Of Melanoma, Botox and Rocket Science

See if this doesn’t leave you shaking your head….  a story in the New York Times about access to dermatologists:

  • If you have a mole, and suspect skin cancer, you’ll have to wait an average of 26 days to get an appointment with a dermatologist.
  • If you want a botox injection to eradicate your wrinkles, that same dermatologist will see you within 8 days.

How did they arrive at those numbers?  Researchers posed as patients and called every board-certified dermatologist in eight major cities across the US, and requested appointments.  That’s how.

Oh, by the way.  The dermatologists make $400 to $600 per botox injection — paid directly from the patient’s pocket.  They make $50 to $75 in reimbursements for taking a look at a mole.  And that’s pretty much wiped out by the paychecks they have to cough up for the staff that has to do the billing work.

What’s wrong with this picture?

Now see if this makes you roll your eyes:  Dr. Jack S. Resneck Jr., the lead author of the study and an assistant dermatology professor at the medical school of the University of California, San Francisco provided this summary, “We need to look further and figure out what is leading to shorter wait times for cosmetic patients.”

Gee, Dr. Resneck.  I don’t think you have to look too far.  Why not consult a few of those rocket science colleagues you have and ask them?  Maybe it has something to do with the differences in how much money the dermatologist can make? 

This might surprise you — I honestly don’t blame the dermatologists.  Not one bit.  Don’t forget — they are business people first.  They have to pay the rent, keep the lights on, and pay their staffs (medical AND billing) — because if they don’t, then the wait time for getting a mole examined will be forever. 

As patients, we should be appalled that our American healthcare system has been reduced to this. 

And here’s a suggestion:  Next time you have strange looking mole, call your dermatologist and ask for a botox appointment.  Once you get there, you can tell them you’ve changed your mind. 

A patient’s gotta do what a patient’s gotta do.

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3 Responses to “Of Melanoma, Botox and Rocket Science”


  1. 1 Carver August 29, 2007 at 2:10 pm

    I have stage III melanoma and I’m pretty lucky in terms of the dermatologist and oncologists who follow me but I’ll pass on your suggestion to people I know that have trouble getting in to see their dermatologist. That’s terrible for it to take so long to be seen in some cities. Carver

  2. 2 bev M.D. August 29, 2007 at 6:08 pm

    I have another suggestion, which I followed when my 17 yr old daughter had a scary looking mole. I went straight to the plastic surgeon, which is where you will (or should) go anyway if the dermatologist decides it needs to come off. (Now, I hear they do botox too, but I got in within about 10 days!) There is a big turf fight between dermatologists and surgeons about taking off moles, but as a pathologist, my money is on heading straight to the surgeon if it’s really funny looking or displays a clear change or bleeding, etc. that assumes your insurance will allow you to do that…..

  3. 3 Eric August 29, 2007 at 7:43 pm

    It’s money: Botox costs about $6/unit from Allergan, and a $300 Botox appointment is paid in cash, and requires 3-20 units. Worst case scenario, it’s $180 in free cash flow for the appointment, and there’s no lag or dealing with insurance.

    Figure that the mole visit is covered by insurance, and when you treat a mole, it’s gone and you can’t ever carve it off again (assuming you did it right the first time.) Botox fades, and people age, and they’ll need to keep coming back time and time again.

    It’s not just suspicious moles – patients with chronic conditions that experience a flare are at the mercy of the same scheduling dragons at the front desk.


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