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Consolidation is the new normal, and while this trend is now being well documented across many specialties, dermatologists and dermatology practices have been ahead of the curve. As it stands, Advanced Dermatology, headquartered in Maitland, FL, is the largest dermatology practice in the country, with more than 140 locations, but growing numbers of dermatology practices are following suit. (You can read about Advanced Dermatology’s model in the August edition of Practical Dermatology® magazine, available at In a lot of ways, consolidation makes financial sense, as it provides a steady paycheck while decreasing administrative burdens and headaches.

Practical Dermatology® reached out to Margaret Cary, MD, MBA, MPH, an executive coach for physicians in Washington, DC to get some tips on how dermatologists can better cope with consolidation when or if it should occur.

Dr. Cary is the author of several books including Telemedicine and Telehealth: Principles, Policies, Performance, and Pitfalls as well as the forthcoming The Anatomy of a Good Doctor.

Why is consolidation becoming the new normal?

Margaret Cary, MD: Economies of scale. A large healthcare organization can spread the costs over a larger area. I wanted a local DC bank for my checking account, so I could drop by or call and be treated as an individual. As life has evolved, I’d like to deposit checks virtually. My small bank doesn’t offer that nor do they make automatic payments, except through a service that charges $15/payment. 

Another trend is quality of life for physicians. The new generations aren’t willing to sacrifice their personal lives for their professional lives. 

What is the biggest challenge for doctors moving to a consolidated practice?

Dr. Cary: The biggest challenge for physicians is the lack of training in teamwork in medical school. At least one medical school assigns cadavers (gross anatomy) to a team of four or five students. Their grade is dependent upon all grades. Grades are sometimes competitive, or graded on the curve, which means students are competing with each other.

The other challenge is the pervasive hierarchy of medicine, with physicians at the top. Medical errors are often due to those lower in the hierarchy being afraid to challenge those above them. Heaven help the medical student who questions an attending physician. This can become a career-limiting move. Students depend upon attending physicians for recommendation letters for residencies. Residents depend upon attendings for recommendation letters for fellowships. Fellows depend upon attendings for recommendation letters for academic placement … and so it goes.

Effective teamwork is a challenge for every industry, not just medicine. How many times have you been a team member where the team decides how it wants to operate?

How can dermatologists better cope with the above challenges?

Dr. Cary: United States Army General Charles Jacoby (ret.) says you have to be in favor of what is in front of you and deal with that. Nearly every industry is experiencing change and chaos. One of the physicians I interviewed for my forthcoming book, The Anatomy of a Good Doctor, is a family physician at Georgetown University School of Medicine in Washington, DC. He gets great satisfaction from caring for patients and he also works in policy to change the system. Think of fulfillment with your career as a physician, rather than focusing on burnout. Survivors tend to be resilient and empathic. Be present and stay in the moment.

Let’s focus on the positives. What are the advantages of the group practice?

Dr. Cary: Less bureaucracy, covered costs, and a regular paycheck, to name a few. Bureaucracy may be reduced for each individual physician because it’s spread out over all group members.

How can dermatologists prepare for an impending consolidation?

Dr. Cary: Read The First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter by Michael Watkins. Don’t make any changes for those first 90 days.  Ideally, you will have Googled the acquiring organization and interviewed clinicians at the organization. During those first 90 days, interview, interview, interview.

Spend time asking questions, rather than giving answers. Also read A More Beautiful Question: The Power of Inquiry to Spark Breakthrough Ideas by Warren Berger. Explore the values of the organization. If your values and theirs are at odds, you likely won’t be happy working there.n

Mark Kaufmann, MD is associate clinical professor of dermatology in the department of dermatology at the Icahn School of Medicine at Mount Sinai in New York City.

Margaret Cary, MD, MBA, MPH, is an executive coach for physicians. She lives in Washington, DC.

Worried About Burnout?

Check out the June 2016 edition of
Modern Aesthetics® magazine at to read about strategies to spot and avoid burnout. Dermatologist Matthew Knight, MD writes about keeping a bright perspective.

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