Your practice is good, but could it be better?

Most dermatologists serve two masters — their patients and their practice. Focusing on the latter generated plenty of discussion during the session “Emerging Practice Models” (F026).

Michel A. McDonald, MD.

Michel A. McDonald, MD, an assistant professor of dermatology at Vanderbilt University Medical Center and the chair of the AAD Council on Practice Management, led the session, which addressed trends in the current structure of the dermatology practice and in the dermatology space in general. Presenters reviewed multiple practice model types to offer dermatologists options when changing or adjusting their current practices.

“The current trends in dermatology practice are consolidation and a decrease in the overall percentage of dermatologists practicing as solo practitioners,” Dr. McDonald said. “This leads to more dermatologists being employed by an entity other than themselves.”

The Academy provides its members with help navigating the pros and cons of various practice models through its Practice Management Center. For example, Dr. McDonald said practicing in a larger group practice versus running your own business may allow you to be relieved of administrative burdens. Such burdens only seem to be growing, she said. The trade-off with this model? Loss of autonomy. Private practice offers autonomy, but dermatologists who opt for it have to handle their own regulatory reporting or pay someone to do it for them.

“It is imperative to keep our members apprised of the changing landscape of dermatology practice so that they can have the most information possible when making decisions related to their careers,” she said.

Disruption in academics

Some of the session focused on the academic practice model as well. Robert T. Brodell, MD, professor and chair of the department of dermatology at the University of Mississippi Medical Center, introduced the subject by pointing out the disruptive forces impacting academic medicine. Those forces are affecting education (medical information doubles every five years, there are new tools and techniques to be harnessed and less didactic classroom time); clinical care (higher costs are promoting the migration of care from academic centers to outpatient settings and community hospitals, and even to retail settings); and research (most notably, the top 20% of academic centers are grabbing a bigger slice of a shrinking research pie).

Robert T. Brodell, MD.

“The old way was one day in the clinic, two days in the lab, one day teaching, mentoring, and writing, and one day of administration,” Dr. Brodell said. “Now, it’s four days in the clinic, one day teaching, mentoring, and writing, and administration, and one to two hours a night doing EHR.”

Functioning like family

Dr. Brodell described the new team-based care model in which each team member functions at their highest level, based on training, certification, and ability.

“We take care of each other like family and always put the patient first,” he said.

As an example, Dr. Brodell said members of the staff could learn to take photographs and master techniques to perform KOH and scabies preps under strict supervision. Having at least two staff empowered to scribe and perform nursing duties for the physician can save even more time and protect physicians from burnout, he said. According to Dr. Brodell, the model works, improving the rate of completed visits and RVU production, while increasing gross charges, and payments.

At the end of the day, however, there’s still one “old school” consideration — your practice culture, he said. It may be good, but could it be better?

“Culture trumps everything,” Dr. Brodell said. “Are the housekeepers, schedulers, and receptionists in your practice happy? If they are, you can be assured that your patients will be happy, too!”

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