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Dr. Kenneth Beer: Physician, know thy place.

dictator.jpgDr. Kenneth Beer is not happy. He posted the following comment on various discussion threads around this site.

Anyone who is not a dermatologist, ENT, oculoplastic has no business doing any aesthetic procedures. All PCPs, PA, RN whatever should be malpracticed out. Read the article in this last months issue, July 2007; Skin and Aging , page 28: The Impact of Core Specialist. PCP's are NOT invited to the Cosmetic Boot Camp and this is the sole reason for blogs like these.
Kenneth Beer MD

1500 North Dixie Highway, Suite #305
West Palm Beach, FL 33401
Tel: 1.561.655.9055
Fax: 1.561.655.9233

The article to which he refers (and he authored) is here: The Importance of Core Specialists

Here are some more of Dr. Beers thoughts as expressed in this article. 

blockquote.gifMany who advertise themselves as aesthetic surgeons, cosmetic surgeons or even dermatologists, are in actuality instead boarded in pathology, emergency medicine, internal medicine or family practice. And while they may be competent in their own areas of specialization, it stands to reason that physicians who would cut corners to get into the practice of aesthetic medicine might be more likely to cut corners in performing aesthetic procedures than those of us who have invested years in training specifically for this specialty.

Unethical Practice

As for the financial aspect of this issue, I do care that others in my community are willing to inject for half of my own fee for such procedures. Moreover, I believe that legitimate core specialists are less likely (as a group) to dilute product or substitute counterfeit than those who have cut corners. One prominent case in point: the counterfeit Botox scare in Florida. When the dust settled, it turned out that the product injected was not Botox and that the injections were not made by a medical doctor who was board certified in a “core” specialty.

In another instance that I documented, a local “aesthetic” physician who was injecting hyaluronic acids at a discount was telling people they were getting Restylane but was in fact injecting the less expensive Hylaform and Captique. This practitioner was trained in family practice and pathology, but had no core-specialty training.

...My point is that I believe those who make a habit of skirting the rules are more likely to do so in other aspects of their lives — especially their practices.

Patient Safety Considerations

What happens to patients who receive cosmetic treatments from self-proclaimed “aesthetic physician”?

They frequently have acceptable results when the treatments are straightforward and involve easily treated areas where knowledge of the anatomy is not needed and a cookbook approach is adequate. But sometimes they get burned — even literally when they are treated with lasers or chemicals by someone with no formal training.

Potential Crisis of Patient Confidence

There is now a segment of the population that has been harmed by cosmetic procedures performed by non-core physicians to the extent that they may well have sworn off Botox, fillers, and lasers entirely. For the corporations that have sown these fields by deputizing non-core physicians like my disgruntled colleague to use their products and train others to use their products, the harvest will be bitter.

As for the core specialists, we can only hope that by highlighting these differences to patients and the media, we can help to restore the integrity of our specialties. Perhaps as we begin to work together we can protect our specialties and our patients.   blockquoteend.gif

My guess is that in his gusto Dr. Beer didn't read that 'plastic surgeons and dermatologists' are also members of this site or perhaps brushing shoulders with the great unwashed masses of other physicians who are busy cutting corners just got the better of him. I'm guessing that he's also missed my opinion on the medical spa franchise model and like systems. Certainly his demand that PA's and RN's shouldn't be performing procedures would put any number of boarded docs right in the can.

It's just a guess here but I'm guessing that this is the type of language that was so effective in changing the laws in FL.

But of course, Dr. Beer isn't adverse to spreading his wings into other endeavors. He has a web portal selling over the counter skin care and even has a software package that he's about to revolutionize medicine with. From a press release:

blockquote.gifDr. Ken Beer's dream may look something like a cross between a Nintendo Game Boy and an Etch A Sketch, but he prefers to refer to it as "the future of medicine." Beer, an entrepreneurial dermatologist, makes software for doctors to run on tablet computers.

... Beer is seeking investors and partners to help him finish and market his first program, called Dermsoftware, which is designed for dermatologists; after that, he will expand in-to other medical specialties. At $24,000 to $32,000 per system (which covers the software license, upgrades, and a Hewlett-Packard server), Beer knows that he is asking a dear price. But he is convinced that medical practices will gladly pay it.   blockquoteend.gif

I too am the object of Dr. Beers wrath since when he signed up as a member of this site he tersely requested that I 'shut this site down immediately'.  Heavens I'm becoming unpopular. Perhaps I'm the only one on the planet who could create an alliance between Beers and Mudd.

Dr. Beers is not only letting his obviously substantial ego run amok, he is chasing a red herring in this case.

"Anyone who is not a dermatologist, ENT, oculoplastic has no business doing any aesthetic procedures. All PCPs, PA, RN whatever should be malpracticed out."

Perhaps Dr. Beers misunderstood what the definition of dermatology actually is while he was career planning. Here's the first definition I found.

Dermatology: The branch of medicine concerned with the diagnosis, treatment, and prevention of diseases of the skin, hair, nails, oral cavity and genitals.

Dermatology wasn't designed to be 'cosmetic' medicine. It's the study of diseases of the skin. The 'cosmetic' aspects of medicine were inherited by dermatology and plastic surgery as they were the closest medical specialities.

So now you have dermatologists who identify themselves as 'Cosmetic Dermatologists'  because there's an understanding that the cosmetic aspects of medicine don't fit under the disease aspects that really is dermatology.

Which brings us to the changes taking place in in medicine. 

The physician of the future will be managing technology, not utilizing an individual skill set. Physicians are a hugely inefficient method of delivering treatments. They're expensive to train, they're slow,  and they're expensive. Dr. Beer really is fighting city hall on this one.

What's better... technology.

Medicine is moving to technology solutions. That's what the market demands. That's what is happening and nothing that anyone says or does will change it. It's happening faster in retail medicine because it's not encumbered by the inertia of the third party payer system but it will happen in all of medicine.

A useful analogy would be the family farm. Everyone likes the romantic notion of the family farm. In fact, legislation is passed and moneys provided to keep family farms in existence. But if you think that the family farm will exist in a hundred years outside of a living museum you're mistaken. The family farm is inefficient and markets and progress demand efficiency. So the family farm will change to more efficient methodologies. Any effort to save family farms just forestalls the inevitable. It's the way of the world and nothing that you, I, my farmer friends, or Dr. Beers does will change the way that markets work.

And as new technologies are developed faster, it negates the 'training' that was needed to ensure the effective delivery of the treatments. I'll bet that there's not a dermatologist in the country who performs every bikini line hair removal treatment in their cosmetic practice.  Where are these hidden hoards of board certified derms and ENT's that are ready to fill the cosmetic demand?

Dr. Beers position would not ring as hollow if he was focused on who could safely deliver services rather than the protection of a club to which he belongs. Certainly his position seems to be that any physician offering Botox who is not a boarded dermatologist is a quack.

I'd suggest that there's an argument that there is a strong ethical conflict for all dermatologists performing cosmetic treatments.

Skin cancer will soon become the most common cancer in the US. In most cases there's a two month wait to get in to see a dermatologist to take a look at a mole. It could easily be argued that any dermatologist performing cosmetic procedures is selling out needed patient care to cash in and make a buck.

I don't subscribe to this theory myself of course. It's just a thought. 

Reader Comments (18)

Well put. I guarantee that if there weren't alot of money to be made in aesthetic medicine you wouldn't this type of rhetoric. How much training does a dermatologist or ENT get in doing aesthetic procedures during residency? Someone who recently finished training may have gotten some, but someone who trained 15-20 years ago probably didn't get any. Should they too be excluded from doing aesthetic procedures because they weren't trained during residency?

08.6 | Unregistered Commenterburned

This seems no different than posts that have been removed from this site for blatant self promotion/spam.

"Certainly his demand that PA's and RN's shouldn't be performing procedures would put any number of boarded docs right in the can."

You're right, Jeff. I wonder if he feels that dermatologists who employ PAs to do general derm (as well as cosmetics) should get rid of them and see all patients themselves! I guess Dr. Beer feels it's ok for patients to wait several months to be seen? Maybe he doesn't like the idea of PAs at all and would like to do away with them in other specialties too. Now that would really turn things upside down, especially in primary care.

08.6 | Unregistered CommenterFiona

Therefore dermatologist should not be performing blephs. or mesotherapy which many are. These are surgical and should only be performed by plastics right ? hmmm....

By the way first case in history of mesotherapy complication: myonecrosis by dr. ---- in california who is a dermatologist. -- i suppose he was not properly "trained"

Case in Oregon, 27 y/o female permanently blind by 1064nm YAG after hair removal on unibrow. --- used wrong goggles. this was a dermatologist.

Fact: How many dermatologist go through formal certified training throught the ANCI - amercian national starndards institute which OSHA abides by? < than 10% of dermatologist, ENT, plastics who use lasers.

In addition: You have to go through residency to removal a skin tag or hair with a laser ? IM injection of botox ? you have to complete residency to inject medication IM ? how about vaccinations ?

Dr. Beer your thinking does not make much sense.

08.6 | Unregistered Commenterrms

Medspa buzz raises a point I'll address about self-promotion. The comments that Dr.Beers made were really an attack. I did remove some since he left so many but he made no effort to hide or pretend that he was anyone else. (In fact, he left his entire contact information including his email which means in 3months he's going to be getting a lot of spam in his inbox.) If he had tried subterfuge or just plugging his training, his posts would have been removed. Since hes a Florida dermmatologist and a shining example of the kind of rhetoric that's being published elsewhere, I thought it worth discussing.

Copied from another page

Dr. Beer

First, I don't understand your statement, "... (we) are NOT invited to the Cosmetic Boot Camp and this is the sole reason for blogs like these". Thank you for dis-inviting me. I have no desire to pay you to teach me what I already know so I wasn't coming anyway. But, "blogs like these" are where like minded professionals come to converse, share information, ideas and experiences, engage in good natured banter, gossip and help each other. I really don't understand your beef with "blogs like these". Most of the professionals who frequent this blog are friendly, nice, courteous, intelligent and positive. Unfortunately, we get the occasional visit from the Br. Beers of the world who are rude, unkind and insulting.

Did you really think it would be helpful for you to use your comments here as a piece of advertisement for your business and list your name, the name of your spa, the address of your spa, the phone and fax number of your spa and your spa's email address? Did you think the readers of your comments would be so dazzled with your brilliance and insight that they would call for an appointment?

The most troubling, for me, is the tone of your message and your over all "know it all, I am THE expert" attitude. You insulted and demeaned the professionals who regularly use and contribute to this site. So, since we are dealing with insults and just for fun, lets take a look at what some of your patients and staff say about you. The following statement, by your patient, was cut and pasted from another public website where your (former) patient is a registered member:

" Very long wait to see Dr. Beer even though I was on time for my appointment. Doctor was not friendly in fact he did not shake my hand or smile. He had a flat affect the entire visit & did not offer advice or help me in any way. Did not seem to care about my skin problems overall. Offered very little help & was very unsympathetic. He provided samples of a prescription medication but then denied my access to these medications with a prescription unless I paid to see him again. Very rude & arguementative over the phone when I asked for his assistance for adult acne. Female staff members stated he is typically unkind to his patients & unpleasant to work with. Will look for a new dermatologist in West Palm Beach as Dr. Kenneth Beer was not looking out for my best interest. I deserved better & thus will not go to see him again."

So, it's not just your demeanor on this site, even your staff says you are unkind to your patients and unpleasant to work with. I feel much better now because I thought you had something against me personally. Now I know you are just an all around jerk.

I really have much more to say but I will save it for another time. Jeff and DermaRogue said most of what needed to be said above. If you want to continue our conversation I will be very happy to accommodate you.

08.6 | Unregistered CommenterPro Docs

I don't think that Dr. Beers posted his contact info as an ad.I think he's inviting people to argue with him directly. It's that innate sense of superiority that he conceals so well.

08.6 | Unregistered CommenterVexed MD

After reading this post, I don't think there will be another bootcamp next year. where else can i go for my botox training??? ahhh...

Hey, Dr. BEERS, what have you been drinking?

Or should I ask how many?

08.7 | Unregistered CommenterMD

dr. beer your local "non core physicians" colleagues that send you referrals or consults ??? shouldn't.... the primary care physicians in your area who are performing aesthetics or considering should NOT be sending you any patients. i personally would not respect you in our area.

any speakers at the "cosmetic boot camp" should also be given the same courtesy as they abide by the same attitudes.

Joel Cohen MD --- big speaker for Allergan -- Botox.

Dr. Beers,

I think there's another case of acne waiting in room #1. You better get in there stat. Fascinating stuff that.

08.8 | Unregistered CommenterJarvik7

Jarvik7, That is so choice. I'm clutching my sides.

08.8 | Unregistered CommenterCarotid

Can't we all just get along...?

Dr Beer should be treated with the respect any physician who has survived med school, residency and fellowship deserves. However, as a 'non-core' kinda guy myself, I find it awfully amusing (in a sad kind of way) that local derms are not even dealing with acne. I have had so many patients come to me because they get tired of so-so results, harsh regimens and 3 month lead times for appointments. The local plastics have stopped doing some of our procedures as well because from our market research at least, we are more accessible, easier to work with, honest about what will work whether it is our procedure or something for the derms/plastics to tackle. I could personally care less if the local plastics are doing our procedures - I tend to doubt they can maintain their million dollar a year salaries and revenue streams based on competitive pricing with us.

Dr Beer - suck it up and deal with the fact that the aesthetic as well as medical profession is a business these days, and business means competition!

08.8 | Unregistered CommenterDermaDoc

Just a quick note. Dr. Beers mentioned the bogus botox thing in Florida well I personally know 2 of the 214 users natoin wide one was derm one was plastics. So, I guess that blows his theory.

08.9 | Unregistered CommenterLH

I am going to recommend that you go to Dr. Beer's website. He has some before and afters. His results are not very impressive. Look at the Restylane lips before and afters. If I had results like that I would definitely NOT put them on my website.

08.11 | Unregistered CommenterLH

Maybe we should come up with some sort of standardized certification for any physcian, PA or ARNP who wants to go that extra mile and not cut any corners. There should be certification courses and training to show who REALLY knows how to inject Botox, fillers and use lasers. There is no standardization of any kind in the field of Aesthetic Medicine. Maybe Dr. Beer should work on this--his entrueprenurial spirit should find some way to make more money for himself out of this endeavor!

10.11 | Unregistered CommenterSL

I just want to add my two cents here. As a BC FP with several years ER experience and now practicing cosmetics, I was, like the rest of the world, brainwashed into believing that only Derms and PS should be providing cosmetic medical services. Until last month that is. Despite my self doubts, I recently opened a medical spa. I am now thoroughly convinced that I am in the right place. I too held Derms on a pedestal. But, then the pts. started flowing in. Pts, burned and permanently scarred by several and various derms. One pt. had a checkerboard pattern permanently embelished on her abdomen by a derm using an IPL at too high a setting. Another misdiagnosed anaphylaxix as a contact dermatitis. (her sx. resolved, by the way, with IV benadryl and solu-medrol.)
I recall my med. school years, rotating on the dermatology service. Sure I learned to identify some rashes, but what I also noted was their severe lack of knowledge of general medicine. To me a dermatologist is nothing more than a glorified aesthetician. A real doctor is as comfortable treating sceptic schock as he/she is at treating acne or injecting restylane. If you're going to call yourself "Doctor" you better know how to practice medicine not just treat rashes.

10.13 | Unregistered Commenterbotoxdoc

Wait until Dr Beers gets wind of this one

Dermatology Practices Turning to Non-Physician Clinicians

Use of nurse practitioners and physician assistants has increased significantly since 2002

Feb 13, 2008

WEDNESDAY, Feb. 13 (HealthDay News) -- Because of a nationwide shortage of dermatologists and persistently long patient wait times, dermatologists are increasingly turning to physician assistants and nurse practitioners to meet patient demand, according to a report published in the February issue of the Journal of the American Academy of Dermatology.
Jack S. Resneck Jr., M.D., of the University of California San Francisco School of Medicine, and Alexa B. Kimball, M.D., of the Department of Dermatology at Harvard Medical School in Boston compared the responses of 1,243 dermatologists to the American Academy of Dermatology's 2007 practice profile survey with responses to surveys conducted in 2002 and 2005.
The researchers found that the number of dermatologists who reported using physician assistants, nurse practitioners or both in their practices increased from 20.7 percent in 2002 to 29.6 percent in 2007 (a 43 percent increase). Although respondents reported supervising non-physician clinicians on-site 92.8 percent of the time, 31 percent reported that they were off-site during 10 percent or more of business hours. Therefore, nurse practitioners and physician assistants were usually allowed to see new patients and established patients with new problems under indirect supervision. The researchers also found that 36.2 percent of respondents expect to hire non-physician clinicians by the year 2010.
"In the absence of explicit consensus or policy as to how the field should ensure future access for patients with skin disease, growth in the use of non-physician clinicians is rapidly changing the landscape in which dermatology is practiced," the authors conclude. "Further data on the evolving use of these non-physician clinicians and the consequences for both patient access and quality of care are undoubtedly needed."
Resneck disclosed receiving a career development award from the Dermatology Foundation, and he chairs the Workforce Task Force of the American Academy of Dermatology

03.20 | Unregistered CommenterFlorida PA

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