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More family practice doctors switching to aesthetic medicine.

Guess what? Family practice Doctors are moving to cosmetic medicine in increasing numbers.

arrowGraphic2.jpgThis isn't any surprise to me but it's going to make the cosmetic medical market even more crowded and competitive. 

Why? because the normal market conditions don't apply quite as much in medicine as they do in the 'real world'.

In a normal market, if you fail, you go out of business.

In cosmetic medicine, physicians who fail (and there are some), just end up making less money since it's the family practice, OB/GYN, or internal medicine practice that's making the bread and butter. Doctors don't die, they just get older and complain more.

As a result, large numbers of physicians are running pell-mell into this market to make that extra $60k a year, flooding the market with me-too competitors who individually can't compete but as a group add up to a significant portion of the available dollars taken out of the marketplace.

This is why the plastic surgeons and cosmetic dermatologists are pulling their hair out. While they're still making good money, the unwashed hordes of unboarded doctors who are moving in are all pulling a percent or two away from the front end of the funnel. Not much as individuals but as an aggregate it really starts to make an impact.

So when a board certified plastic surgeon or dermatologist sees a burn, blister, or other complication, his predilection is to chalk it up to another one of those 'bargain basement cosmetic practices'  that have opened their doors down the street. (and he might be right since it really is kind of the wild west out there.) 

I do have two predictions here.

Since it's the state medical boards that make oversight and regulatory rules and since those boards are made up of physicians, I think that:

Both of these strategies will fail. While regulations probably should be tightened in most states, the current system is hugely inefficient and natural market forces will force the vast majority of physicians into a commodities market which will shrink physician incomes. Nor will plastic surgeons and dermatologists be able to keep non-boarded physicians out of cosmetic medicine (This recent Florida situation with off site medical spas notwithstanding.)

So if you're running a medical spa or laser clinic or you're a plastic surgeon or derm... it's only just begun.

Reader Comments (10)

Its all politics.....when was the last time a plastic surgeon learned how do do laser hair removal in a plastics fellowhip? Give me a brake!!! They stole the procedure as they stole liposuction which was first developed by an Ob/Gyn. I have no sympathy for a plastic surgeon who's making several hundred thousand if not a million a year complain that FPs or Obs are taking their hair removal pts. That's an utterly rediculous argument. Firstly, they are not "board certified" in hair removal. And to say an FP is not boarded is just as absurd. And secondly, there is absolutely no evidence that having a cosmetic procedure performed by a dermatologist or PS is any safer or results in fewer complications....
Sorry, Jeff, but you present a very weak argument....

07.15 | Unregistered Commenterbotoxdoc

I think Jeff is on your side here, botoxdoc.

07.15 | Unregistered CommenterJarvik7

Jeff, I'll add another prediction that the FP's doing non-invasive procedures will be more prepared to add "wellness" (or anti-aging..etc) items to their spa menu; whereas, the Derm or Plastic would have no interest in monitoring cholesterol, CRP, smoking cessation, or talking diet. These additions would make the primary care medi-spas more desirable.

07.15 | Unregistered CommenterDermaRogue

you must have skimmed.

I said, "Both of these strategies will fail." and "Nor will plastic surgeons and dermatologists be able to keep non-boarded physicians out of cosmetic medicine."

The point of this post is that the level of competition is only going to increase as more and more non-core trained docs move into cosmetics to support their current incomes. No one will be able to stop the influx of new competition which since the barriers to entry are so low.

Supply and demand will dictate that since the supply will increase (as many of us have seen) competition will increase, and will stay increased since doctors don't 'go out of business' in the ways that regular businesses do.

There's a reason while the plastic surgeon and derm boards keep the supply low. It's to keep demand high.

The pie, while growing, is still only so big.

Well Jeff, I think you sparked a little fire with this posts. I do not think this was an attack on us just a statement of fact. This will likely get a lot of comments. I hope that the derms and plastics docs will comment as well.

I have an issue with the statement of "non-boarded" physicians. I am board certified as an FP and I would bet the majority of your physician readers are not plastics or derm. Most of us are board certified in our specialty. You also need to understand that there are a lot of FP's that do more than see patients for runny noses. Many do C-sections, colonoscopies, EGD's, vasectomies and removal of skin cancers including the face. I even do some flaps.

I believe this is an important topic and must be discussed. Some of it is political and territorial. If you watch, some plastic surgeons hate the fact that derms, ENT, ophthalmologist and even some maxillofacial surgeons (dentists) are doing cosmetic surgeries. Plastics think the only ones that can do the cosmetic procedures are them. The thing that ticks me off about many of the plastics associations and physicians is they complain about non-core physicians doing these procedures and they have a PA/NP or even a RN do these procedures.

What we are going to see is the derm and plastics medical boards as well as AAD and ASAPS etc are going to join forces and try to legislate all others out of business. They are on that path right now in Florida. In Florida they have all ready passed restrictive laws to limit non-derm/plastics form being medical directors. They are also trying to make it unlawful for any physician other than plastics or derm to own/operate (even if they are on site fulltime) any form of clinic where the majority of the care is for skin.

I agree with both of your predictions as stated above. I think the medical boards will start to crackdown on who can own operate a medspa/aesthetic center. There are many that currently operate illegally as a non-physician can not employ a physician. So if I were a non-physician thinking about investing in a med-spa make sure you have excellent lawyers that understand the legal aspect of cooperation between a non-physician owned medspa and the physician. Basically, if I were a non-physician thinking of investing in a medspa I wouldn't. The slightest change in laws or a crack down by state medical boards can put you out of business. Locally, I have seen one shut down by our state medical board.

I also think that the plastics/derms are going to increase the fight within the medical world to try and legislate others out of business. They have already done it in Florida (using poor quality science). They also fought all the way to the California Supreme Court to not allow the American Academy of Cosmetic Surgery to be considered a board which can certify physicians. The AACS won. The AACS is open to non-core physicians although I do not feel they are as open as they should be to primary care physicians. I am not sure what that will mean to us but it should help.

So to all of you make sure to watch what is happening in your state legislature and also with your medical boards. I have already contacted my state medical board and asked them to call me if any questions arise as far as the aesthetic medical industry. We have to make sure they hear both sides of the story.

I also think you will continue to see more primary care physicians get on board. Most will not jump in head first and open a medspa but many will start to add smaller procedures such as botox, hair removal as an adjunct to their current practice. FP's are being marketed to at a very high rate. The AAFP will offer seminars on some of these procedures at the national AAFP convention in October.

I think the plastics/derms need to look at the big picture. Most of the things done in a primary care setting such as botox will introduce patients to the world of cosmetic surgery. Many of these patients would have never seen a derm or plastics for more invasive procedures but now may proceed to the more invasive procedures. As more patients learn of what can be done more will start to take advantage of them and the minimally invasive industry will grow very rapidly.

There are also a lot of financial pressures placed upon the primary care physicians. They tend to work longer hours for less reimbursement. As an FP, you can spend 3 hours with an MI (for you non-primary care physicians that stands for myocardial infarction) patient and get less than $100 or you can do some botox that takes 5 minutes and make more money. So what you are seeing is the frustration of primary care physicains jumping ship. As the old saying goes, work smarter not harder. Or we can use an OB, I would see the patient at least 10 to 15 times throughout the pregnancy review multiple labs ultrasounds etc then do a normal vaginal delivery (often at 3am after spending hours in the hospital) and get reimbursed about $1900 or I can spend about 1 hour doing a full face thermage (at 2pm) and get $2000. Believ it or not because I delivered babies my malpractice insurance was 5 times as high as it is for cosmetic procedures. So the question is, which would you choose?

Next thing to look at is should plastics and derms be doing these procedures? I know this is a wierd question but we need to ask it. I live in a town with a fare number of derms most of whom dabble in cosmetic procedures. One is a friend of mine and he has the busiest cosmetic practice in town of all the derms. The highest numbers he ever achieved was about 17% of his patient load. The plastics as above have someone else do the procedures rarely under direct supervision. I own an aesthetic business and do all of these procedures myself with the exception of hair removal or IPL treatments. So that means that 100% of my revenue comes from cosmetic procedures.

So who should be doing these procedures? Should the derm doc be doing botox if they only do 100 unit every 2 weeks or the FP (board certified) that does at times 300 to 400 units in a day? Should these procedures be done at the medispa with a plastic surgeon as a "medical director" who is on site once a month or less and lives 60 miles away or the FP that is on site almost all of the time and does most of the procedures?

I think that patient demands are going to shape the future of cosmetic medicine. I feel that many of the derms and plastic surgeons will maintain what they have. I believe that the only derms.plastics that will be hurt are the ones with no bedside manner. They will lose because there will be other choices added that will treat the patients with respect. The derms/plastics that book 3 months out will also lose. Patients do not want to call the derm doc for botox and be told that they will be 8 weeks out. The addition of primary care physicians into the cosmetic arena will only make it grow. Many patients will realize that these procedures are accessable and not as expensive as they thought. They will also have already had a relationship and trust with their primary care physician.

So what I am telling the derms/plastics is that you have nothing to worry about if you do a good job and have a good personality. You will continue to stay busy. If you are a derm or plastics doc that think they are "god", then I would worry a lot. Also, if you are a pysician that does more invasive procedures you would be smart to "team up" with one of these primary care physicians. Remember, you will make a lot more money doing a bleph or face lift than you will doing the minimally invasive procedures.

So in the famous words of the great orator Forrest Gump, "thats all I got to say about that"

07.15 | Unregistered CommenterLH

Sorry about such a long post, I guess I got a little carried away. The post just struck a nerve.

07.15 | Unregistered CommenterLH

This post definitely strikes a nerve. I really believe that an aesthetic medicine board is really needed for all the non-PS and non-Derm physicians. At the end of the day it is a political battle that will be won through lobbying and PR. Without a more organized effort, more legislation similar to Florida's will get passed. The PS and Derm's already have their New Beauty magazine that plants the seeds that no one else is qualified to provide these treatments.

07.17 | Unregistered CommenterRichard


Couldn't agree more. You hit the nail on the head. Its ALL politics. I've incorporated as the American College of Cosmetic Physicians, INC. with an associated board called the American Board of Cosmetic Medicine and Surgery, Inc. in the state of Florida. I'll be rolling out a web-site soon. Its open to all, but designed as a political forum for non-Derms non-PS doing cosmetic procedures. We need to get the word out to the public that you don't need to be a Derm or PS to do Botox, LHR, or even Liposuction...If you're interested in helping start this up, please let me know....or anyone else for that matter....I've been busy opening my clinic and haven't had a chance to get it rolled out yet.
Because were disenfranchised, (those of us non-boarded in PS or Derm,) we have no polital clout. Hopefully, that will change soon...

07.18 | Unregistered Commenterbotoxdoc

Very interesting article about doctor trends. It will be interesting to see what happens with regulations in the future. Click here for more information about medical spas.___________

(This comment has been modified for violating my policies on spamming.Kylie's IP address has not been blocked for now but I'll hope this isn't repeated.)

07.18 | Unregistered CommenterKylie


You are going to have to explain why clicking on that will answer my questions. All it does is take you to your (I assume) medspa website. My assumption is that Jeff will pull this as soon as he sees it.

07.18 | Unregistered CommenterLH

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