Re: More Doctors Turning to the Business of Beauty
From: art fougner, md (evsono@pipeline.com)
Fri Dec 1 07:45:24 2006
Also. physicians are either joining insurance companies, eg UNH, or
*shock* going to law school.
Art
At Thu, 30 Nov 2006, Dean Huffman . wrote:
>
>..
>
>More Doctors Turning to the Business of Beauty
>
>In her three years as an obstetrician and gynecologist in Brooklyn, Dr. Ngozi
>Nwankpa-Keshinro delivered several hundred babies, conducted several thousand
>pelvic exams and diagnosed everything from infections to infertility. But this
>year, with a little additional training, she has entered a new field: cosmetic
>medicine.
>
>As one of the owners of a medical spa in Brooklyn that opened in January, she
>has given dozens of clients Botox injections to relax their wrinkles and
>Restylane injections to fill out their smile lines and plump their lips.
>
>“The two fields are as alike as an apple and an orange,” Dr. Nwankpa-Keshinro
>said. “One can be lifesaving, while the other is not. But when you clear up
>someone’s acne or facial hair, they are as grateful as if you delivered their
>baby.”
>
>Cosmetic medicine also provides a more relaxing lifestyle, she said. “And it’s
>very satisfying.”
>
>Five years ago, cosmetic medicine was primarily the domain of plastic surgeons,
>facial surgeons and dermatologists — medical school graduates who undergo
>several years of training in facial skin and its underlying anatomy. But now
>obstetricians, family practitioners and emergency room physicians are
>gravitating to the beauty business, lured by lucrative cosmetic treatments that
>require same-day payments because they are not covered by insurance and by a
>medical practice without bothersome midnight emergency calls.
>
>Dermacare Laser and Skin Care Clinics, for example, is one of the nation’s
>largest medical-spa chains. It has 28 franchises run by 32 doctors, including 6
>internists, 7 family physicians, 3 emergency room doctors, 2 urologists, 3
>naturopaths, a chiropractor, an ophthalmologist and a psychiatrist, according
>to the company’s Web site, dermacareusa.com.
>
>There is also one dermatologist, a facial surgeon and another doctor whose
>specialty is not listed. And there are five obstetrician-gynecologists,
>including Dr. Nwankpa-Keshinro and Dr. Oyenike E. Kilanko, her business
>partner, whose Brooklyn spa is a Dermacare franchise.
>
>Dermatologists and plastic surgeons refer to their new colleagues as “out of
>scope” or “noncore” physicians, and they strongly object to the intrusion,
>insisting that cosmetic medicine requires lengthy training.
>
>But the dispute also has all the elements of a turf war, with specialists
>reluctant to cede ground in a field in which Americans spend an estimated $12
>billion a year.
>
>“Dentists are doing Botox, and urologists are doing hair transplants and vein
>removal,” said Dr. Ellen Gendler, a dermatologist in Manhattan who is a
>clinical associate professor at New York University School of Medicine.
>“Everyone wants to be a plasticologist.”
>
>For their part, some doctors from other fields contend that the latest cosmetic
>procedures, like facial injections and vein removal, are far less complicated
>and risky than Caesarean sections or appendectomies and that the fundamentals
>can be learned in continuing-education classes.
>
>“We are all doctors with the same primary training whose education continues
>after medical school by learning new techniques,” Dr. Kilanko said. “I know
>core physicians don’t want noncore physicians like me in it, but dermatologists
>and plastic surgeons can’t own aesthetic medicine by themselves.”
>
>In the United States, all doctors with state medical licenses are allowed to
>administer all kinds of treatments, regardless of their training. But after
>residencies in specialties like ophthalmology or anesthesiology, doctors have
>not commonly set up shop in fields far outside their expertise, administrators
>at medical associations say.
>
>That has been changing. Insurers and medical groups do not track what kinds of
>doctors perform cosmetic medical procedures. But specialists and pharmaceutical
>companies who make cosmetic medical products agree that more and more doctors
>from other fields are joining in, with some incorporating beauty treatments
>into their practices, and others opening medical spas.
>
>MedSurge Advances, a Dallas company that trains doctors in beauty procedures and
>sells them devices like lasers, said that in the last four years, it had helped
>more than 300 doctors, including emergency room physicians, internists and
>gynecologists, to go into cosmetic medicine.
>
>The American Academy of Family Physicians, a national group that represents
>94,000 family practitioners and medical students, has started offering courses
>for its members on how to use Botox, facial fillers, lasers and chemical peels.
>
>Dr. Larry S. Fields, the group’s chairman, who is a family physician in Ashland,
>Ky., said that such “cash-upfront treatments help family doctors stay in
>business at a time when Medicare is cutting reimbursements.”
>
>Some see a danger in the trend, especially as nonspecialists move into
>more-invasive cosmetic procedures like breast augmentation and liposuction.
>
>“You can’t assume that everyone with a pilot’s license can fly a 747 as well as
>a Piper Cub,” said Dr. Stephen H. Miller, president of the American Board of
>Medical Specialties, an umbrella organization for the examining boards that
>certify doctors after their residencies. Dr. Miller said certification
>confirmed a doctor’s ability to deliver quality care in a specialty.
>
>“When you use a generic medical license to practice other forms of medicine,” he
>said, “there is an inherent danger to patient safety.”
>
>Dr. Mark L. Jewell, a plastic surgeon in Eugene, Ore., who is a past president
>of the American Society for Aesthetic Plastic Surgery, said the advent of
>physicians from other fields was likely to confuse patients, who do not always
>investigate a doctor’s training when looking for a cosmetic medical expert.
>Even more confusing to consumers is that many nonspecialist physicians are
>marketing themselves using terms like “cosmetic surgeon,” “aesthetic surgeon”
>and “laser surgeon,” he said.
>
>“Next thing you know, chiropractors will be doing liposuction,” Dr. Jewell said.
>“And psychiatrists will be ‘head surgeons,’ giving you Restylane with your
>Prozac.”
>
>Robert Huckels, vice president for marketing at MedSurge, said some
>nonspecialists were turning to cosmetic medicine because they were tired of
>heavy patient caseloads, long workweeks, high malpractice insurance premiums
>and the paperwork and payment structure imposed by Medicaid and managed care.
>
>But Mohit Ghose, a spokesman for America’s Health Insurance Plans, an industry
>group, denied that managed care was the impetus. “These doctors are just
>looking to generate new revenue streams,” Mr. Ghose said.
>
>According to an annual survey of doctors’ incomes published in July in Modern
>Healthcare magazine, family physicians earn $142,000 to $190,000 a year, while
>emergency room physicians earn $180,000 to $262,000 and obstetricians earn
>$219,000 to $302,000.
>
>But doctors have increasingly been complaining about their income, particularly
>as malpractice insurance costs have risen, Mr. Huckels said.
>
>The average medical spa takes in $40,000 a month, with popular ones in big
>cities taking in $100,000, he said.
>
>“It works well for emergency room doctors seeking less stress and for
>gynecologists who already have a ready-made female audience,” Mr. Huckels
>said.
>
>Dr. Nwankpa-Keshinro and Dr. Kilanko are board-certified
>obstetrician-gynecologists who graduated from N.Y.U. School of Medicine. After
>several years of working at hospitals — Dr. Nwankpa-Keshinro at Brookdale
>University Hospital and Medical Center and Dr. Kilanko, who is still practicing
>at Woodhull Medical and Mental Health Center, both in Brooklyn — they wanted to
>open a practice. But Dr. Kilanko said the $160,000 they would each have to pay
>yearly for malpractice insurance for obstetrics in New York was prohibitive.
>
>The doctors, who both have young children, wanted to find a specialty that would
>allow them to continue working in women’s health but spend more time with their
>families, Dr. Kilanko said. They settled on cosmetic medicine, where they set
>their own hours; malpractice insurance is costing them about $20,000 each this
>year, Dr. Kilanko said.
>
>“This is another part of women’s health that we can contribute to without
>managed care telling us that they are going to pay us $90 per visit, regardless
>of what gets done during the visit,” Dr. Kilanko said.
>
>The two started their Dermacare franchise in August 2005, when they traveled to
>the company’s headquarters in Scottsdale, Ariz.
>
>After a week of training at Dermacare, which included learning how to use
>several kinds of lasers and injections, Dr. Nwankpa-Keshinro and Dr. Kilanko
>enrolled in a daylong training course on Botox and another on Restylane in New
>York, they said.
>
>In January, they opened their storefront spa on a bustling block of Atlantic
>Avenue in a neighborhood of town houses. The spa has warm terra-cotta-colored
>walls and wall-to-wall carpeting; the menu includes face peels, acne treatments
>and laser hair removal.
>
>Dr. Nwankpa-Keshinro said she expected the clinic to take in about $300,000 this
>year but projected that revenues would reach $1 million within the next two
>years.
>
>She said the doctors’ backgrounds enhance their ability to work with female
>patients; they also treat men.
>
>But Dr. Kilanko said she and her partner knew their limits. “We are introducing
>these treatments for the everyday woman who wants to take care of her lips and
>her frown lines,” Dr. Kilanko said. “If a woman wants her cheeks or chin
>sculpted, I refer her to a plastic surgeon.”
>
>Still, critics say treatments by physicians with one week of training cannot
>compare in safety and efficacy with those performed by dermatologists and
>plastic surgeons.
>
>Dr. Amy E. Newburger, a dermatologist in Scarsdale, N.Y., says she regularly
>treats complications caused by noncore physicians. One recent patient, she
>recalled, came in with a botched Botox treatment from an oncologist: one
>eyebrow was almost an inch higher than the other.
>
>“All the patient got was a wallet biopsy,” Dr. Newburger said. Dr. Alexa B.
>Kimball, an assistant professor of dermatology at Harvard Medical School, said
>that while there were no studies specifically focusing on complications caused
>by doctors from other fields who practice cosmetic medicine, there were ones
>showing that other kinds of doctors make more mistakes diagnosing skin ailments
>than dermatologists.
>
>“When doctors practice out of their scope, you would anticipate problems to
>arise from inadequate training,” Dr. Kimball said.
>
>Dr. Kilanko said that in their first year of cosmetic practice, she and Dr.
>Nwankpa-Keshinro have not seen complications among their patients except for
>“maybe a couple of ulcerations in the skin, but no permanent scarring.” She
>said that the doctors were as qualified and adept at performing cosmetic
>procedures as were some dermatologists who did not focus on aesthetics in their
>residencies and now study how to inject Botox at medical meetings.
>
>Still, Dr. Kilanko said she understood the discomfort over physicians who
>practice outside their board certification, and she objected to the suggestion
>that a dermatologist might perform a Caesarean section after a day course in
>obstetrics.
>
>“They would have no business performing a C-section,” she said. “But you can’t
>compare the knowledge of the anatomy, level of difficulty and risk of
>complications of a C-section with Restylane injections.”
>
>Dr. Gendler, the Manhattan dermatologist, vehemently disagreed.
>
>“They don’t think it’s brain surgery until they have a problem,” she said. “Then
>the first thing they do is send the patient to a dermatologist.”
>
>NY Times
>
>http://www.nytimes.com/2006/11/30/us/30plastic.html
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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