PracticalDermatology

Although the COVID-19 pandemic is not behind us yet, many cosmetic and medical dermatologists are beginning the reflection process. In that vein, Cosmetic Surgery Forum (CSF) faculty took a long look at the income loss and other downstream effects of the pandemic and the shutdowns it sired.

A panel of dermatologists—Vivian Bucay, MD, founder of the Center for Dermatology and Aesthetics in San Antonio, TX; Suneel Chilukuri, MD, FAAD, Director of Cosmetic Surgery at Refresh Dermatology in Houston; Jeanine Downie, MD, Director, image Dermatology PC in Montclair, NJ; Michael Gold, MD, founder of Gold Skin Care Center and Tennessee Clinical Research Center in Nashville; and CSF founder Joel Schlessinger, MD, FAAD, FAACS of Omaha, NE—get candid about how the pandemic affected their practices and their outlook for the future.

To furlough or not to furlough

The Paycheck Protection Program (PPP) allowed many dermatologists to keep staff on during forced office closures.

Dr. Schlessinger retained his entire nursing staff and support staff, other than pregnant and at-risk individuals, during the crisis. “There were a few individuals who didn’t want to work at other positions in the clinic during this time, and they were furloughed, but I was proud that we retained 23 employees,” he says. “All our employees are back and our spa opens on June 1, which is when the state determined they could open safely.”

Dr. Gold presented staff with two options. “I said, ‘we can see bizarre dermatology only, nothing routine or elective, work shorter hours, and do projects until this is over or we furlough,’” he says. All but one employee agreed to keep working. “The goal was to try to bill enough to keep the staff paid, and, amazingly, it worked.” Dr Chilukuri chose to keep his seven-member staff on board throughout the closure and was fortunate to later receive funds through the PPP.

Dr. Bucay kept her staff of 17, as she knew that onboarding a new team when the practice reopened would be extremely difficult. She got a PPP loan from the second tranche, which will help her as she slowly ramps up her practice.

Dr. Downie had to furlough all but four of her 12 employees.

Implementing austerity

Saving money was paramount for all practices during the shut-down. Dr. Gold reined in all unnecessary costs during the eight weeks that his office was closed. “There is no buying right now except things that we must have,” he says. He also dramatically reduced the number of skincare lines and SKUs he offers.

Dr. Chilukuri found solace and profit in skincare sales during the shutdown. He offered complimentary skincare consults via video and expanded his skincare offerings to include professional-grade and spa-quality at-home masks and peels. “I’m now set up to where we can launch an online store if we have to when and if a second wave of coronavirus hits,” he says.

Dr. Downie was also able to grow her skincare business while she couldn’t perform procedures and see patients. “Every day, I shipped out cosmeceutical products to patients who were requesting them, put people on AutoShip and saw a lot of virtual medical appointments as did our physician assistant,” she says.

Dr. Bucay says that skincare and gift card sales helped her meet payroll when the offices were closed. She gave $200 gift cards to patients who put down a $1,000 deposit toward a procedure, which many cashed in for skincare.

Let’s make a deal

Dr. Schlessinger took a look at his expenses and made changes. “We canceled many ads in magazines and other outlets [and] we scrutinized our full list of vendors and found many that were simply being paid and hadn’t worked for us for years,” he says. “It was shocking, frankly.”

Dr. Bucay also negotiated with some of her contractors. “We got a one-month deferral on rent and a deferral from some vendors.”

Dr. Downie got laser companies to add two months on the backend of each of her service contracts and worked with her malpractice company to go from full-time status to part-time status as she was barely seeing any patients.

Staying afloat

Dr. Downie spent the downtime working on clinical trials, consulting, and participating in webinars. “All of this helped toward our bottom line,” she says. “Although the income loss was devastating, we did have that as a cushion.”

Dr. Bucay utilized telemedicine via Facetime or WhatsApp to see acne, psoriasis, atopic dermatitis, and cosmetic patients.

Ramping up

Some dermatologists are slowly re-building their schedules. Dr. Chilukuri is offering extended hours and will see patients two extra days a week instead of travelling. “Twenty percent of your practice creates 80 percent of your income so these are the first patients we got back in,” he says.

Dr. Downie is up and running with her full staff. “We kept meticulous records of all patient appointments and are restructuring our patient visit times to try to accommodate everyone,” she says. She extended annual Mother’s Day specials through the end of May; patients are appreciative, and injectable procedures are up. “We are sending out the Brilliant Distinction points from Allergan email blasts; patients want to recoup their points, so this is encouraging people to come back.”

Everything looks and feels different at practices that are now open. “Patients get temperature checks, they must wear a mask, answer a series of questions about travel and possible COVID-19 exposure, and wash their hands in front of a nurse,” Dr. Gold says. He has also clamped down on his no-show policy: Patients who don’t show can’t reschedule for several months, as they have taken away another person’s spot. There is hand sanitizer everywhere; all treatment rooms are sanitized between patients.

Dr. Downie installed Plexiglas shields at her front desk. “I also am doing temperature checks (on patients and employees) and making people wait in their cars. We are not using the waiting room except for the occasional patient who comes by Uber or public transportation.” Dr. Downie is also swabbing nostrils of staff members and patients with Betadine. “This kills a multiplicity of bacteria and viruses, including the coronavirus temporarily, for up to three hours,” she says.

Exit strategy

Dr. Downie is looking to conserve resources in case of a second wave of closures, meaning no new large purchases. She also took out a line of credit as the pandemic emerged. “On days we are slower some of my staff is willing to be dismissed earlier so I do not have to pay them the full amount.”

Dr. Bucay received funds from the Economic Injury Disaster Loan (EIDL) COVID-19-related assistance program that she will tap if there is a second wave. She plans on continuing to provide teledermatology care unless and until the CMS puts barriers back in place. She is also working out a deal with her associate who wants to become a partner.

Cosmetic Surgery Forum 2020 is December 2-5 in Nashville. To register: cosmeticsurgeryforum.com/