Finding the Intersection of Success and Work-Life Harmony
By Paul Koshgerian, DMD, MD
My name is Paul Koshgerian, and I am the founding partner of The Oral Surgery & Dental Implant Specialists of San Diego. My partner, Johnathan Shelton, and I have a two-surgeon, two-office practice in San Diego, which I started in 2016, and he joined in 2018. We are both originally from Kentucky, and trained under the late, great Brian Alpert, at the University of Louisville.
I grew up with two hardworking parents–my mother an elementary school teacher, and my father the owner and operator of a chain of gas stations. I was always encouraged to develop a skill that would be marketable, but more importantly, to be my own boss. The sense of independence and freedom which comes along with that was ingrained in me during my development and carried through my educational years and residency training.
Upon matriculating from my residency program, I was personally unattached and entertained many different opportunities from Miami to Seattle, and everywhere in between. The map was big and I considered myself to be somewhat of a “free-agent” being that I was in the position that I only had to consider myself. I wouldn’t be uprooting my family, and there weren’t several other variables that graduates with families would have to consider. I interviewed with existing practices who were offering associateships, I discussed transitions with surgeons who were late in their practice careers, and I considered “hanging a shingle” in my hometown of Lexington, Kentucky. I was open to everything and wanted to do my due diligence in vetting as many opportunities as possible. During that process, I found wonderful opportunities across the country and a tremendous diversity in those opportunities when it comes to practice scope and organization.
My sister and only sibling moved to San Diego in 2008 after her husband had started a small business. My parents and I would visit during the holidays when the weather was cold and grey at home, and I was always inspired by my visits to southern California. The sun was bright, the Pacific Ocean’s beaches were packed, and residents led active lifestyles, all creating lure. In January of 2016, I was contacted by a broker regarding a practice in San Diego. At the time, I was working for a corporate outfit outside of Philadelphia managing the exodontia and implant needs of their patients. The harsh Northeast winter combined with the “corporatism” of my position was beginning to wear on me, and San Diego seemed to be just what I needed.
The opportunity was tough. The previous owner had developed some unfortunate medical issues and the practice had been managed by temporary associates for nearly two years. As one could imagine, the practice’s staff, systems, equipment, and reputation were in disrepair. The staff was a group of misfits who had been under no real leadership for quite some time, the waiting room and operatories were dimly lit, and there was a patina to the walls which certainly dated their paint to the mid to late ‘70s. The business side of the practice was equally anemic but, to me, anything more than the $52,000 per year residency stipend seemed promising. Regardless, the price was right and among all of these blemishes, I saw opportunity.
While presented in strange ways, the disorganization and disrepair provided an opportunity for me to create the practice I had always wanted. I wasn’t walking into a well-oiled machine. I wasn’t acquiescing to practicing the way the current partners or the past surgeon wanted. I wasn’t faced with hearing, “Well, this is the way Dr. Blank used to do it.” It was as clean of a canvas as an existing practice could be. I was going to start from scratch in a practice which, although currently run aground, had been in existence since the ‘60s.
The practice purchase was finalized on the 1st of April in 2016 and, from that point on, there wasn’t another option but to make it work. The practice loan I had taken out had to be paid every month, and I knew I had my work cut out for me when the monthly collections at the end of April totaled $24K. Instead of lamenting, I focused on how each of the blemishes represented a way for me to improve the practice. I was going to develop the paperwork, the surgical schedule, the business cards, the mission statement, the surgical material lists, the colors on the walls, and everything else in between. This was going to be my creation.
For every patient I saw, I contacted their dentist and went to see them. I introduced myself and talked about my philosophy of patient care. I had time to spend with each of the patients (mostly because I didn’t have any patients waiting on me!) and I was really able to create memorable experiences for the patients I was fortunate enough to see. We worked tirelessly to create internal systems and to gain organization inside of the office. The motley crew of staff were whipped into shape and performed remarkably well once given the leadership and structure they were desperate for. The May collections doubled, and then the June collections doubled, and, from that point, we began to feel like we were a real practice.
From sleeping on my sister’s couch in the spring and summer months of 2016 to the present, we have continued to grow and our practice has continued to mature. As an owner and surgeon, I have been responsible for continuing to keep our focus. Our philosophy of “patient service,” a mesh of patient care and customer service, has been the aim from day one. Our goal is to create a memory with a patient and to provide an experience so positive they can’t help share it with their friends, family, and dentist.
As surgeons, we often think we can carry a majority of this load, but our mindset is quite the opposite. Surrounding ourselves with like- minded administrators and staff has allowed us to have extensions of ourselves which touch every facet and moment of the patient experience. We’ve made investments and partnerships with folks we were confident understood our practice and our position. The more established oral surgery practices in San Diego have dominated the area for decades, and we knew we were going to need to think and act differently to become a player. Creating an environment of excellence among our staff has been critical, and holding ourselves and our employees accountable has created a team culture. Finally, caring about and addressing even the most minor of details, is the exact thing those who excel focus upon.
With the help of my partner, our administrators, staff, outlying collaborators, our referral sources, and my family, I have been able to turn my vision into reality. I’m out of bed around 5 and I use the first hour of the day to manage my personal well-being. I run or go to the gym, and I push myself physically. Physicality is good for the body, but I find this time also extremely helpful for the mind. The mornings I run, it’s still dark, and I avoid listening to music or podcasts during this time as it’s important to me to be able to process my thoughts. Often, I am my most creative during those times because, as most of us know, it’s nearly impossible to have a moment when people aren’t pulling you in 10 directions once you’re in the office.
On the way to work, I usually listen to a podcast or audiobook and often call my family or friends living on the East Coast. By the time I arrive at the office for the first case, I have gotten my body and mind prepared, have been able to connect with those I love, and am ready to attack the day unencumbered. I once heard success isn’t one decision, it’s a million small decisions every day. To be able to properly see and assess these decisions, you have to prepare yourself.
The practice has grown to exceed my expectations. We have become the premier oral surgery practice in one of the most competitive cities in the country. While my story is just my story, I want to close with a few pieces of advice. The first is a challenge to spend time every day listening to yourself without interruption. Take time to formulate your goal(s), ensure those goal(s) are what you truly want, and devise a plan on how to get there. The plan doesn’t have to be (and won’t be) fool-proof, but goals without plans rarely materialize. Second, don’t rush and do things the right way. Each day represents a series of conflicts between the right way and the easy way. Resist the temptation to take the easy way, and focus on the right way, and whatever it is you want to build personally and/or professionally will undoubtedly emerge.
Paul Koshgerian
DMD, MD
Dr. Koshgerian is a board-certified oral and maxillofacial surgeon, completing his residency at the University of Louisville. He now practices the full scope of surgery with his partner, Dr. Jonathan Shelton, at his private practice in San Diego, CA.