The Future Of (Plastic) Surgery

I recently came across a series of excellent articles on the future of surgery by Dr. Bard Parker, a community general surgeon in Georgia, detailing the growing shortage of surgeons and the public's desire to be treated by specialists.Dr. Parker has an excellent site and I would highly recommend kicking around it for a few minutes.

"The crucial issue for the patient may well be: Will there be a doctor to care for me?

It is now strongly suggested that by the year 2020, there will be a large shortage in the physician workforce, none more obvious than in the discipline of surgery. If one accepts the postulations based on gross domestic product increases, then by the year 2020, there will be an approximately 200,000 physician shortage in the United States. Although some of this shortfall can be made up by nonphysician clinicians, a serious shortfall in physicians, particularly specialist physicians, is projected.

A recent survey of 70 medical schools in 35 states reported shortages in surgeons that approximate 20%. A survey by the Massachusetts Medical Society suggests a physician shortage in general surgery of 32%, with orthopaedics, neurosurgery, and urology having even greater shortages."

It's a very interesting take from surgeon.

Filler Injections For Lip Augmentation

Injections

Your surgeon will most likely use topical anesthesia (painkiller applied directly to the lips) for injections. These are performed on an outpatient basis in your doctor's office or an outpatient center and you will be sent home the same day.

Here are the options:

* Artecoll is a synthetic material that plumps up the lips. Because it's synthetic, you are at higher risk of having an allergic reaction to it than if you got an injection of collagen or fat, but it lasts longer than either.

* Autologen is an injection of your own collagen, extracted from another place on your body. There's no risk of allergic reaction, however, the results are only temporary. This may be good for people who aren't ready to commit to a permanent result.

* Collagen can be extracted from cows and injected into the lips. There's a risk of allergic reaction, so it's best to have your surgeon give you a test dose before proceeding to the full dose. The results are temporary lasting 4 weeks to three months.

* Dermalogen is collagen extracted from deceased human donors. It's also called injectable Human Tissue Matrix. This is also a temporary fix, but your body should not reject it.

* Fascia injections use a specific type of connective tissue harvested either from your own body or from a deceased human donor. It can be implanted surgically or injected. The main drawback is that within a year of injection, your body will reabsorb the fascia.

* Fat from your own thighs or abdomen can be injected into your lips. There's no risk of allergic reaction and you may achieve permanent results. This can also be implanted surgically (see below).

* HylaForm is a material created from natural body substances. There's no risk of infection, but you will need repeated treatments to maintain the result as it's only a temporary fix.

* Restylane is a clear gel. It contains hyaluronic acid, which naturally occurs in humans, so there's little chance for an allergic reaction. It's biodegradable, so your body will absorb it within about six months of the injection.

The Future Of Medical Spas

Work in Progress. Check back later.


Technology Factors: Technology companies are tripping all over themselves in order to come out with new technologies and gain market share. With over 30 companies offering devices for hair removal alone, choosing technology is an important part of our offering. The cost of picking the wrong device can increase your cost substantially. We have seen that in some of our competitors. They can't offer hair removal for large body areas (legs and backs) and make a profit. This has forced them to eliminate these areas from their offering.
 
The addition of treatments like Thermage, Collagen Point Induction, and Pointe Lifts place us in direct competition with plastic surgeons.
 
Regulatory Issues: We expect regluatory issues to continue to increase. This benefits us by increasing the barriers to entry in the marketplace. There are currently many states that have little if any regulation about physician oversight with these medical devices. As states and state medical boards look more closely into these new treatments it is expected that the majority of states will only increase the ammount of physician oversight required. The fact that there are numerous non-physicians taking money away from physicians and the occasional horror story should also factor in. If and when increased regulation takes place it will impact our competitors to a great extent. We predict that all states will settle around Surface's model; Direct, on-site physician oversight.
 
Anticipated Changes & Trends in Industry: As the population gets older the market will only grow. We also expect to begin see a shift away from day-spa treatments in favor of proven medically based treatments. Non-invasive technologies will also take off as more treatments come online.

Changes in Medicine: The move towards technology solutions should present us with growing opportunities. As we grow our patient base we become more attractive to other businesses looking for a foothold in the market.

Medical Spas - Competitive Analysis

Work in progress.  Check back later...

Retail medicne has not been refined, there is little competition compared to other markets, use of technology is minimal, and medical offices are not designed for efficiency. These features of the industry have created a situation that is ripe with opportunity for a retail chain with the right mix of business strategy, medical offering, and marketing.

There are no core cosmetic medical giants. The largest competition consists of individual physician practices that do focus exclusively on medical technologies as part of their product mix. These practices are generally poorly managed and poorly marketed. Most of these practices manage one clinc, with a small minority managing two locations.

Most physicians use the same technology they did ten years ago—a cash register and a calculator. If they’re ahead of the curve they might use spreadsheets and a copy of Quickbooks or an outside service. Supply chain management, true online retailing, and real-time systems are almost unheard of in the medical industry outside of large hospitals.

Conventional cosmetic practices attempt to get customers in the door with yellow page ads, sell their clientele products they'll probably only use once, and then get them out the door. The medical spa by contrast is not just somewhere to buy something, but a destination in and of itself.

There are three types of service providers that form our current competition and from which potential customers may choose; medical spas, plastic surgeons/dermatologists, and day spas.

Medical Spas: Success breeds competition. Starting up a clinic or medical spa needs only financing and physician oversight. Neither presents much of a barrier to entry. What does create a barrier however is being first to market. A lead, especially in a rather small and insulated community should lead to an insurmountable barrier.

Some franchises and small chains have attempted to fill this market by creating an offering that attempts to remove the physician from the business as far as possible. These businesses "rent" a physician in order to provide medical oversight to their operations (either by co-locating or off-site) but their business plans are flawed.

• This model prevents offering treatments that must involve or be performed by a physician.
• The model presents a "strip mall" look and feel as a medical practice.
• The physican providing oversight is at risk: It's his medical licence on the line.
• The physician discovers that he can do it himself leading to managerial problems.
• The physician can not be bound to provide oversight if he chooses not to.
• The model makes less money since physician treatments have the highest margins.
• There is no opportunity to add new physician treatments or technologies.
• Marketing and PR abilities are curtailed.
• The patient wants a specialized physician.
  

Plastic Surgeons/Dermatologists: The bulk of our competition comes from individual physicians offering cosmetic treatments, usually Botox, hair removal and/or skin rejuvenation procedures. In general, physicians do not have the marketing, advertising or PR savvy to pose a significant threat to entry into this business. In fact, prices and marketing will put pressure on these practices to stop offering competing services. 

Day Spas: Day spas offer some competition with their current client base and established presence. Their competing offerings may consist of hair removal, microdermabrasion, non-medical wrinkle, cellulite and facial treatments, and some Botox by visiting physicians. These visiting Botox treatments are generally promoted poorly. 

None of these competitors have a specialized scope of offering, marketing resources or focus that prevents competiton from entering the market. Those that offer competing services do so on a small, (and sometimes shoddy) scale and without  marketing savvy. 

Franchises and Chains.

More coming later...