The post on LS, a dermatologist that's pissed at OBGYN's and FP docs in cosmetic medicine has 51 comments as I write this.

Certainly there will probably be more.

I've posted three comment from that thread here. Disenchanted is not generally happy with docs whose

Disenchanted thinks that physicians who are not plastic surgeons or dermatologists are 'money-hungry whores'. (emphasis mine)

As a second year resident having survived internship and still possessing a genuine interest in patients suffering from disease, this whole thread saddens me. No wonder the prestige of the physician has fallen, what a bunch of money-hungry whores. You can have all the lasers and cosmetics and make your money...better yet just trade in your MD for a cosmetology degree and think of all the lives you can make better and impact you will have on the world. Non-plastics/derms who do cosmetics have no professional integrity. All of the above posts are just sad justifications for selling out. I want an FP who will provide appropriate preventive care to my family (if you don't like how GME are reimbursed, spend the time/resources you put into cosmetics courses into a lobby for change). I guess since there's finally some awareness that Obs are cashing in on unnecessary C-sections (hysterectomies etc), need more ways to make cash money. My 2c, flame on brothers and sisters.

LH thinks he's somewhat naive.

Disenchanted, You probably are barking up the wrong tree. So what you are saying is it is OK for derm/plastics to do cosmetic procedures and anyone else that does is a money-hungry whore? I do not get the difference.

I think your opinion will change after you have done this for a while. I would like to speak to you in about 15 years when you have worked 70hours per week been up for 36 hours straight and delivering hundreds of babies in the middle of the night. You get about 1 week vacation per year and your family forget what you look like. All of this to continue to have to work harder to make the same income.

Also, you may want to understand that some of us actually enjoy the artistic side of cosmetic procedures. I also enjoy it because I get to spend more time with the patients.

So I have chosen to alter my career path and that makes me a whore in your eyes. I am OK with that and will not lose an ounce of sleep over it. It is much easier to change my path than the entire practice of medicine. I have fought many a battle including the political ones. It is best for you to look at the serenity prayer "God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference".

(Prodocs also comments)

DermaDoc also has something to say.

If I may chime in here for a moment - I am guessing Disenchanted is a resident who went directly from high school to undergrad to med school to residency and has never had a real job or real responsibilities in his/her life. I have been through residency, built a practice, served the underprivileged, and spent many sleepless hours on call taking care of 'real' patients. And I still do because it is who I am. I find it more indicative of a poor attitude that someone in residency already has a grudge against people that may horn in on the money making territory as a matter of free competition rather than settle for our dwindling reimbursements, skyrocketing overhead and more and more demanding professional obligations. I've done my time and no one else is going to pay my mortgage but me. I am not abandoning my patients at al, I am simply making my life better so I can be at my best when they need me.

On the other hand, the medical field looks like crap these days, so I can understand a little bitterness on the part of a resident who has already put a bunch of years into training with a constant stream of bad news about their prospects for a decent lifestyle and working conditions.

So Disenchanted, don't take it out on us if we are in survival mode. Find what you love doing and do it regardless of the payoff. I thankfully have found that place myself. Not alot of cash but I actually enjoy what I do, and that is fine with me.

As for myself, I'll point out that Disenchanted's suppositions rests on a number of key points that are tenuous at best:

That no physician should be able to change their mind or practice after deciding upon a specialty.
That, for some reason, physicians who decide on a 'cosmetic' specialty like plastic surgery or cosmetic dermatology have somehow taken the high road (This one I really don't understand.) and since they chose one of these early on that they are somehow more ethical that physicians not 'core trained'. (Why Disenchanted gives them a pass on this I have no idea.)
That physicians choosing to perform or offering cosmetic medicine are neglecting the obligation they have to their patients.

Since consulting, I've been approached by physicians from the following specialties: Plastic Surgeons, Dermatologists, Anesthesiologist, General Practitioners, Emergency Room Docs, Internist, Family Practice, Cardio-Thorasic Surgeons, General Surgeons, Psychiatrists, ENT, OBGYN, (I know I'm forgetting a lot).... and even a Pathologist. I've said no to many more than I've said yes to, and I have met a number of physicians who I felt were money-hungry and yes, even unethical. But not many.

I also have nothing bad to say about Plastic Surgeons or Dermatologists.

Certainly I understand how Disenchanted feels. But I'm afraid that the holes in the argument are just too big. I would have thought that Disenchanteds derision would have been more thoughtfully focused on Plastic Surgeons and Dermatologists performing cosmetic treatments. Certainly skin cancer should be the focus of Dermatologists and Plastic Surgeons should be performing cleft-palate repair. I would think that Disenchated should laud the Family Practice doc who frees up these specialist for their needed work since it's really not that hard to perform a Botox injection and the patient's right there for their flu shot anyway.

It brings to mind the following quote: "If you're not a liberal when you're twenty you have no balls. And if you're not a conservative when you're forty you have no brains."