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's 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 name is Eva Sheie, and my guest is Dr. Michael Baumholtz. He's a plastic and general surgeon based in San Antonio. Welcome to the podcast. 

Dr. Baumholtz (00:43):
Thank you for having me. What a treat to be here. 

Eva Sheie (00:46):
So you're right down the street from me. You're in San Antonio. It's such a funny market, I think in the sense that you, San Antonio surgeons are really laid back and low key and I don't see a lot of crazy stuff coming out of San Antonio. Do you think that's accurate? 

Dr. Baumholtz (01:03):
It's interesting. So I'm an east coaster, born in Philadelphia, and as you said a minute ago, got to Texas as soon as I could. For the seventh largest city in the US, we have a surprisingly small plastic surgery community. For better or worse, I'm currently the president of our San Antonio International Plastic Surgery Society. There may be 50 to 70 plastic surgeons in San Antonio. That number gets a little bit bigger in terms of overlapping specialties like oral surgery, ocular plastics, those kinds of things. But when I was in Philadelphia, we had, and certainly my friends in New York City, they were buildings where you could have 15 or 20 or more plastic surgeons in one location and then go another mile down the road and have the same thing. In fact, when I was deciding as I transitioned out of academics and I was debating whether to come back here where I had finished my training in San Antonio and then went back to Philly where I was from, and we'll get into that in a minute, but the local hospitals, one had 30 plastic surgeons on staff and you go five miles down the road and that one had 25 and you go another five miles and that one had 35. 

(02:06)
I think you find a diverse group of plastic surgeons in San Antonio. It nicely represented across what represents San Antonio in terms of the makeups, men and women, different flavors and varieties. And I think that's great because I think finding a plastic surgeon has a lot to do with, I mean, aside from the basics, I'm sure we're going to cover about credentialing and experience and all that, but it also has to do with the fit. Do you like your surgeon? Can you communicate well with them? And I think more and more it's important that there's some shared experiences for that to happen. 

Eva Sheie (02:37):
So have you always been in solo practice or did you ever work in a group? 

Dr. Baumholtz (02:41):
Well, so when I came out of academics, I came back to San Antonio and so I did all general surgery and I went and did hand and microsurgery for adults and children at Baylor down the street in Houston. And then I came here to San Antonio and did plastics and pediatric plastics. And then I went back to Philadelphia. My then wife had time to get a job, and I spent four years splitting my time between Temple University for adults and the Shriners Hospital for Children. And I had an awesome practice. I mean, the weirder the better. We really focused on super high complexity cases and it was great. I just never saw my own children awake and so made the decision to leave academics. And my ex-wife and I both really liked San Antonio when we were here and we came back and I joined a friend from residency and we were together for about four years. And then most marriages, business or otherwise, we went our separate ways. And so I've been on my own ever since. And so I split my time now between my commitment to the VA and what I do in my private practice. 

Eva Sheie (03:42):
Geographically speaking, what part of San Antonio are you in? 

Dr. Baumholtz (03:46):
Well, San Antonio is a series of loops. Four 10 is the inter loop, 1604 is the outer loop. 46 is about to be completed as the outer outer loop. And then Camp Bullis, the major military base splits San Antonio, and 10 is on one side of it, and 2 81 is on the other side of it. And so the residential community of San Antonio exists sort of in between that as it arcs out in a way. And so I'm between the first and second loop, sort of between 10 and 2 81 right in the middle. 

Eva Sheie (04:15):
Well, and those loops really make it easy to get around town no matter what part you're in, right?

Dr. Baumholtz (04:20):
You haven't visited in some time. Oh four has been under construction this summer and it's still nothing like east coast traffic or Houston traffic, but San Antonio is really getting its first taste of congestion and sustained congestion. Really almost doesn't matter what hour of the day you're out and about, you're going to get to sit for a little while. 

Eva Sheie (04:39):
Yeah, well, at least there's good podcasts to listen to when you're in the car. 

Dr. Baumholtz (04:45):
Hopefully this will be one of them. 

Eva Sheie (04:46):
No shortage. There is no shortage of podcasts to hear. 

Dr. Baumholtz (04:50):
Well, good. 

Eva Sheie (04:51):
So what are the patients like in San Antonio? What kinds of people do you find coming to see you? 

Dr. Baumholtz (04:57):
Yeah, for the most part, there is some segmentation of the practices. My practice is made up mostly of, I'm fortunate, I see a lot of family members of physicians. I see a lot of attorneys, professional folks, and then just everyday moms and regular folks because I like to look after revision surgery. I like to look after complexity. I like to take on some of the cases that maybe some of the folks in town don't like to do, not because I've got the crystal ball to different things. I've just been at this for a while and complexity and untangling those kinds of things. And so on any given day, it'll be a police woman or a military person and then a school teacher and then a physician or physician's child and everything in between. 

Eva Sheie (05:43):
So you've built a reputation for yourself as the guy who likes the challenge around town. 

Dr. Baumholtz (05:49):
I think that'd be a nice way to put it. But I mean, I think for the most part, you train as long as I did and you do as many different things and you sort of build that base of experience. It allows you to look in on things that maybe somebody else doesn't want to. Sure. The first timers are great. I love the first timers. I will often approach the first timers with information that I think that they should know as if they're going to be in somebody's office someday. And for most plastic surgeries, they will be in somebody's office someday talking about, okay, what's next or what comes, because while we can turn back the clock, we never actually stop it. Hopefully. 

Eva Sheie (06:22):
So true. Are there any recent cases you can kind of describe in terms of these challenges or complexities that have come your way? I think we love to hear stories, and I wonder if you have any. 

Dr. Baumholtz (06:35):
Yeah, I mean a lot of times what we'll see is a gal who in her earlier years may have had children and then got a breast augmentation, was probably on the fence for needing a lift at that point. And then along the way in the next decade, got another now even bigger implant. And this process repeats because there are both surgeons and patients that don't like the idea of lifts. And so they get talked into increasingly larger implants, which has an anatomic impact. The skin gets thinned out, the tissues can't hold it. And so now you have someone with a very large implant, very thinned out skin. And so there are times, fortunately rarely, but there are times where you sort of take everything out. You got to let the tissues heal. Well, that's a tough consultation and then start from scratch. Other times it's a matter of downsizing them, providing some sort of internal support and internal bra or mesh and then reshaping the skin around it. 

(07:27)
And that's a pretty common common thing we see on the reconstructive side. Fortunate to get involved in different congenital breast differences, tubus breasts is probably the most common. That's where typically the inferior aspect of the breast doesn't develop and the breast tissue herniates or protrudes into the areola around tight rings. And so they're challenging to open up the rings and then to get that tissue to resettle. And I think that the biggest challenge across the board in plastic surgery, whether it's aesthetic or reconstructive, is managing patient's expectations. You're reconstructing trauma patient, it's never going to be the same. We're going to do our best to make it as good as it possibly can be. Here are the limitations, and social media is a poor representation of reality. And for some people that is a very hard message to get across. In fact, a little bit far field. 

(08:20)
I don't know why, but there were some students from there, ut San Antonio, they were in the journalism project, and somehow I got picked to get interviewed and they came and they said, well, what's been the most incredible advance in my practice lifetime? And then what's been the most negative thing in my practice lifetime? And the answer to both is social media without a doubt. And what do you mean? Well, on the one hand, social media has absolutely normalized the conversation about aesthetic surgery. So at once was whispered or you'd have a separate entrance in your practice, whatever it might be is now you to the restaurants and you'll see someone in a facelift dressing or you name it, it's out there. Everybody's talking about the procedures and whatnot they've had done. Okay. On the other hand, it has absolutely created a tidal wave of unrealistic expectations. 

(09:08)
So people look and they don't look critically because they were not trained to look critically. I can have the same person and I haven't photoshopped anything, but if I hold the light a little bit differently, if I hold the camera a little bit differently, if where it bounces off their skins a little bit different, boy those pictures can look like I'm a much better surgeon than I really am. And I think the other aspect is people will bring us pictures and we'll say, I want to look like this. He said, well, that's just not possible. Well, Dr So-and-so said he or she could do it. I said, well, great. Can I call you a cab? Because it's hard. But I know you asked another surgeon, what's the ideal patient? And forgive me for still on that question from them. But the ideal patient is really somebody that gets it. 

(09:52)
Someone that comes with an open mind. They say, this is what I don't like, or this is what I'd like to see changed. And then we talk through the realities, Hey, you've had four kids or you had a gastric bypass and you lost 180 pounds, and your skin is taffy at a good day. And so talking through realistic expectations with reasonable people is a joy. However complex the case is, I'm having a good time talking through cases with patients where they come in with preconceived ideas, not only about what they want done, but how it's to be done all the way down to including, I've had people tell me what suture material am I going to use? And that part of the day is kind of exhausting. And despite being from Philadelphia, I do my level best to maintain some neutrality, although my friends will often joke that I don't need a mood ring, I just have a face. But that's kind of been one of the, I 

Eva Sheie (10:42):
Think we probably have the same friends then. 

Dr. Baumholtz (10:45):
That's really been the challenge. And there's a fabulous little book called The Death of Expertise, and this is something I'm fairly passionate about. I'm part of a group called the Physicians for Patient Protection. I really think that in the face of social media, we have absolutely abandoned what we valued about experts and expertise. It used to be that the experts had access to a certain knowledge set or database that maybe not everybody could have access to. That was part of the expertise. And this is what the man argues in this book, in the modern era, everybody has access to almost the same dataset. I mean, Google Chat, G B T, all that kind of stuff. Everyone can access this. But what people aren't trained to do and what they don't do, they don't think critically about it. They don't put it in the context. And we see people all the time that practice, like my third and fourth year medical students that I still interact with, where it's what's called experiential medicine. 

(11:36)
They've seen it once. And so therefore, this must be the rule as opposed to we look at the literature, we say, okay, here's what happens across the population. And I don't know how we swing the pendulum back the other way. I really don't. I mean, I do have some concerns about modern medicine as we replace many, many physicians with non-doctors, I, there's a real danger there. And that's a topic for a different day. And we're seeing it more and more in aesthetics because the allure of the cash patient has drawn in so many non-plastic surgeons into this arena. And I think the average person has no idea who's giving them the treatment. What are the risks of the treatment? If heaven forbid there's a complication, who's managing that? Who's going to care for them? These are all questions that I would want to ask, but that's been replaced with, well, Susie or Sammy or Steve, whatever it is, they've got 150,000 Instagram followers. They must be the expert. And I don't know how we fight against that. 

Eva Sheie (12:31):
I represent the voice of the patient a lot because I'm in this seat of what I think is great privilege to talk to doctors all the time and ask these kinds of questions. So I take that seriously. And I think what I've started seeing just anecdotally from my own experience is if I'm reading about a health topic, then it seems like all I see is negative signal. And so my perception starts to get skewed and think that, well, if I've seen this much bad, the whole thing must be bad. But maybe it's like only people who are having a bad experience are going on the internet and complaining about it. And the other 99.5% of them are just going about their day being happy. 

Dr. Baumholtz (13:18):
In Gary Vaynerchuk's book, the Thank You Economy, you're much more likely to hear from your unhappy customer or patient than you are from your happy ones. And we joke when residents ask about transitioning from the reconstructive side to the aesthetic side, first I tell them, you want to be a really good aesthetic surgeon? Be a really, really good reconstructive surgeon. You got to know your blood supply. You got to know your anatomy. You got how tissues move. You got to know how to deal with scar tissue. You want to be a really good reconstructive surgeon, be a good aesthetic surgeon. Then it really does matter where you put your incisions and those kinds of stuff. But I jokingly will tell them that if your patient really, really loves you, she'll tell one girlfriend. And if she doesn't, she's telling Facebook. And you kind of have to get used to that. 

(13:57)
I mean, I can remember when it used to be called Angie's List, but I remember when they first started, I remember when they first started to review doctors in 2006, 2007 roughly, and I canceled my subscription because I thought it was the most insane thing that nonmedical people were rating doctors. And more to the point, the doctor couldn't even respond and say, well, maybe the bad outcome had to do with the fact that you're significantly morbidly obese and you have diabetes and you smoke, and there are some fundamental realities here that you don't want to face. Doesn't make me a bad doctor. Are you a bad person? But there are still fundamental realities, and I think that's what we've really, really lost sight of, especially in hospital medicine and other parts. But I'm so glad to hear that you're out there speaking for patients, advocating for them, clarifying, educating, teaching, I think is fundamental to you want to be a really good plastic surgeon. You have to love teaching, at least I do. One of the great sadnesses for me leaving Temple in the shrine was that I wasn't a full-time academic appointment. So I have an appointment at ut. I'm an adjunct professor there, and I stay with the VA because I still get to teach residents, and that's super exciting. A resident that comes and wants to learn, they come prepared. Of course, we jokingly say in the modern era, even a little bit prepared, it is a joy. You feel energized. 

Eva Sheie (15:17):
How much of your day or how much of your week is spent teaching then now? 

Dr. Baumholtz (15:22):
So I recently switched from two full days to now one day. So every Monday, but also I do try to participate in their teaching conferences. I've been very, very pleased to serve as an examiner from time to time for the American Board of Plastic Surgery. That's really one of the highlights. I'm very involved in the Texas Society of Plastic Surgery. So I do think that giving back to the specialty is not just lip service, but it's really fundamentally something that is important because this is the generation that hopefully is going to take care of us when we're older, older, older. 

Eva Sheie (15:54):
Yeah. You're painting a really interesting picture of where you go and what you do every week. So when it's not Monday, what does the rest of your week look like? 

Dr. Baumholtz (16:05):
Yeah, there was a time in my life, I had surgery days and I had clinic days, and now I just have days, and that's okay. So this morning did a fabulous tummy tuck, lovely, lovely woman, and then came here, saw patients get to do this, have some interviews to do later this evening for some things. And it's just rarely, if ever the same day twice. And I think that's what makes it fun. I think one of the things that drew me to plastic surgery, well, there was actually a couple of things. When I went into general surgery, I was convinced I was going to do a trauma. I was absolutely convinced I was going to be a trauma surgeon. And those who know me, especially in the reconstructive world, I still sort of approach it as if I'm a trauma surgeon because that's just the way my brain thinks about things. 

(16:47)
And then what's the worst thing that's going to happen here? Let's plan for the worst and let's hope for the best. I think that's kept me and my patients as much out of harm's way as possible. But when I was at York Hospital in York, Pennsylvania, now not so small little town in central Pennsylvania, and the hospital was this enormous community hospital and had seven plastic surgeons on staff, which is bananas. And they all appeared to love what they do, and they were the doctor's doctors. So if neurosurgery couldn't get the head closed or CT surgery, couldn't get the chest closed or orthopedics needed help with the knee or whatever it was, they would call plastics. And I thought, man, this is great. And you really had a chance to be a general surgeon in the sense that from kids cleft care, cranial facial care, all the way up to near the end of life pressure sores and the like, you could be involved in this really very sacred position. 

(17:39)
And I don't say that lightly because I mean, I jokingly tell my patients all the time, I don't take me seriously, but I take my work very seriously. It is a privilege to be part of their lives, especially you're seeing people sort of at low points of their life and you get a backstage pass to what's going on. I mean, every aesthetic patient that walks in the door within a few minutes, they've got their clothes off, they're totally vulnerable, and you have to appreciate that role, and you have to be approachable. You have to be personable. That's not the time to be cold and standoffish. And so I try to make a little humor in there so that people do feel a little more at ease. Some days it works and some it doesn't. 

Eva Sheie (18:13):
Yes, I can relate to that too because most of the time my jokes don't land at all. Well, sometimes they do. I'll keep trying. 

Dr. Baumholtz (18:21):
Yes. That's all we can do next. Keep trying. 

Eva Sheie (18:24):
Yeah. In the data, the key driver of choosing a surgeon as the surgeon made me feel comfortable. So that's sort of my guiding principle around everything that we build and do and work is if I can translate you making someone feel comfortable to the internet, then I've done my job well.

Dr. Baumholtz (18:41):
Wonderful. People ask me all the time, what should I look for? I'll get family members to call and people from out of state, wherever, who should I go see? Or how do I know? And I say, well, first of all, let's start with this is the person board certified in the field of interest? So in this case, we're talking about board certified plastic surgeon. Not to be confused whether a board certified cosmetic surgeon, I know other guests of yours have mentioned that. I'll just mention it, that they are not the same. And that's a topic for a different day unless you want to come back to it. But are they board certified in the field of interest plastic surgery next? Have they done enough of the procedure to be comfortable? I don't care what that number is. I mean, in training, believe it or not, that number is typically between three to five. 

(19:21)
And then if you get into some of the things that we used to do at the Shriners Hospital, people would go their whole careers and not see three to five of some of these things that we saw pretty regularly. So I really got to see some pretty unusual things with the training. But it's okay, are they board certified? Have they done enough of this to be comfortable? Have they seen enough of the complications to know how to manage them, and are they comfortable with that? If you've got those three, that really puts you light years ahead of picking the right surgeon, you can then get into, well, are they members of A S P S or asaps? That's a little bit of a stamp of approval. By definition, if you're a member of A S P S, you've passed your boards, or at least you're on your way to passing your boards, asaps, you've passed them and now you've demonstrated a certain level of volume of aesthetic surgery. 

(20:05)
And then is do you connect with them if heaven forbid there's a complication of some kind, is this someone you're comfortable interacting with at two in the morning? If you can't, I tell patients all the time, if we can't communicate effectively by bright light of day, there is no way I'm able to shepherd you through some problem in the middle of the night, but one of us knows what we're doing and you're going to have to trust me, then I'm going to get you through this as safely as I can, but I need you to trust me. We can't establish that early on. Then I tell them maybe somebody else is better suited for them, not in a negative dismissive way, but really looking out for them and what works in that connection because it is a big deal. I mean, people are choosing to reach into their pocket and spend some ridiculous amount of money to have something done that is a want, not a need. 

(20:48)
And I think the bar has to be set much, much higher than in our reconstructive world where, I mean, if you get a free flap for my, I used to do a lot more microsurgery, and so if any of my micro friends are listening, please turn the mic off for the moment. But if you do a free flap and you get it 85%, right, you're patting yourself on the back depending on what kind of case. But if you do a facelift and you get it 85%, right, you are having a bad day, it's not good. 

Eva Sheie (21:15):
Yeah. I spent two years doing a breast cancer podcast, and I discovered that from the patient side too, that the standards are not quite the same as an aesthetics, but the patient isn't necessarily looking for perfection either. Their perspective is different too, and it is very different. 

Dr. Baumholtz (21:35):
There's also a difference here. On the one hand, you have a person who has cancer or trauma or whatever it is, there tissues are injured or traumatized. You are catching them wherever they are in the arc of their life when this problem arises versus you are choosing when to do something that puts a big hit. And so for me, we turn down a fair number of patients because while I think they're going to be good candidates, they're just not good candidates today. And I say to all them, look, you're going to find someone who's going to want to cash your check today. That's just not me because I'm more interested in you than I am in that. Some of them come back and some go on to somebody else, and sometimes I see them later for revision and sometimes I don't. That's all okay. I don't like to practice with the mentality that I'm getting away with it as opposed to here, we've planned for this and this is how it worked out. 

Eva Sheie (22:23):
It's very well said. Let's talk about who you are when you're not at work. 

Dr. Baumholtz (22:29):
Sadly, for those around me the same. I've got two children, a 16 year old, a 12 year old, and then I've got three furry children. So I've got three full-sized German shepherds. My house is turned into a German Shepherd nursing home. It's great. I mean, the timelines don't match up, but someday I'd like to come back as one of my shepherds. They live a pretty charmed life. I grew up around the restaurant business, what my parents did, and so I like to cook. Teaching my kids to cook. The 16 year old is getting a little more interested in now that he's dating. And so, believe it or not, I was an English major in college. I like to read. I try to alternate a fiction book and a non-fiction book. I wish I read more in the modern era. Life just sort of gets faster. My son expressed an interest in guitar, and so we were trying some guitar lessons, but boy, that's a skill set that is thus escaping me. And that's about it. I mean, the days just sort of fly by. 

Eva Sheie (23:22):
Yeah, they sure do. 

Dr. Baumholtz (23:23):
But in my practice at least, it's just me. We don't have an answering service. If someone's having a problem at night, you call the office and it just rings my phone. I say, well, don't want answering service. It delays the time that we're going to end up talking to each other. And I encourage people to call. I mean, I can think of maybe three times in all of these years where someone's ever really taken advantage of it. One was when I was in Philly, I used to get these calls at night from one of the prisons, and the first time was I had never gotten a call from a prisoner. I dunno if you ever have. It's an interesting way that the call is introduced. That's kind of fun. And then from then on, I would just morbid curiosity as to what this person was going to say, always at two in the morning and finally was like, you're kind of waking me up here. Let's stop that. 

Eva Sheie (24:06):
Well, how did they get your number? 

Dr. Baumholtz (24:08):
Because from the time I left residency, I've never had a problem giving out my number to people. If they're having a problem, I'd rather hear about it and try to help them answer questions, something, keep them out of the emergency room if we can. So the bigger the institution, sometimes the harder it is to actually find the doctor that helped you. That's certainly how it was at Temple. And so I had no problem handing out my number and still do. And the only reason I have people call the office is because, believe it or not, most of my house is in a dead zone. And so if they just use my cell, there's a better than average chance that I don't get it. But when you call the office, it triggers a text, an email, and then the phone call. So it sort of makes sure I get tracked down. 

Eva Sheie (24:49):
Oh, that's nice. You told me earlier you are not the foodie, but the foodie in your family. 

Dr. Baumholtz (24:55):
I like to cook and bake, and if my internist is hopefully not listening during Covid, my daughter and I, we went through, we did a candy phase, we did an ice cream phase. Oh, fun. We did all these different things. I like building things, whether it's a bookcase or just something simple around the house. It doesn't look like much. That's often debatable whether I did it or my kids did it, but they probably would do a better job. But it's just doing something with your hands and just sort of disconnecting for a little while just makes it fun. And so I keep myself busy with those kinds of things and very few dull days. 

Eva Sheie (25:33):
That is a nice place to be. If someone's listening today and they want to come see you in person or you want to reach out for more information, where should they look for you online? 

Dr. Baumholtz (25:44):
Easy. Baumholtz plastic surgery, B as in boy, A U M as in Mary, H O L T Z, Baumholtz plastic surgery. The email for the office is just info@bplasticsurgery.com. And the office number is 2 1 0 8 8 0 3 7 0 8. And we're in Shavano Park, which is again, central San Antonio. 

Eva Sheie (26:08):
Thank you so much for sharing yourself with us today, Dr. Baumholtz. It was a pleasure. 

Dr. Baumholtz (26:12):
I had fun. Thank you for having me. It really is a very good thing what you're doing. 

Eva Sheie (26:17):
Thank you. 

Dr. Baumholtz (26:17):
And I'm sure your audience appreciates the introduction to the different surgeons. I read the background story about the idea of trying to get people introduced to them before they even come in. What a fabulous idea. So thank you very much and best wishes. 

Eva Sheie (26:31):
Oh, thanks. I appreciate that. 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.