Heidi A. Waldorf, MD, FAAD is Director of Laser and Cosmetic Dermatology at The Mount Sinai Medical Center. She is also in private practice in New York.
Understanding the flow of one's practice and patient base is essential in knowing which procedures to offer and emphasize. This is especially true in the device-based treatment realm, which can be much trickier than other aesthetic treatments. Whether you learn about a new device in a journal, at a meeting, or from another colleague, or you determine a category of procedures in which you would like to become involved, selecting a new device to offer in practice requires a multifactorial analysis. Regardless of our expertise with aesthetic devices, the rapid development of device technology coupled with the expensive nature of the equipment requires us to carefully consider each move when investing in a device. Everything from floor space in your practice to the price of disposables demands a high level of scrutiny in order to make the best decision for our practices and our patients.
Setting the Groundwork
You may have an exact idea of the machine you'd like to add to your practice, or just the category of device, but either way it's important to know what's available and to survey the market. Magazines like the Aesthetic Buyer's Guide feature lists of every product by category with features and price. However, determining the ‘need'—a combination of the amount of use it will get and its profitability— for a particular category of device within your practice must be the initial step.
Determining need requires analyzing clinical and financial issues, many of which overlap. First and foremost, do you believe in this procedure/technology from a medical and scientific perspective? If so, do you have a sizable enough patient population who will be interested (i.e. appropriate candidates and financially able to afford the procedure)? Is the device something that must be used by the physician or can ancillary staff provide the service (based not only on state laws, but also your comfort with the risks)? How long does each procedure take from prep to finish and how much of that time will involve an exam or procedure room that could otherwise be used for something else? Is it painful and if so, what kind of pain medication or anesthetic is needed? Is it an issue if your patients need someone else to drive them home after a procedure? Do you have the physical space to accommodate the device when in and out of use? Can treatments be performed throughout the day, interspersed with other appointments, or does the procedure demand certain scheduled blocks that will remove you or your staff from other tasks?
You will also need to figure out how exactly this device would be situated amongst the other procedures you perform and devices you use. For example, would purchasing a new device make another device obsolete? Is it displacing something that is potentially still useful? For example, I have a Q-switched Nd:YAG laser that I have used for brown spots and tattoos for over a decade. It is a mainstay in my practice since I still have patients who want only one or two lentigenes treated. I see very few tattoos so if a patient comes in with a complex multicolored tattoo I feel is beyond the scope of my machine, I'll refer him or her out to a colleague. I don't need something else in that category as long as mine keeps working. However, at my university office we decided to trade our hair removal laser for a newer model because it would have been almost as expensive to fix the old one. Treatment trends can also force your hand. Although most of us who did ultrapulsed CO2 laser treatments years ago still recognize their utility, it would be hard to find a patient in most of our practices who is willing to go through the prolonged healing. The trend has been for more treatments each with less downtime so many of us have been through more than one other resurfacing device since the UPCO2 days.
Give serious thought to how many of the devices are in your area. For instance, is the device you're looking to buy being offered at spas at a lower price points than you can offer? Can you provide value added in terms of safety or outcome for that specific procedure to make it worthwhile to patients to have it done in your practice despite a higher price?
At what price…
You've decided you want to make the purchase, but is it a good buy? When determining the cost of the device, add in all the expected additional fees beyond the upfront purchase price. Device companies have changed the paradigm to now require the purchase of disposables. Find out how many treatments each disposable will provide and if there are volume discounts or purchasing plans. Because devices today have more complicated software and hardware, I almost always recommend getting the service contract. It's good to have someone who understands it on call because the machine being down costs your practice money (and the happiness of patients who can't have their scheduled treatments). If you already have one or more machines from the same company, ask if there are volume discounts or purchasing programs for all the required disposables and service. Paying upfront for several years of service may also offer savings.
Since you'll hopefully get many years out of your purchase, do your due diligence on the company selling it. Are they stable financially, or, if not, have they been around long enough and sold enough machines to make them likely to be purchased by a more stable company. The technical assistance available from the device company is as important (or more) than that from your car dealer's service department. What is and isn't included in the service contract? How long does it take to schedule routine versus emergency service? Is service done on site or is the machine sent to the home office? Is a loaner available if your machine goes down? As noted above, lost procedures means lost dollars and patient dissatisfaction. Get as much as you can in writing and read the terms and conditions no matter the small size of the print. And speak with trusted colleagues about their experience.
“The Next New Thing”
No one can see into the future. History is full of stories of the ‘next new thing' that was ousted out of the limelight and into obscurity in the wink of an eye (my family had a station wagon with an eight track player). Then there are the ‘new things' that stand the test of time… until the next newer thing (looks at CDs versus music downloads to your iPod). Look for devices with which you will do procedures that really fill—or create—a niche in your market while being practical for your practice.
With each new device that reaches the market, there is always a push from some clinicians to be the first one in their area to showcase a device. And while this can be a strong source of buzz and media attention that may result in an initial bump in revenue, we should always be thinking about whether these “latest and greatest” developments will maintain or live up to expectations. Many clinicians who are the first to test something new will attest that an off-the-bat media sensation may not translate into longterm revenue for a practice.
Avoid the $150,000 Mistake
There is no one device that's going to be the perfect fit for every practice. Speak with anyone who has been in practice long enough and he or she will tell you there have been winners and losers in terms of purchases. As physicians and business owners/employees, we need to balance the science, the art, and the economics of every purchase.
Like your mobile phone, every new device is a work in progress, a step toward something different and potentially better (or not). The ebbs and flows of the market are certainly not easy to make sense of, but if we apply our clinical skills and maintain a detail-oriented approach to thinking about whether and how to situate new devices into our practices, we may put ourselves on a path to better decisions and wiser investments. At the end of the day, purchasing any new device is as much of a gamble as buying a new stock. But if we do our homework and ask the right questions, we will be less likely to end up with a $150,000 doorstop.
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!
