Dermatologists Are Most Qualified to Provide Cosmetic Procedures, say Primary Care Docs

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PCPs View Dermatologists as Best Choice for Skin Procedures

Emma Hitt, PhD

 Oct 16, 2012

October 16, 2012 (Atlanta, Georgia) — Primary care physicians (PCPs) believe dermatologists to be more qualified than plastic surgeons, otolaryngologists, and ophthalmologists to perform a variety of cutaneous cosmetic and surgical procedures, according to a new study. However, for some procedures, lay people prefer plastic surgeons over dermatologists.

Omar Ibrahimi, MD, PhD, from the Connecticut Skin Institute in Stamford, presented the study findings here at the American Society for Dermatologic Surgery 2012 Annual Meeting. The findings were also published in the October issue of Dermatologic Surgery.

In an interview with Medscape Medical News, Dr. Ibrahimi noted that there is a great deal of "snake-oilmanship" when it comes to surgical and cosmetic procedures of the skin.

"This is really a disservice to patients because they can be confused about who the best specialist for a particular procedure might be," he said. "We know that primary care physicians serve as the gatekeepers of medicine and are a trusted source of information for their patients, so we felt it was important to objectively assess their perceptions," he explained.

Dr. Ibrahimi and his colleagues conducted a Web-based survey of physicians in primary care, family medicine, and internal medicine training programs (collectively referred to as PCPs). Overall, the 561 respondents identified dermatologists as the most qualified specialist to evaluate and biopsy worrisome lesions on the face (95%), perform skin cancer surgery (56%), inject botulinum toxin (61%), inject fillers (55%), and perform laser procedures (75%).

Specifically, when asked what specialist was most qualified to evaluate and biopsy a worrisome lesion on the skin, 521 of 548 respondents said a dermatologist (95.1%), 22 said a plastic surgeon (3.9%), and 5 said an otolaryngologist (less than 1.0%).

Female respondents were nearly 1.5 times as likely as male respondents to select a dermatologist as the best specialist to perform skin cancer surgery.

For the delivery of fillers, just under 50% of lay people selected a plastic surgeon, and just under 50% selected a dermatologist. In contrast, nearly 60% of PCPs selected a dermatologist and about 40% selected a plastic surgeon.

"The lay public did have a preference for plastic surgeons, although it wasn't as big a difference as we initially expected," Dr. Ibrahimi reported.

For skin cancer surgery and laser treatments, both lay people and PCPs selected dermatologists more often than plastic surgeons, although lay people were still more likely than PCPs to select plastic surgeons for these tasks.

"The data reflect the leading role that dermatologists have played in developing and improving many of these procedures, which, taken together with the nearly 8 million surgical and cosmetic procedures dermatologists perform yearly (according to 2011 ASDS Survey on Dermatologic Procedures), is wholly consistent with the very high preferences exhibited by primary care physicians for dermatologists for a variety of surgical and cosmetic procedures of the skin," he told Medscape Medical News.

According to Dr. Ibrahimi, dermatology is the only specialty in medicine where physicians master the medical and surgical management of the skin. "The survey results suggest that they are also the 'doctor's cosmetic doctor'," he said.

The findings are consistent with attitudes in the community over the past 25 years, said David Leffell, MD, from the Yale School of Medicine in New Haven, Connecticut, who was not involved in the study.

"There is a lot of confusion in the patient or consumer community about what specialists do, what qualifies as a specialist, and what the differences are between specialties," Dr. Leffell told Medscape Medical News. "In the area of cosmetic intervention, the spectrum is even broader than for procedures that are clearly medical," he added. "That is, cosmetic skin care runs the gamut from aestheticians to board-certified surgeons and dermatologists."

According to Dr. Leffell, with respect to medical procedures, with accountable care organizations on the horizon and the expectation that PCPs will play a critical role, "it is very important for them to understand the nuanced differences between a dermatologic surgeon and a plastic surgeon, and the difference in training, outcomes, and costs."

"We have known for some time that there is specific confusion about plastic surgeons and dermatologists," he said. "The truth is that plastic surgeons go through extensive training, and their frame of reference is typically general surgery, not the biology and physiology of the skin. Throw into this mix the confusion about 'facial plastic surgeons,' and the public, and even primary care docs, have a right to be confused," he noted.

Dr. Leffell added that plastic surgeons, to their credit, have "worked hard to define their capabilities, and the field of plastic surgery, which is practiced by many different types of doctors, is often confused in the public mind with the specialty of plastic surgery," Dr. Leffell explained.

"My view is that the training background is less important than the skill and judgment of the doctor. That will remain a challenge for the consumer to sort out until there are outcome measures and public reporting for the procedures we perform," he said.

The study was not commercially funded. The study authors and Dr. Leffell have disclosed no relevant financial relationships.