Historically, the practice of medicine and the world of business seemed at odds, standing in opposite corners. Therefore, many practice owners sidestep their business roles, opting instead to center on patient care.

But cosmetic medicine requires practice owners to spend equal time finessing their clinical skills as they do nurturing their inner entrepreneur, according to top dermatologists who presented at the annual meeting of the American Society for Dermatologic Surgery in Orlando, Fla. These physicians shared tips, from arriving on time to duly compensating and recognizing your staff, to steer the often overlooked management aspects of practice. These proficiencies form the foundation of your practice's current and future success.

Set the Tone

As owners, you set the tone for your practice, says David A. Laub, MD, owner of Laub Dermatology & Aesthetics in Mill Valley, Calif. So be aware of how your demeanor affects those around you. "What happens when you don't smile when you walk in the office in the morning?" Dr. Laub asks. "Did you ever notice that your staff seems to stop smiling? We need to let that [negative emotion] go at the door."

Positivity begets positivity, Dr. Laub explains. A golden rule is to start and finish each day the same way: with a smile and graciousness. "I say good morning, being upbeat and leaving all personal problems behind," says Jeanine B. Downie, MD, FAAD, owner of Image Dermatology® PC in Montclair, N.J. She also makes a point of saying thank you each night when she leaves.

Be sure to extend this affability to patients as well. Jerome R Potozkin, MD, who owns practices in Danville and Walnut Creek, Calif., calls each patient to see how they're doing after a procedure. "Nothing goes further than calling your patients," says Dr. Potozkin, commenting that many patients have never been personally called by a physician. "This action engenders good will," he says and drives home the message that you care.

Provide a Polished Image

Like you, your staff should set the tone for your office. Studies show it takes just one-tenth of a second to make a first impression, and then six months of continued contact to overcome a bad one, says Alan Wirtzer, MD, owner of Mid Valley Dermatology in Sherman Oaks, Calif.

Make sure your staff greets patients by name. Remind them to smile when they come in your practice's door. Train your staff to get into the habit of smiling on the phone, since this lightens the voice, Dr. Wirtzer says.

In addition, your staff should be aware of how they talk to each other, taking care not to indulge in chastising banter. "Patients are keenly aware of negativity between staff members," says Dr. Wirtzer. Often, they can misinterpret even innocent comments. To ensure professionalism, set the example yourself. Never berate or correct a staff member in front of patients. And be respectful of others by coming to the practice on time; tardiness forces your staff to play catch-up all day long.

Professionalism should permeate every aspect of your practice, down to the smallest details. Something as harmless as an assistant's questions can erode the expert image you'd like to portray. Dr. Wirtzer has a policy that "silence is golden" and encourages his staff to avoid asking questions in the treatment room.

An assistant, for example, may innocently ask if she should turn on the suction for bleeding-a question no patient wants to hear. Or she may simply say "sorry" during a procedure, which may breed apprehension in patients.

Dr. Wirtzer, therefore, encourages his staff to communicate in nonverbal ways-holding up two scalpels with an inquisitive look instead of asking if he wants the straight scalpel or the curvy one.

"Patients want to come to well trained, knowledgeable people," he says, emphasizing that even innocent questions can undermine patient confidence. "It's better if staff doesn't acknowledge uncertainty in a verbal way."

Reward Employees

Staff members also need to feel valued. Compensation is the strongest way to send that message, but other efforts, such as employee recognition, go far as well.

Roy G. Geronemus, MD, PC, director of the Laser & Skin Surgery Center of New York, says he continues to research salaries and benefits of competing offices in the Manhattan area. He believes in rewarding staff, giving them eight to 10 paid holidays a year, along with holiday bonuses.

Providing flexibility also can show that you value your assistants' personal lives. "I value family, so I will let staff leave early for family functions," Dr. Downie says, mentioning that people will appreciate it if you value the things they prize too.

An employee recognition program, such as employee of the month awards, can provide much needed acknowledgement, while allowing other staff members to model behavior. Winners of these accolades can be given free treatments or weekend trips away. Smaller practices can reduce the frequency of awards to ensure the program isn't redundant or that the same people aren't getting recognized each month.

For the smaller touches, don't underestimate the value of socially getting together your staff, says Dr. Laub. An occasional lunch or an annual holiday party can show your appreciation for a job well done.

Don't Forget Accountability

While gratitude for good work is essential, remember you're still the boss. Therefore, hold your staff accountable. This can be difficult some doctors, who may not be used to being in charge. "We need to remember our staff is working for us," says Dr. Potozkin. "We are not working for them."

Don't be afraid to address subpar performance in writing and directly with the employee. A staff member who consistently doesn't follow directions or who has a negative attitude can poison the office. So first document and then do the hard thing, which may mean termination.

Be aware that many standard insurance policies don't cover your practice if an employee decides to sue you for wrongful termination. Employment practice liability insurance, however, provides coverage in cases of discrimination or wrongful termination lawsuits. Having this insurance helped at least one doctor win a wrongful termination suit, which cost the insurance company at least $70,000 to try the case. If not for the insurance, the high expense would have most certainly resulted in a settlement.

Other infrastructure changes in a practice can cut down on staff abuses. For example, instead of having patient report their hours, invest in a time clock system. This removes the temptation to pad hours. It also will save you money if your staff has been adding hours to their timesheets.

When implementing a new automated clock-in and out system, many physicians fear the reaction of their staff. "They will be upset at first," admits Dr. Potozkin. "But they will get over it in a day." Be sure to explain that you want to give your staff full credit for the hard hours they put in, not necessarily to catch them on the hours they aren't.

Keep a materials log sheet, so you can account for units of Botox and fillers. Interestingly, Dr. Wirtzer pointed out that the person most likely to steal from your office is the one who's been there the longest. Having a log sheet helps you track your inventory and ensures injectables don't go missing.

Be Creative

As a final step to success, don't be afraid to try new things. It will help keep your practice--and the people who work in it--thriving.

Wendy Roberts, MD, owner of Desert Dermatology Skin Institute Inc. in Rancho Mirage, Calif., has implemented four-day workweeks, so employees work four, 10-hour days. Dr. Geronemus also has implemented a stock-sharing program, so employees can become vested in the practice's success.

Dr. Wirtzer is implementing an express checkout for his patients, so patients don't have to wait in line to pay their bills. Instead, office personnel call them after the fact to let them know their credit cards have been charged.

Each of these moves requires examining your practice with fresh eyes and stepping out of conventional roles. Your practice doesn't just depend on clinical results, but also on your practice management skills. Being a good doctor, which is obviously necessary, is simply not enough, so give your inner entrepreneur a chance to take the wheel of the practice. This initiative is key to driving your practice's success.

Marci A. Landsmann is managing editor. She can be reached at mlandsmann@advanceweb.com.