Clarence Brown Jr., MD, discusses the start-up of a Mohs practice.

Dermatologists from many walks of the specialty converged at Saturday's Focus Session to learn about "Establishing a Mohs Practice: Pearls for New Surgeons" from Clarence Brown Jr., MD, who addressed everything from needs assessment and marketing to equipment and appropriate staffing.

Dr. Brown reminded attendees that a needs assessment is an essential part of any decision to start a Mohs practice. If you have identified a region you want to practice in, you have to assess the need in supporting that decision. Just because you like a space and your health club is just down the street, that doesn't mean it's the right location, he said.

Make sure the patient population is one that requires Mohs surgery, he advised. Obtain a map of the region to determine population density, determine the mean age of the population, and identify locations of other dermatologists and Mohs surgeons in that region.

When opening a practice, marketing is one of the keys to the success of a Mohs practice. One logical source to inform the community about your services is the local newspaper, but that may not necessarily be the most effective or least expensive. Dr. Brown advertises in various outlets, from Chicago Magazine's edition of Top Chicago Doctors to Women's Day Magazine, but his favorite marketing sources are those that come at no expense.

It is highly effective to secure speaking engagements about skin cancer at community group meetings and skin cancer screenings at the local hospital. Additionally, physicians can place a list of services in their waiting rooms, including Mohs, and that may generate patients to turn to the dermatologist's practice for that service.

If you don't manage marketing well, it can be huge expense to your practice. You need to gauge the outcome of your marketing efforts.

The new patient form is the most effective means for tracking your practice's marketing success. Place a section near the front of the form before patients are worn out by form questions. Ask patients where they heard about your practice, providing them with choices from sources where you advertise. These include an advertisement in the paper or online, a recommendation of a friend, or a presentation at a community group.

Staffing and equipment concerns are very important to starting a Mohs practice, Dr. Brown said, adding that the amount of resources you have available to start the practice may be limited, so you often have to make concessions, such as purchasing used equipment.

He does caution that used equipment requires more maintenance and, like a used car, you never know what you will get. Of four pieces of used equipment you might purchase, three of those may work well for years, while one piece is just a lemon that requires constant service. However, when you are ready to take the leap into new equipment, you can sell the used equipment back to help pay for the expense.

When it comes to staffing requirements, Dr. Brown is a great advocate of finding people who can do double-duty. For example, rather than hiring a receptionist when you first open an office, hire an office administrator who will field the calls until your practice is busy enough to require a receptionist and billing clerk. He also discussed the role of medical assistants versus nurses in the dermatology and Mohs surgery practice.

Dr. Brown professed to being a big fan of certified medical assistants, as opposed to nurses. Medical assistants see their role that much more clearly in a smaller outpatient setting. Nurses tend to be oriented toward larger, institutional, inpatient settings, and it is not an easy transition. "You can find medical assistants who are bright and motivated; they can troubleshoot, and they will do double-duty as the histology tech," he said.

Dermatologists who are introducing Mohs to their practice will probably need to hire additional personnel, Dr. Brown noted. Extra hands from the medical assistant world will be needed to help facilitate the practice.

"The future is that the Mohs surgeon will be much more engaged with the primary care physician," he said. "Our practice is extremely busy and has grown predominantly through primary care referrals. It's also a good way to get medical dermatology referrals as well."