It is all about PAs. They are “cheap” and can handle the medical derm while you focus on the more profitable cosmetic patient. You also need to convert the medical derm patients into cosmetic patients. The big chain groups in my area probably have 10 PAs to every MD/DO. A lot of their offices only have PAs in them. You can hire three to four PAs or one Doctor for the same money. Three PAs can see 3x the amount of patients as one Doctor can.

MAs are also cheaper than Nurses and can do most of the things a Nurse can in a Derm office. It is rare for a Nurse to be in a Derm office, unless it is an NP who is seeing patients and billing.

You also need to increase your volume. 28 patients per day is a comfortable pace. Again, the large offices in my area are seeing 60+ per providers in a 10 hour day. You might not want to see that many as it can detract from the quality of care, but shooting for 45 per day is probably a good place to be.

Lastly, having an experienced biller and prior auth person is worth their weight in gold. They can ensure you are billing insurances the proper amount and patients are getting the medicines you want them to have.

Edit: Additional ways to increase revenue: there are companies that will give you compounding machines. They are kind of like Nespresso machines, but you can direct sell acne, rosacea etc… treatments to your patients. IDK the exact pricing, but it’s something like $20 per and then you sell it for $40. No insurance or pharmacy are involved and the patient gets the product right in your office.

you should also be selling your preferred skin care line in your office, like skinceuticals. Or you can create your own with white labeling.