Q&A: Early-Career Dermatology Pearls on Defensive Patients and HS Coding

Early-career dermatologists moving from academic training into private practice face challenges well outside the scope of clinical medicine. Building a multidisciplinary care team without established referral patterns, protecting time outside the clinic, and understanding reimbursement all shape whether a new practice thrives. Professional self-doubt compounds these pressures, and a research letter in the Journal of the American Academy of Dermatology examined impostor syndrome among those in the US who are dermatology residents.¹

Hidradenitis suppurativa surgery illustrates the reimbursement problem. Procedural interventions, including deroofing and excision, hold a defined place in the North American clinical management guidelines for hidradenitis suppurativa from the United States and Canadian Hidradenitis Suppurativa Foundations.² Yet the complexity of these operations does not always translate into proportional payment, a gap with direct consequences for dermatologists building surgical hidradenitis suppurativa services.

The Early Career Dermatology Initiative at the 2026 Fall Clinical Dermatology Conference in Las Vegas addressed these issues in a non-CME session titled “Career and Life Practical Tips” on October 10, 2026.³ Faculty included Aaron S. Farberg, MD, Sandra Lee, MD, and Diego Dasilva, MD, among others. Harrison Nguyen, MD, MBA, MPH, managing director of Harrison Dermatology Research Group and clinical assistant professor at Baylor College of Medicine and the University of Houston College of Medicine, sat on the panel.

He spoke on the case for general dermatology during the session’s debate. Below, in this second segment of his Q&A, Nguyen shares his approach to patients who push back, along with the single piece of career advice he left with the audience:

HCPLive: What tips did you and your fellow panelists highlight during the “Career and Life Practical Tips” session?

Harrison Nguyen, MD, MBA, MPH: It was so fun to be on the early career session at the Fall Clinical conference. I was on that panel with Aaron Farberg, Sandra Lee, aka ‘Dr. Pimple Popper’, Dan Butler, and Diego Dasilva. We talked about some of the challenges you encounter early on in a career as a dermatologist or dermatology clinician, and how to navigate them. We talked about how you navigate the challenging patient in your clinic, and you can think about the challenging patient from different perspectives. One is the complex, challenging patient, the patient with really complex or difficult disease, and how you organize multidisciplinary care, especially in a private practice setting. A lot of us are coming from academics.

Residents especially will often train in an academic setting where you have established referral patterns, but when it comes to private practice, you have to organize your own multidisciplinary care team. So that was one pearl we shared. Then there’s also the challenging patient from, let’s say, the more emotionally or socially challenging side, or the patient who argues back on every topic you bring up, and we talked about different ways to help navigate those patients.

We also talked about work-life balance. That’s a term that’s commonly used, but often it’s really work-life harmonization: how do you integrate both work and life and make them both come together? For me, I suggested scheduling life the same way we schedule things for our work. We scheduled this discussion, you and me, Tim. It’s just as important to schedule life events: dinners with my fiancé, making sure breakfast with the grandparents is scheduled, making sure the vacation with family is scheduled out next year, and protecting it in the same way we protect our professional engagements.

We also talked about billing and coding tips. I talked about HS, and to be aware that HS surgeries often come with a 90-day global period. Especially in my neck of the woods in Texas, we did a single-site analysis of claims, and we found we’re actually reimbursed less for doing these really complex, challenging HS surgeries than for cutting out a simple cyst plus a repair. So I talked to the audience about how to navigate that. Finally, we had a debate between myself and Diego about the pros and cons of super-specialized dermatology versus generalized dermatology. I was tasked with arguing on behalf of the generalized dermatologist, while Diego argued on behalf of the specialized dermatologist; let’s say you’re only doing Mohs, or you’re only specializing in HS. There are certainly pros and cons to that, and we had fun doing it.

HCPLive: When a patient pushes back on everything, what usually drives it in your experience, and how do you address it?

Harrison Nguyen, MD, MBA, MPH: It depends on the patient. I think one of the insights is we have to spend a little bit of time with that challenging patient to understand where he or she is coming from and why they’re being combative or defensive. Sometimes it has to do with negative experiences they’ve had at other dermatology practices. Sometimes it has to do with an experience a loved one had with the healthcare system. Sometimes it has to do with an interaction the patient had with your front desk staff that maybe didn’t go as well as it could have. When you see that patient, sometimes you see it before you even hear it. You see it in their body language; you see it in their facial expressions.

It’s important to make sure you take a pause and maybe even sit down. I like to sit down with every patient; I have a stool in the room. We know sitting down at the patient’s level makes patients feel like we’re spending more time with them. So I like to sit down, and then with a patient who has already shown they may be a little defensive, or not easy to get on the same wavelength with, we take the extra couple of moments to communicate that we are there to take care of them, that we’re on the same team, and that we’re here to listen to them as well. We make sure we hear what they’re saying so we can appropriately address it.

HCPLive: Among the tips shared, which takeaway do you think clinicians are least aware of?

Harrison Nguyen, MD, MBA, MPH: We were also asked to conclude the session with the one tip we wanted to leave the audience with, and the tip I shared is to bet on yourself before you’re ready. The path of medicine often leaves us with imposter syndrome, where we don’t think we’re ready. There’s always this voice inside you making you second-guess yourself. I want our community and early-career dermatologists to bet on themselves before they ever feel ready: to get on the podium before you feel ready, to take that consulting opportunity before you feel ready, and, if you’re interested in starting a practice, to get out there and start making those steps before you ever feel ready. I’ll tell you from personal experience, as someone who has done a lot of those things, you never fully feel ready.

You never fully feel like you have all your ducks in a row, but that’s just how our lives and our careers go. So for those who have aspirations extraclinically, we’re already trained to be good dermatologists, but if you want to pursue other opportunities in your career, maybe launch a social media platform, do it. Bet on yourself and take that chance, because you’ll never look back and say, “Man, I regret taking that chance or that opportunity.” But you may look back and regret not doing it. That was my tip for the audience, and I hope it resonates with our early-career dermatologists: bet on yourself, because no one else will.

Editor’s Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. Regan PA, Shumaker K, Kirby JS. Impostor syndrome in United States dermatology residents. J Am Acad Dermatol. 2020;83(2):631-633. doi:10.1016/j.jaad.2019.10.018.

2. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76-90. doi:10.1016/j.jaad.2019.02.067.

3. Fall Clinical Dermatology Conference. Fall Clinical 2026 attendee agenda. Updated August 21, 2026. Accessed October 26, 2026. https://a-us.storyblok.com/f/572562823577716/x/1e5af87c27/fall-clinical-2026-attendee-agenda-v5-08212026.pdf.