New York Times Examines 'Dual-Class' Treatment To Cosmetic, Medical Patients By Dermatologists

Main Category: Cosmetic Medicine / Plastic Surgery
Also Included In: Dermatology
Article Date: 29 Jul 2008 - 5:00 PDT

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The New York Times on Monday examined how "dermatology is fast becoming a two-tier business in which higher-paying customers" seeking cosmetic procedures "often receive greater pampering" than "medical patients for whom health insurance pays fixed reimbursement rates."

According to the Times, dermatology is one of the specialties in which patients "are not only willing to pay for quality-of-life treatments that may not be covered by insurance," but also are willing to pay "much more for such treatments than insurers would pay for a medical procedure that takes a similar amount of time." Health insurers typically reimburse a physician $60 to $90 for a visit that includes a full-body skin cancer check, which takes about 10 minutes. Dermatologists might receive $500, paid on the day of treatment, for a Botox injection to the forehead that takes 10 minutes.

The Times reports that some dermatologists have separate waiting and examination rooms for cosmetic and medical patients. In addition, some dermatologists offer additional services -- such as valet parking -- for cosmetic patients. Donald Richey, a California dermatologist, said, "Cosmetic patients have a much more private environment than general medical patients because they expect that," and physicians "are a little bit more sensitive to their needs." Richey said his efforts to cater to cosmetic patients do not hinder the level of care for medical patients and noted that he keeps walk-in times available to see medical patients.

A study published last year in the Journal of the American Academy of Dermatology found that dermatologists in 11 U.S. cities and one county offered appointments to patients seeking Botox sooner than patients inquiring about a changing mole, which is a possible sign of skin cancer. The study also found some dermatologists are staffing nurse practitioners and physicians' assistants, known as physician extenders, to primarily see medical patients.

Mixed Message?
According to the Times, as "dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases." Several people interviewed by the Times said dermatologists they saw for medical reasons treated them as potential cosmetic patients.

Davis Pariser, a dermatologist and president-elect of the American Academy of Dermatology, said, "The message is that the cosmetic patient is more important than the medical patient, and that's not a good message." Julie Cantor, a lawyer and medical school graduate who teaches a medical ethics course at the University of California-Los Angeles, said, "If you really started treating patients differently based on their ability to pay out of pocket, that's a real problem," adding, "People who want their wrinkles fixed to go to a wedding should not be treated better than those who have psoriasis" (Singer, New York Times, 7/28).

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