Starting small and slowly helps build successful elective-procedures practice

"Establishing an elective-procedures practice gives an individual a lot more flexibility and frees them from the yoke of the insurance companies to some degree," says Dr. Bock, a dermatologist in solo private practice and owner of California Skin Laser Center and California Skin Laser Spa, Stockton, Calif.

"Prices are becoming more constrained on medical dermatology," he adds. "Medicare is basically attempting to reduce prices, and a lot of the insurance companies tie their fees to Medicare's prices. So even though our costs are going up, our ability to obtain reimbursement is staying steady or declining."

Other advantages of cosmetic practices include the fact that in many states, such practices allow one to use staff members to amplify results, care for patients and generate income from procedures that don't require a doctor's direct involvement, Dr. Bock says.

No less important is the fact that the ability to provide elective procedures is "something patients are beginning to expect in dermatology," he tells Dermatology Times. "I've had patients come to me and say, 'My regular dermatologist doesn't do this, so I'm glad to be able to find somebody who can do both general and elective dermatology.'

"We have credibility as medical dermatologists. We know what we're doing, and we're not someone whose basic business is delivering babies. Because of this, we tend to do it better than other specialties. As dermatologists, our visual orientation is a big asset under these circumstances."

He adds, "We're in the golden age of minimally invasive procedures. There's a plethora of new procedures and devices available that enable us to do minimally invasive procedures better. Plastic surgeons used to tell patients, 'It's better to have your facelift done by a plastic surgeon, because we're safer.' Now, they're saying, 'We can do minimally invasive procedures as well as dermatologists.'"

Advantages of cosmetic practices mean little, however, if dermatologists don't like this type of work and are merely in it for the money, he says.

"One can get into trouble if money is one's sole motivation," Dr. Bock says.

Start small

In starting a cosmetic practice, he says, "It's important to get very well trained, to understand what one is doing, and to start out with small procedures. Inexpensive examples include botulinum toxin, fillers and chemical peels.

"I'm practicing in Stockton, Calif., which is not a wealthy community. In my practice, we do a lot of Botox, laser hair removal and tattoo removal, intense pulsed light photorejuvenation, sclerotherapy and fillers. Most of these are procedures dermatologists can get into with very low cost."

Regarding equipment, he says, "There haven't been any major advances for a while in instrumentation. Newer equipment has bells and whistles that older equipment doesn't, but often one can get older equipment at half the price and do quite well."

Whatever equipment one chooses, he cautions, "Details are everything. That's what helps us differentiate ourselves."

More specifically, he recommends that practitioners pay attention to everything from the type of needles and anesthetic they use to meeting the needs of cosmetic patients.

"One must get them in quickly and give them priority - don't make them wait," he explains. "These are special patients in one's practice, and one must treat them as such."