i know... Dont look at the money but...

[Maybach]

Hi guys,
I know wdon't go into a specialty for the money, but I am was just wondering, what is the highest salary you have seen for a plastic surgeon practicing only cosmetic surgery? Show me the money!!! Thanks

---

Members don't see this ad.

 

[donkeypunch]

The answer to that question is going to vary by how long the people have been in practice and what area of the country they are in.

I am currently working with 3 different guys. One has been in practice 10 years. He quit taking insurance at year 6 in practice. He quit taking any kind of call except on his own patients at year 5. This year he built his own surgicenter with medispa. He has 11 employees and is expanding to somewhere close to 50 once his surgicenter/spa is fully operational. Once he told me that his take home is close to 2.

Another guy has been in practice for 15 years. He works 3 weeks a month and takes a week off. He doesn't bother with his own surgicenter but takes his cases to one that he owns a little piece of. He has 10 employees. He has said that his takehome is a little over 2. Of course he doesn't take insurance or call.

Another guy does some cosmetics but a lot of pediatric stuff. He does some craniofacial, some otoplasty stuff, some skin lesions, and various other pediatric things. He owns his own surgicenter with a partner who does mainly facial cosmetic stuff - facelifts and brows. He said he has no difficulty pulling in the 1.5 region because of the facilities fees at his surgicenter. He takes insurance. The partner who does mostly head and neck aesthetics doesn't work as hard and doesn't take any call, but supposedly makes a little less because his cases take longer and he can't bill insurance for the facility fees on his cosmetic cases.

Keep in mind these are mature, well established practices. When you first start out it depends on if you accept a job from a hospital or if you go the academic route or if you just hang a shingle. I have looked into all of these options and have decided on hanging a shingle. The first 6 months I won't make hardly anything and I will have to live on a line of credit loan, which I am estimating to be at least $250k. After the first 6 months you start getting a little bit of money rolling in but it is nowhere near what you will make at 5 or 10 years in practice. All of the guys that I talked about above hung a shingle. Its painful at first and not many people have the guts to do it or can take the uncertainty of no money rolling in for a while, but in the end you get to keep all of the benefits of your labor and you are your own boss.

 

[Maybach]

Thanks man, Excellent answer!

 

[LuckyMD2b]

Hey D-punch, how do you interpret these figures that were posted on the Ortho forum.

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

http://residency.wustl.edu/medadmin/resweb.nsf/WV/62353A93C5C35CB186256F850071BD86?OpenDocument

The plastics averages look a little low to me, they got ortho making more than plastics.

 

[Maybach]

The difference, I think is due to the fact that cosmetic surgery, is an indpendent branch of plastic surgery, they don't take insurance do they, they are self employed, so they have the ability to maximize profit, especially if they live in Beverly Hills or places like that, but thats only my thought, I might be the farthest from the truth. Whats your take?

 

[alexroet]

Wow... what a range...
A close family friend of ours hung his shingle back in '82. Solo private practice, no medispa, etc. One employee. Takes some insurance, I think. Always on call, for his own patients, stopped taking ER call after 20yr of practice... Does some cosmetic, some recon- mostly breast reductions and skin cancers, though. All in all, a small-time bread-and-butter plastics guy. He's happy, has time with his family, sent his kids to good schools, hours are decent. Makes about $250K- at least that's what's on the books. He refuses to do Botox, doesn't want to sell his own makeup line, doesn't put up billboards and TV ads, etc. Knows he could make more if he "marketed himself" differently, but wouldn't feel good about himself if he did.
I guess the bottom line is just that you have to strike a balance that makes you happy. And also- how much money do you really NEED? I mean, after 4/5/600K does it really make a difference? I guess if you want ten ferraris and stuff it does...

 

[donkeypunch]

I couldn't open the second link above but the first one seems a little out of whack to me too. The general surgery numbers are WAY high except for the 'most ever' column. I know a general surgeon who works like a horse and makes in the $750 salary range before taxes. Keep in mind to make that he has a resident doing cases all day while he is in clinic. Quasilegal at best but it is in a small town. A typical monday would be lap chole, lap chole, ventral hernia repair, APR, right hemi colectomy, RIH, RIH, lap chole, total thyroidectomy, biceps muscle mass biopsy and one or two emergencies from the ER, finishing usually around 2 in the morning. Do this every day, 5 days a week and you can do $750 before taxes as a general surgeon. The problem with those surveys is that not everyone responds to them and the people who do don't necessarily answer honestly. I get surveys all the time in the mail and they go straight into the trash. I don't want to be on anyone's junk mailing list.

He refuses to do Botox, doesn't want to sell his own makeup line, doesn't put up billboards and TV ads, etc. Knows he could make more if he "marketed himself" differently, but wouldn't feel good about himself if he did.

More power to him but he would make a lot more cash doing that type of stuff. All of the guys I talked about do non-operative treatments in their office and offer skin care products etc. In the end you gotta be comfortable with how you do things. I bet he doesn't work very many hours to make $250. Compare that to how hard a general surgeon has to work to make 250.
Where I trained in GS, there is a guy who tries to only do Whipples. He says that on average his reimbursement from a whipple is $1200. That includes the week of ICU care, the week of floor care and all the followup for 90 days. Oh and guess what, if you have to re-operate, its on you. No reimbursement if it falls in the 90 day window. But wait it gets worse. He occasionally has to take general surgery call. He says that by the time he drives in and pays the overhead to see the patient in the office, he loses $40 for every appendectomy he does. It didn't take me long to figure out that if I didn't match into plastics I wasn't going to do general surgery.

 

[droliver]

Donkeypunch,

As a practicing Plastic Surgeon, I'm skeptical on those net income figures. There are not enough hours in the day to make that much money doing surgery even in 99.9% of cash only practices.

Aesthetic practice tend to run high overhead (60%+). You're talking $4-5 million in gross revenue for $2 million take home. In all but a handful of practices where a surgeon can charge $20K+ for a facelift and do 150-200/year + other cases, the numbers do not add up.

 

[drbruce]

I read in a newspaper article that Harley Street surgeons in London are doing very well financially by setting their operating fee to at least £2,000, on average.

The article went on to say that under normal conditions it was very common for a Harley Street surgeon in full time private practice to operate on 2 patients a day. This makes (2,000 x 2) = £4,000 per day or £1.2 million a year ($2.16m dollars) if he works 300 days per year.

 

[droliver]

The article went on to say that under normal conditions it was very common for a Harley Street surgeon in full time private practice to operate on 2 patients a day. This makes (2,000 x 2) = £4,000 per day or £1.2 million a year ($2.16m dollars) if he works 300 days per year.

Your math isn't real world numbers:

Assume there are 104 weekend days in the year leaving ~ 260 working days. Of that knock out 20-30% (1-1.5 days/week) of that work-week spent seeing consults & post-ops. Remember that you will then knock 40-60% of the gross for practice overhead.

To net $1 million from these conservative projections you must produce produce in excess of $10,000 in surgical fees a day for 200+ days of the year. That's hard to do with rare exception

 

[donkeypunch]

As a practicing Plastic Surgeon, I'm skeptical on those net income figures. There are not enough hours in the day to make that much money doing surgery even in 99.9% of cash only practices.

Aesthetic practice tend to run high overhead (60%+). You're talking $4-5 million in gross revenue for $2 million take home. In all but a handful of practices where a surgeon can charge $20K+ for a facelift and do 150-200/year + other cases, the numbers do not add up.

Rob,
If I told you who these guys were you would no doubt believe it. They are both 100% cash up front cosmetics and are the 2 busiest guys in town for cosmetics. One told me that he structures his fee schedule such that he makes no less than 24k a day every day he is in the OR. He operates 3 days a week and has 2 days of clinic. Right there, without doing any non-operative facial rejuvination in the office, he has made well over 3 million, figuring that he takes a significant number of weeks off. Once again, these are VERY established practices and they are the top dogs in town.

Like I said, there is a huge range of salaries in PRS. I don't expect to make any more than upper 100's my first few years. I'm planning on hanging a shingle. I'm happy with that amount of money because I wouldn't have to be that busy (read not work that hard) to make that amount of money in PRS. The only reason I mention this at all is by way of comparison to general surgery. You have to work your a$$ off in GS to make in the upper $100's range. The absolute cieling for GS that I have seen in $750. By contrast, the cieling for PRS seems almost unlimited, and I personally know 2 guys that take down in the 2 range. You've only been in practice a couple years. I suspect that your practice will pick up significantly in the next 5 years and you won't have to work all that hard to make amazing money, especially after your dad retires.

 

[drbruce]

Most Harley Street surgeons work weekends as well and I was just referring to the surgical fee, not the entire cost of the operation.

Private operations in the UK are particularly expensive though, much more so than in the US where the supply of plastic surgeons is relatively high.

Most consultants, however, combine their private work with NHS so their income is rarely in the million pound range.

 

[sistermike]

I'm kind of trolling here, however I thought I would give some input. I recently had a consult with a surgeon who does hair restorative treatment. I spoke with him for approximately an hour (had the general consult and then spoke to him about his practice). He told me did GS and urology (I wasn't sure how the urology aspect fit into his GS practice) for 20 years. After 20 years of his GS practice, he left it behind to start a hair restorative practice.

He has been doing hair restoration for 10 years now. His practice started out a little slow, but after 5 years he said he became world renowed and has had clients from hollywood and said he has worked on presidents from other countries. Anyways... he quoted me $14,000 for his services and later knocked some money off of that. My treatment isn't even that excessive (I will have low level laser treatment which cost $2000 and the hair restoration which is another $10,000). I asked him on average how many hair restorations he does a week and he told me he doesn't like to over-burden himself with work, but he ususally averages 7 - 10 restorations a week (Mon-Fri.. ocasionally Sat. he said). The average patient gets between 1500 - 2000 hair grafts and he charges $5 per hair graft. He also does LLLT (laser treatment) to prevent future hair loss and he charges $4,200 for a year "supply" of laser treatments (basically the client goes in twice a week 30 min a treatment). He said this LLLT procedure (which he developed) is fairly new, but he had about 250 people (men & women) purchase this plan within the last year.

Those are the only 2 services he offers in his practice. He is the only physician in the practice and has approximately 15 staff members between two locations within the city. Before taxes and all of his overhead costs (staff wages, mortgages on his two clinics, malpractice, etc. etc. etc.), I figured (and was pretty low on the estimates) he was bringing in 4 million a year.. easily. I even figured in 6 weeks a year he wouldn't be working due to vacations, holidays, etc.

He was also telling me about some of the major investments he was doing... haha... this guy is loaded with cash. I think the major reason why he has so many clients is because he is the ONLY hair restoration practice in our city of almost 1 million ppl.

 

[alexroet]

that makes me think- who even DOES hair transplants? It's certainly not part of general surgery training... not plastics as far as I know... somehow I doubt it's urology... Is it derm? Do you even need to be a surgeon? Sounds like it brings in some cash, but it is not something I'm interested in doing, I must say. (no offense).

 

[sistermike]

that makes me think- who even DOES hair transplants? It's certainly not part of general surgery training... not plastics as far as I know... somehow I doubt it's urology... Is it derm? Do you even need to be a surgeon? Sounds like it brings in some cash, but it is not something I'm interested in doing, I must say. (no offense).

I actually spoke to him about that. He had told me that basically anyone with an MD/DO can do hair transplants. He said many dermatologists go into the field of hair transplants, but usually have lawsuits flying at them. This is why he kept on stressing to me that he is a board certified general surgeon. He got into hair transplants for numerous reasons -- obviously, money and lifestyle were big factors. He also told me that at the time he was going bald and started looking into it and noticed that only dermatologists were doing this. Because he is a general surgeon and has chosen to bring hair restorative surgery to the fore front of the 21st century, his practice is extremely successful and he is world renowed. I would personally never go to a dermatologist or any other speciality for hair restoration. Surgeons who do hair restoration are obviously much more expensive than a dermatologist who does them, but I would prefer to have a natural looking head of hair than a botched hair transplant.

 

[Dunce]

Surgeons who do hair restoration are obviously much more expensive than a dermatologist who does them, but I would prefer to have a natural looking head of hair than a botched hair transplant.

Out of curiosity, what makes a general surgery trained physician so much better at hair transplants than someone with a different background?

 

[toofache32]

Out of curiosity, what makes a general surgery trained physician so much better at hair transplants than someone with a different background?

I, also, was wondering how 5 years of gallbladders, butt pus, amputations, and ex-laps makes one so adept in hair-transplant surgery. Maybe it's the 1-3 months spent on the liver transplant service that helps.

 

[Tristero]

hey toofache,

why the fuuck do you spend so much time on the plastics board? This thread doesn't pertain to OMFS, and no one is asking for your opinion, much less a sarcastic comment about general surgeons. those guys work way too hard to deserve lip from a pu$$y a$$ biitch like you.

 

[toofache32]

hey toofache,

why the fuuck do you spend so much time on the plastics board? This thread doesn't pertain to OMFS, and no one is asking for your opinion, much less a sarcastic comment about general surgeons. those guys work way too hard to deserve lip from a pu$$y a$$ biitch like you.

Thanks for contributing to the discussion in true general surgery style. Geeez. I'm not sure why you care which forums I scroll through....do you card everyone at the door? We all work hard. Especially those of us not bound by the 80-hour rules.

 

[sistermike]

Out of curiosity, what makes a general surgery trained physician so much better at hair transplants than someone with a different background?

I have no idea. In my original post, I stated I was trolling. I am not a surgeon or a dermatologist -- hell, I am no where near that stage of my life. I had asked him about any "training" pertaining to hair transplants, and he said there are hair transplant programs in foreign countries (not fellowships -- but rather, just independent "training programs"). He has not attended any of these, but rather spent time with other world renowed hair transplant surgeons and basically learned from them. When I go in for my actual procedure, I will have nearly 6 hours to talk to him a bit, so I will see if he will provide me with any other information.

Many people I have spoken to have ridiculed the field of hair restoration. However, I truly believe there should be more physicians out there willing to specialize in this. Most people are not aware of this option. Men who are in there 20's and already are quickly going bald should definitely look into an option such as this.

 

[alexroet]

hey toofache,

why the fuuck do you spend so much time on the plastics board? This thread doesn't pertain to OMFS, and no one is asking for your opinion, much less a sarcastic comment about general surgeons. those guys work way too hard to deserve lip from a pu$$y a$$ biitch like you.

Jesus, what's YOUR problem?
I think he was making fun of hair transplantation, not surgeons.

 

[ellieamee]

This WAS an incredibly long post that, after re-reading it, I realized it would not only not help the Forum; it would have probably confused everyone, so I decided to edit the whole thing out. However, if anyone's got questions on Plastic Surgery, feel free to holler this way! My fiance' is one (a plastic surgeon).

Get some sleep, people!

E.A.

 

[MOHS_01]

I actually spoke to him about that. He had told me that basically anyone with an MD/DO can do hair transplants. He said many dermatologists go into the field of hair transplants, but usually have lawsuits flying at them. This is why he kept on stressing to me that he is a board certified general surgeon. He got into hair transplants for numerous reasons -- obviously, money and lifestyle were big factors. He also told me that at the time he was going bald and started looking into it and noticed that only dermatologists were doing this. Because he is a general surgeon and has chosen to bring hair restorative surgery to the fore front of the 21st century, his practice is extremely successful and he is world renowed. I would personally never go to a dermatologist or any other speciality for hair restoration. Surgeons who do hair restoration are obviously much more expensive than a dermatologist who does them, but I would prefer to have a natural looking head of hair than a botched hair transplant.

Wow... wrong. There is a professional hair restoration society ( http://www.ishrs.org/ )

Look at the "who's who" -- current president, past presidents, etc. All derms. Medline hair restoration techniques.... follicular unit transfers... the pioneers were dermatologists.

Nothing against PS -- they have the best propoganda machine going that the world has seen in over 50 years.

I don't do hair transplants -- I hate them, BTW. Most tedious surgery known to man.