Reflections on 25 Years of Private Practice

By Joel Schlessinger, MD

Having been in practice for 25 years as of this month, I wanted to take this moment to look back on lessons learned in that quarter of a century. My perspectives may differ from others’ since I am a solo-practitioner in Omaha, NE; unlike many others in starkly different settings with varying styles of practice. Hopefully, most of what I write is fairly universal in nature.

For those who are starting practices now, please remember that the best part of being in private practice revolves around the relationships you make over the years. Your staff, patients and family will remain the one constant (although they will change and grow over the life of your work as a dermatologist). Constantly evaluating and refining relationships is the hardest and most important thing that many practitioners will do, but the effort is worth it. My patients have taught me by recounting the smallest things about interactions (both good and bad sometimes!), but the judgment and wisdom that come with time and experience make it easier to achieve the desired outcome when dealing with varied individuals.

Realize that you aren’t in control of your staff. They are actually in control of you. The relationships you cultivate with your staff over the term of your practice are crucial to your success and happiness as a practicing dermatologist. Treat your staff well and you should be happy, but you should not hesitate to let staff go if they aren’t part of your vision. Not all dermatologists have this luxury, but if you do have the option of hiring/firing, exercise that option both in hiring staff that might or might not fit and in terminating toxic individuals from your practice. The results will improve your life and the lives of your staff immeasurably. And don’t give up on individuals too soon—there are many times when training someone seems to be an endless task. Then, something clicks and your problem staff member turns the corner and becomes a long-term, beneficial employee. Small joys like the maturation of a staff member stay with you and the individual in a beautiful way.

I have also realized that technology is fleeting and it must be embraced with caution and changed when its time is up. We have had many lasers, some of which were unqualified successes over a long period of time. Others are either in the garbage or never used. That’s worth remembering when you consider purchasing new equipment. The equipment won’t make your practice, but you and your judgment will, just as a nice outfit won’t change the person wearing it. And don’t forget that the availability of technology will only produce success if you choose patients wisely for procedures and refer out when you don’t have the technology, skills, or talents necessary for the job at hand. Sometimes, refusing a procedure is the best thing you can do!

Remember that new isn’t always better. There are far too many instances of new lasers, new procedures, new products, and new techniques that have turned out to be dead ends. These will continue to happen and require you to always be careful and continue to do due diligence even after the sale. Your patients deserve it.

Don’t forget or neglect your family. If you think of taking a vacation or going to an event with your family and work gets in the way, think about a way to make it happen. My friend, Joe Eastern, always says that you won’t regret not going into the office more and he is exactly right. One of the best decisions I made was giving up Saturdays in the office and eventually turning Fridays into a time for meetings and administrative duties. Find a way to make vacations, kids’ recitals, school events, and joy happen. My wife, Nancy, and children (Claire and Daniel), as well as my parents, June and Bernie, have been an integral part of my practice and have contributed immensely to my personal well-being as has my 20 year physician assistant, Jackie Hall. The interplay between family and practice has never been a zero-sum game due to their love and respect for my professional endeavors and my desire to keep a work-life balance.

Ever important to remember: Honor your mentors. No one becomes a good dermatologist without help. My first major exposure to dermatology occurred in the office of Dr. Barry Ginsburg in Birmingham, AL. Without that, I wouldn’t have ever understood the beauty of dermatology and for that I am extremely thankful. Last month I mentioned another mentor from my residency at Washington University of St. Louis. This month I will travel to honor the legacy of yet another, Arthur Z. Eisen, MD, my program director while at the same institution. Goodness knows he (and others) took risks on me and for that I cannot thank them enough.

Lastly, my story isn’t unique. Whether you have been in practice one year, 10 years, or 50 years, each reader has their own story. I’d love to hear that and any tips you have for new and not-so-new dermatologists. Please send these to me at and I will publish a compilation of the best tips and anecdotes in an upcoming journal. Thank you!

—Joel Schlessinger, MD
Chief Cosmetic Surgery Editor
Founder, Cosmetic Surgery Forum


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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.