 4:00 and I'll get to the office or the hospital early. I get there super early and I will immediately.... I bring my laptop everywhere. So automatically, anywhere I go I'm on my laptop. I'm organizing pictures for before and after pictures or for insurance cases, I organize pictures. And I have this down to such a science that at 7:10 every morning, an email goes out from RealSelf. It has questions, it has about 40 questions that I can start answering for the day. That's my goal. Every day, I wanna answer all those questions and so, from about 7:10 to 7:22 in the morning for those 12 minutes, I'll be on RealSelf because I get there so early that I... my cases usually start at 7 a.m. So at 6:30, I start to mark the patient. I have the patient all marked and ready to go, then the patient goes in the operating room at 7 a.m. At 7:22 is usually when they need me. So I have those 12 minutes. And then every single time in between every case, I'm on my laptop answering questions, or responding to emails, or having conference calls, or doing all sorts of things. And it's all about maximizing time efficiency.


One thing that I recently started doing, I just realized I'm so busy at this point and have so much going on that I don't really have time to drive. So I take Ubers everywhere and I'll take an Uber, and it can save me all the time in the world because then when I'm in the Uber, I'm working on my laptop. I have a mobile hotspot that our IT department got me and I'll just Uber around everywhere, and just work while in Uber.


Eva: Like "The Lincoln Lawyer," Dr. Reish.


Dr. Reish: But that was the problem is I said, "How do I create more time in the day?" And you just have to create the time somehow and then it allows you, you know, to go home and be a normal person instead of, you know, immediately going home and having to do work all the time. So creating more time efficiency in your day can go a long way.


Jeanine: I have a question for Dr. Reish. Do you sleep?


Eva: Yeah. What time do you go to bed?


Dr. Reish: I try... One thing I'm actually very serious about is getting enough rest every night because I think it's so important that I'm well-rested for surgeries. I will see patients or operate six days a week. So I do it on Saturdays too and the big cases all the time. And so, you really need to be well-rested and that goes a long way in that I actually do get a lot of sleep. I don't take emergency room calls anymore which I used to. So then it does afford me the chance to sleep.


Jeanine: So what time do you go to sleep at night?


Dr. Reish: It's earlier than you think.


Jeanine: Really?


Dr. Reish: I usually try to get to sleep by like, 11 or so. You know, it's not too bad. I used to stay up much later, but I really make an effort to get a lot of sleep, be well-rested, be energized for the morning. And I have very strict rules about another thing. I don't drink alcohol during the week. I just really wanna be in good shape for surgery because it's someone's... I mean, this is serious stuff that we do. It's someone's life, it's someone's whole dreams on the table in front of you, every single case. And when you do a lot of cases, sometimes people can forget that. But I try to always remember that for every single case I go into.


Eva: We teach at RealSelf that if you want to see your brand reflected back to you, you just read your reviews and see. If my brand is being welcoming, friendly, accessible to my patients, and that doesn't show up in your reviews, then you have work to do. And what I saw in your reviews when I read them was that they weren't just positive, they were over the top with compliments about the way that you interact with your patients and care for them.


Dr. Reish: Oh, thank you.


Eva: And so I don't wanna be depressing with this question. But do you think you're gonna be able to keep this energy level up forever?


Jeanine: I just... I love it. I went on vacation recently and I was gone for a week. And I was telling the resident in surgery with me Monday morning when I came back that I missed it so much. We were opening a nose and I just, I missed it and I couldn't wait to get back. And I just...  I think that's just not gonna change, you know. There's not a day that goes by that I don't say, "Oh, God, I can't believe I have to text all these patients in the morning. Why did I give them my cell..." I love it. I love making my patients, you know, feel that they're well cared for and nothing makes me happier to be honest with you, when I read those reviews and I do see what people write. It's very rewarding, but nothing makes me happier than when I see when they mention my staff by name too. I'm so proud of our... We have some wonderful nurses. I have a very amazing PA who works with me exclusively and her name is Rachel. All my patients know her and she's just outstanding, and really has taken on that same sort of, you know, caring that I do for our patients.


Eva: So, Instagram. So you just got married.


Dr. Reish: Yes.


Eva: And I noticed that you posted quite a few photos of your wife on Instagram, and that she's tagged. And then you can actually go look at her Instagram. And as soon as I see that, I feel a little bit vulnerable on your behalf. And so I wonder if you've thought about how much of your personal life you're willing to share. It seems like more than most that I look at. And what's your philosophy going to be there around that?


Dr. Reish: Yeah. I love it. I'm selective in what I post and I like to have a nice balance between work and personal where I've been shocked, my patients love it when I post personal things.


Jeanine: I was gonna say, you probably get more likes on your personal photos than your clinical photos.


Dr. Reish: I do, I do. And it's just shocking because patients, they want to get to know you, they want to know your family, they wanna know what you do outside of work. And that's been the most surprising thing to me of all. They love it when I post pictures of my wedding and my wife, or my honeymoon. Now, I'm not one of these people that's, you know, ever going to... You're not gonna see me posting a video, you know, drinking in a club or dancing, and making a rap video in the operating room, or something like that. It's just not my personality or, you know, I think some people go overboard with it and they're a little too cavalier on their Instagram pages. And I think that's a mistake. I think you want... Every time you, you know, you sort of post something, you should ask yourself, "Do you want your patient who you're gonna be operating on Monday morning seeing this?" And I think some people should ask themselves that before they post.


Eva: There was a surgeon really early in my career, I think it must have been around 2005 that was a lot younger, who I took out for a drink and we ended up staying out until 2:00 in the morning and drinking all the way through, and he had a case at 7 a.m. And I was so, like, offended to the core for the patient who was supposed to be in his care.


Dr. Reish: I've seen that before with some surgeons unfortunately and I couldn't agree more with you. We have such a duty to our patients to be well-rested, to be at our peak level of performance every single case. And so I think you just really have to be careful about that and also, quite frankly about what you show and post on Instagram. I always, whenever I talk about this and I'm giving advice to other particularly younger surgeons, I always tell them, you know, "Just don't post anything with alcohol in it." If you're having a casual drink with colleagues, partners from work... And we go out when we have dinner, I always actually tell everyone to put, you know, if you're having a glass of wine or something, put it down for a picture. There's no reason for that to be on your social media page and I think people just have to be very cautious about what they're doing. I see people, I'm sure Jeanine has seen it too where I am literally shocked and appalled at what they put on their Instagram page where they'll be in a surgery with the patient asleep and taking off, let's just say it's a tummy tuck, taking off a big piece of tissue and throwing it to each other across the room or dancing to a rap video. And I just think why on earth would you number one, do that, why would you post about it. It's really shocking and embarrassing.


Jeanine: I think if you have any hesitation too just as, you know.


Eva: Should I be posting this?


Jeanine: Yeah. Then you probably shouldn't.


Eva: I have a folder on my computer called The Hall of Shame where over the years, I've collected all these bad examples and excised tissue is one of my most popular entries in The Hall of Shame because patients don't understand that, then they feel disrespected by it. So Jeanine, you were here this morning talking about Instagram on a panel with several other really smart people and I'm curious what kinds of questions were asked by the audience in the Instagram... You were talking about Instagram. So tell us more about that from this morning.


Jeanine: Sure. Well, it was a great panel. It was Dr. Heather Furnas, Dr. Paco Canales, and Dr. Karen Horton. And unfortunately, we all went a little bit over with our presentations so we couldn't field too many questions. But we definitely... One of the ending questions we had was, "How can you do Instagram efficiently?" Because while we talk about this all the time, Dr. Reish, it's not... You don't have to put thousands of dollars into it. You got to put your time, and your commitment, and your dedication towards it, but that's worth something too. So... And I mentioned this earlier in our talk, I feel that it's a change in your mindset. As you're moving through your day, think of the story that you want to tell. Instagram really is about a day in the life. You want your brand and your practice to come to life. You want people when they walk in the door to know exactly what to expect.


Eva: And I would add, you want the user, who's looking through their phone to stop and say, "What's that?" with whatever you post, "What is that?" And that's the secret sauce is what makes them stop and look at something, and engage with it is when they in their mind go, "What's that?" That's why.


Jeanine: I agree. And I think while the caption is important, it's again, getting them to stop scroll and take a look, and wanting to read the caption.


Dr. Reish: Yeah. I think something interesting that Jeanine just brought up was that for my Instagram, I've spent zero dollars on it. It's a great.... it's a tremendous ROI for that zero dollar investment for a lot of marketing power, but as Jeanine said, it's a tremendous time investment. But it's well worth it in my opinion.


Eva: Do you think it's gonna continue?


Dr. Reish: Instagram, absolutely. So one thing that is sort of the elephant in the room on a lot of these panels that Jeanine has been on and something that people don't really talk about is buying followers on Instagram. A lot of people do it and unfortunately, a lot of people in our society do it too meaning ASPS and all the societies. And it's out there. I get emails all the time from different media type of companies saying, "Oh, here's, you know, 20,000 followers you can buy for $10," or it's usually $9.99, something in that nature. You can buy 20,000 followers and you can buy 1,000 likes on every picture that you post of 5,000 likes on every picture that you post, or 10,000 likes on every picture that you post to really perpetuate this sort of deception that you're giving patients. And I mean, I have countless examples in my mind of surgeons out there who've done this. And they'll be, you know, suddenly they jump up to 16,000 followers on Instagram and then for the next year, they're still stuck at 16,000.


Eva: And they get no engagements.


Jeanine: And they're... engagement. Yes. The engagement is...


Dr. Reish: Exactly. And so, it's... And certainly, there's some people out there that have very popular Instagram accounts who are surgeons, who I'm not, you know, talking about that, but there's definitely people out there who bought followers and...


Eva: We track them all. We actually know where they all are and there's brands doing it too. So it's an epidemic.


Jeanine: And I do believe it's a violation of ASPS code of ethics because you're buying... It's almost like buying reviews, you're buying endorsement that's not necessarily authentic.


Eva: Absolutely.


Dr. Reish: I agree. It's a big problem and it's something that we're actually thinking about writing a paper on with my residents is looking into this and using some...sort of trying to find some algorithms to discover. But it's very difficult to track as I'm sure you know.


Jeanine: And there are some tools available online where you can see where somebody will spike from 1,000 to 6,000 in a week. And you know that that's not a natural build.


Dr. Reish: Yeah. There's some accounts out there that have 250,000 followers and then they'll post a picture, and get 60 likes on it. But it doesn't make any sense. And then some... maybe a little further down the line, they'll start renewing their lease on the buying of likes and then suddenly, they'll get 10,000 likes. It's really... I think it's something that needs to be looked into by the society.


Eva: I understand that you can buy engagement on posts too.


Dr. Reish: Wow, wow.


Eva: Which is really scary. Yeah. So I think we're just at the beginning of understanding the cause and effect of that. But my guiding principle in marketing has always been that you're gonna get caught eventually and you'll end up further behind than whatever gain you made by cheating. So I just have never cheated. I know you haven't either.


Dr. Reish: I completely agree.


Eva: Everyone has a super power. I have a feeling I know what yours is. I'm gonna ask Jeanine first. What's your super power, Jeanine?


Jeanine: Eva, this wasn't in the questions you sent me.


Eva: Surprise.


Jeanine: I'm gonna have to think about that.


Eva: I think he said it earlier.


Jeanine: Just being very diplomatic.


Eva: That deescalating things.


Jeanine: I think so. I think I'd have to say that. In all areas of my life, I try to defuse and be very diplomatic.


Eva: They're lucky to have you doing that.
 
Jeanine: Oh, thank you. I'm not sure if that was quite the most interesting answer.


Eva: What would you say your super power is?


Dr. Reish: Absolutely, work ethic. It's just... Everything I built has been based on work ethic and, you know, dedication to that.


Eva: Where did it come from?


Dr. Reish: You know, I can tell you growing up, my parents got divorced when I was about 12 and a year after that, very unfortunately, my older brother was diagnosed with Hodgkin's lymphoma and at the age of 14 had to go through a year of chemotherapy and radiation treatment. And it was the worst time in our lives. We were really..... you know, our family was torn apart, my brother had this terrible illness, and we didn't think he was gonna make it. And it was that time, you know, just taught me to really... that's when I really got into my studies and really started taking an interest in medicine as well. And it was just a time that taught us a lot of perseverance in the face of adversity and it has a happy ending though. Thank goodness. My brother went to remission and he's now a surgeon as well with three children. But that time in our lives was... It's just something... There's just certain things that drive people, I find, and that's the pivotal moment in my life where I look back and I think, "Gosh, that really influences me every single day." Every single time I go into surgery, I think... I mean, I think about this every day of my life and...


Eva: He's your older brother?


Dr. Reish: He's my older brother and it really just drives me to wanna be the best I can at everything in order to give back. I feel like I owe a huge debt to medicine and to society. And I feel like that's what drives me to really be the best at everything that I can be.


Eva: Thank you for sharing that. Thank you both for sharing your stories. This has been really interesting and it's exceptional to know that you're out there doing the work that you're doing. So thank you.


Dr. Reish: Well, thank you so much for having us.


Jeanine: Thanks. That was a lot of fun.