Dermatology
Built for the economics of a modern dermatology practice.
Dermatology practices balance high-volume cosmetic revenue, insurance reimbursement cycles, equipment depreciation, and product inventory in ways generic CPA firms routinely miss. We help dermatology owners make decisions with the full picture.
The Reality
What dermatology practices struggle with.
Cosmetic vs medical revenue tracking
Most dermatology QuickBooks files lump everything together. The economics are radically different — cosmetic services post on a 7-day cash-pay cycle at 60–80% margins; insurance dermatology runs 30–90 day collection cycles at much thinner margins. Without separation, you cannot price intelligently or coach the practice.
Laser and equipment depreciation
A $90K laser is a tax decision, not just a purchase. Section 179, bonus depreciation, and the real cash-flow impact across 3–5 years all change the picture. Generic CPAs default to the simplest path. Dermatology practices need the most strategic one.
Retail product (skincare) COGS
Most practices selling skincare retail never set up product COGS properly. Margin on retail is small but real, and it touches sales tax, inventory accounting, and pricing decisions across the practice.
MD-owner vs PA-employed structures
Many dermatology practices grow into multi-provider models with PAs delivering most of the volume. The supervisory and ownership structures have material tax implications that are not obvious until they bite at year-end.
Our Approach
How we serve dermatology owners.
Bookkeeping built for service-line clarity
Separate income accounts and classes for cosmetic, medical, and retail revenue. Monthly close on a fixed cadence. Syft dashboards that show margin trend per line, not just aggregate revenue.
Tax planning for capital-heavy practices
Equipment depreciation strategy, R&D and Section 179 modeling, multi-year tax projections that account for planned laser or build-out investments before they happen.
CFO advisory for growth and structure
Pricing analysis across services. Provider compensation modeling. Buy-vs-lease decisions for equipment. Acquisition or sale prep when the time comes.
Coordinated multi-entity tax
If you operate a PC, an MSO, a Medspa, and a real-estate holding entity, we keep all of it aligned. Filing sequence, owner-level coordination, planning integration.
Frequently Asked
Questions dermatology owners ask.
How should we track cosmetic vs medical revenue separately?
In our setup we use distinct income accounts (and often distinct classes/locations) for cosmetic services, medical insurance services, and retail product sales. That structure flows through to the P&L and the Syft dashboard so you can see margin trends per service line in real time, not just at year-end.
What's the right depreciation strategy for laser equipment?
It depends on the practice's overall income, expected near-term revenue, and other equipment plans. Section 179 and bonus depreciation can fully expense a laser in year one, but that's not always the optimal answer — sometimes spreading depreciation matches better against future income. We model both paths before recommending one.
How do you handle skincare retail in QuickBooks?
Retail product gets its own income account and a corresponding COGS account. We track inventory at cost (often using a periodic method given practice size), reconcile to physical counts quarterly, and keep sales tax handling separate from professional service revenue.
When does it make sense to add a Medspa entity alongside the practice?
Sometimes — particularly when cosmetic services scale meaningfully and there is a non-physician owner involved. The decision sits at the intersection of state corporate practice of medicine rules, tax structure, and operational reality. We work with your healthcare counsel on the structure and own the financial-modeling side.
Can RTW help us prepare the practice for a sale or partnership?
Yes — that work falls under our Personal CFO Advisory service, specifically the Active and Executive Partnership tiers. We produce buyer-ready financials, model deal scenarios, and coordinate with M&A counsel and any private equity counterparties.
Talk to a CPA who knows dermatology.
We work with a small portfolio of dermatology practices. If we are a fit for yours, the strategy call is the next step.