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Medical doctors attracted to cosmetics: Physicians can earn more with lasers and Botox than primary care
(Houston Chronicle (KRT) Via Acquire Media NewsEdge) Jun. 2--To most people, the word "obstetrician" signifies babies, not Botox.
Yet a number of obstetrician-gynecologists, as well as primary care doctors and dentists, are peddling cosmetic treatments that relax wrinkles, plump lips and banish cellulite.
Why? The short answer is cash.
A more nuanced answer gynecologists and internists give is that people are getting these procedures anyway at spas or other nonmedical locations, so they might as well get better treatment in a safer environment from a doctor they trust.
"You can't base a business on what insurance companies are paying you, anymore. You have to transition," says Dr. Susan Hardwick-Smith.
An OB-GYN for nine years, Hardwick-Smith spent the last two of them building up the aesthetic side of the business. These procedures can be as simple as Botox injections or as complex as laser vaginal rejuvenation -- to tighten the birth canal -- and labiaplasty -- plastic surgery to alter the genitalia.
In an environment where Medicare and insurance companies are cutting many reimbursement rates, some physicians say seeing sick patients can be a costly, protracted exercise.
Hardwick-Smith says Botox, laser hair removal and other cosmetic services smooth her cash flow while she waits 30 to 90 days for insurance companies to pay up on the medical side.
Some of the same patients who complain about co-payments rising $20 to $30 for doctor visits will happily swipe their credit cards, charging $300 or more, up front, for a shot of botulinum toxin type A between the eyes to take out a frown line. Procedure and payment take mere minutes.
Dr. Elvis Torres, who bills himself as a cosmetic gynecologist, still delivers babies "for the fun of it."
"What do I get paid to deliver a baby?" Torres says. "That's nine months of care, delivering her and then waiting 21 years to see if the child will sue me -- between $800 and $1,600 -- about $1,200 on average."
A matter of priorities
Torres and his nurse practitioner see around 50 patients a day on the medical side of his gynecology practice. An additional 10 to 20 come in for spa services, such as laser hair removal and Restylane injections to fill in laugh lines.
"I can see maybe 50 patients a day on the medical side. We may make $2,000 seeing every one of those people," Torres says of insurance and Medicare reimbursements.
"I have one woman who comes in several times a year to see us on the spa side, and she spends $2,000 every time on Botox and Restylane," he says.
That doesn't keep Torres from shaking his head at some people's priorities.
"It's sad," he says. "We've seen women, for instance, with ovarian cysts. I'll tell her she needs an ultrasound to check it out. She decides it's not bothering her and she can't afford it. As she's walking out of my office, she sees the video about Botox and wants it, and I have to tell her, 'No injections until you get your ultrasound.' "
"You take care of your health first, and then we'll talk about your looks."
Mary Beth Robinson, marketing director for Obstetrical and Gynecological Associates, which specializes in fertility issues and offers cosmetic treatments through its nursing staff, said one woman admitted her husband did not know she was getting Botox injections. When the name of her spa shows up on credit card bills he complains about her spending habits, but he never bats an eyelash at a charge from a doctor's office.
Torres and Hardwick-Smith say they're committed to medicine, but they acknowledge demand on the cosmetic side of their practices is huge and could threaten to take over.
Torres also says many procedures perceived as cosmetic, such as plastic surgery to alter the vagina, can be medically necessary.
Dr. Ivonne Smith, an OB-GYN with Obstetrical and Gynecological Associates, says some women who come to the office for cosmetic treatments confess they've missed pap smears for several years in a row. Smith says the "superficial side" of the practice can be a lure for women to get needed treatment.
"It's obviously superficial," she says. "When it comes to feeling healthy, sometimes people put that off. But when it comes to feeling good, people pay for that."
In one case, a woman referred by friends for laser hair removal found out she had polycystic ovarian disease, which can cause a severe hormone imbalance that creates excessive hair growth.
"She wouldn't have figured that out at a spa," Smith says.
But jumping on the beauty bandwagon is a fast, easy way to add to the bottom line. The popularity of minimally invasive, purely aesthetic treatments has exploded in recent years, and they aren't cheap.
Take Botox. The injections, used to relax muscles that cause frown lines between the eyebrows and crow's feet around the eyes, have jumped from 1.6 million administered in 2002, when the U.S. Food and Drug Administration first approved the procedure, to more than 4.6 million in 2007, according to the American Society of Plastic Surgeons.
Profitable practice
Botox manufacturer Allergan charges physicians $525 per vial, each containing enough for eight injections. That's a cost of about $65 per shot.
For patients, Botox injections average $500 per shot, according to the American Society of Plastic Surgeons.
So, five Botox patients a day could potentially add hundreds of thousands of dollars in profits to a doctor's practice each year.
Some specialists worry that the profit incentive puts procedures in the hands of non-physicians and doctors without the necessary training.
In a 2007 survey of its membership, the American Society for Dermatologic Surgery found that 62 percent said they had seen patients in the last year for complications arising from dermatologic procedures performed by doctors who aren't dermatologists.
Dr. Paul Friedman, who specializes in laser treatments at Derm Surgery in the Texas Medical Center, says patients sometimes don't stop to consider the difference in training among physicians.
"I studied lasers during a three-year dermatology residency program followed by a one-year laser surgery fellowship," Friedman says. "The bottom line is you want to put your face in the best, most qualified and experienced hands possible."
Tied to insurance
Leslie Bryant, a spokeswoman for Allergan, said the company actively markets Botox to only core specialists, such as dermatologists and plastic surgeons. But any licensed physician can buy it.
Erik Goldman, editor of trade magazine Holistic Primary Care, says many family doctors are desperately seeking ways to add out-of-pocket services to their practices because poor insurance and Medicare reimbursements have chipped away at their income.
"Most stuff that's considered 'holistic' isn't covered by insurance," Goldman says. "Everything under the primary care bailiwick has suffered. Anything that involves spending time with patients is not well reimbursed. We're seeing lots of doctors building in fee-for-service components. For some that's nutrition counseling, for others that's aesthetics."
lynn.cook@chron.com.com
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