Setting up a dermatology practice is expensive but more so when offering laser treatments. “I always tell people it’s a lot cheaper to start with injectables and pills,” Anne Chapas, M.D., told delegates attending American Society for Laser Medicine and Surgery annual conference in April.
“You don’t only have to purchase a device, but there is maintenance, there may be construction issues and you have to think about how you are going to learn how to use it. I’ve actually seen people go bankrupt because they didn’t know how to use this very expensive laser that they purchased,” said Dr. Chapas who is founder and medical director of Union Square Laser Dermatology in New York.
Dr. Chapas took out a large loan to buy eight lasers when setting up her practice in Manhattan seven years ago, but she advises others that only two are really needed. Her practice now has around 30.
When choosing which type of laser to buy, consider what services the practice will be offering, she says, and this will depend on the local population, what treatments are popular and the existing competition. In general, it is worth remembering patients coming to dermatology practices are most interested in treatments for wrinkles, redness and sun damage, she points out.
Union Square Laser Dermatology has lots of machines that perform a single function very well, but these are expensive so are best for bigger practices, she says. Such machines are also large and heavy so can’t really be moved around. Platform machines are a good option for those starting out, as they are more portable and will usually have one stronger feature. Newer machines that are adaptable also require fewer service contracts and engineering visits, but on the downside if the machine breaks down, the practice may not be able to operate. Dr. Chapas cautions against opting for the newest technology.
“I can’t tell you the number of kinks that first generation lasers have so they usually need to be worked out. Patients are looking for really good results, so if there are disappointing results, it is going to affect the reputation of your practice,” she said.
Then think about the practicalities, she says. First ensure the premises are big enough to bring in and install the equipment, and whether it will be covered by existing building insurance. While some lasers run on 110V, many require 220V power supplies, so if the office does not have the correct sockets they will need to be fitted. Lasers give off a lot of heat, so the air-conditioning system needs of each room must be considered, otherwise there is a risk that the laser will overheat and shutdown. Other equipment may be needed, ranging from a simple vacuum if offering hair removal, to serious protective equipment if radiation is used to treat skin cancers.
There are lots of purchase options, and Dr. Chapas has tried most of them, from short-term trials to see if the laser is right for the clinic, through leasing to own, to buying the laser outright.
Buying is the cheapest option if the cash is available but she would not advise physicians purchasing their first laser to take this approach as they need to “be pretty savvy” to ensure the machine supplied includes everything they need.
Leasing may be a better option for first timers, she says, bearing mind that once signed leases are very difficult to get out of. Interest rates on leases can vary over time, so the overall rate needs to be calculated to allow terms of different contracts to be compared. Costs of maintenance and updating equipment also need to be factored in.
“You really can haggle between the different companies,” Chapas says. “Everything is negotiable until you sign.” Discounts off the list price may be possible, and once the limit has been reached there, try pushing them to throw in more disposables, she advises. Shipping costs also need to be considered if the equipment is coming a long distance, and also whether the relevant sales tax is included in the price. Most devices come with a one-year warranty, but it is worth extending this as it is cheaper to do so upfront. When weighting up, fixed business costs, running costs and staff need to be factored in — even if the purchase is a good investment.
When a physician purchases a device, she recommends making sure that the company representative attends the installation, in case there are any teething problems and to ensure that the staff who will be using it are fully trained.
The rules and regulations on operation of lasers very markedly from state to state. In some states, only physicians can operate the devices, while in others non-medically qualified staff are allowed to under supervision. In some cases, this means direct supervision, while in others, the medical practitioner does not have to be on site.
“How to Buy Your First Two Lasers,” Anne M. Chapas. American Society for Laser Medicine and Surgery annual conference. April 13, 2018, Dallas.