Episode 31: Sunday January 24

Drs. Sam Jejurikar @samjejurikar, Salvatore Pacella @sandiegoplasticsurgeon, and Sam Rhee kicks off another season with a special solo multi-part interview. Drs. Sam Jejurikar, Salvatore Pacella, and Sam Rhee welcome special guest Dr. Stephanie Cohen MD.

In Part 2 of the podcast, Dr. Rhee talks to Dr. Cohen about her experiences starting a successful plastic surgery business. If you are interested learning how successful people overcome challenges and adversity, this episode is a MUST WATCH!

Dr. Cohen is a Board Certified Plastic Surgeon by the American Board of Plastic Surgery located in Maywood, NJ. Dr. Cohen completed plastic surgery training at the New York Hospital/Cornell Medical Center and the Memorial Sloan Kettering Cancer Center in New York City. There, Dr. Cohen developed a special interest and skill in the area of reconstructive surgery, especially concentrated on the breast. Her dedication to the craft has earned her the nickname of the “breast whisperer” from her fellow colleagues and patients.

A long time dream of Dr. Cohen’s was to travel to developing countries and provide expert surgical care to those who have no other possible access to medical care. This became a reality in 2007 when she became a founding member and Vice President of ISMS Operation Kids.

Full Transcript (download PDF here)
2021.01.24 S02E02 STEPHANIE COHEN PART 2
Dr. Sam Rhee: [00:00:00] How did you after you finished your training, figure out. Where you wanted to practice what you wanted to do, who you wanted to join up with, having a partner, which you've had in your practice for many years, it's like a ma it's more than a marriage in some ways, because, it's there are so many issues that have to be dealt with and you've had one of the more successful practice.
 Practices with another plastic surgery partner. I always feel like it's hurting, like trying to get cats to come together.  It's impossible. It's very difficult. And yet so how did you start all that? And what did you think, how did you figure all that out? 
Dr. Stephanie Cohen: [00:00:37] So I have seen, I've or heard of over and over again.
So many plastic surgery practices that don't make it, that that seems like a good thing when it starts and turns into disaster, quite frankly. And it, we have a really unique Richard Winters and I, we have a really unique relationship and a really unique history that's gone on for 22 years without ever having an argument.
I would add we've never had a disagreement. We've never had an argument. I am not married to this man. My husband is a child psychiatrist and he has his own wife and he's been married to his wife for almost 30 years. And we have a wonderful professional relationship and we really never have had a major disagreement, which is like that.
I don't think there's been a plastic surgery partnership maybe in history. That's ever gone that far without it. I don't expect there will be. And, it's an interesting beginning. He was a year ahead of me at Cornell. So we only overlapped by a year. And I had kids, he didn't have kids yet.
We were both married to our spouses. We lived in a patient house across the street from the hospital and I didn't meet him for for a really long time because they tended to take the strong residents. And not pair them with the other strong residents. Take that for what it is, but I never worked with Rick.
And we used to meet at a M and M conferences and at journal clubs and things like that, but I never, yeah. Really worked with him all that much. It just knew of him. And anybody who knows anything about my partner, Dr. Winters, is that everyone knows of him. And he has a very strong personality and a very, a unique personality.
And is one of the, certainly one of the best people I know, but at the time, I didn't know that. And my wife, my husband and his wife met first in the building on their free time. And they became friends before I ever met before I ever really hung out with Rick Skip forward.
He had gone to his fellowship at the bunkie clinic out in California, too in San Francisco to do a microsurgical fellowship and a hand fellowship. And I was in my second year of plastic surgery and had started to look into, where I was going to go practice. And Rick was going to go practice in Connecticut, where he had come from university of Connecticut and I had gotten, I'd been talking to some people in Manhattan.
I've been talking to some people in New Jersey. My father was an attending at Hackensack hospital. Did practice there for 40 years at the time, it was about 25, 30 years in OB GYN. So I always knew that would be advantageous to have a parent, who everybody knew, who delivered everybody's children and Burton Downey.
And I had come out to Hackensack to get the lay of the land. And I had talked to one of the wonderful. Plastic surgeons out there, Craig hall. He was no longer with us, unfortunately, but was a wonderful person and a wonderful creative facial surgeon as well. And he and I talked about potentially me joining his practice.
I had I had talked to a few other people and I had talked to the administration there about, what my focus was going to be reconstructive surgery, microsurgery a lot of Breast reconstructive and cancer reconstructive. And I got a phone call. This is very strange scenario.
I got a phone call from the administration of the hospital. And they said, We're thinking about hiring a plastic surgeon on staff would you like to come and would you like to bring a friend? We think there's more work here than one person can accomplish. And w we, we were thinking about hiring staff, plastic surgeons.
So I thought it was interesting ideas thought that I hadn't, it really. Clicked with anybody that great. As far as being a partner, being a junior partner and long story short I talked to Rick, he was out in California. He flew out. He was the first person I thought of when I thought about, who else might consider, throwing it all up and.
Come into Hackensack with me. He came, he met, he Rhee, we met everybody long story short while we decided it was a great thing to do. We got the lay of the land. We saw how busy Hackensack was. We saw how busy their breast center was and their drama center was and what was going on there. At that same time, Hackensack decided they didn't want to hire any plastic surgeon.
Dr. Sam Rhee: [00:04:46] Great. surprise. 
Dr. Stephanie Cohen: [00:04:51] So after we were halfway down this road where we had already been talking about office space and salaries and all this kind of thing the worst, what are the worst? Days of my practice life was the day I had to call Rick after he had given up the job in Connecticut call him at four o'clock in the morning, his time, because he was out in California and I of course, was going to the operating room at Cornell and tell him that I just had a call from one of the administrators at Hackensack who had said that the deal's off.
There's no deal. We don't need plastic surgeons. And to his amazing credit, he sorta took a half and I was devastated. I thought, Oh my God, I've ruined this guy's life. I've changed the path of his career. And now I have nothing for him. And to his credit, he took a half a breath and he said, you know what?
We're going to do it anyway, because it is a great opportunity. And for what I've seen there, there's a lot to do. And this will be very beneficial and people balked at us coming there must be a reason. And they're worried about us coming there.  So what we're going to do, and I said, okay.
And we decided, so what we did was something very unusual, which was we went into private practice with two junior partners and no senior partner. And we both luckily had spouses that worked. So that we had some supportive salary and we opened it, we hung up a shingle essentially.
And we said, you know what, let's give it a year. And we'll just be at Hackensack. Let's not run around to seven different hospitals and, The itinerant surgeons. We want to just try to focus on one place and if we're making money out of here, we'll we'll,  we'll keep going.
And it's six months we were making a salary and the rest is history. As they say, it just went, it just went from there. We have had no operating agreement between the two of us for 22 years. We have, we, we have not that's all other story, but we met a lawyer in our first year who said I don't understand.
You're both here. You need to have your own lawyer. And one of you needs to have me and then we can make an operating agreement. And we just said, we make us something. He said I'll make you a vanilla document. And then in a year, one of you will. Come with your own lawyer. And one of you will keep me and we'll make a, we'll make an operating agreement.
And that, that vanilla document that we made 22 years ago is still sitting in a drawer somewhere. We've we've never touched it. Never looked at it, never changed it. And I think that the key for us has been we have the same philosophy about running our practice.
Obviously we want to do good surgery. We care more about taking care of people and doing. Surgery well  and really fixing complicated problems care more about that, then, how much money we're making sad to say, but that's unfortunately some people's motives. And both of us wanted the other to succeed more.
We started everything at 50 50 when we opened up this practice, we literally split everything down the middle 50 50. So there was, and both of us wanted to be the one that worked harder. And got the 50%, but neither of us want to be the slacker.  We both worked our butts off and Obviously, our financial arrangements got more sophisticated over time.
And now we have two partners, obviously.  They have an operating agreement and and the way we, the way that we, it, we split everything up. Got more sophisticated as time went on and there were more time constraints, I don't know. I don't know if you'd know this, but several years into practice I fractured my cervical spine in in five places.
Yeah.  So I was in halo for four months and I I, it was a horseback riding accident and I I couldn't operate  for three of those four months.  Didn't want, at that time, I didn't want. He, we were still paying each other 50 50 and I said that's not, that's ridiculous.
 I'm not doing anything for three months. So we started a different, slightly different system where we still paid ourselves equal amounts, but then we bonus based on how much each one was working and that kind of more complicated thing, but the nuts and bolts aren't as important.
But but but that's how it's gone  and it's been that way ever 
since. It's amazing. Because it flies in the face of everything that I've ever heard with any other plastic surgeon. So every other plastic surgeon you're right. Always senior partner, junior partner, because someone has to be established.
Nobody just starts a practice with two juniors. Everyone starts at multiple hospitals taking ER call,  building up from the ground. Everyone has complicated financial agreements because everyone knows someone's going to be backstabbing somebody else, or there's going to be some other issue.
Nobody does it on a handshake essentially is, which is what you guys did. And and your personalities are so diametrically different. In so many ways, if you literally took one person and split their personalities in half, like they do on a science fiction show, you'd have for pickup.
Right.
And  It can be done. I would say that what you guys have done is like hitting the lotto. Probably. 
Yes. It would be hard to say people ask us all the time, for practice advice and Rick better than me could give you some very practical practice advice and contract advice  and all that is salary advice and all that kind of thing.
But in the end, we, I would never S. Point to my experience and say, this is what you need to do because it's not reproducible. It really isn't. It just happened that way. And we were very lucky. We were very lucky. We've always known it. Like you said, it's like a marriage, and we've always known throughout the whole history of this, that if something was really important to him, I didn't care.
And if something was really important to me, vice versa, he didn't care. So there's always been that very, if there's something it's important to you and whatever you do, what you want to do, it's it's fine. We always called him the business partner and me the creative partner. So I get to make the creative decisions and he gets to make the business decisions.
And  it's worked out very well for both of us.
Dr. Sam Rhee: [00:10:41] I'm sure this would be a good MBA case study somewhere that they could figure out,  what actually made this one work when most of them actually don't. So then as you started developing your practice, you already knew you wanted to do cancer reconstruction, breast reconstruction.
From the get go. Is that right? 
Dr. Stephanie Cohen: [00:10:58] Yeah. I, you know what we were when I came, we were both very much like we're going to do everything, we're gonna we're gonna do all kinds of reconstruction. And we started doing that, but just having been very confident in my experience at Sloan Kettering and dining, having done a lot of breast reconstructive surgery.
I felt very comfortable with that. So I started giving lectures to the breast surgeons, to the oncologists to the radiation oncologists, to, to the OB GYN, giving lectures about breast reconstruction was in a sort of a transitional phase of that. I was mostly believe it or not giving lectures about autologous.
Breast tissue reconstruction, because which as you know is not really my my, my focus now I do far fewer. I still do them obviously, but I do far fewer autologous reconstructions than I do implant based and implant with autologous combo type of reconstructions. But we were really, we really came in and had a big focus on very complex reconstructions and Rick and his personality really they fit in well with the chest surgeons and the orthopedic surgeons in mind fit in well with the breast surgeons. And so we by default headed that direction. And then obviously now we're super specialized. I , haven't done a case where there's pus involved in a very long time, 
Dr. Sam Rhee: [00:12:06] Such a  smartperson for doing that. Very smart.  
Dr. Stephanie Cohen: [00:12:13] Yeah, so that got developed obviously in the, in, in that direction as we went our more separate ways,  it took about five to 10 years before we really layered it out. Rick, believe it or not, I used to do rhinoplasties and do replants and Rick used to do breast reconstruction.
 It seems strange now because there's been so many years where we've really gotten away from that. But but that's all that. That's how that all settled out. 
Dr. Sam Rhee: [00:12:35] And then, so now what are your favorite operations? What do you enjoy doing? 
Dr. Stephanie Cohen: [00:12:40] I, my, every, all the residents can tell you immediately.
My favorite operation is to do a latissimus reconstruction for breast for breast reconstruction. And I just think that is the best operation on the planet to, to fix almost any problem that muscle could reach. And I tell them. I tell the residents when I'm teaching them you can't kill a latissimus flap is the most versatile, most functional. And  I'm swimming upstream in the breast reconstruction community.  Went to a breast reconstruction conference a long time ago. It was like, 1520 years ago. And Sumner Slavin from Harvard was giving a talk about latissimisses and he was saying, it's the best operation in the world?
Why is everybody doing tram flaps when you can do a latissimus flap and then slowly but surely I became some Sumner Slavin because  just can't stop touting the advantages of latissimus flaps of in February, actually in PRS. We have paper coming out on outpatient latissimus flaps for secondary breast reconstruction.
I it's an outpatient surgical procedure. Everybody does well. They don't have pain. I love the physical doing of it. It's as simplest flap to dissect out. And it always gives you, excellent amount of coverage for whatever it is you want to do. So I love doing that operation. Yeah, 
Dr. Sam Rhee: [00:13:50] reliability, especially as you start doing so many cases is very key for everything.
Dr. Stephanie Cohen: [00:13:56] I've had a very strong desire since going into breast reconstructive surgery to make it more of an outpatient experience for patients have always had this very strong belief that if a woman who has to have a mastectomy can not stay in a hospital I always tell patients that if I can.
The smallest surgical footprint that I can leave on somebody. I think that they Rhee emotionally and psychologically, it goes in an enormous way towards getting people over it and past it. And and obviously you need to have a stable reconstruction so that they don't look at something that's ugly or it has to be covered every day.
But But to do that at the same time that you can get someone out of the hospital in the same day, get them up, walking, moving, eating, all the things that can sometimes be an uphill battle against patients and hospitals and patients, families who want them to sit in bed all day long.
Will, go to my grave saying that the less time people spend in a hospital and the faster they get up and move the better.  So that's my favorite by, by, by far. 
Dr. Sam Rhee: [00:14:58] So at this point in your career, what is it that you look forward to every day or every week? And what is it that is.
The most annoying for you as a plastic surgeon at this point 
Dr. Stephanie Cohen: [00:15:08] in your career? I will say we haven't gotten to talk about my my mission trip, which I told you at the beginning of this as like the, the, it's my favorite thing to talk about. I'm very yappy. I apologize. I talk a lot, so there's a lot of information, but I would say that the biggest, my biggest disappointment of 2020 with the COVID epidemic was that we had to cancel at the last minute, our trip to Ghana which was going to be our 13th medical mission trip.
And that I, certainly on a yearly basis that I look forward to that all year, because those. 10 days that we spend doing surgery in in other countries and other places are by far my, what I look forward to all year. And whereas on a daily basis in my practice I get.
A ton out of taking care of my breast cancer patients and doing breast reductions and helping women who, feel happier after all this has done and feel more settled. There's really nothing like the week that you experience when you're, in a third world country and these people who have had no other option,  you.
The, our team falls out of the sky for these people. We they have no option to have any of these issues fixed and we fall out of the sky and they come and droves and that and you can fix so many things in such a short. Period of time that never would have happened.
Had you not been there? And the people are so grateful. There's no paperwork. And there's no, there's no legal lot, there's no lawyers to hound you  for small things. And and so you really get to be a real doctor. And and that's I think something that, unfortunately we're losing nowadays.
Doctors are different,  it's not like my father's era. And I really enjoy that. I really enjoy the, I really enjoy the challenge of diagnosing something. I love puzzles. I love the challenge of trying to figure out how to fix something really complicated things. I love the challenge of trying to get those little tiny lips back together.
Again, the noses still look like they're supposed to look. I love the challenge of a really bad. Burn scar contracture that we don't see here in the United States. I have patients with burn scar contractures where their arms are. Solidified to their sides from their shoulder to their elbow.
I'm sure you've seen it there. The elbow was bent, at such an angle that it's completely stuck down. Things that you never really, we see contractors in the U S but nothing like this. And really trying to figure out those complex problems, other than the good feeling you get from going and doing good for people.
In my own personal, like what really gets my juices flowing is the puzzle of figuring those things out. And I think best on my feet. So I'm not one of those plastic surgeons who spends a lot of time, like designing things before I go into the operating room as you'll, as any of my residents will tell you they're always like what my arch did you put on the patient?
And I'm always looking at, yeah. marks are for rookies. Which is very, also not what most plastic surgeons will tell you is a very, most plastic surgeons feel very comfortable and for good reason marking everything out very carefully before, before you lie a patient down or before you take a patient in the operating room I I'm much better on my feet and I'm much better without.
Putting a lot of constraints on myself before before I get there. And usually my answer when the residents are asking why did you do that? I say, cause that was what you needed to do. That was what was right. I 
Dr. Sam Rhee: [00:18:25] think that this is the part where, you know, how they have a car commercial and they say professional driver owned do not attempt.
That would be my caveat for this is. When you're starting out, make all the marks you want, do all the planning do not attempt professional driver 
Dr. Stephanie Cohen: [00:18:44] a hundred percent. And there are some very accomplished surgeons who do beautiful work, who feel very strongly that the marks are really the most important thing.
That's not how my, as I have my brain works, that's not how I work.