When it comes to choosing a dermatologist for a medical problem, such as psoriasis or acne, we expect we’ll be put in the doctor’s schedule at some point in the next week or so. We’ll sit in the waiting room forever, and finally get called to the examination room where we’ll sit or lie on a paper covered table. The dermatologist will come in, maybe a little distracted or harried due to their busy schedule, examine us for five or ten minutes, give us a prescription, then send us on our way. They’ll tell us to call them if there are any problems, or if we need our prescription refilled.
However, if we call a dermatologist for a cosmetic issue, such as BOTOX® or Juvederm, the dermatologist will probably be able to see us in a day or two. We may even be told about the valet parking spaces available to us, and other cosmetic procedure-seeking patients like us. Rather than sitting in a Spartan waiting room, we may be ushered into another room with spa-like amenities. The staff will be attentive to our needs, as will the dermatologist. After our BOTOX® treatment, we may be ushered out with all sorts of niceties, and someone will call us the following day to see how we’re feeling.
Does this sound fair? Think hard about your answer, because this is the reality with some of the nation’s dermatologists these days. While many of them got into dermatology with the misguided notion of wanting to help people with sometimes problematic skin conditions, some of them are now only seeing the lure of money tied into making people look better for six months to a year. In a sense, they’re still helping people, but at what cost?
Changing Role or Aberration?
In the second installment in of a series called “The Price of Beauty” the New York Times is doing, this is one of the ideas examined. The dual nature of what it means to be a dermatologist these days, when cosmetic surgery is exploding and the economic benefit can be incredible, as well as still trying to function as a medical professional, such as examining someone whose mole seems to be growing and they’re worried about melanoma, seems to be one of the main ideas. The Times also brings up that many skin patients are left waiting while dermatologists cater to those looking for some kind of temporary youthful appearance.
However, they note that though there are millions of cosmetic skin treatments done every year, only a tiny minority of dermatologists give those seeking beauty over medical issues preferential treatment. Be that as it may, those who have separated their medical practice into two different ways of treating patients do give the cosmetic patient the best possible care. These dermatologists have separate office numbers: one that goes straight to voicemail for the medical patients, and one that is answered by a staff member for the cosmetic patients. They give the cosmetic patient better treatment because “they expect that,” according to Dr. Donald Richey. He adds, “We are a little bit more sensitive to their needs.”
One reason this is going on, and one that has been alluded to here, is the money issue. While most, if not all healthcare providers, won’t pay for a cosmetic treatment, that hasn’t stopped people from reaching into their pockets to pay. The Times article states that while a dermatologist might be reimbursed $60 to $90 for a cancer check that will take ten minutes, a BOTOX® treatment might pay $500 for a ten minute treatment. Not only that, but the dermatologist will get paid that same day. It is also noted that Allergan, the makers of Botox, state the annual net income for a dermatology practice that focuses solely on skin diseases might be $387,198. Those that focus on cosmetic procedures might net $695,850 annually. You can almost see the mindset change of once stalwart physicians happen when presented with these numbers. And giving a 50-something-year-old a youthful appearance is so much more fun than looking at some poor kid with horrible acne, or giving someone a malignant melanoma diagnosis.
Of course, while money is one thing, there is also the fact that this is what the good people seem to want. Melanoma, psoriasis, and acne will always be a part of life. And, yes, these people deserve and require medical care. But more and more people are seeking cosmetic treatments, and they are often repeat customers. For some, money is no object, and they demand certain things, like looking perpetually 30. And we can’t fault certain doctors who see this as an opportunity to retire early. Isn’t that what we all want? But if that melanoma could have been prevented if the victim could have gotten an appointment just a few days earlier to save them, then that dermatologist needs to rethink why they got into medicine in the first place.