Uncertain future for healthcare prompts dermatologists to expand, adjust services

Key Points

What's more, November's presidential and congressional elections could change the direction of the country. On Call asked dermatologists around the country what they, or their practices, are planning this year as they await a determination of what healthcare delivery will look like. Are they making any major changes, expanding or downsizing their practices?

"The advantage we have is that it's a critical access hospital. Whether it's real or just perceived, I think there is some protection from major changes in the healthcare system, because of the hospital being critical access for Medicare," he says.

In practice for five years and on the clinical faculty for Pacific Northwest University and Idaho State, Dr. Wray says that at this point in his career, it's nice to have that kind of security.

"Had I not been married and had kids, I possibly would have gone out on my own. The challenge of running a practice is something that interests me, but when you have medical school loans to pay off, and mouths to feed, that security is important."

Out-of-pocket only

In Monterey, Calif., Christopher Dannaker, D.O., has positioned himself so he is insulated from what the government will do about healthcare. Seven years ago he transitioned to a totally cosmetic practice, and he doesn't accept Medicare or any other insurance.

"I opted out of Medicare so as not to create any positive dissonance between a patient receiving treatment then trying to file for Medicare. By opting out, we can perform cosmetic services without concern about whether or not Medicare would deem it to be noncosmetic."

Dr. Dannaker, assistant professor at the University of California, San Francisco, thinks his practice may have seen some of its more difficult times in the past few years.

"Cosmetic dermatologists did get hit when the economy fell. I also faced another difficulty because new competition developed around here from noncore specialists, and even RNs.

"But over the last couple of years, despite the economic recession, our business started to pick up because many patients who had services from those paramedical and noncore specialists have become dissatisfied, at least in our small community. Therefore, after a few years, they've actually came back to our practice."

Dr. Dannaker says he thinks he is well prepared for what comes next because of actions he's taken over the past few years.

"After three years of trying to lean out the practice, I think it's matured to the point where we don't want to become any more lean in terms of office staff. My economizing moves have probably already occurred.

"Now we are looking at the acquisition of new capital equipment very carefully. We don't try to amortize our costs over a long period, even five-year leases. We want that technology to pay for itself in a much shorter lifespan, because we can't be fully confident of what patient desires for that technology will be in the future," Dr. Dannaker says.

A decision to sell older equipment shortly before the economy tanked worked out well for Dr. Dannaker's practice, he says.

"I'm a solo practitioner with seven lasers, so I do have a lot of technology. I made my purchases before the economic downturn. Then, at the beginning of the downturn, I purged and sold all of my older lasers that I felt were redundant or not as useful. If I had waited, those would be unsellable now," he says.