Surviving and thriving after a natural disaster

By Emily Margosian, Assistant Editor, September 1, 2023

DermWorld talks to Mary Lupo, MD, FAAD, from the Lupo Center for Aesthetic and General Dermatology in New Orleans, about how to prepare your practice for a natural disaster.

Dr. Lupo: I opened my practice in 1984 right out of residency. In 1998, I hired another doctor, and he was with me until 2005, which is when Hurricane Katrina happened.

DermWorld: How did Hurricane Katrina affect your physical office space?

Dr. Lupo: I was out of business for four months after Katrina. There was six feet of water in the office building that I was in, and it was decimated. Fortunately, I was on the third floor, so there wasn’t any physical damage to my practice space, and I didn’t lose any equipment. However, prior to the storm I had just bought a huge order of neurotoxin, which had to be refrigerated. Since we didn’t have electricity, I lost all of that.

We didn’t start using electronic medical records until 2010, so we weren’t impacted in that way by Katrina. I had paper charts, but because our office had no wind or water damage, I didn’t lose any of those. I was very fortunate; I know another doctor in the area who had the roof blown off her space. She lost lasers and other equipment as well because of rain and wind getting into the building when the roof was compromised. Going through a hurricane you almost feel like a prizefighter — you don’t know where the next punch is going to come from.

DermWorld: What was the financial impact on your practice?

Dr. Lupo: The fact that our office escaped being flooded complicated our business interruption insurance. Since I didn’t have physical damage to the office, the insurance company only reimbursed me for days that fell under what they call “civil closure,” which is when they close an area because of dangerous conditions. When the water receded after about three weeks, that translated to only roughly 11 covered business days. Even though I was ultimately out of business for four months because there was no electricity to the building, and you cannot practice without electricity, they only gave me those 11 days of coverage.

I was able to pay employees out of personal funds for six weeks because I didn’t want to lose them, but after that period I suggested they file for unemployment. Fortunately, after we re-opened, I retained almost all my staff.

DermWorld: What did the process of re-opening your practice entail?

Dr. Lupo: I reopened in January 2006 after electricity was restored to the building. Although we had electricity, we still didn’t have an elevator, and didn’t have our phone lines or internet restored until about April 2006. Initially, I was only able to communicate with patients by cell phone because there were no landlines for months. I think my cell phone bill was $1,200 a month in 2006 because that was the only option I had. In the beginning, we literally became a walk-in clinic where people would climb two flights of stairs just to see if I was in for the day — which I was. I was in my office from 8 a.m. to 5 p.m. every day waiting to see patients. I can’t tell you what it meant to people when they came in and asked if they could make an appointment, and my staff would say, “You can see her right now!”

It was quite challenging, but also cathartic, because every patient who came in had a story: how they evacuated, what happened to their homes and their family members. I heard some of the most heart-wrenching, endearing, and uplifting stories from patients as people gradually made their way back to New Orleans. Today I am still in the same space, and I’m very glad that I chose to stay. We came back better, and we’ve been very successful post-Katrina.

DermWorld: What steps have you taken to physically safeguard your practice after Hurricane Katrina?

Dr. Lupo: I’m in an office building, so I don’t have a generator for my practice space. However, I did purchase a huge commercial generator for my home where I can store perishables if needed. Now, when we have a bad hurricane coming, we will take our lasers or other expensive equipment and put them in our office interior away from any windows that might be compromised. Our EHR system is backed up routinely to protect patient records.

While we don’t have a formal emergency response plan at our practice, the nice thing about hurricanes is that you usually have plenty of warning, unlike a tornado or earthquake. Usually, we have three days’ notice that something is coming our way and it’s time to get out of Dodge. We respect the recommendations of the authorities, close our practice appropriately, and encourage our employees to follow the recommendations of civil authorities based on the severity of the storm.

DermWorld: What steps can dermatologists take to financially safeguard their practice in the event of a natural disaster?

Dr. Lupo: My advice is don’t have a lot of debt, and make sure you aren’t over-leveraged with what you’re spending on your practice relative to what you’re earning. For example, make sure you’re not buying expensive equipment where you’re not going to get a good return on your investment. Like any business, you have to look at every decision as a risk-benefit ratio, and if you don’t have a lot of debt, you can survive a period where you don’t have income coming in.

It’s also important to have savings in reserve to pay employees. Consider that you have people who are dependent upon you for a living and can’t afford to be out of work as long as you can be. We as dermatologists are in a position to have personal savings that we can rely on, but our staff may not. Those are things I don’t think physicians always consider beforehand. So, take that into account and make sure you have the funds to support yourself and your staff in the meantime, similar to what we had to do during COVID.

Dermatologists should also make sure they’re insured responsibly. There are very few places in the United States where flood insurance isn't needed because you can have a flood anywhere at any time. By and large, if you’re not in a flood-prone area, flood insurance is going to be extremely reasonable. Dermatologists should also secure business interruption insurance, but note that there is now a longer waiting period before it kicks in. It used to be a week, and now in disaster-prone areas you typically must be out of business for three weeks before it kicks in.

I also recommend documenting equipment. We have pictures of everything. Keeping up-to-date records can help prevent insurance companies from arguing with you about depreciated value, although don’t be lulled into a false sense of security. Operate on the assumption that insurers will do everything they can to pay you as little as they can.

DermWorld: How can physicians maintain morale during a natural disaster?

Dr. Lupo: Believe in yourself and your team. When these things happen, the patients who relied on you are going to be back, and they’re going to want you to continue to care for them. You will be inconvenienced, you may be temporarily offline, but your patients will come back to you, and your business will still be there.

DermWorld: What role do physicians play in their community following a natural disaster? 

Dr. Lupo: Your continued presence in an area that has experienced a disaster is part of the healing for that community. If their grocery store or doctor doesn’t come back, it can cause a great deal of added stress. I think it’s a civic duty to do your best to re-engage in your community. I ran into an ophthalmologist from New Orleans nine months after I re-opened. She left after Katrina and was working in a different state because she didn’t think the city was going to bounce back. She was miserable, and asked, “Do you think I made a mistake not coming back? I was afraid I wasn’t going to have any patients.” I said, “You absolutely made a mistake, because your patients were looking for you, and you weren’t there.” I think doctors should be tough, and help their community get through a crisis.

Don’t be afraid to reach out and ask for help from colleagues. Over the past several years, there have been natural disasters that have affected dermatology practices across the country. I’ve received phone calls from other doctors asking for advice, and when I was recovering from Katrina, I had people shipping me supplies for my own offices. Don’t be too shy or proud to reach out and ask for help. My message to other dermatologists is that you can go through an absolute catastrophe and still survive and thrive afterwards.

Mary Lupo, MD, FAAD, is in private practice in New Orleans, and is clinical professor of dermatology at Tulane University School of Medicine.

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