This episode’s specialty spotlight is Dermatology! Celebrity dermatologist Dr. Paul Jarrod Frank joins us to share challenges in cosmetic medicine. We discuss scaling a practice and opening multiple locations, balancing patient care and internal training, liability, and supervision and delegation rules for cosmetic procedures.
Listen to the full episode using the player below, or by visiting one of the links below. Below is the episode’s transcript which has been edited for readability. If you have any questions or would like to learn more, email us at firstname.lastname@example.org.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues, simplified through real client stories and real world experiences. Creating simplicity in 3, 2, 1.
Brad: Welcome back to another episode of the Legal 123s with ByrdAdatto. I’m your host Brad Adatto with my co-host Michael Byrd.
Michael: Thanks Brad. As a business and healthcare law firm, we represent clients in multiple sectors and multiple specialties, especially healthcare.
Michael: This season, our theme is specialty spotlight, where each episode we’ll visit about some of the nuances that can be found from a business and healthcare perspective in the various practice specialties.
Brad: Michael, I’m really excited today. We have a second time guest joining us today. It’s going to be awesome.
Michael: Alright, before we start talking about our guest or to our guests, I’ve got some work for you. I have a quiz for you, Brad.
Brad: Oh, no, I don’t like quizzes. It’s a quiz from you, so I’m very suspicious.
Michael: Okay. I’m gonna read you four headlines.
Brad: Alright. Fair. [00:01:00]
Michael: They’re a little out there. Out of all of them, I want you to tell me which one is a true story.
Brad: Okay. Sounds fair. I’m ready.
Michael: Okay. Notice the animal theme as we get into this.
Michael: Number one, rats fitted with tiny backpacks are being trained to help earthquake survivors.
Michael: Number two, company is willing to pay homeowners $2,000 for a study, if you allow 100 cockroaches to be released in your home.
Michael: Number three, California court rules that bees are legally fish again.
Michael: New York court rules that elephants are not people.
Brad: Alright. Well, believe it or not, Michael, I actually know three of these stories are true because I think we read it in the same newsletter that you and I like.[00:02:00] I’m struggling that any sane person would allow a hundred cockroaches in their home, but considering the other three were true I’m gonna say all four headlines are true.
Michael: All four are true and it’s no fair, cause I got ’em at the same place that you know where they are.
Brad: Got it. Well, tell the audience where you found these weird animal stories.
Michael: So full credit goes to an online newspaper, so to speak. People don’t know the term, newspaper, the younger generation. It’s called The Morning Brew and they’re a great source of news in an easy to read format. They often have these kind of weird, but true articles.
Brad: Offbeat is putting it really nicely for these examples. Can you at least give the audience a little bit more context? I know you love context behind these headlines.
Michael: You wanna know what the actual story is?
Brad: Yes, yes.
Michael: Oh, okay.
Michael: Okay. We’ll start with the backpack wearing rats. [00:03:00] In Tanzania, a special group of rats are learning to crawl into earthquake debris, wearing tiny backpacks, allowing rescue teams to communicate with the survivors. The backpacks apparently contain microphones, video gear, and location trackers.
Brad: Okay, so who would’ve thought this diseased rodent could be helpful. As grateful as I’m sure the survivors are to have a rat show up with this little tiny backpack with stuff, it still probably is a little bit terrifying. You’re terrified to see a rat pop out at you. You’re covered in rubble and then it starts talking to you, turns out, obviously, it’s not the rat talking.
Brad: Okay. Alright. What’s the next one?
Michael: Cockroach story?
Michael: Okay. Apparently a pest control company in North Carolina is offering up to seven homeowners the opportunity to have 100 cockroaches released into their homes. This is a 30 day study that will allow them to test a new treatment [00:04:00] and they will be paid $2,000 for this. I guess my question to you, Brad, is would you do that?
Brad: These cockroaches in North Carolina cannot be like the cockroaches I grew up with in New Orleans, Louisiana, where they were giant, like huge, flying cockroaches. No sane person could ever live in a house, with just a few of these flying beast. I guess everyone has a price, Michael, but I think mine would be closer to 200 million, not $2,000 because first off my wife and kids would move out immediately and then I’d have to probably nuke the house and start from scratch.
Michael: Yes. My kids would completely lose it.
Brad: I’m not saying I wouldn’t, but not for two grand.
Michael: 200 million is pretty good.
Michael: I probably would take a lower number than that.
Michael: The next one really makes my head spin, man. I mean, a court rules [00:05:00] that bees are legally fish again.
Brad: Yeah, the “again” part caught my attention. Give the background on this one.
Michael: Okay. The classification by a court that bees are legally fish. It protects bees under the California Endangered Species Act. This is apparently the culmination of a four year legal battle between environmentalists and agricultural groups.
Brad: Tell the audience apparently what the California Endangered Species Act is.
Michael: I’m going to, but I want everyone to note that I do not specialize in the California Endangered Species Act.
Michael: And don’t have great legal counsel.
Brad: Based on the fact that bees are fish, I don’t think many people specialize in this.
Michael: Probably so. It is an old law that originally only protects plants and the animal species.
Michael: Apparently back in 2018, environmental groups were worried about the declining bee population makes sense and found a workaround to expand the legal [00:06:00] definition of fish to cover four species of endangered bees.
Brad: So let’s go with one fish, two fish, red fish, bee fish. I really do think Dr. Seuss would actually love hearing bees are fish now.
Michael: Oh man, we made it six minutes in before the first Brad joke, but I will say this just shows you the power of having a good lawyer.
Michael: You can get a bee classified as a fish.
Brad: Fair enough.
Michael: Okay. The last story is the slimmest connection that we have to our guest today because it happens to have happened in the home state of our guest. So this is the New York top court ruled that an elephant can’t be considered a person.
Brad: Right, so give the backstory in this one.
Michael: Okay, well, once again, this is originated from an animal rights group and the group claimed that an elephant named Happy at the Bronx zoo had been illegally detained and deserved to be transferred to a larger elephant sanctuary.
Michael: The court determined that Habeas [00:07:00] Corpus, something we all learned in law school.
Brad: That’s a great word.
Michael: A fundamental right that protects against unlawful detainment. It doesn’t apply to non-human animals.
Brad: All right. Well, Michael, I guess the animal rights group should have claimed that the elephant was a bee, which we now know is a fish, and then Happy would’ve been protected under California’s Endangered Species Act, and therefore must be released.
Michael: Well, I like where your head’s at, but we’re really reaching on our stretch there.
Brad: You know what, let’s bring on our guest. He’s been very patient listening to the animal stories so bring him on.
Michael: All right. Okay. We’re moving on to the real stuff now. Okay. Our guest today for the second time is Dr. Paul Jared Frank. He is a dermatologist in Manhattan. Born and raised in Manhattan. He went to New York medical college, did his training in New York. He has a practice with traditional dermatology and cosmetic dermatology. [00:08:00] Again, I think we quoted this last time, the number, I looked it up b because we want to be accurate.
Michael: I want to be able to tell my kids, I know someone that is certified on social media and has 160,000 followers on Instagram. He is super active. What is really cool in our kind of our common bond is that there’s just a heavy focus on education and training.
Michael: It’s a great resource and Paul, welcome.
Paul: Thank you, my friend. I first want to give my disclaimer for this podcast that I would like to be legally determined as a Panther. Not just as a dermatologist. My closest college friend went on to the Disney school of animation and he had made the decision that each of all of our friends would be designated as a different animation character. It never came to fruition, but now I realized I can do this legally. [00:09:00]
Paul: I think that’s good. I also wanna make sure that I get you guys on my social media platform and to show my audience here. I wanna show everybody that it does take good lighting to make me look good. You guys are certainly well coiffed and I wanna make sure that we can include all this cause we’re always working on the internet. You know what I’m saying? Again, it’s a pleasure to be here a second time. I promise I’m gonna be even better.
Brad: Well, absolutely. Thrilled to have you and glad to learn that you’re a Panther. Maybe you would have an opinion. I mean, you’re in the New York area. You’ve probably been in the Bronx zoo once or twice in your lifetime.
Where are you standing on this whole flight or freeing of Happy the elephant.
Paul: You know what, I think when it comes to human politics, the only thing that is more potentially inflammatory is animal [00:10:00] politics and how people feel about them. I am going to abstain from that. I just want everyone to be happy.
Brad: Yes. Love it.
Michael: Love it. Oh, that’s great.
Paul: That’s what my lawyer would tell me to do.
Michael: Yes. Yes. I was giving you hand signals under the table.
Paul: That’s right.
Michael: Let’s jump in. You heard the introduction, Paul and this whole season, we’re really camping out each episode with different specialties, really to highlight that there are nuances, that you can’t just say I’m a doctor and, that all the healthcare laws are just that’s that and that you actually have different business and healthcare challenges. I’d love for you to introduce the dermatology specialty to the audience.
Paul: Well, the dermatology specialty, in my opinion is probably the largest growing field of [00:11:00] healthcare. Mostly, because, well, we live in an aging population. That’s one thing, so healthcare as a whole is growing rapidly, but dermatology is one of the unique professions that has as much elective focused procedures as it does medically essential ones. Because of the financial incentives involved in elective medicine, clearly it is such a booming market. Now this is a good thing for consumers. It’s a great thing providers, but it comes really with a responsibility to be successful and safe and keep yourself out of legal trouble. It’s really important that we educate the consumer, because people come in with preconceived notions, a lot of question marks, and they really most importantly, in my opinion, need guidance. Now in my business, we perform general dermatology and a full array of cosmetic and [00:12:00] surgical procedures. So because of that, I really have to remain very focused and with the legal guidance of folk, like you who really help make help make my brand successful.
Michael: Talk a little bit about the difference between traditional dermatology and elective cosmetic. What are the types of procedures that you do?
Paul: Well, my focus as the lead provider is I focus on aesthetics. I’m trying to make people the optimized best version of themselves looking in the mirror. I do bring in skin health, skin care prevention, and all these things, cause I do believe healthy skin is beautiful skin, but I’m really focusing on the elective things. These are the things that are out of pocket and it’s a great topic, because there are overlaps, right. Acne is a reimbursable [00:13:00] insurance treatment. There are I.C.D nine codes and procedural codes for this. As soon as we start using lasers for acne, it becomes a non-coverable procedure. I’m sure that there are a lot of people out there who would think acne is a cosmetic disease that it doesn’t affect your organs, yet we know skin is the largest organ of the body. This is what makes it not only exciting, but more difficult because a lot of people have a question mark. What is cosmetic medicine? What is medical? I mean, I know of someone suffering from eczema and psoriasis all over their body. It’s a physical disease, but we know that it affects the way they are perceived on an aesthetic level and an emotional level on the outside. To me, this is the most exciting thing about dermatology, because ophthalmologists have always kind of coined the thing eyes are the window to the soul. They may have better marketing, but honestly I think the skin is really the window to the soul cause it tells us so much not only about our overall [00:14:00] health, but also on how we perceive ourselves and how the other perceives us on the outside.
Brad: Yeah, absolutely. Now that you kind of worked through just what is dermatology and the differences just in your practice alone, when you have these patients coming into your practice, what are some of the biggest challenges you see in dermatology for patients?
Paul: Well, as a provider, again, the procedures I’m doing all day, I’m injecting all day. I’m using devices and lasers all day. I’m doing body sculpting all day. Those are basically how it goes. I got 40 different technologies in my office. When someone comes in, they’re usually coming to me with how they look and it’s important to realize that I have to temper the expectations of patients. People may be coming in with insecurities. They may be coming in with information and ideals that are beyond the scope of what can be done because of Instagram filters, or they are looking at themselves in [00:15:00] certain angles, in the rear view mirror on the selfie. I have to really focus on aligning their expectations to what I could offer them, including considering risks, benefits, cost, willingness for downtime. These are all subtle innuendos that subconsciously go through my head after 20 years of practice with them. The main difference between what I’m doing and if a general dermatologist or a skin cancer specialist comes, if someone has skin cancer, there’s an acceptance of risk. They’re gonna have a scar. This has to be done. It’s medically necessary. It’s a whole different ballgame when people are choosing something that is not medically necessary so I have to be very cautious and to me, this is the most important skill of a cosmetic dermatologist. You could learn how to inject. You could learn how to laser it’s developing that doctor, patient relationship. When [00:16:00] COVID hit, you saw the news and the articles about the zoom boom on elective medicine. Did you notice different perceptions that people were coming in, when they were seeing themselves on zoom and then coming in and asking for treatments. Were they asking for different things?
Paul: Well, people are always looking for excuses to wanna do things aesthetically for themselves and I think every generation, every few years, there’s some sociological impactful event that changes the narrative a little bit. When MTV came out, rock stars, they had to become pretty for video. You know what I mean?
Paul: When the internet existed, people started doing things that looked differently. When the iPhone came out, the selfie became a thing and now it’s the zoom boom. So, again, I think overall we [00:17:00] realized that whether you’re a movie star or rock star, a widget salesman or an attorney, that we’re all on camera, right? We’re all on camera and that means that we all want to be well groomed. We want to look vital, restful not stressed, and a little bit better looking if we can. I think these are all like pieces of a puzzle. I think it’s just headlines that the zoom is the new boom. You know what I mean?
Michael: Yeah. Yeah. Well, let’s shift a little bit from kind of the patient challenges in dermatology and move over to the business of dermatology and talk a little bit about the biggest business challenges you see in the business side of your specialty.
Paul: Well, I think the first and foremost is providing good care and after doing this 20 years, that’s my priority. I’ve learned that education is the most important thing. [00:18:00] Also after 20 years, I’ve come to the conclusion that the most important part of my success is to make sure I have fun along the way. That’s a big challenge when you have a busy, successful challenge. As you climb the mountain, people think it gets easier, but it’s tougher as you reach the top. There are more things trying to pull you down. I think you, we have to focus on the big picture as the industry grows like that. I think uniquely as a healthcare provider, we are a service industry. Whether you’re making pizzas or have a massage shop or a spa or a doctor, you have to focus on things like staffing and training and providing a service. What is unique about the healthcare profession is that we are not distributing candles and giving massages, we’re doing healthcare so it’s a whole new level of liability, of responsibility and of [00:19:00] goals. I think the biggest business challenge is making sure that managing staff, training staff and protecting people at a healthcare level is the most important to a successful business because I’ve met many really smart doctors out there. People I’d love to learn things from that can’t figure out how to rub two pennies together in a business. I have also seen very good healthcare business people that could use some help on the bedside manner and the actual skill of providing healthcare. My aspirations are to be a lot of both.
Michael: You have multiple offices.
Michael: When you went from one office to multiple offices, did you find that challenging? Obviously, you can only be in one place at one time and you’re trying to find that right balance between good patient care and training with your staff. [00:20:00]
Paul: This is the most difficult thing, Michael, because again, we live in a world as you know right now where there’s enormous scaling going on in dermatology: private equity, buying out of practices, bringing in extenders, PAs, nurse practitioners, diluting the quality of the care, cutting overhead, trying to change margins of profit. To me, this is my major focus. I always focus on quality of care. I really try, I put a lot of effort into training my registered nurse, aesthetic healthcare providers, having PAs that I’ve had. I just hired a new associate and really focusing on training. I know not everybody can be me. I don’t want them all to be me. I don’t want to have 30 offices one day and I don’t want to make a big sale and cash out to private equity. That’s not my goal. People always want to know what’s my end game. My end game [00:21:00] is to enjoy the ride and to try and make a stamp on as many people as possible. Knowing I have only two hands, it’s really about training people, keeping them close and making patients feel like if they’re not seeing me, they have a piece of me and I don’t plan on having that change as I grow. The battle continues.
Brad: Yeah. I know we’ve talked about this in our episode with you before and how important education is for you and for your team. Maybe you can share with the audience, and you’ve said it a couple different times about training your staff. Tell the audience, if you wanna share, what do you do to do that? Do you have them shadow you? Do you have classes every Saturday morning? What are some of the mechanisms you utilized to train?
Paul: Well, first and foremost, I try and take ’em out, be social and once in a blue moon, get them a little tipsy because I think comradery and everybody getting along is the most [00:22:00] important thing I look at. I have a very close family and I look at the P Frank MD family as an extension of that. They’re important part of my lives so it’s important that people get along the best they can. Number two, anyone that works for me is spending a large portion of their first year, just following me, following my social media. All the things we give to my patients to educate them from my media, my marketing, my advertising, I give to my staff on a layman’s level. Most of my nurses and doctors come from ICUs, NICUs, and general dermatology practices. They first come as highly skilled healthcare professionals. They need to have some sort of experience in the healthcare field before they come to me. Unlike med spas, I’m not like looking to pick nurses or PAs right out of their training and thinking that they could take a six hour course on injectables and do that. So they come to me with a very strong skill set and after I educate them, that’s when I start, [00:23:00] having many companies I consult and work with, train them on the various devices. We have a hierarchy. I have seven different managers in my practice and each one of them spend time with each new employee, training them from social media marketing to how to use the lasers and the signature protocols we use. I wish I could say it was always so formal like they’re going to a camp, but there is a method to our madness. I always say with every person that works in my office, this is not a nine to five job. It is a position of growth. There are people that sometimes come and go. We’re not for everybody, but I always promise my staff it is never easy, but always exciting. There is a method to making sure that they become part of my brand.
Brad: Yeah, absolutely. We’ve kinda walked all the way to the, I guess, very end in which we’re going to the very last question, which is, [00:24:00] from your perspective as a dermatologist, what is the biggest healthcare compliance challenge that you face?
Paul: Wow. Well, that’s where you guys came into my life because, as I noticed, I don’t know, 10 years ago, something like that, the boom of the industry getting so exponential that there were non-healthcare professionals, limited expertise, healthcare pro licensed hair professionals, private equity, other people trying to make more of a business rather than a healthcare art out of what I do for a living. I really needed the guidance of you guys, legally, structurally, ethically, and in business wise to really make sure that I keep things legal and on brand because I want people to come to my practice and feel that first and foremost, they’re safe and that they feel that I’ve ironed myself out as the prestige brand. I don’t claim to be the cheapest person on the street, but I do [00:25:00] promise that we’re gonna give people the best experience with the most training and expertise. I think the biggest challenge for the whole industry is keeping it safe and keeping it legal because as we know, it varies so much state by state and consumers out there looking to at all price points. They just don’t know and unfortunately, 10 to 15% of my practice is still dealing with complications and the overwhelming majority of those patients have stories of not knowing the education and background of the providers, not knowing if they were even doctors around, and not even knowing the procedure, laser injectable that was even performed on them. Even though I think my game is pretty tight, it’s really about making the public, from my perspective, know the challenges out there as a consumer.
Brad: That’s great.
Michael: That’s awesome. Well, believe it or not, Paul, we have [00:26:00] used up our time for this episode. Again, we are so grateful for your wisdom.
Michael: Well, we’ll do like last time.
Paul: It’s a constant, as a healthcare provider, you’re always a student, you’re always a teacher and it really does take an army as we grow our expertise. I’m very appreciative to have you as one of my troops, so to speak because, things are always changing and that’s the fun part. You gotta keep it as smooth as possible.
Michael: We’re grateful for you and appreciate that.
Michael: What we’ll do now is we’ll say goodbye, we’ll go into commercial, and Brad and I will come back after commercial and do a little legal wrap up. Otherwise, thank you so much for joining us.
Paul: Alright guys, stay cool and enjoy the weekend. Appreciate you.
Brad: Thank you
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Brad: Welcome back to Legal 123s with ByrdAdatto. Brad Adatto still here with my co-host Michael Byrd. Michael, we have this great focus on the specialty spotlights, and we’ve been having these incredible guests join us throughout the season and having Paul join us was amazing. Again, second time guest, but each time he is on I definitely get some different takeaways and you could hear again for our audience, I hope you found his passion for educating and training his team and really finding what’s legal, on [00:28:00] brand, and making it safe for his patients and really making sure they understood that. It reminded me of other conversations we’ve had throughout many seasons here, when we talk about, in every single state supervision and delegation rules can be so different. Where, as Paul said, I might be the one doing the injection, but you went and saw someone else who injected and maybe they shouldn’t be doing it, or someone was injecting and maybe they needed a physician or PA or nurse practitioner on site. The supervision and delegation rules are so unique in every single state, but dermatology itself is a very unique scope or practice and maybe you can jump in and talk about the uniqueness of New York versus other states.
Michael: Yeah. I mean, if you think about, you have, as you mentioned, this brought more broadly the importance of supervision and delegation, and then you get into, particularly in dermatology, different treatments that because they’re elective in nature, you don’t sometimes know [00:29:00] which license they fall with under.
Michael: So, Paul talked about lasers and that’s medical in most states and most lasers are medical in New York. However, in New York laser hair removal is considered non-medical.
Michael: You could walk into a spa with no doctors and get laser hair removal. It doesn’t mean that just because you can that that’s a good idea.
Michael: Your risk goes up as a patient, if that happens. As a physician in dermatology, your boundaries, if you offer that service are one thing and then, even in microneedling, which is a pretty noninvasive procedure, common, you would think for a dermatologist who specializes in skin.
Michael: Yet, there’s like the tattoo board saying, or not the tattoo board, the acupuncture board saying, this is [00:30:00] acupuncture, so you have to be certified to be able to offer those services. Now, that’s really for illustrative purposes. There’s some definite gray area on that. The point is, is that even in, especially in dermatology, you gotta drill down, not just on who are the people that are doing things, but what are the different procedures and trying to figure out, is that medical? Is it non-medical? If it’s medical, then who can do it?
Brad: Well, Michael, it flew by, again, that’s the end of this episode, but audience members do not panic. We will be back next weekend with a specialty spotlight with Jonathan Kaplan, and we’re gonna focus on the surprise act. The no surprise act.
Michael: I want a surprise.
Outro: Thanks again for joining us today and remember if you like this episode, please subscribe. Make sure to give us a five star rating and share with your friends. You can also sign up for the ByrdAdatto [00:31:00] newsletter by going to our website at Byrdadatto.com. ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney, client relationship. Any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.