Dr. Kenneth Beer: Physician, know thy place.

Dr. 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 , www.skinandaging.com 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

PALM BEACH ESTHETIC CENTER

1500 North Dixie Highway, Suite #305

West Palm Beach, FL 33401

Tel: (561) 600-4848

Fax: 1.561.655.9233

Email: info@palmbeachcosmetic.com

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. 

Many 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.  

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:

Dr. 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.  

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.