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.”