In a world in which insurance reimbursements keep getting cut, more and more medical professionals – physicians and nonphysicians alike – are looking to fee-for-service procedures and practice models for increasing income. Sometimes, this may involve physicians delegating procedures to nonphysicians. Franchised clinics open up with a physician to “oversee” the clinic, while extenders often perform the procedures (many times without the physician present). Physicians who are neither trained nor specialized to do certain cosmetic procedures start to perform them. Patients get used to receiving treatments from nonphysicians or from physicians who are not specialized to perform cosmetic procedures, and then may devalue the procedure, feeling it’s unnecessary for a physician or a specialized physician to perform it.
For these types of cosmetic procedures, such as laser tattoo removal, which are not covered by insurance, patients also sometimes seek treatment at a discount (#don’tGrouponyourface), but often at the expense of being treated by a less well-trained or less-qualified individual. This happens with botulinum toxin injections, fillers, and lasers (particularly laser hair removal and laser tattoo removal). It spirals down a path that devalues both our specialty and the high level of training we have received. Then we – the highly specialized physicians – frequently are expected to manage the complications when they occur.Much of this is the fault of our own specialty (dermatologists and plastic surgeons) in delegating physician cosmetic procedures to nonphysicians. When nonphysicians perform these procedures, then nonspecialized physicians may devalue the procedures and start to believe that a weekend course is enough to be able to learn them if a less trained individual can do them. In some instances, it is appropriate to have an extender help with a procedure, but where do we draw the line? How do we protect patients, maximize our practice, and maintain the value of our specialty for the level of training that we have? Should only specialized trained physicians (board-certified dermatologists and plastic surgeons) be allowed to perform certain cosmetic procedures? While this approach may decrease overall income to some clinics, it would maintain the trust between the patient and the physician, the quality of care, and the integrity of our training, education, and specialty. While opening multiple laser tattoo removal clinics may seem like a smart business idea, if the physician can’t be there to oversee and actually perform the procedure, the risk of all of the problems outlined above can occur.Dr. Wesley and Dr. Talakoub are co-contributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.
