Today we would like to address the issue, which was covered by CNN in November 2008. The report stated that nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative. What are the reasons for such an exodus among family doctors and internists, widely known as the backbone of the health industry?

Here is the data from the survey:

• Questionnaires were sent to more than 270,000 primary care doctors and more than 50,000 specialists in the U.S.
• Of the 12,000 respondents, 49 percent said they’d consider leaving medicine
• A shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted

Reasons:

• Overwhelmed by red tape generated from insurance companies and government agencies
• Rising cost of malpractice insurance
• Shrinking reimbursements
• Declining income

Dr. Alan Pocinki has been practicing medicine for 17 years. He began his career around the same time insurance companies were turning to the PPO and HMO models. So he was a little shocked when he began spending more time on paperwork than patients and found he was running a small business, instead of a practice. “I had no business training, as far as how to run a business, or how to evaluate different plans,” Pocinki says. “It was a whole brave new world and I had to sort of learn on the fly.”

We hear from many health professionals that it’s no longer worth running a practice and that they want to change careers. Just like for Dr. Pocinki, it will be very difficult to start a successful career outside of the medical field. Physicians go a long way to complete their training, licensing requirements, pay the loans and set up their practice. Medicine is what they chose to do in their lives.

LaserOffers’ panel and in-house discussions have helped us realize that the fee-for-service based anti-aging and aesthetic field can be one of the better alternatives for family doctors and internists. There are plenty of examples to demonstrate that the transition is fairly painless and can be accomplished in a short period of time. Training is quick and easy. In most cases capital expenditures, such as buying laser equipment, can be financed, and the demand for anti-aging and rejuvenation treatments is standing strong even during the recession. Baby boomers want to look young and they have discretionary cash to spend. People on the job market need to look fresh and young during the interviews and are willing to spend about $1000 on their looks.

LaserOffers comment

We see a clear trend towards anti-aging and preventive treatments in today’s medicine. Physicians in general will need to move from the current perception of their mission in treating symptoms to preventing their occurrence,  from using drugs to extend patients’ life to making them more active and happy. Aesthetics will definitely play a major role in the process. We will come back to the subject periodically in our future posts.

The American Academy of Cosmetic Surgery is a professional medical society whose members are dermatologic surgeons, facial plastic surgeons, head and neck surgeons, general surgeons, oral and maxillofacial surgeons, plastic surgeons, or ocular plastic surgeons — all of whom specialize in cosmetic surgery.

The AACS has completed its annual Procedural Survey and the most notable finding is the shift towards non-invasive laser treatments.

Over the past three years, cosmetic surgeons have seen a significant increase in both males (456%) and females (215%) electing to have laser resurfacing. Laser resurfacing is performed with a carbon dioxide (CO2) laser that delivers short bursts of high-energy laser light to minimize wrinkles and lines on the face. In addition, laser hair removal has jumped to the overall number two most performed non-invasive cosmetic procedure.

“Cosmetic surgery technology is advancing at the speed of light,” states AACS President Patrick McMenamin, MD. “As we learn more about the cosmetic uses for lasers, the more patients benefit from effective results and quicker recovery time. It is an exciting time for both cosmetic surgery patients and physicians.”

Although the economy is struggling, these laser procedures seem to be recession resistant. For instance, laser resurfacing has seen an approximate $450 decline in price since 2002. “As long as these procedures are effective and affordable, their demand will continue to remain steady.”

Other notable findings from the survey include:

In 2008, cosmetic surgeons have seen a 29% increase in their female clientele. Despite the economy, women are continuing to invest in their appearances. In addition, cosmetic surgeons have seen a 2% decline male patients proving that when times are tough, cosmetic surgery is the one of the first things men delete from their wish lists.
The top three most performed invasive cosmetic procedures in 2008 include: liposuction, blepharoplasty and breast augmentation; while the most popular non-invasive cosmetic procedures were Botox(R) injections, laser hair removal and hyaluronic acid.

The 2008 Procedural Data is based on a survey of U.S.-based AACS members completed in December 2008. The entire report, conducted by RH Research, is available by contacting the Academy.

Related Documents

• AACS 2008 Procedural Survey Results
• AACS 2008 Procedural Survey Fact Sheet
• AACS Economic Fact Sheet

A review of an article published in Houston Business Journal – by C. Richard Cotton

Originally trained in internal medicine, Dr. Kim Vo shares her new field of medicine — aesthetics — with other Houston doctors like Jim Cain, whose original specialty was interventional radiology.

Both physicians eventually ended up in the field of aesthetics, which, quite simply, is where many people turn to look better and younger.

Laser treatments, Botox injections and wrinkle fillers are the new Fountain of Youth — a step up from over-the-counter potions, but less expensive and intense than cosmetic surgery. And, weary of chasing insurance and Medicaid payments, physicians nationwide are capitalizing on the trend.

Cain compares the influx of physicians into aesthetics with a similar rush into pain management a decade ago: “It was mainly an economic thing — and this is the same thing.

“Doctors are looking for a way to get cash into their businesses,” he says, “and aesthetics is a cash business.”

Few insurance policies cover aesthetics procedures since they are primarily cosmetic and elective. But the economic times, Cain admits with a laugh, are not optimal for entrepreneurial endeavor: “There probably isn’t a worse time in history to start this.”

The Patients
Vo says the typical patient at her Dermagenix Medical Spa, which she opened in the spring of 2007, falls into two main categories; younger patients seeking hair removal and treatment for acne and older patients in their forties or fifties.

“They want to continue looking good for jobs or their social lives,” Vo says of the latter group. “They want something more than the moisturizers found at the mall.”

Of the younger set, she says, “By the time they come here, they’ve been to the dermatologist and through over-the-counter products.”

Vo came to aesthetics through “personal interest” in the field, wanting to explore her own anti-aging options: “I’m getting older and wanted to know what’s out there.”

Through Continuing Medical Education, she studied the procedures for two years, “until I was comfortable with them.”

Her choice of names for her clinic describes its perceived duality of purpose, as much spa as sterile clinic; expect, as Vo describes it, “a combination medical facility in a spa environment with music and ambiance.”

The Procedures
Dermagenix offers the full range of aesthetics, from laser to injections. Vo says Botox injections run $200-$300; fillers of hyaluronic acid, $500-$800; and lasers, $300-$2,000.

Vo notes that lasers, in particular, are coming into more and more applications, including tightening skin, hair removal, vein treatment and skin resurfacing.

She says that in Texas, lasers are in something of a regulating gray area; a physician must purchase them but, beyond that, there is little regulation. Employing them in treatment, for example, is not restricted to a physician. Texas law, in fact, doesn’t mandate the purchasing physician even be on the property ­— or in the state, for that matter — where the laser is operated.

“Since it is my responsibility, I operate the laser,” Vo says.

“I have lasers that can burn a hole through the wall,” says Cain, co-owner of Innovative Aesthetics. With his initial training in interventional radiology, Cain already had experience in the laser arena.

The Doctors
Cain opened his clinic six months ago but still also practices radiology. Through his explorations of other specialties, particularly anesthesiology and pain management, Cain says he became fascinated with anti-aging medicines.

“I’ve just got to get into it,” he recalls thinking before becoming a fellow in aesthetics medicine through a program established by the American Academy of Anti-Aging Medicine.

Cain and his partners opened Innovative Aesthetics in extra space on Audley Street at one of their two imaging centers.

Dr. German Newall offers both aesthetic treatments and cosmetic surgery through Aesthetic Center for Plastic Surgery, of which he is a co-owner. The group maintains two offices and a surgery center.

“While I’m interested in aesthetic surgery,” says Newall, “these (aesthetic treatments) are part of the practice.” He adds that not all plastic surgeons delve into the aesthetics arena.

Newall, who is certified by the American Society of Plastic Surgery, says as a surgeon he’s “more readily available to deal with complications if they arise.” He adds this caveat: “If you do enough through the years, you’re going to have complications.”

And he says he’s dealt with patients who received less-than-ideal results from physicians who have gotten into aesthetics as a way to increase the bottom line.

“I do understand because of economic situations doctors want to subsidize their salaries through aesthetic procedures,” says Newall, “but I do think that making it readily available to MDs is maybe not such a good idea.”

He notes that those times when botched aesthetic and cosmetic procedures and surgeries get the media’s attention, which they periodically do, “it takes all the good guys with the bad guys.

“I think we need stricter regulations. We’re working toward that but it’s not easy.”

He points out that filler and laser manufacturers, naturally, want to be able to sell as much of their product as possible so tighter regulation is not necessarily in their best economic interests. There is, however, one regulator that works to keep the field of aesthetics from being even more flooded. Newall reports that laser machines can cost hundreds of thousands of dollars each.

“Easily,” says Newall, “the investment for a clinic start-up can run $700,000 to $1.5 million for equipment.”

In addition to the LightSheer(R) Duet(TM) Diode Laser System, Lumenis(R) rolled out another laser at the 2009 American Academy of Dermatology (AAD) Annual Meeting in San Francisco.

The system is called UltraPulse 4x for Fractional C02 Rejuvenation, which will significantly reduce treatment times to provide cost-effective-high value cosmetic options during challenging economic times.

“The cosmetic industry is certainly feeling the effects of the economy and the resulting decline in elective, fee-per-service procedures. We have focused our development efforts on time and cost saving innovations that will provide physicians with innovative and competitive solutions that can sustain, differentiate and grow their business during challenging times”, said Mr. Robert Mann, General Manager of Lumenis Global Aesthetics and Dermatology.

The UltraPulse CO2 Laser System delivers ActiveFX, DeepFX and TotalFX fractional resurfacing in a single treatment with only a single pass. The new UltraPulse 4X upgrade now covers twice the treatment area and twice the speed. These changes significantly improve practitioner and patient acceptance of fractional resurfacing, as well as increase the revenue potential for physician practices and clinics.

The UltraPulse 4X has a micro-second pulse, which allows efficient ablation, lower downtime and more comfortable treatment. The UltraPulse 4X now covers twice the surface area per scan, expanding from 7x7mm to 10x10mm and delivers twice the pulse speed, from 300Hz to 600Hz.

LaserOffers.com comment

Fast is good when patients, for whom time is money, are lining up at the door of the physician’s office. What’s the rush in a slow economy? These days, esthetic practices are looking for patients who are looking for jobs. Bothe have time to spare. Affordability of a laser procedure is key, but it is unlikely that with the high cost device physicians will be able to drop their fees.

Photoaging of the skin is a fact of life. Unpleasant, but manageable. Lasers and light-based treatments are extremely useful tools, which should be used by all clinics offering complex anti-aging services.

To obtain the most successful results, protocols involving single or combination systems can be used, depending on skin type and the stage of the photodamage. In the last years, the trend is to choose noninvasive or minimally invasive treatments, with the aim of reducing the risk of side effects, complications, and, most importantly, the downtime.

Selective photothermolysis by lasers and intense pulse light devices is presently considered the most suitable technique by a growing number of practitioners. A large range of wavelengths can be used to safely achieve good results for patients with fair skin. The 1064 nm Nd:YAG has become the golden standard for treating the skin of color.

Photodynamic therapy is another effective tool in photoaging treatment, especially in the presence of precancerous conditions.

In mild and severe photoaging, ablative laser resurfacing is a particularly successful technique, although requiring a more skilled hand.

New systems using fractional photothermolysis are gaining ground in the marketplace. The non-ablative group has yet to prove its advantages over established technologies. The newest trend is ablative fractional lasers. More research of the efficacy of these devices in direct comparison with existing ablative lasers will be required to prove the claimed and percieved higher efficacy and less risks.

Obviously, lasers and light-based treatments alone might not be sufficient to control all aging symptoms. Combination treatment with botulinum toxin, filling agents, chemical peels, systemic and topic antioxidants should be used to improve the final clinical outcome.

AAD launches today include the Aesthera’s acne system with the peer reviewed clinical paper titled “Treatment of Acne with Photopneumatic Therapy,” by Tina S. Alster MD et al. The paper studies the clinical efficacy of Photopneumatic Therapy for the treatment of mild to severe facial acne. “Our study noted greatest improvement in patients with severe acne. We are pleased with treatment outcomes, especially for severe acne,” said study co-investigator Dr. Alster. The study was performed using Aesthera’s ISOLAZ system, the only FDA cleared device for the treatment of Comedonal and Pustular Acne.

Aesthera is launching Profusion(TM) – (Pro for Professional and Fusion is a Combination) – a skin therapy that combines the Photopneumatic light treatments with the delivery of Aesthera’s proprietary skincare to enhance skin treatment outcomes for acne, skin rejuvenation and body tightening. “Profusion’s novel mechanism has tremendous therapeutic potential for innovative new applications. We are very excited about its clinical potential,” says Vic Narurkar, MD, Chair of Dermatology at the California Pacific Medical Center (CPMC) in San Francisco, CA. “Profusion Skin Therapy is the fastest growing procedure in our practice. We routinely perform it in combination with the majority of skin treatments we offer,” he adds. New applications of the technology include body tightening and skin lightening.

Body Tightening Technology. What’s it all about?

It is about Photopneumatic(TM) Technology, a delivery mechanism, and the applicator that will allow for high treatment precision and focused energy delivery. The patient benefits of Aesthera’s unique solution will be fast, painless, and extremely precise treatments.

Photopneumatic Therapy, that powers the Isolaz(TM) and Isolaz Pro(TM) system, is a proprietary combination of pneumatic energy and broad band light. Photopneumatic devices are the only laser or light based devices cleared by FDA for the treatment of inflammatory acne, comedonal acne and pustular acne. They are also cleared for the treatment of mild to moderate inflammatory acne. Photopneumatic treatments have an immediate visible impact on acne 24 – 48 hour post first treatment and are painless. Facial treatments take approximately 10 minutes, require no anesthetics or numbing creams and provide additional cosmetic benefits such as smoother appearing skin. Additionally, Photopneumatic treatments have an immediate visible impact on acne 24 – 48 hour post first treatment and are painless. Facial treatments take approximately 10 minutes, require no anesthetics or numbing creams and provide additional cosmetic benefits such as smoother appearing skin. Additionally, Photopneumatic Therapy is also cleared for the treatment of benign vascular and pigmented lesions and hair removal.

Cynosure has a new machine for the American Academy of Dermatology’s 67th Annual Meeting in San Francisco – Elite MPX for its Smartlipo MPX laser lipolysis workstation.

Through the company’s patented MultiPlex(TM) technology, Elite MPX combines two wavelengths — 755nm Alexandrite and 1064 nmNd:YAG – along with Xenon Pulsed Light (XPL2) technology to create one of the industry’s most powerful workstations for vascular treatment, hair removal and skin rejuvenation. In addition, Cynosure is introducing two new intelligent delivery systems for the Smartlipo MPX workstation for laser lipolysis: SmartSense with ThermaGuide and ThermaView, the world’s first subcutaneous temperature sensing technology and thermal imaging system for Laser Body Contouring.

Elite MPX incorporates Cynosure’s proprietary MultiPlex technology, which sequentially fires two wavelengths for more effective treatments than single-wavelength systems. A completely new software system runs the graphically enhanced Graphic User Interface, which makes its operation simple and easy.

The workstation also features a built-in Zimmer SmartCool(R) skin cooling system that is exclusive to Cynosure. Rather than requiring a separate SmartCool device, Zimmer technology is integrated into a single compact module, saving precious office space and reducing treatment time. In addition, the Elite MPX includes eight different spot sizes, including an 18mm spot size that results in 44% more treatment area per pulse than standard spot sizes.

“Cynosure’s Elite MPX is a powerful and versatile system that enables clinicians to customize treatments for a broad range of skin types and conditions, including sun-damaged skin, pigmented lesions, dyschromia and rosacea,” said Emil Tanghetti, M.D., Clinical Professor of Dermatology at the University of California, Davis and Director of The Center for Dermatology and Laser Surgery, Sacramento, California. “As practitioners, we are seeing a growing cultural diversity within our patient base, and I expect the Elite MPX will provide benefits across the spectrum of applications for these patients.”

According to InMedica, the worldwide demand for hair removal, pigmented lesion removal and vascular lesion removal is expected to increase from $650 million in 2007 to $750 million by 2010.

SmartSense with ThermaGuideis equipped with a thermal sensing cannula for measuring temperatures in the subcutaneous areas of the body. This technology allows the practitioner to set temperature thresholds to achieve targeted and controlled energy delivery for a safe and optimal clinical endpoint.

The ThermaView thermal camera system measures skin surface temperature and provides a visual map of temperatures within the treatment area in order to provide a homogeneous delivery of thermal energy. This intelligence is integrated into the Smartlipo MPX system. As a result, thermal energy is delivered to a targeted temperature setting, helping to ensure the safe and effective treatment of the superficial layer of the surface area.

LaserOffers.com comment

Many people will call these advances bells and whistles. We disagree. Cynosure has come up with a lot of real technological advances rolling out this system. High capacity, large volume clinics will benefit from it, if they can afford it. All it takes to get your money back is a few hundred patients a month. Every month.