Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest today is Jonathan Kaplan and he's plastic surgeon in San Francisco where I think I heard once that there were 200 plastic surgeons in four square miles. Is that right? 

Dr. Kaplan (00:45):
They they always say that per capita, there's more plastic surgeons in San Francisco than there are in Beverly Hills in the Los Angeles area. 

Eva Sheie (00:53):
I heard that about Grand Rapids too per capita. I've heard it about Utah too. I'm not sure which one is the actual winner. 

Dr. Kaplan (01:01):
I think people just figure if they keep saying it, it somehow magically becomes true. 

Eva Sheie (01:05):
Yeah, actually was talking to a surgeon in New York recently and he said, I'm the only plastic surgeon on my block. 

Dr. Kaplan (01:14):
That actually says a lot, actually, probably in New York. 

Eva Sheie (01:16):
It does say a lot in New York. I think San Francisco's probably like that. 

Dr. Kaplan (01:20):
There's eight plastic surgeons in our building, but I know in LA there's like 40 something in one building, so I may not, but again, it was a per capita number. 

Eva Sheie (01:28):
I know, and I think to myself, whoever has the dancing banana could just win it. Just put the banana out or the signs. 

Dr. Kaplan (01:39):
<laugh> I'm walking outside the A-frame on or the A-frame.  

Eva Sheie (01:42):
<laugh> Yeah, exactly. So how long have you been on your own there in the Bay? 

Dr. Kaplan (01:49):
Right, so we've been here in town for 10 years. I was originally practicing in Louisiana for six years, and then my wife and I came here 10 years ago. So yeah, I took over an existing practice in 2013, so exactly 10 years now that we've been here on my own. 

Eva Sheie (02:05):
I have been following you for quite a while because you also have your hands in other things besides medicine, which is not a story for another day, but you left Louisiana. That's a kind of hard place to leave. People really love it there. So what made you decide to go to San Francisco? 

Dr. Kaplan (02:24):
Well, I always thought, I mean, I grew up in Louisiana. I'm the youngest of seven kids and I enjoyed growing up in Louisiana, still like Louisiana. I thought I was going to be there forever. And my wife though is from Connecticut, and so she was used to being closer to New York, big cities like that. And so I think she always had ideas of being in a bigger city. And I remember one time I was in La Jolla for a wedding and I was on the top floor of this building, and this is before I met my girlfriend who became my wife, but I was on the top floor of this building in La Jolla looking out onto the water and all the palm trees. And at that time I'm in Louisiana and I'm wondering, why don't I live here then? So that was the first seed, and then when I was in Baton Rouge, I met my wife, my girlfriend. 

(03:10)
I told her about this job opportunity in Southern California and I told her like, oh yeah, I was going to recommend one of my friends for this job opportunity in Southern California was like, wow, what a great opportunity for him. And my wife's like, why is it not a great opportunity for you? And I was like, well, I did think about the fact that La Jolla was so beautiful. And so we started, that's when I first started moving on with the idea of, okay, I guess I could be someplace else besides Louisiana, found this opportunity in northern California where I could take over an existing practice that had its own accredited operating room, 

Eva Sheie (03:43):
Ah. 

Dr. Kaplan (03:43):
Which was something I always wanted because as an employed physician at the hospital in Louisiana, they were never going to build in my own operating room, which is understandable, but as you get into more cosmetic cases, patients want their own operating room. They don't want to have to go to a surgery center where next door is a kid screaming and just got their tonsils taken out. And so I found this opportunity on an ASPS, American Society of Plastic Surgeons job listings board for a doctor that was retiring in San Francisco and to please fax in your resume 

Eva Sheie (04:13):
Fax.

Dr. Kaplan (04:14):
If you want to learn more. I know which, I mean fax obviously even at that time in 2013 when I looked at it was antiquated, but I also thought maybe he was doing it to provide some anonymity so nobody would know what practice it was. It was a phone number, it wasn't an email address. So although that might be giving him too much credit, I don't know. Anyway, so yeah, so we started looking at this practice and when I came out here in February of 2013, saw that it was legit that there was an accredited operating room that you could see both towers of the Golden Gate Bridge from the office in Pacific Heights. I was like, yeah, this might work, this might work. 

Eva Sheie (04:49):
I once had a consult for fibrous whatever, and I got sent to this plastic surgeon in Houston and she still was using typewriters and I had already been writing code for,

Dr. Kaplan (05:02):
Wow. 

Eva Sheie (05:03):
I had probably been writing code for 15 years, and I was terrified because they had typewriters in this office. They were typing on index cards and it was so strange. It was like I walked back in time. 

Dr. Kaplan (05:19):
That is a little unnerving. I'll be honest with you. When we have patients call in that don't have an email address, we don't turn them away, but we're just, we are not going to really be able to communicate with you without an email address. How we send all of our paperwork is online. We don't wait for the patient to come in to fill out their paperwork. I mean, we really want you to do it online. We want you to be sort of tech savvy because I text patients after their operation to check on them to see how they're doing. I want them to have the lowest hurdle possible to get in touch with me so that they don't go to the er. They don't call friends and family. They don't go online looking for answers. And so if you don't have a phone number that I can to you don't have an email address, then you're probably not going to be a good fit for this office. And it's not because we're technological snobs, but we're just trying to make it as easy as possible for you to be able to communicate with us. 

Eva Sheie (06:09):
That's a theme for you, isn't it? That you're always trying to make things easier and more efficient and not just saying it, but really doing it. 

Dr. Kaplan (06:17):
No, I don't know that I've ever thought of it like that, but I think I'm definitely always trying to find the most streamlined way of doing things, automating what I can, but not just for me, making it easier for the office staff and making it easier for the patient. For sure. 

Eva Sheie (06:31):
I'm having a memory of something that I remember just being so wowed that you were doing that had to do with when people reached out to you on the website, you were doing something really exceptional to communicate back to them. Is that ringing a bell or am I imagining it? 

Dr. Kaplan (06:47):
Well, I mean, it might be the price estimators that we would always allow patients to be able to check pricing rather than them having to call and ask about pricing and then giving the runaround or having to go through the contact submission form on the website and then wait for someone to reply to you about pricing. We always have made it available for patients to go to the price estimator on our website, and they put in their contact information and then they get an automated email with a breakdown of the pricing for that procedure, so they don't have to wait for us to call 'em back with an answer. They get that answer immediately, 

Eva Sheie (07:15):
Yeah. 

Dr. Kaplan (07:16):
But then yes, we also get their contact information to be able to follow up with them to see if they have any other questions. 

Eva Sheie (07:21):
Yeah, pricing is really your sort of parallel passion. I don't even want to put it in second place. 

Dr. Kaplan (07:26):
It's exactly a parallel passion. I don't think of it as a side hustle. You're exactly right. I definitely, it's just so crazy the idea that people want to know how much a car costs before they go into the dealership or how much a house costs before they go to the open house. And when you're talking about a 15, 20, $30,000 procedure with a plastic surgeon or any kind of healthcare service, I don't know why that became a thing where you didn't tell people how much it costs. Now if you're going through insurance, maybe you just didn't know how much it was going to cost, but even those walls are getting broken down now. But certainly with aesthetics, I mean, the way I always said it is that Obamacare, for all its failings with the healthcare.gov website not working really, they've gotten that to be a better website where you can go and you can check all these different insurance plans for the bronze, gold, and platinum plans in your state. If they can do all of those different things to show you all the benefits and the deductibles and the out-of-pocket maximums for all those different categories, for all those different insurance plans and all those different states, I think you can tell people the breakdown of a breast augmentation with silicone implants and you can give 'em a breakdown of breast augmentation with saline implants. 

Eva Sheie (08:33):
If you want to.

Dr. Kaplan (08:33):
It's always been a big thing. If you want to. And I think that's the other thing is that the providers don't want to, because for whatever reason that they don't want people to know because they're worried about their competition finding out whatever it is, you have to always remember we went into healthcare to help patients, and that is a patient satisfier for them to be able to determine pricing ahead of time. And because you get their contact information in the process, you can follow up with them to give 'em more context and explanation, whereas if you just list a menu of pricing and you have no idea who's looking at it, yeah, I don't think that's a great idea, but the fact that you get this even exchange of they get pricing, you get their contact info, then you can provide more context and information and education. 

Eva Sheie (09:17):
Certainly back when I was working on surveying patients, we always asked about price and what we learned. We surveyed something like over 200,000 people in the years that I was working on that when people were prepared for the price ahead of consultation, the scheduling rate was double on the day of consult. And so just from a pure number standpoint, why wouldn't you want people to know what they're getting into before they're in front of you? Just didn't, 

Dr. Kaplan (09:47):
Especially since a lot of doctors offer free consult. So you go through this 30, 45 minute consult, not only is the patient divulging their deepest insecurities, but time is money in your office and it ends at the end of the consultation. They have sticker shock. I mean, how does that benefit anybody? I actually used the data from that study you're talking about as one of the articles that we wrote, and we found that similar thing that when patients knew pricing ahead of time when they were price aware, by the time of the consultation, they were 41% more likely to book a procedure than the price unaware patients. So yeah, it's an obvious time saver for everybody. 

Eva Sheie (10:22):
That's funny. I always say twice as likely, but it was 1.7 x, which is 41%. 

Dr. Kaplan (10:28):
Yeah, yeah, exactly. That's so funny. 

Eva Sheie (10:30):
Oh, yeah. Oh, data is just the greatest thing. I love it. 

Dr. Kaplan (10:35):
And all the data that we've collected from our practice for price transparency, from weight loss medications, all that data, it's so much fun to have because it sees that you're not just going by the gestalt or by the gut, by your gut, no pun intended, but you have something to provide. We actually even provide that data on our website to patients, well, in particular for the weight management aspect, but then you can go and you go to meetings and you give presentations on the data, and I think the people in the audience appreciate that also when they're seeing the data. 

Eva Sheie (11:06):
I think you've had, and maybe you know this or maybe you don't feel it, I think you've had a massive impact on changing the way aesthetics thinks about price transparency. And I mean, I can't speak to whether that's extended past aesthetics, but you really made it the norm to be transparent with the work that you were doing, and it probably didn't feel like you were getting anywhere for a while, but I think that it's really come a long way in 10 years since you started doing it. I dunno, what do you think? 

Dr. Kaplan (11:37):
No question. Oh yeah, no, you definitely felt like, I definitely felt like I was banging my head up against a wall, but the reason I just kept pursuing it is because it was working great for my practice and for the other doctors that were using our platform for price estimation. So yeah. Yeah, it definitely felt like I was beating my head up against the wall. But now even though there's still a ton of resistance that people are still stuck in the past, the federal government launched the no surprises Act a couple years ago, and so now once you get the federal government involved people whether they want to or not, they're eventually going to have to succumb to that train barreling down the track at them. 

Eva Sheie (12:14):
Yeah, I know. 

Dr. Kaplan (12:16):
And I say people, I'm talking about providers. 

Eva Sheie (12:18):
I feel my age when you say things like that. This was like they forced us into EMR and they forced us into all kinds of things over the years that were really hard. 

Dr. Kaplan (12:27):
Yeah, I'm still not sure EMR was a good thing, but I mean we're using EMRs and things like that, but I think the tough thing whenever you're working maybe at a hospital that they're trying to make every specialty use the same EMR, and it's unfortunately never going to be a great fit. Some are better than others though.

Eva Sheie (12:45):
There is no perfect solution. 

Dr. Kaplan (12:48):
And then also when they try to make all these different modules within that solution be the best and it can't be, and so that's why people have to go out and get other third party vendors for this issue. And so when you look at a hospital in their IT department, I mean, they're dealing with like 30, 40, 50 different vendors just surrounding the EMR. I'm not even talking about biomedical and engineering and all that stuff, but people don't just use Epic. There's so many other things that they have to use to support Epic. 

Eva Sheie (13:18):
And think about how big Epic is. I know we've gone down a rabbit hole here. 

Dr. Kaplan (13:22):
EPIC is huge, right? 

Eva Sheie (13:25):
Aesthetics leads the way on lots of things, and I think patient experience is one of them because if you don't deliver a great patient experience, people will just go somewhere else. And so you've done that on price transparency. Have you done that in any other areas of your practice? 

Dr. Kaplan (13:43):
As far as the weight management program, we definitely have really tapped into trying to provide aspects of weight management that are patient satisfiers to make that as easy as an automated as possible for patients. I mean, it requires probably a little bit of background, but 

Eva Sheie (13:57):
Tell us how you got into the weight management piece and how that came to be one of the ways you're helping people. 

Dr. Kaplan (14:05):
So one of the ways that we've really tried to implement that patient satisfier mentality aside from price transparency is weight management. And the reason we got into weight management is because a couple years ago, our nurse practitioner and nurse noticed that we had patients coming in for body contour procedures. We have our own accredited operating room in the office, and we were doing tummy tucks and liposuction mommy makeovers, and patients were coming in that wanted those procedures, but their BMI, their body mass index was a little bit too high. And when your BMI is higher, there are increased risks associated with anesthesia and surgery. So you don't necessarily want to operate on somebody with too high of a BMI. And so they suggested rather than turning these people away for surgery, they were thinking of tummy tuck is like a weight loss operation rather than being, what it is is a body contour procedure. 

(14:56)
And because you can remove the excess skin from the abdomen, but you can't really remove the excess fat on the inside around their intestines called visceral fat that requires weight loss. So they suggested rather than turning these people weight, let's help 'em lose weight in a weight management program. And after they lose weight, maybe they have excess skin, maybe they're good candidates for surgery or they lose weight, their skin tightens and they're happy. And we've contributed the decline of obesity in America. Either way, it's a win-win for all everybody. So that's why we started a weight management program a couple years ago, and then we were doing things like phentermine, which unfortunately can only really be used on label for about three months, makes people feel kind of jittery. And then we got access to the compounded versions of Semaglutide and Tirzepatide, which are the active ingredients found in Ozempic and Mojaro respectively. 

(15:42)
And since the compounding pharmacy can legally make duplicates of commercially available drugs when they're on an FDA shortage list, then we were able to get 'em from the compounding pharmacy. So to repeat that, because Ozempic, Wagovy, Mojara, all these amazing weight loss drugs that are part of the GLP one receptor agonist class of drugs, since they're all on an FDA shortage list and official list, then the FDA says, well, if they're on the shortage, we still want Americans to be able to get these medications. So then they allow compounding pharmacies to make duplicates of these medications. And the thing is, when people come out and say, well, how do we know it's the same thing? Well, actually by law it actually has to be a duplicate of the active ingredient found in those drugs. That's the only reason they allow you to do it. 

(16:23)
It's like can't make a quasi duplicate version of it. It's got to be the same thing because telling Americans that you can get this medication even if it's on shortage. So that's why by law it has to be a duplicate. And then you can get a certificate of analysis to determine whether it truly is the same protein chain or peptide chain, the same number of 31 amino acids in the case of semaglutide or 39 amino acids in tirzepatide. So you can actually prove that it is the same or it's the duplicate of those activities. So anyway, point being is we're able to get access to these medications and now we're providing these medications through a weight manager program in the practice. 

Eva Sheie (17:01):
And how popular is the program? 

Dr. Kaplan (17:03):
It's become very popular because I think not only because these medications work and the side effects are relatively low, but because we've made it easy for patients to sign up for it, and I'm not saying easy in the sense that they just put in their name and email address, we send 'em medications, but we still do our due diligence, get their medical history and everything like that. We get lab work, but we've made every step of that very easy. We can get into the ways I've made that easier to be a patient satisfier, but now we have over 430 patients in our weight management program, and those are patients that are using either Semaglutide or Tirzepatide. 

Eva Sheie (17:41):
Give me some highlights from those patients and their results, the results that they're getting, and because you've been doing it for a while. So certainly they're on a continuum. 

Dr. Kaplan (17:51):
And so we have a coaching and a non coaching program. So the coaching patients were able to certainly keep up with their weight loss, but everybody, we send a survey to every month asking, what was your starting weight? What's your current weight? And then do you have any issues? Do you need us to follow up with you tolerating things? So we're like, no matter who it is, we're trying to stay in touch with all of 'em and have some follow up. So yeah, we have good data that just kind of overall between Semaglutide and Tirzepatide, I'll say that there's lots of published data out there, but the published data is paid for by the companies that make the drugs. So that's kind of why you can't always believe it. So that's great about having so many patients and following so many patients is that we got a lot of our own data. 

(18:31)
And I can say that with Tirzepatide that on average patients are losing one to three pounds more on average per month compared to the semaglutide patients. So one to three pounds, not a huge difference, but what is significantly different is the patients that are on Semaglutide that are having side effects that they can't really tolerate when they switch Tirzepatide, much fewer side effects. So that's what seems to be significantly different. And the price difference is semaglutide is 500 a month, Tirzepatide is 600 a month. So you have to decide, is that a hundred dollars difference worth it for the tears appetite for one to three pounds on average, more weight loss per month, or maybe it's worth it for the reduction in side effects. And we just let patients make that determination. I will say that there's recent data that shows that if you have fatty liver, if that's a thing that you know about, your doctors told you that tears appetite appears to provide greater fat reduction in your fatty liver than other medications. 

(19:26)
But I'm still not convinced that fatty liver always has clinical ramifications other than it might be because you're overweight. So yeah, I could just take you through a step-by-step. So a few different ways. We try to make this as easy as possible for patients. So the first step is reaching out to us. They can either go through our website through a price estimator, find out how much a consult is, which is a hundred dollars. They can actually purchase the consult online through our website. We get notified, our office staff follows up with them. We can email 'em, we can text 'em, we can make it as easy as possible. They can set up the consult and pay for it online. Then we email them all of the paperwork through Hello Sign or whatever. And so we make the paperwork process as easy as possible, and then we set 'em up for a consultation, either virtual via Zoom or FaceTime, or they can come in person if they want. 

(20:16)
And then after that we do get labs on them. If they already have labs that are recent enough, they can email 'em to us and that's great. And then we don't have to redo that. But when it comes to the labs, we make that really easy. And the cool thing about that is that if they're ready to move forward with one of our programs coaching or not a coaching, all we have to do is we submit an electronic order through the LabCorp portal. And because we do that, then they can go into any LabCorp in America, wherever they are. I mean, we can only treat patients where have state licenses, but they can go to LabCorp anywhere in America. And because we ordered it, we automatically get the results back the next day. And because we have it set up with LabCorp, all the billing goes back to us. 

(20:55)
So the patient walks in to any LabCorp, gives 'em their name, LabCorp has their name on file, they draw their blood, they don't have to owe anything out of pocket, they've already paid us basically. And then we get the results automatically the following day, and then we send them a link to sign up for the medication online as a medication subscription, just like a Netflix subscription. And they sign up for either the Semaglutide or the Tirzepatide. We also have an oral version of Semaglutide that are lozenges. That's another option. But anyway, they sign up for the subscription and then they're automatically charged every 28 days. We ship out the medication to 'em every time they're charged. We ship it to 'em as four prefilled syringes, not as a vial, so they don't have to figure out how to pull it up out of the vial. And then each month they get the next higher dose, what the regimen is for the name brand drugs. So I hope I clarified it. Each one of those descriptions every step of the way, we found a way to make it as easy as possible for the patient. 

Eva Sheie (21:48):
Yeah.

Dr. Kaplan (21:48):
So that as much of that can be done online, that they're not having to call and like, Hey, let me give you a new credit card. If their credit card fails, they have a way to go to the website and update their credit card. They don't have to. And even better, we don't have to keep all the credit cards on, won't fall in our office, which is a huge security risk, and we're not having to manually charge them each month either. 

Eva Sheie (22:06):
The wildcard in here is really LabCorp. You can't control what happens at LabCorp very well. Every time I go to the lab, their computer's down, and I'm always like, how come I'm only here on the day that computer's down? 

Dr. Kaplan (22:19):
I know. That's interesting. That's a good point. Well, the other option we do provide for patients who live nearby, we're taking care of patients in Hawaii, California, Arizona, and Florida, is that if they are local, they can come into the office and we can just draw their blood and weed, walk down the hall to LabCorp. So that's the other way we can do it. 

Eva Sheie (22:37):
Oh, that's nice. 

Dr. Kaplan (22:38):
Yeah, luckily our weight management program coordinator is also a phlebotomist. I mean, he's a nurse, but he's also a phlebotomist. So he's pretty good. And we also have a nurse practitioner, so if he can't get the blood draw, the nurse practitioner or a rockstar Iraqi war veteran can get the blood. 

Eva Sheie (22:53):
Your team sounds like they are stacked. Tell me about the people in your office. 

Dr. Kaplan (22:58):
So we've had great individual employees throughout the 10 years I've been here, different people and maybe they moved out of the state, so we lost them, but this is the first time where the entire team was just incredible. We have two really smart people at the front desk that are not going to be here forever. One's going to go to med school eventually one's going to go to PA school eventually, but we have two great people at the front desk. We have the nurse practitioner, and then we have the nurse who's our weight management program coordinator who also can double as a phlebotomist, who can also triple as the recovery room nurse as well. So we're lucky we're in a good place right now and I don't take it for granted, and I've tried to appreciate it as much as possible in this moment while it lasts. 

Eva Sheie (23:41):
Now, your wife used to work in the office too. Does she still do that sometimes or not really? 

Dr. Kaplan (23:46):
Kelsey actually really never worked in the office. She was always kind of helping out with social media and marketing, which didn't necessarily require to be at the office. Maybe if there was like we were short staffed early on in the 10 years we were short staffed. Somebody called in sick, maybe she'd come and answer the phones or something, but definitely nothing consistent at all. But she's still doing her social media influencer thing where she's doing collaborations with different clothing and shoe brands that she posts on Instagram. And now that we have a two and a half year old, she's dressing him really cute and so do a lot of collaborations on his behalf as well. 

Eva Sheie (24:19):
Oh yeah. Any favorite brands or do I need to go look? 

Dr. Kaplan (24:22):
Well, specifically for the children, it's actually really hard to find matching clothes for the father and the son or the mother and the daughter. And so she's found a lot of that through Zara and Hatley and Flowers. What's his first name? It's like beach wear, and they actually make a lot of it out of Columbia, but I forget his name. Jimmy Flowers. Jeremy Flowers, something Flowers. Those are a couple brands that she orders a lot from. Not Gap or Gap Kids, unfortunately, they don't have as much as what she's looking for, but Zara is really big one and Hatley is another one. 

Eva Sheie (24:56):
Yeah, you'd think there'd be more of a market for daddy and me matching clothes, but there just really isn't. Would you wear it?

Dr. Kaplan (25:03):
Maybe that's something we'll work on. I wear it all. I love matching Emilio. It's so cute. It's so much fun matching, whether it's the shorts or the shirt. I mean, when we went to Italy recently, I mean we had matching swim trunks or matching shirts. And for example, I had a white linen shirt. He had a white linen shirt. I had some lemon shorts. He had some lemon shorts. But the difference is he would wear his linen shirt fully open. I did not.

Eva Sheie (25:36):
<laugh>Your stylist would not allow you to just go all in on the matching. Yeah, that's great. 

Dr. Kaplan (25:42):
No, no, no. But I all Kelsey, she does a great job. Yeah. 

Eva Sheie (25:45):
Oh, that's so fun. Well, I'll make sure that I put both her and your handles in the show notes so that if anybody wants to look at what she's doing, we can see that. 

Dr. Kaplan (25:54):
Oh yeah. Great. Yeah. Kelsey Kaplan fashion. Yeah, it's a good feed. I think she's going to incorporate more pictures with her and Emilio in it just because he's so cute. And I'm not saying they necessarily match, but their clothing certainly 

Eva Sheie (26:07):
Coordinated. 

Dr. Kaplan (26:08):
Coordinates. 

Eva Sheie (26:08):
Yeah. What do you see coming in the future? Where do you want to go? You're always doing something new and interesting, and it's always patient focused. So tell me a little more about where you're headed. 

Dr. Kaplan (26:22):
Well, certainly because our weight management program has been successful in our practice, we are offering that and onboarding that in other practices. They can use the platform for patients to be able to go and check pricing, purchase the consult to the program or sign up for the subscriptions. So we're definitely expanding that to other practices to use that. And we're also providing consulting services to other practice because there is sometimes a shortage of compounding pharmacies that have these medications available. Especially it's tough in California, they're a little bit more restrictive. So that's one of the things we're always searching and finding new compounding pharmacies and providing that information to our doctors so that they can prescribe to patients and order the medication from the compounding pharmacy. So that's a big expansion of we're providing this proof of concept to lots of other practices now and then all the automated charges go through the platform. 

(27:17)
And so we just try to make it as easy as possible for the doctor's office and offer any kind of blueprints for implementing a weight management program. So that's one thing. We're just going to continue expanding that and semaglutide tears appetite aren't going to be the last weight loss medications coming down the pipeline. There's a lot of other ones they're going to maybe be even better, or maybe they'll have more prolonged weight loss even after you stop the medication. So there's a lot of exciting things coming down the road. So I think it's cool because I've been doing plastic surgery now for 16 years and I love it. I still enjoy operating on the patients instant gratification, but there's only so many operations you can do in a week or a month, and that's what I love about weight management is that I'm treating over 400 patients now with my nurse practitioner. 

(28:04)
And so there's a lot more instant gratification because these medications really work. And now that we've had access to these medications for almost a year, I can really definitively see that. At first, I wasn't sure. How does it fit within the risk benefit ratio? Well, it's clear now. The benefits outweigh the risks so far and wide, even if the news wants to bring up any of the side effects, these medications class has been around for over 20 years, so anything the news brings up that's clickbaity, like, oh, stomach paralysis, that sounds scary, but it's also called delayed gastric emptying. It's something that they know about and it's actually a feature of the medication. It's how you lose weight. It's not a bug. So the news comes out with things that are like these so incendiary sounding, and it's like, yeah, we kind of know about that. 

(28:47)
But the risks of that are taking that to an extreme. The risks are very low. And so I can really count on one hand the number of patients that have quit our program because of the side effects. Most patients who quit, it's because they reach their goal weight. So it's just the point I'm making is lots of instant gratification with these patients losing weight. And also because this is a burgeoning field, it is stimulating my intellectual curiosity again, whereas plastic surgery, it starts to plateau after you've been doing it for 16 years. As far as that intellectual stimulation, this new burgeoning field is just fascinating. So there's so much to learn and it's fascinating to see all the new, because I'm not an obesity medicine expert. Don't say I am, haven't done a fellowship in it, but all the new things coming out, I'm learning that at the same time as the obesity medicine expert. So it's not like they know something that I don't. When it comes to the new developments, I mean, it's new data, it's new research I'm keeping up on.  

Eva Sheie (29:45):
It is really exciting. 

Dr. Kaplan (29:46):
So maybe they know the metabolic pathways in the brain and they can quote different compound neurotransmitters in the brain better than I can, but I feel like I'm doing my best to educate myself on this whole process and we're seeing success. 

Eva Sheie (30:03):
It is really exciting, and I don't think any of us ever thought it would happen in our lifetimes. It was like the thing that 

Dr. Kaplan (30:12):
It's amazing. 

Eva Sheie (30:12):
Just seemed so, so, so out of reach and all the attempts at medication to help with that in the past were such poor, they just didn't work well or they just were bad. Like you said, phentermine at the beginning. Nobody wants to go on phentermine. 

Dr. Kaplan (30:30):
Yeah, people talk about the HGH program. It does work, I think, but for short periods of time because it becomes really restrictive as far as the diet. So it's just hard to maintain where once per week shot or a daily lozenge, a daily pill, people can do that. And the thing that's interesting is that right now there's definitely, it's taboo the way it used to be taboo to get Botox, people kept that a secret. So nobody's talking about to throw weight loss injections, but eventually it's going to become less taboo and people are going to, they're not going to feel like they have to stop and then just resort to diet and excess. People are going to realize that, okay, maybe I don't have to take the shot every week. Maybe I can take it every 10 days, every 14 days, and people are going to start to just use it as maintenance for the rest of their life. 

(31:14)
You're going to have to do something for the rest of your life. It's either going to have to be diet and exercise that works, or it's going to be these medications because we're not always just doing it to be skinnier, but if you can reduce your visceral fat, the fat that's on the inside around your intestines, you're reducing your cardiac risk. And these medications have already been shown to reduce cardiac risk, risk of stroke, heart attack. So it's like, why would I not take this if you're telling me that it would make me healthier and reduce these things, so if I do live longer, I'll be able to live a healthier lifestyle as opposed to being miserable and short of breath all the time. 

Eva Sheie (31:49):
There's two mental health pieces to this that no one talks about, especially the news. I've never seen the news mention this, that what you realize very quickly is the food noise in your head is almost instantly gone. And when you don't a skinny person and you don't know what food noise is, you would, if someone turned that on for you as a skinny person, you would go absolutely insane. It would make you into, you'd have to check yourself into a mental hospital. When the food noise goes away, your life changes. There's room in your mind for other things because you're not thinking about, I'm eating too much, I'm not eating enough, I'm not eating enough protein. If I eat this, it's going to ruin my week. It's going to take me four weeks to lose this pound if I gain this pound today. Maybe speaking from a little bit of personal here. And then the other mental health piece is what happens as you go through it and start feeling better and looking better and getting compliments is that starts to change your life too. So between those two things, I actually think those are better benefits than the weight loss itself is the mental health part. 

Dr. Kaplan (32:58):
No question. I want to touch on those two, but also mention a few others that the first time I heard a patient describe food noise to me, it's almost a year ago now. I was like, oh, I totally know what you're talking about. I'm not necessarily qualified as obese, but I know what she's talking about as far as the food noise. It was such a fascinating concept, and I see what you're saying that if a skinny person, if you could turn on that food noise, let them experience what that feels like, it would drive them crazy. And the thing is, that's the thing is when you're not hungry, you don't go around thinking, I'm not hungry. It's like your head's not filled with thoughts of I'm not hungry. You aren't thinking about that and you're thinking about other things. And so when you turn off the food noise, you're no longer thinking about you don't go from thinking, I'm hungry to, I'm not hungry. You just go to not thinking about that and you're thinking about other things. 

Eva Sheie (33:47):
It's actually a Weight Watchers trick that I learned when I was like maybe 10 or 12 years old. All you have to do is imagine yourself after you've eaten, once you've eaten, you've forgot what you ate. There's like a mental trick for projecting yourself into the future where the food noise is gone. And I knew that one, but that doesn't make it go away. It just gives you a way to think about it. 

Dr. Kaplan (34:12):
Right, right. That's interesting. So yeah, that's what I tell patients that after the first shot, the food noise goes away most times. And then on average, we find that with semaglutide, there's like a seven and a half pound weight loss in the first month, 12 to 13 pounds over the first two months. And I can quote a bunch of numbers, but then it goes back to the Tirzepatide is one to three pound average weight loss over that. But yeah, so the food noise seems to go away almost immediately. And then as far as being thinner and happier and being able to fit into your clothes and not having to worry about can you fit into the seat on and coach on an airplane, I mean, those are a lot of really, really important things. That's not vanity, that's not you being selfish and things like that. 

(34:56)
The other thing I wanted to bring up was the mental aspect of these medications that they don't quite understand yet, but I've gotten so much feedback on it from social media that it is anecdotal, but it's just a lot of anecdotes that it is reducing people's OCD tendencies or any vices they have. These medications are reducing it so people are biting their nails less, their online shopping, less, they have a lesser craving for alcohol. We certainly know about the lesser craving for food, lesser craving for smoking or vaping, lesser craving for carbonated drinks. It's really amazing how, again, I guess it's probably all somewhere in the hypothalamus where it's reducing your appetite as well. But it is really is people are just starting to understand how amazing these medications are, because at first, again, the news is just trying to scare you. It's just too good to be true. 

(35:47)
But again, the medications have been around for, not Ozempic, Wegovy and Mojara, I'm not saying that, but the class of medications has been around for over 20 years for human use. So we really do know a lot about it. We certainly know a lot more about the long-term risk of these medications than we do know the long-term effects of the Covid vaccine. I'm not saying that I'm vaccine hesitant. I got my covid vaccines and my boosters and everything, but I mean, if we're going to have a logical conversation, there's more years of data behind these medications then there are of the Covid vaccine. 

Eva Sheie (36:19):
Yeah, there's lots of things on the market that there's less data for. 

Dr. Kaplan (36:24):
Oh, for sure. And that was one of the things that I drew, I made a graphic of it, is that the compounding pharmacies can only make medications make the duplicates of these commercially available medications while the commercially available drugs are on the shortage list. So if they come off the shortage list, does that mean the compounding pharmacies can't make anymore? Well, I mean based on superficially, it seems like they would not be able to, but then I made this graphic that compared people who are eligible for these medications and then the number of people that are eligible for the Covid vaccine and the Covid vaccine, let's say all of America, three 30 million people are eligible for the Covid vaccine. Remember, that's one shot per year, and they had trouble keeping up with the demand when they first came out with them. But now a lot of people are covid vaccine hesitant, nobody's obesity shot hesitant. 

(37:10)
And then when you look at the number of people that are considered obese in America, 42%, and then you take into account the fact that they need a shot once per week, not once per year, and let's assume they take it for 52 weeks for a year, then that means the pharmaceutical companies are going to have to produce 7.2 billion, with a B, 7.2 billion syringes to accommodate everybody in America. And that doesn't even take into account the fact that it's not just 7.2 billion syringes, but everybody's on a different dosage because you increase your dosage each month. So that means you have to figure out the logistics of having the different dosages available for those 7.2 billion people. So 

Eva Sheie (37:48):
So you're saying we're not going to run out anytime soon? That's my point. I mean, we're not going to Yeah, 

Dr. Kaplan (37:53):
Yeah, they're not going to run out. They're not going to come off the shortage list anytime soon. And if you don't take my word for it or my math, well, early in September on CNN, the CEO of Novo Nordisk, the maker of Ozempic and Wegovy said it would take several years before they can meet the demand. 

Eva Sheie (38:09):
Oh, good. 

Dr. Kaplan (38:10):
That's what he said, so I'll take his word for it. 

Eva Sheie (38:13):
That is good news. Yeah. 

Dr. Kaplan (38:15):
Because obviously the benefit of the compounded version in case people don't understand, not only can you get the medication easier, and you don't have to go to a pharmacy to try and figure out do they have the stock or do they have the supply? Do they have my dosage I need? That's the beauty of the compounded version is the doctor can just ship it to your doorstep. So there's a convenience factor, and even though it's more convenient in contrast to a convenient store where everything's more expensive, in this case, the actual medications or compounding pharmaceutical are less expensive than the name brand drugs. 

Eva Sheie (38:47):
They are. This is one of my favorite topics. I feel like we could probably talk for another hour about it, but I know you have people to see. So if someone's listening today and they want to reach out and potentially come to see you for a consult or find out more about weight management, where should they go to look for more about you? 

Dr. Kaplan (39:06):
Yeah, it's very easy to get in touch with us. You can go to our website, which is kind of long, but it's easy to remember because I'm a plastic surgeon in Pacific Heights in San Francisco. The website is pacific heights plastic surgery.com. The other way you could get to the website is if you follow me on social media or want to follow me on social media, my Instagram, TikTok and Snapchat handle is Real Dr. Bae, I'm in the San Francisco Bay area, but it's R-E-A-L-D-R-B-A-E, not BAY, like your Boo or your bay. So real, dr bae.com or real Dr. Bae on any of those social media channels. We talk a lot about weight management on all of the social media channels, so that's easy way to get in touch with us. But if you have a pen in hand, you can write down our phone number 415-923-3005. 415-923-3005. And all you have to do is send a text and the conversation will go from there. 

Eva Sheie (40:06):
So easy. Like everything you do, 

Dr. Kaplan (40:08):
Try to be. 

Eva Sheie (40:09):
Thank you, Dr. Kaplan. It's so nice talking to you today. 

Dr. Kaplan (40:12):
Great talking to you. Thanks so much for having me. 

Eva Sheie (40:18):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s .io.