In this episode of Business Unblemished, Dr Dawn Merritt and Dr Aaron Farberg discuss how to efficiently implement photodynamic therapy (PDT) for actinic keratosis (AK) in dermatology practices. They address common misconceptions about PDT’s cost, logistical challenges, and practical strategies to maximize both its clinical and financial value.

Why use PDT for actinic keratosis?

PDT is an effective field therapy for actinic keratosis. While individual lesions can be treated with cryotherapy, many patients require broader treatment, making PDT an excellent in-office option.

Dr Merritt, an early adopter of PDT, has integrated the treatment into all 10 of her practice locations, where it is performed daily. Dr Farberg strongly believes every dermatology practice should offer PDT, noting that dermatologists are likely to see multiple patients every day who could benefit from it. While topical therapies remain a viable and effective option, PDT offers greater control over treatment application and adherence, ensuring patients receive consistent and effective care.

Optimizing workflow and staffing

Dr Merritt emphasizes that proper scheduling is key to ensuring PDT does not disrupt clinic flow. Instead of scheduling PDT as a physician-led appointment, she recommends setting it up as a nurse visit:

• Medical assistants (MAs) handle the setup and patient preparation
• The physician only needs to be present for consent, curettage, and product application, allowing them to continue seeing other patients while the PDT session runs in the background

Dr Farberg adds that while MAs can manage most of the process, physicians should personally apply and initiate PDT for optimal reimbursement and quality of care. A simple way to improve efficiency is to provide patients with a bell to call for assistance while MAs manage other tasks such as prior authorizations or patient paperwork.

Space considerations for PDT implementation

One common concern among dermatologists considering PDT is space requirements. However, PDT does not require a dedicated room:

• Dr Merritt recommends using a nurse visit room or an overflow exam room to allow smooth patient flow
• Dr Farberg has successfully implemented PDT in small rooms, demonstrating that space limitations should not deter practices from considering the service

Addressing cost concerns and maximizing revenue

For newer or smaller practices, the upfront cost of PDT equipment may feel like a barrier. However, both doctors emphasize that PDT is a long-term revenue generator:

• Established practices can confidently invest, knowing they will recoup costs over time
• New practices with tighter budgets can explore equipment rental options, which allow them to offer PDT without large upfront costs

Dr Merritt routinely budgets for PDT when opening a new office because she knows its profitability and value to patients.

Educating patients about PDT

Dr Merritt emphasizes that patient education is crucial for successful PDT integration. She advises new practices to:

• Create a simple handout explaining what patients can expect
• Always schedule 2 PDT treatments upfront, with a third follow-up visit 8 weeks later for evaluation.

Dr Farberg finds that offering multiple field therapy options allows patients to choose what works best for them, though many prefer PDT due to its ease of use and convenience.

Training staff to promote PDT

Dr Merritt utilizes rolling screen advertisements in her offices to inform patients about PDT before their appointment. Additionally, she has trained her MAs with instructional videos that cover:

• PDT setup and application
• How to explain the procedure to patients
• When to involve the physician during treatment

This structured approach ensures the entire team is aligned and helps patients feel more comfortable with the procedure.

Identifying ideal candidates for PDT

Dr Merritt has a simple rule of thumb for determining when to recommend PDT:

• If she has to freeze more than what fits on one hand, the patient needs field therapy—and PDT is her first choice

Dr Farberg also sees PDT as a built-in marketing tool; patients who receive it often remark that they have never had it offered at other dermatology offices. These patients share their positive experiences with friends, bringing in new patients and strengthening practice growth.

PDT remains one of the most effective and well-established treatments for AK field therapy. While some dermatologists hesitate due to logistical concerns, both Dr Merritt and Dr Farberg emphasize that with proper implementation, PDT can enhance patient care while becoming a valuable revenue stream.

Key takeaways

• PDT offers precise, in-office field therapy for patients with AK
• With efficient scheduling, PDT can be integrated seamlessly into any practice workflow
• Space constraints should not deter practices from offering PDT
• The cost of PDT equipment is quickly recouped, and rental options are available
• A well-trained team and patient education help maximize PDT’s impact