Incorporating Lasers Into Your Practice
Wednesday, August 15, 2007
The decision to add laser procedures to your current practice
can be daunting yet exciting. Realistically, this is unlike
Field of Dreams, as patients do not materialize just
because you have a new laser. Certain questions are important to
answer in making this decision.
What Specific Laser Procedures Are of Interest to You and the
Your particular practice may help you determine the best
procedures to consider, as your current patient base is likely to
be the primary users of your new technology, at least at first. For
this reason, a group practice, whether single or multi-specialty,
has certain advantages. It may be unwise for a practice with a
patient population over 50 years of age to consider laser hair
removal, yet this could be a good target for lasers that address
photoaging and dyspigmentation, especially if other cosmetic
services such as fillers and botulinum toxin injections are being
offered or contemplated.
Your own interests are an important consideration, especially if
your local laws require a physician to perform any laser
procedures. Risk tolerance plays a role here as well, as virtually
any medical laser has potential for harming patients, sometimes
irreversibly. Clearly, some are more likely to do so than others.
Laser hair removal, when parameters are matched to the skin type
and performed properly, is relatively safe. Vascular lasers, as
some have found to their dismay, can leave scars, particularly when
used in an aggressive manner for lower extremity veins.
As in any cosmetic procedure, it is better to under-promise and
over-deliver. For example, for facial telangiectases, I typically
tell the patient to expect three treatments, knowing that 80% will
be satisfied after one or two.
How Much Are You Willing to Market the Service?
Marketing is necessary for your new baby to mature into a profit
center for your practice, but it can be limited to "internal"
marketing - educating your current patients on the benefits of the
laser. Simple techniques include:
- brochures and posters (often supplied by the manufacturer)
- "message-on-hold" information
- photo albums with before-and-after pictures
- email messages
- after-hours seminars
It's important to educate your referral base as to your new
procedures. Inviting their office managers and assistants for free
services is a good way to keep your practice at the top of their
list, and you may be able to leave some of your brochures in their
Be absolutely sure that your staff is familiar with your new
service. I'll never forget overhearing a receptionist telling
someone on the phone that she had never heard of laser hair removal
6 weeks after I had become the proud owner of one of the first
Epilasers in the southeastern United States.
"External" marketing can be limited to yellow pages advertising
or more aggressive as in television, radio, and billboard
advertising. While discouraged in the past, this type of practice
promotion is becoming more common.
Are You Comfortable Waiting for the Laser to Become
When purchasing a new laser, remember that the salesperson and
laser company is interested in their profit, not yours, so take any
projections they may offer with a grain of salt. Many times I have
seen what I would consider to be overly optimistic spreadsheets
among their marketing materials. Some laser salesmen take a
long-range view of developing a relationship with you, realizing
that their future sales are easier with a satisfied client base.
Fortunately, these seem to be more common in recent years than the
stereotypical laser/used-car salesmen of yore.
Negotiating skills are very useful in most laser purchases.
Additionally, referrals, testimonials, and high-quality
before-and-after pictures are frequently in great demand by the
manufacturers, and providing these may translate into direct income
or free consumables such as cryogen spray or single-use fiber
Also, consider the stability of the company. You want to be
reasonably certain that it will be around for at least the life of
your laser. There have been a number of laser companies that have
gone out of business. Upgradeability of your laser can be a
desirable feature; some companies are more attuned to this than
Should You Buy or Lease New or Used Equipment?
You can certainly save a lot of money buying a used laser, and
there are many available for a variety of reasons. Ensure that the
laser is functional and that there is support available. Most
lasers these days have proprietary software that restricts
maintenance to the manufacturer. Some lasers are more prone to
maintenance issues than others, and especially for these, service
contracts may be advisable. I advise contacting the manufacturer
regarding these issues before purchasing any used laser.
I recommend avoiding leases longer than 48 months. I prefer 36
months when I lease, as laser technology advances rather rapidly,
which can leave you with obsolete equipment and a year or two to go
before you are relieved from the monthly payment. I like an option
to purchase at the end of the lease, and I have exercised it on
In the United States, there are tax benefits to purchasing. The
Internal Revenue Code 179 allows you to depreciate up to $112,000
for eligible property placed into service in 2007. Prudence
dictates that you discuss the relative benefits of these options
with a qualified tax professional familiar with your situation.
What Should Your Insurance Agent Know?
While on the subject of consulting with other professionals,
it's a good idea to keep your insurance agent apprised of your
plans, both for liability and loss or damage to your equipment. Two
weeks after I had received my first pulsed-dye laser, a
particularly malevolent employee engineered an overflow in an
upstairs sink causing a ceiling collapse atop my brand new toy.
Property insurance saved me from financial disaster. Lack of the
same was nearly ruinous for a friend whose laser was submerged when
the levee broke in New Orleans during Hurricane Katrina.
How Is the Competitive Landscape?
Visiting other practices employing the types of lasers you are
considering is wise, even if a bit inconvenient. Sometimes, the
representative can arrange such visits, but you can also do it on
your own. Many of your colleagues can be remarkably gracious in
Prepare before the visit by researching, writing a list of
questions, and selecting a nice restaurant where you can treat your
host. It's being gracious in return, and it's tax deductible.
Who Will Be Using the Laser?
Training on new equipment is essential, both for you and for any
assistants you may anticipate operating the laser. (First, check
your state's law to determine if your assistants are permitted to
You must be facile with your equipment even if you plan to
delegate the usual operation to an assistant in order to be able to
train new employees. It is customary for this to be provided by the
manufacturer when purchasing new equipment, often at another user's
office. If the training is such, take the opportunity to get copies
of informational and promotional literature, consent forms, and
procedure documentation records.
Definitely bring your camera. Your colleague is being paid to
give you this training and should be willing to be available in the
future, either by phone or email, if you have further questions. I
provide my email address as well as a toll-free phone number.
A laser safety officer is necessary for any practice using
medical lasers. In the United States, this officer should be
certified, and compliant with ANSI Z136.3 - Safe Use of Lasers in
Health Care Facilities. Occupational Safety and Health
Administration (OSHA) regards this as the definitive document.
Speaking of OSHA, always remove the key from the laser after
each use. Failure to do so can result in a significant fine.
Proper signage and appropriate wavelength-specific goggles or
eyewear are supplied by the manufacturer and must be used. It is a
good habit to check the goggles with each use if there are multiple
lasers in the same room or office. They will bear a notation as to
the optical density (OD) and the wavelength(s) they protect
against. Most will have an OD of at least 5 for optimal protection.
It goes without saying that lasers can blind at the speed of light.
Don't forget proper eye protection for the patient, too.
How Can I Stay Informed of New Developments?
Join organizations such as the American Society for Laser
Medicine and Surgery (ASLMS) and the American Society for
Dermatologic Surgery (ASDS) in which you can enjoy the benefits of
your colleagues' experience, learn how to manage and avoid
complications, and be exposed to new and emerging technology.
The one thing I have found constant in two decades of using
lasers is change, but keeping up with the developments in this
still nascent field has been very enjoyable and stimulating.