Complicated Mohs surgery with facial reconstruction? No problem. Laser hair removal on skin of color without any complications? Consider it done.

There’s really not a difficult aesthetic or medical dermatology case that Kavita Mariwalla, MD can’t handle with grace and skill, but when it comes to dealing with the human resources aspect of her practice, she admits feeling a bit bewildered.

She is not alone.

Many dermatologists are struggling with the business side of running a practice as this is not taught in most medical school curricula. That’s why Dr. Mariwalla, a dermatologist in West Islip, NY, wrote a book on the subject with Jeffrey Dover, MD, co-director of SkinCare Physicians of Chestnut Hill, MA. Here, Dr. Mariwalla discusses the new textbook, The Business of Dermatology, and what she wishes she knew before starting her own practice.

Why did you and Dr. Dover write “The Business of Dermatology”?

Kavita Mariwalla, MD: Over the last decade I feel like I have witnessed an alarming trend of physicians selling to large corporations for a number of reasons, one of them being all that goes into running a practice. Similarly, young physicians seem to be getting scared off from hanging their own shingle. So, this book was born as a way to level the playing field for dermatologists. It’s a one-stop shop for great advice from dermatologists who run successful practices. We know that board-certified dermatologists are fantastic physicians and that always comes first. To see a patient and deliver care, the door needs to be open, the lights on, and the staff humming along. That is where this book comes in.

What was the best business advice you ever received?

Dr. Mariwalla: Don’t ever chase money. My dad told me this when I was starting out. As long as you deliver excellent patient-centered care, you can make a go of hanging your own shingle. Even when it seems everyone around you is selling, patient care should always be the driver and you will be okay. 

 What is one thing you wish you knew before hanging your shingle?

Dr. Mariwalla: How difficult the human resources side of being a practice owner is! 

What are the three most important building blocks or elements for a successful practice?

Dr. Mariwalla: Availability, affability, and ability. These three As have always been the cornerstones for any successful practice. 

How do you accrue and retain patients?

Dr. Mariwalla: When I started out, I offered evening and weekend hours. Most people have to work and can’t take time off to bring their child in for an acne visit.

I think it is important to explain routines to patients and to write things down, so they remember your instructions. And above all else, practice good medicine. 

Any tips on hiring practice managers and others to help run your practice?

Dr. Mariwalla: You have to decide how much control you are interested in relinquishing. You can hire a practice manager who has an MBA who will run your practice and you can give some input. At a certain size you have no choice because without a practice manager, your practice will actually start to falter. For me, I was small in the beginning and did it all, but over time, I promoted someone from within who understands my values and goals and functions as someone who executes those tasks on my behalf. 

How do you decide what to outsource and what to do in-house?

Dr. Mariwalla: This will change as your practice size changes and your number of employees changes. For example, I outsource portions of my billing revenue cycle management, but in the beginning, I outsourced it all. On the flip side, I had done all of the human resources in house and am now thinking of outsourcing that to make it more streamlined. As a fellowship-trained Mohs surgeon, I did not have to outsource that type of procedure or my aesthetic patients. I do still send pathology out. Again, as time changes, some of these things change as well.