Dr Beth Goldstein of Modern Ritual: 5 Things You Need To Create A Successful Career As A Dermatologist
An Interview With Luke Kervin
Enjoy people. One of the things I love about dermatology is getting to know someone beyond their dermatologic condition. For instance, I met a patient the other day who is 80 years old. She grew up in the bush of Alaska with her father’s career being a large game guide/hunter. There were a total of five people in her “village.” Her family and two old gold miners. Her stories of how her life transpired were so interesting. When she went to upper school in Sitka, she sat watching Orca whales out her windows.
As part of my series about healthcare leaders, I had the distinct pleasure of interviewing Dr Beth Goldstein.
Dr. Beth Goldstein is the co-founder and Chief Medical Officer at Modern Ritual, a new men’s skin healthcare platform. She is also President of Central Dermatology Center in North Carolina, one of the largest private dermatology practices, where she focuses primarily on the treatment of skin cancer, including performing Mohs surgery
Thank you so much for joining us in this interview series! What is your “backstory”? What led you to this very interesting career?
As the eighth person in my family to go into medicine, becoming a doctor was not a unique decision. From the age of 12 I worked in the town’s GP’s office doing every job from rooming and assisting with patients, answering the phones, filing, you name it. I knew I wanted to go into medicine but after my third year of medical school I was quite disheartened. Much of that year is spent in the hospital and I preferred outpatient care with long term relationships with patients that I had seen during my years working with Dr. Baugh, the town GP. He did everything from caring for the nursing home patients, prisoners, to home visits. He was inspiring and I knew I wanted to have that experience in my career where you got to know your patients in an impactful way. My cousin’s (then) wife was a dermatology resident, and he was an OB/GYN resident. I thought I would love women’s health, but everyone seemed burned out and miserable. He suggested I try dermatology. He said they are all HAPPY! I spent my first month on the rotation being exposed to a specialty I had never personally experienced and did not even remember the medical student lecture. After the first month I was not yet convinced about the relationship with patients. I did a second rotation and the residency director shared with me the following that I have found to be completely true. When you take care of a publicly facing issue or a miserable skin condition, it is extremely impactful for your relationship with that patient to improve their quality of life. Also, you can see patients of all ages, families and over time. There is surgery which I love, but it never takes more than an hour! It is procedural and intellectually stimulating with crossover with many areas such as infectious disease, rheumatology, oncology, pediatrics, etc.
After 17 years in practice, I was able to pursue my dream of focusing on the treatment of skin cancer with learning the Mohs surgical technique. For the last 14 years I have focused primarily on the treatment of skin cancer. I continue to supervise our physician assistants, so I still keep my general dermatology skills up and enjoy the variety.
Can you share the most interesting story that happened to you since you started your career?
I have been thinking about this. I would say the patient that had been misdiagnosed with an abscess on the back of her scalp came to see me. She was in horrific pain with very swollen lymph nodes and a draining wound on the back of her head. She shared that she had been hiking in Central America. I took one look and knew it was a botfly larva, removed it and she healed quickly. I have treated this condition again a few times, but there is nothing like a first on this one.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Well, I was working on a gentleman and he said, I have a stomach tickle (turns out a diverticular flare) and he had a large wound where I had removed the cancer but had not stitched him up just yet. I had to walk around the room with him putting in his sutures. It was “interestingly funny” …poor man, but we got him fixed up.
Are you working on any new or exciting projects now?
I am! I have my practice that I built as the founder/sole proprietor in 1994 that is now six locations, twenty-two providers and growing. I have also started a company with my daughter, Modern Ritual. Our mission is to help men have their healthiest skin. This came out of a desire to help my male patients have a product to use on a daily basis with SPF 30 that was made for them, that they would actually enjoy using. My husband had his first skin cancer scare around this time which pushed us to move forward with this initiative. We did a research project with two published, peer reviewed articles (along with my husband — so father, mother, daughter on two articles) and formulated our product, The Daily by Modern Ritual.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Gosh there are so many people that I am grateful to have in my life along this journey. I would say the most important person is my former practice partner, Dr. Jennelle Williams. She has recently retired after 21 years of working together. We met after I had recently opened my own practice to talk about working together, but I had no space! She took a job at Duke and as soon as I had space, I met with her, and my luckiest day is when she said she would join me in practice. She is a brilliant dermatologist, a kind and humble person who taught me to be as comprehensive as possible in thinking about solving complex patient problems. She was the most fair and supportive person I have ever encountered and am beyond blessed to have had her in my practice and continued as a close friend. Our most supportive moments were when we needed to “re-calibrate” after a stressful patient experience or difficult situation. She is beyond wise.
Additionally, my husband, who is also a Professor Family Medicine at UNC. We will be celebrating our 37th wedding anniversary this year. We have coauthored two books, several articles, lectured across the country and are co-editors on several topics on UpToDate. Not only do we have our three children and a lovely granddaughter, but he continues to help me stretch my comfort zone professionally. He is my biggest cheerleader, and I could not have asked for a better partner in life to have in this journey. We are continuing with our daughter, Elianna, to do more research and writing even at this point in both of our careers.
Is there a particular book that made an impact on you? Can you share a story?
I would say Mountains Beyond Mountains, the story of Dr. Paul Farmer who recently passed. This story is about a physician who overcame difficult odds to become one of the most important figures in making a difference in the most underserved patients in our world. His story of overcoming not only his personal adversity but his passion to make a difference. When you think the problems are too hard or too big, you can feel as though you cannot make a difference. His story shares that you can, even with small steps.
He in particular cared for HIV patients. My brother died 30 years ago from AIDS around the time he started his work in Haiti, so there was an emotional connection to the direness of the situation he was addressing at the beginning of his career.
I have worked to rejuvenate and create a structure for a community of caring in my faith community that helps support those in need. I feel he inspired me to act, even if small and local, to make a difference, to set up structures to improve the lives of people, one at a time. It does not have to be a big project to make a difference.
How have you used your success to bring goodness to the world?
One patient at a time I remind myself that I am grateful for this opportunity to care for patients and hope that this transfers to the care and healing of each and every patient. I also mentor many pre-Med, pre-PA students in my practice who do go forward to have careers in many specialties, but quite a few in dermatology. We work to donate supplies and personal care products to local clinics on a regular basis.
My main contribution would be in philanthropy. I support many causes from our local Rape Crisis Center, food insecurity nonprofits, among many others. I am an Amonette Circle member for Skin Cancer Foundation, supporter of many nonprofits over the years along with my department that trained me. I also continue to volunteer for Community of Caring Committee which helps support people in times of need.
Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant to you in your own life?
God grant me the Serenity
To accept the things I cannot change,
Courage to change the things I can,
And the Wisdom to know the difference.
I had a patient in this week who has a severe seizure disorder. I was able to remove her skin cancer via Mohs. However, it was more extensive and needed a complex repair. After her having two seizures during the Mohs procedure, I knew she needed sedation that I cannot offer in order for her to have the best result. I was unable to get her into a Plastic Surgeon on her insurance plan and my staff worked tirelessly to get her insurance to approve the out of network Plastic Surgeon for her closure for the best outcome. I could not change some of the aspects of her situation but did work to change the things that I could along with a supportive staff. It was stressful for all involved and remembering that to do what we could, was key and to act on that.
Thank you for all of that. Here is the main question of our interview. What are your “5 Things You Need To Create A Successful Career As A Dermatologist’’ and why?
1. Enjoy people. One of the things I love about dermatology is getting to know someone beyond their dermatologic condition. For instance, I met a patient the other day who is 80 years old. She grew up in the bush of Alaska with her father’s career being a large game guide/hunter. There were a total of five people in her “village.” Her family and two old gold miners. Her stories of how her life transpired were so interesting. When she went to upper school in Sitka, she sat watching Orca whales out her windows.
2. Learn from your patients. When I finished my training, it was only the beginning of the journey of taking care of patients. I learned a lot from my patients, not just from journal articles or conferences. I remember a woman who was so miserable and itchy. We did testing, elimination diets, you name it. I sent her to a contact dermatitis specialist. It turned out that the patient figured out that she was allergic to the aspartame in her diet drinks. From then on, when I had someone so itchy without a clear-cut source, one of my first questions from then on was “do you drink diet drinks?” So simple, but so impactful to stop her misery! Another story is that a patient brought a recipe of herbal teas for perioral dermatitis treatment. When all of my conventional therapies would hit a dead end, I would pull up the recipe and lo and behold it worked more times than not!
3. Seek knowledge with a critical eye. Sometimes the latest and greatest new treatment is tempting to try. There was a new psoriasis treatment many years ago as a new revolutionary immune treatment. While it worked, it turned out that it did reactivate a fatal virus in a few patient’s brains. This signal of concerning side effect was not found during the initial trials but only after it was in the market. I learned that you don’t need to jump on the bandwagon of the newest and latest treatments if you have not exhausted what typically can work. Reserve use for those patients who are non-responders to more conventional treatments that have been out for a while.
4. Be respectful of your staff and show appreciation. It does not matter how your experience is with the patient or your wonderful care. If the person answering the phone to schedule, the assistant bringing the patient back, checking them out to the biller, is not respectful, it is a reflection of YOU. They are as integral to building a successful career as any other aspect of your care. I have had patients share how much the care and support during their experience made all of the difference in their healing. I had a patient who could not care for his wound. He lived alone and fortunately could drive. My staff reassured him that we would work to help take care of his wound for him. They did not even ask me, I found out about this later. Your staff will follow your lead. If you are compassionate and put the patient’s needs first, so will they.
5. Love to learn. We are fortunate as dermatologists to have such amazing advances in therapeutics, diagnostics that are evolving every month it seems. Surround yourself with colleagues who have the same desire to continue to keep abreast of the literature. In my practice we often can share history, photos, prior treatments with our colleagues when we need support in making certain we are giving our patients the best care. My husband had a colleague who was the physician on a ship for Semester at Sea. He sent photos of the young woman’s face. He had already tried multiple antifungal creams but was not seeing any improvement. One of my colleagues knew exactly what this rare tropical fungus was and how to recommend an effective treatment (once they come into a port!)
What are the “myths” that you would like to dispel about being a dermatologist?
There was a great Seinfeld episode where he is accusing his date who is a dermatologist…oh you are just a pimple popper; you are not a real doctor. One of her patients then comes up to thank her for diagnosing his melanoma and saving his life.
There is a perception more recently that dermatologists focus on cosmetic treatments and are not serious about practicing “real medicine.” While esthetic treatments can certainly enhance lives and should be done in a safe and quality environment, that is just a fraction of our training and what we offer to our patients.
Can you explain what you mean?
Our depth and breadth of disease diagnosis with our primary care and specialty physicians is often not known or appreciated. For instance, a particular birthmark in a newborn can herald internal serious illness from spinal cord to heart to brain issues. Often the skin is the presenting sign of many conditions from internal malignancies, leukemia, thyroid disease, inflammatory bowel disease to just name a few. In addition, the disease states that we manage such as psoriasis, eczema, hidradenitis have been well documented to have extreme negative impacts on quality of life. We also diagnose and treat the most common and prevalent cancers.
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
Of course, as a dermatologist we are all about reducing UV damage. There is a clear importance of also early detection of skin cancer. While there is some controversy regarding potential overdiagnosis of early melanoma. However over 90% of costs of treatments for skin cancer, the most common cancer, is to manage late-stage disease. Therefore, early treatment can not only reduce costs, but reduce morbidity and mortality.
Awareness of why we should use sun protection every day, year-round as a public health message such as they do with slip slap slop campaign since the 1970’s and banning of all tanning beds.
I have started an initiative with my daughter with a program to give access at home for early diagnosis of skin cancer.
I have received hundreds of comments from people across the country who want to know if their spots are — or are not — skin cancer. They could not get an appointment with their dermatologists or had to drive hours to get to the nearest location. It had me thinking more, perhaps there is a role for Modern Ritual, our company, in making this easier.
That is where the idea came for our at-home ‘spot check’ came from. We use real dermatologists to evaluate images taken at-home using an iPhone attachment for enhanced imagery. Once ordered, a kit is be mailed out with all the supplies needed to take high-quality images of the lesion.
The program, still in beta testing, will launch in North Carolina, and several more soon to be announced states this fall.
We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them 😊
I would enjoy meeting with Melinda Gates. She has been a visionary in making a huge impact in meaningful ways to reduce suffering on the planet. Learning about her worldview, how she approaches problems and seeking guidance on how to make a difference, even if you are not a billionaire!
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