The Birth of Golden State Dermatology

Four years ago, I helped create Golden State Dermatology, which is a group of dermatologists working together to provide high quality affordable patient care.

It has been nearly four decades, since December 6, 1980, when I “hung out my shingle” and began my Walnut Creek dermatology practice. Fortunately, my wife, Alicia, has been a constant and reliable source of encouragement, wisdom, and management help. Alicia came with 25 years experience with Contra Costa County Hospital. She began by helping me part-time on weekends until the business grew to the point that I could utilize her full-time. Alicia currently serves as the Practice Administrator for Walnut Creek, Ygnacio Valley, and Brentwood locations (and much more).

My engagement with my profession and service to my patients got a huge boost when I joined ten other doctors in a state-wide program called the Patient Experience Collaborative. For two years, we studied ways to ensure that our patients have the best possible experience. We continued to meet several times a year in various parts of the state to work on improving our patient service skills. We made instructive videos, gathered data through surveys, and attended sessions with psychologists who helped us focus on making patient encounters as friendly, supportive, and effective as possible. By the time the collaborative was finished, I felt that I had become a specialist in the art and science of managing patients’ visits.

Twenty years ago, I finally expanded my practice by adding several Physician Assistants (PAs). Jay Zimmerman, M.D. joined me in 2012 as my first partner, and we opened a second office in Brentwood. We formed Walnut Creek Skin and Laser in 2014 and developed partnerships with several other dermatologists. Over time we expanded our facilities to accommodate our growing number of patients. Our original five exam rooms ultimately grew to 27, including seven exam rooms in Brentwood. I became a member of several boards in the John Muir Health System and saw that the Healthcare industry was going through revolutionary change. healthcare consolidations and mergers were taking place at every level. I realized that the dynamic environment afforded an opportunity in which I could move local dermatology practices to a new level. By assembling dermatologists into a group practice and sharing resources and expertise, we could create large scale synchronicity and offer full-service dermatology that is both the highest quality and affordable.

TIME TO GO GOLDEN

Jeffrey Bortz, M.D., the best Mohs surgeon I ever met, was the first dermatologist I reached out to with my vision. After some convincing, he got on board with my plan.

The second doctor was Robert Greenberg, M.D., a psoriasis expert who has offices in San Ramon and Livermore. We began planning the details of what a large group practice would actually look like. Rather than following in the well-trodden pathway of the big medical groups, we would support doctors working in their own practices, while integrated in our network offering a wide variety of shared services and resources.

In December 2016, Jay, Jeff, Robert, and I became founding members of the Golden State Dermatology medical practice. We have added a plastic surgeon, Michael Hall M.D., a dermatopathologist, Emily Green, M.D. and eight other dermatology practices. We extended experience and knowledge gained from running our family businesses to setting up an appropriate management system. We recruited a Stanford vice president, Matt Perdue, as our CEO and hired vice presidents of operations, finance, business development, marketing, HR, and billing to serve as department heads managing the various parts of the organization.

The group has grown quickly and now includes 21 dermatologists in 15 locations, all of us with personal practices but sharing resources, expertise, services, and referrals with each other. By the time you read this, the number might have grown because several practices are currently in the process of joining. We are expanding throughout Contra Costa County, the South Bay, Central Valley, Marin County, Berkeley, San Francisco, and the Peninsula. By the end of this year, our group will include as many as 75 providers in 25 locations. Member practices will eventually be found in nearly every part of the state. Our partner doctors have access to such things as centralized billing and accounting, plus HR and IT support. Our medical records system provides digital access to patients’ charts, medications, and diagnoses for all our providers in all locations.

My wife, Alicia, is in charge of purchasing cosmetic supplies and products for all 15 practices. As a result, we have established national accounts with a number of companies. For example, we are in the top 100 practices in the United States in purchasing Botox and fillers from Allergan. Companies acknowledge our special status by providing higher levels of service, such as first look at new products and sending company reps to conduct in-house training.

For example, Coolsculpting is introducing a new CoolTone device that uses stimulation to build and strengthen muscles even beneath layers of fat. The product is an effective resource for anyone concerned about maintaining their figure. Spending an hour a week for four weeks on a CoolTone device can tone and give definition to a guy’s “six-pack” that might cause people on the Santa Cruz Boardwalk to look twice.

Coolsculpting has given us three of only 20 CoolTone systems available in Northern California and 500 in the entire country. We have placed them in our Walnut Creek, San Mateo, and Merced offices. We have also added two new non-surgical treatments offering skin-tightening, called Scarlet and Agnes that use micro-needling combined with radio frequency to tighten facial, neck, and chest skin for patients who choose not to have surgery.

We maintain a lab where doctors can send specimens for a pathology report. We do ingroup referrals for patients with various skin conditions to doctors in the system who specialize on that particular condition.

We have an informal but effective process for vetting new doctors who are interested in joining. Residency programs at UCSF, UC Davis, and Stanford are reliable sources of qualified dermatologists that we might recruit into the group. We meet with promising candidates and invite some from each of the three schools to work two Saturdays a month in our Walnut Creek clinic to determine whether they are a good fit for us and we for them.

Golden State Dermatology is owned by the dermatologists who have a personal stake in ensuring that we remain healthy beyond an employee-level of commitment so that we continue to provide high-quality care and services in an environment that is appealing both to staff and patients. We are working with all providers to solicit feedback that will help us improve patient care and satisfaction. As a result, we offer quality care equivalent to UCSF and Stanford where patients pay as much as three times more for the same services.

We have procedures in place to ensure continual improvement in patient care. We zealously follow Maya Angelou’s philosophy, “Do the best you can until you know better. Then when you know better, do better.” We invest money and resources in providing opportunities for ongoing growth for each provider. We administer quality-of-care measures to identify opportunities for improvement both in patient experience and medical outcomes. The results have nothing to do with judging or criticizing performance but serve to foster a culture of personal growth and professional improvement.

Research has shown that medical procedures are more effective when compassionate attention is paid to the patient’s emotional and spiritual state as well as to his/her physical condition. It takes only a little time to give patients the comforting feeling that we have listened to their fears and are answering their questions. We learn to look them in the eye and make a connection. We communicate clearly while explaining their condition, the action plan we are putting into place to deal with it, and what their role is.

Health care has been changing during the decades I’ve been in the industry, and the rate of change is constantly accelerating, so no one can predict the changes coming during the next five years. However, our Golden State Dermatology structure and business model are flexible and should be able to adapt to new technologies and best practices as they appear.

My purpose in Golden State Dermatology was never to increase my personal wealth but to realize my dream of gratefully giving back to the community and to my field in response for the satisfying career that I have enjoyed myself. I wish to do something more than simply retire and play golf with other seniors, but to leave behind a legacy that will enrich the lives and practices of other dermatologists and ease their way into the profession for those who will follow us.

I’m so thankful for how it all came together and for the growing number of people now working together to make my dream come true.

Photos by Melissa Van Ruiten