Who Should Perform Facial Cosmetic Procedures?: Turf Battle Between Core and Non-Core Physicians

These days, it is not uncommon for doctors from all types of specialties to offer aesthetic procedures for the face, such as filler and Botox injections for wrinkles and superficial peels with lasers or glycolic acid to remove sunspots and wrinkles. According to a recent New York Times article, obstetrician/gynecologists, family physicians, and other doctors are offering these services to patients after completing only brief training, and patients may not be savvy enough to question their credentials. The incursion of non-core physicians into the turf of facial plastic surgeons and dermatologists is worrisome to some core physicians for several reasons: threats related to loss of income and potential dangers to patients. Additionally, some worry that this is a slippery slope and that some of these non-core physicians will turn to more invasive procedures, increasing the dangers of surgery gone awry to unsuspecting patients.

click for large version

Figure. Superficial cosmetic procedures, which are comparatively easy to learn and perform and are relatively low-risk, are becoming more popular among non-core physicians, causing concern to facial plastic surgeons and dermatologists.

Why They Do It

Core physicians interviewed for this article agreed that one of the main reasons non-core physicians are opting to offer superficial cosmetic procedures is a quick and uncomplicated financial reward. Superficial cosmetic procedures procedures are relatively easy to learn and to perform, are low-risk, and are not reimbursable by insurance companies, so customers pay cash. Little or no paperwork is involved, and hardly any staff time is taken up with billing and collecting fees.

The main reason non-core physicians are entering this arena is financial. The physician can take advantage of cash payments without the need to bill third-party payers. This is a short-circuit way for them to improve their bottom line, because these procedures are easy to do and there is a fast turnover, said Shan Baker, MD, President of the American Board of Facial and Plastic Reconstructive Surgeons (ABFPRS).

Dr. Baker believes that it is not particularly dangerous for non-core physicians who are well trained to offer superficial cosmetic treatments such as fillers and peels. But he sees this as a first step by non-board-certified physicians to get into more complex surgical procedures that he believes could be dangerous for patients, such as chemical peels, face lifts, and dermabrasion.

With more complex procedures, it becomes a quality of care issue. Patients are confused and don’t really know if a doctor is adequately trained to perform these procedures. They should be made aware of the need to have proper credentials, he said.