PracticalDermatology

Dispensing skin care lines and products is not only an extra revenue stream for our practices, but also a means for physicians to be advocates for what we believe in. Whether patients are visiting your practice for a medical condition or for cosmetic procedures, cosmeceuticals offer additional opportunities for them to maintain the health of their skin and boost any regimen. For physicians, although the decision to dispense in practice should be easy to make, executing a plan and carrying out the details require a great deal of attention and skill. Dispensing product lines in-practice is a complex enterprise, but with appropriate dedication and strategy, it can offer mutual benefit for physicians and patients.

A Rationale for Dispensing

Physician-dispensed products are much more refined than the typical over-the-counter (OTC) products in supermarkets and pharmacies. Often, physician-dispensed lines carry a higher percentage of active ingredients, such as glycolic acids and other anti-aging ingredients and growth factors. Thus, these products tend to be more efficacious and targeted, meaning that patients are getting more bang for their buck. Another advantage of in-office dispensing for patients is convenience. Rather than going online or to the store to purchase skin care products, patients have the option of one-stop shopping at your practice.

For dermatologists, the obvious benefit of dispensing inpractice is supplementary income. But dispensing products in-office also offers something that all of us wish we had more of: control. If a patient walks out of your practice with products that you’ve recommended and subsequently sold to them, you have the advantage of knowing what they are putting on their skin. If your patients are seeking skin care from outside of your practice, control is absent. For example, the patient may select a different product than what you recommended, opting instead for a cheaper, less efficacious option. It is also possible, due to the daunting number of products lining the OTC product aisle, that patients may confuse ingredients/products altogether.

Whatever the reason, the bottom line is that you are much less certain that the patient is purchasing and using products that are ideal for his or her skin if they are acquiring them outside of your practice.

Tips to Maximize Dispensing

There are many moving parts to any dispensing operation within a medical practice. While it is important to customize a business model for dispensing to the rhythms of your own practice, through my own experiences with dispensing I have learned several “ground rules” or broader principles that may be useful for any practice. Some of these are simple and practical steps, whereas others are more philosophical in nature.

Dispense What You Know. Trying anything before selling it has been a foundation for how I have approached dispensing. For example, when I started practicing, I carried several glycolic acid and anti-aging products for acne and a variety of other conditions. I tried every single product and was able to differentiate between them based on which were my own favorites.

The reality is that there are countless products on the mass market and in private, physician-only lines. It can be dizzying to try to keep up with the number of products available. That’s why I recommend dispensing only what you know. You may not be able to try everything, but over time you will form trusting relationships with companies that manufacture products that work for you and your patients. On that note, I feel it is important never to bow to outside pressure. This carries over to how companies conduct their businesses, as well. I have learned only to deal with companies that are consistent and have a solid track record and an excellent return record. If shipment arrivals are erratic or not timely, you cannot afford to carry their products in practice. Company reliability is essential when it comes to bringing products into your practice.

Position The Display Cabinet Strategically. Your display cabinet should be in a location near the waiting room or check-in area for all to see. But visibility is only half the battle. The contents of the display cabinet, as well as the cabinet itself, should be pleasing to look at. It should be well-lit and clean with all your products. If you can, write up a menu of products with descriptions and put it in your waiting room and in several patient exam rooms.

Train a Knowledgeable, Friendly Staff. In addition to working with reliable companies, your practice staff is also an essential factor in whether your dispensing enterprise is successful. You want them to try the products and see what works for them so that they can provide patients with their own accounts. I give my staff trade sizes of various products and free Latisse (Allergan). This way, they have used most/all of the products and are engaged in patient discussions. However, while staff members can be advocates for the products, they can also be potential roadblocks. For example, if a staff member isn’t knowledgeable or communicative with a patient before and after the exam, it’s very likely that not all of the patient’s questions have been answered. Sometimes, staff can be the pivotal factor in whether a patient leaves with a solid understanding of their regimen or has decided to purchase a product.

Monitor Inventory. One of the more logistical factors that must be considered is product inventory. Keeping a strict control check over your products is important for a number of reasons. For example, an organized flow sheet helps you to gain a sense of which products patients are interested in buying. Tracking return rates and satisfaction levels also helps to know what patients are responding to and what they are not. These trends are no doubt helpful when making stock judgments both in the short run and the long run. Monitoring inventory also serves a more fundamental function of protection, as well. There can be a number of reasons for why the inventory sheets don’t match up (theft, mismanagement, etc.), but the main point is that when you’re selling products, staff members must be given a clear line of communication of what they can and cannot do regarding the use and sale of products. Do not leave any room for misunderstanding.

Don’t Overdo It. I recommend keeping your product lines as simple as possible. Make sure that you cover all of your bases, but always remember that patients crave simplicity. When situations arise in which substitutions can be made, by all means you should be prepared and willing to answer those questions. However, I don’t believe we should be selling patients “everything but the kitchen sink.” You don’t want to overwhelm the patient with an influx of products. Representatives from product manufacturers are going to come to your practice and tell you that their latest product is the greatest thing since sliced bread. But, in addition to my original point that you should only sell what you know and believe in, if you have too much on your shelves, nothing will sell. You may also have difficulty keeping track and differentiating between a product you like and a product you’ve never tried.

Price Reasonably and Don’t Cut Corners. The general rule on pricing is to charge about double what you paid for the product. This pricing will vary based on your competition, experience, and patient base, but no matter what you set your price lines at, be sure to account for sales tax when you are mapping out your budget and expected income. You should be receiving double for the product price you paid plus the sales tax on top of that. When it comes to the products themselves, never settle for cheaper substitutes in order to maximize profits, as you might risk bringing in a diluted product. Go with what’s tried and true.

Talk to Your Peers. If you have not yet gained familiarity with skin care companies, I recommend speaking with your mentors; find out what they’re selling and what they recommend. Medical meetings such as Cosmetic Boot Camp and the annual American Society of Dermatology Surgery (ASDS) conference are also great resources for networking and learning about the latest advances in products.

Dispensing and the Patient Relationship

Importantly, selling products in your practice adds an additional element to the doctor-patient dynamic. We should therefore always be mindful of how this can change our relationships with patients. There is no reason to feel any guilt about trying to sell our patients something, particularly when it plays such an active role in skin health. By contrast, what you are offering patients by dispensing in your practice is the additional convenience, expertise, and ultimately trust in what they’re investing in. Nevertheless, you do not want to give off the impression that you are a salesperson. I always try to make sure I am meeting my patients halfway.

One strategy that may be helpful with return patients is to offer options for how they can receive more products. It is always a wise decision to offer to keep credit card information on file, thus making the transaction more expedient and convenient for the patient. However, in general, I find that extending the option for patients to call whenever they need something and offering to hold any products they should need goes a long way with many patients. Also, consider setting up a charge/send system to mail out products. I also allow my patients to come in during regular office hours and pick up products at the front desk without any scheduled appointment. Whatever you ultimately offer your patients, keep in mind that in the realm of non-prescription skin care, options are nearly limitless. That’s why I try to make the process as convenient as possible.

In the exam room, I find it best to discuss skin care toward the end of the appointment. Particularly for return patients, I will often say as they are leaving something to the effect of, “It was nice to see you; be sure to schedule a follow-up, and, by the way, if you need any product, either I or my staff can assist you.” For patients who aren’t return buyers, take the time to review specific options with them. Write down products and how to use them properly. Patients appreciate a doctor who takes an extra minute to explain something or guide them, and I find that taking that extra minute ensures a securer patient base and thriving product sales. If you are sensing that a patient is resisting based on cost, be prepared to discuss more costfriendly options. When it comes to fielding general inquiries about cost, one method that I’ve had success with in my practice is to have price sheets in every patient room, taped inside the cabinet door. That way, my staff and I can quickly refer to prices without fumbling around with sheets of paper in our pockets. I have most prices (with the sales tax) memorized and find this works for me.

In terms of how to incorporate skin care more generally into your practice methods, I believe that it is our job to streamline treatment for them. I’ll often ask myself: What does this patient need for her or his skin? If it’s an acne patient, I will write down a medication, a sunscreen, and a night cream that decreases redness. (It’s important to indicate a sunscreen you would recommend in order to get the patient thinking about sunscreens as an essential part of skin care. Depending on skin type, facial aging pattern, pigmentation, and other factors, each patient will require different types of interventions, whether that’s with cosmeceuticals or sunscreens.)

The conversation you have with patients about skin care and health should not be something you do not have time for. I view it as a critical aspect of what we do as physicians. I have a large mirror with great lighting in each exam room. These help you to walk through with the patient how certain cosmetic interventions can help their individual skin. Also, to see exactly how you are tailoring a regimen that’s right for their skin helps patients to understand why skin care is so important. For a new patient, I may be more inclined to keep the products focused on what the patients want. But as they grow more comfortable, I might begin making additional recommendations for how they might benefit from different types of products.

In the end, all of these measures should boost the quality of the relationship you have with patients. By engaging patients and learning their lifestyle and their levels of prioritization for skin health, you can streamline the entire process and give them the treatments and skin care they deserve.

Believe in What You Sell

According to the ASDS, 70 to 80 percent of patients, within a few days of leaving your office, will purchase skin care products from Sephora, drug stores, or the Internet. Dispensing offers opportunities for both patients and physicians that are well worth exploring, provided that they are pursued in a smart, ethically conscious manner. I believe in dispensing because it represents the best way for us as physicians to be advocates for the lessons we teach about skin health. Nevertheless, it is imperative that we sell only what we believe in and always keep our relationships with patients the primary focus. Dispensing can offer lucrative financial compensation, but that’s only an added bonus for the level of control and convenience that it offers both physicians and patients.

Dr. Downie is a consultant for Allergan and SkinMedica.

Jeanine B. Downie, MD, FAAD is Director of image Dermatology® PC in Montclair, NJ and is also an Assistant Attending Physician at Mountainside and Overlook Hospitals.