LS, a Derm that's pissed at Medspa FP's and OB's.
The war to control cosmetic medicine that's been raging between plastic surgeons and dermatologists has a new additon, aesthetic physicians. And here's one derm that doesn't like it.
LS posted this comment on: Botox certification for family Practitioners
"When I graduated from med school, only me and another guy got into a derm residency - and he had a PhD in Immunology before getting into med school. The OB's and FP's were at the bottom of the class. Now they want to get into cosmetic dermatology for the money - but they are NOT TRAINED to do anything with skin. Derm is a 3 year residency - these people know so little they don't have a clue how little they know. Studies have shown that when primary care physicians get minimal (like 4-6 weeks) of Derm training, they begin to see that it's an incredibly complex field of which they know not, and the number of referrals to derms INCREASES - the more training they receive, the more they refer.
The Cosmetic companies and laser companies are all in it for the money so they don't care WHO they sell to. This is all going to change - the policy makers are already working on it so these FP's etc who are going into it better have their own practice of sore throats and earaches to fall back on since the balloon is about to bust."
LS has a point. Dermatology is a specialty.
It's also the study of 'diseases of the skin', not Botox and laser hair removal. Although some medical schools are geting into this, Dermatologists generally get training in cosmetic procedures the same as other doctors... see one, do one, teach one.
Dermatologists are physicians (medical doctors) specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages...
Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there are a wide range of congenital syndromes managed by dermatologists.
LS is right that Florida has passed legislation, but it's going to be harder to enforce than keeping Paris Hilton at home.
There's also something of a conflict in that dermatologists are trained to treat medical problems like skin cancer. With skin cancer the fastest growing cancer in the US, there's a train or thought that says dermatologists should focus on where they can do the most good, not where they can make the most money. Of course that's not the real world either.
Comments?
Jeff, Medical Spa MD | Filed in Cosmetic Dermatology 
Reader Comments (122)
Jeff and med spa guy,
Sorry I have not posted the burn lawsuit info but I have had a death in the family and other unexpected events. Will get to it as soon as I can. Sorry.
I know this post is old but looking over it in all its archived glory, I agree with Disenchanted -- it's a little appalling. Considering there's a shortage of doctors and medical staff in general, as a patient with no medical training myself, it really turns me off to using any medical or cosmetic services for aesthetics.
Fear is a good antidote to vanity!
I think it's funny how people are burning derms for being the 'easy' doctors -- it's just like the Seinfeild episode. And maybe this is an industry forum so it's not meant for non-medical types, but the hubris that some of the non derms -- and non MDs? -- practicing aesthetic services is alarming.
As a patient, one nightmare thing I want to avoid at all costs is a practitioner who has an ego, something to prove, or otherwise overly confident of their abilities. To me that spells mistakes and beyond that not properly correcting the mistake. Basically a nightmare for the patient (and possiblt the practitioner when the lawsuits start coming)
And so far it seens like everyone except maybe CT sounds like they might be more trouble to see than its worth.
As an OB/GYN I first used a CO2 laser on the cervix while I was an intern. I treat rashes, abscesses, skin tags, answer questions about moles, growths, bumps on a daily basis. I have had skin care questions on nearly every test given. I refer regularly for unusual lesions noted to local dermatologists. Some of them have startled me with their lack of knowledge.
I had a brown recluse bite diagnosed by one as a deep infection that must be from a hysterectomy done the month prior coming to the surface ( I am serious). This was a classic brown recluse lesion. she also had a bite lesion on her ankle and her breast.
I had another that diagnosed herpes labialis (albeit slightly atypical with deeper tissue invasion) as an allergy to her birth control pills which she was advised not to take anymore. Fortunately she trusted me and took the Valtrex.
I had first become interested in just doing hair removal after referring a person to a dermatologist for recurrent MRSA infections in the pubic area where she shaved regularly. I thought that one might do laser hair removal and thus decrease her chances of getting the recurrent infections. I saw her back, and found that the Dermatologist had sent her to a GYN that would do the hair removal "downthere". She didnt have a table with leg stirrups.
I have practiced cosmetic medicine for 3 years now and my fund of knowledge has grown. With it my services offered has expanded. I have always been sure to be educated and recieve certification before adding any service to my practice. I only perform procedures that have been cleared by the FDA. I have a nurse practioner and a medical assistant that are trained to do some of the procedures, and provide direct supervision.
I attend annual CME on aesthetic subjects, and read constantly.
Dermatologists may want to say they know more about skin disease, that is fine, but they don't know more about aesthetic skin care, because most do not recieve anything but a small sampling of training for true aesthetic medicine. They get their training after residency just like all the other specialties who have decided to go into it.
LaserGynMD:
I agree with you wholeheartedly. As an FP, and many years of service in the ER and 2 years gen. Surg. residency, I find it ludicrous that Derms think they have a corner on the aesthetics market. Like you said, they only get a small sampling of aesthetics in their residency. In fact, many of the "older" more established derms frown upon those who practice aesthetics. However, the general population, (refer to Lurker Edna's post) still beleive that only Derms should be doing aesthetics. And they are misinformed about how much actual training they get in their residency. Part of this is misinformation from the media. Edna seems to think its hubris for a non-derm to practice aesthetic medicine.
I did a smartlipo course several months ago. It was given by an OB/GYN. Next to me sat two dermatologists taking the exact same course. How then can a Derm say he/she has more, or better, training than someone like myself.
Its all about politics and nothing about medicine.
I think its time to unite all the disenfranchised aesthetic practitioners into a unified nationally recognized society. Then we can change perception.
BTW, to Edna, please refrain from critizing that which you are not familiar with. The reason why there is a shortage of physicians has nothing to do with the doctors. Medicine in this country is not run by drs. any more. Health insurance companies, large for-profit corporations, and med-mal insurance has made the environment in the medical profession very hostile. A few of us have sought an alternative, aesthetics. The numbers are very small and has very little effect on the total physician pool. The fact that you have to wait 6 hours in the ER to be seen is more a consequence of the way the system is administered and very little to do with the dr. on-call. S/he is just doing his/her job the best s/he can.
I started on my own and am doing well. I work with a Derm in town (actually my own doctor!) that I refer to for skin checks and biopsy procedures etc. I am more than happy to not have to deal with that aspect for more than a few reasons. I have been teaching him about what I do but it is not his passion.
The number of referrals to derms INCREASES - the more training they receive, the more they refer.
As a patient who, over the years, has used the services of an opthamologist (lower blepharoplasty), plastic surgeon (extensive lipo under general anesthesia and upper blepharoplasty), dermatologist (Foto-facials - actually at first he did them himself, but then began having his PA do them -- and fat injections) and an ob-gyn (Botox), I found this discussion fascinating.
My ob-gyn does a great job with Botox. He charges less than my dermatologist for the procedure, it is much quicker to make an appointment and I don't spent hours in the waiting room twiddling my thumbs for a two-minute Botox shot while the doc is finishing a Mohs procedure. It's a no-brainer for me. And my ob-gyn is a great guy and if he can make some extra cash by doing Botox to help make up for the crummy insurance reimbursements, I'm happy for him. It's a win-win situation. And I would definitely rather have an actual MD putting Botox into my forehead than a 23-year old PA.
Dobi
How would you feel if the MD was 23 years old? I'm not trying to be smart, just curious is it the age or the designation?
The medical school I attended had an accelerated program with another university and there were some advanced students starting at 17 years who became MD's at 24 or so.
I am fascinated by this thread. Can't we all just get along? So who do I believe? The Plastic Surgeons and Dermatologists who vocally feel other MDs should not be injecting Botox or Fillers or using Lasers do not make any sense, especially if they allow their brethren to employ technicians or nurses to do it in their own practices. I have only been doing it for a few years, but my practice has grown because my patients prefer "a real MD" doing their procedures. This competition has been good for the patients on L.A.'s westside, as now more MDs are doing their own procedures.
It is disingenuous for any MD to say they are the only one trained enough in the correct specialty to do a certain procedure, yet have a nurse perform that procedure in their office. Hippocracy of Hippocrates.
There is a Dermatologist close to my office that does general practice and USCIS (immigration) physical exams. I still send him skin cancers, as I will not treat skin diseases unless they are straight forward. We do what we are comfortable doing. Does a bad ankle sprain patient have to see an orthopod that specializes in ankles?
I do agree with the plastic surgeon that commented about treating the complications of the Dermatologist's breast augmentation. We should be prepared to treat the complications of all the procedures that we do, or not do the procedure. That is why I would never do liposuction, and cringe when I read of the Beverly Hills Radiologist that has one of the biggest liposuction practices. He advertises as "Board Certified" deceptively. California should have a law that any MD that says "Board Certified" should complete the info of what they are Board Certified in.
I have Board Cerifications in ABMS specialties, and always list what they are, as they are not in Plastic Surgery or Dermatology. But it is ridiculous to think that a physician doing pericardiocentesis or corneal foreign body removals could not do botox injections as well as the NURSE in a Dermatologist's or Plastic Surgeon's office. I even have patients that would only allow an MD to do Tattoo or Laser Hair Removal. I hate Laser Hair Removal, but I do it because it still pays better than the miserly reimbursement for taking care of sick people, and it is a joy to bypass the medi/insurance cabal.
ScottyR,
Well said. I agree with you.
My personal favorite is "non core" (meaning not IM, FP or Endocrine) Docs who take a three day course in "anti-aging and bio-identical hormone replacements" and are experts in HRT. Then have the audacity to claim board certified in anti-aging medicine. What a joke!! This is some serious misleading of the public.
Dobi: You went to surgeons (plastics, ophthalmology) for surgical procedures. You have chosen to go to non-surgeons for your non-surgical procedures. That's OK.
As a plastic surgeon, while I would love to have your non-surgical business too, I think that many specialties can be trained to do routine Botox treatments reasonably well.
As someone who does lots of facelifts & browlifts, I actually see and work with the facial anatomy "up close and personal". Few other specialties have that advantage!
I completely agree with you, LS. I am a Dermatologist and worked hard to achieve that status. Fortunately, I had 24 lasers where I trained and had a large amount of cosmetics during training, but that does not matter for a core specialist. Dermatologists understand the physiology of the skin and where to inject fillers (ie. not into an artery b/c we understand the skin at a deeper level). We also understand that "brown spots' is not a diagnosis and there is a huge difference between the static pigmentation of lentigines vs. the dynamic pigmentation of melasma or PIH. I have reviewed many cases to the medical board of non-core specialists who did not know the difference, did not understand the response the skin should or should not have to various treatments, and permanently scarred patients or wasted their money and hope on procedures that didn't work. If you wanted to go to treat skin conditions, go through a Dermatology residency! Don't fake it.
Oh, and many derms includying myself enjoy that the skin is the window to the inner health of the body. I have been able to diagnose DM, Endocarditis, lymphoma, IBD, and numerous other conditions by looking at the skin findings of a patient. Everything isn't "maculopapular". There is a reason for 3 years after residency.
I am an board certified FP in practice for 33 years. 12 Years ago, I began incorporating cosmetic procedures into my practice. Before the year 2000, we already had and utilized 5 different lasers and had already performed 1000's of botox and filler injections. I took exactly the same laser training in my residency as derms, plastic surgeons, and cosmetic surgeons, NONE. I did take numerous courses and traveled all over the USA to get the training I needed.
In the succeeding years, I continued my cosmetic education, became an ASLMS Fellow and served ASLMS as their research awards chairman.I have gained enough respect from my "better trained" colleagues, that I have been nominated for the Laser Surgery representative for the ASLMS board of directors. My platform was to increase educational programs for the FPs and OBs who want to get into or are practicing Aesthetics. I have served as the medical director of an Aesthetics Institute where doctors and nurses are taught laser physics, safety and technique.
I have personally performed tens of thousands of procedures. I have a busy practice of happy and satisfied patients who happily volunteer when I train a plastic surgeon or derm in laser cosmetic procedures. I am a speaker for 3 laser companies. 10=15% of my practice is fixing mistakes made by others (usually derms).
I list these accomplishments not to brag but to point out the fallacy of LS's argument: It is not the specialty one trained in many years ago that determines the quality of a laser cosmetic practitioner. It is the how well trained that practitioner is in the procedures to be undertaken and the knowledge to stay out of trouble.
LS is a Dermd Bigot.
Dear Dr. Gutman:
Very nice post. Although I believe "JH" made some valid points, I believe that by requiring "non-core" physicians to participate in some advanced educational programs covering perhaps a more in depth knowledge of the skin, etc.-- which may be part of the curriculum you mentioned working on for "the FPs and OBs who want to get into or are practicing aesthetics" -- the concerns of "JH" and others in hism camp could be assuaged. I have always been curious how many of the dermatology advanced hours are spent on study of the skin in general as opposed to skin diseases? If someone could put together an advanced dermatology course which covered everything besides the myriad of skin diseases it would probably be manageable. You mentioned that you have also "served as the medical director of an Aesthetics Institute where doctors and nurses are taught laser physics, safety and technique" and I am curious what the name of that institute is and the number of hours required to complete the course?
I agree with most NON DERMS here.. those my age who are in residency or almost about to finish residency in Derm dont even have a clue about differences in lasers and are not even aware of the existence of Idebenone.. DUH!!!! I had to teach them the difference between monopolar and bipolar radiofrequency!!!! Excuse me LS but as far as I know I got higher ranks than them in med school.. so stop with the arrogance LS! It is not like we obsess with the money, we spend so much on training and quality machines at the same time!! Did you even get to do botox in residency to even say you are board certified and the highly qualitfied for it already after finishing derm residency? you are so bitter! Medicine is an art and science dear elder LS, its growth just wont wait for you, so better make the most of your residency and treat patients! else take the same courses we took..and practice a little more..
Disenchanted One - how can your ethics even say we are "money hungry whores"????? whew! their goes your hypocrisy!! just because it is a prestigious field does not mean we do not do charity or the service part, we wake up early mornings not because of the MONEY for the immediate non surgical face lift our patients want, but since we also care enough to believe in the holistic being or the attention, care and support people need in this very competitive era. We talk to patients and care for them maybe even more than you do, we understand their feelings and it is but palliative for science to help them age gracefully and we are here to research and treat them as doctors too!!!!! Goodness!!!! I do not even charge consultations for a very obvious fungal infection and yet you say we are whores???? how can you say that!!!! 2 of my friends who are in aesthetic medicine already put up their foundation for free vaccinations and clinics. you are so narrow minded! bottomline ----- ETHICS will define the real MDs who work with true care and compassion whatever their means would be.. given the chance, I may even take dermatology when I get older, So I wont even have to hire you bitter Resident Derms and I will have more FREE SKIN PATHOLOGIC LABS and CLINICS!!!
DERMATOLOGY is NOT the SAME AS AESTHETIC or ANTI AGING MEDICINE...
AESTHETIC MDs are not vying for your title... SIMPLY because
#1. IT IS NOT YOUR SPECIALTY TO DO LASER TRAINING OR BOTOX OR FILLERS EITHER!
I will not even send you a referral for a tiny wheal that is obviously an insect bite that needs a calamine lotion or a pustule that is obviously ACNE. But I will send you those that are PATHOLOGICS ENOUGH not because It is NOT money making, but because we really do not charge for pathologics and because out of respect to your studied expertise, you should know better.. aesthetic medicine charges because the training, the meds, the machines cost so much too,, By the way, when it comes to the common URTI of your relative, do you not treat them too????????
We define our practice as long as we keep up with the standards of good ethical practice. PF always depends on training.. sometimes the 3- 4 year derm residency training just cant keep up with the other VERY EXPENSIVE, and Intense trainings we just happen to take..
Here's my take on it. I am a plastic surgeon with an aesthetic practice. For 5 years I was the only person providing cosmetic services in my town. Then one day another person opened an aesthetic practice 1/10th of a mile from my office. Everyone was very concerned for me as they felt my business would suffer. I, however, was thrilled that I had competitiion. His business simply increases the awareness of the product we both offer. There will be plenty of people who price shop and go back and forth between the practices. Not only that, it makes me become quite creative at my marketing. There is more than enough business out there for everyone. My advise to those who expend time and energy bad mouthing their competition is to focus your energy on YOUR practice and provide optimal care, further your education, and market market market!!!
@ Gene, you are so right!
I have so many customers come to us because competition(s) are bad mouthing our business.
Weird? yes...
Dont forget, those who can afford to spend money on us are usually educated, smart and sophisticated.
They are not dumb. They can see and feel who offers the best.
If you have been consistently providing good services, taking care of your customers, you will be the winner of all the competition.
I can honestly say my competition are doing us the favor by bringing more awareness to our business. Our business has increased 300% as to compared to a year ago even the economic conditions in the area is not so rosy.
I practiced internal medicine for 15 years before switching to Aesthetic medicine. I put in my time taking care of the sickest of the sick. I view my decision to go into aesthetic medicine as an early retirement from medicine.
Having an MD certainly helps in being able to perform these procedures safely but let's not kid ourselves. When we are injecting cosmetic Botox or doing laser hair removal, we are NOT practicing medicine. It's an insult to my medical colleague, whom I left behind in the trenches to keep taking care of the sick, to think of myself a a "real" doctor anymore.
Aesthetic medicine IS a business and we ARE in it for the money and the lifestyle. When I see a suspicious lesion, I am certainly not going to try to biopsy it, I would refer the patient to a dermatologist. My dermatologist in turn refers his patients to me for aesthetic procedures because I have a lot more experience and much better equipment than he does.
I disagree. I am a dermatologist and a real physician. When we are performing Botox, laser resurfacing and hair removal we are practicing real medicine with real risks, real complications and real benefits.
It is very self-serving to try to put down dermatologists as not having as much training or experience as non-derms in the practice of medicine as it pertains to the skin. It is simply not true.
Justify your own training if you wish, but don't insult the dermatologists by stating that you know more than we do.
And if I see a suspicious lesion (and I know one when I see one) I am going to biopsy it. Because I am a real skin doctor.
I am a medical doctor who performs esthetic procedures outside of US. In my country we had this problem between plastic surgeons, dermatologists, and esthetic doctors since 5 years. There were so many law suits between each other, lawyers earned so much money. In the end of the last year everything gets calm, in here every doctor has right to do those non surgical esthetics procedures.
While we doctors are complaining on each other, we make ourselves more weak. Around us there are so many non health stuff which are getting more stronger. They try to do those esthetic procedures even illegally with help of doctors who are greedy to earn money just by giving their diploma to others. I even do not mention that equipment sellers and drug providers do not care who make those procedures. So please do not forget that we all are in the same boat. We should stick to each other not fight. Even I am in another country it does not mean those fights will not affect me. Conflicts between doctors are getting spread to other countries and when my patients go abroad they get ideas from different doctors with some prejudgements.
Laser operation is not hard. It is not rocket science. But to do it with a "wow" effect, it takes a lot of experience,and put aside the ego to admit the wrong you have done before.
It is like flying a plane. Anyone can fly a plane, but to fly well, and safely, it takes experience. Obviously, flying a cessna and flying a 747 are not the same.
I am doing 20 plus laser treatments a day from co2, erbium. nag to basic IPL, six days a week, 4 years straight, since I left my family practice. I prefer laser treatments over practicing medicine, because I was depressed and often time got too carry away that my sick patients were not getting better. The only time they came to see me were when they were sick. But for now, all my customers come to see me, they are always happy. I also can spend more time with my family.
I make far less than on laser treatments than practicing medicine, but at least, I am a happy man with a big smile on my face when I go to sleep.