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Opinions on Practice Management

Ben M. Treen, MD

Incorporating Lasers Into Your Practice

Ben Treen

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 Community?

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 waiting rooms.

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 Profitable?

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 optics.

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 others.

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 several occasions.

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 this regard.

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 do this.)

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.