The secrets to starting a successful laser practice

Laser—short for “light amplification by the stimulated emission of radiation”—can also be an acronym for “Lasers are a source of extra revenue.” Conversely, laser can also stand for “Losses are significant without education and research.”

Opportunities abound in the billion-dollar laser industry, but too many physicians open laser practices without the requisite knowledge and tools to help their practices achieve their potential and deliver a quality product.

Starting a laser practice can be one of the largest investments a physician can undertake. The lure of extra income that is not encumbered by insurance paperwork and Medicare payment restrictions can be very tempting. Devices previously limited to physicians practicing aesthetic medicine are now being used in a wide variety of practice settings. For example, endocrinologists are acquiring hair-removal lasers to treat patients with hirsutism, and gynecologists are offering aesthetic services to their patients. Even family-practice physicians are creating ways to add revenue to their practices’ bottom lines.

Physicians are not the only medical practitioners who are becoming more inclined to perform fee-for-service procedures. Nurses, aestheticians, and other individuals who provide aesthetic services are aggressively making headway into the aesthetic laser market as well.

Representatives of laser companies will show prospective buyers simulated reve­nues obtainable by incorporating lasers into their practices. This information, along with the purchaser’s own research, will lead to establishing of a solid business plan for a profitable laser practice.

Equipment Selection

With numerous types of lasers and laserlike instruments—such as intense pulsed-light (IPL) systems—currently available, the primary consideration is which laser to buy. An owner of an established laser practice will have a clearer understanding of the type of machine to add, based on existing patient demand.

When you choose the first laser for your practice, you must decide on the types of patients and the conditions you would like to treat. Photo­re­ju­venation, treatment of leg veins, and removal of hair, vascular lesions, brown spots, and tattoos are a few of the many possible applications of aesthetic laser therapy. However, different conditions re­quire different types of lasers and treatment parameters for optimal results.

For example, if you want to establish a hair-removal practice, is your patient population predominantly light- or dark-skinned? This is important because skin type is a major criterion for determining the optimum machine for effective hair removal. Similarly, treating tattoos can be very challenging because more than one laser type may be necessary for adequate therapy.

Do the Math

Are you going to try to attract new patients to the practice, or will you focus on internal marketing to your existing patient base? Are your existing patients requesting a particular service?

Budgets and strategies must be established to promote your laser services. Marketing begins with a knowledge of your potential clients that enables you to understand how to spend your promotional dollars effectively and efficiently. Whereas a comprehensive marketing campaign may include print, mail, radio, Internet, and even television advertising, remember that one of the most effective sources of new business is referrals from clients and other practices.

The laser field is extremely competitive in terms of attracting new patients to your practice. This means that marketing strategies are essential for establishing a profitable practice and avoiding financial disappointment.

For new laser practices, one practical option may be to purchase an IPL system that can treat a variety of conditions. The various handpieces of an IPL system function as filters that can be interchanged to treat targeted tissues and conditions. This may be more feasible than buying several lasers as an initial investment, because it allows you to determine the types of treatments that will be most popular in your practice setting.

Another effective method is to rent laser machines by the day or half-day. After all, new and improved lasers enter the market constantly. A laser that is not being used is not only losing revenue, it is quickly becoming obsolete. Buying an expensive laser just to “test the market” could be a costly mistake. However, if you have a proven patient base, then purchase the safest and most effective laser available to treat your clients’ conditions.

Staffing Considerations

Another essential question is: Who will treat the patients with the laser? The answer depends on the laws of your state. Some states require a medical director to personally oversee all patients receiving laser treatments, while others only expect the director to be available on the premises. Will you, the physician, personally perform the treatment, or will you hire someone? If you decide to perform the treatments yourself, are you making the most cost-efficient use of your time?

If you have an existing busy surgical practice and are looking to add laser treatments to your menu of services, treating patients yourself is likely not an option. If you will have an employee perform the treatments, will that person be an experienced laser technician, or will you train someone? A technician who knows laser physics, understands skin and hair biology, and has good patient skills can be the most important building block for a successful laser practice. These elements are critical to ensure appropriate and reliable treatments for your patients.

For example, using an Nd:YAG laser to remove hair from a light-skinned patient will yield a poor result, not to mention a painful treatment for that individual. The right treatment for the right patient is vital for patient satisfaction and safety—and ultimately for the success of your practice. In addition, whether you or your designated therapist performs the treatment, liability issues concerning safety are extremely important considerations. The physician’s malpractice insurance must cover any problems that may occur.

Some of the new IPL systems offer guidance on treatment planning. The machine reads the patient’s skin type and automatically recommends treatment settings. This is different from the single-wavelength laser machines that require a working knowledge of wavelengths, fluences, pulse durations, spot sizes, and skin cooling to produce a successful treatment. The importance of achieving safe and effective therapy in today’s litigious society should not be underestimated.

However, if adding a full-time experienced laser technician to your staff is not an option, nurses and other practitioners with laser expertise can be employed on a per diem basis. Your local laser representatives should be aware of these individuals in your community and should be able to furnish references.

Financing Options

There are many ways to finance the purchase of a laser or pulsed-light system. The best advice is to contact your accountant or financial planner to determine the tax benefits available to you for acquiring these expensive machines. In Texas, where my practice is located, physicians can deduct approximately $100,000 per year for capital improvements. Therefore, we were able to write off the purchase price of our lasers.

In deciding whether to purchase or lease, you must consider your available funds for this investment. Interest rates for leasing a laser are usually higher than for purchasing that same machine outright. In addition, lease financing only permits a monthly expense deduction.

Lasers, like automobiles, should be viewed as constantly depreciating pieces of machinery in a field where new technologies are constantly emerging. When you contemplate your laser purchase, you should recognize that the amortization period for these machines should be about 3years—by then, newer, safer, and faster systems will be available. This is especially applicable in competitive markets, where patients specifically request treatments with the latest laser technologies.

A Cautious Approach

I believe that a wait-and-see approach to emerging technologies is prudent. We advise our patients who inquire about these new systems to not be experimental subjects for the latest machine. If the novel equipment proves to be as effective as advertised, we will offer the treatment. Our loyal patient base appreciates this conservative and safe approach, and we rarely lose existing patients to the competitor offering the latest treatment.

From the type of laser to patient demographics, from technical staffing to marketing and financial considerations, there are many important issues to contemplate when deciding to add a laser to your medical practice. These machines are not innocuous toys for inexperienced users—you do not have to look hard for patients injured by inappropriate laser therapy. Used correctly, however, lasers are very effective tools for treating photodamaged skin, excess hair growth, and vascular lesions.

Our practice maintains an excellent relationship with our laser-company representatives, who have assisted with marketing ideas and strategies long after the purchases were made. Adding a laser to an existing medical practice or starting a stand-alone laser business can generate tremendous revenues, but only if the practice is actively supported by the requisite treatment expertise, marketing tools, and business acumen. With a well-conceived business plan, you can optimize your chances for a successful laser practice.  PSP

Benjamin A. Bassichis, MD, is a board-certified facial plastic and reconstructive surgeon and the director of the Advanced Facial Plastic Surgery Center in Dallas. He lectures throughout the United States on the latest aesthetic surgery procedures and laser techniques, and he has been featured on national news programs. He is a clini­cal assistant professor at the University of Texas–Southwestern Medical Center and volunteers to care for veterans at the Dallas Veterans Administration Hospital. He can be reached at (972) 774-1777 or via his Web site,