Two-tiered treatment system for skin patients, with better care given to cosmetics than to diseases

Several months ago, we reported on an article in the American Academy of Dermatology which reported that patients could usually be seen much more quickly for Botox injections than they could for life-threating skin cancer examinations.  The results were startling, both in terms of the delay encountered by patients with potentially serious lesions and in terms of the preferential treatment received by cosmetic patients.  The New York Times reported on July 28 that this problem has continued, and perhaps become worse, in the months since that article was published.

While dermatologists are warning U.S. consumers of the potential for an epidemic of life-threatening melanoma, due to the damaged ozone layer, many are also creating a two-tiered treatment system which favors cosmetic patients.  Insurers pay about $75 dollars for a full-body skin cancer check that takes about ten minutes.  A Botox injection to the forehead, however, takes about the same amount of time, requires no paperwork, and costs the cosmetic patient as much as $500.00 dollars, cash.  As a result, doctors from Allergan, the makers of Botox, claim in their marketing presentations that a dermatologist can increase his or her income from about $390,000.00 annually to about $700,000.00 annually  by adding cosmetic medical procedures.  Doctors are advised to "identify and segment high priority customers".

At the annual meeting of Dermatologists, a Del Mar dermatologist, Jason Lupton, advised yound doctors to oblige cosmetic patients by scheduling them within seven days and then filling in the schedule with "general" dermatology patients.  The University of Michigan Dermatology web-site requires a physician referral for medical patients, but entices cosmetic patients with inducements like valet parking (no 'script required). 

Dr. Allan Halern, chief of dermatology at Sloan-Kettering in Manhattan, suggests that the problem has gone so far that "physician extenders" [i.e., nurse practitioners and physician assistants] are being hired to perform medical dermatology while the physicians themselves perform cosmetic dermatology.The New York Times quotes physicians who maintain separate receptionists, waiting rooms, examining rooms and even follow-up staff to provide preferential treatment to vanity customers.

It is a sad state of affairs when, as Julie Cantor, who teaches medical ethics at UCLA, put it: "People who want their wrinkles removed before next week's wedding are treated better than patients with [genuine medical issues]."