The Art of Altruism
by Rich Smith, Plastic Surgery Products
Selfless acts not only create a solid reputation
among patients, they make life-altering differences for those
unable to afford corrective surgery
It
costs more than $40,000 each time Larry S. Nichter, MD, MS, FACS,
flies to a third world country to devote as much as 3 weeks to
teaching physicians abroad how to perform various plastic and
reconstructive procedures. However, that money only covers the
tangible expenses, like transportation and equipment. Not included
is the potential income Nichter forfeits by being away from is
southern California-based practice, the Pacific Center for Plastic
Surgery. For Nichter, altruism is what drives him to participate
in these medical missions, which to date, has been more than 30
times in his career.
Nichter
performs a comprehensive
consultation, which is essential in ensuring
a successful outcome
“Most
of us who go into medicine do so with a desire to accomplish
wonderful things by helping people in need,” says
Nichter, who is board certified by the American Board of
Plastic Surgery, the American Board of Surgery, and has
certification of added qualifications in hand surgery.
“But
somewhere along the line, a lot of us become disillusioned
by the harsh realities of running a practice. By making
altruism a formal part of my practice, I have been able
to avoid disillusionment and burnout. For example, when
I return from an overseas mission, I have a greater appreciation
of my family, staff, and patients because I realize how
fortunate we are that we don’t live in grinding poverty
where access to even the most basic medical care is often
unavailable.”
Nichter’s
deeds are not confined to foreign shores, however. He is a firm
believer that charity begins at home. “ A short time ago,
I spent half a day in surgery with a neurosurgeon to work on a
child suffering from a very unusually shaped head,” he says.
“ No bills were sent afterward. I did this purely as a labor
of love.”
Nichter’s practice partner, Jed Horowitz, MD, FASC, board
certified by the American Board of Plastic Surgery, explains that
taking care of indigent patients is something the two have always
opted to do. “Providing life-changing care to those who
cannot afford it is a great source of satisfaction for us,”
Horowitz says.
In
some instances, it turns out to be less of a financial strain
on the practice to provide free treatment than it would be to
charge for services. “We are very dedicated to collecting
financial data so that we have a clear picture of its fiscal health,”
says Nichter. “ We discovered that with our state's Medic-aid
patients, we were losing significant sums of money because of
the expense involved in documenting, submitting, tracking, and,
if necessary, appealing claims. We looked at what it cost to provide
treatment divorced from the cost of jumping through all of the
insurance hoops and found that we were better off giving away
our services to those patients.”
Altruism
is also beneficial by the goodwill it engenders among the
public. According to Horowitz, prospective patients tend
to feel more certain about using the services of practitioners
with a solid reputation for selfless acts.
“Thanks
in part to our reputation in the community, we have been
able to build a large - albeit informal - referral network
that supplies us with a reasonably steady stream of new
patients in need of complex reconstructive services, “
says Horowitz.
“There
are fewer and fewer plastic surgeons willing to take on
the challenges of complex reconstructive patients these
days, so our referral sources are understandably appreciative
that they have us to see their patients.
Performing
surgery in the ambulatory center and hospital
setting is equally important, according to Horowitz.
Even with
this network, the practice has observed a shifting emphasis from
reconstructive work to cosmetic procedures. “It is a natural
evolution that most practices experience as time progresses,”
says Horowitz. “Today, cosmetic procedures are about 60%
of our work.”
Horowitz’s
and Nichter’s aesthetic-oriented expertise includes breast
enhancements, breast reductions, breast lifts, upper –and
lower-eyelid surgery, laser resurfacing, chemical peels, nose
reshaping, liposuction, and tummy tucks, and they periodically
perform their procedures as a team. Most often these cases involve
bilateral procedures, such as breast enlargement and breast reduction.
“If a breast enlargement takes one doctor 3 or 4 hours,
we can complete that same procedure in half the time by working
in tandem,” says Nichter. “This is advantageous for
our patients because the shorter duration of surgery means less
risk of morbidity and nausea.”
Where Paths Cross
Both Nichter
and Horowitz- who met and became friends as plastic surgery residents
at the University of Virginia, Charlottesville - have practiced
in southern California since 1985, although separately at first.
That year, Horowitz joined an established Long Beach practice
of a solo plastic surgeon. It was based in 1,100-bed tertiary
hospital, which ensured the practice a large volume of referrals.
“Because of our hospital location and, in part, because
I had gained a clinical appointment at nearby University of Southern
California, Los Angeles, we sought to position ourselves as an
academic-oriented practice, but in a private setting,” says
Horowitz. “Our capabilities were such that we could perform
all of the cutting-edge reconstructive and cosmetic procedures
offered by university-based groups.”
Nichter likewise
held a full-time teaching post at USC, which he acquired upon
arriving in Los Angeles. Several years later, Horowitz convinced
him to join the same hospital-based group. Following Nichter’s
recruitment, the practice grew to six plastic surgeons working
from four locations.
Problems arose
when managed care muscled its way to become the dominant force
in financing health care services. “Managed care adversely
impacted our business plan,” Horowitz recalls. “Health
plans did not care that we could provide all these quality services;
they just wanted to contract with the lowest-priced provider they
could find. As a result, our patient volume decreased, and the
economies of scale we had achieved as a sizable group ceased working
for us.”
In 2000, the
group disbanded. However, Horowitz and Nichter decided to stick
together. “We looked at our options and realized we worked
well together as a team,” Horowitz says. Horowitz and Nichter
purchased the old group’s locations in Huntington Beach
and Newport Beach, Caliornia., and downsized the staff to trim
costs. They also scrutinized the managed care contracts they still
individually held, dropping those that were the most economically
disadvantageous. They did the same with the hospitals at which
they had privileges, but for logistical reasons.
“We
were doing surgeries at a dozen hospitals spread across the market,”
says Horowitz. “We reduce that number after we realized
that the commute time between surgical appointments was limiting
our productivity.”
Today, they
perform surgeries in about half as many hospitals as before. However,
the majority of operations now take place in an ambulatory surgery
center they helped establish in Huntington Beach.
“We
formed a joint-venture partnership with one of the local hospitals
and a management company that operates more than 300 ambulatory
surgery centers around the country.” Horowitz asserts it
is a plus to still be performing a significant number of cases
in hospital setting rather that solely in the ambulatory surgery
center. “When you only perform surgery in a self-contained
facility, you lose the opportunity to interact with other physicians
in your community,” he says. Nichter adds, “Being
in the workplace of those other physicians and letting them see
what you do on a routine basis is the best form of marketing.”
Nichter and
Horowitz prefer marketing that is personal. For example, some
months back, they set up displays at various upscale department
stores to demonstrate their computer imaging capabilities to interested
shoppers. At one of the stores, they hosted an event billed as
“Gentlemen’s Night Out,” a guys-only affair
where attendees received tips from the physicians and noteworthy
health and beauty experts on how to look good, all while enjoying
food, spirits, and good cigars.
Altruism at Work
Because overseas
medical missionary work expenses are so high, Nichter established
a nonprofit entity 4 years ago by the name of Plasticos Foundation
as a vehicle for supporting and perpetuating this facet of his
practice. Although Plasticos Foundation does not have professional
fundraisers, the need to recruit some has been a matter of discussion
at recent board meetings. Currently, Plasticos Foundation generates
operating capital through a casual network of donors – mainly
patients - who are aware of the organization through conversations
with the physicians or by reading about it in the waiting rooms.
Some have even elected to contribute after seeing the 1997 Oscar-winning
video A STORY OF HEALING, which spotlights Nichter as the leader
of a medical mission to Vietnam under the auspices of Interplast,
the oldest and perhaps the best-known of the nonprofit organizations
involved in arranging and underwriting medical missionary trips.
It was by
happenstance that Nichter, a longtime Interplast member, ended
up leading that mission to Vietnam. Another Interplast physician
was to go but he was sidelined at the last minute. A Denver-based
film crew was to accompany the group, and Interplast officials
asked Nichter to step up to the plate, an assignment he happily
undertook. “I was really thrilled when A STORY OF HEALING
won at the Academy Awards,” says Nichter. “It was
competing in the category of best documentary short subject, and
was going up against several big budget, professionally produced
IMAX films.”
"The
success of our foundation is directly effected by donations both
monetary and that of supplies and equipment," according to
Dr. Nichter. While the award proved beneficial for public awareness,
the Plasticos Foundation and its southern California chapter of
Interplast continue to be in need of donations, especially following
the September 11th tragedy. The operating expenses for our missions
are extensive, with the help of generous supporters our missions
continue to help hundreds of deserving individuals.
Recently,
Nichter and Horowitz donated medical reference books for distribution
to third world physicians and nurses. “While many of the
foreign lands we visit have brilliant and talented surgeons, they
are nevertheless technique-starved; we hope our book donation
will help address this,” says Nichter, who describes the
medical libraries in those countries as virtually non-existent.
“On
our Plasticos Foundation Sponsored trips, we often work under
difficult and primitive conditions, correcting deformities such
as cleft palates, webbed hands or feet, burn scars, tumors, and
the like. As we operate, we simultaneously train local surgeons,
anesthesiologists, and nurses in reconstructive surgical techniques
and patient care, so their work can continue long after our team
has gone home. The reason we focus on training through Plasticos
Foundation is that we believe in the ancient Chinese proverb,
if you give a man a fish, he eats for a day, but teach him how
to fish, and he eats for a lifetime.”
Larry
S. Nichter, MD, MS, FACS, the founder of Plasticos Foundation,
began performing reconstructive surgery and training
local surgeons in the treatment of congenital deformities,
trauma care, burn, and hand reconstruction in 1987.
Since then, he has undertaken more than 25 missions
to various countries around the world.
Mission
Statement: To provide reconstructive plastic surgical
training and care to those in need, regardless of
their ability to pay, and to advance the field of
plastic surgery through education and research.
Making
a life-altering difference:
$100 will buy medicine for a child
$250 will buy medical supplies for a child
$700 will fund a surgery for one child
$3,000 enables one physician or nurse to operate
overseas for 2 weeks
$5,000 will buy surgical instruments for a typical
trip
$30,000 funds entire surgical mission including
12 medical professionals
An endowment of $750,000 will fund one yearly
trip forever
To
donate or learn more contact:
Plasticos Foundation
7677 Center Ave, Ste 401
Huntington Beach, CA 92647
714-902-1100 ext 135 www.plasticosfoundation.org
