I have been planning to open a small medspa for a while now and I am at the stage where I am looking at equipment. I keep coming back to one of the main players here in Australia because a few clinics I spoke to use their stuff and seem happy with it.

The thing I am struggling with is the upfront cost. I got a rough quote for a new multi-platform system and it was over $100k. That is basically my entire startup budget gone on one device. I looked into refurbished options and they are cheaper but I am worried about reliability and whether they still get support.

From what I understand you buy direct from the manufacturer here. They have a local office and they do bundles with the handpieces you need. Training is included which is good because I am not a doctor, just a nurse practitioner, so I need to make sure I am operating within my scope.

I am trying to work out the numbers. If I charge around $800 for a full face resurfacing, how many sessions do I need to do a week to make this viable? I have heard of clinics doing 3 or 4 a day which would obviously pay for the machine fast but I am not sure if that is realistic for a new place.

I am also weighing up whether to lease or buy. Leasing seems to reduce the upfront pain but I am not sure if the long term cost is worth it. And I know I need to factor in servicing and consumables which I probably have not budgeted enough for.

Has anyone here gone through this process with a similar brand? What was your actual experience with the costs and the timeline to profitability? And did you start with one device or try to offer multiple services from day one? Any honest advice would be appreciated.

In case you arent' already aware, BCBS Texas, Illinois, New Mexico, Oklahama, Montana under the HCSC private company has instituted a policy to automatically downcode all E&M codes. I am sure they and other payers have been doing this elsewhere but this has finally come home to our state. They are the biggest payer by far and our practice future depends on them.

This downcoding is blanket. It is done by AI/claim edit rules. It does not discriminate between providers who upcode or providers who truthfully document and code. It is unethical and could be illegal. Courts will take years to decide.

State medical societies are "monitoring" the situation. /eyeroll.

This has created hundreds of downcoded claims for our practice within a few weeks.

Each requires going into Availity, searching for claim, filing reconsideration with medical notes, awaiting decision, writing letters justifying coding, filing second level appeals etc etc.

To get paid what we should have been paid anyway.

What a ridiculous burden.

What is more after submitting reconsiderations their robot continues to maintain the downcoding stating the following -

According to CMS guidelines: To bill any code, the services furnished must meet the definition of the code. CMS further states, Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. If an E/M code is reported and the level of service exceeds the maximum level of service allowed, based on diagnostic information, an EMRC flag will be applied, and the E/M code will be recoded to match the level of service allowed.

What the hell happened to Moderate Decision Making (MDM) criteria? What is this EMRC flag and how is this legal? Their own published coding policy says they adjudicate claims based on MDM.

So what is this new EMRC flag???

How have you successfully overturned these? And will we have to submit notes and reconsiderations and appeals in perpetuity??

I came across a post on a TCM subreddit where someone who has experienced severe blistering as a result of suction cup practice has been seeking advice as to whether it is 1) normal or a cause of concern and 2) what should they do next.

There is a mix of responses, and it made me wonder how should dermatology as a field respond to practices like this, if at all?

https://www.reddit.com/r/ChineseMedicine/s/Ofo8qgsekx

I start my new job today in dermatology. I was told, when I asked, that they will train me until I am comfortable. I hope that is accurate because, for me, being properly trained is so important. I did my externship in OB/GYN and I thrived. 4 of my references are from my externship(manager, director, NP and MA who trained me). I’m most nervous about learning ModMed. During my working interview the MA who did my working interview went extremely fast so I couldn’t write anything down. I need the time to take notes and then the time to look at those notes to do the task on my own. How does one keep up with the pace of the office and still learn? Both Office Managers are very nice but I get the feeling that they are desperate to get me in there and to stay long term. I just really am worried that I won’t get appropriate training. Any advice at all on how to handle the training period and the learning curve?

I guess this is more of a vent. Are there any practice owners out there that actually pay their mid levels what they are worth, because it seems most just exploit them for their own personal gain.

It has become increasingly frustrating as a seasoned Derm PA with over 15 years experience. All the practice owners employ APPs to see the high demand of pts coming into the practice, while rarely hiring other MDs. This is obv done in order to keep profits high for the owner, while the other providers continue to make 5x less or more in pay.

Don't get me wrong, i know MDs have the education, own the practice, took the risk to start the practice etc etc., but as a seasoned provider I have become increasingly jaded as I work more days, see more pts, never need to consult my supervising physician while making pennies in comparison.

Providers continually say Private equity bad, private practice good, but this isnt the case to lowly APPs. With this normally comes worse production bonus %, higher thresholds, worse benefits etc working with a private practice physician.

Working in derm for so long, as I have, exploits pay from us from the get go. Most offices want to offer an abysmal training salary for so long, which isn't normal in any other specialty outside Derm. I see it everyday on reddit still. Offices wanting to pay MA pay for a new grad training period.

Sorry for the long ramble, I'm just honestly frustrated and over it. To the good ones out there that respect your APPs and pay them accordingly as they churn out 30-45 pts a day, thank you. To the ones that only offer a salary, or make providers reach 4x or more base to get production bonuses and then still offer a low %, do better. I'm not asking for the world, I just want to feel appreciated for all the hard work I do day in and day out without even to so much ask for any medical advice anymore at this stage in my career.

My mother is a huge crunchy person. Tons of natural health stuff. I’m not necessarily against all of it but she’s obviously been taken advantage of by “natural health companies” that claim to change your life. Anyways, I usually always wear sunscreen on my face. She gets upset at this. One, because it blocks out vitamin D. Which I do understand, but I have a vitamin D supplement I can just take for that. However, she also claims it has toxic chemicals that are bad for you blah blah. Is this true? And if not can someone explain why, so that I can actually use scientific facts to argue against her claim?

I'm a 24-year-old female dealing with dark pigmentation on both collarbones, around my knees, and two dark circular patches on my left shoulder.

I visited a dermatologist, and she told me it was due to Vitamin D deficiency and keratosis pilaris. She prescribed medication, and I have been taking it, but I haven't seen any noticeable improvement.

Before visiting her, I consulted another doctor. At that time, the pigmentation was much smaller, but after using the creams he prescribed, it seemed to worsen and spread. That experience left me feeling frustrated and worried.

What confuses me is that when I compare my symptoms with pictures and information about keratosis pilaris online, my collarbone pigmentation doesn't seem to match. Because of that, I'm unsure whether the diagnosis is correct.

This condition wasn't present from birth. It started about 3–4 years ago as a small patch and has gradually become much larger over time. Seeing it spread has affected my confidence, and I'm feeling very stressed because I don't know what to do next.

If anyone has experienced something similar or has any advice, I would really appreciate your help.

Has anyone found a way to successfully and easily chart a slow Mohs using the spaghetti technique? The current “staged excision with permanent pathology” plan doesn’t pull appropriate codes.
The repair also doesn’t seem to be something that is built into the system. I have reached out to their support team to build a new “plan” for the clinic, but haven’t actually seen any progress in that regard.

Hey! I'm a student who is just about the enter university for a bachelor's degree. Came across a bachelor's degree in aesthetics and skincare technology. Any professionals who could lmk if this is a good field to choose. Does it have any scope or any information abt it. I'd love to know ur views on this. Thanks!

I am a Non US IMG from India . After much thinking about what I want - i arrived at the decision that I want to be a cosmetic dermatologist in USA .

I know it’s hard and competitive . But I have seen profiles of a handful of people who have taken similar path . They had to undergo more years of training , more courses , probably many difficult choices etc .
But they did .

And Elon musks quote “ if something feels important enough , go for it even if the odds are against your success “ propelled me further .

If anyone is a US dermatologist in this community — I would love to connect .

Also any advice and opinion is welcome :)

Our company was recently bought out by Epiphany dermatology and our team has had a really bad taste in our mouths since shortly after the corporate teams have arrived. I want your real, raw and honest reviews. I have a few things that I could say about the way that this company has already changed our practice before we’ve even started with them and it’s not good. Also, the way that they’ve been dealing with us during the acquisition/transition has been disheartening to say the least.

I have used this mixture at different points in my life to remedy. Many skin related issues. It always helps.

How do you handle HIPAA and GDPR compliance when sharing visual patient data (like skin lesions or gait videos) with outside researchers?

I am trying to understand the process. Do you just manually blur faces in Premiere/Photoshop? Do you just avoid sharing it entirely? How much of a bottleneck is this?

So i was wondering "Hey i have eczema what if i become a dermatologist and help people like myself?". And i decided to look at some pictures of the worst looking conditions like Hidradenitis Suppurativa, and oh my god. I was at a loss for words, usually im pretty desensitized to shock images but i was genuinely about to throw up and just decided to make this post.

If there are any dermatologists reading this, THANK YOU. Genuinely without you all the world would be such a terrible place for people with skin conditions. I'm incredibly thankful to you all and i truly appreciate the work you all do. Again thank you from the bottom of my heart.

Hi everyone,

I’m exploring an idea for a tool that helps dermatologists receive better clinical images from patients for giving remote advice, triage, or follow-up.

I’m not trying to build a diagnostic AI tool or replace dermatologists. The idea is more focussed on helping patients take photos that are actually useful: correct distance, lighting, focus, framing, body location, multiple angles, and relevant history/context.

I’d really appreciate insight from dermatologists, residents, or anyone involved in teledermatology:

1. How often do patients send images that are too poor-quality to make a useful assessment?
2. In what situations is this most frustrating? triage, follow-up, private messages, GP referrals, mole checks, rashes, acne, wounds, etc.?
3. What do you currently do when the images are unusable?
4. Do you already give patients instructions for how to take better photos? If so, what do those instructions look like?
5. Would a structured photo-taking flow be useful, or would it add too much friction?
6. What would make you immediately ignore or reject a tool like this?

I’m mainly trying to understand the real pain points before building further. Any honest thoughts would be very helpful.

Thanks!

Managers should bring a Dermatologist to speak on sun exposure

July is UV Safety Awareness Month. And why shouldn’t it be? July is usually peak summer time in the US and when UV radiation is strongest. And for outdoor workers specifically, it's the highest-risk period of the year. In particular,  about 45 million Americans, roughly 1 in 3 workers, are regularly exposed to the sun as part of their job. 

Here are the facts:

• Around 50% of outdoor workers reported getting sunburned
• Skin cancer is the most common cancer in the US
• 1 in 5 Americans are likely to develop skin cancer by age 70
• Working outdoors raises a person's risk of nonmelanoma skin cancers by 60%

This is why July is the right time for managers and business owners to take UV exposure seriously as a proper workplace hazard.

And it's not just workers who feel the impact. According to the Centers for Disease Control and Prevention (CDC), skin cancer costs the US over $100 million in lost worker productivity every year.

How exactly does UV exposure cause skin cancer?

What most people don’t know is that UV radiation comes in two types: Ultraviolet A (UVA) and Ultraviolet B (UVB). 

UVA rays make up 95% of UV rays and are less noticeable, but reach deeper into your skin. If you notice any wrinkles or feel like your skin is aging faster, that’s because of the UVA rays.

On the other hand, UVB rays make up only about 5% of UV radiation, but they're the more aggressive of the two. They directly damage the DNA in skin cells, which is what causes sunburn, cell mutations, and most skin cancers.

The biggest risk here isn't going to work under the sun once on a hot day. It's the cumulative factor. UV rays attack you over time, and years of daily exposure, even at moderate levels, significantly raises skin cancer risk.

As a worksite manager, your best friend is the UV Index, which you can find in most weather apps. The UV Index measures radiation intensity on a given day. At a reading of 3 or higher, sun protection is recommended. At 6 and above, it's not optional for anyone working outdoors for extended periods.

Peak UV hours are between 10 AM and 4 PM, so it'd be best to check the UV index before heading out. 

What managers can do about it right now

The basics, done consistently, make a real difference:

• Provide broad-spectrum sunscreen (SPF 30 minimum) as standard sun protection  for any outdoor role.
• Check the UV Index daily and schedule heavy outdoor tasks before 10 AM or after 4 PM.
• Make Ultraviolet Protection Factor (UPF)-rated clothing, wide-brimmed hats, and UV-blocking sunglasses available on site.
• Build shaded rest areas or provide tents in job sites that’s easily accessible by all. 
• Bring in a dermatologist or occupational health nurse to speak on sun exposure.
• Review your sun safety policies and check if there are any gaps.
• Use a heat illness prevention checklist to track safety measures that are actually being followed on site.
• Encourage your employers to get annual skin checkups. 

UV Safety Month is just the friendly reminder, but sun safety shouldn't stop once July is over. This is an every single day thing.

Like the title says, I would love some advice on what I should be doing from this point as an incoming M2.

I connected with my home derm program and am currently working on a case report, but other than that I haven't done much related to the specialty. I would of course love to get started on some research through my home program and shadow soon. I am also working on research in another specialty (path) but I do not have any pubs or presentations (besides 1 undergrad poster presentation lol) at this point.

I'm feeling a bit antsy because I want to be competitive during the match without having to do a research year. I LOVE research but I do not want to extend my time in medical school any longer than it already is. What else can I be doing at this point? Do I need to be attending derm conferences? Should I be reaching out to other programs for research?

Thanks in advance!

Bonjour,

J'ai 13 ans et j'ai un problème de peau depuis environ 3 ans.

J'ai des taches plus claires que ma peau, uniquement sur le visage, surtout autour des yeux. Elles ne me font pas mal, elles ne me démangent presque pas, mais elles s'agrandissent avec le temps.

Chez nous, en dioula, on appelle cette maladie « zanfara ». On dit qu'elle est contagieuse et je pense l'avoir attrapée auprès d'une amie qui avait les mêmes taches.

En ce moment, j'utilise de l'huile de frein de moto parce que des personnes m'ont dit que ça pouvait guérir cette maladie. J'ai aussi une crème appelée Naomi, mais je ne sais pas si elle est adaptée.

Est-ce que quelqu'un reconnaît cette maladie ? Quel pourrait être son nom médical ? Si vous avez déjà eu quelque chose de similaire, quel traitement vous a aidé ?

Merci d'avance pour vos réponses

I'm working with a skincare brand that has seen strong growth in both the U.S. and international markets. As we continue to expand, we're interested in connecting with a U.S. board-certified dermatologist for potential collaboration and professional consultation.

Our products have completed the necessary testing and compliance requirements, and we're looking to work with someone who has experience in skincare, cosmetic dermatology, or product evaluation.

If you're a dermatologist or have recommendations for someone who may be interested, please feel free to send me a DM.

I'm working with a skincare brand that has seen strong growth in both the U.S. and international markets. As we continue to expand, we're interested in connecting with a U.S. board-certified dermatologist for potential collaboration and professional consultation.

Our products have completed the necessary testing and compliance requirements, and we're looking to work with someone who has experience in skincare, cosmetic dermatology, or product evaluation.

If you're a dermatologist or have recommendations for someone who may be interested, please feel free to send me a DM.

It's nearly unusable. The pages take forever to load, every login is fragmented three ways to sunday, and searching something would be better if I wrote my query on a memo ad shoved it up the webmaster's nose. We pay money for this. It's I N S A N E. Can't wait to see where their PE centered slopfirm takes us next.