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I began my career at UCLA as an outcast, a role with which I was actually quite comfortable. It defined pretty much my whole life. I was an outsider at Harvard; I was an outsider at Ohio State; and there was no reason for this to start out any differently. Everyone was uncertain of exactly what to expect. Gradually the residents and attendings
began to warm up. The first three months were actually tremendous fun. I was
running conferences, I was helping the residents with their clinic, and I was
doing surgery on my own patients with me making all the decisions, and yet there
was comfort in knowing that in the next room was someone there if I needed
help.

This cruised along for another month, and then things began to change.
More and more of the clinical staff began to question the necessity of a
fellowship in cosmetic surgery. They weren’t really sure why we needed one. I
was confused by that posture. There was a fellowship in microsurgery. There was
a fellowship in craniofacial surgery. There were even fellowships in hand
surgery.

Obviously I agreed with Dr. Miller that there should also be a fellowship in cosmetic surgery. This is why I was there. We, as plastic surgeons, were expected to do the best cosmetic surgery. It only seemed natural that we should be the best trained in it. Besides, there was certainly a lot of animosity over the fact that gynecologists had started
doing liposuction, ophthalmologists had started doing more eyelid surgery, and ENT
people actually began to call themselves facial plastic surgeons.

Many plastic surgeons felt that their area was being infringed upon and they resented it. My concern, however, was that their resentment was misdirected. Their frustration was not directed at those people whom they thought were infringing on their rights. Their anger did not motivate them to be better at it. They began to do the absolute incorrect
thing. They began to fight amongst themselves.

As is the case with most institutions, they crumble from within, not from without. Dr. Miller’s Aesthetic Fellowship became the first thing for the clinical faculty to attack.
They were more concerned that if they helped train too many people with more expertise
at cosmetic surgery than they had, then eventually they, in some manner, would
be below the standard of care. This was indeed a very short-sighted conclusion.

The clinical staff began to fabricate reasons for needing to dissolve the fellowship: It was too time-consuming. It required that the resident train too long (as if they cared
how long someone else had to train). They began to question whether the program
itself was economically feasible. Nonetheless, I was able to demonstrate that
the Aesthetic Fellowship had in fact earned more money than it had cost to pay me.
I compiled the lists of the surgeries I had performed, what revenue it brought
in, and compared that to what I was being paid. It wasn’t even close. UCLA was
coming out way ahead. Nonetheless, the idea that the clinical staff wanted to
dissolve the fellowship, less than six months into it actually began to chip
away at the enthusiasm with which I had begun the job. I was devastated that
the faculty was actually killing a program because it raised the standard of
care.

By the time May had rolled around, they had actually succeeded in undermining the program. Even though there was a resident who had signed up to follow me, you could tell that the program did not have much of a future. I resented that. My immediate reaction
was to isolate myself from this group.  I would prove to them that I was a better surgeon. I was determined to treat my patients better than any of them treated theirs.

I decided that once I started my practice, I would do my work and go home. I would limit my interaction with my so-called colleagues to the absolute minimum. I would as much as possible avoid the politics and petty jealousies. I knew to isolate myself from this group, my colleagues, was, career wise, not the smartest thing to do, but once again,
people had demonstrated to me that they were best avoided.  I refused to live the rest of my life looking over my shoulder watching to see which plastic surgeon would be the one to stick a knife in my back. And I knew being out there on my own meant sooner or
later one of them would. Look at what they’d done to Tim Miller and his program.

My decision to participate in a TV show was much more desperation, than inspiration. When I finished at UCLA, the hard question once again was whether to pursue a career in academic medicine or to go into private practice. In a sense, fate answered that for me.
Medicine was experiencing, from an economic standpoint, a drastic slowdown. As
a result, those people who had entered into academic positions, who normally would
have matriculated into private practice, were no longer doing so. They were
holding onto those jobs because they offered security.

I put a call into my former chairman, Dave Smith, to discuss my options. His first inclination was that I should look for an academic job. I considered a job at the University of Nebraska, the only opening available at the time, but a trip to Omaha in April,
with the temperature still a brisk minus fourteen degrees farenheight convinced
me this was not the place for cosmetic surgery. My other alternative of course was
to pursue a career in private practice. I was offered a position as an
associate of John Williams.

John was the premier plastic surgeon of his time. In a sense his career had defined cosmetic plastic surgery, particularly in southern California. I enjoyed the moments I spent talking with him.  He’d often reminisce about the good old days when celebrities or movie stars would come into his office, lay down $20,000 or $30,000, and ask him to fix them. In today’s world, from his perspective, that had changed drastically and was dead. The patients were now coming in telling him what they wanted him to do, describing how he should do it, demanding that they pay him less, and yet, at the same time, wanting him to take the responsibility for the outcome. Somehow this seemed backwards, just plain wrong.

In our very private conversations, he’d suggest that for the long term I consider doing other things. He thought that the future of plastic surgery was bleak. He just
thought that people were getting more selfish and mean and that the ‘good old
days’ of plastic surgery were gone. I chalked it up to progress, but now I
believe John was right. It was not sentiment on his part, it was observation.

John Williams believed my future lie in media. In particular, he appreciated the fact that I was able to explain very complicated medical issues in layman’s terms. Our office,
Aesthetica, was at 5757 Wilshire Boulevard in the same building that housed the
offices of the Screen Actors Guild. Across the street were the offices for E,
Entertainment Television.

Aesthetica, as an office, was beautiful. It was modern, tastefully done with soft pink colors, and a tremendous office staff that screamed success. John’s brother Jim had worked
with him at one time; in fact, they were twins. Jim’s practice, however, never
really took off to the extent of John’s practice, but it was obvious as to why.
No client was going to walk in off the street for plastic surgery and choose you, meaning any other doctor, knowing that John Williams was right next door.

Garth Fischer, who had finished at UC Irvine a couple of years earlier, had also taken a position as an associate with John. Garth proved helpful because of his insight into getting a practice started. He seemed comfortable at Aesthetica, and so I settled in and
began the task of creating a private practice.

Things went wonderfully well at first, as all the people who were waiting for me to complete training began having procedures done. But realistically, after you’d completed surgery on all your mother’s friends, it was now time to get going. The real game was now on.

In one conversation with John, we talked about how, in the past as a physician, you could go into a bank and get the funds needed to start a practice. In today’s world, that was clearly not going to happen. Many plastic surgeons, particularly the older ones, were
retiring because they were unable to make ends meet. In the long run, it just
wasn’t worth it for them to be spending money out of pocket to survive if they
weren’t producing the volume to replace that money.

I solved it by covering emergency rooms throughout the South Bay. I had received a call from Dr. Pearlman Hicks, down in Long Beach, California, whose wife unfortunately had developed breast cancer. After her death, he was looking for a way to spend more time with his children. I consented to cover his call schedule so that he would have more time
for his children, two boys.

And so, in addition to Aesthetica, I became a staff member at approximately 12 hospitals in the South Bay. At first it was almost comical. I would be at the emergency room at Long
Beach Memorial at 3 a.m. Friday/Saturday morning, and at the same time get a
call to sew up the face of an accident victim at Downey Hospital approximately
20 miles away. The weekends were spent driving from one hospital to the next,
sewing up lacerations, repairing hand fractures, and attending to accident
victims.

At first it was fun. After a few months, it became tedious, especially since you started to realize that the insurance companies were not only paying you 10-20¢ on the dollar, but many times not paying at all. I attempted to solve this problem by using an
independent billing service, International Medical Financials. I met its owner
and heard his pitch. They were representing hundreds of doctors. I believed that
the billing would be standardized and as such would be paid in a timely
fashion. Eight months went by before small checks started to trickle in.

Also by that time I was seeing patients in follow-up on Tuesday afternoons from 2 to 5 in the office of Dr. Hicks. It seemed unfair to ask some of these people who were general laborers to drive all the way to Beverly Hills. Since Dr. Hicks’ office was located near
the hospitals where these people had been seen, I thought it easier that I pick
a day and see them down there.  It worked fine at first and then became an economic issue. Dr. Hicks began billing me for a third of his office’s overhead but I didn’t have an office there. For the three hours once a week that I went there, I worked out of a nurse’s station
and basically saw only follow-ups; and even with that, I was paying his office
50% of the revenue.

That apparently wasn’t enough for him, and the bills for a third of his overhead kept coming.  I met with Dr. Hicks and explained to him that I did not have an office here.  I pointed out that I was working at his request so that he could spend time with his
children. Furthermore, we had never talked about me joining his practice or
paying him for a third of his overhead. Also, 100% of this money was insurance
money, and he was already in fact getting half of that.

But it was easy to understand why this was happening. Dr. Hicks was not just another plastic surgeon, he was my father’s brother and the truth of the matter was that we were never close. He also wanted to treat me like a nephew and not a colleague (as it suited him). As was standard for the profession, if you took on a new partner, you took out
a loan to pay him a salary until money started to come in. Dr. Hicks didn’t
want to do that for me. Apparently, he had done it for a previous partner who
had gone out on his own. I didn’t understand the connection.

In my mind he was simply abusing our relationship. I made a number of attempts to create a working situation, but everywhere along the line, he was more of a hindrance than a help. He wanted me to do certain things as long as I remained subservient to him, but he didn’t want to do the things that helped a new partner develop a practice. I asked him
to talk with the guys at emergency rooms that were sending patients to their
friends when we were the on-call staff. He didn’t. He didn’t want to make waves
and so we suffered.

Perhaps too, he reminded me too much of my father.

Abandonment, by a parent is a tricky thing. As children, we resolve that things are the way they are and move on, but not without first burying a lot of hurt and anger deep inside that eats at us from time to time, and rots us from our core. Unfortunately, I thought I
had resolved it, but obviously I had not.

I do credit my father and a conversation we had at my grandmother’s funeral with
one profound epiphany: Sometimes you can’t get what you need from a parent
because it isn’t there. As a child, they never got it themselves.  People can’t give you what they do not have.

Sometimes, if you are to get from them the things that you need, you somehow have to help them get it first for themselves. You have to act as your own grandparent, and give your parent what they didn’t get as a child so that they, in turn, can pass it on to you.  That was my epiphany.

I decided to accept my father for who he is; to honestly find those things for which I could be proud; and speak to him about them. I resolved to tell him that I was proud of him for working at the VA hospital (Disabled American Veterans is one of my charities); and
especially that I was proud he had the guts to confront his addictions and
overcome them.

I resolved to be proud of him, so that he could be proud of me.

As a mentor, Tony simply did not have it.

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