Five Tips for Long-Term Success

In the “Dear New Resident” section in the Resident Resource Center June 2018, proper attribution was not provided for content from Andrew Krakowski, MD. Dr. Krakowski is a pediatric and adolescent dermatologist who founded Peds Derm LLC, affiliated with Bryn Mawr Hospital in Bryn Mawr, PA (PedsDerm.org). In case you missed it, Dr. Krakowski provided the following advice to residents and dermatologists new to practice.

Take seminars on how to successfully negotiate and how to have difficult conversations. You will need these skills throughout your hopefully long career for everything from new and extended contracts, asking for a raise, or leading your team in the day-to-day joys of clinical practice. What’s working against you? As a group, physicians are trained cynics. It is our job to distrust new information to keep our patients safe from the harms caused by bad science or unfounded fads. Add to that the fact that we tend to be conflict avoidant and, to put it mildly, a bit headstrong; now, you have a recipe for communication disaster.

I have not found the physician-led seminars on these topics to be all that worthwhile. A class designed specifically for executives or even one that offers a psychology-based approach, for me, is much more enlightening and practical.

Rage against signing a “geographical” non-compete. You just spent the last three years training to be a board certified dermatologist—with skills very few people in the world possess. Why allow someone to leverage your proficiencies against you when, in fact, it is your expertise that they are looking to hire in the first place?

Instead of a conventional non-compete covenant based solely on geographical location, I prefer a non-solicitation agreement in which the person being hired agrees not to actively recruit patients away from the hiring practice if there ever is a parting of ways. Such an agreement makes sense based on the hiring practice’s outlay of resources on recruiting, marketing, and developing the newly hired dermatologist around town. A non-solicitation also speaks more directly to what should be the true concerns of the hiring practice and still allows for flexibility down the line.

Stop hiring, training, and agreeing to supervise your eventual replacements. I read someone’s profile on LinkedIn the other day where the person claimed to be a “board-certified physician assistant dermatologist.” I laughed and cried at the same time because, honestly, we did this to ourselves.

At some point, it will boil down to a bean counter and an Excel file: A mid-level working at 25-50 percent of a board certified dermatologist’s salary, seeing the same number of “Patients Per Day” as the dermatologist (or, perhaps, even two-to-three times more in some unscrupulous settings)—even with a 15% hit in reimbursement rates—looks highly profitable in a board room. For that reason, new dermatologists will have to decide if they are going to hire and train mid-levels to perform specialty-level services. If they do, are the dermatologists prepared for the possibility that mid-levels might be preferentially chosen to do our job because they deliver the goods financially and operationally?

I would rather not even make that scenario an option. Alternatively, if you are trying to grow your practice or extend your reach, then consider hiring a fellow board certified dermatologist as a part-time employee. It might be worth it in the long-term.

Insist on transparency and then remember that, well, “you asked for it!” In this era of data-driven everything, you should have full and open access to your own professional and financial data: Total Revenue, # of Encounters, Revenue Per Encounter, No Show Rates, Re-Book Rates, % New Patients, Third Next Available, Internal Referrals (i.e., to Mohs or a sub-specialist or particular service line), Patient Satisfaction Scores, Coding Audit results, MIPS data, E&M bell curves for both new and return patients are all very helpful, and you can use them to better yourself and your practice.

The downside is that the numbers do not lie, and you may be faced with a statistic that bruises your ego or paints you in an unflattering light. Resist the urge to kill the messenger when you see that your Revenue Summary is off budget, and do not get depressed that your collections dipped a bit during the week of Spring Break. Instead, use your practice’s resources to learn from prior data and start to anticipate the dips and surges so that you can adjust to them proactively. It’s not personal. It’s just data.

Get out and promote yourself. No one knows you better than you, and at the end of the day you are the dermatologist—the face of your clinical practice. Your business manager does not generate $1 worth of revenue, and the CEO of the hospital or private equity group does not get personally reviewed on Vitals.com or Yelp.com. But you do, so take every issue and small detail personally! Create some “you-specific” service lines. Develop your personal brand, and build a following around it on social media. Travel to the offices of every potential referring physician around your area and grind out the “meet and greets” that will lead to a full patient panel sooner than anticipated and/or budgeted.