Wednesday, November 14, 2018

Tips to Manage Hiring and Firing in your Dermatology Practice

A collection of PAC Pearls from the Women’s Dermatologic Society

Managing staff employment is an essential element to a successful private practice. The WDS Practice Advisory Committee (PAC) has put together a list of pearls to help navigate staff hiring and firing in your Dermatology practice. 

1. Hire Slowly and Fire Quickly 
Consider a prolonged new employee interview after initial screening, where the candidate spends time in the department they will work in. Get feedback from your current employees and make sure that the candidate is someone they can see themselves working with. Have a 90 day trial employment with assessment by the office manager and the physicians at the end of the 3 months. Be clear that if they are not working out after 90 days, they will be let go. This makes everyone re-evaluate the candidate. If someone is not performing, or is a negative energy in your office, let them go. Delaying firing a weak or negative employee, no matter how difficult, drains the entire staff!      
- Sara Jackson, MD

2. Clear Communication
Clear communication and expectations are important for effective management of staff members within a dermatology team.  A written delineation of roles and goals is particularly useful when it is time to give feedback and serves as a reference for what staff need to do to ensure that the practice functions at its best.
- Molly Hinshaw, MD

3. Be Organized and Know Thyself
Two things I have learned in my twelve years of business ownership: 1) organization is key and 2) know thyself — you must know who you are and what you want out of your career/business. As to hiring, a new person must fit into your culture. If you can provide a detailed list of job duties, an understanding of your philosophy and values and allow candidates to spend a morning with you on your busiest day, both of you can see if the position is a good fit. As to firing, you must recognize when it is time for someone to leave your organization. Sometimes it is clear that a toxic person is holding you and your staff hostage, other times, it is subtle. Regular evaluations can help both you and the employee know if the fit is still good.
- Elizabeth Long, MD

4. Seek Feedback
Do an exit interview. Whether you are firing, or the person is choosing to leave, this is a great time for candid discussion of the pros and cons of working at your office. Sometimes it hurts your feelings! Sometimes it's sour grapes from someone unhappy, but often there are some nuggets of feedback that can help you be a better boss.      
- Deirdre Hooper, MD

5. Develop Resources
Create a handbook that can be passed along from previous to current employees. It will serve as a basic guide for day to day clinic tasks and also provide instructions for managing issues such as trouble shooting computers, cameras, or lasers. The handbook can be periodically updated and is a great resource for current employees, but especially helpful for new hires.     
 - Jeanette Black, MD

Wednesday, October 10, 2018

Managing Angry Patients #PACPearls

The Practice Advisory Committee has put together a list of pearls to help manage angry patients.

Anger in some situations is a secondary emotion. I try to identify and address the primary emotion instead of the anger. For example, fear and anxiety are two primary emotions that can result in anger. Reassuring the patient by addressing their fear and anxiety helps dissipate the anger.
- Molly Hinshaw, MD

Listen, 90% of the time an angry patient just wants to be heard. And often they have a valid point. I always say I hear you, let me take care of your skin, and then I’m going to make sure that your problem gets taken care of. And if it’s my fault, for example running late, I apologize and move on.
- Deirdre Hooper, MD

Listen with empathy. Let the patient express what they would like to say and acknowledge their frustration to deescalate the situation as much as possible. Even several minutes of letting the patient talk without interruption can really help to turn the tide for mood in the room.
- Monica Li, MD

When dealing with an angry patient, I find it most helpful to acknowledge, apologize and then move forward. If you walk in and immediately acknowledge that they are angry, tell them you understand why they are angry and apologize immediately it can deescalate the situation. I think most people just want to be heard and can then move on.
- Sarah Jackson, MD

Take a deep breath, allow them to vent for 1-2 min, then give a calm, thoughtful response including re-stating the patient’s concerns.
- Mark Kaufmann, MD

Managing an angry patient takes a lot of time and effort and can become emotionally draining. After the situation is resolved it is important not to let one negative patient interaction effect you for the rest of the day. It isn’t fair to your other patients or your staff if your mind is distracted and you remain upset all day. Additionally, taking home this negativity isn’t healthy for yourself or your family. After an interaction with an angry patient take a moment to reset and refocus so you can move on and don’t internalize the anger.
- Jeanette Black, MD

Wednesday, September 12, 2018

Tips to Avoid Burnout in Your Practice #PACPearls

WDS Practice Advisory Committee PAC Pearls: Tips To Avoid Burnout in Your Practice

The Practice Advisory Committee has put together a list of pearls
to avoid burnout in your practice.

Focus on Your Strengths
You should spend your day doing what you were trained to do, and minimize the time you spend on regulatory and administrative tasks. 
- Dr. Mark Kaufmann, MD

Get the Support You Need
We hired a coder/biller who reviews our notes after we are finished. She verifies that what we have recorded in the note meets the level of service that we have billed. This has saved me hours of tediously going through notes to make sure I have coded correctly. This has increased my job satisfaction tremendously. Well worth it!
- Dr. Sarah Jackson, MD

Expand Your Passions
Find a passion (or a hobby) outside of medicine. My outside interests in art and design have led me to engage more in my community, travel, and improve the visual state of both my home and office. A happy visual space makes for a place I want to be in.
- Dr. Elizabeth Long, MD

Connect with Nature
Nature is a great way to soothe the mind and soul - schedule a hike, day by the lake/ocean or an outdoor activity at least once a month to recharge and reflect.
- Dr. Monica Li, MD

Give Back and Get Inspired
Get involved in training programs. This could mean anything from letting residents or medical students shadow or spend time rotating with you, lecturing at medical schools and residency programs, or helping to staff resident clinics. It could be a small time commitment as little as 1-4 times a year or more regularly. 

It is a nice break from our regular clinics and the time to interacting with medical students, residents, or fellows can be inspiring and refreshing. The energy and excitement of young, eager physicians helps to remind us of how far we’ve come and what it was that first inspired our passion for dermatology. 
- Dr. Jeanette Black, MD

Engage Your Curiosity
Find a topic that interests you outside of your day to day practice grind, learn more about it, and get involved! Join a committee, volunteer to review a journal, get involved in advocacy, or write a paper. Dermatologists are such an interested, smart bunch of people and expanding your knowledge will help you engage with others and broaden your support network.
- Dr. Deirdre Hooper, MD

Tuesday, September 11, 2018

Young Physician Spotlight - Dr. Arisa Ortiz, MD

Dr. Arisa Ortiz, MD

Arisa Ortiz, MD, is a board-certified dermatologist and director of laser and cosmetic dermatology at UC San Diego Health. She specializes in the latest noninvasive procedures, including laser skin resurfacing, dermal filler and toxin injections, body contouring, skin tightening, and the treatment of scars.

Dr. Ortiz is a frequent speaker at the American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and currently serves as chair of a national aesthetic meeting. She was a guest editor for Journal of Lasers in Surgery and Medicine and serves as a reviewer for Dermatologic Surgery Journal. In addition, she has published over 30 original medical articles and chapters on new innovations in cutaneous laser surgery.

She completed a laser and cosmetic dermatology fellowship at Massachusetts General Hospital, Harvard Medical School and Wellman Center for Photomedicine. She acquired additional fellowship training in Mohs micrographic surgery at UC San Diego. She completed her dermatology residency at UC Irvine and the Beckman Laser Institute. Dr. Ortiz earned her medical degree from Albany Medical College in New York and is board-certified in dermatology. She is a fellow of the American Academy of Dermatology (FAAD). Dr. Ortiz has received many honors and awards including the 2014 Doctor’s Choice Award in dermatology for La Jolla. (Source)

How did you become involved in the WDS and what benefits do you think WDS membership provides for residents/young physicians?
My first introduction to WDS was through one of my mentors, Dr. Tina Alster. She invited me to the annual luncheon at the AAD. I think that’s probably one of the main benefits of WDS is establishing mentorship, lifelong membership, with women that you can look up to and emulate and go to with any of your questions about your career or about how to balance life with career. I think those relationships that you maintain have been the most significant benefit for me.

At what point did you decide that you wanted to do academics versus private practice? What's the biggest challenge you've faced in academia?
Throughout residency I assumed I would go into private practice, but my career path sort of led me towards academics because I ended up doing multiple fellowships after residency and I felt like academic medicine would help to make use of those fellowships. I also felt like continuing my research interests would be more supported in an academic setting. Also, I had the opportunity to develop the cosmetic practice at UCSD since there really wasn’t one at the time. It was an opportunity to build something from the ground up.

There’s always different hurdles whether you’re in private practice or academics. One of the biggest challenges in academia is just being patient. There’s always a process to getting things approved or adding new procedures. Even sometimes adding a consent can take 6 months to get approved. I think I’ve just learned to be more patient. Change takes longer in academics.

What advice do you have for residents and young physicians who want to become more involved in research?
Start early. It’s nice to build research skills while you have someone guiding you, so starting early while you’re still in training is helpful. This way, when you’re out on your own, you already have that skill set. Regarding research topics, it’s good to always be thinking of what’s missing in your daily practice- what could we be doing better, where could we advance medicine, etc. Also, just being excited and passionate about the research topics you choose.

Who were/are your mentors?
My very first mentor in Dermatology was Dr. Gary Lask. I met him when I was 18 years old, he was my dermatologist. I had gotten the chicken pox later in life and had developed scars on my face. Initially, I thought I wanted to be a pediatrician, but then I was introduced to Dr. Lask because I was seeking out scar revision. I literally chose him out of the yellow pages. It was just kind of serendipitous that I found a great lifelong mentor and he’s still my mentor to this day.

What are you working on now?
My passion right now is trying to find a way to non-invasively treat basal cell carcinoma. I have been doing a lot of 1064 Nd:Yag laser work which I think is very promising but is still very new. I think we need some more long-term data which we are currently working on. Also looking at how to optimize those treatments. I am also looking at nanoparticle-assisted laser therapy for basal cell carcinoma.

What future goals do you have?
In a year from now when I’m technically 5 years out of fellowship, I would like to start a cosmetics fellowship through the ASDS.

Do you have advice to young physicians on achieving work/life balance?
Schedule things in, because if you don’t, you’ll have a tendency to just get wrapped up in work. For example, if you want to exercise more, just dedicate the time to do it and just commit to it and make it part of your routine. I find that if you just dedicate the time then you find a way to fit it in. Regarding time for family, I’m lucky enough to live close to the office so I can go home at lunch to see my daughter. It breaks up the day for me. Also, when I come home from work, I dedicate my attention to my daughter and husband, I don’t talk about work, or check emails. Then when she goes to bed I have time to catch up on work.

What do you like to do in your free time?
In my free time, I like to spend time with my family. We like to go to SeaWorld a lot, the zoo, and we like to go hiking. We have this trail in the back of our house (Rancho Penasquitos) where you can walk to a waterfall. I also just picked up Pilates. My guilty pleasure is shopping!

Tuesday, August 14, 2018

New Skin Biopsy Codes #PACPearls

By Dr. Mark Kaufmann

On July 12, 2018 CMS published their proposed rule on the Medicare Physician Fee Schedule. This 1,440 page document is filled with some very broad ranging proposals.

These proposals include a blended E/M code system (one E/M code to replace 99202-99205, and 99212-99215), a 50% cut in E/Ms billed with a modifier -25, and another call for comments on whether global period visits are happening, just to name a few.

While many of these changes could have wide ranging effects on all of our practices, today’s pearl will deal with the one change that will definitely happen on January 1, 2019- 6 new skin biopsy codes to replace the 2 that we are used to using.
  1. Current CPT codes 11100 and 11101 will be deleted from the CPT book AND will be denied payment if used on or after January 1, 2019.

  2. Replacing them will be 6 NEW codes- 3 base codes and 3 “additional biopsy" codes.

  3. The three new categories will be “Tangential Biopsy of Skin" (think Shave Biopsy), one for “Punch Biopsy of skin,” and one for “Incisional Biopsy of Skin (think wedge biopsy).”

  4. If you do more than one biopsy, using more than one modality, you would use the base code for the more valuable service, and the “additional biopsy” code from the lower value service. (eg if you do a punch and a shave, you would code the punch base code, and the tangential add-on code).
The following tables will help you to better understand the proposed work RVUs and payment for these new services:

Monday, July 9, 2018

Practice Management Classes at Summer Academy #PACPearls

The Practice Advisory Committee doesn't want you to miss these practice management courses at the AAD Summer Academy:
F013 – Trends in the Practice of dermatology: Consolidation and the Role of Private Equity
F016 – Coding and Documentation
U020 – MACRA,MIPS, and Advanced APMs

Also stop by the AAD Resource Center to check out Digital Derm Coding Consult Pro and the new 2019 coding resources.

Check out the full list of session here:

Monday, June 25, 2018

Spotlight on Esteemed WDS Member, Dr. Amy Paller

Spotlight on Esteemed WDS Member, Dr. Amy Paller
By Kate Oberlin, MD

Dr. Amy Paller is the Walter J. Hamlin Professor and Chair, Professor of Pediatrics and Director of the Skin Disease Research Center at Northwestern University’s Feinberg School of Medicine. She received her undergraduate and graduate degrees from Brown University and her medical degree from Stanford University.  Dr. Paller completed residency training in both Pediatrics and Dermatology at Northwestern University and her postdoctoral research fellowship at the University of North Carolina.  She is an author of more than 400 peer-reviewed publications and serves on the Council for the National Institute for Arthritis, Musculoskeletal and Skin Diseases.  Her NIH-funded laboratory focuses on the use of nanotechnology for topically applied gene regulation in treating skin disorders and on the role of glycolipids in the impaired wound healing and cutaneous innervation of diabetes. She runs a large clinical trials unit focused on pediatric dermatology.  She has been President of several national and international dermatologic societies, including the WDS. Dr. Paller is an eminent leader in pediatric dermatology and has been bestowed with multiple honors, including the Rothman Award from the SID, the Clarence S. Livingood, MD Memorial Award from the AAD, the Mentor of the Year Award/ Rose Hirschler Award/ Wilma Bergfield, MD Visioning and Leadership Award from the WDS, and the Founder’s Award from the Chicago Dermatological Society.

What motivates you? I’m driven by a passion to make a difference, whether in the lives of my patients, in the future careers of my incredibly enthusiastic trainees, or in adding to our understanding of how the skin works. I particularly like to work collaboratively – and learn so much from doing so. Dermatology is such an exciting field right now – with discoveries in the clinic and in the lab leading to such an array of novel approaches therapeutically. I love being part of this journey.

Who has influenced you the most?  I am influenced daily by everyone with whom I work from my fellow dermatologists and researchers to our trainees and my administrative support. When just starting in dermatology, my mentors (such as Nan Esterly, Ruth Freinkel, Al Briggaman, and Fred Malkinson) really helped to steer me in directions that could leverage my interest and my passion – and I am eternally grateful.  Mentorship never stops – and I continue to learn more from my colleagues than I could possibly offer to them.

Which leadership skills were the most difficult for you to develop?  I have been fortunate to have been in leadership roles since shortly after I finished fellowship, first as a chief of dermatology at our Children’s hospital/Dept of pediatrics and for almost 15 years now as a department chair of dermatology. Along the way, it’s been a pleasure to serve as a leader for many of our national and international organizations. My desire to get things done in an efficient way has been a great help in moving organizations and programs forward. However, an early lesson learned (and still a challenge at times) is the need to delegate and wait patiently for others to come through, even if that requires some prodding and tips along the way.  This approach, though, engages a group in “owning” projects, pulls in a lot of creative ideas, and tends to lead to the best possible endpoint with broad acceptance – even if it takes longer.

What advice do you have for young dermatologists about reaching their career goals? 1) Figure out what you are passionate about and focus on making this a large part of your career so you’ll truly enjoy your work; 2) Build a team of mentors – and take the time to engage them in decision-making and skill-building; 3) Be entrepreneurial and take advantage of the best of your environment to grow personally and professionally; and 4) Make sure to save time for family and friends.

How do you manage an appropriate work-life balance?  I have a wonderful husband who from the beginning has been supportive and shared with me throughout the past almost 35 years the joys of raising my 3 sons, but also insisted that we save time on weekends to be together alone. I have always been a “juggler”, and am able to stop and start projects easily – which helped me to spend time with family and others – and then easily get back where I left off. I think it is also important to “say no”, not just to unnecessary projects, but to life tasks that just are not important.  For example, having someone help with cleaning – and even with grocery shopping and chopping vegetables for salads and meals – let me have more time with my children and my husband throughout the years. Looking for ways to increase “quality time” while saving overall time has been key.

Do you have a favorite book? I love to read (although it’s hard to find time). I was recently catching up on my “want to read” list and enjoyed The Nightingale (although it’s been out for a few years).

What do you like to do for fun?  We’re lovers of theatre – and see wonderful plays in the Chicago area once or twice a month. We love walks around our area and seeing our sons, including more recently traveling to Dallas to see our now 8 month old first granddaughter!