Lasers come in different shapes and sizes. They range from handheld to desktop to floor models. They can be attended or unattended. Their peak power can be very low or very high. Their average power varies dramatically as well. Is there a “best” laser? No.
Is there a best laser for your practice? Yes. How do we know that? Success with patients.
I am often asked to compare and contrast different lasers. I always make sure we are talking a common language. Below are a few terms that are standard regardless of which laser we are talking about.
Frequently-used laser terms1
Watt (W): The unit of power, equivalent to one joule of energy per second.
Joule (J): A unit of energy describing the work required to produce one watt of power for one second (one watt-second).
Joule per cm2 (J/cm2): A unit of radiant exposure used in measuring the amount of energy per unit area of absorbing surface. Also called the dose.
Peak power: The maximum pulse power output of a laser; this output is fixed by the laser manufacturer, measured in watts (W) or milliwatts (mW).
Average power: Refers to the average power per second a laser emits during treatment, measured in watts (W) or milliwatts (mW).
Power density: The intensity of the laser beam; average power divided by the size of beam (spot size); relates to the dose.
Watt per cm2 (W/cm2): The unit of irradiance used in measuring the amount of power per area of absorbing surface. Also called power density.
Energy density: The amount of joules emitted to the tissue per cm2 listed in J/cm2. This is often listed over a period of time, such as one second or 60 seconds.
Cold laser vs. hot laser
Please note the terms cold laser or hot laser are not defined. Lasers do not emit coldness. Originally, the term cold laser was used to distinguish therapeutic lasers from surgical lasers in the 1970s, which were “hot” or had a thermal effect as a result of the focused average power required to cut and perform surgery. The FDA did not clear any lasers above 500 milliwatts (mW) of power until 2004. Therefore, a maximum 500 mW or Class 3b became the de facto power level equated with non-surgical or cold lasers.
Laser classifications
Manufacturers and many practitioners refer to lasers by their laser classification as shorthand for their amount of power. The FDA established the safety classification system primarily to indicate the risk of injury to the eyes.
Laser and LED Safety Classification* | |
| Class 1 | Safe under reasonable operation |
| Class 1M | Generally safe – Some precaution required |
| Class 2 | < 1mW average power, visible light low power; blink response limits risk |
| Class 2M | UV or IR light at low average power, generally safe LED systems |
| Class 3R(A) | Safe for viewing with the unaided eye |
| Class 3a | 1-5mW of average power |
| Class 3b | 5-500mW of average power; viewing beam is hazardous to eyes, but diffuse reflections are safe |
| Class 4 | >500mW average power all the way to industrial MegaWatts; hazardous to eyes under all conditions |
| *Based on safety, not clinical performance | |
Photobiomodulation therapy (PBMT)
According to the American Society for Laser Medicine and Surgery, “A suggested definition for PBMT is a form of light therapy that uses non-ionizing forms of light sources including lasers, LEDs and broadband light, in the visible and near infrared spectrum. It is a non-thermal process involving endogenous chromophores eliciting photophysical and photochemical events at various biological scales.”2
The biological effects occur provided a sufficient dose is delivered to the target tissue. The mechanism of action can be primary, secondary or tertiary. Therefore, Class 2, Class 3b and Class 4 lasers can influence biological changes. The key is training on how to use the laser to achieve your treatment goals.
Your colleagues’ laser experiences
Chris Proulx, DC, PhD, CSCS, practices in Brookfield, N.H. He has utilized lasers in his practice for nearly two decades with excellent results. He has lectured on lasers to thousands of healthcare providers around the world. He stated, “Although there are many overlapping benefits of various class lasers marketed as low-power to high-power, with each having their place, the high-power lasers allow for higher dosing and the ability to cover larger surface areas.” He elaborated by adding, “This provides an opportunity for applications or indications not feasible (given time, and likely energy dissipation) by lower-powered lasers.” Proulx summed up by noting, “High-power lasers also allow for patient sensory stimulation, which may add to the multi-dimensional aspect of patient satisfaction and subsequent clinical outcomes.”
Michael Sheps, DC, practices in Los Angeles, Calif. He has lectured and shared his techniques with many colleagues around the U.S. and internationally for more than 20 years. Like Proulx, he has increased the power of his lasers over the last decade. He is a former athlete, which has led him to work with Olympic, college and professional athletes for many years. Sheps noted, “Laser is a great modality for treating not just athletes, but also my everyday patients. In both cases, I need to get the patient back to pre-injury condition as quickly as I can.” Furthermore, he stated, “I use laser with other modalities to maximize the body’s natural healing power.”
Thinking about adding laser to your practice?
Show me the numbers
Intrigued about adding a laser to your practice? The Chiropractic Economics 27th Annual Salary and Expense Survey reported the average doctor of chiropractic pays themselves $99,327 with average total compensation of $143,098.3
Revenue potential
So, let’s examine some revenue models for laser treatments in your practice. Allowing for four weeks of vacation, the chart below shows 48 weeks of patients receiving laser therapy within a 12-month period. The assumption is each patient receives five treatments, which is very typical. Also keep in mind multiple streams of revenue are possible from your laser, depending on which treatments your particular office desires to perform.
Twenty-five patients per week paying $40 per treatment in a series of five treatments equals $48,000 per year. What would an extra $48,000 in cash do for your practice?
Review the chart for the scenario you feel matches your practice’s potential.
Potential Annual Revenue from Adding Laser Therapy* | |||||
| Average Charge | $30 | $40 | $50 | $60 | $75 |
| 5 pts x 48 weeks | $7,200 | $9,600 | $12,000 | $14,400 | $18,000 |
| 10 pts x 48 weeks | $14,400 | $19,200 | $24,000 | $28,800 | $36,000 |
| 15 pts x 48 weeks | $21,600 | $28,800 | $36,000 | $43,200 | $54,000 |
| 20 pts x 48 weeks | $28,800 | $38,400 | $48,000 | $57,600 | $72,000 |
| 25 pts x 48 weeks | $36,000 | $48,000 | $60,000 | $72,000 | $90,000 |
| 30 pts x 48 weeks | $43,200 | $57,600 | $72,000 | $86,400 | $108,000 |
| 35 pts x 48 weeks | $50,400 | $67,200 | $84,000 | $100,800 | $126,000 |
| *Based on five treatments per patient over 48 weeks | |||||
The bottom line
It is hard to cut expenses sufficiently to greatly impact profitability. It is more effective to increase revenue, especially cash, in your practice. Laser therapy is a valuable modality that can help you achieve your goal of increased profits while achieving better patient outcomes.
ROB BERMAN, MBA, is a partner at Berman Partners LLC, a medical device sales, service and marketing company. Berman Partners specializes in new and pre-owned therapeutic lasers. He also is partner at Energia Medical LLC, which specializes in light therapy products. He helps doctors improve patient outcomes while increasing their income. He has held a variety of marketing roles during his career. He can be contacted at 860-707-4220, rob@bermanpartners.com or bermanpartners.com.
References
- Hode, L, Tuner J. Laser Phototherapy Clinical Practice and Scientific Background. 2014. Sweden: Prima Books.
- Photobiomodulation. American Society for Laser Medicine and Survey (ASLMS) website. https://www.aslms.org/for-the-public/treatments-using-lasers-and-energy-based-devices/photobiomodulation. Accessed April 8, 2024.
- Payne A. 27th Annual Salary and Expense Survey. Time to start thinking big. Chiropractic Economics. Issue 8, May 19, 2024.
