Bobby Buka MD, opened his dermatology practice, Bobby Buka MD, in June 2007. He has since opened 10 locations. Ahead he discusses how he grew his pediatric dermatology practice into a group of practices offering medical and cosmetic treatments to patients of all ages.

Modern Aesthetics: What first made you interested in dermatology?

Dr. Buka: Dermatology is unique insofar as it's largely an exclusive visual diagnostic specialty. There are very few specialties like that—it hearkens back to more traditional forms of medicine where we didn't have CAT scans and MRIs, and we were reliant on our tools of observation to make a correct diagnosis and treatment plan. Also, dermatologists are susceptible to what I call the “cocktail consult,” where you get asked at parties to look at something on someone's skin and make an immediate diagnosis. I think that part is what's most interesting about the specialty—the immediacy of diagnostic awareness.

MA: Describe your first practice and what piqued your growing interest in cosmetic dermatology?

Dr. Buka: I did a fellowship at the Rady Hospital in UCSD in pediatric dermatology, so I first came back to New York thinking I would join a larger group and focus on pediatric dermatology and, in fact, started out that way. Then when I went on my own, the idea was to continue to see just kids, but then family members started asking me if I would see adults as well. So, the practice quickly grew. Pediatric dermatology was really interesting to me because they're probably the most appreciative patients of all. But it is always amazing to me when dermatologists say, “I'm just a Mohs surgeon” or “I'm just a cosmetic dermatologist.” It's important to me to embrace all of the different elements of our specialty. What makes it a really enriching field is that it spans into cancer and aesthetics. To give up one in favor of the other, I think, is a missed opportunity to capture the vibrancy and comprehensiveness of the specialty. I love the variability of my day.

You expanded your practice and opened several offices? Why? How do you ensure quality care at each practice?

Dr. Buka: I opened our second practice in 2010, three years after opening the first one. We have 10 practices and will be opening eight new offices in the next year. I think it gets easier with each one. When I'm asked, “How do you run 10 locations?” I say, “How do you run just one?” Taking that first leap was the hardest leap I ever took. Once you get a sense that the community is responsive and you're confident in your ability to help and get people better, that's when opening a second or fifth, is almost second nature, because you have your model down. You have your flow down. You know the kind of demographic you're after, you know the type of employee you're looking for—those are all unknowns before you open your first. I like to be a part of our new office openings to make sure we're opening the right way and that there is a standard approach to care. So after I'm gone, if a patients sees a PA, one of our MDs, or a nurse practitioner, I have a sense of what that standardization is. I'll be in a new practice for a few months before I pass the baton.

MA: What are some benefits of multiple locations? Downsides?

Dr. Buka: First and foremost, it consolidates a lot of the back-office stuff that a single office can be strained with. We have one phone center for all locations, one billing department, one marketing team. You've already invested in those areas, and now they can fuel six, seven, or 10 offices as opposed to just one.

The downside is making sure that each one we open has the same standard of excellence our first one did. It's making sure that there's presence there. That we know the names of our employees working there, that we know the type of experience that the new patient is getting in a new neighborhood and making sure that it's very similar to some of our more established offices.

MA: What advice would you give a new aesthetic physician? Is having a private practice still a viable option?

Dr. Buka: Be a dermatologist (or plastic surgeon) first. Instill the trust in your patients when you treat their rosacea, acne, or psoriasis, and you'll be surprised in six months or a year, that patient will say, “Oh my friend was asking me about Botox, do you do that?” That's the best kind of capture, rather than find a patient off of Instagram or an influencer, or because you've got the shiniest bauble that's a new laser. Have them come from your existing practice. That's how our aesthetic practice grew—being good at our medical specialty and then extending to the cosmetic elective elements of it.

I do think having a private practice is still a viable option—but I do think margins are getting a little tighter for people just coming out with regard to insurance enrollment. So that's even more to my point of rather than expose yourself to just aesthetics or just being a Mohs surgeon or just being a dermatopathologist, we have such a cool specialty. We can do so many things. You may prefer one to another, but throw a wide net. You should be proficient in all those things coming out of residency so that's an amazing time to throw a wide net. When I came out, I thought I was just going to do peds derm, but part of starting a private practice was throwing a wide net, opening the practice up to cosmetic things and adult dermatology. And I think when you do that, you gain a lot more flexibility in terms of what you want to focus on. But first build with a wide net, and then you can focus down the line.