Practice Setting and DNP Role Integration

Initial reflection on current practice setting, organization and outlook for DNP role integration and project implementation

Practice Overview

I function out of two independent, but collaborative practices. The first being my own practice, MAINTENANCE, which is a non-surgical aesthetics clinic focusing on non-invasive and minimally invasive cosmetic facial, skin and body contouring, tightening and rejuvenation. I began my practice with my collaborating physician, Dr. Jaime Schwartz, in an effort to help simplify aesthetic medicine and promote evidence-based care; with a concierge-style, my clinic values investing time with patients to educate on all options to achieve aesthetic goals, develop custom treatment and ‘maintenance’ plans, with importance stressed on continuous consultation and re-evaluation for changing needs, and to provide referrals when indicated. The second being the office of my collaborating physician, Dr. Jaime Schwartz, and my previous employer, The Roxbury Institute, which is a multispecialty private practice organization comprised of plastic and reconstructive surgery, cosmetic and general dermatology, naturopathic medicine and women’s health. The vision of the practice is to offer an integrative center for comprehensive cosmetic and wellness needs.

Organizational Structure

The organizational structure of my practice is very simple; only consisting of myself, my collaborating physician, and medical assistant involved in direct care, and outside support of my healthcare attorney and accountant. This design allows me to be very nimble and implement decisions and projects with ease.

The global organizational structure at The Roxbury Institute represents a traditional hierarchical design with all decisions and practice changes made top-down. There are sub-units of "profit-centers" with some crossover discussion for potential practice growth among the sub-units, but inherent stagnation can be observed when attempting to affect change. The individual sub-unit of my collaborating physician’s practice within The Roxbury Institute, is a fairly structured team. Dr. Schwartz is well-versed and experienced in healthcare organizational design, from building a breast cancer and reconstructive center while chief of plastic surgery for a community hospital to growing a plastic and reconstructive surgery private practice. Together, we’ve built a great collaborative practice of comprehensive surgical and non-surgical aesthetics; we function very well as a team and our approach to care and goals are aligned.

Current Practice and DNP Role Integration

I actively see patients in my practice 2-days per week and communicate with my collaborating physician as needed for additional consultation or escalation of care (i.e., if I am unsure about appropriateness or response to treatment, I desire to implement a new, or updated, treatment protocol, or should I believe a patient would benefit from surgical consultation and approach v. non-surgical). DNP role integration is very streamlined, projects can be implemented seamlessly into current system.

My role at The Roxbury Institute is two-fold. I see patients for non-surgical aesthetic consults and treatments one day per week; upon resigning from my full-time position at the end of June of this year, the practice and I came to this agreement to complete existing patient treatment series, etc., for a non-specific length of time. While the practice is supportive of my scholarly efforts, due to the inherent limitations of the existing organizational structure, I am uncertain as to the extent that I may integrate my role as a DNP student or application of my project from a practice-wide perspective. However, my second role is working directly with my collaborating physician and his practice. I assist with perioperative patient management and care – process flow and medical clearance pre-op, current clinical trial enrollment, first-assist intra-op and post-op care as needed. Dr. Schwartz is very excited about my DNP project ideas and implementation within his practice, and eagerly offers great mentorship for practice and project implementation and [future] dissemination.

I think performing an initial SWOT analysis of the overall organization with my collaborating physician (also serves as role of mentor and primary organization stakeholder) would be extremely beneficial for efficient and effective project implementation.

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