This episode’s specialty spotlight is Plastic Surgery! Board-certified plastic surgeon and recognized aesthetic industry leader Dr. Brad Calobrace joins us to share hurdles unique to plastic surgery. We discuss the impact social media has on patient expectations, the retail side of plastic surgery, and thinking like a business leader to scale a practice.
Listen to the full episode using the player below, or by visiting one of the links below. Below is the episode’s transcript which has been edited for readability. If you have any questions or would like to learn more, email us at firstname.lastname@example.org.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real world experiences. Creating simplicity in 3, 2, 1.
Brad A: Welcome back to another episode of the Legal 123s with ByrdAdatto. I’m your host Brad Adatto with my cohost Michael Byrd.
Michael: Thanks, Brad. As a business and healthcare law firm, we represent clients in multiple sectors and multiple specialties, especially healthcare. This season our theme is specialty spotlight where each episode we’ll visit about some of the nuances that can be found from a business and healthcare perspective in the various practice specialties.
Brad A: Yes and Michael, before we bring on today’s guests, I actually have a question for you. Do you know who Sir Edmund Hillary is?
Michael: I always like it when you ask questions that are super obvious and I know the answer to, but you could pretty much know that if you ask me if I know someone that goes by [00:01:00] Sir, that I don’t know them. I don’t know any Sir’s. So, no, I don’t know him.
Brad A: Our guest wants to answer now. Sir Hillary was from New Zealand and became the first known climber that’s confirmed to reach the top of Mount Everest on May 29th, 1953.
Michael: Oh, wow. Okay.
Brad A: Follow up question for you. Do you know who Alan Shepard is?
Michael: Brad, I have no idea. I don’t know what you’re doing to me.
Brad A: Oh my God, you’re killing me! On May 5th, 1961, Alan the Shepherd became the first American in space doing a suborbital flight in a mercury capsule named Freedom 7.
Michael: Okay. Well, keep going.
Brad A: All right, one more question for you. I think we’re going to have another failure here. Do you know who Daniel Hale Williams is?
Michael: I can start making something up, but it’s going to fail pretty quickly. I have no idea.
Brad A: All right. Daniel Hale Williams was the first known [00:02:00] doctor to perform a successful open-heart surgery during an emergency procedure in 1893. Also another fun fact, Dr. Williams was born in 1858 in a small town in Pennsylvania. He was the fifth of seven children, son of a barber and found the first ever known black owned hospital in America.
Michael: All right. Well, I am struggling to connect the dots here, but I do have a theory.
Brad A: Okay.
Michael: You’re really bearing all of this around the fact that you asked if I knew a Sir, and you know that our guests is named Brad and you’re wanting me to distinguish the two of you by calling you, Sir Brad.
Brad A: Well, that’s actually a really good theory so far, I’m really into it.
Michael: It’s not going to happen.
Brad A: Okay. Well, all right. So, I think one of the things that our audience knows is when you’re the first to do something, it can be rewarding but at the same time challenging, right? We had someone who was known to be the first to climb Mount Everest, the first American to go into space, the first [00:03:00] doctor to sit there and do an open heart surgery in an emergency procedure, and there’s a rumor that today’s guests may be one of the first people to introduce Botox to his patients in the state of Kentucky. I want to hear this story, but let’s bring on today’s guests and you may call me, Sir Brad afterwards.
Michael: Sure. Yeah, and we can then next week do the world’s shortest podcast and talk about the things that you were the first to accomplish.
Brad A: Fair enough.
Michael: Okay. Dr. Brad Calobrace is joining us today. He is a graduate of Indiana University medical school. He completed residencies in both general surgery and plastic surgery at the University of Southern California in Los Angeles. He completed a cosmetic and breast surgery fellowship with Dr. Pat Maxwell, he began his plastic surgery practice in Louisville, Kentucky in 1997. He has dual clinical faculty appointments with the departments of plastic surgery at the University of Louisville and the University of Kentucky. He’s director of aesthetic surgery fellowship, [00:04:00] endorsed by the aesthetic society. He’s a board certified plastic surgeon. He has been awarded numerous top doc awards by both patients and peers, both Brad and I, and I think Alex have shared the stage with Dr. Calobrace. I’m going to go that route instead of the Sir Brad for you. So he’s a prolific speaker and teacher. He’s the founder and owner of Callow Aesthetic Plastic Surgery Center and Callow Spa Rejuvenation Centers. I hope I got all of that right. Welcome!
Brad C: Thank you! Yep, that was all right. I was finding it interesting how I have to go back and I’m like, oh boy, it’s been 25 years that I’ve been in practice, which is kind of shocking because you know how it is. It always seems like it’s about somewhere around seven or eight years, but it’s more than 25 years though. Nobody’s asking me anymore, what’s my future plans other than what’s my exit strategy. How many more years are you going to practice? You know, you’re not retiring yet. [00:05:00] The most common thing I get and I’m like is that where I am.
Brad A: Well that’s okay, Brad. You know, Michael has been practicing law for like 900 years, so, you know, don’t worry about it.
Michael: Actually, Sir Brad over here is in his 25th year of practice right now as well.
Brad A: It’s true.
Brad C: Well, yeah, I think clearly parents named their children Brad during our generation, I guess.
Brad A: I guess so. All right, Brad, and the story of first, you know, like I said, I heard this is a rumor, but I’d love to hear it. Were you truly one of the first physicians to bring Botox to the state of Kentucky?
Brad C: Yeah, I was probably the first. It was because nobody was really doing it when I came into town. Shortly thereafter it kind of caught on, so I started practice in Louisville and I came from Los Angeles and then through Nashville with Pat Maxwell. So I came from LA and I thought the idea when I came to Louisville, it seemed like the patients perceived it [00:06:00] as sort of sleeping and sort of like, you know, old fashioned surgery. So they really weren’t having more modernist study practice. They felt they would have to go to one of the coast to be able to get that, go to New York. Many of established people and socialites of Louisville actually would always go out of the city to get their treatments, like facelifts, etc. and I felt that we could bring, you know, I came from Los Angeles so, we could bring modern medicine, modern plastic surgery, to global, community. One of those was just Botox, which I had been using and have learned in my residency in Los Angeles. Only at one doctor that I know of at the time in LA had just earned a user, a guy named Gareth Wootton, who is now pretty much retired, but he did all the celebrities Facelifts. He was the celebrity facelift surgeon, at the time. So he clearly thought outside the box, and that’s where I got introduced to it. So shortly thereafter, when I was in practice, I [00:07:00] thought it was a nice thing to introduce into the practice. What is funny? I’ll tell you one story about it, so it is 1997 and I’m putting botulism toxin in people. This is five years before its FDA approved for cosmetic uses. I was brand new in town. Nobody knew who I was, so I’m sure it was a touch scandalous. If you know anything about Botox, you know, it lasts about three or four months and it goes away. So there was one rumor because people love rumors when you’re new in town, and it was that I was getting sued for a Botox treatment, going back to when I was getting my haircut and that rumor was going around and I said, well, I don’t think that’s true, but if it is, they’re probably going to drop the lawsuit in about four months because everything will go back to normal. It wasn’t true and as it’s turned out, Botox is clearly what’s happened to the toxin market, around the country and around the world now, I mean, it’s as common a name as any other pharmaceutical name there [00:08:00] is out there. It is the number one most recognizable pharmaceutical name in the country, so how different has it been in 25 years? So I was the first to bring it a little.
Brad A: That’s so awesome! I love it!
Michael: That’s fascinating too. I was just thinking about how widely accepted it is now to be kind of there on the forefront, where you’re trying to convince people that this foreign substance is going to make them look better.
Brad C: Patients have a lot of trust with me now, but you know, back then I was just so unknown. I must look back today and go, well, that was kind of crazy. I don’t know how that was perceived by some, because the first time I ever heard of it was with Dr. Wootton. I was like are you kidding me? I am definitely not injecting botulism toxin into somebody for our cosmetic reasons. So, you know, but at that time also, what was new was even the name of a medical spa [00:09:00] so in 1997, I was introducing the concept into my practice that we are something more than surgeons. We are aesthetic doctors for our patients and that we should try to bring all of that into our practice to help them aesthetically along the way because we were getting more and more good non-surgical options for them like laser devices and toxins, and then became the fillers and all the things that we know today, microdermabrasion, all those things. So we brought skincare into the practice in 1997, which I think was very new for plastic surgery back then. So I think it was part of all of that Botox stuff, right? I’d give them any stock.
Michael: That’s fascinating.
Brad C: We know where that is today, too, right?
Michael: Yeah. Right. It’s yeah, completely different. When people ask us if we ever heard of a medi spa or a MedSpa, you know, eight years ago, we’re laughing because of course, you know, they didn’t call it that, but all of our plastic surgeons had [00:10:00] variation of that the early adopters, like yourself back in the nineties, but there’s not many, most of them came several years after that.
Brad C: Yeah, I agree. I think that is one of the challenges that faced us in aesthetic medicine, because in the past, most of those treatments were enhanced. People doctors who had spent most of their career training for, preparing for, treating patients aesthetically, dealing with the emergence of new techniques and how you bring them in and make them safe and yet very effective for our patients, we had our whole reputation on the line to make sure we only bring to them things that we think are effective and are safe for them, and that’s where it was. Today, as you all know, it has emerged well beyond the hands, plastic surgeons or dermatologists, into what we would call non-core people and trying to keep that same level of safety [00:11:00] and efficacy, from non-physicians, and people that maybe got a weekend course, as it relates to that, is really a challenge. It’s not that I’m necessarily against it. I just think it is a challenge that we need to find a way to address. I think nobody’s better to address that then the experts and the plastic surgeons. They can help find a way that will keep it safe and yet be accessible to patients in an affordable way.
Michael: That’s really interesting. I’m going to pivot and go back in time a little bit. Tell us what drew you to plastic surgery as a specialty when you were in training.
Brad C: Well, you know, it wasn’t too complicated. When I was in college, I had a teacher of mine, a nutrition teacher, Brenda Sands. She said that her sister had been in a car accident and she had plastic [00:12:00] surgery. She was so impressed with the plastic surgeons and she knew my personality and said she had an epiphany. She came to me and she was like, I know what kind of doctor you should be, you absolutely should be a plastic surgeon. The truth is, this is in 1983…
Brad C: A long time ago. I did not know what a plastic surgeon was. I had never heard the term, a plastic surgeon. So how, I don’t know, I lived in Indiana. I don’t know if anybody else knew what they were, but back then, it wasn’t talked about, I didn’t know anybody that ever had plastic surgery and so I didn’t know what she meant actually, then she kind of described it and I knew that there was something called a facelift, so I kind of, oh, that’s those facelifts, then I forgot about it, but I had it in the back of my mind. When I was in my third year of medical school, so in like 1987 or 88, I did a rotation. I thought, you know, I really don’t want to be a surgeon [00:13:00] and so let’s get surgery out of the way. My first two rotations in my third year, we went to clinicals, was to do general surgery for the first month and the second month was a specialty and I’m like, oh, I’ll do plastic surgery because that’s what Brenda Sands told me to do. I did that rotation very naively, I would say. What’s interesting is, it’s strange, like in year or two, you have to sort of figure out what you want to spend the rest of your life doing.
Brad C: And you don’t really know that much about any of these specialties, but when I did that month, I absolutely knew, I was like, oh no, yep, nope, I’m a surgeon. 100%. I’m a surgeon. And that’s what I’m meant to do. And so then you have to do five years of general surgery, two years at that time, two years of plastic surgery, and fellowship after that. That’s after eight years, it’s like 15 years of training and that’s a lot to bite off in 1988 or 89, but that’s what I did because I thought it was the balance of [00:14:00] just being a surgeon, but it’s so artistic and it’s so creative and that’s exactly why my teacher had said to me, that she thought I should be a plastic surgeon. You know, and ultimately it was like, I just had to close my eyes and do the training because it was my perfect career, and it did deliver to my spirit and soul what would fulfill me and so that’s how I did it. Pretty much did a rotation and went okay, you’re right, that’s exactly who I am and that’s my going to be my career.
Brad A: Did you ever go back and thank Brenda?
Brad C: I didn’t because I haven’t gone back to the college. So just know that she was my nutrition teacher, so really we were in the sciences, I was in the sciences, but I believe nutrition was important for medicine. She was more in like the home-ec department. So, you know, it’s not something we got that much of a relationship with, but we became very close friends. You know, I was always a good student. I was the best student in my class. Yeah, because I graduated number one in my college class. [00:15:00] So, you know, you got close to your professors. Matter of fact, when I graduated from high school, I didn’t get most likely to succeed, I got the award teacher’s pet and that could tell you everything you need to know. So yeah, I used to, I don’t know if she’s still alive, but everybody knew it because I never referred to her as Brenda Sands. She had, you know, back in the days, the hair was much bigger and she was very put together, always very pristine so I called her Brenda bay hairspray because once you get to know me, you know, that’s kind of who I am. After this many years, I still honor her, I don’t forget. I remember my fourth grade teacher very well and went back to her, to how pivotal she was, and sort of changing me and making me a good student. So, you know, you try not to forget. We were on the shoulders of giants, always on people that have done great things for us, and so I try to remember them.
Brad A: That’s great. [00:16:00] And you were talking a little bit about this as to, you know, being a plastic surgeon, you were talking obviously about the education and the training side of it, but like all doctors, there’s a time and once you treat patients and with your specialty, are there certain challenges that are unique to when you’re dealing with patients that are different than in your specialty and maybe other specialties?
Brad C: Well, I think that more recently over the last decade it has been well, you know, I do fully aesthetic medicine now, so it’s all pay without insurance involvement. So I think there’s a certain level of expectation. I will tell you when somebody is coming to see you, it’s mostly because they’ve been referred by their friends or family or reputation. It’s not because your colleagues or other doctors refer them, which is much how it happens in medicine and insurance-based medicine. That’s who you went to school with, is who you refer them to.
Brad C: So you’re depending upon your previous work, as guiding on the next patients for that, [00:17:00] and that’s sort of how it’s been. I think that looks into new challenges because now patients start totally normal, other than they have an aesthetic problem. They’re not sick. You can’t play blame patient disease. So you’re on the line to make sure there’s no complications and there’s no prompts as much as possible because it’s not good for business. They have a different expectation and you know, that any problems they have, you could help create. I think that makes it a little different than when I was a general surgeon. You had issues, you kind of went back to what was a tough situation because we started with a patient that’s very sick and they had a problem. More recently, I think it becomes more challenging because of the social media and the internet and marketing and that sort of thing, like a credential online. People do their research. Either if we’re good or bad, they have come in with expectations, by pictures on the internet, which are often [00:18:00] modified with misinformation. There’s this kind of expectation that has been created, an illusion that’s happened through social media that things happen, and everybody turns out perfect. And you know, you take one perfect case out of a hundred that you did and you present that online for the next six months, but you don’t show the other 99 that didn’t quite have that exact same result. I think it just sets up a different expectation. We spend a lot of our time unraveling what they came in with, and then trying to reeducate and recreate. I think that’s where I can be very powerful because I spent my life being an educator. So I take that on to make sure that I set the stage for what I can do, what their expectations should be, to make sure at the end to under promise and over-deliver my results. And so I think that just creates a little bit of a challenge, especially if a young surgeons coming in.
Michael: You know, that’s really interesting. I [00:19:00] hear all the time, you know, the challenges in plastic surgery of identifying people that may have a body image disorder or something like that, but I’d never thought about it from the perspective of their whole expectations have been kind of reset by the social media channels.
Brad C: And their dysmorphia is created by those same social media channels, right? Because they’re seeing these expectations, these looks and people, and they’re presented in their very best place. I mean, it could be as much as what their lives are like, what they’re involved in, what activities, who are their friends are, and exactly what their appearance is and it’s not exactly what the reality is and that’s these patients trying to achieve something that’s probably, for most of us, not really achievable. It sets in that and they go to the plastic surgeon to try to get to that place. And that’s unfortunate, that I will tell you as it relates to [00:20:00] cosmetic surgery gone bad, like it goes too far, the patients have done too much. It takes two to tangle on that one and it takes the patient that has some dysmorphia or poor expectation, but it also takes the doctor, the surgeon who steps into it to go down that path with them. And so I think that we could be the gatekeepers to that and to be the people who say no, let’s do something different, let’s redirect, and help you up through that. Unfortunately, when you say no, they’ll often go find somebody who will say yes.
Brad A: Yeah, totally agree.
Michael: That’s really cool.
Michael: Great, great perspective. So, I know you give entire lectures on the business side of your specialty and, so, I’d love for you to kind of pick one to touch on. What are some business challenges in plastic surgery that are kind of unique to that industry?
Brad C: Well, I think it’s unique because we are a retail business and a [00:21:00] patient business drive in a retail type of environment. And yet we’re still medicine, right? And so you always have this ethical dilemma. Is selling skincare products in your practice, is that truly medicine if I have something to gain on the other side of it, you know, and fuck it, so I always find that balance. Am I over selling that procedure, because that’s how I make money on that procedure? I think it’s a unique challenge. That’s why for so many years, so many of my injectors and estheticians we didn’t have incentive plans because we didn’t want them to be incentivized, to oversell any products to sort of find that line. We do understand that the business of any business, employees love incentives. And I know as a plastic surgeon, the harder I worked, I’m incentivized by that in the exact same way. So, I’ve sort of had to mature in that, but I think that we find that as a challenge. I think coming through Covid [00:22:00] we spent a lot of uncertainty about what would happen to our specialty, in it, and had I known that we would do so well after it, I could have enjoyed the seven weeks off. But we were busy trying to figure it all out and try to find PPP. Its things that people do to protect our patients and how we were going to remerge. As you guys all know, and I’m sure I’ve talked about, plastic surgery on the other side of Covid was very successful, so much so that surgical procedures in aesthetics increased by 60%, in 2021. So, we’ll see what happens. Now the question is, will we see a swing in the other direction? I’m sure to some degree we will. I think that what I learned from them and I’m taking that into my business sense of my business is what holds patients back from doing procedures and why non-surgical procedures that become so [00:23:00] popular, is it’s time. Its patients don’t have time to recover and to get through some of the surgeries that they’ll do non-surgical because the time ending, all of us who were extremely busy, the time to take two or three weeks off to have your tummy tuck or your facelift is really like, oh, I’d love to do that, but that’s not going to happen anytime soon, they’ll be lied to. And then the other thing is that if the patients have money, if the stock market was good. They weren’t traveling, they weren’t going out to dinner. They weren’t spending money on all those things. So they were putting pools in their yard and they were buying boats and they were having cosmetic surgery is what I, this is my assessment of what they’re doing with them, but I do think, you know, I think its enhanced aesthetics. It’s certainly created a divergence of a lot of many spas suddenly where it gets to an explosion. We’ve definitely seen private equity interested in [00:24:00] getting in the game of plastic surgery. We’ve become, we already come as doctors, and everybody knows, it is no mystery, that doctors are the worst business people, right? You’ve heard that a thousand times, you guys know, you deal with them all the time. So, in aesthetics or if you’re really going to scale your business and, or have a big business, you have to become businessmen as well. And you have to be able to speak some of that language if you’re going to be successful in it. So I think we’ve had to go back and be educated. And I think that’s what I say. And I think Brad was at one of my last lectures I gave in San Diego. I gave a 45 minute lecture talking about that and I talked about employees and emergence, all the things. It was really just about how you have to think about your business and you can’t delegate your responsibility. You’re the leader of the organization. You’re the CEO of unit by title or by the fact that you are the surgeon in that practice and to understand how to make business decisions, it becomes extremely important. And I think doctors aren’t prepared for that. And I think [00:25:00] that’s what we tried to help them, to become a little smarter about such things.
Brad A: Those are all great points. I mean, and I think what I did, I think I told, Michael, afterwards how much I enjoyed your presentation because you did hit on so many elements of just in general. And this particular, for our audience members, Brad was when he was speaking on this, he was really focusing on the aesthetic noninvasive side, as to why it’s so lucrative if you do it correctly. And I think Brad, I don’t know if you’ve ever heard this story, but Michael and I were giving a speech in Vegas once and we had an older physician, much older than anyone on this podcast, get up to the mic and tell us to our face, And we were talking about med spas, that med spas are lost leaders, anyone who wants a med spa, it’s a waste of your time and waste of your money. And meanwhile, we’re sitting up there and we know at the time that med spas are making 3 or $4 million a year and it was just because they weren’t treating it like businessmen. [00:26:00] They were treating it as a separate entity that they weren’t paying attention to because they make so much more money on the other side of the aisle. So I think your leadership, and I know that you’re very vocal with the fellows because you and I spoke with the different fellowship symposiums over the years, that leadership is so good for the plastic surgeons because, and I do agree with you, they were getting lapped by non-core doctors because they were just so concentrated on the surgical side.
Brad C: You said it just perfectly, and that’s what it is. We can make a lot of money on the plastic surgery side of it, and it seems like a waste. If you’re talking about taking a 50% margin, versus a 10% margin, but it takes 50% of that margin takes me actually doing all that work and 50% at the best, still good comparatively because the overhead is much greater on the mini spot business, but you can scale it up, and you can use extended providers, etc., to do it. So, as Brad knows, he does my financials, [00:27:00] so I started the business, so when I opened Callow Spa in Callow, Texas in a separate building in 2007, so now we’re 15 years into it. You create a brand, I mean, you brand the Callow Spa and expand and we have multiple locations and it expands far beyond, you’re the foundation of it, but expands far beyond on what you can do in your own practice. It’s good for the practice because it brings patients in for plastic surgery as well, too. But we end up scaled and I think this year we’ll do $3 or $14 million in our medical spa business, which even if you get a lower margin, a 20% margin or 25% margin, it can end up being a lot of revenue. But what I said in that lecture, what I was trying to say is with what you just said, Brad, if you don’t have the energy or the bandwidth to put the energy in that it’s going to take for it, then you can’t do it because it will be a loss later and it won’t be [00:28:00] successful. You have to be willing to work hard and know who you are as, so I think I said, are you a don’t miss the boat or don’t sink the boat kind of person, right? So are you the person who doesn’t want to miss the boat and wants to be able to really build something special? Or are you very cautious and you don’t want to sink the boat and things are going well as a plastic surgeon, why would I mix that up? You have to know who you are going into it if you’re going to be successful because don’t do what I did. If you aren’t willing to do what I did to get there. I was told when I was building this building, “Oh my God. You’re doing great for your business and 12 employees. You are great.” And I’m so glad I didn’t listen to that cause now I have 85 employees, we have multiple locations, and I’ve definitely scaled up beyond my own practice and beyond that, I feel proud of it and I enjoyed it and I know a lot and I know a lot of [00:29:00] people. The experience has been really, really good too. I’m smarter at plastic surgery because I’m smarter at nonsurgical treatments for my patients.
Michael: That’s so well said. And P.S., I’m going to have to steal that expression of don’t sink the boat or don’t miss the boat. I love that. Very powerful. I can’t believe it again. We’re have already flown through our time together. Thank you so much for coming on. What we’ll do next, Brad, is we’ll say goodbye, we’ll go to commercial and then I’ll pick back up with Sir Brad to have a little legal wrap-up on the other side.
Brad C: Okay. Thanks for having me on!
Brad A: Thanks Brad!
Brad C: Bye.
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Brad A: Welcome back to Legal 123s with ByrdAdatto. I’m your host Brad Adatto with my cohost, Michael Byrd. Michael, this season, we are having a specialty spotlight and we’re bringing on all these amazing individuals. We just had Dr. Brad Calobrace, not to be confused with Sir Brad over here, and he had so many great takeaways. I know we’ve said this before in other podcasts already, but we easily could have gone on there for another 30 minutes just hearing his thoughts on a lot of different areas, but because we’re focused on plastic surgery he brought some great points to light, which is, ultimately you have a retail side of it, but you’re still practicing medicine. maybe for our audience, in the [00:31:00] last few minutes we have together, just highlight some of the legal implications of what he meant by that.
Michael: Yeah, and there’s some very real pressures if you’re in this kind of plastic surgery, even elective medicine, because the way you get business is going to feel like retail. You have to convince people to choose to come and get a treatment. At its core this is the practice of medicine and you can’t let hold of that. And the threats to that are not going to be obvious, so you’re like, I need to get a new sales technique to come in and you hire a sales person who may have a retail background, so, you know you’re going to bring that in and you can inadvertently violate kickback laws or other laws like that with how you structure compensation to them or to your employees. You bring in website people that may come from other industries [00:32:00] that are really good for business to draw in patients, but I have no idea about the regulations that go with false and deceptive advertising. We’ve talked about in prior episodes. And so really at its core I think the takeaway is understanding at the very foundation of your business, you’re a medical practice and there are regulations across the many things you do from a business perspective. And so, you just have to navigate that, check the boxes, navigate that as you try to be creative in running the business, like a retail business.
Brad A: Yeah, absolutely. I think those are all really good takeaways in that sense. As Michael said, just remember it is the practice of medicine ultimately, and there will be other rules surrounding that, but Michael, believe it or not, we are way past our normal time so let’s move on audience. Next Wednesday show we now have [00:33:00] another specialist spotlight on ambulatory surgery centers with Woody Moore.
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