RX7_Lily Talakoub, MD, Founder, Derm To Door: Audio automatically transcribed by Sonix

RX7_Lily Talakoub, MD, Founder, Derm To Door: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Narrator:
ForbesBooks presents: Entrepreneur RX, with Dr. John Shufeldt. Helping health care professionals own their future.

John Shufeldt:
You know, I've been told by close friends that I have a face for podcasts, so this week's guests could probably help me out quite a bit. Her name is Lily Talakoub, and she's a board-certified dermatologist and founder of derm to Door, a customized online skincare experience. Lily, welcome to the podcast!

Lily Talakoub:
Thank you for having me.

John Shufeldt:
So you are the, you were the first dermatologists we've had on the podcast, and I have to say that dermatologists I know are almost uniformly entrepreneurial. Why is that?

Lily Talakoub:
You know, I don't know. I think it's because the field is a very out-patient-based. There's very little in-patient. So you have to be in private practice without a lot of help from a, overseeing hospital. Although the scope is changing now with a lot of private equity's taking over a lot of these private practices. But you have to be in private practice for all of dermatology mostly, so you need to kind of have a little bit of an entrepreneurial spirit to start a practice or work in a practice and deliver patients and get patients so. But you know, it's not something that you learn in medical school, unfortunately, or is it something that you're trained in, in life when you go into medical school or you're going through residency because it's far from that.

John Shufeldt:
Yes, absolutely. But it is funny. Some specialties seem to push more towards this entrepreneurial side, and derm is definitely one of them. Now you went to BU undergrad, correct?

Lily Talakoub:
I went to McGill undergrad. I went to Bu Med School.

John Shufeldt:
BU Med School, McGill undergrad. So, OK, so you went to Canadian undergrad, then BU medical school. When did you think you want to be a dermatologist? Because I have to say for whatever reason, that path never crossed my mind. Probably out of ignorance, but I never even thought about it.

Lily Talakoub:
You know, it never crossed my mind, either. I actually was going to do orthopedic trauma and I loved orthopedics and I loved the procedures and the surgeries. And I like the trauma a lot because the excitement, my last year of medical school, I met my current husband, whose family, his brother was in orthopedics, and he said to me, you know, you don't want to be doing that because you're going to have a lot of nights in the hospital and it's going to be hard if you have kids and you want to be a mom. And so, you know, you should look at something that has a little bit more of an outpatient life. If you want to do procedures, dermatology would be the field. And so I started looking into it. It wasn't something that was even on my radar, either, although, you know, it's probably the best decision I've ever made. I'm so happy every single day. I'll be doing this now for 12 years and I come to work happy every day, so it wasn't on, most, my radar or anybody else's that I know of, actually.

John Shufeldt:
Yeah, it's, I don't even know people when, I mean, I graduated quite a while ago and I'm not sure I can think of anyone in my class that did derm, but it definitely now is one of the, one of the most competitive residencies to get into, particularly the straight dermatology residency. But you did it the, I guess, traditional way you did went to Stanford and did internal medicine and then derm?

Lily Talakoub:
No, the internal medicine was a year of categorical for internal medicine, I didn't have to do that. And then and then I did dermatology too. So I did the traditional way as well. But it is very competitive. You have to graduate among the top one percent of your medical school class just to get an interview. There's very limited spots and, you know, dermatology, it is very competitive. But I have to say it's not for everybody. I'm in a business right now where I interview dermatologists all the time, and not everybody has the, I would say, the fortitude to do dermatology. You have to want to build your own patient base. So when I interview people and I say, you know, you have to be your own marketer, you have to get out there and meet people and give your card out and get patients. And people are looking at me like, I'm crazy, like, oh, you're your office isn't going to just put patients on my schedule? That's how it usually works, right? So coming out of medical school, they don't teach you to kind of get out there and learn how to market yourself, but you really need to be able to do that, coming out of medical school, in dermatology.

John Shufeldt:
I suppose, probably particularly today because it is, it is so competitive out there. You know, it's funny in the emergency, perhaps emergency medicine. And there are so many times I'm thinking, oh my god, I wish we had a dermatologist in-house because these crazy rashes will come in or some of necrotizing fasciitis, I'm like, oh my god, where's the dermatologist when you need one? And we can search laughing like there are no dermatologists running around the hospital?

Lily Talakoub:
Yeah.

John Shufeldt:
Ok, so after residency, you did, you worked for the surgeon general, what did the dermatologists do for the Office of the Surgeon General?

Lily Talakoub:
So I was really involved in communications before I did medicine. I work for ABC News. I did medical editing, medical reporting, I did a lot of medical writing. And as you know, the Surgeon General's Office is a communication office. It is... The way we communicate health problems and public health efforts to the public. And so I did a lot of writing and researching while I was there. It was great because I learned how to write. I learned how to communicate to people, and it made me a better communicator, and it's really made a difference in my career because now I, you know, I am on editorial boards for a lot of major journals, I've written for probably over five thousand magazines, Allure, Vogue, Elle, Shape, I write every single week for online editorials and it's really helped me be able to communicate medicine to my patients.

John Shufeldt:
That's, you know, when you said it that way, it makes tremendous sense. But I guess I didn't put two and two together that you're right, the Surgeon General's Office is to disseminate our information and a better be well thought out, well communicated that information. Did you just apply and say, look, here's my background, here's what I can do for you? Or did you answer an ad, so to speak? Or did they recruit you?

Lily Talakoub:
So, you know, I've always had this philosophy in my life that, you know, what's the worst that can happen? And the worst that can happen is that you fail or somebody says no, right? And so and I'm not afraid of failure. I never have been. I've worked since I've been 13. I've held jobs through high school, college, medical school. You know, I've done things because I've kind of just had to and I decided I wanted to work, I didn't even live in D.C. at the time. I grew up in Boston, I was living in Boston. I wrote a letter about how I was interested in the communication of health to the people and the public, and just wrote what I wanted to be doing. And I thought to myself, what's the worst that can happen? And is they, nobody calls me back. And honestly, that's it. I wrote the letter. Eight months went by. Nobody called me back. One day I got a phone call from the Office of the U.S. Surgeon General, saying we'd like to do an interview with you. And there I was. A month later, I started working there. So my philosophy and I hope every doctor or a non-physician has that as well in life is that you really have to just go for it and expect the worst and just hope for the best. And hopefully you're not afraid of failure because if you are, you haven't really tried.

John Shufeldt:
No, it's literally you taking quotes out of my mouth and I always say, you know, how bad can it be if no one's dying? I grew up failing, so failure to me came very easily, so I never really feared it. But you know, I see a lot of these kids today who are going to the medical school, I mentor a lot of them, and they will decompensate when they get to be in a class. And I always kind of look at them quizzically, I go, well, I mean, you know, I know you want an A, but a B is not awful. And they said, well, I've never gotten a B in my life and like, my world's coming to an end, I'm like, oh boy, you know, I started calling them the fragile perfects because their whole life has been this and they just haven't experienced failure, which, like you said, is actually kind of good to experience because, but for that, people don't risk.

Lily Talakoub:
Correct. And that's a problem with medicine is that it's a very secure environment where, you know, you have people that are overlooking what you're doing in medical school and in residency, until you go out there and then something happens and you get really hard on yourself, you know, you, I always tell my staff and I have twenty-nine people that work for me that I'm constantly mentoring to move on in their careers, to go to nursing school, to medical school. I help them write their resumes. I always say, you know, forget the mistake, remember the lesson, just forget the mistake, all right, just keep moving forward. There's two types of personalities, and when I give feedback to people like something happens or I say, there's, some people take the feedback and they become stronger, some people take the feedback and they go in a corner and they have tears in their eyes, right? You have to learn to cope. You have to learn to fail. You have to learn to take that risk, move forward, and leave the office. Brush it off your shoulder. Come back the next day and tell me it'll never happen again. Now I know what I'm supposed to be doing, and that's how you move forward. If you worry about what's gone wrong, you'll never try anything that's new and honestly, every single part of my life. It was a huge risk to be able to take that next step. And there has been a lot of mistakes and it's OK. And I've learned from a lot of those failures. And I, you know, started my business from nothing, nobody. I didn't take over a business. I didn't buy a business. I had no money. I couldn't afford to even like, look into partnering up in a business. I, you know, I just walked around one day. I knew I was living in this new area because I had just been married and I had a baby. I walked around to every doctor's office within a five-mile radius. I knocked on their door, talk to the office manager, made cards at Kinko's and dropped off my cards and said, hey, if you have a half a day a week, I can sublease, I'll sublease your space and did it 15 times all day long. And finally, one person called me back and said, we have the doctors in the O.R. on Tuesday mornings, come and you can use the space Tuesday mornings. So I said, I'll take it, and I paid rent for those Tuesday mornings because that's all I could afford, and went to Home Depot. I got a red tool cart that I put on my tools in, drag that in every Tuesday morning, and got a sign from Kinko's and put on the door and sat there the first day with one patient that came in and had no staff, I checked them in myself, I checked them out myself, I called the insurance myself, then knew that I had to pound the pavement and went out there and took my son to the park. And every person that I met at the park, I gave them my card and talk to every mom that was out there because the network of moms is powerful. So and then one mom would tell another, and I just knew, my husband told me not to start in this neighborhood where I am because there was a lot of competition. There's a lot of plastic surgeons and dermatologists, I just knew in my heart that I, I really could take very good care of people, and I knew if you take good care of people, people will come. Doesn't matter how many other people are out there that are competing with you. I wasn't focused on money, revenue, growth, I was focused on my, client, my patient, and that customer service and that client care and the, you know, really great care of them. I could take care of them medically better than anybody else, and I knew that. And that basically grew. And now I personally see two hundred patients a week and my office sees over a thousand a week. So we've grown to now have twenty-nine staff and see, we take care of a lot of skin diseases here. But it took a lot of tears and a lot of kind of getting up in the morning and knocking on the doors again. But it wouldn't have happened had I not done that.

John Shufeldt:
Well, how long ago was that when you started?

Lily Talakoub:
12 years ago.

John Shufeldt:
Wow, in 12, literally 12 short years, you went from renting an office on Tuesdays mornings to now seeing a thousand patients a week with a staff of twenty-nine. That is remarkable growth. And so did you imagine that 12 years ago, where you would be today? Is this what you envisioned?

Lily Talakoub:
No, I didn't envision the scope or the scale of what I'm doing, but I did, I did know that I knew people would come because I cared. I really cared about my patients. To this day, I still hug a lot of my patients. I know that's not COVID-friendly, but I do. I care about my patients. I see them on the street, I see them at the grocery stores. I know the grandparents, I know the kids, I know everybody in that family and I care about them and I knew we could deliver the better care. We outgrew every single dermatologist in this entire area, in this area, and we still are very busy because we take good care of people. And I didn't envision the scope of it, but I've had a lot of failures. You know, things didn't work, people didn't work out, you know, office spaces didn't work out, leases fell through, everything that happens in business, but it's OK, it's going to happen, as long as I knew I put my head on the pillow that I did right by every patient I saw, it was going to be fine.

John Shufeldt:
Yeah, that is so true. If you put caring first, everything else follows. So, OK, talking about dermatology today, it almost seems like if you wanna do dermatology, you literally, unless you're going to work for somebody else, you literally have to go out and just learn business quickly, learn marketing quickly, set up the practice and be comfortable with all the different modalities, I looked at your website and I own an aesthetic business for about 15 years where we had, you know, we did cool sculpting and hair removal and all those sorts of things. Then I had a group of nurse practitioners who did it. But it's a tough field. And I mean, literally, it's about as competitive as any field of medicine is. I just I guess, I just am shocked that come in right out of residency and fellowship, boy, if you're not on it, if you're not in that game, you are already behind.

Lily Talakoub:
Well, you know, I recently read the Jeff Bezos book, the Amazon Store. And, you know, when he first came out similar concept, he says in his book, he says there's some businesses that are focused on competition, there are some businesses that focus on revenue, there's some people, businesses that focus on scale. We're focused on the customer, and it didn't matter that there was a Barnes & Noble's out there. They were focused more on the customer and that's what made them develop. The patient is our number one priority and we've always made it the number one priority, always. And so no matter how much revenue you have or how many other people you're competing with, you focus on that care of that patient or that customer, you will always be able to do well and there is no other competition out there. So I really feel like if you have to have the right vision and not worry about how much money you make, because that's really not what this business is about, we're in medicine to treat and heal. We're not medicine, it's not a business, it's not an operation. Although at some point it becomes one because you have to manage an operation. But again, every single day, we're focused on the patient.

John Shufeldt:
All right, let's switch here a little bit and talk about some of your entrepreneurial ventures. I mean, first off, you know, you said you were working since you were 13, when in the dawn on you that you were really an entrepreneur at heart as well as a physician?

Lily Talakoub:
So when I was in medical school, I actually didn't see myself as an entrepreneur. I went through residency and of course, you know, through residency that you do a lot of these things to kind of learn and expand your knowledge. And when we were graduating residency at the graduation ceremony, the graduation, the residency director would stand up and give all of us our plaques and we give a speech about every resident that was graduating. And my friend, who started a kids camp for skin diseases, got a speech about how this person started a skin camp and the other person got a Ph.D. and did this amazing research in immunology and dermatology, and he got a speech about that. And so when they went to give up my speech, my residency director got up on the podium, grabbed my plaque, stood up there, and said, so if Lily were to start a practice across the street from us, we'd all go out of business. And so and everybody laughed in the stage and I thought to myself, well, maybe I should start my own business, and maybe this is something that I could do, that, you know, I've never heard anybody say that, but that's amazing. And I think maybe this is where my future takes me and so I did, and I started this business that we grew. And then in 2019, I started a secondary business which is called Derm To Door. And that was a business just honestly from the communication I have with my thousands of patients over the years who don't know what to use on their skin. I decided to start a E-Commerce site that's now a tech start-up, and we've developed an app where you can buy skincare products that I test, I, we communicate with you about what's right for your skin. And we have a new teledermatology platform on the app that's going to be launching soon, where you can make an appointment with a dermatologist and A get a consultation or B figure out what to use on your skin directly from your phone.

John Shufeldt:
I saw that, I was just getting ready to download that and I ran out of time, so ... that was your first that was your skincare product, that's medical-grade, naturally sourced ingredients.

Lily Talakoub:
Yes. And then

John Shufeldt:
Did you start?

Lily Talakoub:
Yeah. And then we expanded on a skincare line, which is just personalized skincare that we made called skinkure, S K I N K U R E. And then our biggest launch this year was the technology company called Derm To Door. And the technology is a fully customizable app where you can do teledermatology visits with the dermatologist, and it has a artificial intelligence facial scanner that can scan your skin and tell you what issues you have with your skin and what products are targeted for that problem. So instead of seeing your dermatologist and taking time out of your day and making an appointment and waiting in the waiting room and checking in and checking out and going for your follow up visits, you can either scan your skin and get recommendations or you can live, make an appointment with a dermatologist in your state and get customized prescriptions that are sent to your house from a pharmacy.

John Shufeldt:
Now was that after reading, the Invent and Wander book by Jeff Bezos, was that the impetus for Derm To Door? Because it sounds very Amazon-esque.

Lily Talakoub:
No, it was just honestly, it was a labor of love. My patients were constantly emailing me about products because the average person chooses seven products at a pharmacy before seeing a dermatologist for a skincare problem. So they're buying seven products before they see a dermatologist. And I just realized people were coming in getting too much influence from the media and social media because there's so many people promoting things now that they were actually ruining their skin. So I decided to start this because I figured that it would be better for them to ask a dermatologist questions than to look on social media and get non-expert advice so you can go on the website and chat with the dermatologist live and get skincare recommendations. You can message us and we answer live about what products to use, and you can see a dermatologist directly from your phone, from our app, as well as get an AI scanned image of your skin with recommendations on what to use.

John Shufeldt:
So I love that, I've owned a telemedicine company for about 11 years, so I'm an absolute believer in it. And a few years ago, I went back to MIT and got one of their certificates in AI, so I totally love AI. Where did you come up with that idea? Because it's genius.

Lily Talakoub:
Again, it was from my patients. They would take a photo of their face and email it to me or text it to me. And I thought to myself, I was like, you know, there's a better way of doing this and artificial intelligence has taken over, you know, a lot of the technology that we use to diagnose lung cancer, and there's artificial intelligence for radiology and for a lot of other specialties. So why not use it for dermatology? So we developed a patent-pending system by which it can diagnose over a thousand skin problems that we integrated in our app, where you can actually get diagnostic information about your skin problems. And then we also integrated a telehealth platform in there. So in case you have something that it can't diagnose or you need additional prescription medicine, a live dermatologist can see you and send you prescriptions automatically.

John Shufeldt:
That is remarkable. I absolutely love that. Is that, you said that's up, up and coming. When is that going to launch?

Lily Talakoub:
The app is up and running. You can text me directly from your phone if you have questions about your skincare. There's a button you press that directly texts me, and people are often, think that it's not me. So they'll message and say, can you ask Dr. Lily if I should use this cream or this cream? And I answer back, this is Dr. Lily, I'm answering you. So I'm actually live-answering all the texts that we get about skincare. And so it's really there's no going back, especially after COVID. Everybody's using AI and honestly telemedicine for their health care. And after COVID, it's not going to go away because the ease of using it has become so mainstream that patients are going to want to use it and they're not going to want to take time out of their work schedules to go see the doctor because it's so old now to kind of take a, you know, it's you can do it so fast from your screens that why not?

John Shufeldt:
I know, I even hate to admit this, but COVID for my telemedicine business was literally, it probably pushed it forward five years. And it's, you know, we went from busy to exploding, which has been really cool. Now you're really active on social media. You have an Instagram page, @DrLilyT, that has got thousands and thousands of followers. How do you leverage that for your business? I mean, how... What was the genesis of that? Because I think again, you've really hit on all these cylinders to be successful, seemingly out of the gate now, I know you said a lot of tears and a lot of mistakes, but you know, from the outsider, it looks like you just were, you're on this mission and 12 years later, you know you're a legend in the dermatology field.

Lily Talakoub:
Again, circling, full circle back to communications, communication with my patients. You know, they wanted the information, they wanted education. We put information out there that's helpful for them. If a patient asks me question in the office about, you know, what's the difference between an alpha hydroxy acid and a beta hydroxy acid? That's my impetus. And I go back and I put it on a social media post because I know there's other people that want to hear it, too. So content is key. People want to know their yearning for information and knowledge. And so again, communication, going back out there and recommunicating with the clients, and it helps the reach to clients that you know, don't know who we are, helps them understand that we are the experts in the field like our dermatology office, were the experts in dermatology in our area. So, you know, it's just getting that information out there was key and we're on everything, DrLilyT or McLean dermatology, that's my business, or Derm To Door, we put a lot of skincare information on our Derm To Door Instagram. We're also on Facebook, Twitter, Pinterest, TikTok, all those different platforms.

John Shufeldt:
Wow. You must be busy with people. I mean, I feel like I'm the doctor to hundreds of people who text me and call me with medical questions and prescription needs, and I said, we'll just go on MeMD, and you know, we'll we won't charge you, but I think you must get this 24-7.

Lily Talakoub:
Yeah. And also, skin is an issue where you could see. So it's not like you have chest pain or, you know, you can message somebody about chest pain, right? So skin is something you could see. There is not a weekend that goes by that I don't get a message with a picture of a rash or somebody's aunt or uncle that has a rash or their kid that fell and had a scrape and now has a scar or that has a growth. There's not a weekend that goes by that I don't get a message from somebody. So, you know, I'm happy to do it, this is, I chose medicine because it's a field of service, and I feel like that connection to people that can feel comfortable messaging me is important. And that's why we put it on our website. On Derm To Door, you can message us directly because it builds our community and people that message me on our text app, from the website Derm To Door or from the actual app on their phone, they think they're talking to a bot, but they're not. They're talking, they're talking to me. I'll message back directly, you know, what I think they should do. And I sometimes mention because like somebody messaged me about a certain type of acne, and the question I asked them was, you know, do you eat nuts? And I think maybe it's due to nuts that you're eating. And they couldn't believe that it wasn't an automated message. But I'm a communicator. I grew up as a communicator. I, you know, I started my career in medicine as a communicator, and I went through my whole career as a communicator. And this is just one arm of the communication.

John Shufeldt:
You know, I'm going to start messaging you from the emergency department and showing you pictures of rashes, right? Just going to warn you, right out.

Lily Talakoub:
There are so many doctors in this area that message me from not just the emergency room for the ICU with drug rashes, and I get these all the time. It's OK. I love doing it, and hopefully, I don't have to message you back if I'm in the emergency room.

John Shufeldt:
All right. So, so last question, now you're located in McLean, Virginia, but you know, I looked all over your website and pictures of your facilities. It looks very Beverly Hills-esque, I mean, it's really high-end. Was that, I mean, I guess that's a very purposeful way to promote the business by the aesthetic feel that when you walk in the door, you're walking into a very high quality, high touch place, is that, did I summarize that correctly?

Lily Talakoub:
Um, you know, I think it's just clean and sterile, it's very white. It's yeah, it's very modern. That's it's kind of a extension of who I am. My office looks like my home. And honestly, your office is your home. I spend more time here than I do in my house, so I wanted to look like what I like it to look like. So if you come to my house, it looks exactly like my office.

John Shufeldt:
That's so funny. I'm sitting in a hangar right now that I wish was my house so I can fully identify with that. Lily, thank you so much. This has been really enjoyable. I learned a ton from you and I'm sure our listeners did as well. You can follow Lily on Instagram @DrLilyT and find out more about Derm To Door at DermToDoor.com. Lily, any parting advice for young medical entrepreneurs who are in medical school or even before that in undergrad, who will listen to this and say, I don't know, but I want to be like her. What's your advice?

Lily Talakoub:
Honestly, when it comes to my heart, I always say, if you've risen, send the elevator back down. And that's hopefully what we can do as entrepreneurs is send the elevator back down, help somebody else rise. You know, people message me for questions on LinkedIn all the time, I help connect people. Don't be afraid of asking people for help because there are people out there, like myself, that try to connect people and try to get them to get out there and push the limits and become entrepreneurs. It's really been, the most rewarding part of my business is helping people move on in their careers, and they come back, 10 years later, they come back and visit me. They've moved on, they've become doctors, and it's really probably the most rewarding part of what I do.

John Shufeldt:
I totally agree. And boy, am I going to use that quote if you've risen, send the elevator back down. Lily, thank you so much. It's been really enjoyable speaking with you.

Lily Talakoub:
Lovely speaking with you. Thank you so much!

Narrator:
Thanks for listening to Entrepreneur RX with Dr. John Shufeldt. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. This has been a presentation of ForbesBooks.

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