On Moving a Dermatology Practice: A Brief Work History

Definitely looks better at night.
Definitely looks better at night.

Moving is popular in the U.S. The average family moves about once every 5 years. But moving a Dermatology or any medical practice is far less common as you might expect. Patients prefer to keep the same doctor in familiar surroundings close to where they live. They expect to lose resident doctors-in-training because they graduate after 3 years, but they expect to keep the same private doctor for life unless they outlive the doctor!

Moving a medical practice is much more difficult for a doctor than a homeowner, especially if the move is to a different state. Here are just some of the administrative tasks that must be done after completing all the legwork involved with finding or building  new office space and signing a new contract with a partner, group, or institution: Apply for a medical license in the new state, inform Medicare, other insurers, referring doctors, and the DEA of the new location, notify all active patients of the move, offer them easy access to their records, and refer them to colleagues if the move is not local.

I have changed practice locations four times in 33 years, not counting moving from dermatology residency at NYU to Columbus, OH as assistant professor at Ohio State University. After 6 years, I moved from Columbus to Cleveland to join the Cleveland Clinic Foundation. Even after that move, I continued to receive patients referred from the same dermatologists as distant as Dayton, Lima, Findlay, and Zanesville in Ohio as well as Parkersburg, WV. Fourteen years later, I transferred to the Cleveland Clinic in Naples, FL to be closer to aging parents and yes, to escape the depressing weather. Oddly enough, I continued to see some of the same patients because of the “snowbird phenomenon,” that is, some of the Ohio patients already had winter homes in Florida, and other patients moved here later and found me. Some with rare or complicated conditions such as pemphigus or lymphoma of the skin continued to fly to Florida for follow-up visits. I’ve actually been seeing some patients for over 20 years in spite of all the moves!

Unexpected Changes

In 2005-6, an unprecedented event occurred. The Cleveland Clinic sold the entire hospital and clinic building in Naples, FL along with all of the doctors’ contracts to HMA, a private hospital management corporation. I didn’t have to move physically this time, but I did have to sign a new contract, change malpractice, health, dental, and life insurance plans, and enroll in a new retirement plan. The hardest part was adapting to the overnight transition from working for a not-for-profit academic institution for 20 years to being employed by a for-profit hospital system. Completely different missions, cultures, and business plans.  I decided to work within the new system at first, joined the leadership team of doctors, even helped write some policies for physicians. But, alas, there was just not enough time allowed or support from the new administration for teaching other physicians, writing articles and books, and performing original clinical research which I believe are essential for the advancement of patient care. For example, a former manager was opposed to allowing me to take an afternoon off to drive to Tampa in order to lecture dermatology residents and medical students at USF, where I still hold an appointment as voluntary clinical associate professor. I resigned amicably from HMA after giving 3 months notice, allowing enough time to do all the things listed in the second paragraph above, and joined Riverchase Dermatology (RCD).

I started working at RCD in March 2009 at the North Naples and Fort Myers offices. Many of the patients followed me, but certainly not all. As with any local move, some patients were delighted that the new Naples office was closer to their home, while others complained about now living 5 miles further away. Some of these patients returned to HMA where they continued to receive excellent care from my former partners who have  remained friends. With RCD’s financial and moral support, I quickly built full-service psoriasis treatment centers in Naples and Fort Myers. Because medical-grade ultraviolet light therapy is not readily available in south Florida, 50% of my patients had been driving 25-40 miles each way from Fort Myers or Cape Coral to Naples to get treatment for psoriasis, vitiligo, and other skin diseases. In some cases, I worried that the drive on the interstate highway system exposed them to more risks than the disease we were treating. All of us were excited about erasing the additional risk of driving as well as the expense of gasoline and  tolls while delivering state-of-the-art phototherapy closer to home.

On the Move Again

During the last two years, as Riverchase Dermatology has added more services, doctors, and mid-level providers, the number of offices has grown concomitantly. First, the North Naples phototherapy units and excimer laser were moved to a freshly renovated building in downtown Naples, and the Camisa Psoriasis Center was established. There was no problem transferring records. Although the new office was only 2 miles south of the original Naples office, some patients chose to stay with different providers there or left RCD entirely to receive their treatments elsewhere. On the other hand, downtown Naples is closer to East Naples and Marco Island, and patients living in those communities found our new office to be more accessible. Because the interstate system connects the east and west coasts of Florida across the Everglades, the so-called “Alligator Alley,” we  have also welcomed patients from Fort Lauderdale or Weston who can make the trip in under 2 hours. Some have told me that they find the stress-free driving and parking in our free lot easier and quicker than driving to the Dermatology clinics in Miami.

Next, new office space was leased and renovated to our strict specifications in Cape Coral which is northwest of Fort Myers and somewhat underserved by dermatologists. We also opened a psoriasis treatment center there, and about 50% of the patients treated in Fort Myers moved with us again because they naturally preferred to be treated closer to their homes. No problems again with transfer of records, and this time no attrition of patients either because the Cape also attracts more patients from North Fort Myers as well as Punta Gorda in Charlotte County.

Things happen for a reason, and sometimes changes including stressful moves, are required to realize opportunities such as opening psoriasis treatment centers in 3 cities, and making hard-to-find treatments more accessible to thousands of patients in their hometowns. In 2014, RCD opened another office  in Bonita Springs, FL with phototherapy services for psoriasis. This new center is conveniently located approximately equidistant between Naples and Fort Myers.

More About Dermatology and Society:
Why Does It Take So Long to Get an Appointment With a Dermatologist? (Part I)
Why Does It Take So Long to Get an Appointment With a Dermatologist? (Part II)




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