derm-based family med practice?

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I see where you’re coming from. They are easy to set up shop and perform which is why we attract a higher number of mid-level and physician imposters. Got it.
Correct. Not once did I say this is a wonderful thing and we should be blessed to have a NP doing fillers and Botox on unsuspecting 40 year olds. I think it’s all stupid as hell.

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There is no such thing as midlevel neurosurgeons or radiologists. Some specialties are easy for midlevels to encroach on. That is the truth. That does not mean that they are good at them.

Because who the hell (other than neuroSx and rads) electively chooses to be up at 2am reading plain films or doing a crani. Laser, Botox, fillers are perceived to be as easy as point and shoot from the hours of 9am-4pm so you get a bunch of unqualified people hopping on the train for a quick buck at potentially the patients expense. Interestingly, I’ll bet no FM would dare point a laser at someone’s eye and pretend to be an ophthalmologist for a day.
 
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Because who the hell (other than neuroSx and rads) electively chooses to be up at 2am reading plain films or doing a crani. Laser, Botox, fillers are perceived to be as easy as point and shoot from the hours of 9am-4pm so you get a bunch of unqualified people hopping on the train for a quick buck at potentially the patients expense. Interestingly, I’ll bet no FM would dare point a laser at someone’s eye and pretend to be an ophthalmologist for a day.

I spent a grand total of 1 day in a busy residents' derm clinic and surprisingly enough saw 2-3 awful complications following faulty application of phototherapy/laser. person looked like they were in epicenter of a nuclear blast. Made enough impression on me that I'd always chose a board certified dermatologist for my cosmetic needs if I ever start caring about my appearance lol.
 
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Once you're medically licensed you can kind of do whatever you want, so long as you can find an institution to credential you and insurance providers who will reimburse you for your work. Non-dermatologists do nevi resections, botox injections, etc all the time. You can go the cash route, but understand that the people willing to pay cash for cosmetic services generally care who is doing the procedure and may not want to pony up the $$$ for a non-dermatologist, but even then there are still avenues to make money.

With that said, medicolegally, you will be held to the Standard of Care should you ever end up in court - meaning if you fxck up you will be held to the standard of someone board certified in Dermatology. Just as how it's not usually a great idea for non-surgeons to do appendectomies or craniotomies, it's generally not the greatest idea for non-derm people to be prescribing biologics, steroids and doing Mohs surgeries.
You know RNs do botox, right? And fillers. And other stuff.

Seriously this whole culture of thinking doctors being held to absurd standards while non-doctors can do anything is nuts.
 
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No, he’s a phoney. I don’t recall, but I think he was in anesthesia then bailed midway through residency. I don’t think he’s board certified in anything.

One poster above commented that patients are smarter and are going to board-certified specialists for their cosmetic work. Whether that’s true or not I’m not sure, but the other aspect is that frauds are advertising themselves as something they are not and patients can’t tell the difference - I don’t blame them for not knowing the inner workings of medical school, residency, licensing etc. For instance, if someone opens a clinic called “California Skin Center of Excellence”, and the physician calls themself a “cosmetic surgeon,” how is a patient supposed to know it’s not a dermatologist or plastic surgeon working there? Shady, shady business by people looking to get a slice of pie that wasn’t theirs to begin with.
Lets be real, he's balling and he produces results in his line of work. To say otherwise is complete jealousy. Business skills are a huge #1 in cosmetics but people pay for results and not a service - and the results literally show.

Idk why y'all are hating on Simon so much. Seems to me the dude is doing it BIG time and achieves better results with what he's doing than probably any derm on SDN
Jealousy. The guy's business acumen is incredible and these guys thought their step scores could also land them a Beverly Hills derm post.
 
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Lets be real, he's balling and he produces results in his line of work. To say otherwise is complete jealousy. Business skills are a huge #1 in cosmetics but people pay for results and not a service - and the results literally show.


Jealousy. The guy's business acumen is incredible and these guys thought their step scores could also land them a Beverly Hills derm post.

More or less agree with this. Most people who go into medicine take the attitude that they'll invest a ton of hours in repetitive training and - upon residency/fellowship graduation - be courted, wined, and dined into well-paying jobs without having to risk very much (apart from having spent their early adulthoods in classrooms and hospitals). Guys like that cosmetic surgeon have (or develop) an entirely different approach toward their careers. They take risks and go outside their comfort zones. Frankly, if he did leave in the middle of his residency, that makes the move all the more impressive.

Self-learning is a phenomenon. I wonder how many of the people who react viscerally to his approach also grumble about MOC and the greed/ineptitude of medical specialty boards.
 
More or less agree with this. Most people who go into medicine take the attitude that they'll invest a ton of hours in repetitive training and - upon residency/fellowship graduation - be courted, wined, and dined into well-paying jobs without having to risk very much (apart from having spent their early adulthoods in classrooms and hospitals). Guys like that cosmetic surgeon have (or develop) an entirely different approach toward their careers. They take risks and go outside their comfort zones. Frankly, if he did leave in the middle of his residency, that makes the move all the more impressive.

Self-learning is a phenomenon. I wonder how many of the people who react viscerally to his approach also grumble about MOC and the greed/ineptitude of medical specialty boards.
Yup exactly. This guy may venture into the grey area when it comes to marketing but so does every single cosmetics guy and... pretty much every large scale marketing venture.
Real derms on here make fun of him because he makes 10-15x their income and hangs out with celebrities.
 
Private practice dermatologist/Mohs surgeon here. I see quite a bit of dermatology being practiced by nondermatologists and I’m cool with most of it.

Most commonly you have family med docs and internists who do basic dermatology out of necessity (a large percentage of presenting complaints to PCPs are skin related). Family docs do better than internists here because they’ve had more exposure and are typically more experienced with a variety of minor skin procedures. So they treat minor rashes with topicals and perhaps do biopsies of suspicious lesions to rule out dysplasia or cancer. I think this is great especially if PCPs are experienced with skin biopsy because early diagnosis makes my job easier and the patients outcome better. Often I see patients with advanced skin cancer who were told by an internist that “It’s nothing” probably not because they recognized it as a benign lesion but because they don’t have the first clue about what they were looking at but are still for some reason giving advice.

Second, I do know some family docs who have opened skin clinics. I don’t think they can call themselves dermatologists but instead will say they are “skin specialists”. I don’t feel threatened by this because the ones I know are either in a very small underserved rural town or on the poor side of a big city. They don’t really take patients away from the dermatologists (it’s tough to find private derms here who take Medicaid for example). As a result they tend to see lots in the Medicaid population. Some do good work. I personally know a family doc who trains others in a fellowship program. They get good training with him. They come out with a healthy understanding of appropriate care and their limitationsand when to refer. I personally haven’t seen one of these family docs practicing inappropriately.

In summary, I’m happy to have PCPs that know some derm and when to refer. The number of primary care folk who just see skin is low and they tend to care for the underserved and aren’t replacing derms. As far as cosmetics, I do none so I don’t care at all about this.
 
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Private practice dermatologist/Mohs surgeon here. I see quite a bit of dermatology being practiced by nondermatologists and I’m cool with most of it.

Most commonly you have family med docs and internists who do basic dermatology out of necessity (a large percentage of presenting complaints to PCPs are skin related). Family docs do better than internists here because they’ve had more exposure and are typically more experienced with a variety of minor skin procedures. So they treat minor rashes with topicals and perhaps do biopsies of suspicious lesions to rule out dysplasia or cancer. I think this is great especially if PCPs are experienced with skin biopsy because early diagnosis makes my job easier and the patients outcome better. Often I see patients with advanced skin cancer who were told by an internist that “It’s nothing” probably not because they recognized it as a benign lesion but because they don’t have the first clue about what they were looking at but are still for some reason giving advice.

Second, I do know some family docs who have opened skin clinics. I don’t think they can call themselves dermatologists but instead will say they are “skin specialists”. I don’t feel threatened by this because the ones I know are either in a very small underserved rural town or on the poor side of a big city. They don’t really take patients away from the dermatologists (it’s tough to find private derms here who take Medicaid for example). As a result they tend to see lots in the Medicaid population. Some do good work. I personally know a family doc who trains others in a fellowship program. They get good training with him. They come out with a healthy understanding of appropriate care and their limitationsand when to refer. I personally haven’t seen one of these family docs practicing inappropriately.

In summary, I’m happy to have PCPs that know some derm and when to refer. The number of primary care folk who just see skin is low and they tend to care for the underserved and aren’t replacing derms. As far as cosmetics, I do none so I don’t care at all about this.
How about nurses doing cosmetics, effectively solo?
 
@zanzizic or whoever would be open to answer the following...

I've shadowed different derm practices that have several PAs and NPs. Are there any Derm offices that will hire FM doctors to work on the cosmetic side of things (lasers etc.) as well as doing skin checks? Or would the FM doctor not be reimbursed at a level that would be worth it for either party?
 
@zanzizic or whoever would be open to answer the following...

I've shadowed different derm practices that have several PAs and NPs. Are there any Derm offices that will hire FM doctors to work on the cosmetic side of things (lasers etc.) as well as doing skin checks? Or would the FM doctor not be reimbursed at a level that would be worth it for either party?

Work done by "supervised" PAs and NPs get reimbursed the same or close as physicians by most insurances, but their pay is less. You're not going to see many Derm clinics willing to pay more to an FM doc when they can get an NP or PA doing the same thing for less pay.
 
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Work done by "supervised" PAs and NPs get reimbursed the same or close as physicians by most insurances, but their pay is less. You're not going to see many Derm clinics willing to pay more to an FM doc when they can get an NP or PA doing the same thing for less pay.
Truthfully many of the PAs in Derm I have worked with are much better than other physicians at Derm (excluding actual dermatologists of course). It’s just a result of other fields have zero exposure and no understanding

but the PAs are miles times more behind us (the Derm residents)
 
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@zanzizic or whoever would be open to answer the following...

I've shadowed different derm practices that have several PAs and NPs. Are there any Derm offices that will hire FM doctors to work on the cosmetic side of things (lasers etc.) as well as doing skin checks? Or would the FM doctor not be reimbursed at a level that would be worth it for either party?
I highly doubt that any reputable (or even non-reputable) dermatology office would ever hire a FM/IM doctor to do anything dermatology related. It would look really bad on their website and on top of that they could hire an RN for cosmetics for 1/5 the price or a mid-level for skin checks for 2/5 of the price of a FM doctor.
 
@zanzizic or whoever would be open to answer the following...

I've shadowed different derm practices that have several PAs and NPs. Are there any Derm offices that will hire FM doctors to work on the cosmetic side of things (lasers etc.) as well as doing skin checks? Or would the FM doctor not be reimbursed at a level that would be worth it for either party?
Why in the world would you want to be hired? You can set up shop and do it yourself.

Of course, cosmetics has a huge downside. The patient population, big marketing game, saturated, etc. Lots of family doctors do botox and other cosmetic procedures though and you'll attract a lot more patients than a midlevel would.
You'd have to leverage your marketing game. I've seen strong setups where they blatantly advertise "no midlevels, no nurses, doctors only" and it goes well with the patient population who really does their research.

If the derm/plastic surgeon is doing an injection - they may hypothetically charge 100$. They'll charge like 60$ for their midlevels/nurses to do it. And you as the family doctor would be charging like 80$ in that market. So patients who have big wallets but not enormous ones (aka entire upper middle class) would be your market.
 
Why in the world would you want to be hired? You can set up shop and do it yourself.

Of course, cosmetics has a huge downside. The patient population, big marketing game, saturated, etc. Lots of family doctors do botox and other cosmetic procedures though and you'll attract a lot more patients than a midlevel would.
You'd have to leverage your marketing game. I've seen strong setups where they blatantly advertise "no midlevels, no nurses, doctors only" and it goes well with the patient population who really does their research.

If the derm/plastic surgeon is doing an injection - they may hypothetically charge 100$. They'll charge like 60$ for their midlevels/nurses to do it. And you as the family doctor would be charging like 80$ in that market. So patients who have big wallets but not enormous ones (aka entire upper middle class) would be your market.

The problem with that supposition is that the patients who "really do their research" will really want someone formally trained in derm or plastics.

That being said, the market is still pretty wide open for botox - I know plenty of EM docs and FM docs who do it on the side.
 
The problem with that supposition is that the patients who "really do their research" will really want someone formally trained in derm or plastics.

That being said, the market is still pretty wide open for botox - I know plenty of EM docs and FM docs who do it on the side.
Right, so they will seek out a derm or plastics. But not if the derm/plastics' RN or midlevel is doing the injection; which is the typical setup in most cosmetics practices nowadays. And for many of those patients, having the derm do the injection is too pricey and they opt for the FM down the road (who will do the injection himself/herself) who also has a cosmetics practice.
 
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