I recently came across some advertising for a physician offering cosmetic and anti-aging treatments. Looking at his background, warning flags immediately came up about his background and qualifications.
This got me thinking; how does the average person know whether to trust a physician? I decided to put together this article about how to evaluate a physician’s background.
Why is this Important?
This is important for two reasons. First, aesthetic treatments have risks. You run the risk of having a bad outcome, insufficient results or a bad reaction. You also run the risk of spending your money on something you really didn’t need.
Second, as recently as 10 years ago only a few physicians were involved in aesthetic medicine. These were physicians who came from the core specialities of aesthetic medicine–dermatology and the various plastic surgery specialties. These were physicians who were trained in the science and skills needed for aesthetic procedures.
Today there is much dissatisfaction among physicians. Many physicians are unhappy with insurance and Medicare reimbursements, and ever increasing red tape. They see themselves working harder but making less money. They are looking to get out of regular medicine completely, or at least to supplement their income with cosmetic services. In droves these physicians are opening medical spas or adding cosmetic services to their practices.
Some of these doctors work hard to be good at aesthetics. They put the time and effort into learning all that they can learn. Others see it as something easy (unlike “real” medicine), often handing over the treatments to their staff.
You, as the potential patient, need know when you can trust the physician’s skill and expertise to provide you with quality treatments that are right for you.
What makes a good aesthetic physician?
What makes someone a good aesthetic physician ultimately is based on three criteria.
- Attitude and Judgement
Though judgement and attitude are best determined after meeting with the physician personally, experience and training can often be determined from reading the physician’s bio or history. So let’s look at training and experience in more detail.
A big decision in a physician’s career is deciding on a speciality. Most physicians spend their entire career in one speciality, while others may actually change specialties at some time in their career. Changing career specialties is a major undertaking and is not something that is done lightly.
The only specialties that specifically have training in the basic science and procedural skills that directly apply to aesthetics are the core specialties of dermatology and the various plastic surgery specialties. Physicians in family practice, internal medicine, ER, general surgery, or OB-gyn don’t spend time studying the basic science and aesthetic procedure skills. These are the non-core physicians. Because they don’t start with this training it takes time and effort to get the training needed to be good at aesthetics.
Non-core physicians can be good at aesthetics but look closely at the training they have received. They don’t start with residency training so they must make up for it with more specific aesthetic training.
Some physicians will promote that they are board certified in a wellness, anti-aging, or cosmetic specialty. But those boards do not require a rigorous residency and are not recognized as a legitimate board certification by the Texas Medical Board. A physician with little experience in aesthetics may become certified by one of those boards in a very short while.
Finally, some physicians will promote attending a training program by the manufacturer of the device or laser that they are using. Those programs are generally one or two days long. The manufacturer’s goals are to sell equipment and make sure that no one can sue them. Manufacturer training programs are nothing more than starting points. They are not designed to teach the physician the comprehensive understanding needed to really use the device they bought. For that, they need additional training and experience.
Even with training, it still takes months and years to become good at something. The same is true for aesthetic medicine. Whether a physician is injecting Botox, or fillers, performing liposuction or laser procedures, one cannot become an expert in a few months. To truly become an expert, whose opinion you can trust, takes hundreds or thousands of procedures and years of practice.
For example, when laser hair removal was first coming on the market, I would attend talks where nationally recognized “experts” would speak on the side effects of laser hair removal. Yet there were side effects of laser treatments that these experts had never seen because they had only done a few thousand treatments. We, on the other hand, having done over 50,000 treatments at that time had been seeing those side effects and figuring out how to deal with them. It takes a lot of treatments to be an expert.
Experience is not just performing a lot of treatments with one procedure but performing a lot of treatments with many related procedures. Many physicians buy one laser system and never buy another. They really do not understand how their system compares to similar devices. Yes, the manufacturers tells them how it compares but that’s like asking the Chevy dealer to compare his cars to Ford. The physician who doesn’t use other treatments or devices never really knows what is best.
Another example—There are many different kinds of fillers on the market, such as Juvéderm, Restylane, or Radiesse. Each one has its place and purpose. Some physicians will choose the wrong filler because they don’t have experience with all of them, and try to make one filler do everything.
To become an expert requires time and dedication. It also requires a certain type of attitude.
Attitude and Judgement
Every physician has flowery language on their website about wanting to take care of their patient’s wellbeing . . . The truth is that these are usually written by a marketing company that creates the website and all the content. There are companies that specialize in aesthetic websites. In the best case, the physician is actively involved in what is written but in many cases, the physician just pays some money to have something written for them. It is important to look at what the physician does and not what they say.
Is the physician committed to aesthetic medicine? Is this their focus? Or are they just adding cosmetic treatments to their practice? Every field of medicine (to include aesthetics) requires dedication, practice, and continued training. A physician can not be an expert in another field of medicine, dabble in cosmetics, and truly be giving the best advice for cosmetics. For many physicians, the attitude is that the cosmetic practice is there to generate additional income. Unfortunately, many equipment manufacturers sell lasers by convincing physicians that they can easily add the device to their practice, have a nurse do the treatments, and make additional income.
Some services can be done by a well trained staff, but certain cosmetic services should be done by an experienced physician. Yet some physicians will delegate those treatments to their staff. When evaluating a physician, ask what treatments are done by the physician and what treatments are done by the staff. Then ask the reasons why. A good rule of thumb is that a treatment using a device, outside of the skin, and where there is no destruction of tissue can generally be safely delegated. But procedures that require the careful placement of an injectable, the insertion of a device, or requires the destruction of tissue really needs the expertise and training of a physician.
The attitude and judgement of a physician ultimately must be judged during a personal visit with that physician. Don’t be afraid to question what the physician is telling you. They should be able to give you answers that are easy to understand and make sense to you. They should demonstrate a confidence in what they are saying. A physician who is annoyed by questions or cannot answer in a way that you can understand may not have the judgement to make the right choice for you.
Putting it together
Ask questions about the training and experience that you find reading their bios and looking through their website. Asking these questions and listening to the answers, will give you a first insight into the attitude of the physician, information about their skill level, and experience. Ideally, you should consult with several physicians and ask them the same questions.
Ultimately, you have to pick the physician with whom you feel the most comfortable. Hopefully, this article has given you some ideas about what to look for and what to ask about when choosing a physician. Finally, pick a physician who is in aesthetic medicine because of what they can do for you rather than what aesthetic medicine can do for them. Even that is a fair question to ask.