At Medly Pharmacy, our job is to make the prescription process painless. The physicians we work with, of course, are an essential part of that process. In our ongoing Medly Provider Spotlight series we’re highlighting various practices and practitioners who’ve partnered with Medly. Today we’re introducing you to Dr. Dina Strachan, a physician specializing in Dermatology.
Dr. Strachan is an internationally recognized, Harvard-educated, board-certified dermatologist as well as a bestselling author, speaker, and consultant. “I'm a big advocate for independent physicians, for dermatologists and doctors being entrepreneurs, providing excellent care as well as being physician leaders,” said Dr. Strachan.
When choosing her career, Dr. Strachan considered a variety of options, from anthropology to film school to med school. These career options aligned with her many and wide-ranging interests.
However, it was a friend who helped nudge her towards dermatology. “He was doing this dermatology rotation and he was so excited, and I was interested in infectious disease at that time and the AIDS epidemic was big,” said Dr. Strachan. “It planted a seed in my mind.”
Before the advent of the array of HIV drugs we have today, the skin is very often affected by the condition as it is the body’s largest immune organ. When Dr. Strachan was on the AIDS service, she said the doctors would often struggle with patients’ skin problems until the dermatologists came through. “I was like, I want what they have,” said Dr. Strachan. “They have this expertise, they have this magic, they walked in and they solved the problem like that.”
This hugely impacted patients, not only from an aesthetic perspective, but also from a care perspective. Dr. Strachan’s residency was right before highly aggressive antiretroviral therapy emerged, so she had the opportunity to witness the “arc and impact” of such therapies. Next, Dr. Strachan served as a consultant and lecturer for the National Minority AIDS Education Training Division governmental program, followed by a two-year stint in academia.
Ultimately, Dr. Strachan said, “After working in a few different environments, I realized I had to start my own practice to have the kind of environment that I wanted to work in.” As she considered herself more of an artist than a businessperson, this caused “a dark night of the soul” as she evaluated her options. “I found that as I started my business, that I was actually good at business and that businesses were artistic and creative and fun,” she said.
As far as advice for other practitioners, Dr. Strachan pushes back against the common idea that doctors are no good at business.
“We get a lot of conditioning and propaganda coming up that we shouldn't care about the business part and doctors aren't good at business, and doctors are no worse at business than anybody else. And it's something that you have to learn if you don't know it,”
Dr. Strachan also warns about physician burnout, which stems from a lack of empowerment as a doctor. “When you are any kind of entrepreneur, you always have to be working on yourself,” she said. “There's continuing medical education, but you really have to be working on yourself because if you're not, if you're not set and you're responsible for the business, it's hard to manage it all and make it work. It's affected by how you are doing.”
There are many resources available for doctors and business entrepreneurs to learn from. Dr. Strachan believes that doctors can learn just as much from a chaotic environment as from an orderly one. “So you actually get better training in a place where there's a lot of chaos than you do where there's a lot of rules,” she said based on her own experience.
She added that there are many resources offered by New York City itself, including classes provided by the city Department of Small Business Services. “They even had one that was for independent doctors because the city thinks that independent doctors are actually very important and that they're the future,” she advised.
There are also business coaches that can respond to your problems and help you with problems based on your needs. “I've had different types of business coaches that I've paid independently for. What kind of coach you need will depend on where you are and what's going on,” she said, explaining that marketing is a common issue for dermatologists.
Dr. Strachan’s dermatology practice is as affected as any other provider by the COVID-19 pandemic. “I had to shut down for a while. We have to be more careful in terms of PPE and we have to reduce the scheduling to facilitate social distancing,” said Dr. Strachan, but she has not seen a noticeable increase in COVID-related skin care issues in her practice.
Regarding telemedicine, Dr. Strachan believes that it lends itself to counseling, but is not so great for diagnoses. “It has its pluses and minuses,” said Dr. Strachan.
That said, Dr. Strachan believes that the next innovation in dermatology will be driven by tele-health services that can help fill that void by assisting with assessment and diagnosis, though she is skeptical about the motives of the lobbies that push for non-stop digital intervention in the practice. “You have these people who are not in the industry trying to control how we do things saying it's better. It's better for them, it's not necessarily better for what we do,” she said.
“This has been a little bit of an issue in the tech world, the health tech world, because often they lobby and push for innovations that are not vetted,” Dr. Strachan said. “It was really pushed upon people and kind of fake news that it was going to make things more efficient, that it was going to do certain things and it couldn't do that. That wasn't the reason it was brought on. It was brought on to collect data for other people… We can't assume that just because there's an app for that, that we should use it and that it's useful.”
Dr. Strachan pointed out that dermatology is the second least diverse medical specialty in the country only after orthopedic surgery, which is something that many in the dermatology community are working to address. “It's a highly competitive specialty and just like anything else, when you're training in medicine, having an impact really starts earlier in the pipeline,” said Dr. Strachan. “So, you have to ask yourself, why are people not applying? Do they not think of it as something that they could do? Are they prepared to be competitive? Are they getting the right kind of mentorship and guidance? That sort of thing.”
Dr. Strachan also points out how a lack of diversity affects the patient population in several ways. First, patients are forced to wait a long time for dermatology appointments because underserved communities don’t have a lot of options in terms of providers who want to work in those communities. “It has been shown that people who are of a similar background or more likely to consider serving in those communities,” said Dr. Strachan.
Second, there is a problem in the education of providers, where providers are unable to meet the needs of underserved communities because they never learned how to. “How are you going to say that you're an expert, a board-certified dermatologist, but you don't know how to take care of the hair loss problems in someone of African-American descent? Then are you really an expert? Is that considered satisfactory? You leave out whole categories of the population that you don't even learn about,” she said.
She added, “Some programs, depending on where they're located, they don't learn anything about how skin diseases present differently in people of different skin colors, different ethnic backgrounds, and then a lot of cultural things impact people's skin behavior, and things that people do will have an impact on what types of skin problems they get.”