How BOTOX affects your access to a Dermatologist. (Hint: it's not in a good way)

From my favorite New York Times columnist, Natasha Singer, comes the story "Botox Appointments Faster Than for Moles, Study Finds". This is similar to a story from MSNBC last year "The Dermatologist won't see you now."

Basically it highlights the September Journal of the American Academy of Dermatology article which published an "expose" on how it is easier to get a Dermatologist to return your call if they think you're going to schedule a BOTOX injection versus getting an appointment to have an irregular mole evaluated for skin cancer.

What was the difference?

More the three weeks delay on average (8 days versus 26 days).

Is this surprising?

Only in the sense that it only took 3 weeks to get in to a dermatologist for a mole to get looked at. Keep in mind that some other similar surveys have found much longer waits. For example almost 47 days in Syracuse, N.Y., 48 days in Phoenix and a whopping 73 days in Boston.

The amount of dermatologists being trained in the US has been artificially suppressed for many years. I saw reference somewhere to the fact that the number of dermatology residency training programs has remained stable for almost three decades with about 300 training positions. It's led to a significant backlog of people being able to be evaluated for cancers as the baby boom approaches AARP status, this volume of patients is expected to explode.

What's more, many of the medical students going into dermatology have no interest in general dermatology or treating skin cancers at all. It's been estimated that there's been almost a 50 percent shift in effort away from medical and pediatric dermatology. If you browse chat-rooms of medical students interested in derm, it's clear that many would like to set up clinics doing nothing but lasers, injectable skin fillers, and BOTOX. In a practice survey of dermatologists I found, younger women going into dermatology spent almost 20% less time seeing patient then male counterparts per week. As women make up increasing numbers of both medical students and dermatologists, this "contraction" of productivity is another factor likely affecting future access.

If you extrapolate that many (most) of these boomer patients will be Medicare beneficiaries, and that Medicare reimbursement could fall as much as 40% over the next few years, it seems likely that this bias towards BOTOX could become significantly larger. Expect to see some lobbying from Nurse Practitioners and Physician Assistant's for greater independent roles in the evaluation and management of skin lesions. For some related Medscape articles click here.

Rob