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Adding cosmetic procedures can insulate derm practice against sluggish economy


Although setting up a cosmetic practice requires commitment and creativity, such practices can help insulate dermatologists against the impact of a sluggish economy, an expert says.

Key Points

"With the economy being what it is, a combination medical/cosmetic practice has the best chance of staying afloat and succeeding," says Doris Day, M.D., a New York dermatologist in private practice and clinical assistant professor of dermatology at New York University.

In a purely medical practice, she says, patients who lose jobs also, unfortunately, lose their insurance, while exclusively cosmetic patients also tend to tighten their belts.

Full service

As proof, she says that while many dermatology practices may be struggling, "I've noticed that I've been consistent in my trends in terms of both medical and cosmetic procedures."

Furthermore, she says that as dermatologists, "We are very capable of being full-service, to a point."

In particular, Dr. Day offers fillers, botulinum toxin injections, sclerotherapy, peels and laser treatments.

However, she eschews liposuction, because in most states, this procedure requires Accreditation Association for Ambulatory Health Care (AAAHC) accreditation, which can be time-consuming and costly to achieve.

Dr. Day says she avoids hair transplantation for the same reason, as well as the fact that it requires having a trained staff dedicated to this function.

Going paperless

One key to the success of Dr. Day's cosmetic practice has been its paperless nature.

"It's a very efficient office," with low overhead and hence less financial pressure than a comparably sized practice using paper record-keeping, she says.

To achieve this efficiency, Dr. Day says, "In many ways, I have reinvented the wheel, so I can help residents and other doctors who want to do something similar to learn from both my pearls and pitfalls."

In the former area, she says she considers her paperless office system, which she tailored and implemented herself, to be her least-expensive employee.

"My system will do my billing, call and confirm my patients, and send e-mails to let them know about new services or to follow up with them.

"It also makes scheduling easier, and sends me ticklers to remind me to call patients back at any time or date that I choose," or to send staff members memos, Dr. Day says.

The system also automatically incorporates patient notes, which Dr. Day enters into templates via handheld tablet PCs (Fujitsu).

"With the click of a button," she says, "I can write prescriptions. It's a very complete system that's easy to use. My staff has never been formally trained on it, but within an hour they're comfortable with it."

Additionally, redundant backup makes the system reliable, even if the practice should temporarily lose Internet connectivity.

With the automated system, Dr. Day says, "All lab reports go directly from the laboratory into the patient's chart and into a workflow queue. Nobody's pulling or filing charts."


In fact, Dr. Day says the system allows everyone in her office to function as a patient coordinator. She has no receptionist; all employees deal with patients either by phone or in person all day.

"We've taken away all the tedious tasks," she says.

In any successful practice, Dr. Day says, "The staffing is the rate-limiting factor. A staff that's nice, happy and hard-working is the hardest thing to find, and maintain."

Dr. Day says she has found that having too large of a staff also can create problems.

"I went from having too little staff to too much, and that was a disaster," she says.


Furthermore, Dr. Day says aspiring cosmetic dermatologists must multitask. Such practitioners must decide early on whether they want to start their own practices part-time while also working at a university or other clinic, or perhaps work on their own.

"If you're not sure where you're going to live or what your goals are," she says, "perhaps you're better off working for someone else."

However, she says that for dermatologists who have settled such issues, "There's nothing like having your own place. I even own my own space, so now I have that real estate asset."


Being her own boss allows Dr. Day to have greater control of her environment and maintain her own patient lists, she says. Conversely, she says, "Some people never want the headache of having to hire or deal with their own staff. And when you work for yourself, it can be hard to take a vacation.

"It takes a certain amount of energy to find an office, build a staff, put the system together and make it work. I didn't understand that as clearly as I should have when I did it."

Business model

Having a strong business model and five-year plan also are critical, Dr. Day says.

Taking advantage of free and low-cost vendor support also helps, she says.

Vendors offer resources that can help fledgling practices with both internal and external marketing.

"If you ask them for help and let them know that you're a loyal customer," Dr. Day says, "sometimes they can help you build your practice. There are many opportunities to ask for help from companies you do business with that don't really cost you money."

Building a patient base

Other tips for building a patient base include joining the University Physicians Network (UPN) of one's local hospital, which can help set up skin cancer screenings and lectures.

The UPN also handles credentialing and negotiates higher fees with managed care organizations, Dr. Day says.

Additionally, she recommends sending introductory letters to local physicians - or meeting with them personally - along with lecturing at local schools and gatherings and conducting hospital grand rounds.

Using the Internet

Dr. Day also has built her practice's website - and rebuilt it five times.

"Any time I offer something new," she says, "I add it to the website. You must keep updating your website to make it fresh."

The site also allows patients to enter all of their intake information before entering the office.

"If your website isn't ahead of the curve in terms of technical capabilities and user friendliness, you're really behind," Dr. Day says.

To check up on her website, she says she periodically asks staff members or other friends to type relevant search terms into search engine websites and make sure the practice's site comes up. She also uses "secret shoppers" to evaluate her employees' telephone performance.

For Internet success, Dr. Day says, "The buzzword is 'keyword optimization.'"

This requires using as many as possible of the keywords potential patients might use to find a physician's practice, and using these terms creatively rather than plugging in verbiage borrowed from elsewhere.

"The more often you update your site," she says, "the higher you'll be listed in search engines."

A site called http://www.addme.com/ enables businesses to connect to multiple search engines.

Inexpensive design

Likewise, http://www.register.com/ allows entrepreneurs to register domain names relatively cheaply, and offers templates to help with website design.

Using these templates, Dr. Day says setting up her first website cost approximately $500. Other options for inexpensive design help include tapping local graphic design schools.

"When you're starting out, it's important to be resourceful," Dr. Day says.

Disclosures: Dr. Day reports no relevant financial interests.

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