From Scratch

Dr. John Cowan established Bowling Green Dermatology & Skin Cancer Specialists as a champion of skin cancer detection and treatment and as a model for independent practitioners

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BOWLING GREEN Fresh out of dermatology residency at Emory University in Atlanta, Ga., in the summer of 2008, John Cowan, MD, knew he wanted to be an independent practitioner. “Instead of joining any other practices, we decided to start our own practice from scratch,” he says. The “we” are Cowan and his wife Amy, who serves as the practice’s office manager. The couple settled in Bowling Green, where Cowan says they found a similar feel to his hometown of Somerset, Ky., and a community that fit their family’s personality. In fall 2008, Bowling Green Dermatology & Skin Cancer Specialists opened its doors.

Cowan attended medical school at the University of Kentucky and took his internal medicine internship at New York University, before completing his residency at Emory. Dermatology was a natural fit for Cowan, who says, “I was always drawn toward the procedural side.” He also relishes the opportunity to see patients of all ages and the chance to stay out of the hospital.

The main focus of Bowling Green Dermatology & Skin Cancer Specialists is diagnosis, treatment, and long-term management of skin cancers. “I’ve had a skin cancer myself, and it’s something I’m passionate about – to help patients overcome the diagnosis and get proper treatment and move on with their lives,” says Cowan. Because it’s focused on skin cancers, the practice heavily favors surgical dermatology, although they do offer medical, pediatric, and cosmetic dermatology services. Cowan performs surgery three to four days a week and holds general dermatology clinic two days a week.

All surgical procedures are performed in-office. “The beauty of dermatologic surgery is that you’re able to do it in the outpatient setting and in your office,” he says, and contends in-office procedures benefit patients by being less expensive and safer, as they avoid the risks of general anesthesia and hospital infections.

Cowan is trained in Mohs Micrographic Surgery and is a fellow for the American Society for Mohs Surgery. “In my opinion, I think every dermatologist should have knowledge of doing Mohs surgery,” he says. Calling it the “gold standard” for skin cancer removal, particularly for head and neck lesions, Cowan values the ability to evaluate 100 percent of a cancer’s margins.

While Mohs training is part of the core competencies of dermatologic residency, some programs focus on it more than others. Cowan says he was fortunate to attend a program at Emory that was “weighted very heavily towards the surgical part of dermatology.”

Of the skin cancers Cowan sees, the majority are basal cell and squamous cell, but he notes they do see a remarkable number of melanomas each year. He has also seen more unusual cancers, such as verrucous carcinoma and merkel cell carcinoma.

In order to ensure there are appointment slots available to evaluate suspicious lesions on a timely basis, the practice holds designated slots for acute patients, a service that is well received by referring physicians.

Leading by Example

Cowan readily admits that there have been hurdles along the journey of establishing and maintaining a solo practice, but he is a staunch advocate for independence and physician leadership. “I think if I were to give anyone starting this process some advice, I would say number one, have the courage to do it because in this environment, with all the health care changes going on, some of the individual physicians do not want to take on the responsibility of being a business person and a good doctor, and I think that is to the detriment of the field of medicine in general,” he says. “We have, in many ways as physicians, ceded our power to what I call the “suits.” The “suits” or health care administrators are not in a position, in my opinion, to really stand up for what the principles of medicine should be about.”

Running a successful practice that demands excellence of its staff and fosters a personal touch with its patients is Cowan’s way of leading by example.

As for his formula for success, Cowan says his business philosophy is pretty simple. “I think the important thing for growth is to try to do right by each patient, try to establish a good reputation … We think patients will find us if we do a good job,” he says.