We recently connected with Tej Mudigonda and have shared our conversation below.

Tej, thanks for joining us, excited to have you contributing your stories and insights. We’d love to hear the backstory of how you established your own practice.

Medicine has transitioned quite a bit from when I was a medical student at Vanderbilt University in Nashville, Tennessee, almost 10 years ago with big hospital conglomerates, large corporate medical groups, and fewer traditional isolated solo/group practices. In my specialty (dermatology), in particular, there has been a surge of large private-equity backed groups and practices dominated by non-physicians (advanced practioners) with few formally residency-trained board-certified dermatologists. This new model, for the better, has certainly immensely improved access to care for many patients in remote areas who may not be able to drive or receive care. At the same time- and I stress this to my colleagues at all levels- it is important to continue to provide the utmost highest level of care to each and every patient as if he or she were a family member and triage patients when appropriate while practicing in this new climate of medicine.

When I moved back to middle TN in early 2024 after having worked in a large organization in California, I sought to establish a practice in a location where I was hoping I could be busy and productive early on. I chose Wilson County, TN, and particularly the city of Lebanon, Tennessee because I felt it was great place to start a medical practice and serve a population in need of board-certified dermatologists and specifically, specialized services (i.e.- Mohs skin cancer surgery, varicose vein procedures). Selecting a location where I felt I could see myself long-term and get established is easily the biggest decision when starting a practice.

The subsequent technical logistics of practice formation certainly have their own challenges compared to working as an employed physician for a healthcare organization/hospital/group. You often take a lot for granted provided by a larger organization, particularly the business facets (i.e.- human resources, payroll, accounting, hiring employees, leasing and designing office space, purchasing medical equipment and recurrent inventory, marketing and building a consistent referral network). It almost becomes a second job – however, my personality has always been to attention to details and micromanaging so I was and still currently heavily invested in these tasks. However, as my practice continues to develop, I would certainly love to be completely focused in patient care and delegate these other tasks to employees.

Overall, I think my biggest piece of advice for anyone considering an independent physician route is to certainly do the market research and consider the reasons why to start one’s own practice. For some, particularly myself, it meant autonomy- the ability to create my own schedule, set up the office, purchase the devices and instruments and design protocols that fit my sub-specializations, and hire/train/retain staff that I felt would best optimize a busy patient schedule and healthy work culture. For others, it might mean financial benefits (i.e.- salary improvement) and a better work/life balance. Regardless, the best recommendation is to realize that starting a practice is similar to starting any type of client-oriented in-person business (i.e.- a bakery, barbershop) in that it takes time and the early phase can certainly be daunting when things are slow. However, I am a believer that the delayed gratification and autonomy long-term are certainly impactful and priceless.

Great, appreciate you sharing that with us. Before we ask you to share more of your insights, can you take a moment to introduce yourself and how you got to where you are today to our readers.

Medical school is a long career.
-4 years of undergraduate
-4 years of medical school
-1 year of internal medicine internship
-3 years of dermatology residency
-1 year of surgical fellowship

Along the way, there were 2 years of dedicated gap research years.

Every facet of my training has contributed to the development as a dermatologist and surgeon. My undergraduate years served as my basis for learning and solidifying my interest in science and interacting with patients. During college, I also worked in a laboratory where I performed surgery on trout fish to understand cardiovascular physiology – this certainly piqued my initial interest in surgery. Medical school allowed my to meticulously learn the human body both scientifically (anatomy, physiology, biochemistry, neuroscience, pathology) and clinically (rotations in internal medicine, surgery, gynecology, psychiatry, neurology). My research years at the National Institutes of Health and at Vanderbilt taught me to critically think about scientific literature and find solutions to complex disease pathology from the laboratory bench to bedside.

From this background, this paved me into a career in dermatology/surgery and into the study of the largest organ in the human body – the skin. The dermatology side of me is very “medicine” oriented as a big part of my day to day is to treat common skin pathology (growths, rashes) with skincare, topicals, oral medications, and injectable targeted biologic therapies. The surgery side in me is very procedural/hands on and integrates my strong understanding of anatomy and facial aesthetics. This involves procedures such as the removal of common cysts/lipomas or skin cancers on faces/hands/feet followed by subsequent reconstruction. It also involves aesthetic plastic surgery procedures – browlifts, blepharoplasties, facelifts, neck lifts – and non-surgical cosmetic dermatology – injectable fillers and neuromodulators, lasers, chemical peels. Overall, I enjoy that my field provides me the versatility to provide a range of medical, surgical, and cosmetic services for a broad range of patients to ultimately achieve a common goal – to look and feel good about their skin.

How’d you build such a strong reputation within your market?

I think what has helped build my reputation in the market has been transparency and education for my patients. I always envision myself in patients’ shoes when they walk in to my office.

If it is a medical patient, they are coming in to see me for the highest level of opinion in my specialization of dermatology for their skin complaint. I owe it to them to provide them the full details of their skin condition and a full understanding of the root causes, pathology, and treatment options.

If it is a cosmetic patient, I often have to dispel a lot of unfortunate “gimmicks” or “quick fixes” with highly expensive skincare and often non-surgical medical spa treatments and focus on the important factors to educate patients – a better understanding of facial anatomy, facial aging, and the tangible solutions that will work for them in light of their finances, safety, downtime, risks/benefits of such procedures. In a social media world of marketing both to the consumer and to myself (practitioner) – I believe patients have appreciated my honesty of focusing on the objective factors that are important.

Putting training and knowledge aside, what else do you think really matters in terms of succeeding in your field?

Being a physician is more than competency of knowledge, cerebral, and procedural skills. More often than not, as we get adapted into a steady state in our career/field we lose focus of the interpersonal values and communication with each unique and individual patient. This is something I try to avoid and make it important to learn about my patients, their life, their families, their hobbies and make it a point to keep up with them during subsequent visits.

Contact Info:

• Website: https://integratedskin.org
• Instagram: integratedskin
• Linkedin: https://www.linkedin.com/in/tej-mudigonda-829215135
• Yelp: https://www.yelp.com/biz/integrated-skin-institute-lebanon-lebanon