This coming year promises to be an exciting one in dermatology with advances in many areas as well a host of challenges in business, including the rising cost of technology and maintenance fees as well as the pressures of Maintenance of Certification (MOC).
Procedure Trends
The percentage of consumers considering a cosmetic medical procedure has almost doubled since 2013, according to data from the American Society for Dermatologic Surgery Consumer Survey on Cosmetic Dermatologic Procedures.1 Nearly 60% of consumers surveyed indicated they are considering a cosmetic treatment, up from 30% in 2013.
The survey identified the top 4 treatments (Table) and the percentage of consumers considering them. The treatments include ultrasound, laser, light, and radiofrequency (RF) treatments for smoothing wrinkles or tightening skin (60%); laser and light treatments for facial redness or to improve skin tone or scars (51%); body sculpting (50%); and laser hair removal (48%).
Fat reduction is all the rage, and I see body contouring as the next big area of interest for 2017. A body sculpting device (SculpSure, Cynosure), which is said to produce a 24% fat reduction in 25 minutes with no downtime is one of the latest fat/body contouring devices. The system is intended for stubborn abdominal and love handle fat, which is resistant to diet and exercise. I have had good results so far, and even tried the device on a former Miss America and am pleased with the treatment results.
We considered other body contouring device options that took longer and appeared to have more side effects. One company required that we share our data with them for preferred per use pricing, which we did not like.
SculpSure requires a per use ongoing fee purchase of “Pac Keys” in order for the machine to be workable. This is an expense that should be inquired about when considering the acquisition of new technology.
Another interesting procedure, The Silhouette InstaLift from Sinclair Pharma is a new and improved version of the threadlift procedure. Described as a new, “midface suspension surgery to fixate the cheek sub-dermis in an elevated position,” InstaLift is a series of sutures with cones made of vicryl-glycolide/L-lactide. Placed by the surgeon into the subcutaneous tissue and pulled into place once the sutures and cones are ready for tightening, InstaLift offers an alternative to hyaluronic acid fillers. The product has been shown to lift the midface and stimulate collagen growth, with results lasting over a year, according to the company.
Another hot item for 2017 is an older technology (bleach) with a unique vehicle—hypochlorous acid, which can be used to kill bacteria and promote wound healing. The pH neutral hypochlorous acid products Alevicyn and Celacyn (IntraDerm Pharmaceuticals) and Atrapro (Exeltis USA, Inc) when applied to the skin create bleach, which can remove biofilms, clean wounds, and reduce itching. Some innovative physicians are using the hypochlorous acid products instead of hibiclens (chlorhexidine) to clean wounds prior to surgical procedures.
Microneedling and microneedling RF technologies are also hot for the coming year. Many patients do not like the downtime associated with carbon dioxide (CO2) laser technologies whether they are fully ablative or fractional CO2 laser treatments. Although I think that the fractional CO2 laser treatments offer better results, many patients cannot be bothered with the 5 to 7 days of downtime associated with ablative technologies. With microneedling and microneedling RF treatments, like Dermapen (Dermapen World) and the EndyMed Intensif RF (EndyMed), results may take more treatments than those with CO2 lasers, but the downtime is less, typically 1 to 3 days. The downside to these needling technologies is that they require a disposable needle or tip, which has to be purchased for each procedure.
Rx Dispensing
Being able to dispense medications out of one’s own office is another trend for 2017. As an office, we now try to fill as many prescriptions as possible “in house.” In so doing, we can figure out what is covered, what is not covered, and, in turn, we are able to limit call backs, and to make sure that patients indeed get the medicines we prescribe.
Our practice uses the UniteRx service at this time, and we make just enough from the in-house pharmacy to cover our costs including the salary of the pharmacy technician. With additional providers and prescriptions, we should be able to turn a profit despite the $800/month and per prescription ongoing fees.
Fees and More Fees
I see 2017 as the year of ongoing fees and the rebellion against them. It seems as if everyone has a hand in my pocket these days, and it is becoming increasingly difficult to purchase services, products, or devices without being forced to pay an ongoing fee. Companies push for ongoing fees. They are a great source of income for the fee collectors—I have even had business consultants advise me to have memberships (ongoing fees) for my patients interested in a monthly facial, laser treatment, or peel.
The number of fees is increasing each year. In addition, to the aforementioned fees, other fees include continuing medical education, which is required in the state of Nevada (my home state) to maintain state licensure and it is an ongoing biannual fee. The Drug Enforcement Administration also requires a biannual fee to write for prescription medications, and the state of Nevada has its own biannual fee for controlled substances and dispensing medications in office.
Our electronic medical record (EMR) company, NexTech requires us to pay a yearly fee in addition to multiple other fees including those of a new provider and per machine fee. The latest ongoing EMR fee is for a tool that streamlines their less efficient practice management system into an information juggernaut.
Other monies include ongoing fees for our credit card processing company, online bill pay, and banking. It seems never-ending, and good for them, good for all of them for getting those ongoing fees. My goal in 2017 is to limit ongoing fees.
Recently, I was asked to speak on social media marketing and various other topics at a number of meetings both this year and next, and although not an ongoing fee, 2 of the 4 meetings where I was asked to speak refused to provide any compensation, asking that I both pay to attend the meeting and give my talk.
Other Business Hurdles
MOC and recertification remain hot topics for 2017. Never did I imagine that after having completed 2 residencies in internal medicine and dermatology that I would have to pay ongoing fees for the rest of my working career.
Despite my having obtained the requisite signatures required to force a membership bylaws amendment vote on if the American Academy of Dermatology (AAD) members support or do not support MOC and recertification, the AAD board of directors refused to put the vote out to members.
Currently, I am in the process of obtaining signatures for another change to the bylaws of the Academy to force a membership vote on MOC and recertification. While the American Medical Association2 and various other professional societies like the Pennsylvania Medical Society3 are looking to put an end to the unfair and punitive MOC and recertification process, the AAD continues to require the “nongrandfathered” among us to pay them yearly and other fees. For more information, please visit https://www.abdmoc.com.
Closing Thoughts
Running a successful solo dermatology practice is difficult and expensive. A colleague recently asked me what tips I could share about starting a new dermatology practice? This friend is leaving academics and joining the real world. My answer: “have a lot of cash.”
A popular segment at one of the meetings I attend in Las Vegas is titled, “Where would you spend $100,000?” Electronic records, office improvements, technology, marketing, where should the dollars go? It is easy to spend money, but spending it wisely, well, that is not so easy.
Recently, I was asked if I had $50 million dollars where would I spend it? My answer: “retirement.”
Dr Greenberg is the founder of Las Vegas Dermatology in Las Vegas, NV.
Disclosure: Dr Greenberg has received honoraria from Cynosure, IntraDerm, and Sinclair Pharma.
References
1. ASDS consumer survey on cosmetic dermatologic procedures. American Society for Dermatologic Surgery. July 19, 2016. https://www.asds.net/_Media.aspx?id=9576. Accessed December 2, 2016.
2. Edison M. New AMA policy opposes MOC exams. RebelMD. June 16, 2016. https://rebel.md/new-ama-policy-opposes-moc-exams/. Accessed December 2, 2016.
3. PAMED issues statement of no confidence in ABIM during national MOC panel discussion [news release]. Harrisburg, PA: Pennsylvania Medical Society; June 13, 2016. https://www.pamedsoc.org/Pages/Article-Detail-Page.aspx?TermStoreId=ab8b8fe3-5cb2-4091-916b-64792bec3d05&TermSetId=a6d4659a-154c-4b15-8266-4135869cd8f0&TermId=66f93c0e-fc0f-4748-bce2-15639060eec5&UrlSuffix=MOCStatementShapiro. Accessed December 2, 2016.
This coming year promises to be an exciting one in dermatology with advances in many areas as well a host of challenges in business, including the rising cost of technology and maintenance fees as well as the pressures of Maintenance of Certification (MOC).
Procedure Trends
The percentage of consumers considering a cosmetic medical procedure has almost doubled since 2013, according to data from the American Society for Dermatologic Surgery Consumer Survey on Cosmetic Dermatologic Procedures.1 Nearly 60% of consumers surveyed indicated they are considering a cosmetic treatment, up from 30% in 2013.
The survey identified the top 4 treatments (Table) and the percentage of consumers considering them. The treatments include ultrasound, laser, light, and radiofrequency (RF) treatments for smoothing wrinkles or tightening skin (60%); laser and light treatments for facial redness or to improve skin tone or scars (51%); body sculpting (50%); and laser hair removal (48%).
Fat reduction is all the rage, and I see body contouring as the next big area of interest for 2017. A body sculpting device (SculpSure, Cynosure), which is said to produce a 24% fat reduction in 25 minutes with no downtime is one of the latest fat/body contouring devices. The system is intended for stubborn abdominal and love handle fat, which is resistant to diet and exercise. I have had good results so far, and even tried the device on a former Miss America and am pleased with the treatment results.
We considered other body contouring device options that took longer and appeared to have more side effects. One company required that we share our data with them for preferred per use pricing, which we did not like.
SculpSure requires a per use ongoing fee purchase of “Pac Keys” in order for the machine to be workable. This is an expense that should be inquired about when considering the acquisition of new technology.
Another interesting procedure, The Silhouette InstaLift from Sinclair Pharma is a new and improved version of the threadlift procedure. Described as a new, “midface suspension surgery to fixate the cheek sub-dermis in an elevated position,” InstaLift is a series of sutures with cones made of vicryl-glycolide/L-lactide. Placed by the surgeon into the subcutaneous tissue and pulled into place once the sutures and cones are ready for tightening, InstaLift offers an alternative to hyaluronic acid fillers. The product has been shown to lift the midface and stimulate collagen growth, with results lasting over a year, according to the company.
Another hot item for 2017 is an older technology (bleach) with a unique vehicle—hypochlorous acid, which can be used to kill bacteria and promote wound healing. The pH neutral hypochlorous acid products Alevicyn and Celacyn (IntraDerm Pharmaceuticals) and Atrapro (Exeltis USA, Inc) when applied to the skin create bleach, which can remove biofilms, clean wounds, and reduce itching. Some innovative physicians are using the hypochlorous acid products instead of hibiclens (chlorhexidine) to clean wounds prior to surgical procedures.
Microneedling and microneedling RF technologies are also hot for the coming year. Many patients do not like the downtime associated with carbon dioxide (CO2) laser technologies whether they are fully ablative or fractional CO2 laser treatments. Although I think that the fractional CO2 laser treatments offer better results, many patients cannot be bothered with the 5 to 7 days of downtime associated with ablative technologies. With microneedling and microneedling RF treatments, like Dermapen (Dermapen World) and the EndyMed Intensif RF (EndyMed), results may take more treatments than those with CO2 lasers, but the downtime is less, typically 1 to 3 days. The downside to these needling technologies is that they require a disposable needle or tip, which has to be purchased for each procedure.
Rx Dispensing
Being able to dispense medications out of one’s own office is another trend for 2017. As an office, we now try to fill as many prescriptions as possible “in house.” In so doing, we can figure out what is covered, what is not covered, and, in turn, we are able to limit call backs, and to make sure that patients indeed get the medicines we prescribe.
Our practice uses the UniteRx service at this time, and we make just enough from the in-house pharmacy to cover our costs including the salary of the pharmacy technician. With additional providers and prescriptions, we should be able to turn a profit despite the $800/month and per prescription ongoing fees.
Fees and More Fees
I see 2017 as the year of ongoing fees and the rebellion against them. It seems as if everyone has a hand in my pocket these days, and it is becoming increasingly difficult to purchase services, products, or devices without being forced to pay an ongoing fee. Companies push for ongoing fees. They are a great source of income for the fee collectors—I have even had business consultants advise me to have memberships (ongoing fees) for my patients interested in a monthly facial, laser treatment, or peel.
The number of fees is increasing each year. In addition, to the aforementioned fees, other fees include continuing medical education, which is required in the state of Nevada (my home state) to maintain state licensure and it is an ongoing biannual fee. The Drug Enforcement Administration also requires a biannual fee to write for prescription medications, and the state of Nevada has its own biannual fee for controlled substances and dispensing medications in office.
Our electronic medical record (EMR) company, NexTech requires us to pay a yearly fee in addition to multiple other fees including those of a new provider and per machine fee. The latest ongoing EMR fee is for a tool that streamlines their less efficient practice management system into an information juggernaut.
Other monies include ongoing fees for our credit card processing company, online bill pay, and banking. It seems never-ending, and good for them, good for all of them for getting those ongoing fees. My goal in 2017 is to limit ongoing fees.
Recently, I was asked to speak on social media marketing and various other topics at a number of meetings both this year and next, and although not an ongoing fee, 2 of the 4 meetings where I was asked to speak refused to provide any compensation, asking that I both pay to attend the meeting and give my talk.
Other Business Hurdles
MOC and recertification remain hot topics for 2017. Never did I imagine that after having completed 2 residencies in internal medicine and dermatology that I would have to pay ongoing fees for the rest of my working career.
Despite my having obtained the requisite signatures required to force a membership bylaws amendment vote on if the American Academy of Dermatology (AAD) members support or do not support MOC and recertification, the AAD board of directors refused to put the vote out to members.
Currently, I am in the process of obtaining signatures for another change to the bylaws of the Academy to force a membership vote on MOC and recertification. While the American Medical Association2 and various other professional societies like the Pennsylvania Medical Society3 are looking to put an end to the unfair and punitive MOC and recertification process, the AAD continues to require the “nongrandfathered” among us to pay them yearly and other fees. For more information, please visit https://www.abdmoc.com.
Closing Thoughts
Running a successful solo dermatology practice is difficult and expensive. A colleague recently asked me what tips I could share about starting a new dermatology practice? This friend is leaving academics and joining the real world. My answer: “have a lot of cash.”
A popular segment at one of the meetings I attend in Las Vegas is titled, “Where would you spend $100,000?” Electronic records, office improvements, technology, marketing, where should the dollars go? It is easy to spend money, but spending it wisely, well, that is not so easy.
Recently, I was asked if I had $50 million dollars where would I spend it? My answer: “retirement.”
Dr Greenberg is the founder of Las Vegas Dermatology in Las Vegas, NV.
Disclosure: Dr Greenberg has received honoraria from Cynosure, IntraDerm, and Sinclair Pharma.
References
1. ASDS consumer survey on cosmetic dermatologic procedures. American Society for Dermatologic Surgery. July 19, 2016. https://www.asds.net/_Media.aspx?id=9576. Accessed December 2, 2016.
2. Edison M. New AMA policy opposes MOC exams. RebelMD. June 16, 2016. https://rebel.md/new-ama-policy-opposes-moc-exams/. Accessed December 2, 2016.
3. PAMED issues statement of no confidence in ABIM during national MOC panel discussion [news release]. Harrisburg, PA: Pennsylvania Medical Society; June 13, 2016. https://www.pamedsoc.org/Pages/Article-Detail-Page.aspx?TermStoreId=ab8b8fe3-5cb2-4091-916b-64792bec3d05&TermSetId=a6d4659a-154c-4b15-8266-4135869cd8f0&TermId=66f93c0e-fc0f-4748-bce2-15639060eec5&UrlSuffix=MOCStatementShapiro. Accessed December 2, 2016.
This coming year promises to be an exciting one in dermatology with advances in many areas as well a host of challenges in business, including the rising cost of technology and maintenance fees as well as the pressures of Maintenance of Certification (MOC).
Procedure Trends
The percentage of consumers considering a cosmetic medical procedure has almost doubled since 2013, according to data from the American Society for Dermatologic Surgery Consumer Survey on Cosmetic Dermatologic Procedures.1 Nearly 60% of consumers surveyed indicated they are considering a cosmetic treatment, up from 30% in 2013.
The survey identified the top 4 treatments (Table) and the percentage of consumers considering them. The treatments include ultrasound, laser, light, and radiofrequency (RF) treatments for smoothing wrinkles or tightening skin (60%); laser and light treatments for facial redness or to improve skin tone or scars (51%); body sculpting (50%); and laser hair removal (48%).
Fat reduction is all the rage, and I see body contouring as the next big area of interest for 2017. A body sculpting device (SculpSure, Cynosure), which is said to produce a 24% fat reduction in 25 minutes with no downtime is one of the latest fat/body contouring devices. The system is intended for stubborn abdominal and love handle fat, which is resistant to diet and exercise. I have had good results so far, and even tried the device on a former Miss America and am pleased with the treatment results.
We considered other body contouring device options that took longer and appeared to have more side effects. One company required that we share our data with them for preferred per use pricing, which we did not like.
SculpSure requires a per use ongoing fee purchase of “Pac Keys” in order for the machine to be workable. This is an expense that should be inquired about when considering the acquisition of new technology.
Another interesting procedure, The Silhouette InstaLift from Sinclair Pharma is a new and improved version of the threadlift procedure. Described as a new, “midface suspension surgery to fixate the cheek sub-dermis in an elevated position,” InstaLift is a series of sutures with cones made of vicryl-glycolide/L-lactide. Placed by the surgeon into the subcutaneous tissue and pulled into place once the sutures and cones are ready for tightening, InstaLift offers an alternative to hyaluronic acid fillers. The product has been shown to lift the midface and stimulate collagen growth, with results lasting over a year, according to the company.
Another hot item for 2017 is an older technology (bleach) with a unique vehicle—hypochlorous acid, which can be used to kill bacteria and promote wound healing. The pH neutral hypochlorous acid products Alevicyn and Celacyn (IntraDerm Pharmaceuticals) and Atrapro (Exeltis USA, Inc) when applied to the skin create bleach, which can remove biofilms, clean wounds, and reduce itching. Some innovative physicians are using the hypochlorous acid products instead of hibiclens (chlorhexidine) to clean wounds prior to surgical procedures.
Microneedling and microneedling RF technologies are also hot for the coming year. Many patients do not like the downtime associated with carbon dioxide (CO2) laser technologies whether they are fully ablative or fractional CO2 laser treatments. Although I think that the fractional CO2 laser treatments offer better results, many patients cannot be bothered with the 5 to 7 days of downtime associated with ablative technologies. With microneedling and microneedling RF treatments, like Dermapen (Dermapen World) and the EndyMed Intensif RF (EndyMed), results may take more treatments than those with CO2 lasers, but the downtime is less, typically 1 to 3 days. The downside to these needling technologies is that they require a disposable needle or tip, which has to be purchased for each procedure.
Rx Dispensing
Being able to dispense medications out of one’s own office is another trend for 2017. As an office, we now try to fill as many prescriptions as possible “in house.” In so doing, we can figure out what is covered, what is not covered, and, in turn, we are able to limit call backs, and to make sure that patients indeed get the medicines we prescribe.
Our practice uses the UniteRx service at this time, and we make just enough from the in-house pharmacy to cover our costs including the salary of the pharmacy technician. With additional providers and prescriptions, we should be able to turn a profit despite the $800/month and per prescription ongoing fees.
Fees and More Fees
I see 2017 as the year of ongoing fees and the rebellion against them. It seems as if everyone has a hand in my pocket these days, and it is becoming increasingly difficult to purchase services, products, or devices without being forced to pay an ongoing fee. Companies push for ongoing fees. They are a great source of income for the fee collectors—I have even had business consultants advise me to have memberships (ongoing fees) for my patients interested in a monthly facial, laser treatment, or peel.
The number of fees is increasing each year. In addition, to the aforementioned fees, other fees include continuing medical education, which is required in the state of Nevada (my home state) to maintain state licensure and it is an ongoing biannual fee. The Drug Enforcement Administration also requires a biannual fee to write for prescription medications, and the state of Nevada has its own biannual fee for controlled substances and dispensing medications in office.
Our electronic medical record (EMR) company, NexTech requires us to pay a yearly fee in addition to multiple other fees including those of a new provider and per machine fee. The latest ongoing EMR fee is for a tool that streamlines their less efficient practice management system into an information juggernaut.
Other monies include ongoing fees for our credit card processing company, online bill pay, and banking. It seems never-ending, and good for them, good for all of them for getting those ongoing fees. My goal in 2017 is to limit ongoing fees.
Recently, I was asked to speak on social media marketing and various other topics at a number of meetings both this year and next, and although not an ongoing fee, 2 of the 4 meetings where I was asked to speak refused to provide any compensation, asking that I both pay to attend the meeting and give my talk.
Other Business Hurdles
MOC and recertification remain hot topics for 2017. Never did I imagine that after having completed 2 residencies in internal medicine and dermatology that I would have to pay ongoing fees for the rest of my working career.
Despite my having obtained the requisite signatures required to force a membership bylaws amendment vote on if the American Academy of Dermatology (AAD) members support or do not support MOC and recertification, the AAD board of directors refused to put the vote out to members.
Currently, I am in the process of obtaining signatures for another change to the bylaws of the Academy to force a membership vote on MOC and recertification. While the American Medical Association2 and various other professional societies like the Pennsylvania Medical Society3 are looking to put an end to the unfair and punitive MOC and recertification process, the AAD continues to require the “nongrandfathered” among us to pay them yearly and other fees. For more information, please visit https://www.abdmoc.com.
Closing Thoughts
Running a successful solo dermatology practice is difficult and expensive. A colleague recently asked me what tips I could share about starting a new dermatology practice? This friend is leaving academics and joining the real world. My answer: “have a lot of cash.”
A popular segment at one of the meetings I attend in Las Vegas is titled, “Where would you spend $100,000?” Electronic records, office improvements, technology, marketing, where should the dollars go? It is easy to spend money, but spending it wisely, well, that is not so easy.
Recently, I was asked if I had $50 million dollars where would I spend it? My answer: “retirement.”
Dr Greenberg is the founder of Las Vegas Dermatology in Las Vegas, NV.
Disclosure: Dr Greenberg has received honoraria from Cynosure, IntraDerm, and Sinclair Pharma.
References
1. ASDS consumer survey on cosmetic dermatologic procedures. American Society for Dermatologic Surgery. July 19, 2016. https://www.asds.net/_Media.aspx?id=9576. Accessed December 2, 2016.
2. Edison M. New AMA policy opposes MOC exams. RebelMD. June 16, 2016. https://rebel.md/new-ama-policy-opposes-moc-exams/. Accessed December 2, 2016.
3. PAMED issues statement of no confidence in ABIM during national MOC panel discussion [news release]. Harrisburg, PA: Pennsylvania Medical Society; June 13, 2016. https://www.pamedsoc.org/Pages/Article-Detail-Page.aspx?TermStoreId=ab8b8fe3-5cb2-4091-916b-64792bec3d05&TermSetId=a6d4659a-154c-4b15-8266-4135869cd8f0&TermId=66f93c0e-fc0f-4748-bce2-15639060eec5&UrlSuffix=MOCStatementShapiro. Accessed December 2, 2016.
