[NPInfo] Interesting

[David Mittman]

Family physicians dabbling in nips and tucks
They want to offer services that don't rely on insurance
Thursday, October 04, 2007
By Diane Suchetka
Newhouse News Service
Doctors have had enough. They're tired of insurance companies cutting how
much they pay them to take care of us.
They're fighting back -- with lasers, Botox and liposuction.
The numbers aren't huge yet. But more and more family physicians,
gynecologists and other specialists are performing cosmetic procedures to
replace shrinking payments from HMOs and other insurers.
Need proof?
Check out this month's annual meeting of the American Academy of Family
Physicians. There, doctors who usually treat high blood pressure and
diabetes will be able to choose from 10 continuing education courses in
chemical peels, cosmetic fillers and Botox.
"We've been doing it for four or five years," said Pamela Williams,
assistant director of the academy's continuing medical education division.
"But we're expanding the amount and frequency."
The courses are so popular some have waiting lists. That's because doctors
know what their patients want.
Last year, more than 11 million cosmetic procedures were performed in the
United States, according to the American Society for Aesthetic Plastic
Surgery.
Because insurance doesn't typically cover treatments that make us look
better, patients pay out of pocket. Doctors save two ways when that happens.
They get the cash up front and they don't have to pay workers to process all
the paperwork that comes with insurance claims.
"In medicine today, everybody is looking for something to do where you don't
have to deal with the insurance companies," said Dr. David Burkons, a
gynecologist who added cosmetic procedures to his South Euclid, Ohio,
practice about eight years ago and has expanded the offerings since.
When he started his practice in 1977, he said, he charged $650 to see a
woman through labor, delivery and postpartum checkup. And he got $650.
When he gave up obstetrics in 2002, because of the expensive malpractice
insurance, he charged $6,000 for the same care. But all he got was $1,700
from insurance companies. Adjusted for inflation, that would be $554 in 1977
dollars.
Family physicians have other reasons for plumping wrinkles and erasing
veins.
"To me, it's kind of an emotional lift as far as getting you out of the
doldrums of family practice," said Dr. Jay Taylor, one of eight physicians
with Lake County Family Practice in Mentor, Ohio. In 2002, he and his
partners opened Northcoast Laser Cosmetics, a separate office where each
works two or three days a month.
"Medicine's a daily grind," Taylor said. "The problems nowadays are more and
more complicated. People are sicker. There's the constant threat of
litigation and diminished (insurance) reimbursement. So you have to see more
patients to meet your bottom line. That just wears you down."
Family physicians say they love the time they can spend with cosmetic
patients just talking -- about the kids, vacations and life in general.
And then there's demand.
"Women would come to me for their annual exams, and you get those lovely
hairs that start growing out of your chin. And they would say to me, 'What
can I do about this hair?' Because they know it's hormonal," says Dr. Karen
Mihalik, president of North Coast Obstetrics and Gynecology and North Coast
Laser Aesthetics and Liposuction in Amherst and Elyria, Ohio.
At first, Mihalik said, she sent her patients to other doctors. Then she
realized she could purchase the equipment, undergo the training and do it
herself.
Her cosmetic practice grew from there.
"Patients would ask, 'When are you going to start doing leg veins, when are
you going to start doing facial wrinkles?' because there's a comfort level.
They already know you."
The comfort level may be there. But what about the expertise?
Doctors who specialize in cosmetic procedures have more experience, are
better able to handle problems when they occur and can offer their patients
more, and sometimes better, options, said Dr. Renuka Diwan, a Westlake,
Ohio, cosmetic dermatologist.
"It's really important for patients to think about what they're doing," she
says. "You're not going to see a plastic surgeon or dermatologist for a pap
smear."
Family doctors who have added cosmetic services disagree. They have as much
training as dermatologists and plastic surgeons, they say.
"All of these technologies are new," Mihalik said. "It's new training for
everyone. It doesn't matter what specialty you're in."

. . . . . . .
Diane Suchetka is a reporter for The Plain Dealer of Cleveland. She can be
contacted at dsuchetk at plaind.com

Patient Donna Piscopo says she never would have chosen a plastic surgeon or
dermatologist over her family doctor for laser treatments on her face. 'For
me, it was a no-brainer,' she says. 'I trust them.'