Investing time and attention in the medical practice staff hiring process can reduce costs and boost staff retention.

In a busy medical office, an empty staff position can be a real problem. Days that were already full and often hectic are even more so. Patients are complaining. The instinctive response is to fill the slot ASAP. Resist the impulse! Any short-term relief will almost inevitably produce long-term aggravation and higher employment costs.

The data vary widely, but it is generally agreed that filling a staff position costs more than the associated annual salary. Most of these costs are “soft costs” that have a real impact on productivity and operating costs but do not require the practice to write a check to cover them. They include:

Lost productivity and increased overtime while the position is vacant

Time associated with interviewing candidates

Even more lost productivity and increased overtime while the new hire is learning the ropes

The biggest soft cost, however, is making a hiring mistake. Hiring carefully is worth the investment. Here are 6 steps to significantly reduce hiring costs:

Experience and credentials are important but they are the easy part of describing requirements. The more difficult requirements are the ones not apparent in a résumé or transcript. They include:

. For instance, should the individual be cheerful? Optimistic? High-energy? Empathetic? Independent?

. Do you want a self-starter? Team player? Leader? Someone who is detail-oriented?

. Should the individual speak up? Look people in the eye? Be poised? Youthful? Mature?

It will be useful to flesh out the attributes by actually describing how your ideal candidate would respond in 2 or 3 hypothetical situations. (You can use these hypotheticals in the eventual interviews.)

I also recommend describing the ideal candidate from the candidate’s point of view. To whom would the job be most appealing? To whom might the appeal be short-lived? Your best source of this information is your impression of staff, current and past. What type of person at what age and stage has performed well, been happy, and stayed a long time? What are the attributes of people who have not worked out well?

The object of the exercise is to have something definite against which to measure candidates. It is unlikely that you will find an ideal candidate, but you will get much closer if you know what you want and hold out for a reasonably good fit.

You may discover that the highly professional, well-turned out, mature person you would really like to hire has no interest in the duties of the job and finds the compensation inadequate. A long-term solution requires adjustments to your requirements, the job, or both.

Think about more than adjustments in monetary compensation. More flexible hours, the opportunity to learn, educational benefits, a pleasant workplace, and discounts on care and services are all examples of perks that have real value to candidates without necessarily increasing costs. Once you know the desired attributes, it becomes relatively easy to tailor the job to attract the ideal candidate.

STEP 4: ESTABLISH A PROCESS THAT WEEDS OUT CANDIDATES FOR YOU

Before anyone looks at candidate submissions, have someone respond to everyone with a request for some action on the part of the candidate. The action should be related to the position so that the request maintains your credibility, but the task itself is unimportant.

The objective is to let casual candidates self-select out of the process. If you still have too many candidates to seriously consider, assign another task. About 90% of the pool will drop out with each request.

STEP 5: VERIFY SELECTED RÉSUMÉ AND APPLICATION INFORMATION

If something on a résumé or application is important to you, independently verify the assertions. Otherwise, ignore the contents of those documents.

STEP 6: GIVE NEW HIRES AN EASY WAY TO QUIT AFTER A SHORT TRIAL PERIOD

It is not at all unusual for a new hire to discover that accepting the job was a mistake. The sooner the new hire can admit it and move on, the less you will have lost in integrating the new person into the practice. A bonus is that your second choice may still be available and willing.

Hiring is a necessary evil. Investing time and attention in the process so that your hires are smart ones reduces the costs substantially.

Carol Stryker is the founder of Symbiotic Solutions, a practice management consulting company. Send your practice management questions to medec@mjhlifesciences.com.

Articles

An expert details the ways to gain and retain new practice staff.

6 Steps to Hiring Great Practice Staff

 explores the top viral beauty products that took over TikTok in 2021, 

 talks with 4 dermatologists about the most popular minimally invasive treatments going into 2022, and 

 highlights lip filler, the emotional impact of hair loss during COVID-19, and traction alopecia.

These Are the Viral Beauty Products That Took Over TikTok in 2021 

Everything You Need to Know About Lip Filler Before Making an Appointment 

4 Dermatologists Predict What the Most Popular Anti-Aging Treatments Will Be In 2022 

My Hair Loss Took the Most Unexpected Toll on My Body Image 

How to Tell If Traction Alopecia Is Causing Your Hair Loss 

This week, consumer magazines highlight TikTok beauty trends in 2021, traction alopecia, and more. 

Predicting the Most Popular Minimally Invasive Treatments for 2022

This week in aesthetics, Zoe Diana Draelos, MD, explores scalp health, Dustin Portela, DO, reviews sleep devices and explores their connection to skin health and Will Kirby, DO, FAOCD, interviews with Emily Kaye Perbellini, MSN, FNP-Ca, about the aesthetics industry.

In this month's Cosmetic Conundrums column, Zoe Diana Draelos, MD, explores scalp flaking causes and treatments.

Pointers with Dr Portela: Can Sleep Devices Help Your Skin?

In this week’s Pointers with Dr Portela, the 208SkinDoc goes into the science behind sleep and skin while also review 3 different sleep improvement devices.

Meet the Aesthetic Expert with Dr. Will Kirby: Emily Kaye Perbellini, MSN, FNP-C

In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with Emily Kaye Perbellini, MSN, FNP-Ca, board-certified family nurse practitioner specializing in aesthetic dermatology. They discuss how to avoid burnout, challenging patient populations, and the role allied healthcare professionals in aesthetics.

This week in aesthetics, we highlight our monthly "Meet the Aesthetic Expert,"  our weekly “Pointers with Dr Portela”, and more. 

This Week in Aesthetics: December 20-24

Welcome to “Meet the Aesthetic Expert,” where, each month, dermatologist 

, of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.

is a board-certified family nurse practitioner (NP) specializing in aesthetic dermatology.She has an unparalleled history of telehealth expertise as well as specialization in clinician hiring, aesthetic training, and continuing medical education. Holding many titles over the year including director of operations, vice president of clinical operations, regional director of standardization, and national director of telehealth, she currently serves as the vice president of telehealth for the nation’s leader in aesthetic dermatology, LaserAway. Extensive personal treatment implementation experience coupled with a long history of managing teams of clinicians both in-person and remotely makes Perbellini a unique force in the aesthetic industry.

Can you please tell our readers a little about your backstory?

Born and raised in Pearland, Texas, I was the middle child, only girl, and grew up trying to prove myself better than the boys. As a natural born feminist, I found myself defying the odds of winning male dominated competitions at a young age including the All-Texas State Drum Competition at age 14, 15 and 17 and the Presidential Award for Athleticism at ages 10, 12, and 13!

This fierce ambition to win in my youth matured into drive to make a positive difference in my career. I completed my undergraduate degree at University of Texas Medical Branch, Galveston, Texas, in 2004 and delivered babies for 4 years before moving to California. There I entered the world of aesthetic dermatology in 2008 and attended Azusa Pacific University, Azusa, California, to become a NP. I have my NP license in 12 states and counting while currently coaching my team through obtaining multi state licensure—a task not for the faint of heart!

What initially led you to an aesthetic career path?

 Well, when I met you in 2008, Dr. Kirby, I was fascinated by your drive for success, business mindset, and perpetual growth quest. Moreover, you had the unique ability to make work fun, which was a new concept for me, and that I was lucky to learn at a young age. Your positive encouragement and mentorship inspired me—forced me?—to obtain my master’s degree and NP license, which has truly given me wings in the medical field and in this industry. I now manage a team of 40 incredibly talented registered nurses (RNs), NPs, and physician assistants (PAs) while serving as the vice president of telehealth for LaserAway Medical Group!

Thanks for your kind words, it makes me happy to hear this! Now then, what is the best piece of career advice you have received?

 When considering a career in aesthetics, seek out a reputable company with strong medical and business leadership that will help foster your success in the industry. Do not “settle” and work for a mediocre company just to get a foot in the door. Make sure to do plenty of research to ensure you join a group that is growing financially with a strong business team with seasoned medical leadership. Furthermore, personal success cannot be rushed in the field of aesthetic dermatology and the learning never stops; it takes years to master bedside presence and technique with patients seeking aesthetic procedures. So be patient and enjoy the journey. 

What resources do you believe aesthetic providers should invest in right now?

No matter the advancements in technology, if you’re not investing in your staff, co-workers, and colleagues, then your business will never meet its full potential. There is great pride and honor in paying well and offering great benefits. Patients absolutely pick up on staff energy and an unhappy clinical team undermines patient confidence—even ruining the patient experience. So, take any measure you can to decrease clinician turnover and keep them engaged and, above all, let them know they are appreciated always! Additionally, recognizing the unique skillset in each clinician and fostering that specific talent is an imperative investment as well. For example, if you have a clinician who is passionate about education, then lead them to educate within your company!

I wholeheartedly agree. What aesthetic patient population is the most challenging to deal with and why?

 Social media influencers have led patients to seek out aesthetic procedures striving to achieve an unrealistic, superhuman look. Many young Generation Z patients are already seeking out excessive filler trying to alter their appearance. This presents such a challenge for aesthetic clinicians in setting realistic expectations. Our job is to enhance a patient’s existing beauty and improve overall cosmesis in a natural way, not to fully alter someone’s look. Convincing a patient that they are already beautiful is sometimes one of the most difficult parts of the job.

What is the biggest myth in the aesthetic industry?

One of the biggest patient myths in the aesthetic industry is that a patient is too young to “need” a product or procedure, or that perhaps it is too late for them to begin their aesthetic journey. Aesthetics is more about prevention and maintenance. When speaking with people in the community about procedures, we frequently hear the comment, “oh you don’t need Botox Cosmetic” or “you’re too young for tretinoin.” Similarly, older patients believe that it might be too late for them to start aesthetic procedures saying, “It is too late for me to try to improve my appearance?” Both beliefs are untrue, as there is no perfect age to begin your personal aesthetic journey!

Telehealth exploded during the pandemic. Is it here to stay? What role will it have in aesthetics moving forward?

 Since the pandemic, my telehealth team has quadrupled in size and now functions in numerous new ways. We provide good faith exams, virtual patient assessments, clinical consultations, follow up care for patient concerns, and prescription products. Our teams are comprised of experienced RNs, NPs, and PAs who are oftentimes the patient’s first encounter with an aesthetic medical professional. Any aesthetic practice not investing in telehealth is likely going to learn a hard lesson in the near term as telehealth is most definitely here to stay and will likely replace many traditional in-clinic processes.

This is a bit of a loaded question, but you are uniquely qualified to answer it because of your history in the field: What role do allied healthcare professionals play now in aesthetics and what role will they play five years from now?

Thankfully, the unfair subjugation that allied healthcare professionals have endured for many years is slowly disappearing. See, several states already allow full practice authority for the NP and as the role of the NP degree expands and gains more autonomy it is likely that NPs will eventually have even more clinical opportunities. PAs are on the same trajectory, gaining additional roles and responsibilities in states across the nation. RNs have greatly benefited from improved clinical education opportunities. On top of all of this, young physicians are more comfortable with delegation and supervision today than at any time in the past. The most successful aesthetic practices have already improved diversity and inclusion by integrating allied healthcare professionals into their teams.

To address the question, many people don’t realize, or even purposely neglect the fact, that allied healthcare professional already account for nearly 70% of aesthetic treatments implemented in the United States and it’s my contention that we will only see that number increase in time. So, allied healthcare professionals already represent the majority of clinicians in our industry and 5 years from now they will be even better positioned for success!

What can the aesthetic industry do to increase diversity and inclusion?

As far as patient treatments go, I have witnessed the aesthetic industry make vast improvements in terms of diversity and inclusion during my career. For example, laser technology has evolved to be safe and effective for all Fitzpatrick skin types, procedures have been normalized for all genders and sexual orientations, and clinicians find joy in helping patients from all walks of life achieve their aesthetic goals. In terms of clinician diversity, as the stubborn old guard willingly retires or involuntary leaves the aesthetic industry because of attrition, we’ll hear new voices and see fresh faces that better represent the patients receiving the treatments and the clinicians implementing them. We still have a lot of work to do. I’m proud of my organization because we already put a premium emphasis on workplace diversity and inclusion!

What advice do you have for people in the aesthetic space to avoid ‘burnout’?

Pace yourself. Work-life balance will always be number 1. Even if you are considering taking on extra days, make sure it fits into your current work-life balance.

Delegate. Encourage the talent of those on your team and give them tasks that they enjoy and are good at. Never try to take on everything on your own.

Trust. Give your colleagues your trust and don’t micromanage.

 My definition of success is to hop out of bed feeling a sense of peace and fulfillment with my at-home and work family! I’m so luck to awake each day with joy and without stress. It’s the ultimate accomplishment and allows me to live in the present. Obviously, we all have daily stressors, but how we handle that stress will determine the outcome of our overall mental health and wellness. Our families and colleagues play an immense role in our happiness. If you are an aesthetic clinician reading this right now and you aren’t happy when you walk into work, then you aren’t working with the right people. Make a change today, send your CV out, apply for new roles – life is too short to work with people you don’t love!

What is your favorite aesthetic treatment to personally receive?

 I absolutely love my results from Thermage FLX device and look forward to treating more areas of my body. As a 40-year-old and just 6-months post-partum, Thermage is one of the few treatments I can receive while breastfeeding and it is such a great solution for skin tightening and maintaining a youthful appearance. Better still, we just launched “Baby Thermage,” it’s a faster treatment that better targets a specific problem area. It has not only helped tighten my postpartum belly, but also has motivated me to continue exercising and making progress to achieving the highest level of health at my age.

If you weren’t an aesthetic expert, what would you do for a living?

Prior to becoming a nurse in 2004, I studied piano performance at the University of Houston Moore’s School of Music, Houston, Texas. I quickly switched majors and decided to go into nursing. While working in labor and delivery at Memorial Hermann in Houston, I recognized that women used music to assist in natural birth. It rarely worked. So, I decided to compose music with a therapeutic goal to help this cause and am immensely proud of the fact that I have composed three records: The Arrival, Departures and Arrivals, and Passengers. These albums were brought to life during my time in California and have been utilized by many to reduce anxiety. If I were not in the aesthetic industry, I would devote all of my time to music therapy!

What is your favorite quote that is applicable to the aesthetic industry?

 “Yet her features were not of that regular mold which we have been falsely taught to worship… [in fact] there is no exquisite beauty…without some strangeness in the proportion.” - Edgar Allan Poe

I love this excerpt from Poe’s Ligeia. It describes the uniqueness of us all which we should learn to embrace rather than change.

What advice would you give your younger self, knowing what you know now?

I was a worrier in my youth. I hustled hard chasing my career in my 20’s and 30’s, but paired it with a lot of worry for the future. Knowing how things worked out, I would have told my younger self to enjoy the journey because everything would work out better than I could have imagined. Every bit of hard work paid off in a big way, all in perfect timing, with all necessary lessons taught along the way.

Emily, thank you so much for your interview! It has truly been an unconditional pleasure working with you all these years and it’s wonderful to watch not just your family blossom, but see your career explode has been an absolute joy to witness as well. You are an absolute inspiration for our field. How can we learn more about you and follow your future accomplishments?

I feel like we are just getting started! Please follow LaserAway on any of our social media channels and connect with me on LinkedIn at https://www.linkedin.com/in/emily-holmes-perbellini-5683362a/. I’m also at Instagram at: @emily_perbellini_np!

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, reviews the Oura Smart Ring which is a wearable sleep tracker, Ooler Pad from Chilisleep which helps control the temperature of the bed during sleep, and red light therapy from Joovv.

See what he had to say in the video below.

Opinions expressed are that of Portela and do not express the views or opinions of Aesthetic Authority™.

Videos

In this week’s Pointers with Dr Portela, the 208SkinDoc goes into the science behind sleep and skin while also review 3 different sleep improvement devices.  

Q: What is postmenopausal dry scalp, and does it cause female pattern alopecia?

Postmenopausal dry scale and female pattern alopecia are common findings in women who see a dermatologist for hair and scalp issues. Remember, menopause occurs due to lack of estrogen, the hormone responsible for encouraging sebum production and scalp hair growth. This loss of estrogen from declining ovarian function may uncover female pattern hair loss, but the hair loss is unrelated to decreases in scalp sebum production.

However, the reduced sebum production does cause dry scalp and an accompanying decrease in scalp exfoliation, which may or may not be associated with itching. The scalp scale typically appears as fine, powdery white flakes; they do not respond to traditional seborrheic dermatitis treatments because postmenopausal dry scalp is not related to fungal overgrowth in the scalp microbiome. Thus, the removal of Malassezia species produces no improvement. There is also no inflammation, as evidenced by the white scale that is not serum stained yellow—unless scratching occurs as a response to itching—so topical corticosteroids are of minimal benefit.

The best treatment for this condition is to remove the scale and moisturize the scalp. Shampoos containing salicylic acid are most useful and should be applied with vigorous scrubbing of the scalp to dislodge the skin scale. Shampooing and rinsing should be followed immediately with a dimethicone-containing instant conditioner for dry hair. Next, before the hair dries, a product with argan oil and dimethicone should be applied. The hair oil should be dispensed into the palm of one hand, and the fingertips of the opposite hand should be rubbed into the oil and then into the scalp, avoiding the hair. The oil may reduce hair volume if intentionally rubbed into the entire length of the hair.

The procedure should be repeated with the opposite palm and fingertips until the entire scalp has been oiled. If shampooing is infrequent and the scalp becomes dry again, it can be oiled between shampoos.

Some information posted on the internet erroneously suggests that hair oils cause further alopecia by “clogging” the follicular ostia. That is not possible—if it were true, hair would not grow due to the presence of sebum that leaves the sebaceous gland and exits the follicular ostia to form a film over the scalp skin.

Removing the scalp skin scale is important in alleviating postmenopausal pruritus because retained scale provides a surface on which sebum, sweat, and bacteria can collect. Usually, the itching will decrease once the scalp has been exfoliated. If using a shampoo with salicylic acid does not remove the scale, a salicylic acid scalp solution can be applied at bedtime and washed out the following day. If the scalp pruritus does not respond, a prescription topical corticosteroid may be indicated.

Q: Do dandruff shampoos encourage hair loss?


The internet is full of posts claiming that dandruff shampoos cause hair loss. It is impossible for a typical shampoo following the dandruff monograph to induce hair loss. The shampoo does not penetrate to the level of the follicle and therefore cannot affect hair growth.

However, the presence of dandruff can indirectly discourage growth. Many people with dandruff experience scalp itching, which varies with the severity of the dandruff. This itching leads to scratching that damages the hair cuticle, reducing the strength of the hair and eventually shearing off the hair fiber, which results in hair loss. Thus, it is possible that patients who have dandruff will experience increased hair loss but not due to the dandruff shampoo; rather, scalp scratching can lead to inadvertent hair scratching and subsequent hair loss.

Q: Are scalp-camouflaging products damaging to the hair and scalp?


Many new camouflaging products on the market increase the appearance of hair fullness and camouflage scalp skin. These products are powders or short hair fibers, usually of animal origin. The particles are charged with static electricity so that they adhere to the native hairs and/or scalp. They may be further held in place with a hair spray–type product. These camouflaging products may be used safely by both men and women and are removed by shampooing. They do not damage the scalp or hair but should not be a deterrent to good scalp hygiene.

In this month's Cosmetic Conundrums column, Dermatology Times® Chief Medical Editor Zoe Diana Draelos, MD, explores scalp flaking causes and treatments.