Can You Match This Price?

By Christopher Hankins, MD

As insurance reimbursements are dropping, more and more physicians are gravitating to the aesthetic market. That is why it is so important for the patient to select with great care and due diligence, the practitioner who will be administering the treatment. The message to the prospective patient is caveat emptor! This is the Latin phrase for: let the buyer beware!

These types of treatments are best administered by physicians who have been extensively trained in plastic surgery, cosmetic surgery or cosmetic dermatology. That being said, aesthetic surgical procedures should only be done by appropriately trained physicians with a strong surgical background. Unfortunately, the market is flooded by “out of scope practitioners”, who during the course of their formal training had no exposure to aesthetic surgery or procedures. Even dentists are administering BOTOX® and fillers! It is important for the prospective patient to know the aesthetic application of BOTOX® and fillers is clearly outside the scope of practice of dentistry as defined by the Texas State Dental Board!

Nurses are also opening their own clinics for the administration of BOTOX® and fillers and employ “Medical Directors” to sign off their charts after the fact. In the vast majority of cases, there is no physician on site when the treatment is being given in the case of a complication or unexpected contingency. Moreover, the only prerequisite that a physician has to be a Medical Director is to have a current medical license. There is no training prerequisite for that physician to serve as a Medical Director. Therefore, it is possible for a physician to be assume the role of supervising a procedure for which he or she has little or no knowledge or experience!

In practice, the Medical Director has no administrative power to establish treatment protocols and guidelines, sterilization procedures, determine which products are used, the supplier of those products, to screen and  hire the personnel to administer treatments or to terminate personnel who fail to perform. This administrative power is usually in the hands of a non-medical entrepreneur or business person who hires the physician to fulfill a legal obligation.

Just last week, I went by to get a haircut, only to learn that the owner of the shop was employing a retired nurse to give injections, administer skin tighten procedures and even apply a device to tighten and “rejuvenate” the vagina! Has the world gone barking mad?

It is of utmost importance for the patient to realize that they are not just paying for the product or treatment that they are receiving but also for the training, knowledge, experience and skill of the practitioner giving the treatment.

We get calls all the time at the office asking if we can match this or that price for BOTOX® or fillers. We have to stress that we are not competing on the basis of price because having a service administered by a nurse, dentist or out of scope physician is not delivering the same value to the patient that we offer. It can’t be argued that having a nurse administering BOTOX® or fillers who is being remotely “supervised” by an “out of scope” physician is delivering the same value as a highly trained physician whose practice is devoted to aesthetic surgery and medicine.

Dr. Hankins does all of the injections in the practice himself and never delegates this to ancillary medical personnel. At the end of the day, the road to success and fulfillment is not achieved by taking a series of shortcuts.


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