News of the Day ... In Perspective

Wrinkles treated more quickly than melanoma

Patients seeking an appointment with a dermatologist for Botox treatment of wrinkles can generally get in within a week or two. But if they are worried about a potentially life-threatening condition, such as a changing mole, they may have to wait months.

�The difference in wait times between medical dermatology and cosmetic dermatology patients is clearly real,� stated Dr. Jack S. Resneck, Jr., assistant professor of dermatology at the University of California at San Francisco and lead author of a study to be published in the Journal of the America Academy of Dermatology.

According to its abstract, the study �cannot differentiate between many possible explanations for the observed differences in wait times. Because physicians in many other specialties with physician shortages are also offering cosmetic services, further studies are needed to assess the broader policy implications of these findings.�

�The study shows that the Botox needs of the United States are being met,� states Dr. Alexa B. Kimball, associate professor of dermatology at Harvard Medical School. A wider array of doctors including plastic surgeons and even some internists offer Botox injections, but the demand for medical dermatologists, in an age of increased awareness about diseases like melanoma, outstrips the supply.

Other dermatologists note the possible role of financial incentives. Dr. Michael J. Franzblau, a San Francisco dermatologist, notes that patients frequently pay $400 to $600 upfront for a Botox anti-wrinkle treatment, which typically is not covered by insurance. Meanwhile, doctors have to wait for insurance to pay them $50 to $75 for a mole examination (New York Times 8/29/07).

Dr. Resneck�s comment that �we need to look further and figure out what is leading to shorter wait times for cosmetic patients� is �clearly laughable� writes internist Alieta Eck, M.D., of Somerset, NJ.

�It has been obvious to us all that anything that is not covered by insurance is completely available today. Chances are, if a procedure is covered by insurance, the payments do not cover the costs, so fewer and fewer doctors are available to do it.�

Dr. Eck notes that an obstetrician in her area does cosmetic vein and Botox treatments to subsidize his obstetrics practice.

�Doctors need to bail out of insurance completely�and take back the practice of medicine,� she writes. �Patients need to be responsible for their bills, and can use the insurance instrument to pay them�but the patient-doctor relationship needs to come first.�

Additional information:

• �Is Insurance Evil?� and �Insurers Deny Right to Self Pay,� AAPS News, July 2006.
• �The Long Road to Freedom in Canadian Medicine,� by Jacques Chaoulli, J Am Phys Surg, Fall 2005.