Re: More Doctors Turning to the Business of Beauty
From: Kim Elise Goldman (goldman@calweb.com)
Thu Nov 30 17:44:58 2006
Interesting that a dermatologist is up in arms about this as they
have essentially no surgical training and no training in plastic or
reconstructive surgery. In the end it is all a turf battle for the
almighty dollar. <sigh>
Kim
On Nov 30, 2006, at 7:35 PM, 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
>
