Board Forum: Best Solutions for Practice

Is there a “can’t live without” tool you rely on in practice?

Haideh Hirmand, MD: I would without hesitation say our very strong IT team, management software (ours is Nextech but I think any great one would do), and by extension I would say a powerful CRM, which we are looking to add on.

Joel Schlessinger, MD: We love our EMR, Nextech, and its correlary, NextPatient. Nextech has been reliable and with its ability to render on an iPhone, I am never away from the ability to look up a patient if I am out and about and have a call. NextPatient allows new and existing patients to schedule appointments electronically and, best of all, sends them a review “ask” after the appointment. This has been the single most important addition to my practice ever, bar none. Our Google ratings went from 3 to 4.6 when we initiated this and has stayed constant at 4.6 since then. If you don’t ask, you won’t get reviews, and this is the best way to ask.

Joe Niamtu, DMD: I have radiowave surgery units by Ellman and Soniquence, and I use them all day everyday for bigger surgeries like facelift and blepharoplasty and for small procedures like mole and lesion removal. They never break or require service. I also have an Iridex 940/532 vascular laser, and it is awesome for telengectasias, DPNs, and other common lesions. The 940 wavelength is really effective on large caliber blue and red facial vasculature ablation.

Joel L. Cohen, MD: Sciton BBL HERO. This stands for high energy, rapid output. The 515 filter allows me to treat lentigines very quickly in a widespread area, and very effectively. With the 560 filter, we can get areas of redness such as poikiloderma. The handpiece is “in motion.” So it doesn’t stay in one place—thus we don’t tend to get any squares or rectangles as with other pulsed light devices. Because the energies are lower and in turn we end up doing more pulses in an area, there is a reduced risk of a burn or discoloration to the skin. It is so efficient that I can treat face, neck, chest, arms, hands, shoulders, and upper back in about 20 minutes. The number of overall treatment sessions needed for a region (like chest, for example) is usually reduced from 3-5, to 2-3 in many cases.

Jason Pozner, MD: We use my Sciton systems every day—best lasers I have ever used. They treat all skin colors, have multiple applications, and it’s easy to deal with the company.

Gregory Buford, MD: Other than my EMR (Modernizing Medicine), I couldn’t live without using the VSEE HIPAA compliant chat in my office. This allows me to communicate with the rest of my team across my office whether I am there or out of the office.

E. Victor Ross, MD: We rely heavily on our Q-switched alexandrite laser for pigmented lesions, unfortunately no longer manufactured by the original company. Hopefully another company will come through or Candela will reinvent and even improve a version of this laser.

Jeanine B. Downie, MD: I can’t live without my TouchMD computer system. It is in every patient room, and we can look at before and after pictures of our patient results from patients that give consent, review before and after pictures of the individual patient, market our practice through TouchMD, and review products recommendations and even sign consent forms on it!

I have been using TouchMD for roughly seven years now and I would never go back. Highly, highly recommended for cosmetic patients that “aren’t seeing a difference.”

Which digital technologies have been most beneficial to you in practice? What would you not recommend?

Dr. Buford: I used Nextech Lite for several years and found that it had very little functionality with respect to lead follow-through and financial dashboard. We have since switched to ModMed but it’s too early to tell which features I would add and which ones are my favorites so far. But in the short time that we have implemented EMR, it has really made a difference in terms of being able to remotely access patient files and seamlessly check my schedule, etc.

Dr. Cohen: The reMarkable2. It allows me to have a tablet that functions as a notebook. I basically set up folders. It does not allow my texts to go through. So essentially, I put away my phone or iPad and I can pay attention during a meeting. When I have staff meetings, I can pick up in a folder where I left off (unlike an actual notebook…where I would simply have to use the next page, and sections would not be continuous). I can email myself from the tablet notes to have a copy or share with my team. And then there is a convert-to-text function as well that does a fairly decent job at reading my writing.

Dr. Downie: A lot of lasers do not live up to what they were purported to be. My Omnilux machine is among the red light machinery that did not live up to what I thought it would. Vet all technology thoroughly before purchasing anything. I have only been stung a couple of times but since all the technologies are so expensive, every little bit counts.

Dr. Hirmand: Nextech and Canfield’s mirror have been very useful for us. I think a business/financial management tool would be timely nowadays for aesthetic practices.

As far as regular technologies, I am very picky and test run technologies as much as possible prior to purchase, so fortunately not too many disappointments. The one that I have had an ongoing poor experience with is the Bodytite and Necktite (I was one of the original investigators for the former, so did try it originally and got it once they improved their platform).

Dr. Pozner: Nextech is our workhorse.

Has there been any specific practice challenge that you finally overcame with a surprisingly simple solution?

Dr. Schlessinger: The biggest challenge (and one that was truly keeping me up at nights), was ratings. We tried everything we could to encourage patients to rate us and despite giving them cards and having signs all over the place, they didn’t follow through. Once we got NextPatient (which was bolted onto our Nextech platform), we got immediate reviews, and our ratings on Google went up. That was a dream come true. We only got NextPatient initially to allow patients to schedule telemedicine visits when the pandemic occurred. This is one of those serendipitous events that was truly life- and practice-changing.

Dr. Hirmand: Our biggest challenge has been HR worsened by the pandemic. I have not overcome it with a simple solution; there is none, but I think learning to “hire slow and fire fast” is probably a simple solution.

Dr. Buford: One of the smartest things that I did in the last few years is to be more present. In the past, like other members of the board, I was travelling a good deal speaking and consulting until I finally realized just how much this can compromise growth of a practice. While podium time has certainly enabled me to build a national reputation and meet other like-minded peers, there is a point when we all need to step back and tend to our own businesses back home instead of growing everybody else’s.

Dr. Downie: My specific practice challenge was finding people who actually wanted to work hard and who care about my practice, my patients, and their careers. I have replaced two inefficient workers (and one lovely employee who retired) with three new people who are actual adults with great values, who work hard, believe in the statement teamwork is the dream work and get along. This was not a simple solution and took time, effort, and energy. My team members that refer someone for an interview get a lot of praise; if that referral gets hired and stays more than six months, I pay the referring employee $500.

Have you adopted any strategies into your day-to-day activity that have significantly benefited you?

Dr. Downie: The day-to-day strategies that have benefited us are checking the pathology book more frequently to make sure we are not missing any patients returning for skin cancer surgeries or being referred out to a Mohs surgeon. Additionally, we always check the sample closet for expired samples. Finally, all items that we mail out to patients receive a tracking number so it does not wind up at their neighbor’s house! We lost a lot of cosmeceuticals at the beginning of the pandemic and this never happens anymore.

Dr. Buford: The best strategy that I implemented is to hyperfocus attention on schedule flow. Simply booking patients is not enough. We have learned how important it is to focus on that flow and which type of patients to book when and for how long. I also learned to avoid energy vampire patients. These are the ones who come in on a “Specials” day (when they know that they have limited time) and want to chat and have a long consultation. Being mindful of this and saying “no” has helped. I lost a few patients along the way, but often for the good of the practice long-term.

Dr. Pozner: Stay organized and clear out your email daily. Book flights well in advance.

Dr. Schlessinger: When I started out, I thought I was going to be the boss of my private practice. That couldn’t be further from the truth. My bosses are my employees, and though I can suggest, I realized that the best thing I could do was to ask my head nurse, who is great, to affect change and let her figure it out. My involvement was not only ineffective, but negative. The motto is: “Get out of the way and let the professionals do it!”

Dr. Hirmand: Weekly staff meetings and as needed break-out meetings with staff. Communication is one of the other challenges in any organization and weekly staff meetings with an agenda helped us tremendously.

Dr. Cohen: It is always challenging getting staff to be on the same page. Cell phone and social media use in clinic has been an ongoing problem. Making sure people don’t clock in too early and get paid for eating breakfast is another issue. It functions best when each doctor takes responsibility for their specific team to help the administrative folks in overall implementation of policies.