Incorporating Phlebology Into a Dermatology Practice

Dermatologists are natural experts in the evaluation and management of skin-related problems. It is a natural fit and progression for them to be involved in the management of venous disorders. Almost on a daily basis, they diagnose and manage sequelae and manifestations of both superficial and deep venous incompetence such as stasis dermatitis, stasisrelated pigment dyschromia, venous ulcers and end-stage lipodermatosclerosus.

Considering these facts, it is a natural fit for dermatologists to incorporate phlebology into their practice. However, this does require decision making, the learning and incorporation of new skill sets, the purchase of required capital equipment, the hiring of trained and skilled personnel, and consideration of other issues that will be discussed further in this article.

In addition, it is well known that several dermatologists have been major thought leaders, pioneers, innovators and educators in phlebology in the United States. These physicians include David Duffy, Mitchel Goldman, Robert Weiss and Steven Zimmet. These individuals have advanced the speciality of phlebology as dermatologists and continue to make active contributions to the development of this field.

These following factors should encourage all dermatologists to take an increased interest in incorporating phlebology into their practices.

Benefits of Incorporating Phlebology Into a Dermatology Practice

There are many benefits of incorporating phlebology into a dermatology practice. Perhaps the most important is the increased satisfaction physicians feel, knowing that they are expanding their medical knowledge and procedural capabilities. The steps nessessary to evolve a sophisticated phlebology venue will be discussed in the next section.

Adding phlebology to your dermatology practice increases the spectrum of services your practice offers. This translates into adding more patients to your base, which translates into more patients who can potentially utilize other medical and esthetic dermatologic services, such as fillers, toxins and hair transplantation. By increasing patient number and by transferring these patients to other provided services you will ultimately gain increased practice income.

A third reason to incorporate phlebology into your dermatology practice is to become one of the few dermatologists who have a sophisticated phlebology practice that goes beyond performing sclerotherapy and handling cosmetic spider veins. By being known for more advanced phlebologic procedure, giving lectures and seminars in this subject to both patients and colleagues, you will gain an increased number of patient referrals. This will continue to augment your practice visibility, prestige and income.

Taking the Next Step

There are things you can do to incorporate phlebology into your dermatology practice:

Take advanced courses
Read comprehensive textbooks on phlebology
Learn the skill of duplex ultrasound
Hire and train personnel
Set up a phlebology suite
Add equipment to your practice (external lasers, endovenous laser and radiofrequency technology)
Set up a marketing/patient education program
Obtain board certification

If a dermatologist wants to advance his skills in phlebology, he needs to take advanced courses on phlebology. Goldman and Weiss have excellent course manuals on learning the practical aspects of sclerotherapy, ambulatory phlebectomy, and advanced endovenous laser and radiofrequency procedures. In addition, the American College of Phlebology, the American Venous Forum, the American Academy of Dermatology and the American Academy of Dermatologic Surgery offer excellent courses and seminars as well as live patient workshops at their annual meetings and teach elementary courses at the annual ACP meetings. Newer technologies are much less expensive than older, bulkier machines, running from $20,000 to $50,000, and many are computer-based with excellent visualization capabilities.

Hiring and training RNs, MAs, PAs, nurse practitioners and duplex technicians is another challenge in transitioning a dermatology practice to phlebology. One can look for individuals already working in this field or send individuals to paraprofessional training courses such as those offered at the ACP’s annual meeting.

Adding equipment as a capital expense represents another challenge in transitioning a dermatology practice into phlebology. The cost of both external and internal endovenous laser and radiofrequency technologies is quite significant. In addition, a significant amount of excess training is required to operate these technologies.The dermatologist considering this major transition must find out if he has a potential source of patients who will fit this practice model. If not, alternative approaches include renting these intermediate and advanced techniques in phlebology. The ACP has set up a traveling Walter de Groot Fellowship, through which practitioners such as dermatologists can have two-week blocks of sponsored educational observation either in the United States or abroad. In addition, the ACP has established a one- or two-year fellowship giving physicians a chance to spend this period of time in an approved academic facility learning all the advanced techniques of phlebology. Such individuals will be eligible for taking the recently advanced board certification exam as well as for fellowship status in this prestigious organization.

Learning duplex ultrasound is an important skill set for dermatologists wanting a full-service sophisticated, phlebology practice. It is a skill that requires time, education and practice. Even though most phlebologists have licensed ultrasound technicians in their practices, the dermatologist wishing to expand his practice in the phlebology realm and establish his expertise should read simplex ultrasound guides and textbooks as well as take practical laser radiofrequency technology workshops from vendors that provide these mobile programs.

Automated pumps are necessary when tumescent anesthesia is contemplated for ambulatory phlebectomy andendovenous procedures.

Setting up a designated suite is an important aspect of good standard practice and specialization of patient care in phlebology. A designated suite where all sclerosants and compression garments are localized facilitates treatment access to the phlebology patient. If you are transitioning to surgical procedures, a designated ambulatory operating room is suggested. With increased regulation coming down the pike, the dermatologist/phlebologist should consider OR certification as part of his practice-building plans.

To begin letting patients know your dermatology practice now has a subspecialization in phlebology, adequate educational and marketing materials should be available for patients in the waiting room areas. Such materials may be self-generated or taken from the ACP.

Finally, as the dermatologist reaches the summit of his or her transition to phlebology, a board certification process has recently been established through the American ACP (see the ACP Web site: www.phlebology.org).

Broad Challenges of Incorporating Phlebology Into a Dermatology Practice

The pros of incorporating phlebology into a dermatology practice that has been previously outlined include professional advancement, increased patient referral and economic practice expansion.

The major challenges in this setting are office reorganization, including personnel changes; time set aside for advanced training and educational courses; financial investment in practice diversification and advancement; and patient education — the introduction to the full scope of phlebology services that are being offered in your practice.

However, all of these challenges are easily surmountable for those dermatologists willing to transition themselves into establishing a world-class phlebology practice.

Conclusion

Incorporating phlebology into a dermatology practice is a rewarding, realistic goal for the practitioner interested in venous disease and motivated to expand his or her professional skills, expertise and career. Increased physician and patient outcomes are the ultimate results of this lofty, rewarding endeavor.

Dr. Sadick, M.D., FACPh, holds four board certifications:

Dermatology, Cosmetic Surgery, Internal Medicine and Hair Transplantation. He has authored more than 500 articles in peerreviewed scientific journals and has contibuted more than 75 chapters of medical books. He practices at two Sadick Dermatology locations in New York.