Starting Up Again

As I write this, it seems that COVID is finally on the run or, at the very least, controllable to some extent. With two years of our lives already having been consumed with it, I am ready to turn over a new leaf and live without its shadow hanging over me and my practice. Let’s hope that 2022 is that year.

I encourage each of you to formulate a resolution or set of resolutions at the beginning of the year. While you may not live up to the resolutions, they are at least a starting place and possible compass for this year or future years.

My resolutions for this year are much the same as in other years; it comforts me to know that I am, at the very least, consistent. I want to keep my staff, my family, and myself safe, happy, and fulfilled. How I do this has changed over time, however.

When I started in practice, my concerns were mainly centered around how to bring a practice from zero to “established,” whatever that means. Back then, it meant sweating it out when the waiting room was empty and worrying that prospective patients would know we were just starting. Now, we strive for an empty waiting room so people don’t breathe on each other! If I had to identify a lesson in this, it would be to worry less about your reputation and concentrate more on giving good care. Reputation will follow.

Staff needs also have morphed over time from when we started. Initially, we were trying to maintain a practice with the least possible expenditures for staff as we viewed our overhead each month as massive (how I would love to go back to that overhead!). Staffing was an area where we could save in order to pay the overhead. Now, staffing is an area for investment, as it returns dividends in patients’ and my personal happiness. “Happy wife = happy life,” should instead be restated as, “Happy staff = more time to laugh.” I cannot overstate the importance of finding a group of individuals you enjoy being around. This is critical to your overall satisfaction and success; paying more for excellent staff and staff you enjoy being around will yield a phenomenal return on investment and personal positivity. Cosmetic practices, in particular, need to pay special attention to this paragraph as staffing will make or break a cosmetically oriented practice even more than a medically oriented one. That extra staff member’s monthly salary could be covered by just one call that is answered promptly and handled correctly. Reflect on that when you hear the phone ringing off the hook!

Work-life balance has always been something I tried to manage as best I could, but in all honesty, I am still working on it. Perhaps this constant goal re-setting comes from the fact that during the pandemic I redefined the “life” part of the work vs. life equation. I became more aware of how much time I had been spending in the office and began to appreciate taking breakfast at home and returning home at a more reasonable hour for dinner. Since that time, I have adjusted my office hours slightly and am enjoying the extra time with my wife, Nancy, and our pug dog, Leo. If I were to do it all over again, I would have started out later in the morning and come home earlier when our kids were at home, though. This is food for thought for those of you who are considering or reconsidering your hours in the office.

Doing what you enjoy is a big part of overall happiness in my mind. Recently, I wrote another column about how being in private practice has allowed me extra control in these areas, but a more universal recommendation is to carefully determine which types of procedures and patients “spark joy” in you. It took me about 10 years too long to determine that large Mohs cases were not enjoyable and I did not prefer doing long repairs. I now refer out more cases than ever and am very pleased that I have great options in our area. While I used to think of it as a shortcoming if I couldn’t handle 100 percent of my patients’ needs, I am now more willing to admit this and refer more cases as needed.

Vacation, as always, has been a focus for me and my family. While I feel we did take the time to be out and enjoy “life,” I feel most dermatologists take too little vacation and could regret it in later years. Clearly, finances are still going to be an issue in any practice, but if more vacation or days off are a possibility for you, it is something to consider strongly.

I have mentioned in previous columns the importance that exercise and keeping healthy has had on my “pandemic” life. While many of you may have succumbed to “COVID-20” weight gain, I strongly encourage you to consider redoubling efforts to work out more often. My regimen of Peloton and swimming has been one of the best decisions I made during the pandemic. If you do join the Peloton community, there is even a group of dermatologists on it: #RoadRash.

Lastly, continuing education is another area wherein you can improve your game, especially in a cosmetic practice. As this new year starts, I hope to have the chance once again to be with my valued and incredible colleagues in “live” meetings. I was very pleased we could hold Cosmetic Surgery Forum this December in Nashville and am looking forward to attending AAD in Boston and ASDS, as well. It has been way too long without the interchange of ideas that happens best when in person and face-to-face.

I look forward to seeing you all this year!