This webinar was previously recorded on July 1, 2020 and is now available on demand.
In Partnership with The Journal of Drugs in Dermatology
This webinar was previously recorded on July 1, 2020 and is now available on demand.
Business intellect, a vital aspect of managing a practice, is not taught in residency. From the infancy of their training, dermatologists are trained to think broadly and scrupulously, using each clue, each corporeal sense, and each available tool to accurately diagnose and manage a plethora of cutaneous conditions. After residency, dermatologists set out armed with the knowledge and drive to deliver expert care to their future patients. However, despite their education and best intentions, lack of business acumen can hinder even the brightest and most motivated of practitioners. In order to enlighten oneself in the complicated field of business management, clinicians are left to fend for themselves, often learning as they go, sometimes making unnecessary mistakes, and adjusting their business practices reactively. Retrospective “trial and error” learning is time-consuming, cumbersome, and costly. Why not short track and get the goods without the trial and error, making costly mistakes and taking years. The new book, The Business of Dermatology is a cornerstone achievement in the standardization of business education for dermatologists.
Edited by Drs. Jeffrey S. Dover and Kavita Mariwalla, and authored by impressive experts in the field, The Business of Dermatology offers a comprehensive guide to opening, maintaining, and sustaining a practice. To start, the power of this textbook fundamentally lies in the experience and scope of its authorship. The authors were hand-selected by the editors ensuring that each chapter was written by a tried and true expert in that subject. Unlike other textbooks in the field of business management and administration that are primarily written by individuals from the business world, some of whom have no insight into the inner machinations of the medical world, or hands-on experience, the authors of this book are well-known, respected dermatologists that hail from thriving practices of their own. The reader has an unprecedented opportunity to learn from the firsthand experiences of top authorities who live and breathe dermatology. Using conversational prose, the authors depict their experiences, trials, and errors, employing specific real-world examples and scenarios while tackling each subject.
A notable forte of The Business of Dermatology is the sheer breadth and range of topics discussed in the textbook by medical as well as surgical dermatologists. Opening and managing a practice is a daunting endeavor with twists, turns, and hidden hurdles that one cannot foresee until stumbling across them. The Business of Dermatology unveils those twists, turns, and hurdles for the reader, taking the “guessing game” out of the equation. Fifty-five chapters elucidate every aspect of running a practice, covering all practice-relevant topics, including office space and equipment, managing financials, diverse practice models, human resources, employment considerations, patient issues, pricing, essential surgical tools/supplies, marketing, and much more. The Business of Dermatology lays bare every facet of handling a dermatologic practice, so much so that even a well-run, seasoned practice stands to learn new tools and tips to elevate itself to a higher level.
And now more than ever in the “Time of Covid” we are in desperate need of information from The Business of Dermatology. Many of us are inventing the wheel with the significant changes that are occurring in Dermatology, and the practice of our specialty.
The wealth of knowledge endowed in each chapter is written and formatted in such a style that renders each chapter extremely easy to read and comprehend. First, the prose used in the chapters is conversational – as such, the reader is fully immersed in each topic as if he/she were having a face-to-face chat with the authors. Furthermore, references are used only when absolutely necessary. The reader is not bogged down by superfluous references and discussions that may dim the vital discussion points of the chapters. Finally, embedded within each chapter are practical tips that are immediately implementable and a Top Ten list that highlights the key take-home points, making “reading on the run” possible. The novice practice owner need not fear the residency dogma of “trying to drink from a gushing fire hydrant” with this easy-to-read, catchy and focused textbook.
On April, 1, 2020, the Journal of Drugs in Dermatology (JDD) and SanovaWorks brands, including ODAC launched Part I of the webinar series: COVID-19: Urgent Dermatology and Aesthetic Issues for Dermatology.
Over the course of the 2 hours, Joel L. Cohen, MD and 6 different thought leaders joined the COVID-19 conversation, discussing the pressing questions that are on the minds of many dermatologists and providers in the country. The initial broadcast attracted 1,900 registrants and nearly 800 attendees comprised of physicians, residents, fellows, nurse practitioners and physician assistants. Attendees were interested and engaged throughout the entire 2 hours with a 76% average attentiveness and 72% average interest rating.
The on-demand broadcast has attracted over 500 registrants as of April 9th and is available on JDDonline.com.
On April 7, 2020, Part II of the webinar series was broadcasted: COVID-19: Your Questions Answered. Dermatology experts and thought leaders examined the legal and financial concerns of dermatology providers during the global coronavirus pandemic. Experts discussed furlough vs. layoffs; mortgage and rent relief programs; the CARES Act; the pros and cons of leveraging NPs or PAs for teledermatology and more. Then, hear questions answered by our panel of experts; discussed practical tips you can use in your practice right now; and how to move forward with patient care. Part II attracted 1,300 registrants with nearly 700 attendees. Attendees were engaged and interested throughout with an 82% attentiveness average and 75+% interest rating.
The on-demand broadcast of Part II will be available on April 11, 2020 on JDDonline.com.
Source: Next Steps in Derm
If you are navigating the confusing landscape of contract negotiations or considering partnership in a private practice after years of employment, then take note! Ron Lebow, Senior Counsel in the Health Law practice group at Greenspoon Marder LLP, led a fantastic workshop at the 2019 ODAC conference. He covered common concerns when negotiating employment agreements with dermatology practices, as well as issues to address when it comes time to become a partner.
The most important point and recurring theme of Ron Lebow’s workshop was simply this:
This point was stressed time and time again and will continue to be the overarching theme throughout the many parts of contract negotiations. With this in mind, here are some of the main takeaways and important questions we, dermatologists, should constantly keep in mind.
Surround yourself with experts! Find people who have your back. Make sure you find a lawyer who deals with medical professionals (particularly your specialty) for a living. You may need to find an accountant to work with you depending on your situation. Lastly, it may be in your best interest to work through recruiters. Some recruiters are better than others, and Ron Lebow recommends Dermatology Authority as an organization that provides good recruiting services for dermatologists.
When dealing with negotiations, it is important to recognize the many aspects of the process. With respect to the job you are offered:
Source: Dermatology Times
Bringing more men into an aesthetic dermatology practice can expand the patient population, increase business revenue, and pay long-term dividends in terms of patient loyalty and repeat business.
But men aren’t like women when it comes to aesthetic concerns, so the strategies used to market your aesthetic offerings to female patients might miss the mark with men, cautioned Terrence Keaney, MD.
Men are less cosmetically savvy and need more upfront education and counseling, Dr. Keaney said at the 2018 Orlando Dermatology Aesthetic and Clinical Conference.
“I spend more time explaining therapies and what might be best for them,” he noted. “I explain the scientific rationale and treatment mechanisms so they will be more comfortable.” Making sure they understand is important, because “men often nod and don’t ask questions.”
The extra effort up front can pay off.
“The beauty of men is when they get a great result and are happy with you, men are very physician loyal. Once they get a great result, they’re yours forever,” said Dr. Keaney, an assistant clinical professor of dermatology at George Washington University, Washington, and a private practice dermatologist in Arlington, Va.
Cost is the leading deterrent for men to embrace aesthetic procedures, a factor that also ranks first among women. Men are also concerned that results will not look natural and want information about safety and side effects, Dr. Keaney said. “These deterrents can be overcome with proper education and counseling.”
Source: Dermatology News
Pearls for providers of photodynamic therapy (PDT) include tips on skin preparation, eye protection, and use of three new codes to maximize reimbursement. Also trending in medical dermatology are best practices for intralesional injections of 5-FU to treat the often challenging isomorphic squamous cell carcinomas (SCCs) or keratoacanthomas on the lower leg, as well as use of neoadjuvant hedgehog inhibitors to shrink large skin cancer lesions, according to Glenn David Goldman, MD.
“This talk is about what you can do medically as a dermatologic surgeon,” Dr. Goldman said at the Orlando Dermatology Aesthetic and Clinical Conference.
Use new billing codes for photodynamic therapy
There are now three new PDT billing codes. “Make sure your coders are using these properly. They are active now, and if you don’t use them, you won’t get paid properly,” said Dr. Goldman, professor and medical director of dermatology at the University of Vermont, Burlington. Specifically, 96567 is for standard PDT applied by staff; 96573 is for PDT applied by a physician; and 96574 is for PDT and curettage performed by a physician.
“Be involved, don’t delegate,” Dr. Goldman added. “If you do, you will get paid half as much as you used to, which means you will lose money on every single patient you treat.”
What type of PDT physicians choose to use in their practice remains controversial. “Do you do short-contact PDT, do you do daylight PDT? We’ve gone back and forth in our practice,” Dr. Goldman said. “I’m not impressed with daylight PDT. I know this is at odds with some of the people here, but at least in Vermont, it doesn’t work very well.”
The way PDT was described in the original trials (a photosensitizer applied in the office followed by PDT) “works the best, with one caveat,” Dr. Goldman said. The caveat is that dermatologists should aim for a PDT clearance that approaches the efficacy of 5-fluorouracil (5-FU). “If you can get to that – which is difficult by the way – I think your patients will really appreciate this.”
An additional PDT pearl Dr. Goldman shared involves skin preparation: the use of acetone to defat the skin, even in patients with very thick lesions. Apply acetone with gauze to the site for 5 minutes and “all of that hyperkeratosis just wipes away,” curette off any residual hyperkeratosis – and consider a ring anesthetic block to control pain for the patient with severe disease, he advised.
Another tip is to forgo the goggles that come with most PDT kits. Instead, purchase smaller, disposable laser eye shields for PDT patients, Dr. Goldman said. “They work better. You can get closer to the eye … and they are more comfortable for the patient.”
Dr. Goldman’s practice is providing more PDT and much less 5-FU for patient convenience. “I believe if someone is willing to go through 3 weeks of 5-FU or 12-16 weeks of imiquimod, they get the best results. However, most people don’t want to do that if they can sit in front of a light for 15 minutes.”
Consider intralesional injections for SCCs and KAs on the legs
An ongoing challenge in medical dermatology is preventing rapid recurrence of SCCs and/or keratoacanthomas (KAs) near sites of previous excision on the legs. “We all see this quite a bit. Often you get lesions on the leg, you cut them out, and they come right back” close to the excision site, Dr. Goldman said.
He does not recommend methotrexate injections for these lesions. “Methotrexate does not work. It doesn’t hurt, but I’ve injected methotrexate into squamous cell carcinomas many times and they’ve never gone away.” In contrast, 5-FU “works incredibly well. They go away, I’ve had tremendous success. This has changed the way we treat these lesions.” 5-FU is inexpensive and can be obtained from oncology pharmacies. One caveat is 5-FU injections can be painful and patients require anesthesia prior to injection.
Source: Dermatology News
In his practice, Joel L. Cohen, MD, spends a good part of his day doing Mohs surgery, “with the goal of cancer removal, and after surgery, having the patient look good,” he said at the Orlando Dermatology Aesthetic and Clinical Conference.
“Having resurfacing in my practice has allowed me to treat not only wrinkles and etched lines, but also help skin cancer patients by blending and minimizing their skin cancer scars,” said Dr. Cohen, an aesthetic dermatologist and Mohs surgeon in private practice in Denver.
For example, one of his patients was a kindergarten teacher who had a large rotation flap scar on her cheek after excision of a melanoma in situ. The children asked her about it all the time during the 2 months after the surgery, and she decided to come in for some laser sessions. “With three ablative fractional laser sessions, she really looked great just 3 months later and wasn’t even interested in wearing makeup at that point.”
Resurfacing in his practice using a variety of lasers is very helpful, Dr. Cohen said. He published a study in November that compared pulse dye laser, CO2 ablative fractional lasers, or a combination of both for modification of scars following Mohs surgery (J Drugs Dermatol. 2016 Nov 1;15[11]:1315-9).
The prospective, multicenter study revealed that although both monotherapy approaches were safe and effective, the combination of pulse dye laser and fractional ablative laser offered some synergy that was preferred by patients.