Archive for May 2009
Getting Real About the Economy (Minus the Spin)
Getting Real About the Economy (Minus the Spin)
From Plastic Surgery Practice
by Jeffrey Frentzen
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| Jeffrey Frentzen |
The deeper we sink into the current recession, as well as understand the finer details of the government’s plan to revive the economy, the more sweat beads appear on my brow and my hands. The economy is in the absolute dumps, and our leaders struggle to articulate the labyrinthine complexity of their recovery plan.
Let’s get real, though, and put aside the red herring of the government’s plan. It will not even begin to rescue a large majority of PSP’s readership.
In the aesthetic medicine area, reports are coming in from the field and the news gets worse with every month. The economic parameters are not looking good. The plastic and cosmetic surgeons I’m talking with are down, on average, around 50%. Some practitioners in Southern California—one of the top markets for aesthetic surgery—are down as much as 80% so far this year. These are people who have been in business for over 20 years. They may go belly-up.
Of course, the US economy will bounce back. Manufacturing will continue unabated, and there is still value in real estate. In the meantime, you must realize that no government Big Brother is going to help you out of it. Here’s the word on the street:
For the practices that are holding their own and are “making it” during this recession, their business is off 35% to 40% over 2007 and 2008. Practices that rely completely on discretionary dollars are clearly in more trouble. They may be down by only 50% if they are really successful in marketing and bringing in patients (and are located in a geographical area that is not suffering too much from the economic downturn).
For practitioners in areas that are hardest hit by the recession—and have nothing to do with quality of service or word of mouth and other factors—business could be down 80% to 90%.
Physicians are responding to all this in interesting ways. For example, some practitioners who are losing their shirts in the hardest-hit areas of the country are opening a second office in a city or region that is more stable economically. Others are pounding the pavement looking for work. Yes, it’s that bad.
Practitioners are working harder than ever to make ends meet, scrambling to get any kind of money into the coffers. What we are seeing across all levels of the economy, including the aesthetic markets, is a move by service providers to offer customers value over extravagance.
Be careful to not go overboard and offer outrageous claims that can’t be met. There are many physicians of all stripes who advertise cosmetic surgery procedures. In one recent example I came across online, a physician was promising patients they will lose 10 inches in 2 weeks via laser-based treatments. Don’t go that route.
More often, lately, the physician-patient relationship kicks off with the patient saying, “I want a facelift,” and the physician responding, “OK. What is a facelift worth to you?” It’s a matter of how much cash can you get from each patient in order to pay the overhead.
Across the board, patients are looking at how they can get good value. As a practitioner operating at between 40% and 80% less income than the previous couple of years, you have to find out what they mean by value, translate that value into some products and services that will undercut the competition without being dishonest in your claims, and use the Internet and other lower-cost methods to get the word out.
PSP will remain on the front lines of this crisis, reporting on how your colleagues are faring during the recession and offering new ideas on how to cope successfully, as well as delivering insights minus the spin of most media outlets. In addition, PSP’s June 2009 issue will be devoted to articles on how practices can survive the current economic downturn.
Cosmetic Surgery Suffer In Recession, While Non-surgical Is On The Increase
ASPS: Looks May Matter Less in This Economy
11/12/08
At the Plastic Surgery 2008 meeting held last week in Chicago, the American Society of Plastic Surgeons (ASPS) reported the results of its recent survey, in which 48% of women considering cosmetic surgery polled in October said they were less likely to schedule a consultation, up from 30% in March.
The ASPS reported that 59% of the 123 women polled in an online survey said the weak economy had an impact on their plans for plastic surgery. In a similar poll in March, 9% of those surveyed said the economy was impacting their cosmetic surgery plans.
Concurrently, US-based cosmetic surgeons are reporting an increase in smaller procedures, such as Botox and minor lifts and tucks, according to ASPS President-elect John W. Canady, MD. Plastic surgeons are seeing greater demand for such procedures because they cost less and take less time, Canady says.
[Source: ASPS]
“Physician Wars” Heat Up (Again)
by Edward B. Lack, MD
From Plastic Surgery Practice
Tough economic times can bring out human nature at its worst
The economy is tight, and people are watching how they spend their money more carefully. That’s the cue for what I call The Physician Wars.
Have you ever had a carpenter come to your house to do a remodeling job? He looks around the room and invariably asks, “Who messed up the work on this house?” It seems that no matter what, the guy who did the job before him did it all wrong.
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It’s the same with physicians. A former employee of mine called to tell me she had applied for a job at a neighboring plastic surgeon’s office. When the plastic surgeon found out she had worked for me, he harangued her for a full half hour on what a bad surgeon I am and how he fixes all my bad results. He must be hurting.
The episode reminds me of when a facial plastic surgeon in my area found out that one of his patients was consulting me. He told her, “Why he’s … he’s… a dermatologist!” Oh my goodness. The word is out. Who among you has not heard that oral maxillofacial surgeons performing cosmetic surgery are … dentists?
The anesthesiologists disparage the anesthetists, the orthopedic surgeons disparage the podiatrists, the internists disparage the family practice docs, cosmetic surgeons disparage gynecologists who perform cosmetic procedures, and everyone complains about the salons and spas.
This feels like the plight of a Christian Scientist with appendicitis. Does anyone remember the erroneous article in 2000 in the Journal of Plastic and Reconstructive Surgery that alleged a 1-in-5,000 mortality rate from liposuction? We all suffered from that one—malpractice insurance in Illinois has yet to recover.
All of this complaining is done under the guise of advising patients about the risks and benefits of medical and surgical care. It is, of course, self-serving and debasing.
Certainly, patients can detect the defensiveness in these attacks. If a physician is willing to disparage other practitioners in the privacy of his office, what might the same person say about his patients?
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Without delay, I constructed rules to judge the ethical conduct of physicians. No one asked for them, but they are needed:
- In patient consultations—and just about everywhere else, for that matter—a physician who openly disparages other physicians is not focusing on the patient’s needs.
- Physicians should always reveal their own work (as in before-and-after photos or their experience in treating a given condition).
- Physicians should communicate with other physicians when unsure about a diagnosis or when the patient is not progressing as well as anticipated.
- Physicians who promise perfect results are not perfect.
- Physicians who do not touch or examine their patients before surgery should not be touching them during surgery.
- Physicians who bill insurance for medically unnecessary procedures (cosmetic) are as likely to lie to their patients as to insurance companies.
- Physicians who don’t have time to sit down with their patients cannot hear what their patients say.
Ultimately, we are the purveyors of care and trust. Despite the internecine hostilities that emerge in our profession during tough economic times, patients pay us great honor by trusting their health and their appearance to our care.
This is what makes the pressures of medical careers tolerable. When we listen to our patients, when we ask ourselves what is this patient trying to say, we not only respond to our patient’s needs, we become empathetic. At that point, there is no time for self-righteous indignation and no need to disparage the care-giving abilities of a colleague.
It is an old adage that when a patient gives you a history that accuses another physician of providing poor care, you are only one physician away from being accused yourself.
Be an educated provider. Stay compassionate and be part of the cure, not the problem.
Edward B. Lack, MD, is a board-certified dermatologist and board-certified dermatologic cosmetic surgeon. He is president and medical director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago. In addition, he was a past president of the American Academy of Cosmetic Surgery. He can be reached at (847) 832-6700.
Despite the Recession, Cosmetic Treatments Remain in Demand
BUSINESS WEST, MAY 11, 2009
To someone who has never considered cosmetic surgery or other appearance-altering medical treatments, they might seem like luxuries, especially in a flat economy. However, both practitioners — surgeons, dentists, eye specialists, and others — and their patients say that body image is often critical not only for self-esteem and confidence, but for career and social advancement. Fortunately, the industry trend is toward quicker, less-costly, and less-invasive procedures, meaning there’s now a treatment option for just about everyone.
To hear Dr. Lisa Emirzian tell it, there’s nothing frivolous about flashing a perfect set of teeth.
“I like to dispel the notion that cosmetic treatment is simply an extravagance,” said Emirzian, an esthetic dentist and owner of Emirzian, Mariano & Associates in East Longmeadow. “In today’s society, an attractive smile is generally understood to build confidence, and this relates to career and personal advancement.”
The question for dentists who focus on cosmetic improvements — as well as plastic surgeons and anyone who practices the medicine of looking better — is how much people are willing to pay for that personal and career boost when so many people in today’s economy are struggling just to keep their jobs and make ends meet.
“From what I can see in the business, traditional plastic surgery has come down with the economy, where our business is booming; we’ve increased tremendously,” said Suzanne Sullivan, manager of Feeding Hills-based Dermique Medical Laser Skin Spa.
She was referring to a range of services — from fat-zapping laser liposuction to skin-rejuvenating treatments — that are less invasive, costly, and time-consuming than traditional plastic surgery, and hence attractive options for individuals looking for, well, options to be more attractive.
“I got nervous back in December, wondering, ‘is my job going to hold out? Will we keep working?’ You’d think this is one of those things people give up,” she said of the faltering economy. “But what they’re giving up is traditional facials in the salon. That’s more daily maintenance — getting a deep clean and relaxation. And plastic surgery is much more of an investment, more costly. But people coming to us are getting great efficacy and minimal downtime at less cost.”
True, plastic surgery that involves going under the knife has suffered, by some accounts, as the economic clouds have darkened. But there are still pockets of growth, said Dr. Simone Topal, a plastic surgeon who operates a practice in Florence and is affiliated with Cooley Dickinson Hospital.
“Strangely, my practice has been growing,” she told BusinessWest. “I think it’s mostly because I’m a fairly new practice; word-of-mouth is getting around, and I’m getting more and more busy. I know that I provide services here that weren’t available before — for example, breast reconstruction wasn’t available at Cooley.
“But I have been getting more cosmetic cases also, which is not the national trend during the recession,” Topal continued. “From what I’ve been reading in my professional magazines, people who depend solely on cosmetic cases for revenue are having problems right now. I’ve been fortunate in that I do at least 80% reconstructive and 20% cosmetic — but that 20% has been growing recently.”
Overall, however, patients seem drawn to procedures that offer results in less time at the doctor’s office and less downtime in recovery. Fortunately for practitioners, that’s exactly the main trend that has emerged across the diverse spectrum of improving the appearance of faces, bodies, and teeth. In this issue, BusinessWest examines some of these services, and why many business owners are smiling right along with their patients.
Small Wonders
It’s no wonder patients are looking for simple, yet effective options, Topal said, considering that cosmetic surgery is a significant medical decision, not to be taken lightly.
“I have to make sure they understand what the risks are, what the recovery time is, what the complications could be, and what’s safe and appropriate for each patient,” she said. But for those who want to improve their looks but are apprehensive about surgery — and those who are cost-conscious these days — a series of non-invasive options has soared in popularity over the past decade.
These include Botox, which essentially involves injecting botulinum toxin under the skin of the face to prevent the muscles from contracting, thereby eliminating the appearance of wrinkles.
“The trend is toward minimally invasive treatments, procedures that can be done quickly and have a quick recovery time,” Topal said. “Botox and injectable fillers are very popular right now because they’re reliable and people like the effects. Sometimes, it’s a way to ease into surgery, or to fend off surgery and do something else instead.”
That said, Topal is still busy with face lifts, breast lifts and augmentations, tummy tucks, and removing excess skin after massive weight-loss surgery, to name a few popular surgical options, along with more medically necessary procedures such as hand surgery, pediatric plastic surgery, and breast reconstruction after cancer surgery.
“It’s a whole range,” she said. “People may see me about problems with a deformity, or they may just want to look better. For some people, it stems from societal pressures or low self-esteem, and some people are just very energetic and say they want to look as young as they feel. I see everyone from teenagers to people in their 60s, depending on what they’re coming for.”
Just as Topal touted a dual focus on restorative and cosmetic surgery, diversification has been a benefit to Dr. John Frangie as well. As the owner of NorthEast Laser Center in West Springfield, he offers a range of vision-correction treatments, from no-blade Lasik to intraocular lens implants for patients with cataracts — which typically stems from a more urgent medical need than laser vision correction.
“We have a very successful, higher-end ophthalmology practice, and for the cataract practice, times have never been better,” Frangie said. “If you ask about Lasik, well, that more closely mirrors consumer confidence — and, again, we’re fortunate that we have a higher-end practice, so our core clientele is there. We have a steady stream of patients for Lasik, but we’re not setting records right now.”
Lasik, although its medical benefits are obvious, is affected by the same economic factors as plastic surgery and esthetic dentistry in that it can be put off when money is tight without much of a health impact; indeed, most candidates already wear glasses or contact lenses. But that’s not the only area in which Frangie is changing people’s appearance; he also offers injectable cosmetic treatments such as Botox — and those, as in Topal’s practice, remain popular.
“This economy seems to offer an opportunity for minimally invasive cosmetic treatments,” he said. “Patients seem to be less interested in the surgical options. Injectables like Botox are small, incremental improvements that don’t require a big investment or any post-operative convalescence. It’s almost as if economic pressures have made people look at this in a more discriminating manner.”
The recession has also presented Frangie with an opportunity on the Lasik side, he said, explaining that the practice has committed capital and time to improving its Lasik treatment by purchasing a new, state-of-the-art laser largely unavailable at other area vision centers. Such an investment makes sense, he told BusinessWest, because Lasik will clearly remain popular for the long haul.
“It’s old news for us, but patients are now realizing the value of no-blade technology — again, a minimally invasive scenario. We now have the ability to treat more patients, and within a day or two the patient is highly functional.
“Patients planning to do this have their own calendar,” he added. “We tend to serve a higher-end clientele, so you don’t see them as subject to the capricious swings of the economy. That being said, though, we’re not seeing people walk in and say, ‘give me your next available appointment.’ The impulse buyer doesn’t seem to be as evident.”
Fat Chance
Even Baby Boomers, many of whom are retired or soon will be, are averse to any downtime in their schedule, and are seeking out minimally invasive, natural cosmetic improvements, she explained. To that end, Dermique offers a range of treatments that emphasize quick recovery.
A service called Pearl, for instance, treats the top layer of skin with pulses of light. A portion of the epidermis is removed, and a natural, protective dressing is formed on the skin’s surface. It peels off within three to four days, revealing new, healthy skin underneath.
“This is a process of turning back the hands of time rather than cutting things out,” Sullivan said. “People don’t want to hide out for weeks. This is four days of downtime rather than two weeks, and it removes fine lines and pigments and smoothes the skin’s texture. It makes a huge difference.”
Some of these same trends toward ease and convenience have permeated esthetic dentistry as well, Emirzian told BusinessWest. “Minimally invasive is definitely the trend at the dentist today, as well as accelerated treatments,” she said, “and conservation of the tooth structures is important, too.”
All that is possible through a host of restorative treatments, from bonding, to restore broken teeth and eliminate spaces, to ceramic veneers that retain more of the tooth’s natural enamel surface than in the past, which results in a stronger bond.
Ceramics has also contributed to a more natural look throughout the mouth, in a host of different procedures, Emirzian said. “It’s very exciting — we use it even for bridgework or posterior teeth. We’ve always had metal reinforcements, and now we have the ability to do all-ceramic bridgework without the metal. It’s very strong and beautiful; essentially, the goal is to have the teeth look like teeth and not a restoration.”
That’s a concept in play with Invisalign, a product that takes the place of braces for the purpose of straightening teeth. Instead of metal bands, patients are fitted with a series of clear, plastic molds that fit over the teeth and gradually bring about the desired changes, usually within a year’s time.
It’s ideal for adults who are wary of a product — braces — so closely associated with the teenage years, and emblematic of people’s desire to improve their smile. Also on the non-invasive side, Emirzian said, teeth whitening has only increased in popularity over the past decade or so.
“That’s a starting point for a lot of people,” she explained. “There are different ways to do it, based on a patient’s needs and goals. Whitening is when you remove surface stains and polish the teeth to bring back the original color. Bleaching is going from the original color to something even lighter. Bleaching is nothing new — it’s been around at least 15 or 20 years — but it remains highly effective, and if you speak with people, you’ll find that it’s certainly not considered an extravagance.”
Agents of Change
Whether patient demands are driving a new emphasis on quick, minimally invasive cosmetic treatments or the public is simply responding to new advances, everyone who spoke with BusinessWest agreed that both our fast-moving culture and economics have contributed to a demand for such products and procedures.
“Some patients are looking to do these things as they change careers,” Frangie said. “They’re trying to reinvent themselves, and they want to look a little younger.”
And it’s up to practitioners to keep up with this upwardly mobile crowd by picking up on the latest trends. Sullivan said everyone at Dermique is constantly researching what’s new, taking continuing-education classes, and trying out new equipment to make sure they meet the demand for the next big thing, whatever that might be.
And, make no mistake, many are still opting for more-invasive surgical procedures, and are benefiting from advances in technique, instrumentation, and drugs that help patients get back on their feet faster than they used to, Topal said.
Still, “trying to do the least-invasive thing to correct the problem may be the new way of thinking,” she added. And in the end, it’s all about making people feel better about themselves.
“My work is very satisfying,” Topal concluded. “Body image is very important to people. This can be a major life change, and it’s really exciting when they’re happy with what they’ve done.”
Aesthetic Medical News 