The New York Times on Monday published a scathing indictment of dermatology practices, which stated that dermatology is becoming a two-tier business: the higher-paying customers seeking cosmetic procedures will frequently receive a higher level of care compared with medical patients for whom health insurance pays fixed reimbursement rates.

In the article,  Donald Richey, a dermatologist in Chico, Calif, says that he has two office telephone numbers: calls to the number for patients seeking an appointment for skin conditions like acne and psoriasis often go straight to voice mail, but a full-time staff member takes calls on a dedicated line for cosmetic patients seeking beauty treatments, such as Botox.

A study published last year in the Journal of the American Academy of Dermatology found that dermatologists in 11 American cities offered faster appointments to patients calling about Botox than for those calling about a changing mole, a possible sign of skin cancer.