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Wednesday
Mar122014

Dr. James Wharton - Louisville Dermatology Clinic In Kentucky

Dr. James Wharton uncovers insights that could lead to better business decisions.

Dr. James Wharton - Louisville Dermatology Clinic In Kentucky

Name: James R. Wharton, MD
Clinic: The Aesthetics Center of Louisville/ Louisville  Dermatology Clinic
Location: Louisville, KY
Website: aestheticscenter.org and louisvilledermatology.org

Tell us about your clinic? What treatments do you provide?

We have separated our practice into two clinics. The Louisville Dermatology Clinic is a full service general dermatology practice. We evaluate and treat patients with any skin disease or condition. We treat adult and pediatric patients. We perform surgical procedures such as biopsies, excisions and more complicated cases requiring Mohs micrographic surgery. We have a full dermatopathology lab that can provide analysis and examination of specimens on site.

The Aesthetics Center of Louisville is located in the same building but is a separate practice. We separated our practices for the benefit of our patients. We feel this ethically is the best representation we can provide to our patients. We have a state of the art full service aesthetics practice that offers: peels, microdermabrasion, make-up application, waxing, lash/brow tinting, dermaplaining, IPL, laser hair removal, laser resurfacing, leg vein treatments, various radiofrequency procedures, Ultherapy, tattoo removal, Acleara treatments for acne, MiraDry, injectable toxins, dermal fillers, and concierge VIP dermatology.

You possess active medical licenses in Kentucky, Arkansas, Texas, Hawaii, Missouri, and Florida. Are there any specific distinctions regarding how you can practice medicine on each state?

I have active medical licenses in multiple states. While I currently  only practice medicine in Kentucky, it is important that physicians familiarize themselves with all the regulatory requirements for their state. There is a great deal of variation in the laws regarding which procedures can be delegated and the requirements of each state can significantly affect a business and what services they are able to offer.

Click to read more ...

Tuesday
Mar112014

Fee-splitting Botox & Restylane In Medical Spas

medical spa fee splitting for botox and restylaneHave you ever paid a commission for Botox and laser treatments? Although it’s very common ... it’s also very illegal.

During the past several years, a very troubling trend has developed in the medical spa industry. Nurses, nurse practitioners, physician assistants and laser technicians are being paid by commission in order to incentivize them to bring new business into the spa. This is very lucrative for both the spa and the individual, but unfortunately, in most states, it is illegal.

However, by accepting commissions for Botox treatments, she was engaging in illegal fee-splitting. Not only could she face significant monetary sanctions if she continued to do so, but both she and her supervising physician risked immediate suspension or revocation of their licenses if the state learned she was taking commissions.Fee-splitting refers to dividing or sharing fees from medical services between a physician and a nonphysician. In most states, all fees generated for medical treatments must be paid directly to a physician or physician-owned corporation. No one other than the physician—including nurses, physician assistants or any nonphysician medical practitioners—may receive any share of a medical fee.

Although the prohibition against fee-splitting has been on the books in most states for years, the practice of paying commissions has become quite prevalent in the medical spa community. This is probably because, in medical spas, most medical directors do not want to spend time firing lasers or injecting since other services can be more lucrative. As a result, injections and laser treatments are delegated to other medical professionals, who, in turn, develop a large client base. An easy way to compensate those professionals is to pay commission.But the consequences for fee-splitting are severe. In most states, the state licensing board has the power to revoke, suspend or refuse to renew licenses in response to fee-splitting allegations. Accordingly, regardless of the monetary incentives, it is always advised to avoid paying or receiving commissions. A safe alternative to fee-splitting is to use a pre-set bonus structure—the nonphysician can still be rewarded for performance, but the bonus is not related to the number of treatments performed.

Recently, a client called me with an urgent concern. This client, a registered nurse in Chicago, worked in a medical spa as an injector and laser technician. She was well-compensated: In addition to an hourly salary, she was also given a commission—a percentage of net revenue—for every Botox and laser treatment she performed. And boy did this nurse perform—during the past 12 months, she personally had generated more than $350,000 in revenue for the spa.

Her concern arose from a conference she had recently attended where she learned that most states have laws prohibiting fee-splitting. She was informed that taking commissions on Botox and laser treatments might land her in hot water with the state nursing board. She explained that this didn’t make sense, given that she had been receiving commissions for years, and that the physicians who paid her surely wouldn’t risk their licenses by doing something illegal.

It is imperative for any medical spa professional to seek legal counsel immediately if being paid a commission for medical treatments. The laws of each state vary and are often difficult to find, but as is often the case, ignorance of the law is never an excuse.

Click to read more ...

Monday
Mar102014

Diane Howlin, MD, FACP of Chelsea Medicine and Laser in Michigan

Chelsea, Michigan Board Certified Physician Diane Howlin, MD, FACP

Name: Dr. Diane Howlin
Clinic: Chelsea Medicine and Laser
Location: Chelsea, MI
Website: chelsealaser.com

That's interesting: In 2001, Dr. Howlin founded Chelsea Hope Clinic, a free Saturday clinic for uninsured patients.  In 2008, she was named the “Howard S. Holmes Humanitarian of the Year” by Faith in Action for this charity work. In 2009, she launched another not for profit free clinic, Chelsea Grace Clinic,  for uninsured and underinsured patients in Western Washtenaw County.

I grew up in Dearborn Michigan. I played the violin in my youth and undergraduate years, touring Europe with an orchestra in the summers. That led me to learn German and be interested in cultures/language.  I went to medical school at the University of Munich in German and married an Englishman. After medical school, we returned to the US for my residency in Ann Arbor, Michigan in internal medicine. I always loved surgery and surgical procedures. But a surgical residency seemed too hard on my family as we had two children. So I chose internal medicine and did my own procedures. I'd spend evenings in the medical library researching cosmetic office procedures like earlobe repair. That led to skin biopsies, lump and bump surgeries, and seeing the cosmetic effects of this work led me to lasers. Now the practice is fully integrated with both traditional internal medicine and aesthetic medicine.

As a female physician, what are the opportunities that you have that

Click to read more ...

Sunday
Feb232014

My breasts are cold!!

“My breasts are cold!!” said a patient of mine in her last postop visit. We did a breast augmentation with saline implants just a few weeks ago, and her postop recovery has been smooth and uneventful. It’s been an unusually cold winter this year, with Arctic blasts and heavy snowstorms, so this kind of complaint shouldn’t be surprising. I guess my southern colleagues and readers have already tuned out, I don’t remember my plastic surgeon buddies in Miami complaining about any snow, but they don’t only do breast implants in Miami you know…

Cosmetic plastic surgery, being elective in nature, is always risky business. We surgeons take the utmost effort to warn our patients about all reasonable risks and alternatives to our various procedures. But, “your breasts might feel cold when it’s cold outside” is usually not part of my consultation. In the grand scheme of things, unless you find yourself in the perfect storm of running a saline implant breast augmentation private practice in Alaska, cold breasts are probably down at the bottom of your risk list. But it is an interesting phenomenon that happens due to the specific heat of water – greatest of all substances known to man. Water, which is for all intents and purposes the major component of saline, can absorb lots of energy, and thus, is hard to heat and hard to cool. Consequently, when it’s cold outside, your saline breast implants are going to get cold. And the bigger the implants, the colder you’ll be. Now once they get cold, it’ll take just as much time in warm weather, indoors or outdoors, for them to warm up.

I find it hard enough to go thru the list of relevant risks as it is, but I suppose as long as we have cold weather and saline breast implants, cold implants are a relevant risk. Now, when I mention it in my consultations, I get more chuckles from my patients than anything else. So, I suppose that little bit of comic relief is a good effect in what is, in the least, an arduous process of informed consent. Now back to all this cold winter weather, I suppose it’s just global warming….

Daniel Kaufman, MD
Discreet Plastic Surgery 

Tuesday
Feb182014

Dr. Richard Moore - The Lifestyle Center In St. Louis Missouri 

Name: Richard Moore, M.D.
Clinic: The Lifestyle Center
Location: St Louis, MO
Website: TheLifestyleCenter.com

Can you tell us your background and exactly how did you get to where you are now?

I have always had a strong interest in business with an entrepreneurial spirit. Prior to medical school, I obtained a masters of international management and worked in the petrochemical industry in Houston, TX. Following several years as a Hospitalist physician and director of a hospitalist program, I decided to switch my focus and concentrate on health and wellness. A natural evolution of this was my involvement in aesthetic medicine.

How is your clinic structured? What is your work day like? What commitments do you have?

My center takes a team approach starting with the front desk or reception area, moving to my nurse sales consultant and then my team of nurses and estheticians. All employees are incentivized to contribute to the success of the center. My personal involvement is a daily presence in which I step in on several consults a day, perform office based liposuction, and for clients who prefer a physician injector I am available.

Click to read more ...

Sunday
Feb022014

Why I Quit Medical School

Why would you not want to become a physician in America?

Jeremy was familiar with life as a doctor. His father's a maxillofacial surgeon. So is his brother who's just a year or two older. Here's Jeremy's post on why he quit medical school and decided not to become a doctor. Jeremy blogs at Never Eat Soggy Waffles

Why I Quit Medical School

It hit me. Sometime around the time I was filling out my secondary application for medical school during my senior year in college… it hit me. It felt less like a swift slap to the face and more like a creeping, slinking hollowness… perhaps akin to a small but persistent elephant sitting on my chest. We’ll call him Chester. I would be able to shake this persistent pachyderm for days, perhaps weeks at a time, but he would always return. Scramble up my leg, nestle down just below my left collarbone and take a nap. Deep breaths wouldn’t make him go away.  Long runs wouldn’t shake him. Most of the time he was barely perceptible, but present nonetheless. Doubt.

Excitement and Doubt

The acceptance letter came. Rejoicing ensued. But halfhearted, fraught with thinly veiled concerns and flimsy self-assurances that this was the path I was destined to take. The letter was like a steroid injection to my ego and my newly muscled ego chased Chester away for a month or two. If medical school wants you, how can you say no to medical school. It’s a privilege, an honor even, to be one of the few and the proud… and it genuinely was. And yet, after the newness had worn off, Chester slowly slunk back to his customary perch. Doubt.

The crazy plan…

It was around Christmas break of this same senior year that my friend Bjorn Harboldt shared with me his seemingly laughable plan to travel from one end of the world to the other… in a year… quite literally. His plan was to start at the furthest southern city in South America Ushuaia in Cape Horn. Travel up through South America, Central America, and North America to Alaska. Find a way across the Pacific Ocean. Continue through Asia, up into and across Siberia to Eastern Europe. Down through Eastern Europe to the ancient shores of the Mediterranean. Cross that sea and traverse Africa to the farthest southwestern corner and the Cape of Good Hope. Quite ludicrous. Ostentatious even. A truly excessive bit of traveling.

“to live a year intentionally…”

At the mere mention of this trip Chester fled. My heart beat with a strong and assured thud at the thought of such an adventure. I did not have delusions that this trip would drastically change anything. I didn’t believe that I would “find” myself because I didn’t really feel lost. I didn’t believe that the trip even made “sense” in the traditional “sense” of the word. My parents and many friends thought that I had perhaps been given over to depravity of a most irresponsible, albeit innocent, sort. My thoughts were simply that this is what I wanted out of life. To broaden my perspective, to live adventure instead of only talking and dreaming about it, to follow the strong and clear thud of my heart, to live a year intentionally instead of following the prescribed plan, to take ownership of my actions.

Although I usually oscillate precariously over weighty decisions… It didn’t take me long to lay my cards on the table and tell Bjorn that I was “all in.”

Planning, saving, selling possessions, successfully attempting to get companies to give us equipment and unsuccessfully getting companies to give us money, getting medical school deferrals, graduating from college, packing, dreaming. It all happened so quickly. And then suddenly… we were getting off the plane in Chile with packs on our back, no reservations, and no real plan except to get to the Cape of Good Hope.

“It opened me up to options and ways of existing that my narrow mid-American worldview would never have even entertained.”

Traveling around the globe by any means possible...

Traveling around the globe by any means possible…

I will not regale you with the details as they can be read at http://www.thewholeworldround.wordpress.com. Suffice it to say that that year of mad capped traveling opened me up to a more global way of thinking. It opened me up to options and ways of existing that my narrow mid-American worldview would never have even entertained. I met people who were living, really living. Not just talking about pedaling a bike from Istanbul to Vietnam, actually doing it. Not just talking about riding a motorcycle from Boston to the bottom of South America, actually doing it. Not just talking about opening up a little hostel in Thailand…. Actually doing it. I met a lot of dreamers… that were actively turning their dreams and interests into realities.

The open road... the ultimate education.

The open road… the ultimate education.

First year of medical school

Chester was mostly absent during this year of exploration. The next time he showed up was the summer after I returned from the trip. He stayed with me all the way through the first year of medical school. He grew into a full-blown tusker of doubt. Doubt about the path I had taken. All the while I created a million well-crafted reasons why I was on the right path. People around me re-enforced this thinking. My own ego re-enforced this thinking. The self-denial was spread thick. I almost dropped out at Thanksgiving break, at Christmas break, at spring break, but my carefully constructed rationalizations kept me around until the end of the year.

It was around this time that I met Lindsay. She is now my wife. I did some hardcore re-assessing during this summer between my first and second years of medical school. I went to an intensive, interactive self-improvement workshop. I read a lot. I prayed a lot. I began telling myself the truth. I did some very hard and very personal growth work. And then second year medical school began….

“I realized that my life was not going where I wanted it to go.”

Two weeks in it all came to a head. The thin veil was lifted. I stopped lying to myself. There were no more rationalizations. I realized that I was in a place I didn’t want to be in. I realized that my life was not going where I wanted it to go. As strange as it sounds, I realized I had gotten there by default. I had gotten there by letting life happen to me. I was not happy. So I made a very difficult decision… I quit medical school.

“…taking ownership for my future instead of just floating towards a sensible default.”

I wish I could say that my life purpose instantly crystallized and it has been all rainbows and sunbeams since I made that decision, but that wouldn’t be true. There was an instant flood of relief once the decision was made, but it has been difficult to let go. To picture myself in the future as something other than a medical doctor. To start taking ownership for my future instead of just floating towards a sensible default. To take steps toward living more wholeheartedly. At some point during this process I realized that Chester was shrinking. Taking ownership for my path in life was causing the change.

Lindsay was with me through the whole process of leaving medical school. She was with me through the doubts, the valleys, the indecision, the oscillating, and even the tears. Six months after dropping out of medical school we were engaged.  Three months after that we were married. We had a lot of long talks and earnest prayers about what we wanted our life together to be like. Global development and humanitarian work was at the core of who we both were. We both love to travel. So we made the decision together before we even got married to do a Master’s in Global Community Development that would begin the fall after we got married. We decided to follow our interests and take ownership for our path. We decided to attempt to turn those interests into a sustainable livelihood. We decided to do this together.

I am writing this from Arusha, Tanzania. I am sitting next to my wife in a little bungalow on the grounds of the Colobus Lodge. We are in the second semester of our Master’s program. We are preparing to go to a rural World Vision project to work on building the capacity of the local office and community there. I can say with complete integrity that this Master’s program is the most fulfilling formal education I have ever had. We have some awesome prospects for international internships. I am seriously considering doing a PhD in International Development. The possibilities seem endless.

I don’t recall the last time Chester was home.

 

Tuesday
Jan282014

What Should You Do If A Patient Wants To Record A Consultation?

patients recording a medical consultation

Patients are now equipted with the technology to record their consultation, whether you know it or not.

With the proliferation of smartphones, many patients now have the ability to record a consultation at their fingertips by installing a simple, and free, app. Recording a consultation has some advantages for doctors and patients. It can help the patient to retain information for example, but when a patient covertly records a consultation, it can cause the doctor to question why.  

One study suggested that patients immediately forget between 40 and 80% of the medical information provided by their doctor and almost half the information they do recall is incorrect.  

Some patients come in with notepads, ready to write down everything they hear. The problem is that when patients are busy writing things down, they may not be completely focused on everything that’s being said. Bottom line, they still don’t get all the info they wanted.

Physicians are split on the subject.

Christopher Eden, consultant urologist at the Royal Surrey Count Hospital, Guildford, explains why he approves. 

The other day, a chap came to see me to discuss his surgical options following a recent diagnosis of prostate cancer. I fully expected he’d have a lot of questions, but the first one lobbed my way wasn’t quite what I’d anticipated.

Clearing his throat, he said: ‘Do you mind if I film you, doctor?

It’s not the first time a patient has asked if they could tape our consultation. But usually they mean an audio recording. Appearing on the small screen - or at the very least his smartphone - was altogether different.

But I didn’t have any objection. Research has shown that patients pick up only a third of what a doctor tells them.

The other side of the coin.

A U.S. cancer specialist recently wrote in a leading journal that he felt taping a consultation disrupted the lines of communication and trust between doctor and patient - particularly if it’s done surreptitiously.

Why, he asked, was there a need to record the conversation at all?

Obviously, I’d prefer to be told if it’s going to happen: if a patient trusts me to save his life, he should feel comfortable enough to tell me he wants to tape our discussion.

So what should you do if a patient asks to record a consultation with you? It is common courtesy that somebody wishing to make a recording should ask permission. If you feel uncomfortable at the prospect then you should express that discomfort and tell the patient that they would prefer the consultation not to be recorded.

If the consultation is recorded, it would be sensible to ask for a copy so that it can be placed in the patient’s notes to form a permanent record.

The content of the recording is confidential to the patient, not the doctor... so the patient can do what they wish with it. This could include disclosing it to third parties, or even mounting the recording on the internet. So what does this mean for doctors?

Doctors should always behave in a responsible and professional manner in consultations. Consequently, any recording will provide concrete evidence of that.

Technological advances will undoubtedly bring further changes and it may well be that in 20 years’ time, recording of consultations, with copies being held by both doctor and patient, will be commonplace.

Does anyone here have experience with this?

Sunday
Jan262014

Yes, I Sometimes Google Patients. Is That Weird?

There's no doubt about it. Typing your name (or your clinics name) into Google or Yahoo and seeing what pops up is something that the majority of your patients are now doing. So, we ask the question, is it fair to do the same?

Humans are curious creatures. Our curiosity has us doing utterly unproductive things like reading news about people we will never meet, learning topics we will never have use for, or exploring places we will never come back to. As social beings we're programmed to be interested in other people. It’s part of what makes us tick. (And let's face it, social media encourages us to become voyeuristic.)

Have any of you Googled a patient you found to be particuarly interesting? A patient you found to be behaving oddly? A famous patient? According to recently published articles, it appears that most M.D.’s answer that questions with a resounding “yes.”

In a New York Times column published online yesterday, Haider Javed Warraich, M.D. discusses whether or not that’s OK.

“Doctors do ‘Google’ their patients,’ he writes. “In fact, the vast majority of physicians I know have done so. “I remember when I first looked up a patient on Google. It was my last day on the bone marrow transplant unit, back when I was an intern. As I stood before the patient, taking her history, she told me she had been a painter and suggested I look up her work on the Internet. I did, and I found her paintings fascinating. Even though our paths crossed fleetingly, she is one of the few patients I vividly remember from that time. “But it surprises me that more physicians don’t pause and think about what it means for the patient-doctor relationship. What if one finds something that is not warm and fuzzy?” I recently read about a case in which a 26-year-old woman went to a surgeon wanting to have a prophylactic double mastectomy, citing an extensive history of cancer in her family. However, she was not willing to undergo any work-up, and her medical team noted several inconsistencies in her story. When they searched online, it turned out she had set up multiple Facebook accounts soliciting donations for malignancies she never had. One page showed her with her head shaved, as if she had already undergone chemotherapy. The surgeons immediately decided to halt her care.

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to. Maintaining trust in the doctor–patient relationship is very important. Can a patient trust a doctor who presents information that has not been offered within the confines of the consultation?

Searching for information about patients online is ethical as long as the doctor is seeking information that helps treatment, Dr Warraich believes. “But if the only reason a doctor searches online is to gather personal information that patients don’t want to share with their physicians, then it is absolutely the wrong thing to do,” he concludes.

Thoughts? Is this a black and white, right/wrong issue? Please share. (We promise not to Google you.)

Sunday
Jan192014

We've Now Made $1,200 In Kiva Loans

The Medical Spa MD community has now made $1,200 in loans to entrepreneurs in third world countries!

If you haven't heard of Kiva, it's a nonprofit who empowers small business in the third world in order to help people start businesses to grow their local economy. Kiva is an online platform that lets individuals extend very small loans (as little as $25) to borrowers around the world – usually folks in developing countries that lack the collateral, employment history, and credit to take out traditional loans. These investments to small businesses and entrepreneurs don’t just create opportunity and support community-driven projects but “connect people through lending to alleviate poverty.  Women are especially assisted by microloans

Note: It's a 'lending' program and not a donation... You can get your money back out of the system after your loan is repaid, or you can just lend it again to someone else.

Take a look at our Kiva group here and consider lending to help someone who could use $25 more than you.

Saturday
Jan182014

Why We Only Accept 30% Of Applicants To Our LinkedIn Group

Getting in to the Medical Spa MD LinkedIn Group might be harder than you think. We only approve about 30% of the people who want to join.

We're not trying to be exclusionary, but we are wanting to make sure that we don't get overrun with salespeople and vendors, who are always trying to spam everyone. We're also active in taking down shameless business promotions and spam links, and we're forced to occasionally boot someone who is doesn't add any value and is just there to post their sales pitch.

We look at every profile of every person who applies to join the group. Here are some of our rules:

  1. No jerks; It's worded somewhat stronger on the rules page but that's the basic idea. It covers a fair amount of territory and has stood the test of time.
  2. No direct solicitations; I want to hear about the latest and greatest, and you might be the person who runs the company or heads the sales force, but I want to know why that's the case, not just see your lame link to your sales page.
  3. No sales-jockys; Sorry, I'm sure that you're great and that you just want to help me grow my business... unfortuantely, I've just had too many bad interactions with people who said the same thing and didnt' really add any value.
  4. No one who is not involve with 'medical' care; this is somewhat loose but we try. We understand that there's huge value in having staff members learn about and participate in ongoing education, not only for the treatments that they perform, but also for what you don't offer. To be approved, you have to have something medical in your profile.
  5. No connectivity; If you don't have quite a few connections you're not getting in.
  6. Something looks fishy; Again, this is something of a judgement call and we don't always get it right (we error on the side of protecting the community so our appologies to anyone who didn't get in but had the best of intensions) but we try our best.

That's just how we roll. http://www.linkedin.com/groups/Medical-Spa-MD-1921044/about

Tuesday
Jan142014

Dr. Robert E. Bowen - The Center for Positive Aging In West Virginia

Name: Robert E. Bowen, M.D.
Clinic: The Center for Positive Aging
Location: Martinsburg, WV
Website: robertbowenMD.com

Click to read more ...

Saturday
Jan112014

More Army Recruits to Seek Laser Tattoo Removal

Tougher standards for tattoos in the Army.

Those of you who perform laser tattoo removal will want to be aware of recent changes to tattoo restrictions in the Department of the Army.

Eminent changes to AR 670-1 will now PROHIBIT TATTOOS:

  • Below the elbow
  • Below the knee
  • Above uniform neckline

The uniform neckline is Class A but also includes the physical fitness uniform.  The physical fitness uniform is being interpreted as the V-neck cut T-shirt.  I have seen 3 disqualified recruits in the past 2 weeks seeking partial removal of tattoo ink showing in the mid upper chest at the sternal notch.

I maintain a relationship with all my neighboring recruitment centers of all branches offering a discount for laser tattoo removal necessary a s a result of disqualification.

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