Starting a Dermatology Practice: Interview with Dr. Sumul Gandhi, MD, MBA, MPH

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Sumul Gandhi MD

 

We talked to Sumul Gandhi, a Mohs surgeon who just finished his residency in dermatology and started his own practice this past year. We asked Gandhi about the process of setting up his own dermatology and skin surgery practice and what when into getting things up and running, as well as the challenges and lessons learned along the way.

Clineeds: I understand you just completed your residency? How has the transition been from training to setting up your own practice?

Sumul Gandhi: Entering the workplace can be a daunting task on many levels. While I received great training during my dermatology residency at the Cook County Hospital in Chicago and completed a Mohs micrographic surgery fellowship at the University of Washington in Seattle, setting up my own practice presented a whole bunch of challenges in which I had to make decisions that I never previously made.

 

Clineeds: What was your biggest challenge?

SG: My relative inexperience was a big one. Being a recent graduate, naturally, I had never started my own dermatology practice. I was lucky to be surrounded by people with more experience, and great mentors who had helped me along the way.

 

C: Because Quincy seems to be a big change from what you’re used to, may I ask what made you choose Quincy Medical Group as the place to start your practice?

SG: I interviewed at a number of places, but I wanted to be near my family. They live in Skokie, IL, which is about four hours away from Quincy. While I really enjoyed Seattle, I’m from the Midwest and always figured I’d eventually move back after training, so I’d have the ability to see my family on a regular basis. In Quincy I’ve had the opportunity to keep a certain degree of autonomy, while having the ability to work for myself and create my own workplace culture.

Plus, QMG was a really supportive environment. From the other doctors to the admin and support staff, I was presented with a really great opportunity to work with great people.

Another thing I really liked about the group was, they really allowed me to interact with the community, while tailoring my practice to my own needs as a professional. As a newer doctor, I really appreciated being able to work within my own comfort zone. I wasn’t pressured to start out with “X” number of cases a day. Instead, I was able to take my time and start slow in a low stress environment, getting to know my patients and staff on a personal level and doing my best work. Ultimately, this was the reason I chose Quincy Medical Group.

C: How much say do physicians have in designing the rooms they’ll be using? Was there a model in place that helped guide the process, or were you starting from scratch?

SG: We actually have a quite a bit of say. Once I agreed to join the practice, the next step was creating clinic space for myself and another new dermatologist who recently joined the group. Once we joined, the hospital administration was extremely helpful in creating an up-to-date, modern feeling clinic where patients could feel relaxed.  Because my practice would incorporate Mohs surgery and my partner’s practice a great deal of cosmetic procedures, eight procedure rooms had to be created.  As a point of reference, I provided the admin staff with pictures of previous places I had worked to give them a visual of what I wanted for my own practice.

In choosing a physical space, you need at least three, but preferably five rooms since it’s likely multiple cases will be going on at the same time, and trying to keep track patients and equipment while shuffling around can be a real hassle.  The rooms themselves must be large enough, but smaller rooms like mine can work extremely well as long as a minimalist approach is taken. Ours are basically a small work area with plenty of drawers and cabinet space, but little else.

Despite all these designs, we still had two major issues.  First, we had wires and plugs everywhere that were getting tangled and causing patients and staff to trip.  Second, our overhead lights had a pivot that was too low, causing me to hit my head a number of times on the solid steel support.  Thankfully, our building staff was able to funnel allow our plugs and cords under a rubber cord protector and raised the light pivot, allowing ample space below and above.  Overall, we were able to create a self-sustaining medical and surgical dermatology practice with 8 clinic rooms, a lab, a Mohs patient waiting room, two restrooms in a 2000 square foot space with extremely low monthly rent.

The construction crew was essential in helping us create our dermatology clinic. The fact that we rapidly converted a medical clinic into a surgical and lab-based specialty area proves providing healthcare can be portable. While the solution QMG presented for us was rather elegant, Mohs practices can be set up in general medicine clinics with much ease, as long the surgical supplies are present along with portable electrosurgery units with possible smoke evacuation devices, along with an area to process tissue samples.

 

C: Can you tell us a little about the process of setting up the clinic?

Ultimately, the group decided an allergy suite with eight clinic rooms and an adjacent blood draw area could be turned into a dermatology clinic. Originally, the rooms had the classic wood-lined exam tables with a pull out extension for the legs, as well a waiting area with benches. We wanted to modernize the space, and create the kind of space our staff and patients can feel relaxed in.  The tables were replaced by reclining, blue, electronically adjustable procedure chairs, while the benches were scrapped from each room to create more space.

Once we got the electrosurgery apparatuses in place, the rooms were complete.  We also redid all the flooring, replacing an older brown carpet with modern hardwood floors. A patient waiting room was created with a frosted plexiglass divide used to separate waiting space from the clinic rooms.  And finally, a histopathology lab with negative pressure ventilation was created from the old blood draw lab by creation of a vacuum from the room to the exterior of the building. Next we selected people to join the team.

 

C: How did you go about making your hiring decisions? How did you source the staff? What qualifications were you looking for? Did the staff previously work in a Mohs office?

SG: I wanted to strike a balance between finding someone who had enough experience to help me start this practice from scratch, yet wasn’t so experienced that they were firmly set in their ways.

I first hired a nurse who’d been at the group for a while, but had been interested in joining the dermatology department.  During our interview, I learned she had a personal reason for her interest and showed a passion for learning that exceeded my expectations.

In essence, I found my nursing manager who will be in charge of clinic and in direct contact with me at all times regarding any staff or patient care concerns.  My nurse actually knew a trained histotechnician, who eventually joined our team, and we then hired a medical assistant, both of whom she trained with my vision in mind.

Once we had the people we needed to start the practice, we were ready for the first day of Mohs surgery.  We scheduled five patients that first day as something of a trial run to see what areas needed more work, and these areas were quickly revealed as we put our clinic through a stressor of sorts.

 

C: How long did it take for everyone to get comfortable in the space, as well as working together?

SG: After our initial test run, we ultimately decided to slow down and start small, limiting our cases to two to three cases per day on Monday through Wednesday mornings. This allowed us to develop our own communication style and learn at a more relaxed, lower stress pace.  While I’ve personally learned a lot in my first three months of a Mohs surgery practice, I can also see the growth reflected in the rest of the clinic staff as well.

 

C: Are you finding that as time goes on, you’re adding more cases, or is keeping things small still the ideal for now?

SG: Now that we’re getting comfortable with each other, as well as in the space, we’ve increased our caseload, and will be ready to take on more once we hire a couple more assistants.

 

C: How did you start building a referral base, and was that something QMG was able to help with, or did you and your team need to do a lot of leg work yourself to start getting patients in the door?

SG: Quincy Medical Group has been great about helping me build my practice. They’ve arranged for us to do television commercials played on local NBC affiliates, features on local news segments informing people how to treat burns, psoriasis or other skin related concerns.

 

C: What are your long term goals for the practice?

SG: Ultimately, my goal with this practice is to keep growing. I’d like to hire more people, as we increase our caseload. Just as important, I want our practice to become an essential part of the community fabric.

 

Please refer to other articles related to this topic.

 

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