woes for derm?

[HQAMIGO]

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People who are betting their future happiness on derm should take note of this story. More and more primary care docs are starting to do cosmetic procedures to make up for falling reimbursements. Since much of the lucrative nature of derm derives from cosmetics, this development will create strong competition in the cosmetics market and possibly drive down profit.


Need Some Botox With That Flu Shot?
http://www.npr.org/templates/story/story.php?storyId=92871258

Day to Day, July 24, 2008 · Primary care doctors say they're having more and more trouble making ends meet. They're drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money.

 

[flip26]

People who are betting their future happiness on derm should take note of this story. More and more primary care docs are starting to do cosmetic procedures to make up for falling reimbursements. Since much of the lucrative nature of derm derives from cosmetics, this development will create strong competition in the cosmetics market and possibly drive down profit.


Need Some Botox With That Flu Shot?
http://www.npr.org/templates/story/story.php?storyId=92871258

Day to Day, July 24, 2008 · Primary care doctors say they're having more and more trouble making ends meet. They're drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money.

This "trend" has been going on for years and dermatologists still have thriving practices and some of the longest appointment wait times in medicine...derm residencies are so highly controlled that the number of dermatologists will never sink the specialty, and this "trend" is unlikely to put a real dent into the specialty, either...

 

[SomeDoc]

This "trend" has been going on for years and dermatologists still have thriving practices and some of the longest appointment wait times in medicine...derm residencies are so highly controlled that the number of dermatologists will never sink the specialty, and this "trend" is unlikely to put a real dent into the specialty, either...

I'm not so sure. With increasing Medicare reimbursement cuts on the horizon (never mind the recent legislation which "kicks the can" in preventing a 10% cut), PCP's may understandably start turning to alternative sources of income to keep their practices in the black.

 

[Long Dong]

Most derms I know don't even do cosmetics and still have 1-2 month waits for new patients. I cousin of mine who just finished residency opened his practice and within 6 months of opening had 1-2 month waits, with no cosmetics at all. When I was a student one of the schools I rotated threw opened up another afternoon for clinic and in the first few hours of the announcement they were booked up 2 months in advance, this was all for medical derm (no cosmetics at all).

 

[RooRoo1]

It would be hard to justify an fp doc asking the same price for something they know very little about besides a weekend course. When push comes to shove, the people who are willing to pay will want their face and body in the hands of the most highly trained professional.

 

[mike1618]

Derm practices don't necessarily have to offer cosmetics to be profitable, although it can be an added benefit. Possibly losing some cosmetic business is nothing compared to the cuts in Medicare. Insurance companies will follow suit. I would like to see Derm practices move more towards the attitudes that dentists have, whereby, the patient has the contract with the insurance company not the derm practice. There would be more price transparency and the patient would have to deal with all of the insurance billing b.s.

 

[Blesbok]

It would be hard to justify an fp doc asking the same price for something they know very little about besides a weekend course. When push comes to shove, the people who are willing to pay will want their face and body in the hands of the most highly trained professional.

And derm is much more highly skilled at botox?

I must have missed the part of the derm residency where they spend a month teaching how to administer it.😕

 

[Comrade789]

And derm is much more highly skilled at botox?

I must have missed the part of the derm residency where they spend a month teaching how to administer it.😕

Derms train with cosmetic procedures in residency at many programs. Also there is much more to cosmetic derm than just botox. Cosmetics is actually offered as a fellowship of derm because there are a lot of different treatments offered. The problem is many of them are expensive to start up (such as lasers). In other words, you have to make substantial investment of time and money to make a full cosmetics practice profitable. Of course, family physicians will take some of the easier and less money/time intensive procedures, but that is only natural in a free market situation. 🙂

 

[MOHS_01]

And derm is much more highly skilled at botox?

I must have missed the part of the derm residency where they spend a month teaching how to administer it.😕

Apparently you did. Many derm residencies incorporate cosmetics throughout the entire residency.

 

[sestamibi]

People who are betting their future happiness on derm should take note of this story. More and more primary care docs are starting to do cosmetic procedures to make up for falling reimbursements. Since much of the lucrative nature of derm derives from cosmetics, this development will create strong competition in the cosmetics market and possibly drive down profit.


Need Some Botox With That Flu Shot?
http://www.npr.org/templates/story/story.php?storyId=92871258

Day to Day, July 24, 2008 · Primary care doctors say they're having more and more trouble making ends meet. They're drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money.

Yawn. Classic scaremongering. This type of uptick in cosmetic procedures has been going on for a while. (The NYTimes published an article like this a couple of years ago)

In the end, people will pay the price they're comfortable with. If I wanted botox, I'd go see a dermatologist.

Not my gynecologist.

And even without cosmetics, derm is a lucrative field thanks to the sheer volume of patients and limited supply of physicians.

 

[HQAMIGO]

I understand that many dermatologist have cosmetics as a small part of their procedures, but I wonder how much of their profit depends on it? Put it another ways, even though the wait list for medical derm is months long, I'm guessing that most people who need derm medical treatment are going to be paying with insurance. With reimbursement rates going down, how much profit can be made from pure medical consults?

There will always be people who can afford top dollar for the specialists, but as medicine is becoming more consumer driven, I think people will start to be more sensitive about price (i.e. walmart medicine). Perhaps I am wrong, but botox and even laser resurfacing seems like it could be learned by any decent PCP who is willing to devote some time to study. Also, the point of contact advantage is important for PCP's in cosmetics. Anyone who goes in for a checkup or some other reason will be subjected to marketing effots if the PCP has a cosmetics practice.

Again, I'm not saying that derm will be replaced. But with more competition, (and the PCP's are getting desparate these days) the margins must be thining.

 

[bcat85]

Yawn. Classic scaremongering. This type of uptick in cosmetic procedures has been going on for a while. (The NYTimes published an article like this a couple of years ago)

In the end, people will pay the price they're comfortable with. If I wanted botox, I'd go see a dermatologist.

Not my gynecologist.

And even without cosmetics, derm is a lucrative field thanks to the sheer volume of patients and limited supply of physicians.

and tanning.

 

[NPR]

There will always be people who can afford top dollar for the specialists, but as medicine is becoming more consumer driven, I think people will start to be more sensitive about price (i.e. walmart medicine). Perhaps I am wrong, but botox and even laser resurfacing seems like it could be learned by any decent PCP who is willing to devote some time to study. Also, the point of contact advantage is important for PCP's in cosmetics. Anyone who goes in for a checkup or some other reason will be subjected to marketing effots if the PCP has a cosmetics practice.

Maybe my mileage differs from others, but I don't even trust my PCP to order lab tests correctly.

I asked for titers for my last set of blood tests for away rotations and my PCP ended up ordering titers for my ENTIRE FAMILY when they came in for their annual checkups.

Yeah, I'm sure they could pick up botox and laser resurfacing quite quickly from courses and whatnot. But they only thing they'll be botoxing/resurfacing is my rear end. I'd entrust my face to someone else.

 

[Taurus]

As the reimbursement levels shrivel, you'll see physicians of many different specialties as well as NP's go into cash-based cosmetics. You'll start seeing more FP's and internists do more botox, exfoliation, etc. The chairman of the my ob-gyn dept was complaining how ob-gyns are moving away from their traditional role and into plastics (i.e., vulvaplasty, tummy tucks, etc). Breast surgeons are learning how to do breast reconstruction. On and on. The real question should be why hasn't this trend happened sooner? Derm and plastics may offer some of the highest skilled people in their respective fields, but I doubt that they will be the only game in town. If you're smart and have some good business sense about you, you can create a niche for yourself too. Remember that cosmetics is not nearly as regulated as medical practice. Therefore, nearly anyone can go into it.

 

[MOHS_01]

I understand that many dermatologist have cosmetics as a small part of their procedures, but I wonder how much of their profit depends on it? Put it another ways, even though the wait list for medical derm is months long, I'm guessing that most people who need derm medical treatment are going to be paying with insurance. With reimbursement rates going down, how much profit can be made from pure medical consults?

There will always be people who can afford top dollar for the specialists, but as medicine is becoming more consumer driven, I think people will start to be more sensitive about price (i.e. walmart medicine). Perhaps I am wrong, but botox and even laser resurfacing seems like it could be learned by any decent PCP who is willing to devote some time to study. Also, the point of contact advantage is important for PCP's in cosmetics. Anyone who goes in for a checkup or some other reason will be subjected to marketing effots if the PCP has a cosmetics practice.

Again, I'm not saying that derm will be replaced. But with more competition, (and the PCP's are getting desparate these days) the margins must be thining.

Botox? Maybe, but the "art" of good Botox administration is not appreciated by the vast majority of people performing it. As far as laser resurfacing.... it would take a fool of a PCP to enter into this realm. Most dermatologists have not business performing it, and increasing numbers of plastic surgeons are abandoning the traditional CO2 procedure as well due to the unacceptably high complication rate and the intense hand holding that is required during the postop period.

If you want to make $$, I strongly suggest finding something that you are good at and do it well. The "greener grass" is not always as easy as it looks.

 

[Monica Lewinsky]

I understand that many dermatologist have cosmetics as a small part of their procedures, but I wonder how much of their profit depends on it? Put it another ways, even though the wait list for medical derm is months long, I'm guessing that most people who need derm medical treatment are going to be paying with insurance. With reimbursement rates going down, how much profit can be made from pure medical consults?

To some dermies, this isn't much of an issue since their practices are high-throughput. Their nursing staffs are well-trained, and these derms are in the room long enough with the patient to make diagnoses, prescribe medication, and do the classic procedures in very short time. Of course, this practice model on works if you don't mind seeing >50 patients per day, but you will always make more money than physicians who are in fields where they must spend longer amounts of time interviewing patients.

As for the cosmetics, there will always be lots of competition for that. Being a derm surely gives one more credibility than say a "cosmetic radiologist" or such. If you are gunning for a heavily cosmetics career, you are going to have to position your training and practice much differently than most other dermatologists, however it is a much better place to start than FP.

 

[Doublecortin]

Maybe my mileage differs from others, but I don't even trust my PCP to order lab tests correctly.

I asked for titers for my last set of blood tests for away rotations and my PCP ended up ordering titers for my ENTIRE FAMILY when they came in for their annual checkups.

Yeah, I'm sure they could pick up botox and laser resurfacing quite quickly from courses and whatnot. But they only thing they'll be botoxing/resurfacing is my rear end. I'd entrust my face to someone else.

well put