Dermatology Practice: A Thirty-Year Perspective

by Dr. Shawna Flanagan, WDS News You Can Use Committee

“Our fatigue is often not caused by work, but by worry, frustration and resentment.” - Dale Carnegie

Dale Carnegie, the author of How to Win Friends and Influence People, was born in Maryville, Missouri in 1888 and graduated from Maryville High School just as I did years later. Many of his quotes resonate with me, not only because of our shared hometown roots but because they echo the lessons I’ve learned over three decades as a business owner.

As of 2025, it’s been 27 years since I opened the doors to my dermatology practice and nearly 30 since finishing my dermatology training at the University of Miami. Thirty years of full-body exams, biopsies, cryotherapy, skin cancer surgeries and laser procedures. Thirty years of meeting patients where they are—physically, emotionally, and sometimes spiritually---and helping them feel beautiful and whole in their own skin.

Along the way, I’ve learned more than just medicine and dermatology. I’ve learned about people, priorities, perseverance, and the power of trusting yourself.

Here are the lessons that stand out the most—truths that have carried me through every phase of this deeply rewarding journey.

Know Your Worth

Whether it’s negotiating a contract, charging fairly for your services, or choosing how to spend your time- knowing your value is essential. If you don’t respect your worth no one else will. Ask for what you need-whether it’s compensation, flexibility, support, or recognition.

Not Every Patient Is Yours to Keep

Fire patients when necessary. If someone doesn’t respect your time, your expertise, or your staff –or if they simply refuse to listen-let them go. It’s not only okay, it’s necessary for your sanity and for the well-being of your practice. Medicine is about compassion, not martyrdom.

Honesty Over Profit

Never perform a procedure or push a product just for financial gain. Patients can sense when your motivations are off. Be honest- always. Integrity outlasts trends, Yelp reviews, and insurance plans.

Family and Career: It’s Not a Choice, It’s a Balancing Act

Don’t try to time having children. Just do it if that’s what you want. You’ll find ways to adapt. Sometimes your family will need more from you than your career does. Sometimes your career will demand more. One won’t break if the other gets more attention for a season. But always check in with your work- life balance - you don’t want a season to take over and become a lifetime.

Evolution is Essential

Change jobs. Change your model. Shift from insurance to concierge or self-pay. If you dread doing something at work stop doing it (I stopped seeing pediatric dermatology years ago - no regrets!). Add new services or cut back. There’s no “one right way” to run a dermatology practice. Reinvention is often the key to longevity. Try new procedures, new workflows, new office hours. Keep learning.

Avoid Burnout by Staying Curious

Try new treatments, techniques and technologies—not for profit, but for passion. Learn aesthetic procedures, dive deeper into medical derm, or teach. Burnout isn’t always about working too much. Sometimes it’s about staying stuck.

Aging Gracefully as a Doctor

Being on your feet all day in clinic catches up with you. Stretch regularly throughout the day. Keep a Thera gun at the office for spot treatments of neck or other tight areas. Do yoga or Pilates. Prioritize sleep. Sit down during long procedures-it’s better for your back and your brain. Mask when using cautery or ablative lasers. You only get one set of lungs!

Patients Love Efficiency

Treat lesions when you biopsy them, if appropriate. For example, electrodessicate the base of a lesion so the actinic keratosis or non-melanoma skin cancer is treated during the biopsy visit. It saves your patients a return trip, shows you value their time, and builds trust. Stay on time. It demonstrates respect for your patients-something increasingly rare in modern medicine. And don’t underestimate the power of Trichloroacetic Acid—it’s simple, elegant, and effective for actinic keratosis and superficial skin cancers. Plus, it spares the plume created by electrodessication.

Staff Are Everything

Your team can make or break your day. Treat them well. Invest in them. Support their growth and encourage professional development. When your staff feels empowered, your practice runs smoother, and your patients feel the difference.

Keep a Sense of Humor

Sometimes humor can defuse tense situations- with patients, family, or staff.

“Laughter is not at all a bad beginning for a friendship, and it is by far the best ending for one.” Oscar Wilde, The Picture of Dorian Gray

Owning a dermatology practice for three decades hasn’t been easy—but it has been deeply meaningful. It’s taught me that medicine is an evolving relationship: With your patients, your team, and yourself. I’ve had the privilege of aging alongside my patients, keeping their skin as healthy and vibrant as possible. I’ve also had the satisfaction of saving lives by catching early melanomas that were fully curable with surgery.

To those just starting out: trust your instincts, set your boundaries, and stay open to growth. Medicine is a marathon. But with the right lessons, it’s one worth running every day.