PracticalDermatology

Juggling Act

A diagnosis of melanoma, “was that big opportunity to realize that life is short. It got me to focus on my priorities and my family,” says Dr. Bucay. She puts, “family first, work second, and then, of course, always try to juggle those things.” The experience, “gave me a little bit more empathy of what it feels like to be on the other side when you are receiving bad news and it helped me with being able to deliver good news, too.” Because of her experience, she makes sure all patients—including her cosmetic patients—get regular skin checks.

As someone who “loves science and loves people,” Vivian Bucay, MD says medicine was, “a natural fit.” She was attracted to dermatology specifically, because, “I’m very visual and I love to work with my hands and I also consider myself a bit of a detective.” An international lecturer and author, she is founder of the Bucay Center for Dermatology and Aesthetics in San Antonio, TX and its suburbs.

What perspective did you gain practicing outside the US when you started out in Mexico City?

What we have here in the US is an incredible amount of advances, very cutting edge, in a country that’s relatively rich. But in Mexico, because people either got their health care through a socialized system or through private pay, I didn’t have to deal with formularies and trying to negotiate what I could do and not do for a patient. I felt that I could actually work more effectively as a physician because I was able to make decisions that were really in the best interest of the patient, whether it be a diagnostic test, a treatment plan, a medication.

I feel that the bond between physicians and patients in Mexico was very respected, whereas here we’re looked at as “providers” and we are rated as if we were hotels or stores. I have great patients and relationships here and have a wonderful practice, but I still feel that I was able to forge bonds differently there without having to navigate so much administration.

What career advice do you give your own daughters?

The most important thing is to have an idea and have somewhere you’re going to start. Too many times, we hear, “You have to find your passion.” Well what if they haven’t found their passion? Or their passion may change over time.

Find something where you have a sense of purpose, and then just take that first step. You have to pick something to start, but then from there, know that it’s going to evolve and change. Initially I went into dermatology to treat acne, psoriasis, skin cancers, infectious diseases. It was already a great career in and of itself. But you have to be open to the evolution of your career. I started to embrace more the aesthetics and came to realize that there’s a mind/body/spirit connection, and medicine should be supportive of that concept.

None of my children are in medicine. I tell them, you may not have found what you’re most passionate about, but do what you’re really good at. It might be that you have a chance to shape it into something about which you become passionate, because certainly nobody likes to go to work and be terrible at something.

How did you navigate building a successful practice on your own?

Initially building my practice in Mexico City, the biggest challenges were that we couldn’t find financing options. Everything was cash pay. When I wanted to bring a laser on board, there wasn’t even a distributor. I was the first person to bring a resurfacing laser to Mexico City in 1995; I had to outright buy it. And then it grew and grew. You have to take it one day at a time and be receptive to what patients are asking for.

It’s also important to find the right people to work with you—not be in a rush to hire, so that things fall through. The key is to find people that align with your vision. If they don’t, you don’t want them, because it’s not going to work out.

What are your greatest personal accomplishments?

My greatest personal accomplishment is my family. That takes a lot of work…For me it’s important to be the person who puts time and effort into those relationships. I’m really happy I survived the melanoma, but I’m sure I wasn’t fully responsible for that, so I won’t take full credit for that.

What has been your greatest professional achievement?

I don’t think I’ve reached it yet. I feel like every day can be a small success, whether it’s with a patient who has a difficult disease to manage or somebody who has low self -esteem and you do a little cosmetic treatment for them and they feel, better, refreshed, empowered. Those patients, really, are a great reason to get out of bed. But, I don’t know what the future holds, so I’m just going to keep at it...Maybe it’s not even about having a single greatest achievement , but more about the small daily victories.

What advice would you give to yourself as a resident?

I would say what you're doing right now is the tip of the iceberg, and you’re learning new ways to think about things. But don't even think that what you're doing right now in residency is remotely related to what you're doing in private practice. That's conceptually. The other piece of advice that I would give myself is to have taken some business courses beforehand.

What advice do you have for women in the specialty?

I think it doesn't apply just to women in dermatology, but I think it's very important that as dermatologists we really own our specialty and maintain proficiency in the things that we started doing. It’s not just about getting to wear nice clothes to go to fun meetings and be quoted in a magazine. It's really taking care of patients and being committed to that. I might be different than some of my friends in that regard, because I don’t always think of myself as a “woman in dermatology;” I really didn't think about a gender distinction, if you will. Yes, my med school class 20% women and 80% men. Residency was 50/50, but I never thought of it that way. And I personally didn't think I was at a disadvantage.

Maybe if I go back and look at things, there might have been some biases, but if we focus on differentiating ourselves each and every time, how are we ever going to be a united, collective entity? I think there needs to be equality for sure. There's still that gender pay gap to address. But I would identify myself first and foremost, as a Dermatologist, and the female part of that might come in secondly, if you will.