The New York Times on Monday examined how dermatology is fast becoming a two-tier business in which higher-paying customers seeking aesthetic procedures often receive greater pampering than medical patients for whom health insurance pays fixed reimbursement rates.

According to the Times, dermatology is one of the specialties in which patients "are not only willing to pay for quality-of-life treatments that may not be covered by insurance," but also are willing to pay "much more for such treatments than insurers would pay for a medical procedure that takes a similar amount of time." Health insurers typically reimburse a physician $60 to $90 for a visit that includes a full-body skin cancer check, which takes about 10 minutes. Dermatologists might receive $500, paid on the day of treatment, for a botulinum toxin Type A injection to the forehead that takes 10 minutes.

The Times reports that some dermatologists have separate waiting and examination rooms for aesthetic and medical patients. In addition, some dermatologists offer additional services—such as valet parking —for aesthetic patients.

A study published last year in the Journal of the American Academy of Dermatology found that dermatologists in 11 U.S. cities and one county offered appointments to patients seeking botulinum toxin Type A injections sooner than patients inquiring about a changing mole, which is a possible sign of skin cancer. The study also found some dermatologists are staffing nurse practitioners and physicians’ assistants, known as physician extenders, to primarily see medical patients.

According to the Times, as "dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases." Several people interviewed by the Times said dermatologists they saw for medical reasons treated them as potential aesthetic patients.

"The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message," says Davis Pariser, a dermatologist and president-elect of the American Academy of Dermatology.

[Medical News Today, July 29, 2008]