Wednesday, October 9, 2019

Difficult Conversations with Employees #PACPearls

PAC Pearls from the Women’s Dermatologic Society

Difficult conversations can be stressful for everyone involved, especially with employees. However, avoiding these conversations won't make the problem go away. By not addressing the issue, you may be enabling negative behavior and allowing it to affect others. Follow these tips from the WDS Practice Advisory Committee (PAC) for all stages of having difficult conversations with employees.

Before the Conversation

Before the conversation, identify what corrective actions or problems to address. However, resist the urge to publicly correct the employee. Having a private conversation creates an opportunity to show respect and sensitivity regarding the difficult topic. If possible, be sure to have an office manager present to provide support.

During the Conversation

During the conversation, ensure you have a clear plan to convey the issue, set expectations for future behavior, and outline a concrete action plan. 

Convey the Issue

  • Give examples for behaviors that need to be amended or adjusted
  • Be specific and factual
  • Use the first person observations (e.g. “I’ve Noticed”)

Set Expectations

  • Listen to your employee
  • Work together for a resolution
  • Convey clear expectations for the desired outcome

Concrete Action Plan

  • Outline actions that need to be taken to achieve the desired outcome
  • Develop clear consequences if the plan is not implemented
  • Document every meeting

After the Conversation

After a set period of time, follow up to ensure the action plan is being adhered to. Revisit matters that were discussed and see if the employee still has challenges or barriers to overcome. Once the issue has been resolved, praise your employee publicly. This reinforces the desired behavior through positive recognition.

The Women’s Dermatologic Society (WDS) Practice Advisory Committee supports WDS members at any stage of their career looking to manage or start their own practice by offering resources on navigating the practice environment.

Tuesday, September 17, 2019

Keeping Up Office Morale #PACPearls

Office morale is very important. Low office morale can wreck total productivity, while high office morale can keep everyone not only productive but happy and fulfilled in their work. Signs of low morale include lack of cooperation, few personal conversations, increased rates of turnover, and overall poor performance or attitude. Here are some tips from the WDS Practice Advisory Committee (PAC) on how to improve morale in your practice.

Daily Opportunities

Inspire your staff and create an environment where they want to help you, rather than just try to stay out of your way. The following suggestions can be implemented daily to encourage positive office morale.

Lead by Example

The best way to encourage positive attitudes throughout the company is by modeling a positive attitude yourself. Positive energy, as well as negative energy, is contagious and compounding.

Say positive things, walk with a smile on your face, and personally greet people when you arrive to work. Your employees will be more likely to do the same things to their co-workers, and before you know it, you'll be nurturing a collective environment of positivity. Remain sincere, as over-the-top positivity can sometimes have the opposite effect, but stay consistent even on the tough days and you'll reap the benefits.

Provide Positive Feedback

Giving praise and showing appreciation is essential. During busy days in the office it can be difficult to find time to give staff positive feedback, but regular positive reinforcement is imperative to keeping up morale. Take time at the end of the day to write down specific things that staff members did well.

Make a point to give them these compliments in the mornings or in an email so these behaviors are encouraged and they do not feel that their efforts go without notice. Too often staff members are given necessary constructive criticism and positive feedback can easily be neglected. It also helps to know each person’s love language as not all people respond to words of affirmation, many prefer quality time with you in or out of the office.

Team Building Opportunities

Communication is key. Whether a weekly huddle, monthly meeting, or quarterly team building event, creating a consistent time to air grievances, review workflow, offer new ideas, and build relationships is essential. Implement some of the following ideas to help keep up office morale.

Team Building Activities

Consider setting aside an office budget to support regular team building and experiment with initiatives for staff to celebrate each other. These gestures of appreciation can go a long way and who doesn’t like a treat?

  • Hold a weekly coffee or lunch meeting to encourage feedback and offer new ideas.
  • Include “Shout Outs” during meetings in which staff can share something positive about a colleague, such as a positive patient comment or a job well-done.
  • Host a quarterly “Happy Hour” to join a fun group activity such as visiting a corn maze in the Fall.
  • Throw a bi-annual office birthday party.

Unique Learning Opportunities – Presentation Coffee Talks

One great idea is to initiate a series of coffee talks before the day gets started that helps to improve patient care and creates a staff bonding experience.

  • Provide coffee and assign one staff member to choose a topic from a list of common skin disorders. 
  • The staff member can present a short summary accompanied by 1-2 page notes about a specific dermatologic issue or disease. 
  • Encourage discussion and add comments to their notes to provide more information.
  • Compile the notes into a staff book for learning the basics of dermatology and recognize each member who has contributed.

It’s important to realize that your staff only learn “on the job” and have never been through formal training. These presentation coffee talks provide the opportunity for staff to learn together as a team and be respected for their contributions.

Additional Considerations

Even with the best of intentions, you still may have to eliminate the bad apple(s). This can be a challenge as the toxic person in the office can often be a key employee or can be hard to identify as they may be adept at hiding in plain sight. You must remove or neutralize them with speed as office morale is readily eroded when you allow such an employee to flourish.

The Women’s Dermatologic Society (WDS) Practice Advisory Committee supports WDS members at any stage of their career looking to manage or start their own practice by offering resources on navigating the practice environment.

Tuesday, August 20, 2019

Should I Buy That Laser? #PACPearls

PAC Pearls from the Women’s Dermatologic Society

The cost of technology has risen substantially in the last few years. Making smart decisions about adding technology to your practice is critical. Many dermatologists find this decision stressful as a wrong choice can be a burden to your practice for years to come. As dermatologists, we are bombarded with claims, some legitimate and some less so, of fabulous results and “returns on investment”. Technology companies are adept at selling and it is up to us to have the tools to decide the best choice for our practice.

This month we are curating tips from the WDS Practice Advisory Committee (PAC) on how to evaluate the best possible technology option for your practice and when to walk away. Once you have decided upon the “perfect” device, have an honest assessment of your practice and never be in a rush to purchase!

Understand your Clientele

No matter what the newest hottest device may be, do your own homework before starting to negotiate. Find out what your patients are looking for and what needs you cannot fulfill with your current offerings. Look at the competition in your area and the general pricing for that service. Do a proforma to make sure the demand is there to ensure you can pay off the device.

Also, new technology may make some of your current offerings obsolete. We often forget to factor in the loss of patients from currently performed procedures when considering adding new device.

Clientele Questions to Consider
  • What are common aesthetic concerns in your practice? Will the new device address them?
  • What is your clientele’s price point for a laser procedure?
  • How many treatments do you anticipate a month realistically?
  • What kind of downtime can your patients tolerate? 
  • What impact will this have on current offerings?

Understand your Options

Don't get too excited and buy into a new device as soon as it hits the market. Wait and get feedback from your colleagues about their real life experiences with the device before making a decision on a big purchase and explore many options. Consider how the new technology will be used including the space and time the procedure will require, who will be using the new device, and if you will have staff training or hiring needs. 

Try before you buy. See what it is like to actually operate the device, from the ergonomics to the software. Since you will hopefully be using this device for many years, make sure you find it comfortable to use and that it is “user friendly”. Make sure that you can replicate the great results in the sales brochure with your own hands. See how the device is used in the real world.

You can speak with your local laser company managers to see if you can have a treatment yourself with a device of interest, or see how a treatment is done by a colleague. These one-on-one live demonstrations can give a better sense of how a device delivers, and add to the informed decision for a purchase.

Option Questions to Consider
  • Is the device comfortable to use and “user friendly”?
  • Can you receive a one-on-one live demonstration?
  • How much space and time will this procedure need?  Who will be doing it?
  • Can your staff be readily trained to operate the device or assist you? Do you need to hire new staff?
  • Do you have the physical space and electrical requirements for the device?

Understand the Nitty Gritty

Do your own calculations for return on investment (ROI) to see if the numbers make sense. Don’t rely on the company’s analysis. Check with your colleagues to see what price they got the device for and consider how the device will be included in your long term budget including any hidden costs.

Lasers, like cars, lose much of their value as soon as they are used. Sometimes an older used item can fulfill a need in the practice. Think about your overall budget for technology and what you are looking to build for your practice over the next 5 years. This can help you put each purchase into perspective.

Consider purchasing your device with an AMEX platinum card (NFI), as it may double your warranty. When they were used to fix an 18 month old laser, they were easy and a pleasure to work with. Also, know that if you are in an academic setting, it will likely be about a year for purchase to being able to use. Plan ahead!

Nitty Gritty Questions to Consider
  • Does the device require consumables? What are the ongoing costs and how are they sold?
  • How long is the warranty and what is covered? Are there additional costs to keep the device under warranty or a repair contract?
  • How long does it take for repairs? (All devices will need one at some point.)
  • When is the next generation due to come out?
  • Are there any restrictions in the contract regarding resale of the device should you choose to sell it later? How much is a recertification fee?

Monday, July 15, 2019

IJWD July 2019 Issue Now Available

The July issue of the International Journal of Women's Dermatology is now available online. Review the full table of contents, access the Women's Health Highlight and Art of Prevention signature articles, and download the Patient Page resources on the new IJWD website:


Clinical considerations for the management of psoriasis in womenAlice B. Gottlieb, Caitriona Ryan, Jenny E. Murase

Read all Women's Health Highlights


The Patient Page is a concise, informative sheet that Health Care Providers can download, print and provide to their patients to prompt them to ask relevant questions and begin focused doctor/ patient dialog. 

Psoriasis Management in Women
Alice B.Gottlie, Caitriona Ryan, Jenny E.Murase


Clinical considerations for the management of psoriasis in women
Alice B. Gottlieb, Caitriona Ryan, Jenny E. Murase

Introduction to The Art of Prevention series
Jenny E. Murase, Dedee F. Murrell

Hyperkalemia in women with acne exposed to oral spironolactone: A retrospective study from the RADAR (Research on Adverse Drug Events and Reports) program
Rebecca M. Thiede, Supriya Rastogi, Beatrice Nardone, Lauren M. Sadowsky, ... Bethanee J. Schlosser

Cutaneous leishmaniasis: A neglected disfiguring disease for women
Asli Bilgic-Temel, Dedee F. Murrell, Soner Uzun

Autoimmune bullous diseases during pregnancy: Solving common and uncommon issues
Aikaterini Patsatsi, Branka Marinovic, Dedee Murrell

Serum homocysteine level, vitamin B12 levels, and erythrocyte folate in psoriasis: A case-control study
Robabeh Abedini, Azadeh Goodarzi, V. Saeidi, Seyedeh H. Hosseini, ... Vahide Lajevardi

Dermatology residents in the era of #MeToo: Ethical considerations of appropriate responses to inappropriate patient behavior
S. Mattessich, A. Chiaravalloti, A. Y.-Y. Chen

Gender workforce disparities - an ethical imperative
Allison R. Larson

Successful management of bullous pemphigoid with dimethyl fumarate therapy: A case report
Aslı Bilgic-Temel, Shilpa Das, Dedee F. Murrell

Keratinocytic epidermal nevus with ipsilateral breast hypoplasia
Eric Chen, Anthony J. Chiaravalloti, Justin Finch

Malignant acanthosis nigricans as a paraneoplastic manifestation of metastatic breast cancer
Javier Arellano, Pamela Iglesias, Claudia Suarez, Yamile Corredoira, Katty Schnettler

Cutaneous myiasis in an elderly woman in Somaliland
Mukhtar A. Yusuf, Bobbi S. Pritt, Josette R. McMichael

Sophie Spitz: A woman ahead of her time
K. Spitz, M. Piliang, E. Mostow

The legacy between the Women's Dermatological Society and leadership in the American Academy of Dermatology
Linda Susan Marcus

International WDS Forum Abstracts 

Wednesday, July 10, 2019

Photography in the Clinic #PACPearls

The WDS Practice Advisory Committee (PAC) shares dermatology photography tips including how to take quality photos and save time, before and after photography, dermoscopy and more.

Dermoscopic Photography

I find it very helpful to monitor pigmented lesions for changes using dermoscopic photography. In order to do this quickly, I have a phone case that is magnetized to hold my dermatoscope in place. Both my dermatoscope and the case are from DermLite. Using an app for EPIC, my photographs can be directly uploaded into the patient's chart for future use. I find this system to be very quick and efficient. 

Taking dermoscopic photographs of things that I biopsy has also improved my own knowledge. I review photographs when dermpath comes back to see if there are any features that I can learn from for a particular diagnosis. For anyone who teaches residents, having a library of dermoscopic images can also improve residency training.

- Lori Fiessinger, MD

Obtain Post Procedure Photographs

Baseline photographs before cosmetic procedures can easily be taken when patients come in for treatments, but obtaining post procedure photographs can be more difficult. To encourage patients to come in for photographs after their treatments, try offering follow-up appointments 2 weeks after a cosmetic procedure for possible touch-ups and photographs. This will help to motivate patients to come in at an ideal time for post procedure photographs in addition to improving patient satisfaction.

- Jeanette Black, MD

Photographing Nails

Routinely examine and photograph nails from their surface and free margin views. In this way you will document the source of a nail disorder (nail bed and distal matrix as depicted in this onychopapilloma) and document progress in response to medical or surgical treatment.

- Molly Hinshaw, MD

Create Consistency

If not ready for a more sophisticated photography setup in your practice, consider choosing a white wall in the same space, mark out on the floor a consistent distance and review with your staff the different angles using anatomical features as landmarks to lineup before and after photos.

The American Society for Dermatologic Surgery (ASDS) has a poster on photographic standards that can be put up on the wall in the photography-designated room. This can help to remind staff of face and body positioning to get greater consistency with photos (poster can be purchased online through the ASDS).

- Monica Li, MD

Not all practices have the resources and space for a sophisticated photography room. You can incorporate inexpensive techniques for photography standardization such as using black or white backdrops made of thick cardboard cut into desired sizes. These can be kept in each patient room, easily accessed and placed behind the patient to efficiently capture photos without having to move the patient. You can also place these behind the doors in patient exam rooms, again for easy access.

- Mona Sadeghpour, MD

Good before and after photos are hard to do- one must reproduce the exact lighting and position of the patient. Using the same room and buying a few lights inexpensive on amazon such as this with a dedicated space is best.

- Margo Weishar, MD 

Useful Apps

Use a program that allows “ghosting.” Overlaying the new photo with the old photo can really improve your accuracy. We use RxPhoto which is a paid program but there are free apps to try as well. iPhone 10 photos are very high quality for everyday use. For publishable quality, you will probably need a higher end camera.

- Margo Weishar, MD

In trying to keep follow-up photos uniform, I would look into an app called Imagine (NFI).

- Mark Kaufmann, MD

*Please note, all products and apps mentioned are included as examples and are not endorsed by WDS.

Thursday, June 20, 2019

Avoiding the MIPS Penalty in 2019 #PACPearls

By Dr. Mark Kaufmann

The bar has been raised.

The amount of MIPS points required to be exempted from the 7% penalty in 2021 (for performance year 2019), is DOUBLE what it was last year. Instead of 15 MIPS points, you now need to get 30 MIPS points. With a little more effort, there is still a way to avoid the MIPS penalty in 2019, and while it’s still possible to do this without using a registry OR an EHR, both of them would make it a lot easier.

Here’s how to get it done:

  • If you are a small (fewer than 15 clinicians) practice, each clinician needs to complete five measures on at least one patient. I still recommend that each clinician complete five measures on more than one patient. Any combination of measures will do, and five will give you 15.75 points.
  • In order to get up to 30 MIPS points, you will also need to do a High Weighted Improvement Activity (IA).
  • You can choose any of the high weighted IAs from the 2019 Improvement Activities List, and if you want to do it without a registry or EHR, I would recommend doing the Complete CDC Training in Antibiotic Stewardship.
  • Without a registry, you would have to attest to completing the IA by using the CMS QPP website, which is probably more difficult than doing the IA itself!
  • If you use a registry, like DataDerm, they will attest for you…and by the way, it’s probably the right time to consider getting DataDerm, as this will probably be the last year that I will be able to write this type of cheat sheet.
  • Starting next year, you will have to choose between getting “in the game” or, taking a 9% penalty every year moving forward.

Food for thought.

Friday, May 31, 2019

Milan Travel Tips for the World Congress

WDS Editorial Highlight
By Jennifer Sorrell, MD

The World Congress of Dermatology is fast approaching, taking place June 10-15, 2019 in Milan, Italy. We would be remiss to not take a moment to discuss some of the wonders of this breathtaking portion of Europe.

Milan is one of the fashion capitals of the world, however there are some fantastic historical sites to take in as well including da Vinci’s “The Last Supper” and the Duomo. Visits to The Last Supper are very limited in availability and should be booked well in advance. Tours of the Duomo are not possible on Sundays or religious holidays. I would suggest a walking tour, as these always provide such amazing information in the moment and make the sites so memorable. Usually, these tours also allow you to “skip the lines”, so that you aren’t wasting valuable sightseeing time waiting. One tidbit I have found after doing lots of walking tours in different European cities is to arrive at the meeting site at least 15 minutes early to account for potential delays.

A day trip option is to take a quick (1 hour) train ride into Switzerland and the town of Lugano is an easy choice. I did note that Lugano was a bit pricey. I highly recommend taking the funicular to the top of Monte San Salvatore.

Lakes District of Italy
If you will have a bit of extra time, the Lakes District of Italy is a must see. Lake Como is an ideal place to “reset” and simply take in the most picturesque surroundings and the cleanest air without a preset agenda.

If you enjoy a more modern hotel experience, I can personally recommend Avenue hotel and Como Luxury Rooms. The Avenue hotel had free bicycle rental allowing us to bike the area with ease, though I felt that Como in general was very walkable. The latter hotel was unique in that it only has 2 rooms and has more of a studio apartment feel in the middle of town. If you stay for dinner, there is a lovely, authentic family run restaurant called Osteria del Gallo. They serve an appetizer of a light cheese stuffed focaccia with thinly sliced prosciutto on top that I could literally eat everyday. Using Lake Como as your base camp, it is quite easy to take the ferry to several of the towns that surround the lakes like Bellagio, which is equally lovely and provides some unforgettable views.

We would love to see the fun times you had at these meetings! Please submit your travel photos to as we will be posting a few members’ travel experiences in an upcoming newsletter. Bon Voyage!