Expanding scope of practice : Address cosmetic needs of current medical, Medicare patients

February 1, 2009

The full-body skin exam is the perfect opportunity to talk with patients about all their skin concerns, including cosmetic. One expert explains how dermatologists can turn medical and Medicare patients into cosmetic patients.

Key Points

National report - It is no secret that patients who come into the dermatologist's office complaining about one skin problem often have another, and the skin issues they have might very well be cosmetic.

With a little probing, dermatologists are in an ideal position to not only find out what might bother their patients cosmetically, but to provide treatment, says dermatologist Wendy Roberts, M.D., F.A.A.N., Rancho Mirage, Calif.

Helping patients solve their skincare-related cosmetic issues is the responsibility of the dermatologist, she says.

"We cannot ignore these patients' cosmetic needs. Think about it. By 2050, slightly more than one in five people will be 65 years or older (U.S. Census Bureau).

"Geriatric dermatology encompasses both medical and cosmetic dermatology. This union is inevitable with the aging of the world and will continue the growth of this specialty," she says.

The argument that the only pure dermatology is medical dermatology leaves patients to go to other types of experts for cosmetic issues, Dr. Roberts tells Dermatology Times.

Dermatology's failure to embrace cosmetic services, including skin resurfacing and cosmeceutical consultation, has opened the door for other specialties - medical and nonmedical - to step in.

Professional approach

Dr. Roberts says an ideal opportunity for talking with patients about all skincare concerns is during a full-body skin exam.

"I schedule about 20 minutes for a full-body skin exam," she says.

During these visits, dermatologists look at patients' medical histories and intake sheets, and can discuss the complete condition of patients' skin - whether that patient has unusual moles or dryness and photodamage.

"Out of the top 12 skin diagnoses of 65-year-olds, 25 percent have a possible cosmetic solution (Roberts W. Dermatologic Clinics. April 2006)," Dr. Roberts says.

"The No. 1 skin problem in the 65-plus population is xerosis. We can help solve that problem with products, nonablative lasers .... In the past, I think we wrote off those problems," she says.

Dr. Roberts cites another common skin condition among the elderly that is not traditionally covered by insurance - solar lentigines.

"Liquid nitrogen is probably the only acceptable medical solution, but that is no longer covered by Medicare," Dr. Roberts says.

"If you address it with the patient, what you end up with is a cosmetic conversation," she says.

Dr. Roberts does not condone a hard sales approach.

"We have to be very careful to say that we are not trying to make cosmetic diagnoses into medical diagnoses.

"The point is to address those cosmetic concerns in your medical patients, and not just deal with the ones that you know are covered," Dr. Roberts says.

"The woman who has the basal cell on her cheek is also very concerned about the solar lentigines on her chest. And one does not have to be ignored," she says.

Armed with information

Dr. Roberts says medical and Medicare patients fill out intake sheets that ask them not only about their medical, but also their cosmetic concerns. She says dermatologists should make the process easy for patients, simply asking them to check among a menu of items that represent skincare concerns.

While staff members do not give skincare advice, they encourage patients to talk with Dr. Roberts about all skincare concerns.

"Your staff are the ambassadors of the work you do and your services," she says.

Dr. Roberts then reviews the intake sheets with patients during the full-skin and other exams. She educates patients about aging skin, barrier function, ultraviolet protection and more.

She says she will first go over the options to treat a patient's medical problems, then talk with patients about their cosmetic issues, being sure to explain what is and is not covered by insurance.

"I am the skin expert, so I like to be able to tell my patients about products versus them going over to the cosmetic counter and to the nail salon person," Dr. Roberts says.

She makes discussions with patients about skincare educational, helping them determine which soaps might not dry their skin or how best to moisturize, for example.

The whole idea, she says, is to create an environment in which patients can talk openly.

"You end up with appreciative patients who think that you are extremely thorough," Dr. Roberts says.

"All the while, you are building your cosmetic practice. So, you increase your cash revenue to your insurance revenue without having to do outside advertising.

"This is all internal marketing and internal changes that you make in your practice, and really, you are just being a good doctor," she says.

Disclosure: Dr. Roberts reports no relevant financial interests.