Iโm a board-certified dermatologist who saves lives (!) by helping people reduce their risk of succumbing to common chronic diseases by fixing their immune systems and getting great looking and feeling skin, hair, and nails along the way. My weekly newsletter is an opportunity for you to get to know and trust me by learning from what I'm building in life and business.
"We want them to be raving fans!" ๐๐ฏ
At a glance
"We want them to be raving fans." โ โโ Dr. Kathleen Brown, pioneer in direct care/pay dermatology and one of my heroes Welcome to the February 18, 2024 edition of the Above & Beyond Dermatology Newsletter. Feedback is encouraged and appreciated, and thanks for reading. The Direct Care Derm โ A Podcast from Above & Beyond Dermatology(The following exchange, edited slightly for clarity, is shared with permission.) The Universe works in mysterious ways. A few days ago, a good friend and reader said to me: "Question for discussion: โ โPoint of fact: Insurance companies have really f'ed [modified for publication] with patient/doctor care dynamics. โ โQuestion: Is the idea of insurance a problem or just the way itโs controlled and implemented." My response: "Great question. My take is that it [health insurance] is no longer insurance.
โ You donโt use an insurance product to pay for relatively low cost things that happen relatively frequently to a lot of people, but since thatโs what we do with health โinsuranceโ, premiums (not to mention deductibles and co-insurance) have skyrocketed. โ
To make even more money, for profit insurance companies meddle to control costs, hospital systems artificially inflate prices to try to push back against that, and independent doctors and patients are stuck in the middle saying WTF.
โ โI love the idea of insurance. I happily pay a lot of money every year for numerous insurance products. โ I want health insurance for when I need to pay for something that would financially devastate me or my family. I donโt want it for paying for a steroid cream for my kid's rash. But, alas, because thatโs the norm, you canโt predict what the cream will cost, and itโs typically insanely higher than the cost of production because of the lack of transparency and plethora of vampires/middlemen. โ Thatโs why I can get most drugs I need [for my clients] from independent [cash pay] pharmacies for a transparent and reasonable price, which often ends up being comparable or less than [what would have been] the patientโs copay, not to mention the hundreds of dollars it saves because the insurance company isnโt paying for the bulk of the med cost on top of that." We discussed this a bit, and he went on to ask about the feasibility of direct care based on specialty and remark on how utilizing direct care while one has health insurance feels like paying twice. Me again: "These are fantastic questions. My job is to educate about this because it is indeed confusing.
โ Broader adoption of direct care, which, yes, is easier for some fields than others but is feasible in just about all of them, is the only thing that will put pressure on the consolidated health systems and insurers to be more transparent about prices and less profitable. This doesnโt mean we shouldnโt have insurance for the catastrophic stuff. This type of insurance just wouldnโt cost such an insane amount. โ So, yes, for now it feels like youโre paying twice, which is why I believe a direct care practice, to be successful, has to deliver a premium product or service. It has to feel/be better than what you would get โin networkโ with your insurance. โ The classic analogy I use is car insurance. If it was the norm to use car insurance for routine maintenance, mechanics would hate their jobs and want to quit, and insurance premiums would feel unaffordable to the typical car owner. โ Since thatโs not what we do, it functions as a true insurance product, and we can mandate auto insurance without offering subsidies or tying it to employment like we do with health insurance. โ โIt all comes down to the fact that what is called health insurance today is not used like an insurance product. Insurance has a specific and narrow use case, which is what makes affordable premiums capable of covering large but rare expenses. โ I donโt use my insurance to pay for labs, for instance, because they're small and affordable services, but because the system is so opaque and we for some reason use our insurance to pay for them, hospitals can get away with charging absurd amounts for them. โ
And, if you arenโt at your deductible, you get to pay the whole absurd amount yourself (in addition to your premiums!). Talk about double paying."
I love having conversations like this. It helps me refine the art of communicating the value proposition of how I've decided to offer my clinical expertise as a physician. I need to keep practicing that. Communicating these things efficiently and clearly is a skill. Back to the Universe.โ Here's a sneak peek (transcript below the video) of this week's episode with the trailblazing, innovative, and courageous Dr. Kathleen Brown.
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"I got very practiced at it, and so did my staff in Oregon, because it did seem very novel.
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We'd been in that town already 13 years. My husband had a small business, so he was always talking to people, and the doctors got it the last.
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Patients would get it right away. Either they liked it, or they didn't like it, and they didn't have to come.
They had other alternatives, but a large number of doctors just said that will never work
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The way that we would explain it was that we work for you; I work for you. And these are the prices. And my staff would say Dr. Brown thinks that she can do a better job for you and can customize.
โ We did spend a lot of time educating people. And so when people would say, "What if I have this, what if I have that?" then we could estimate it for them. Now that's in the law that we're required to give a good faith estimate, but we would do that anyway. โ
People would come in and they would say, I brought this much money. "I brought $60." "I brought $80." And so my staff would cue me in, that's how much they had to spend, and we would see what it was they were dealing with and try to make really good use of their time. They ended up, in general, being very happy with that.
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I had a happier day. And I think that patients would have a happier experience. They wouldn't always have a happy thing. We're doing medicine, and some of the things that we see are tough health conditions to deal with, but in terms of how people are treated, we want them to be raving fans.
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I think my rule would be a golden rule, just treat people as I would want to be treated, and that doesn't mean the same as I would want to be treated, but the way that person would want to be treated."
I have a lot to learn from Dr. Brown and am grateful for her generosity and wisdom. The show is up to 844 listens in 6 weeks. Thanks to all of you who have listened, subscribed, rated, reviewed, and given me feedback/encouragement. It helps keep the train running and means a lot to me. Episode #009 is now available! โKathleen Brown, MD, is a visionary and pioneer in bringing high quality, affordable, accessible dermatology care directly to the people without the interference of meddling third parties. Join us as we explore her career and learn how we too can build a successful direct specialty care business, practice medicine with joy, and make lots of people happy along the way. She wanted more control over the way she practiced medicine, and felt that physicians should not allow billing and diagnosis codes to affect or control the practice of medicine, and also that fees should be predictable and reasonable. In 2011 she opened her own solo direct pay dermatology practice, Oregon Coast Dermatology. It operated free from third-party payers such as insurance companies, Medicare, and Medicaid. For almost eight years, Dr. Brown worked directly for her patients by getting rid of the middlemen and posting prices in public, based on time spent with the patient. She has continued to help other physicians succeed in third-party-free practices. She has also kept up with her specialty of dermatology and is ready to open a part-time mobile direct pay dermatology practice. She is a director on the board of the Frontier Institute, and stays involved with the Free Market Medical Association. What I'm LearningWay more people than I previously thought have been walking around for years with a diagnosis (either presumed or given to them by a "provider") of acne when they actually have rosacea. I took care of two lovely clients recently, both of whom came to me with "acne" that wasn't getting better with the usual acne medications. They'll both be much happier within a couple months. People also appreciate simply having the correct diagnosis. Dermatologists can often arrive at the correct diagnosis within seconds, but sometimes this requires extra time, asking the right questions, and hearty doses of humility and active listening. Heat is a well established trigger for rosacea, so I always counsel folks about the paramount importance of sun protection to help control their disease. One of my clients asked me for sunscreen recommendations because he had already tried nine different sunscreens and bought two more that he plans to try. I had a gut feeling about what I would recommend, but while I was waiting for him to gather and send me the list of what he has already tried, I found myself at the Winter Clinical Miami 2024 dermatology conference surrounded by many of the giants in my field. So, I decided to ask Dr. Linda F. Stein Gold, Director of Dermatology Clinical Research and Division Head of Dermatology at Henry Ford Health and one of the world's experts in acne and rosacea, for her thoughts on this. She admitted it's so tough for folks who struggle with rosacea to find a sunscreen they can tolerate and suggested sticking with mineral-based active ingredients (e.g., zinc oxide and/or titanium dioxide; also sometimes called "physical" blockers) as opposed to chemical-based active ingredients (e.g., octinoxate), which tend to be more irritating. โDr. Gary Goldenberg of Goldenberg Dermatology in NYC added that he has seen good results with the product I was planning to recommend to my client: Vanicream Facial Moisturizer with Broad Spectrum SPF 30 (zinc oxide 19.5%; no conflict of interest for Dr. Goldenberg or me). Vanicream formulations are developed with the needs of folks with "sensitive skin" in mind. I've had a lot of success recommending their products over the years. What I'm TryingSpeaking of branding and marketing, I'm laser-focused on refining my brand messaging and getting it out in the world, especially within my local community. This takes deliberate effort and lots of practice, which is why it fit with theme of what I'm trying. I recently overhead my friend and fellow local entrepreneur, Bryson Bernarde, talking to someone about a local radio segment and podcast called "Wellness Wednesday." I later asked him if he would kindly send my information to the host. I alluded to this briefly in last week's letter. Within less than a week, I was sitting opposite the delightful Cindy Opichka, host of WAVE 100.5's "Wellness Wednesday", in the WAVL-FM studio recording the first of what will be a recurring local radio spot for Above & Beyond Dermatology. We talked about what wellness means to me, how I try to create it for others, the mission of Above & Beyond Dermatology (to raise the standard of care in dermatology), and some introductory aspects of a terribly frustrating thing that many people, especially women, deal with into adulthood: persistent, hormonally driven, adult acne. At Above & Beyond Dermatology, there's hope for people struggling with this. I'm comfortable discussing and prescribing conventional FDA-approved treatments such as oral contraceptive pills (OCPs), retinoids, and antibiotics as well as off-label treatments such as spironolactone (a fan favorite!), but I also make time to discuss things I know you think and care about like how lifestyle factors like stress, nutrition, and sleep quality influence this disease. We can also dive deep on the elephant in the room โ what the heck is actually going on with those hormones?! This is one of my favorite things to treat because the eventual transformation brings so much joy, peace, and renewed confidence. What I'm WritingNot a whole lot this week. And that's OK. I did write a short piece on LinkedIn that was inspired by the following sponsored post I saw on Instagram (the two emojis at the bottom were added by me).
A big part of why many doctors have such a maladaptive and ultimately detrimental mindset when it comes to โbranding and marketingโ is that we mistakenly assume we have to sacrifice trust and authenticity to engage in these acts successfully. We value trust and integrity. Part of my mission is to empower others to know they don't have to sacrifice these values to build a successful, sustainable, and joyful business. Celebrate the Small Wins
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Chestnut๐ฐ CheckersThis recurring segment was inspired by an episode of Nathan Barry and Rachel Rodgers' excellent podcast Billion Dollar Creator, in which they explored ways that some creators are playing chess while others are playing checkers. They referred to this as "chess not checkers," but Nathan mentioned that some people thought they said "chestnut checkers" and were confused. I laughed. ๐คทโโ๏ธ So, where am I playing Chestnut Checkers? At Above & Beyond Dermatology, we'll be offering the option of belonging to an accountability group made up of peers who are on a similar journey to you. These will be smaller and more active and structured than the peer support groups I've talked about previously. Think a group of 3-5 people who agree on a time to meet virtually at regular intervals to check in on each other and share where they're succeeding and where they're struggling. They'll have something in common, such as a specific disease they have, a specific medication they're taking, or a specific lifestyle change they're pursuing. When it comes to doing hard things, we tend to be more accountable to others than to ourselves. We don't like to let other people down, so when we tell other people we're committing to something, we're more likely to accomplish it. We're also more likely to overcome the inevitable bumps in the road if we have a small group of people who know what we're going through to support and encourage us when times get tough. Catnip (Dognip?)
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โAbove & Beyond Dermatology
Stephen Lewellis, MD, PhD
Iโm a board-certified dermatologist who saves lives (!) by helping people reduce their risk of succumbing to common chronic diseases by fixing their immune systems and getting great looking and feeling skin, hair, and nails along the way. My weekly newsletter is an opportunity for you to get to know and trust me by learning from what I'm building in life and business.
I'm setting up the first brick and mortar outpost of Above & Beyond Dermatolgoy. It's a leap of faith, but I'm confident. My office/consultation space is single room I'm renting inside a fantastic independent fitness center in Plover, WI. If I'm not the only dermatologist located inside a gym in the country, I'm one of very few. I arrived this morning to bring some boxes from home, set some things up, and do a workout. I was hardly through the front door when an elderly patron in a Packers...
Welcome to this week's edition of the Above & Beyond Dermatology Newsletter. Thanks for reading. Feedback is encouraged and appreciated. If there's something you'd like to see more (or less) of here, please let me know by replying to this email. I want this to be worth your time and attention. If you have a dermatology or other health-related question that you'd like me to answer in the newsletter, let me know! At a glance (for my skimmers โ I see and honor you ๐) ๐Did Tax Day Make Your Hair...
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