Thursday, June 14, 2018

Pearls for the First Year out of Residency #PACPearls

The Practice Advisory Committee has put together a list of pearls
to keep in mind your first year out of residency.

Pearls from Dr. Sarah Jackson 

Many of us had no formal business training, yet we run successful businesses now. If you are starting your own practice, you must seek out the advice of experts, just as you would for a tough medical case. Throw yourself into learning about business, and utilize courses, mentors, and experts outside of our specialty. You will reap the rewards throughout your days of private practice!

Pearls from Dr. Monica Li 

Do not let patients pressure you into providing an intervention that you are not comfortable with.

When in doubt, go back to the basics and be systematic.

Always be nice to your support staff - they can be so helpful in ways known and unknown to you!

Pearls from Dr. Elizabeth Long 

Learn from failure. When patients express dissatisfaction from a treatment, a drug price, an interaction with staff, etc... always contemplate how that could have been avoided. For example, maybe they didn’t understand the diagnosis is a chronic problem that will require some degree of attention, intermittently, forever. To improve the experience, give patients a clear diagnosis and prognosis in addition to a flare and maintenance treatment plan or let them know it may take a couple of visits to determine the diagnosis and treatment plan. Setting clear attainable expectations can make a huge difference.

Keep an organized patient encounter. To combat a busy clinic with a wide variety of patients and chief complaints, I depend on personal handouts of my top 10-15 diagnoses that explore prognosis and treatment elements. I then review each sheet (and sometimes multiple ones) with the patient with customized recommendations for them based upon needs and budget. I update them annually and add new topics as I find myself handwriting the same instructions over and over.

Become a part of your community. I live in a small town and understanding the relationships between my patients leads to a deeper, more rewarding connection. It also gives you more feedback on both success and failure.

Pearls from Dr. Mark Kaufmann 

You may not have been exposed to coding in your residency, but you’ll likely be doing it for the rest of your career. Find a mentor in coding, buy a manual, and go to courses. Correct coding is vitally important.

Pearls From Dr. Deirdre Hooper 

Pay attention to relationships. When you meet other physicians as well as people in the industry, exchange contact information and stay in touch in the office or at meetings. Respect what that person knows. Your career is long and you never know who will be a mentor, who is someone you can mentor, and who will be a great friend.

Tuesday, June 5, 2018

Young Physician Spotlight - Nada Elbuluk, MD, MSc

Dr. Nada Elbuluk is a board-certified dermatologist and assistant professor in the Department of Dermatology at USC Keck School of Medicine. She received her bachelor’s degree in Psychology from Princeton University where she also minored in Gender Studies and African American Studies. She went on to complete her medical degree from the University of Michigan where she graduated with a distinction in research. While there she received an NIH award that allowed her to also obtain a Master of Science in Clinical Research from the University of Michigan, School of Public Health. She completed her dermatology residency at Johns Hopkins Hospital. Afterwards, she served as a fellow and clinical instructor in the dermatology department at The University of Pennsylvania.

Dr. Elbuluk’s clinical and research interests include general and cosmetic dermatology, with a special interest in ethnic skin and pigmentary disorders including vitiligo, melasma, and postinflammatory hyperpigmentation. Dr. Elbuluk is a Diplomate of the American Academy of Dermatology and holds professional memberships with the American Academy of Dermatology, the Women’s Dermatologic Society, and the Skin of Color Society.

How did you become interested in dermatology and what led you to where you are now?
I had an early fascination with dermatology and the visual nature of the field going into medical school. This was solidified after taking our second year dermatology course. I then had the opportunity to shadow Dr. Lorna Thomas in Detroit and had a wonderful broad exposure to dermatology and a diverse array of patients with different pathologies in her clinic. I decided after my third year of medical school, to gain more experience on the research side of dermatology. I spent a year doing an NIH T32 award program at the University of Michigan where I obtained a Master of Science in Clinical Research and received mentorship for my clinical and translational research from Dr. Sewon Kang. By the end of that year, I'd had experience on both the clinical and research sides of dermatology and knew it was the perfect fit for me. Those experiences also helped solidify my interested in pigmentary disorders and ethnic skin, which I specialize in now. I went on to do my residency at Johns Hopkins where I continued my research in these areas. After residency, I spent a year at the University of Pennsylvania with Dr. Bill James doing the Clinician Educator fellowship. This year better prepared me for a career in academia by allowing me to further develop my clinical and research niche as well as preparing me for how to best teach and mentor residents and medical students.

What are you working on now?
I currently am an assistant professor of dermatology. I've spent the last four years at NYU and will be moving this summer to start the next chapter of my career at USC. I am currently working on several research projects and papers on vitiligo, skin of color conditions, and procedural dermatology in ethnic skin. I am also active with several organizations. I just finished my term as chair of the WDS Young Physicians Committee and am now serving on the new WDS Integrative Task force committee as well as continuing my term on the Media Committee. Additionally I am on the board of the Skin of Color society where I chair the Research committee, and I also serve on the AAD's Young Physicians Committee. 

What advice do you have for residents and young career dermatologists who want to become more active in reaching the underserved populations?
I'm very passionate about diversity and helping the underserved. I have spent the last few years at NYU as the Diversity Ambassador for the Department and as NYU's Diversity Champion for the AAD's Diversity Task Force. Through these programs, I've had the opportunity to create many great initiatives to help increase diversity in medical schools and dermatology residencies. I'm a strong believer that this process starts early and for that reason have worked on pipeline volunteer programs that start as early as elementary, middle, and high school, where we either go out to the schools or have them come visit us at the hospital and talk to them about career options in medicine and how to pursue this path if interested. I think for anyone interested in doing this kind of work, the AAD Diversity Task Force and the Skin of Color Society both offer many resources on programming and how to get started. For those interested, forming a committee at one's program can help create an organized effort for various programming that helps underserved populations. Lastly, finding a mentor who is doing similar work can also be a tremendous resource. One of my mentors, Dr. Amit Pandya, has been very supportive and helpful in this realm.

How did you decide to pursue a career in academics vs. private practice? Can you speak to the benefits and challenges you face as an academician?
I was fortunate to have exposure to both academics and private practice while I was a medical student. I saw advantages to both but felt for me, I wanted to try having a career in academia. I was attracted to the variety of roles one could have in an academic institution, the ability to do a mix of clinic, research, teaching, and administration, and the opportunity to be part of an institution where I could collaborate with others in and out of my department. I also like the ability to work with medical students and residents. With that said, I have mentors in private practice who have academic affiliations and who have been able to find a similar balance. I think one has to know their personality and try out what they think is the best fit for them. Fortunately, we have lots of options in dermatology to practice in different settings and
to find the right combination of settings in which we can thrive and be happiest.

What advice can you give young physicians on achieving a work-life balance?
This is a challenge that I feel I'm always working on especially after becoming a mother. One thing I try doing is putting aside blocks of time for doing things. I try to compartmentalize as much as I can, so that when I'm at work, I try to be as efficient and productive as possible during the time I have there and when I'm at home, I try to be fully present and engaged with my family and not do work related things. I think having good help also makes a big difference and buying yourself time by outsourcing things that you don't feel are a good use of your time.

What do you do in your free time?
I love to spend time with my family and friends. I enjoy the outdoors, photography, reading, and traveling.

Tuesday, May 29, 2018

The "Business" of Dermatology - An Editorial on Practice Management

The “Business” of Dermatology
By Shawna A. Flanagan, MD
Practice Management
During medical school and training many decades ago, business classes were not part of most physician’s curriculum. It is possible friends or family members may have helped guide your decisions, as far as business decisions were concerned, but usually, most of us just figured it out on our own. That is how I did things when opening my office twenty years ago. I just winged it! Fast forward to 2018, and it seems like the time has come for dermatology to be part of the business world.
If you attended the annual meeting this year, you might have noticed the overwhelming number of practice management booths. I receive several emails and letters every month with the offer to buy out my office and take over the “management.” In this month’s editorial , I will try to explain the business of dermatology, and this current “buy out” frenzy in an oversimplified version from a doctor, not an investment banker or a writer! Like my days as editor of my high school newspaper, I will investigate the who, what, where, when and why of this issue.

Private Equity (PE) Firms:  An investment management company that provides financial backing and invests in the private equity of startup or operating companies through a variety of loosely connected investment strategies. Each firm raises money from investors who expect to then make a return on their investment by recapitalization, mergers or acquisitions, or initial public offerings. The recapitalization means that extra cash earned by growing the business is distributed to the owners. Mergers and acquisitions mean the smaller firm might sell to another firm for a multiple of the business, and an initial public offering is when the company offers stock options to the public to invest in your dermatology practice. Usually, in addition to these the PE firm will take a management fee for helping build the business while using their money to do so. Private Equity firms usually hold on to companies for the long term if they are profitable. PE firms are different than Hedge Funds which typically make shorter-term investments in securities or other more liquid assets. Well, known examples of private equity firms are Goldman Sachs and The Carlyle Group.  

You can either be an employee of one of the groups that is backed by a private equity group, or you can partner with a PE firm to provide equity to grow your dermatology business without having to risk all your own assets to do so. If you are older and ready to phase out, you can sell your practice based on a multiple of EBIDTA, (earnings before interest, taxes, depreciation, and amortization) and negotiating a valuation of your practice.  

The trend seems to be going on throughout the entire United States.  Different PE firms are concentrating in different areas of the country.

This seems like an exit strategy for an older dermatologist if you can get equity out of your office and phase out in a way that will allow you to have more free time. If you are younger and have more than ten years left before you want to wind down the numbers may not make sense for you. You should discuss any proposals with your accountant and your lawyer to see if they make sense for you. There are also models that involve only a partial sale of your office which might make more sense if you have many years until you want to retire. Today many doctors embrace the idea of spending 100 percent of their time providing patient care. For younger dermatologists who don’t want the headaches or responsibility of owning their own practice these PE backed groups may offer fair compensation as an employee.  

Why PE Firms Want Dermatology:
This model has previously worked in dentistry, emergency medicine, radiology, and other healthcare specialties. Dermatology is very attractive to PE firms, because the demographics of the US are aging. According to the US Department of Health and Human Services, the average age in the US by 2019 will be up to 54 Million people over the age of 65, from the current 46 million. More of these seniors will have access to healthcare which will boost the demand for dermatology. These patients usually have expendable income, and many dermatology patients who come in for general dermatology or surgical dermatology will also be cosmetic patients. Cosmetic procedures produce cash income that is not regulated by insurance companies or the government. Dermatology is outside hospital systems, and not subject to the cost savings that hospitals try to impose on procedures done in the hospital or its surgery centers.  

Why Would a Dermatologist Work with a PE Firm?
In speaking with many of my colleagues these are some of the pros and cons of having PE firms owning or managing your office:

The Pros:  This may give you the ability to collaborate and network with other dermatologists which could possibly make a good dermatology practice even better by pooling resources. These loosely affiliated groups can simplify administrative burdens. It is difficult for solos providers and small physician groups to afford to purchase and maintain electronic health record s and comply with government reporting requirements. Billing cost represents about fourteen percent or more of visits in small offices.  Billing costs are lowered by pooling your billing personnel and software. This also may help with product purchasing in bulk as well as a shared marketing and social media for the company. With a larger company there may be improved benefits and human resources and as well as possible maternity leave allowances or job sharing options.  

The Cons: You may have loss of autonomy due to the administrative support of a corporate structure.  This may include loss of major purchasing decisions as well as key decisions about the practice. This may also include inability to hire or fire your own ancillary personnel. The company may encourage you to hire extenders or aestheticians to supervise to grow the practice but possibly not respect your role as the physician in the professional hierarchy of the office or practice. Always get your employment agreement reviewed by a lawyer and try to negotiate anything you can’t live with or without.  

In Conclusion:
In the end, as always, when things are changing around us, we can choose to bury our heads in the sand, or we can become knowledgeable about what is going on and make an educated decision.  Is the business of dermatology a bad thing? I think as long as we continue to give patients the quality of care they deserve and don’t compromise our Hippocratic Oath, partnering with the business world is something that might be here to stay. 

Wednesday, May 9, 2018

How to Choose your Path: Part 2

When working in the field of dermatology, you will find yourself wondering about whether to go into academia or private practice, what area to make as your niche, and how you balance work with your life so you don't burn out. Hear from leading dermatologists on their thoughts to follow your passion, and how to create the path you want to follow.

This webinar featuring Drs. Carrie Kovarik, Alexa Boer Kimball, Abrar Qurechi, Barbara Gilchrest, Lorraine Young, Roopal Kundu, Jean Bolognia, William James, Cheryl Burgess, Jane Grant-Kels, Elizabeth Hale, Jenny Kim, and Lynn Drake goes into detail on how to decide between academia and private practice, developing a niche, and thoughts on work-life balance.

Continue watching the WDS Webinar Series by following the WDS YouTube Channel

The WDS Webinar series is brought to you by the Young Physician Committee
and sponsored by Galderma

Monday, April 30, 2018

Finding Serenity - An Editorial on Work-Life Balance

Finding Serenity
An editorial by Samantha Schneider, MD

As physicians, we are constantly faced with new challenges and potential sources of stress. There are the pressures of increasing regulations, less time for patient visits, and, not to mention, all of our other “life” obligations. One key to success in this ever-evolving technological world of more, faster, now - is to unplug.
One of the most therapeutic things that I have discovered during my training is to turn off my phone and get outside. Now, let me start by saying that I never thought I would have said this before medical school. I did not enjoy being outside at all. I say this as a way to encourage some of the possibly more reluctant readers. You can do it! And, you may even surprise yourself.
                Start small. Maybe you will just walk around your neighborhood (without your headphones). You’ll be amazed at how much more you notice from the birds chirping to new flowers along your route. If you have a local county or state park, find a trail and get after it. Once you get started, you’ll see that “hiking” is really just walking on dirt instead of a sidewalk.
As you become more advanced, you may head to a national park for bigger landscapes (and depending on the time of year and the park, bigger crowds). Some of my favorite national parks for hiking and camping are Zion National Park in Utah and Kings Canyon and Yosemite National Parks in California – all of which tend to be very popular destinations. On each visit to the park, we plan a trip to the “backcountry” which sometimes can mean just one to two miles away from the popular tourist destinations. It is remarkable how quickly the crowds can melt away. That being said, we also always spend at least one day doing the typical touristy “front country” hikes. You can’t go to Zion and not see The Narrows or go to Yosemite and not see El Capitan.
And, as your love for the outdoors grows, you may even start to seek the opportunity to be outdoors. Now, my husband and I travel for a week in the national parks carrying all of our food and water and camping in remote locations. There is nothing like fully immersing yourself in nature away from our busy daily lives. It is remarkable how restored one can feel after a few days in immersed in nature. You get a sense of how small we are compared to the rest of the world and sometimes we need that reminder and that ability to re-center.

This is a view of the mountains in Kings Canyon from our tent.