Family Practce docs operating as dermatologists

[novacek88]

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I'm seeing this trend more and more. But is it realistic for a family practice physician to lure enough patients for cosmetic procedures when dermatologists exist? I have heard mixed reviews about this. I have heard this is an excellent way for a FP doc to make some $$$. Others say it's not practical and that luring cosmetic procedures as an FP is next to impossible. What's your take on this issue?

 

[Fermata]

I'm seeing this trend more and more. But is it realistic for a family practice physician to lure enough patients for cosmetic procedures when dermatologists exist? I have heard mixed reviews about this. I have heard this is an excellent way for a FP doc to make some $$$. Others say it's not practical and that luring cosmetic procedures as an FP is next to impossible. What's your take on this issue?

Think about who controls referrals.

 

[Pilot Doc]

...when dermatologists exist?

That's the key point. The derm powers that be purposefully constrain the supply of dermatologists. The supply-demand mismatch allows the cash only practices with 8 week appointment backlogs typical of dermatology. In that setting, their turf is ripe to be poached by FP's and everyone else.

 

[novacek88]

Think about who controls referrals.

But cash based procedures do not require referrals. A patient does not need an FP doc to refer him or her to a dermatologist if the patient is seeking botox and cash based procedures? A patient can make an appointment directly with the dermatologist in this example. I can see FP docs taking business away from dermatologists because they offer reduced rates for common procedures and have less wait time like someone already mentioned.

 

[allendo]

So if fp's don't make referrals to Derm; who do they make referrals to? And who does'nt need a referral from fp?

 

[Winged Scapula]

Its not that FPs don't make referrals to Derms...they do. But, if you are seeking a consultation for which you will be paying cash you can walk in off the street (albeit you will sit there for 8 weeks until the Dermatologist sees you. 😉 ); you only need referrals for SOME insurance companies. My insurance company does not require me to have a referral to see a specialist but many do; hence the conversation above. If you aren't going through your insurance company, you don't need a gatekeeper referral.

 

[raptor5]

For some things it seems FP's just sends you to the dermatologist/specialist regardless of whether you need a referral or not. My family doc sent my wife to a Dermatologist recently for a mole on the back of her neck that seemed irregular. Needless to say it was a 6 week wait, so my wife saw the Derm PA the following week. Dermatologost billed $125.00, Insurance pd. $65.00 plus our $10 copay. My wife was literally in their for less than 5 minutes. The PA said to return in a year. Maybe when I am a little further in med school my wife will listen to me. The mole was hardly irregular.

 

[novacek88]

Its not that FPs don't make referrals to Derms...they do. But, if you are seeking a consultation for which you will be paying cash you can walk in off the street (albeit you will sit there for 8 weeks until the Dermatologist sees you. 😉 ); you only need referrals for SOME insurance companies. My insurance company does not require me to have a referral to see a specialist but many do; hence the conversation above. If you aren't going through your insurance company, you don't need a gatekeeper referral.

This is precisely my point. For cash based cosmetic procedures, patients don't require a referral. So the gatekeeper concept really doesn't apply when discussing whether a patient will choose a dermatologist or a family doc who performs cosmetic procedures. Therefore, why would anyone see an FP doc when one can see a dermatologist for cosmetic procedures? They are paying cash anyway; why not see the one with the most expertise?

 

[dr_almondjoy_do]

This is precisely my point. For cash based cosmetic procedures, patients don't require a referral. So the gatekeeper concept really doesn't apply when discussing whether a patient will choose a dermatologist or a family doc who performs cosmetic procedures. Therefore, why would anyone see an FP doc when one can see a dermatologist for cosmetic procedures? They are paying cash anyway; why not see the one with the most expertise?

word of mouth from a few friends at the beauty salon will do better than any referral. for non-invasive derm procedures, you do not have to be a dermatologist. you just have to be certified. that can be done by anyone legally able to provide injections.

at times, the dermatologist is not the one doing the procedures, a well trained tech is. so if a dermatologist can observe a well trained tech give an injection or work a lazer machine, so can a family practitioner.

the derm experience comes in when the well trained tech messes up and burns the pt. or if there is botulism poisoning that is reported to the news channels and transferred to the local ICU.

If the FP messes up and burns a pt or worse, they can always refer out, and not be in trouble if the pt signed a release form. they do this in derm offices too, since there is always a risk of injury.

 

[ny skindoc]

If the FP messes up and burns a pt or worse, they can always refer out, and not be in trouble if the pt signed a release form. they do this in derm offices too, since there is always a risk of injury.
Anyone performing a cosmetic procedure should be fully prepared to handle its common complications.Its not so easy to refer out ones own "mess ups".
Other physicians often do not want to see such patints for fear of being involved in the situation and if they do the patient will be hit with substantial charges.If you handle it yourself you will treat the patients complications gratis.A consent form in no way protects you from litigation.Any good malpractice lawyer will not be dettered by these forms.Cosmetic procedures are not medically necessary,problems associated with them carry very high risk.Be sure you understand all the risks and complications before you do them.FPs performing such procedures will be held to tthe same standard of care as a Dermatologist or other specialist.

 

[shivalrous]

Its not that FPs don't make referrals to Derms...they do. But, if you are seeking a consultation for which you will be paying cash you can walk in off the street (albeit you will sit there for 8 weeks until the Dermatologist sees you. 😉 ); you only need referrals for SOME insurance companies. My insurance company does not require me to have a referral to see a specialist but many do; hence the conversation above. If you aren't going through your insurance company, you don't need a gatekeeper referral.

Haha, I need to get the same insurance that you have! 😀. It seems that FPs can bankroll if all of this true and especially if it's a cash business. My guesses are if FPs have clinics in low-income or rural areas, patients would more than likely get these procedures done with their FP than go through the wait. Just my $.02, please enlighten me if I've misjudged something. 🙂

 

[azcomdiddy]

Haha, I need to get the same insurance that you have! 😀. It seems that FPs can bankroll if all of this true and especially if it's a cash business. My guesses are if FPs have clinics in low-income or rural areas, patients would more than likely get these procedures done with their FP than go through the wait. Just my $.02, please enlighten me if I've misjudged something. 🙂

Referrals, referrals, referrals...that's what it's about. If you have several happy clients, you will receive plenty of new patients. Your title and degrees mean very little. Your patients are not like pre-med gunners that obsess over initials and where you went to school. Patients just expect quality work. If you are known for providing quality, you will receive many patients.

 

[azcomdiddy]

Any good malpractice lawyer will not be dettered by these forms.Cosmetic procedures are not medically necessary,

And any good malpractice attorney is unlikely to take such a case for a variety of reasons. The consent form is certainly a detterant. It may not be an impediment but many attorneys would avoid taking such a case because of this. It also depends on who drafted the consent forms. There is a distinction in the quality of the consent form depending upon who you hired to draft it. Furthermore, the damages that could result from these procedures are not life threatening in most cases and thus will not cause the type of damages that could award a large settlement which is what attracts reputable malpractice attorneys. Good malpractice attorneys seek larger and more substantial cases. And finally, the nature of the case will affect a judge's opinion should a case like this go to trial. Cosmetic procedures rarely inspire much sympathy unless the patient is permanently disfigured or handicapped which is rare considering these are non-invasive outpatient procedures.

 

[ny skindoc]

And any good malpractice attorney is unlikely to take such a case for a variety of reasons. The consent form is certainly a detterant. It may not be an impediment but many attorneys would avoid taking such a case because of this. It also depends on who drafted the consent forms. There is a distinction in the quality of the consent form depending upon who you hired to draft it. Furthermore, the damages that could result from these procedures are not life threatening in most cases and thus will not cause the type of damages that could award a large settlement which is what attracts reputable malpractice attorneys. Good malpractice attorneys seek larger and more substantial cases. And finally, the nature of the case will affect a judge's opinion should a case like this go to trial. Cosmetic procedures rarely inspire much sympathy unless the patient is permanently disfigured or handicapped which is rare considering these are non-invasive outpatient procedures.

Problems related to cosmetic procedures gone wrong are a common cause of litigation.Things that may seem minor to you may be taken seriously by an injured party and their lawyer. Juries do view a complication in the course of a medically neccessary treatment more sympathetically than a problem from another type of surgery -thats why Plastic Surgeons have significant risk even though they rarely cause life threatening injuries or disability.
Most non invasive procedures such as Botox,microdermabraison etc carry little risk of injury. Deeper chemical peels and laser resurfacing are another story.Scars can result. What is the potential economic claim for a woman with a burn scar in the middle of her face? I'll leave it to you to determine.
A consent form is neccessary and will assist in your defense.However if a lawyer thinks he can make a claim of negligence,a form will in itself not stop him.
My point in all this is to say that cosmetic procedures are not trivial.Physicians regardless of specialty need to select their patients very carefully as psychological issues are common in patients seeking cosmetic work. If you prepare yourself and the patient properly you can do fine with these procedures.

 

[novacek88]

Juries do view a complication in the course of a medically neccessary treatment more sympathetically than a problem from another type of surgery -thats why Plastic Surgeons have significant risk even though they rarely cause life threatening injuries or disability..

Plastic surgeons also perform procedures that are much more invasive and thus do cause disfigurement and disability. A permanent scar in the middle of a patient's face would fit under disfigurement. However, if the patient's scar healed by the time the case went to trial or before a judge, it could very well be thrown out depending on the duration o the scar. Juries also take into account a plaintiff's reasons for getting cosmetic work. A woman who seeks a breast implant due to a masectomy will inspire much more sympathy than a woman who already had implants and merely wanted to replace them with bigger implants. Contrary to what is seen on television, the real legal system doesn't just award plaintiffs money for anything. Everything is taken into consideration. Everyone remembers the big cases but most people don't know that juries side with physicians over 90% of the time. We just never hear about the cases that get thrown out or the cases physicians win. But I agree that physicians have to be careful about selecting patients and thoroughly diagnosing them for potential risks. I understand that physicians should be careful but I don't want physicians to be deterred from performing these procedures due to a misconceived or inflated fear.

 

[dr_almondjoy_do]

Most non invasive procedures such as Botox,microdermabraison etc carry little risk of injury. Deeper chemical peels and laser resurfacing are another story.Scars can result. What is the potential economic claim for a woman with a burn scar in the middle of her face? I'll leave it to you to determine.

Hence the new term non-invasive dermatology. This is the new label for derm procedures that do not require anything more involved than laser hair removal. Especially with elective procedures like these, there is a very very very small chance of a pt wanting to sue for a mistake.

This is the website of a family practitioner that does derm:

http://www.cfishermd.com/about/