Forefront Physician Voices: My Advice to Residents

Margaret “Molly” Moye, MD, is a Board-certified Dermatologist and Fellowship-trained Mohs micrographic skin cancer surgeon. She joined Forefront Dermatology’s Louisville, Kentucky office in 2016.

My Job Search as a Resident/Fellow

I graduated from fellowship in 2016, so my job search began in 2015. After having moved across the country multiple times for training, my husband and I wanted to find a place to call our own, so location was a huge factor for me. At that time, a Forefront office in Louisville, KY was hiring a Mohs surgeon, so I explored that opportunity just as I explored academic and smaller private practice opportunities. My mentors were supportive of my exploring all available options and encouraged me to find a group of Dermatologists I trusted in a practice where I would be treated fairly and have the necessary resources to thrive.

Even though I only graduated from fellowship a few years ago, it feels like quite a different time in our specialty. Back then, Dermatologists as a whole seemed to get along better without advocating for or against specific practice models.

I joined Forefront Dermatology, a physician-led, PE-backed dermatology group practice, in 2016. I practice Mohs surgery and general dermatology. As someone coming out of fellowship, I felt it was a strength that I would have other Dermatologists and Mohs surgeons from across the country to lean on for advice on setting up a Mohs lab, managing complex patients, and growing my practice.

I am not a shareholder in Forefront, although I have the opportunity to become one in the future. By sharing my hiring story, I simply hope to give others coming out of residency training a better understanding of what working for this particular practice is like.

Making the Decision

When I was considering my options after fellowship, I heard that Forefront was growing quickly. At that time it wasn’t framed as a negative or a positive: it was just a fact. And while this growth spoke to the health of the group overall, the most important thing for me was connecting with Forefront’s physicians. First I spoke with all of the Dermatologists I already knew, then I asked to be connected with others in my specialty of Mohs surgery.

What struck me most about those conversations was how differently everyone practiced. To a person, the physicians I spoke with set their own schedules and cultivated their own interests, whether that was surgery, cosmetics, or contact dermatitis. After talking with so many people practicing the way they wanted, I was confident I’d be able to carve out a niche I felt comfortable in.

Autonomy and Support: The Day-to-day Balance

Since joining Forefront I have never once been told how to practice medicine, nor have I been asked to do things any differently than how I was trained to do them. Coming from the program I trained in, that means fairly conservative Mohs utilization; I probably excise tumors that others would do Mohs on. No one at Forefront has encouraged me to do otherwise.

In the area of autonomy, then, the reality closely matches the expectations I developed during the recruitment process, when I was assured I’d have complete clinical autonomy as well as access to an array of shared services.

Critiques of shared or “centralized” services suggest that these services may constrain physicians in some way, or make the culture feel more corporate. I have not found this to be the case. On the contrary, having scheduling and patient calls received centrally means that the phone is not constantly ringing in our office, so our nursing staff are able to fully participate in patient care and our front desk staff can focus on the needs of the patients in the office. I receive tasks from our central nursing staff related to patient needs or concerns through our EMR, which I take care of during the day during clinic downtime.

Academic practices are also switching to centralizing call triage and scheduling, often bundling various specialties together to achieve cost savings. At Forefront, our staff are managing 100% dermatologic concerns, which makes for a much shorter learning curve than if they had to handle multiple specialties.

No matter what the practice setting, it takes time for staff to learn a physician’s preferences for scheduling and patient care matters like post-op instructions. At this point in my career at Forefront, the dedicated individuals in central services who manage my patient concerns and Mohs scheduling know how I practice, and are part of my clinic team! In fact, I can always tell when someone new has been hired because for a couple months I’ll receive questions that our veteran staff already know how I would like handled. The thing is, it’s my responsibility to help get these new people up to speed, just like it’s my responsibility to train the people in my office. Something not taught in residency is the importance of investing, leading, and empowering your staff. It’s our job as physicians to establish the culture we want, and to provide the feedback to maintain it.

In this realm (and others), I’ve learned a lot from Forefront’s network of physicians.

Myth #1: Private Equity Calls the Shots

After reading another diatribe about private equity (PE) in Dermatology, I decided to tackle head on some of the wildest myths I’ve heard. And while I can’t speak to all private equity-backed group practices, I can speak to my experience at Forefront Dermatology.

What is the Proper Role for Private Equity in Dermatology?

Dermatology is a small specialty with many bright leaders and differing opinions. As we experienced firsthand at this year’s outstanding Annual American Academy of Dermatology Meeting, Dermatologists take pride in debating practice issues with great spirit, vigor, and intellectual honesty. At the moment, one topic drawing much debate is private equity (PE) and its proper role in our field.

I believe conversations about the role of private equity in dermatology are healthy and necessary. But, as a physician and the President of Forefront Dermatology, a successful group practice backed by private equity but led by me and other physicians, I can also say that we must make those discussions fact-based and attuned to difference.

 

Leverage Resources to Mitigate Physician Burnout

As an American Board of Dermatology Diplomate since 2011, I am a regular reader of Dermatology World. As a practicing board-certified dermatologist and President of Forefront Dermatology, the September 2017 cover story titled Feeling the Burn caught my attention as it listed sources of dermatologist burnout and mitigating strategies.

The common burnout drivers discussed in the cover story are all real challenges that I and my 125+ board-certified dermatologist colleagues see and feel in our practices each day – I get tired just listing the culprits: increasing regulations and paperwork, electronic medical records (EMR) impacting patient throughput, high patient demand in underserved areas, increasing patient expectations, and the hurdles, costs and challenges to prescribe medications, to name just a few. Whether you are a new or experienced physician, the effort required to manage and maintain, let alone grow, a practice today is significant and the environment is only increasing in its complexity.

At Forefront Dermatology, we have spent the better part of the last decade building a practice model to combat our environmental assault.

 

Dermatology Group Practice Growth Accelerating

The landscape of dermatology changes every day, and it seems that nearly each change is at the expense of dermatologists. Rising regulatory and administrative costs, coupled with reimbursement uncertainty are making the practice of dermatology difficult for those physicians who value their patients, as well as their independence. This trend is causing a steady decline in dermatologists who can maintain a private practice. As a result, increasing numbers of residents and practicing dermatologists are left to choose between large dermatology practices, multi-specialty groups, or hospital – based organizations.

The Forefront Difference

The truth is your options do not need to be limited to a multi-specialty group, hospital or any place where your work status will read “employee”. At Forefront Dermatology, we have been physician owned and operated since our founding in 2001. Today, we have over 100 board-certified dermatologists and 25 Mohs surgeons practicing across 11 states. Each one of them is entitled to autonomy over their practice and the backing of our best in class support services organization.

Whether you are a resident, practicing dermatologist or looking to sell your practice, we want you to learn more about us and the Forefront Difference. Our redesigned website, www.joindermsuccess.com, is structured to be both informative and educational. Browse through the website to learn more about Forefront Dermatology, our mission and vision for our practice, and the different types of opportunities for joining our practice. Check out the educational and industry events that we will be sponsoring or attending throughout the calendar year.