The perils of climate change

As we lay the groundwork for opening Duet Plastic Surgery in 2008, we definitely felt the rumblings of change in the cosmetic surgery sphere. What may have been a very open and inviting climate just a few years prior was now being aggressively defended by overcrowded veteran practices. And if the rumors were to be believed, even those practices were looking for a way to get their hands back in the reconstructive, insurance-backed pot.

It was a little bewildering for us. While we were in school and training, we had observed a certain "circle of life" with regards to plastic surgery practices. Fresh, hungry graduates would hang up their shingle, take call at the local emergency rooms to sew up cuts on faces and fix broken fingers, hang around the established practices in hopes of snagging any "small" cases that the veteran surgeons were "too busy" to take, all the while building up a foundation for a cosmetic-focused practice. Once you developed that loyal client base, you were then able to shed the call and insurance cases for the next batch of up-and-coming surgeons. After a respectable career arc, you settled into the pleasures of retirement, allowing room for those young practices to flourish. This seemed to be the reassuringly predictable pattern for decades.

But as we were beginning to make our entrance into the real world, that once stable pattern had turned all topsy-turvy. Everyone - not just the expected competition from derm and ENT - we're talking about pathologists, emergency room physicians, pediatricians - was trying to make a "quick buck" by doing "cosmetic surgery". That hard-earned but dependable stream of income from taking plastic surgical call? Dried up, because veteran plastic surgeons suddenly wanted back in after decades of private practice. And the space cleared by the graceful exit of retirement-age physicians? It didn't happen, because 401k's and pension plans shriveled with the plunge of the stock market, and doctors were forced to stay in the job market.

This has certainly hit the Bay Area plastic surgery community pretty hard; and I can imagine that a lot of major metropolitan areas around the country are seeing the same thing, as this article in New York Magazine describes.

As you may have deduced, we weren't intimidated out of the fray. It may be a little tougher and it may take a little longer than if we had gotten started even two years earlier... But we honestly believe that Duet is different enough to distinguish ourselves from the rest of the crowd (hello out there - two female plastic surgeons, right here!), sturdy enough to outlast this rough economic time, and strong enough to succeed. I'll keep you posted.