Dr. Emilio M. Justo Of The Arizona Eye Institute & Cosmetic Laser Center On 5 Things You Need To Know To Create a Highly Successful Private Practice

An Interview With Jake Frankel

Be a leader and not a follower……do not be afraid to take a stand on a position and push towards your goal, even if others around you may say “Are you crazy? That will never work!” Do your research first, put together at least some sort of rudimentary business plan (although I never took a single business course in my education), identify a goal, then create your strategy and then stay on course following your vision. It is OK to make adjustments along the way as you have small failures, but always have your primary long-term goal imprinted at the forefront of your mind.

As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Emilio M. Justo, M.D.

Dr. Emilio Justo is the Founder and Medical Director of the Arizona Eye Institute & Cosmetic Laser Center, with offices in Sun City West, Sun City and Wickenburg, Arizona. Since 1989, Dr. Justo has been one of the Phoenix area’s premier ophthalmologists and cosmetic surgeons, specializing in laser-assisted refractive cataract surgery and CO2 laser blepharoplasty. In addition to his professional medical accolades, Dr. Emilio Justo is also a two-time international TEDx speaker with the #3 most-watched global TEDx video in 2023.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?

My journey is a rather unique journey in that I came to the United States at the age of 3 as a Cuban refugee fleeing Fidel Castro’s communist regime. I grew up from kindergarten through 4th grade within the Tarkio College campus in Tarkio, Missouri, followed by growing up from 5th through 12th grade in Crown Point, Indiana just outside Chicago. Being an immigrant with an “education first” mentality, I worked extremely diligently in high school and became Valedictorian of Andrean High School’s graduating class of 1979. I was furthermore extremely blessed and fortunate to be one of ten nationwide out-of-state applicants accepted into the University of Michigan’s prestigious six-year pre-medical/medical program, thus allowing me to graduate with my M.D. degree at the age of 23. I then pursued my ophthalmology residency at the Washington Hospital Center/Washington National Eye Center in Washington, D.C. and finished residency at the age of 27 at which time I decided I wanted to pursue my career in the sunshine and palm trees of the Phoenix, Arizona metropolitan area. I have been in Arizona ever since and have practiced ophthalmology and cosmetic surgery for over 35 years.

I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?

I would say that my biggest mentor has been my “life mentor”, that is, my father. I have always adored and respected my father for being courageous enough to lead my family’s escape from Cuba. Without a penny to his name and without knowing the English language, he and my mother navigated the treacherous journey from Cuba to Mexico and ultimately into the United States in search of freedom and limitless opportunities. My father worked two full-time jobs for the first seven years in the U.S. and saved aggressively to give our family the opportunity to purchase our own home when I was in 5th grade. His conservative philosophy and one of perseverance, resilience and determination helped shape who I am today. Although I am extremely blessed and grateful for having two parents who were ideal role models for me, and taught me how to navigate life independently at a young age, my father has been my biggest mentor simply by example and showing me how to become mature early in life. Unfortunately, my father passed away relatively young in 1995 so he was not able to witness all of my professional and personal achievements but I am sure he is looking down from heaven with a big smile on his face!

What made you want to start your own practice? Can you tell us the story of how you started it?

As I finished residency, my goal was to either start my own ophthalmology practice or else seek partnership with an established ophthalmologist. I did not simply want to be an employee throughout my career. When visiting and interviewing with various ophthalmologists in the greater Phoenix area (some of whom were looking for an associate while other were ready or close to retirement), I met an older, well-established ophthalmologist by the name of Scott Skinner, M.D. Dr. Skinner had been looking for 5 years for a young ophthalmologist to join him so he could start slowing down and eventually retire and sell his practice. However, Dr. Skinner told me he had not found the “right fit” of someone he admired and trusted. Dr. Skinner and I hit it off, and we developed a 5-year plan whereby each year I would buy into his practice gradually such that by the end of the 5th year I would take over fully and he would retire. Since life is full of unexpected surprises, within two weeks of me joining Dr. Skinner as a new ophthalmologist employee, he developed an acute medical illness which would ultimately jeopardize his career and his life. Dr. Skinner knew that he had to fast-pace his retirement plans accordingly so we both worked diligently such that I fully purchased and acquired his practice within 5 months of joining him, at which time Dr. Skinner retired. Unfortunately, his medical condition became grave and unrelenting and he succumbed to his disease a few months after retirement. Given my relative youth and inexperience at the age of 27 with the business side of medicine, I was soon on my own learning to tackle my own challenges and being taught by “the school of hard knocks”.

Can you share the most interesting story that happened to you since you began your career?

To me one of the most interesting stories was at the very beginning when the former owner of the practice, Dr. Scott Skinner, and I were negotiating for me to purchase his practice relatively quickly after the acute onset of his grave medical condition. Even though one would think that because of his medical condition that Dr. Skinner would have been somewhat lenient and accommodating in helping me at age 27 purchase his practice, it was actually very challenging on many levels and quite a difficult negotiation, both because of purchase price and terms related to the acquisition. The initial game plan was for me to take over his existing employees as well as his medical office lease. Dr. Skinner would also keep his own accounts receivables. The main stumbling block was that I needed a $50,000 line of credit in order to manage payroll, rent and other miscellaneous expenses while I started collecting monies for my own services and my own accounts receivables. Well, in 1989 this was not as easy as one would think. I went to every major national and regional bank in the area asking for this line of credit, but because I did not have any personal collateral to pledge, every single bank denied me. Dr. Skinner of course wanted first position lien on all the medical equipment in the practice so I could not even offer the banks a primary lien to collateralize this line of credit. The months were slowly passing by and I truly thought that this practice acquisition was not going to come to fruition. My parents always tried to help me financially but being refugees and immigrants they did not have the funds either to assist me financially, so it was all up to me! At the 11th hour, I got a lead regarding a very small local bank just a couple of miles from the practice location known at the time as “Sun City Bank”. I met with the president of the bank, Marty Ganzel, and ultimately he decided to take a chance on me without the traditional collateral. I was forever grateful and became a loyal customer of Sun City Bank for many years until the bank was acquired by a large national bank. This to me is a story of not only conviction but also that there is a God looking out for me, and the power of prayer!

Because it is a “helping profession”, some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?

This is a great question because it is true that “old style” medicine back in 1989 was viewed as simply a “healing profession” and the talk or thought of making money was almost considered taboo. In addition, the thought of advertising publicly (e.g. external marketing) was also frowned upon by many physicians. I personally always felt that being ethical and placing the patient’s needs first while at the same time generating income were not competing interests. One can “walk and chew gum” simultaneously and the two viewpoints are not mutually exclusive. Early in my professional career, I did start advertising in local newspapers and there is no doubt that certain patients and physicians may have viewed this as a “cowboy” mentality, but this thought process gradually started shifting year by year, whereby ultimately I think I was viewed as an innovator or “thinking outside the box”.

Additionally, after 5 years of staying in the same rented medical office space that Dr. Skinner’s practice had created, in an effort to have patient continuity and familiarity so as to keep the majority of his existing patients after his retirement, I decided to do two major things that would ultimately change and shift my professional destiny. The first was to move out of this rented medical office space that really had no street visibility to drive-by traffic, and instead to purchase my own small building in a high traffic area nearby with outstanding visibility and signage. This was definitively stressful as now I had a mortgage payment in addition to doing a complete full interior renovation of the building (which used to be a bank) and another huge loan. This created a very large financial burden in the short-term but proved to be one of the two most savvy business decisions in my medical career. The signage outside this building was incredible and the amount of drive-by traffic calling for appointments far exceeded my expectations.

Fast forward another 5 years after purchasing and renovating this first building above, I decided to purchase a second, larger building in the adjacent nearby community (Sun City West), which also had to have a complete interior (and partially exterior) makeover. However, now my thought process had extended beyond my traditional ophthalmology practice which I had for the first 8–10 years of practice. Now the goal was to diversify into the medical aesthetics arena by incorporating a type of medspa within this building, offering non-surgical cosmetic treatments such as Botox, dermal tissue fillers, chemical peels, medical grade skin care, laser hair removal, microdermabrasion and more. Additionally, I also constructed inside of this building my own ambulatory surgery center (ASC), ultimately becoming state-licensed, Medicare-certified and AAAHC-accredited. The construction of my own ASC whereby I could perform 100% of my own surgeries proved to be the 2nd most important business decision in my medical/surgical practice.

Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?

This is the million dollar question! It definitely is challenging to take on both roles. In my case, I must admit that I made numerous mistakes in my first 15 years of practice. It was a result of these mistakes that I changed course and made the last 20 years of my practice much more productive. One can easily get “swallowed up” when trying to manage a practice while practicing clinically full time. I am sad to say that I sacrificed a lot of family time in my efforts to manage my practice, not to mention learning the “business” of ophthalmology. Ultimately one of the remedies is to splurge and hire an exceptional and well-experienced administrator or manager to take some of the weight off the shoulders of the practice owner/clinician.

From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?

Besides the earlier story in terms of finding financing to engage in the daily activities of starting the practice, my biggest struggle….and frankly, mistake…..was early on in my career to place too much faith and trust in my office manager. Although this past office manager did have many positive attributes, I became blinded and hence did not really oversee closely the financials of the practice. I devoted myself to the clinical realm but did not take an active role in the administrative and financial arena. Although at the time it seemed devastating to me, it was really a blessing that I found out through a local pharmacy that my former manager had written prescriptions for controlled substances in my name without my knowledge. This led to the immediate termination of this manager. During the aftermath and “clean-up” I was forced to really look at all the financials and books, only to find that we were months behind on payments to vendors and suppliers. What an incredible shock this was to me! It was at this point that I made it my mission to devote myself to knowing where every single penny of the practice funds were being directed, and made sure to pay off all past invoices and payables in the short months ahead so as to finally get caught up. What a great feeling this was, as I always viewed myself as an honest, ethical businessman and I wanted each and every vendor paid immediately upon receipt, regardless of terms. I furthermore interviewed and hired the next manager/administrator with much more experience but then started overseeing everything with great scrutiny, asking questions, and “following the money”. The negative side of all this is that indeed I became a “micro-manager” but the positive side is that for the next 20 years of my career my practice became financially healthy and abundant.

Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why? (Please share a story or example for each.)

1. As per my first TEDx talk, practice DELAYED GRATIFICATION in the early stages of your career. Invest your time and energy into growing your practice, and re-invest any excess monies to organize, market, improve technology, train staff, and educate yourself. Such a thoughtful, slow approach will reap large dividends years later and will be a continuing and recurring source of practice growth for years ahead.
2. Clearly define your most important long-term goals. Write them down, meditate on them. Maybe keep a written journal. This will ultimately become your professional blueprint for success, practice growth and fulfillment. Make sure that you do not under-estimate your goals….make them lofty enough whereby you need to strive daily, but not so unrealistic in the short term that you will lose motivation and passion. Chart your progress regularly and do not be afraid to “change roads” if need be to get you to your goal.
3. Remember, PROGRESSION REQUIRES OBSESSION! Be obsessed with what is most important to you, whether it be in your practice/professional life, but also your personal life. Do not let the nay-sayers distract you from your goals. Sometimes those closest to you may give you well-meaning advice which indirectly may distract you from your goals. In order to achieve great things in this life, whether professionally or personally, one must be obsessed with constant and never-ending improvement. Each day is one step closer to achieving your goal. Celebrate small victories and milestones along the way to give you positive reinforcement for the long journey ahead.
4. ALWAYS BE HUMBLE, GRATEFUL AND ETHICAL…..do not let greed ever enter your mind. Remember, as physicians our first duty is to the patient, not to our pocketbook. Be forever grateful and humble that God has blessed you in such an extraordinary way that you can positively touch the lives of so many around you. Do not take this gift for granted, but cherish it, nurture it, and never let arrogance get in the way.

Although by no means have I been a perfect role model for each of my 5 key principles above throughout my entire career, I can definitely say that I have practiced delayed gratification throughout my career. I have constantly re-invested in my practice, whether it be in the latest technology, hiring outstanding staff, training staff members, incorporating good HR practices into the workplace with good employee benefits, and most importantly, continually training myself to learn new surgical procedures and educating myself so as to bring new options to our patients. I learned to become obsessed after the major mishap with my blind trust in one of my original office managers. This obsession is what ultimately led to the progression and incredible success of my private practice. I stayed on course with my vision throughout my career and steered clear of any negativity. Most importantly, I can honestly say that I have tried diligently to always be ethical and treat each of my patients as if they were my own family. As a result, I feel that I have been humble and to this day extremely grateful for all the blessings bestowed upon my 35-year career.

As a business owner, you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?

My personal feeling is that as an over-simplification and perhaps stereotype, I think most physicians are frugal and do not invest significantly in their practice. As the old adage states “you’ve got to spend money to make money”……..I truly believe this. I believe the sooner a young physician is financially stable enough to budget and invest in both external as well as internal marketing, upgrading systems such as computer systems, telephone systems, patient recall and reactivation systems, and educating themselves as far as new technologies, procedures, systems, etc.…..the sooner the better! This will allow at an early stage for the practice to organically grow which in turn feeds positively on itself. I firmly believe in re-investing in one’s own practice. Rather than attempting to “pocket money” early in one’s career, better to earn a modest income but devote any extra monies into facilitating practice growth, including the possibility of adding additional doctors and ancillary providers if the need is there. I would argue that even spending significant dollars on a medical practice consultant is money well-served, as I did this 10 years into my career and found it very useful. The key ingredient is finding the time to do all of the above while maintaining your full-time clinical duties of clinic and/or surgery. If you are a solo practitioner, this may require putting in extra hours in the evenings and weekends, but I fully understand that not every physician is willing to sacrifice so much of their personal time. These are very difficult and personalized decisions that must be made on a case by case basis.

I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?

Yes, there is no doubt that as physicians and being in the medical profession there are numerous stresses, from staying solvent and hopefully financially profitable, to avoiding burnout and leading a healthy life, both physically, emotionally and spiritually, as well as avoiding the stresses of potential patient-related issues or possible malpractice claims. In certain specialties, there is also the stress of naturally poor patient outcomes such as in oncology and others. As physicians we encounter many patients who have serious physical and psychological challenges that we may not be able to help or fix, and this can lead to additional stress, sadness and disappointment on the part of the physician.

Besides of course relying on your immediate family and spiritual faith to guide you, there are many live workshops and seminars that can assist a physician. I found early on in my career, that I became a dedicated aficionado of Anthony Robbins and began attending some of his live events, many of which focused on physical, emotional and spiritual health. I even attended several of his 10-day master class events. These live in-person workshops have been invaluable, and there are many similar events nationwide besides Tony Robbins. Getting outside your comfort zone in a neutral space with like-minded achievers and entrepreneurs can actually be invigorating and exhilarating!

Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?

One of my favorite quotes is from Winston Churchill, as he stated “Success is not final, failure is not fatal. It is the courage to continue that counts”.

I am an adamant believer in this quote, as I have had many monumental failures, as well as successes, in my life, both professionally as well as personally. I learned quickly that I must “strap on my big-boy boots” and move on in order to succeed. One of my most embarrassing failures which has shaped me and taught me great life lessons is that during the peak of the real estate market in the U.S. around the year 2005 or so, I was swept up in the mania to become a real estate magnet, quickly acquiring a multitude of single family homes with little to no money down…..only to find quickly that I could not sustain this long-term with exorbitant mortgage payments far exceeding my rental income. As I wasted my life’s savings keeping this monstrosity going, I finally realized that I had to disavow myself of these properties for fear of risking bankruptcy. My wife was a huge support to me, as she had always told me what a bad idea this was from the beginning, but yet she supported me during my failure and to this day she has counseled me stating “when life deals you lemons, it it up to you to make lemonade”. How true….a day does not go by that this message does not resonate inside of me. As Winston Churchill stated, it was the courage to go on for me from this colossal failure that allowed me to re-shape my thinking and my career strategies, which ultimately led to my success.

How can our readers further follow your work online?

Please learn more about me both personally and professionally at both of my websites:

Personal: DrEmilioJusto.com

Professional: AZEyeInstitute.com

Thank you for these great insights! We wish you continued success and good health!