Dr. Lily Talakoub, or Dr. Lily as she is known to her patients, expanded her dermatology practice in 2018 from an 1800 square foot location to new offices with over 5000 square feet. In just 9 years, McLean Dermatology and Skincare Center went from having 1 employee to 19 full-time staff members including a second doctor and a nurse-practitioner. “We’ve grown twenty-fold in the past two years alone,” Lily says. “It’s all been word of mouth, and that works best because I’ve been obsessed with my patients from the very start. I’m obsessed with helping people get better. That’s what medicine is: you take care of the person. If you take care of people, you’ll do well.”

I’m obsessed with helping people get better. That’s what medicine is: you take care of the person. If you take care of people, you’ll do well.

She would appear to be right about that: Lily has made the Northern Virginia Top Doctors list for the last 8 years in a row and was named a top doctor by Washingtonian magazine in 2018 because, well, she’s been pretty good at treating people. But with every success story, the unseen hustle starts long beforehand.

Lily’s ambitions started at a young age, and her desire to serve others may derive from the struggles she faced herself as a child. Her parents emigrated to America from Iran when she was one year old. They settled on the outskirts of Boston, where her father worked in the building trades while her mother, who spoke no English, ran their home. In most respects, Lily and her brother and sister enjoyed a typical American middle-class childhood, skiing in the winter, playing tennis in the summer, and working very hard in school. “Nothing less than excellence was tolerated,” Lily recalls. “You couldn’t come back to the house if you didn’t get an A. That may sound harsh, but it worked.”

Lily’s parents also wanted their children to appreciate the value of a dollar, so they were all required to work outside the home from an early age. Lily started babysitting at ten, and soon thereafter she began teaching younger children to swim and play tennis. “I always helped other kids with their work in school, too,” Lily adds, “and if the teachers had to step out, I’d kind of watch over things for them.”

The challenges associated with leaving behind your country of origin and starting life from scratch in a new land were exacerbated sharply when Lily’s father, whom she has no relationship with today, decided he was going to return to Iran. Her mother refused to uproot her children, so Lily’s father left the family. Lily was 15 when she found herself fatherless, and since her mother still spoke little English, she wound up shouldering many of the responsibilities of raising her younger brother and sister. With the loss of her father’s income, she had to bolster the family coffers by working every day after school, and she had to serve as the interface between her siblings and the public school system, communicating with their teachers and attending all the parent conferences along with her mother:

Lily credits school and her education for helping her achieve her goals: “I knew what I wanted out of life and I wasn’t going to stop until I got it,” she recalls.

“I had to tutor my siblings, arrange their schedules, and serve as their role model,“ Lily says. “I basically became a parent at that point, and in retrospect that was the best thing that’s ever happened to me because it forced me to develop a laser-like focus on my own work so I could get it done efficiently and be there for them. I still have that focus today.”

Lily credits school and her education for helping her achieve her goals: “I knew what I wanted out of life and I wasn’t going to stop until I got it,” she recalls. “That meant pursuing education to the highest possible level. I was always so focused on the end goal that the path is a little bit of a blur. I just had my sights set on getting to college,” she remembers. “I wasn’t adamant about medicine at that point – math was my thing, and to this day I really love math and I use it every day in medicine – but I was also really good at science.”

After finishing high school in Lexington, Lily studied microbiology and immunology at McGill University in Montreal. “It was very difficult to leave my brother and sister,” Lily says, “and I didn’t realize how hard it was for my mother to get on without me until years later when she told me about her struggles during that time.” By then, Lily’s mother had started going to night school to learn English, and she had taken some computer classes so she was able to join the workforce before Lily left for college.

“My sister wasn’t as focused on school as I had been, so I was the one keeping her in line,” Lily recalls. “When I left for college, my mother had to take over that role.” During her years at McGill, Lily earned money working in campus labs researching HIV. That experience helped her decide to pursue a different kind of professional life.
“I knew that I had to be with people every day, because that’s what drives my happiness,” she says, “so I chose to do medicine. I knew I’d have to be in the top 1% of my class to get into med school, so I studied all the time. I was in the library from six in the morning to eleven at night every single day. I had no friends, and no boyfriends but there was no way I was going to get less than 100% on anything.”

After receiving her undergraduate degree from McGill, Lily was accepted to Boston University Medical School, so she returned to her childhood home to live with her mother and her siblings during that time. She decided to pursue dermatology, which meant that after medical school she would have to do one year of residency in internal medicine and three years of residency in dermatology. “To get into dermatology, you have to graduate in the top one percent of your med school class,” Lily says, “and even then it’s the hardest residency to get into – the lifestyle in dermatology is so good that competition is really high for those spots.”

To reach that goal, Lily once again embraced the monastic life of constant study – no social activities, no boyfriends. “I wouldn’t leave the library,” she says. And that dedication paid off: she did indeed graduate in the top one percent of her class, and she secured residency interviews at several prestigious institutions including Harvard, Columbia, Cornell, Brown, Duke and Stanford. “There was a blizzard in Boston when I left for my interview at Stanford,” Lily recalls. “I got off the plane there and it was 80 degrees. I checked into my hotel in Palo Alto and said, ‘I’m never leaving.’” She did her internal medicine residency there and was then accepted to the dermatology program at the University of California at San Francisco, the top-rated program in the country.

During the holiday season of her final year in medical school, Lily had given herself the gift of a study break to attend a friend’s Christmas party, and there she met a young man named Pouyan, who was finishing dental school at nearby Tufts University. They immediately hit it off; so much so that when she left the east coast for the west coast, he followed – proposed – and they were married. They loved San Francisco but the cost of living was exorbitant, so Pouyan suggested they consider returning to his hometown, McLean, Virginia, after Lily’s residency.

“I cried – a lot – when we had to leave, but every single person in my husband’s family is a doctor, including every in-law, so it seemed like a good place to practice medicine and start a family,” Lily says. They moved to McLean in 2008 and Lily spent a few months helping colleagues she had met in med school with procedures on an ad hoc basis while exploring possibilities for her own practice. Pouyan suggested she establish her practice in Woodbridge or Ashburn where the number of dermatologists was low, but she wanted her office to be near her home so she could maximize time with her children – she had a two-year-old and an eight-month-old baby by that time. To get a foothold in McLean, she visited every doctor’s office in town and asked to sublease space.

“Only one person called me back,” she says, “an Ob-Gyn whose office had pink walls and pink furniture. He offered to rent me a room for half a day a week. So I went to Staples and I bought a computer and a phone, and I went to Home Depot and I bought a rolling tool cart with a lock. I put all my supplies in that cart, and then every Tuesday morning I’d roll that cart into my little office space and set up shop. I took all the calls myself, greeted all the patients myself, and did all the billing myself.”

On days when she wasn’t working, Lily took her young children to local parks and chatted with all the other mothers who were out with their babies. “I gave my business card to every mom I met,” Lily recalls, “and they started coming to me for help. You know the network of moms is the strongest thing out there — there’s nothing more powerful than moms — and the ones who came to me would recommend me to their friends, and that’s how it started. The network of moms is how I built my business.”

“I built my business this way, one step at a time, paying only for what I could afford, because I didn’t want to spend my life chasing debt,” Lily explains. “For the first three years, I didn’t pay myself a salary — everything went back into the business.”

At the end of her first year, Lily had more patients than she could accommodate in her half-day schedule, so she expanded to a full day, and at the end of her second year, she needed a second full day, so once again she set out to knock on doors. “I found an internist who was willing to give me three days a week, so I started seeing patients there, and I hired my first employee, a receptionist to take phone calls, which I couldn’t do anymore because I was seeing patients all the time.” Shortly thereafter, she hired a medical assistant, and in 2011 she moved the practice into an office of its own in downtown McLean. Now, thanks to yet another move that landed her in her current space with three times the number of exam rooms, she sees 150 patients a week. “I built my business this way, one step at a time, paying only for what I could afford, because I didn’t want to spend my life chasing debt,” Lily explains. “For the first three years, I didn’t pay myself a salary — everything went back into the business.”

Apart from that philosophy — take care of people — Lily has little training in business. “But I’m not afraid to ask questions,” she says. “My patients are my primary resource, so I ask them all kinds of questions about how they do things. I have a couple of mentors who have bought and sold large businesses, and I ask them for advice. Maybe someday I’ll go to business school! But I don’t really think of this as a business: it’s a love. I love what I do, and I try to keep learning.”

Lily says that she leads by example. “I don’t tell people how to do things; I do them myself and expect employees to follow my example. I try to create a path to help people get to where they want to go, and I teach them how to take care of people. For Lily, the principle of taking care of people extends beyond the circle of her patients. She runs a mentorship program for high school girls, and she trains many young interns in her practice. “If you’ve risen to the top, you have to send the elevator back down,” Lily says. She trains dermatology residents at George Washington University and the Washington Hospital Center as well, and she serves on the Board of Visitors for the Children’s National Medical Center.

Her advice to young people would be to devote as much energy as possible to their education. “To this day, when I apply for things like board licenses, they ask for my college transcripts, so good grades really matter.” She suggests that young people not look for freedom in college. “Freedom comes later,” she says. “Freedom comes when you’re financially stable. Freedom comes when you own your own business. In college, you’re still a dependent. You’re never independent until you’re financially independent.”

Lily inherited that rigorous work ethic from her parents, and now she’s beginning to see it in her daughters. “I feel guilty every day because I have three kids,” Lily says. “I feel guilty being at work and I feel guilty being at home — that constant turmoil in my head. But I love what I do so much that I know I’m a better mom because I do it. My husband relieves some of that tension by taking care of the kids so I can work at building my business at night — he’s great about that — but it still tugs at me.

“Sometimes my kids beg me to just stay home — they say, ‘Mommy, why can’t you just stay home today?’ I feel guilty going to work, but I know it’s going to teach them the right lesson. For example, the other day my three-year-old was playing with her dolls, and she had one in the little baby car-seat. She looked to me and said, ‘Okay, you stay here and take care of the baby. I’m going to go make money.’ And she grabs her little purse and heads for the door. At that moment I thought to myself with tears in my eyes, this is why I do what I do.”