Adding a New Staff Member Read this Article Now

Understanding Search Engine Optimization Read this Article Now

July 2012

Also

Adding A device: Dos anD Don’tsHere’s how to ensure a new device is a great practice opportunity—

not a long-term source of regret.

CliCk here to read this article

Editorial Board

Kavita Mariwalla, MD, FAAD Editor-in-Chief is Director

of Mohs and Dermatologic Surgery at St. Luke’s-Roosevelt

and Beth Israel Medical Centers in New York and Assistant

Professor of Dermatology at Columbia University and Stony

Brook University.

Amy Derick, MD, FAAD is Founder and Director of Derick

Dermatology, LLC in Barrington, IL and is an Instructor of

Clinical Dermatology at Northwestern University’s Feinberg

School of Medicine.

Steven M. Hacker, MD, FAAD is in private practice in

Boca Raton, FL. He is author of The Medical Entrepreneur

Pearls, Pitfalls and Practical Business Advice for Doctors

(TheMedicalEntrepreneur.com).

Firas George Hougeir, MD, FAAD is a Fellow of the American Society for Mohs

Surgery who also specializes in General and Cosmetic Dermatology at Family

Dermatology in Atlanta, GA.

Todd E. Schlesinger, MD, FAAD is director of Dermatology

and Laser Center of Charleston, SC. A Fellow of the American

Society for Mohs Surgery, he is past president of the South

Carolina Dermatologic Association.

1 Hiring and Retaining Good EmployeesYou learned how to find good candidates, now find out how to keep them on-board.

By Sharon Andrews, RN, CCS-P

In the last edition (available online at NewDermMD.com), I outlined strategies for recruiting applicants and conducting interviews for new employees for a dermatology practice. In this edition, I’ll review the process of making an offer and bringing a new staff member on-board.

Making the OfferOnce you identify the right person for the job, make the formal offer in a written “Letter of Offer.” Do not use terms like “contract” or “agreement,” as the legal significance of these terms exceeds the intent of your offer letter. Provide two copies of the letter, detailing each of the elements listed in the sidebar (right). One is for the employee’s records and the other should be signed and

The LeTTer of offer musT sTaTe

• Duties• Hours• Pay• Benefits• Start date• “Contingent upon criminal, credit, and drug tests”

Provide two copies, ask candidate to sign one and return it as acceptance

submitted back to you to signify acceptance of the position and terms.

OrientationEvery new employee needs an orientation to the practice. There should be a set “agenda” for the orientation to ensure that each new hire gets all the relevant information they will need. The orientation should include an overview of the facility itself, as well as basic procedures and protocols. This is the ideal time to introduce key staff members and their responsibilities (such as who has the keys to the supply closet, who is responsible for ordering supplies, etc.).

Employee Policy Manual Every practice should have an employee policy manual that details all the basics of benefits, job descriptions, etc. The contents of a well-constructed employee manual could be the topic for a full article. For now, consider these important points. Explain vacation and sick policies as well as procedures for requesting and recording time off. Outline maternity leave, sick leave, and other special circumstances. How often are employees paid and how (direct deposit vs. live checks)? There is a uniform or dress code? Phone policies? Internet policies? Is there drug testing? It is essential that the employee sign a form indicating that they received the manual.

The PaperworkThere are multiple forms new hires will need to complete. These include but are not limited to:

• W4 form• I9 form• Health insurance, retirement plans, or other benefits forms.

Compliance TrainingDepending on his or her individual role in the practice, each employee will need specific compliance training. If employees are required to have a certain documented amount of training at regular intervals, such as nursing CEUs, be sure they are up to date and that the professional license is current before they begin working for you. Some regulations with which employees may need to be compliant are: OSHA, HIPAA Privacy and Security, and Medicare. All employees, including all clerical staff and even aestheticians who may never look at a patient’s “medical” chart, are required by law to have training on HIPAA Privacy and Security, which applies throughout the practice. Clinical employees or any employee who has a chance of being exposed to bloodborne pathogens in the performance of their duties must have OSHA Bloodborne Pathogens Training before being assigned to duties in which there is a possibility of exposure. The law also requires annual re-training. While not required by law, a Medicare compliance program and its related training are valuable to your practice.

Scheduled EvaluationsAll employees should have regular evaluations. Once per year is acceptable, but more frequent evaluations may be helpful, especially early in the employee’s tenure. Any new employee will benefit from a 90- or 180-day review. The evaluation is an opportunity to recognize those things the employee does well and to address any areas of poor performance or concern. It is also helpful to set realistic goals for growth or improvement during the evaluation.

Keeping Good EmployeesOnce you’ve invested the time and effort in finding a good employee, it will take a bit of effort to retain them. The key is helping employees achieve a high level of job satisfaction, which is not necessarily the

Career TraCk Tip

Integrate Medical and Cosmetic Dermatology:

“it’s fairly easy for a medical dermatologist to integrate cosmetic procedures into practice, and in my opinion they should, because cosmetic dermatology is an integral part of all of dermatology. What will happen when you are doing medical dermatology is patients will ask you, ‘What about my forehead lines?’…”

—Hayes B. Gladstone, MD, FAADBerman Gladstone Skin institute, California

play video

learn more about dr. Gladstone

same as happiness. Perks like product samples, performance incentives, and generous holiday gifts are nice to brighten their day, but employees need consistent and long-term job enjoyment. This starts with good training. The employee who is well trained will appreciate the investment of time and resources into her/his success and is less likely to experience frustration. The office culture must be one of respect for patients and team members. Public reprimands and complaints about staff rarely achieve their desired end, and they may reflect poorly on you in the eyes of patients and other staff who overhear them. Discipline with respect. The value of the physician thanking the employees at the end of the day or for a particular outstanding performance is immeasurable. Hold regular staff meetings. This is a good time to address recurrent problems without making it personal (such as a reminder to all staff to lock the sample closet or shut off the printer at the end of the day); never call out a specific employee before the group. Giving employees a regular update on the practice confirms their status as valuable team players. It is important to involve employees in the meeting and to solicit their ideas to improve the practice. It seems obvious, but it’s worth addressing the importance of fair compensation. Employees should receive appropriate compensation for the work they perform, reflective of their education, training, skills, and

experience. Online resources may provide information about salaries in your area. Also consider speaking with a colleague in town or in a similar area of the country or a consultant to help determine an appropriate salary for specific posts. Finally, regular skills training and continuing education opportunities will ensure that the employee is up-to-date and able to perform his/her duties effectively, providing a benefit to your practice. Put a line item in your budget for continuing education and provide the necessary time off for an employee to attend conferences or classes.

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Sharon Andrews, RN, CCS-P is founder of DermResources, a dermatology consulting company that is national in scope and dermatology-specific. Their mission is to assist dermatology practices in establishing and maintaining professional and business practices that result in higher patient satisfaction and overall practice efficiency. Ms. Andrews is the

author of DermNews, a monthly publication for dermatology practices. For more information: www.dermresources.com

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In any healthcare center, whether a hospital or clinic, there is a flow of manpower. After the most qualified individual is hired to add to this flow, the orientation of a new comer is the first step.1-4 Orientation programs are an important component of employee retention and engagement, yet the importance of orientation is often overlooked by many organizations.2

New employee orientation sets new employees off on the right foot and effectively integrates them into the organization, quickly enabling each individual to become a contributing member of the work team. New employees should feel the hospitality of the working place through orientation; a lack of an adequate orientation program can result in new employees finding it difficult to adapt to the organization’s culture and may lead to high turnover rates.2

Because orientation is their first impression about the practice, new

An Appraisal: Orientation of New Employees

By Khalid Al Aboud, MD

employees should feel every effort to make the first impression a good one. It must be carefully planned and executed to ensure that the employee learns all about his or her future duties and the practice in general. Hospitals and medical centers have utilized different tools to achieve a successful orientation program. These tools include lectures, videos, checklists, printed manuals, and online materials.2 Creating a folder of necessary information about the organization is possibly the easiest way to speed up the orientation. This pack may contain the phone directory, organizational chart, important safety measures, and general policies and procedures of the clinic. A good final step in the orientation program is to have each new employee evaluate the entire orientation process. That information can then be used to update and revise the program.5

1. Bodinsky GN. The orientation process: developing an orientation program for endoscopy personnel. Gastroenterol Nurs. 1991; 13(3):146-51.

2. Blackhurst K, Dowd T. Orientation: the key to successful, engaged staff. Radiol Manage. 2009; 31(4):45-9.3. Wolgin F, Fluke C. Employee orientation. J Healthc Mater Manage. 1987; 5(1):75-80.4. Ehrhardt P. The new employee: proper orientation and training go a long way toward job success. Clin Lab Manage

Rev. 1999; 13(5):262-5.5. Edwards K. Developing an orientation program. Radiol Manage. 1999; 21(1):24-8.

Khalid Al Aboud, MD is a clinical dermatopathology Fellow in the pathology department at Wake Forest University in Winston-Salem, NC.

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2 First-Time Buyers: The Dos and Don’ts in Device PurchasesFollow these tips to ensure that a new device is a great practice opportunity—not a long-term source of regret.

The expanding realm of aesthetic devices leads dermatologists to seek the integration of a device for the first time, and the selection of an appropriate system can be a challenge. To help practices navigate the device market and make wise patient care and practice planning decisions, I will offer tips for identifying and evaluating new opportunities.

The DosDo see the device in action. Visit a physician to get opinions and hands-on experience with a system prior to purchase and evaluate how to utilize it best. Then, once the practice is familiar with its use, learn how to package it for the patient base. Even if a system offers dramatic and consistent results, it is not a wise investment if it’s not a match for the practice’s patients. In addition, experience is critical to ensure success. A cosmetic dermatology or procedural fellowship can be invaluable. Younger dermatologists may consider a young physician preceptorship through the American Society for Dermatologic Surgery. Always get training

By Todd E. Schlesinger, MD

specific to the device or procedure the practice intends to offer.

Do start small. Focus on core devices. Hair removal, rejuvenation, and laser resurfacing are popular requests, so select a device that targets these issues but one that also allows for a broad range of application. Look for a device with multiple hand piece options, so it can grow as the practice and staff expertise expand. Keep the number of devices low, so they do not sit in the corner collecting dust. It is no stretch to say that a practice can meet the needs of 60 to 70 percent of its aesthetic patients with just two or three strategically selected devices.

Do calculate the best way to purchase and its return on investment. The world of devices offers many options for purchasing: cash, lease, rent, capital lease, and the company’s own financing, to name a few. In a capital lease, the lessee purchases the device from a bank or leasing company per contract terms

experT inSiGhTS

Anticipate Demand for Non-invasive Fat Removal“i think that we’ll continue to see that

blood vessels and pigment will be the

number one and number two things

that we treat on a daily basis, but

after that i think skin tightening will

continue to evolve, as well as laser

based technologies and non-laser-

based technologies for non-invasive fat

removal. So those are two areas where i

believe we’ll see the most growth.”

—E. Victor Ross, MD San Diego, CA

WatCh video

learn more about dr. ross

(typically for $1) and pays monthly over the expected useful life of the equipment. At the termination of the lease, the lessee can purchase or potentially resell the device. The choice of a capital lease may be the best way to get started with a device, particularly with certain tax advantages, but consider seeking professional advice to determine the best purchase option for the practice. Also, be sure to research what others charge for the services the practice may be contemplating. In addition, be sure the return on investment for three to five years predicts demand as accurately as possible. To that end, use intake questionnaires to help identify interest in cosmetic procedures among existing patients. Especially early on, most cosmetic patients will be converts from the medical practice. It typically takes some time for a clinician to become established as a cosmetic service provider and thus attract new patients specifically for aesthetic services. Make the questionnaire simple, and provide check boxes for the procedures the practice may be considering. Ask patients to check off all services that may be of interest.

The Don’tsDon’t “over-buy.” Not buying more than a practice can afford may seem obvious, but it can be a common pitfall. There are two main ways to over-buy. The first is to jump at every new device or procedure that becomes available. While it can be beneficial to be on the leading edge in the community, some “exciting, new” procedures may not provide their initially anticipated aesthetic (patient) or financial (practice)

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benefits. Unless a practice strives to be the leading cosmetic provider in an area, there is no need to be ahead of every hot trend. There will always be a market for the “basic” device-based services with a proven record of efficacy. One can also over-buy when the system is good but the investment is simply too great. If practice demand is not sufficient to cover the costs of the device, then don’t proceed. Being saddled with high loans or purchase payments can cripple even a very busy practice.

Don’t overlook intangible costs. Beyond the price of the device itself, become familiar with the costs of assistants’ labor or ancillary equipment, such as cooling devices or a vacuum. In addition, don’t forget about insurance, warranties, and maintenance. Shockingly, maintenance can cost 10 to 15 percent of the cost of the device annually to keep up the warranty, either with the company itself or another provider. The big tip here is to negotiate about a month in advance of the purchase, as practices have the most leverage when in the buying stage itself. Try requesting a longer warranty with maintenance coverage paid up front so all fees can be rolled together, or negotiate for a price warranty break for years three, four, and five. Also, buying at certain times of the year may offer additional negotiating leverage as equipment vendors strive to meet sales goals.

Don’t forget about safety and legal issues. Be sure to get training from the company on the device, and follow guidelines provided. Hang the provided guideline posters in office spaces, and invest some time into

creating office staff manuals and procedure protocol manuals for all procedures offered. Organize a certified course for all staff held at the practice itself or while attending a large industry meeting. For a fee, some compliance companies will review the office for OSHA compliance and aid in correcting issues (i.e., labeling, needle safety, privacy rules, and physical office setup).

Striving for SatisfactionAcquiring a device can be an anxiety-inducing process for any practice. Most devices require a significant investment by the practice in terms of acquisition costs, not to mention the investment

STraTeGiC markeTinGGoogle Juice or What You Need to Know About SEO

“a smart link-building strategy must be at the

core of the SeO plans for your website. many

SeO service providers commit the cardinal

mistake of linking your dermatology website

with irrelevant websites through automated

link-builder programs. This can temporarily

bring high traffic to your website but will be

largely irrelevant for your purpose. in the long

run, irrelevant and low-quality link-building

will downgrade your search engine rankings.”

— Naren Arulrajah with Vikas Vij Ekwa Marketing

read full artiCle

or WatCh it on dermtube.Com!

of time in system research, training, staff education, and marketing. The anxiety is compounded by questions about patient response to the new system or device. Whether a device is the first or fifth for the practice, it is never possible to know that patient demand will be sufficient to justify the purchase. With the proper research and thoughtful consideration, a practice can optimize its chances for success. Understanding the types of devices available, their respective effects, and their realistic role in the practice will help in making a smart decision. Practices should be receptive to opportunities to augment their service menu with new treatments that do not require a significant financial outlay. A procedure like photodynamic therapy may expand treatment options with minimal cost to the practice.

Todd E. Schlesinger, MD, is director of Dermatology and Laser Center of Charleston in South Carolina. A Fellow of the American Society for Mohs Surgery, he is past president of the South Carolina Dermatologic Association and a fellow of the AAD, ASDS, and ASLMS.

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reSOurCeSWebsites, products, or service providers mentioned in this edition:

» Assessing Dermatologic Devices in Practical Dermatology

» DermTube.com

» DermResources

» Hiring the Right Staff in NewDermMD article

WOrTh nOTinG

See kavita mariwala, mD discuss “Dermatologist By

Your Side,” a new program developed by La roche-

posay gives consumers instant access to educational

videos about skincare topics and product selection.

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