Finding the Right Mohs Opportunity – Part 1
Many solo Dermatologists or general derm practices have considered hiring a Mohs Surgeon or maybe a part-time Dermatopathologist to help increase revenue. Before making this decision, it is important that every practice conduct a cost-benefit analysis based on anticipated revenues from Insurers and Medicare and compare this to the associated cost. For this article we will only cover what Mohs surgeons should look for in their practice and what General Dermatologists should consider when hiring a Mohs Surgeon.
Typically, it takes 2 full time (busy) Dermatologists to support one Mohs Surgeon 2-3 days per week. But this is only true when the 2 full-time Dermatologists are actually referring all of their “mohsable” skin cancers. Many general dermatologists do quite a bit of surgical derm so it is important for Mohs Surgeons to speak with the derms in the practice to find out what they currently do and what they refer out. This can be a good litmus test as to what you can expect in terms of referrals.
For most college trained Mohs Surgeons, they should be comfortable with doing 4-10 cases per day with the necessary closures. What we recommend is to schedule your faces in the morning and if they end up being multiple stages, bring them back the next day. They should also be comfortable with closures on the nose, ear, mouth, scalp, and trunk. However, they should also be willing to refer to a plastic surgeon when cosmetically necessary and especially when the patient asks. Performing 4-10 mohs cases a day is really determined by:
- Your surgical techniques, the work-flow of the practice, the lab efficiency, your surgical assistants, your histo tech, lab/surgical equipment, and competent scheduling
If you are joining a practice it is important that you feel confident in the leadership and staff. If they tell you that you will get one medical assistant and you are used to having two surgical assistants, this can be a major hindrance in your surgeries. You need to make sure that the leadership respects you enough to allow you to make decisions regarding your area of expertise. You cannot afford to have a domineering general dermatologist making decisions that they are not qualified to make.
Many dermatologists have their own set of expectations, in terms of how many cases a mohs surgeon can do in a day, so it is important to clarify this during the initial interviews. You also must consider who the partners are in the practice and how soon you will be offered partnership. This is who will be making your decisions so it is important that you gain a comfort level with them. Before accepting a position, try to obtain a positive biopsy report or something that will give you a clear indication of how many cancers they are actually finding. We hear so many times of Mohs Surgeons being hired with a claim of 2-3 days of Mohs per week, only to find that there is enough to barely fill a day. Determine what you want as volume and spend the time to make sure you have it at your next job. If they don’t have it initially, just make sure that they are committed to adding Mohs to their practice and making the necessary decisions to increase the volume as necessary.
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