Most of us chose medicine as a career because of an interest in science and a desire to care for patients. In the “old days,” a well trained physician could open a practice just about anywhere and have an emotionally and financially satisfying career. The business aspects could be managed by a good office manager and accountant. Advertising was frowned upon. PR and marketing consisted mostly of joining the local hospital and getting involved in local social and community activities. However, times have changed. There seems to be a continuing wave of increasing necessities to practice: computer hardware and software, contracts with providers of practice management and electronic medical records, and maintenance of certification. Although aesthetic medicine doesn't carry as much of the burden of government regulation and third-party payers as our non-aesthetic colleagues, aesthetic practices face unique expenses. Webmasters, social media consultants, and even press agents have become near necessities for all but the most tech savvy aesthetic physicians. The lasers, devices, and disposables necessary to remain competitive seems never ending. As Z Dogg MD sings in his parody “EHR State of Mind,” “Out there docs can't take it…half of y'all won't make it.” Whether a new or established practice, owner or employee, core cosmetic physicians must be vigilant to the business of practice in addition to the art and science.
Just as we all have checklists for our procedures to help us balance risk and benefit, we must have similar procedures to manage our business. Incorporating routine checks and balances into business procedures that include scheduling, confirming appointments, billing, collecting and posting payments, managing inventory, and hiring and paying staff. Honest mistakes happen but so does theft. No doubt we all know someone with a story about the long-time office manager who embezzled or the clinical staff who pilfered product from them. Simply splitting responsibility for different steps in a process among employees can make a difference. For example, ordering and receiving supplies should not be the responsibility of the employee who manages the books. That way, the bookkeeper can confirm that the amount the vendor charged matches what was received. Similarly, having front desk staff post patient charges and collections when the payment is made and secure cash payments immediately and having a billing supervisor or office manager confirm that charges and collections match daily can limit loss.
Many practice management systems now include inventory control systems with scanners to track the flow of items dispensed and even disposables like fillers or device tips can be tracked. And it is critical that they be used even for “freebies.” Keep records to track and confirm that what comes in the office equals what goes out, including any giveaways offered to patients or take-a ways for yourself or family. Consider video cameras in areas of inventory and money collection as a back-up check to these practices.
Beyond these day-to-day best practices, quarterly or–at the very least—biannual meetings with your accountant are a must in order to review both the details and the big picture. These meetings are your time to catch major discrepancies, evaluate the profitability of procedures, and potentially spot areas where you might be overspending. Take the time to evaluate your expenses and be open to changes that might lead to savings. For example, instead of renting scrubs and exam room linens, perhaps consider buying those items and a washer and dryer to keep them clean. Watch spending on services like phone and internet services that can be renegotiated or bundled for a better price. And remember that some bills that have may have been on auto-renew for years, like phone book ads, may be unnecessary expenditures for your practice.
Although there is pressure to offer as many procedures as you can, less may be more. Take a close look at which procedures are actually making money and which are not. For the “nots,” have they become obsolete and would another procedure or device do better or is it just a matter of increasing awareness among your patients with marketing? Just as it is less expensive to market to the patients you have than recruit new patients, it may be better to maximize utilization of the devices in your office rather than adding new ones. Before adding a new procedure or device, consider if it is something that you must do yourself or if you can delegate it to physician extenders, a decision based on both your confidence in your staff and on state laws. Procedures that can be delegated bring in revenue without the physician's time.
Some of us loath and others revel in the business aspect of aesthetic practice. Either way, we all need to hone our business sense just as we've done with our aesthetic eye. Fortunately, good practice management along with a quality staff and standardized fiscal policies and procedures can help us achieve happiness and financial security in our chosen careers. n
Steven Dayan, MD, FACS, and Heidi Waldorf, MD, FAAD