Procedure stealing by FP

[Jiminy Cricket]

Anyone else concerned about this. They say that our reimbursements are going to go downtown to Chinatown!

There are 3 FP's in my town itself that have set up cosmetic practices!

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Members don't see this ad.

 

[dynx]

Procedure stealing? Are you serious? Cutting off a mole? let it go man, you're over paid anyway.

 

[cdql]

Hmm...two posts in a derm forum. Both bashing dermatologists. Trolling anyone?

 

[dynx]

Hmm...two posts in a derm forum. Both bashing dermatologists. Trolling anyone?

Not bashing, pointing out the obvious. Touchy much?

 

[porokeratosis]

Hmm...two posts in a derm forum. Both bashing dermatologists. Trolling anyone?

I agree...TROLLS who wish they were dermatologists...they probably were rejected and now eternally bitter

 

[porokeratosis]

Procedure stealing? Are you serious? Cutting off a mole? let it go man, you're over paid anyway.

BABY TROLL

http://www.navigator-troll.de/garbage/5/51244/1492068.gif

 

[dynx]

BABY TROLL

http://www.navigator-troll.de/garbage/5/51244/1492068.gif

whatever gets you through the night.

 

[sophiejane]

They say that our reimbursements are going to go downtown to Chinatown!

It is true that medicare reimbursements have declined recently for specialty medicine, and those for primary care are increasing. It is likely that this trend will continue until we have made a dent in the dangerous shortage of primary care doctors in the US.

 

[cdql]

I can see the logic in increasing primary care salaries.

I still think, however, it will remain an unpopular field as long as primary care physicians are asked to work such long hours and manage such mundane cases. (Saying "Hello! Good morning! Lose weight!" to your first 20 patients probably isn't satisfying even if your pay is increased.)

 

[Polska]

Its not trolling, its a genuine interest on what you or your colleagues are planning on doing. Or does the possible decline of income not really affect your choices?

Just a quick google search on it.. Two news stories about it today.
Primary care docs offering botox and other cosmetic derm procedures..

Alternative approach : Doctors turn to medical spas to build business, serve patients
http://www.eagletribune.com/lifestyle/local_story_317123416?keyword=topstory


Something about a new primary care clinic opening with Botox, microderm abrasion, etc..
http://www.centralpennbusiness.com/view_release.asp?aID=288




Academic Paper: http://www.medscape.com/viewarticle/412751

Introduction

Roy G. Geronemus, MD (Chief of Laser Surgery, New York University, New York, NY), discussed issues facing dermatologic surgery during "Dermatology Dilemmas in the New Millennium," the opening session of Academy 2000.[1]

While there are many issues facing dermatologists today, a major concern for those who perform outpatient surgery is procedure-restricting legislation being promulgated by our colleagues in plastic surgery. Plastic surgeons have adopted techniques developed by dermatologists, and are now pushing legislation that would limit the ability of dermatologists to continue to perform these procedures. Plastic surgeons have assessed their members and mounted an aggressive public relations campaign to promote their specialty.

An Economic Turf War
The underlying reason for this new "turf war" appears to be economic. Dermatologists leaving residency now are increasingly focused on cosmetic procedures as a mechanism for maintaining income. Under pressure to recoup expenses,

 

[sophiejane]

I can see the logic in increasing primary care salaries.

I still think, however, it will remain an unpopular field as long as primary care physicians are asked to work such long hours and manage such mundane cases. (Saying "Hello! Good morning! Lose weight!" to your first 20 patients probably isn't satisfying even if your pay is increased.)

Mundane is in the eye of the beholder. You've obviously never experienced rural family medicine--it's anything but mundane.

Similarly, I think I'd shoot myself if I had to look at rashes, zits, and moles all day. To each his or her own.

(And by the way, the only people who work long hours are those who choose to. Many FPs make a very comfortable income on 35-40 hours/week. FPs are some of the most satisfied docs I've run across).

I think your perception is the overwhelming one among most medical students and other physicians, however. Fortunately, there's not much truth in it anymore.

 

[Polska]

It is true that medicare reimbursements have declined recently for specialty medicine, and those for primary care are increasing. It is likely that this trend will continue until we have made a dent in the dangerous shortage of primary care doctors in the US.

Source? (Just interested in an article or something)

 

[sophiejane]

Source? (Just interested in an article or something)

There is a PDF file where you can look up procedure reimbursements currently and with the proposed change due to take effect in January, 2007 (most take a hit, few remain the same or increase), but it's too darn big to post...I'll work on it...

In the meantime, you can go to this thread and check out Kent W's post #14 on the thread, and the link works from that post, but not when I try to cut and paste it here.

http://forums.studentdoctor.net/showthread.php?t=301664&highlight=medicare+reimbursement

Here's another, discussing improved reimbursements for longer (i.e. primary care) office visits where healthcare management is addressed.

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1887

 

[fun8stuff]

I still think, however, it will remain an unpopular field as long as primary care physicians are asked to work such long hours and manage such mundane cases. (Saying "Hello! Good morning! Lose weight!" to your first 20 patients probably isn't satisfying even if your pay is increased.)

lol... like dermatology isn't mundane (Saying "Just pop the zit! Stay out of the sun! Put some of this cream on it! Here, have some botox" )

 

[iatrosB]

lol... like dermatology isn't mundane (Saying "Just pop the zit! Stay out of the sun! Put some of this cream on it! Here, have some botox" )

To each his own I guess.

 

[cdql]

lol... like dermatology isn't mundane (Saying "Just pop the zit! Stay out of the sun! Put some of this cream on it! Here, have some botox" )

hahaha

that's true

can't argue that

the hours are better though!

 

[fun8stuff]

hahaha

that's true

can't argue that

the hours are better though!

and pay!

 

[deleted87716]

the hours are better though!

and pay!

So, it sounds like you understand why some primary care docs might want to set up cosmetic dermatology practices.

Edit: I'm not sure how this is "stealing"...most people would simply call it "competition." If patients are paying cash, whoever provides the best service (or does the best job marketing themselves) wins.

 

[1bloodyred]

Many of the MEDSPAs are going out of business. It is a business. It has to be treated as such.

doing cosmetic services or placing greater focus on derm services can improve your bottom line, help you work less, have more time for more vacation etc.

I think if FMs advertised their FM practice they would increase their overall patient volume. They could bring in another doctor as an employee or hire a PA or NP (I prefer the former) but you will make more money if you do the other.

It used to be a taboo to advertise but now many do it.

I read somewhere about an FM doc who worked 3 days a week and made 300K a year.

 

[bkpa2med]

It's not procedure stealing. It is well within their scope so please don't complain. Dermatologists are well off and deal with many pt's with skin cancer's and whatnot and have great salaries.

 

[Faebinder]

 

[deleted87716]

Dermatologists are well off and deal with many pt's with skin cancer's and whatnot and have great salaries.

Given the three-month wait for a new-patient appointment with most of the dermatologists in my area, I don't think any of them are complaining about not being busy enough...

 

[deleted6669]

Given the three-month wait for a new-patient appointment with most of the dermatologists in my area, I don't think any of them are complaining about not being busy enough...

true story-
I recently called for an appt with a very well regarded local dermatologist with strong ties to the local medschool. I thought I was in for a 4-6 week wait and was surprised when told I could be seen the next week.
his secret apparently is that all of his pts are 1st seen by a pa who does initial screening. those with mostly cosmetic concerns are managed almost entirely by the pa. those with skin ca concerns have baseline biopsies done by the pa and then if mohs is indicated the md does that. those who are diagnostically complex(weird rashes/lesions, etc) see the pa who does initial testing then f/u with the dermatologist after biopsy, lab, fungal analysis, etc is complete.
this way the dermatologist essentially only does surgery and the eval of those with complex issues. seems to work very well judging by the guys vast office complex.

 

[deleted87716]

his secret apparently is that all of his pts are 1st seen by a pa

That wouldn't fly with me. By the time I refer someone to derm, they need to see the dermatologist, not somebody with even less training than I have. I don't take kindly to specialists who waste time, mine or my patient's.

 

[QuantumMechanic]

That wouldn't fly with me. By the time I refer someone to derm, they need to see the dermatologist, not somebody with even less training than I have. I don't take kindly to specialists who waste time, mine or my patient's.

yeah but with waits to see derms in many areas being on the order of months, this derm is just trying to screen his patients in the most effective manner so that he can see the patients that truly need his expertise in due time. so in the end, he's probably saving time for the people that you are refering to him that do need specialized care.

isn't it likely that this derm PA has lots of experience (especially after seeing every patient of this derm for years) and is well trained through such experience to know what is a zebra and what is a common and easily treated problem?

 

[deleted6669]

kent- I imagine you manage lots of your own minor derm. many of your colleagues refer out every pt who needs a biopsy or has acne, rosacea, seb. keratoses, warts, etc
most of these conditions can be treated very easily by someone with some extra derm training( or realistically by most folks with primary care training). I even see some of these folks in the emergency dept;"my regular dr doesn't treat xyz minor derm problem but the wait for dermatology is 2 months and I'm tired of having zits".
presumably you would refer only complex cases to derm in which case the pa would either know the answer or not. if he was not 100% sure of himself your pt would see the derm md. chances are the derm pa knows more derm than you do. he does 100% of his cme in derm and reads several derm journals/month, do you?
this guy(the md) was chief of dermatology at a major medschool for over a decade. I imagine he knows what he is doing.

was your derm training in fp this good?

UT Southwestern's Dermatology Physician Assistant Training Program
University of Texas Southwestern Medical Center
Dallas, Texas


--------------------------------------------------------------------------------


PROGRAM DESCRIPTION AND HISTORY:
The University of Texas Southwestern Medical Center Physician Assistant Dermatology Training Program commenced on June 30, 2001 as a 12-month educational program integrating didactic instruction and direct patient management experiences in skin, mucous membrane, hair and nail diseases. Supplemental funding support has enabled the early addition of a second trainee position on April 1, 2002, and a third on September 1, 2002. Additional starting dates may vary somewhat through the year when identification of supplemental funding occurs, but plans exist for at least one trainee to be enrolled each year.

Clinical training includes direct patient care under close supervision of attending physicians and residents of the Department of Dermatology. The program includes exposure to general dermatology, dermatopathology, and procedural dermatology.

PROGRAM START DATE:
July 1 to June 30 - may be adjusted as additional funding identified to exceed one trainee per year.

UNIVERSITY AND INSTITUTIONAL AFFILIATIONS
The University of Texas Southwestern Medical Center at Dallas
Parkland Health and Hospital Systems (the Dallas County Hospital)
St. Paul University Medical Center at Dallas
Children's Medical Center at Dallas
Zale Lipshy University Hospital
The Dallas Texas Veterans Affairs Medical Center
The Fort Worth Texas Veterans Affairs Medical Center
The Bonham Texas Veterans Affairs Medical Center
ENTRY REQUIREMENTS:
Completed application submitted prior to the posted deadline
Graduate of an ARC-PA accredited Physician Assistant Program
National Commission on Certification of Physician Assistants eligible or certified
Basic Life Support certified

Texas Physician Assistant License - temporary acceptable for new graduates until permanent license issued upon receipt of passing Physician Assistant National Certifying Examination Scores
Telephone or personal interview for most competitive candidates
ROTATION A
MON TUES WED THURS FRI
7-8 am Surgery Conference UTSW Clinic
8-9 am Int Basic & Clinical Science Conference Dallas VA Clinic UTSW Clinic Grand Rounds UTSW Clinic
9-10 am Int Basic & Clinical Science Conference Dallas VA Clinic UTSW Clinic Clinical Pathological Correlation Conference UTSW Clinic
10-11 am (Ad hoc elective) Dallas VA Clinic UTSW Clinic Rounds (10:30)
11 am -
12 pm (Ad hoc elective) Dallas VA Clinic UTSW Clinic Rounds
12-1 pm Pearls Conference
1-2 pm UTSW Clinic Dallas VA Clinic Dallas VA Minor Surgery Clinic Dallas VA Clinic (Ad hoc elective)
2-3 pm UTSW Clinic Dallas VA Clinic Dallas VA Minor Surgery Clinic Dallas VA Clinic (Ad hoc elective)
3-4 pm UTSW Clinic Dallas VA Clinic Dallas VA Minor Surgery Clinic Dallas VA Clinic (Ad hoc elective)
4-5 pm UTSW Clinic Dallas VA Clinic Dallas VA Minor Surgery Clinic Dallas VA Clinic (Ad hoc elective)
5+ pm UTSW Clinic 4th Tues
5-8 pm Dallas/FW Dermatology
Meeting

ROTATION B
MON TUES WED THURS FRI
7-8 am Surgery Conference UTSW Clinic
8-9 am Int Basic & Clinical Science Conference UTSW Clinic Bonham/Fort Worth VA Clinic Grand Rounds Conference UTSW Clinic
9-10 am Int Basic & Clinical Science Conference UTSW Clinic Bonham/Fort Worth VA Clinic Clinical Pathological Correlation Conference UTSW Clinic
10-11 am (Ad hoc elective) UTSW Clinic Bonham/Fort Worth VA Clinic Rounds (10:30)
11 am -
12 pm (Ad hoc elective) UTSW Clinic Bonham/Fort Worth VA Clinic Rounds
12-1 pm Journal Club Pearls Conference
1-2 pm Dallas VA Clinic UTSW Clinic Bonham/Fort Worth VA Clinic Children's Medical Center Clinic (Ad hoc elective)
2-3 pm Dallas VA Clinic UTSW Clinic Bonham/Fort Worth VA Clinic Children's Medical Center Clinic (Ad hoc elective)
3-4 pm Dallas VA Clinic UTSW Clinic Bonham/Fort Worth VA Clinic Children's Medical Center Clinic (Ad hoc elective)
4-5 pm Dallas VA Clinic UTSW Clinic Bonham/Fort Worth VA Clinic Children's Medical Center Clinic (Ad hoc elective)
5+ pm 4th Tues
5-8 pm
Dallas/FW
Dermatology
Meeting

CREDENTIALS AWARDED:
Upon graduation, the physician assistant dermatology trainee receives a UT Southwestern Medical Center at Dallas certificate documenting completion of one year post-graduate training in dermatology. Candidates without graduate-level PA degrees are encouraged to concurrently enroll in the University of Nebraska Master of Physician Assistant Studies program in Distance Learning with a concentration in Dermatology.

 

[deleted87716]

isn't it likely that this derm PA has lots of experience (especially after seeing every patient of this derm for years) and is well trained through such experience to know what is a zebra and what is a common and easily treated problem?

I don't refer common and easily treated problems.

chances are the derm pa knows more derm than you do.

That's very presumptuous of you.

I suggest you stick to subjects within your experience, which doesn't include me.

 

[deleted6669]

KENT- you have already conceded in other posts that it is likely that a specialty pa knows more about their specialty than the majority of physicians who do not practice that specialty. if you hppen to have a special interest in derm and are quite good at it than I owe you an apology-consider it given-if you are a more typical fm residency grad than it is likely that a derm pa knows more derm than you.

on a separate note-
the derm pa in this office bills out at 125 dollars for a 15 min appt before any labs/procedures/biopsies/etc
that's $960,000 of billing a yr if all his appts are filled. I'm guessing he probably makes 125k/yr so the derm md is making bank by using him.
I haven't seen the derm md yet but I'm guessing if I do he bils out at more than 125/15 min appt.

 

[deleted87716]

My third year of med school, I was rotating on FP. One of the residents I was with had a gyn patient with chronic vag bleeding he hadn't been able to manage, so he referred her to Gyn.

A few weeks later, I ran into him in the hall, he had just started an Ob/Gyn clinic month. On his first day, he got a consult from himself, and saw the same damn patient from his FP clinic . . .

Such is the irony of the teaching hospital. However, now that he's working directly with an OB-Gyn attending, it's a great learning opportunity. Next time, he might not have to refer a patient like that at all.

 

[Faebinder]

Such is the irony of the teaching hospital. However, now that he's working directly with an OB-Gyn attending, it's a great learning opportunity. Next time, he might not have to refer a patient like that at all.

Yup, the supervisor of the OBGYN will be different than that of the FM... so obviously the teaching experience will be different.

 

[Faebinder]

KENT- you have already conceded in other posts that it is likely that a specialty pa knows more about their specialty than the majority of physicians who do not practice that specialty. if you hppen to have a special interest in derm and are quite good at it than I owe you an apology-consider it given-if you are a more typical fm residency grad than it is likely that a derm pa knows more derm than you.

on a separate note-
the derm pa in this office bills out at 125 dollars for a 15 min appt before any labs/procedures/biopsies/etc
that's $960,000 of billing a yr if all his appts are filled. I'm guessing he probably makes 125k/yr so the derm md is making bank by using him.
I haven't seen the derm md yet but I'm guessing if I do he bils out at more than 125/15 min appt.

Dermatology is a basic part of FM residency and it's not the first time they are exposed to the specialty... (after med school clinical and basic science). Hence the whole topic of this thread.... FM is starting to do more and more procedures in the clinic because there is less and less need to refer them... Dermatology PAs will not be needed as much in the future if FM continues to take the turf that the Dermatologists refuse to commit to by refusing to increase their numbers.

This is clearly a turf war. Check it out.

http://www.cnn.com/2006/HEALTH/12/22/botox.at.the.mall.ap/index.html

 

[deleted87716]

Dermatology PAs will not be needed as much in the future if FM continues to take the turf that the Dermatologists refuse to commit to by refusing to increase their numbers.

This is clearly a turf war. Check it out.

I didn't see anything in that article about a "turf war." The article was about shopping mall Botox treatments administered by nurse practitioners, and the need for physician supervision to prevent poor outcomes in the face of increasing demand and profit motivation.

That being said, any licensed physician can open a "medical spa" and perform or supervise minimally-invasive cosmetic procedures. Let's face it...Botox isn't rocket science.

 

[Faebinder]

I didn't see anything in that article about a "turf war." The article was about shopping mall Botox treatments administered by nurse practitioners, and the need for physician supervision to prevent poor outcomes in the face of increasing demand and profit motivation.

That being said, any licensed physician can open a "medical spa" and perform or supervise minimally-invasive cosmetic procedures. Let's face it...Botox isn't rocket science.

Here is the part from the article..

Leavy said each state has different qualifications rules for those who perform minimally invasive cosmetic procedures. Work done by those poorly trained can lead to "a lot of complications," he said.

In October, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery drew up "guiding principles" for supervision of non-physician personnel in medical spas. Specialists in the field say the issue is who's running these spas and who's supervising.

Dr. Richard A. D'Amico, president-elect of the American Society of Plastic Surgeons, said the concern is more about safety than location. He said that it's important that such procedures are at least overseen by a plastic surgeon or a dermatologist.

The procedures may look like simple injections, but serious complications could result if someone isn't properly trained. For example, an injection that paralyzes the muscle, like Botox, given in the wrong spot could cause an eyelid to droop, he said.

Skinovative USA, a Tempe, Arizona-based chain of medical spas that opened in 2001, does not demand that its medical directors be plastic surgeons or dermatologists.

 

[deleted6669]

Dermatology is a basic part of FM residency and it's not the first time they are exposed to the specialty... (after med school clinical and basic science). Hence the whole topic of this thread.... FM is starting to do more and more procedures in the clinic because there is less and less need to refer them... Dermatology PAs will not be needed as much in the future if FM continues to take the turf that the Dermatologists refuse to commit to by refusing to increase their numbers.

This is clearly a turf war. Check it out.

http://www.cnn.com/2006/HEALTH/12/22/botox.at.the.mall.ap/index.html

Fair enough....I'll butt out of this conversation now unless more pa input is needed.....

 

[aggernodi]

New to this forum, but thought to mention a few things:

1) Turf wars are everywhere, even in my specialty in ENT:

Thyroidectomy: GSU, ENT
Skin Cancer removal: ENT, FP, PCP, Peds, PSU, GSU, Derm
Trach placement: GSU, ENT
G-tube placement: radiology, GSU, GI
Neck mass removal: GSU, ENT, oral surgery, PSU

etc, etc.

Turf wars are a part of life. If you provide a good service, patients will come, no matter what specialty you represent.

2) Derm is sometimes not the best ones to remove skin cancer. In fact, derm sometimes refers to ENT for skin cancer removal of the face, especially when it comes back SCC, deep BCC, etc since neck dissection/parotidectomy may be needed. In turn, ENT often refers to derm for skin cancer as well, esp if diffusely spread out.

Instead of viewing it as a turf war, consider it to be a service provided for patients and who would be the best to address a given problem. We are all colleagues and can benefit more from working with each other.

 

[IzzyMD09]

but, what I do remember is a series of planar warts all over my hands...probably from the HPV or something i got from living in military barracks for 3 years (yes I was a bad kid), and going to an FP for 2 years...it was horrible, that liquid nitrogen burning off method is mighty painful, i cried...several times, of course im a big wuss, but it was remarkable returning every 2 months or so to watch the bumbling idiot (not all FP's probably just this guy) say over and over again, well We will just try and burn it off again

This was getting ridiculous, maybe he was just trying to make a quick buck, i mean it took 5 minutes and i was out, finally after 2 years, reffered to a Dermatologist, interferon shot, 3 days later warts were gone, forever,

thusly and therefore vis a vis and concordantly, I wouldnt be worried about this procedure outsourcing issue, chances are FP's have there talents in the more general disease recognition and treatment, and when it comes to any specialized therapy they will have to refer elsewhere, suffice to say, I never went back to that FP again, and that happens a lot from what i hear

so keep cool,

izzy

 

[Faebinder]

but, what I do remember is a series of planar warts all over my hands...probably from the HPV or something i got from living in military barracks for 3 years (yes I was a bad kid), and going to an FP for 2 years...it was horrible, that liquid nitrogen burning off method is mighty painful, i cried...several times, of course im a big wuss, but it was remarkable returning every 2 months or so to watch the bumbling idiot (not all FP's probably just this guy) say over and over again, well We will just try and burn it off again

This was getting ridiculous, maybe he was just trying to make a quick buck, i mean it took 5 minutes and i was out, finally after 2 years, reffered to a Dermatologist, interferon shot, 3 days later warts were gone, forever,

thusly and therefore vis a vis and concordantly, I wouldnt be worried about this procedure outsourcing issue, chances are FP's have there talents in the more general disease recognition and treatment, and when it comes to any specialized therapy they will have to refer elsewhere, suffice to say, I never went back to that FP again, and that happens a lot from what i hear

so keep cool,

izzy

Not to rain on your parade but i had the same exact case (12 plantars on my fingers!!) before med school..... went to the dermatologist and had 7 sessions of liquid nit.... till finally i went to another derm and he told me either surgery or try aldera.. which is not usually used for plantars.. I went for aldera and luckily aldera worked....

Moral of the story.... don't be too quick to judge...a specialist might not always know better...

 

[Faebinder]

New to this forum, but thought to mention a few things:

1) Turf wars are everywhere, even in my specialty in ENT:

Thyroidectomy: GSU, ENT
Skin Cancer removal: ENT, FP, PCP, Peds, PSU, GSU, Derm
Trach placement: GSU, ENT
G-tube placement: radiology, GSU, GI
Neck mass removal: GSU, ENT, oral surgery, PSU

etc, etc.

Turf wars are a part of life. If you provide a good service, patients will come, no matter what specialty you represent.

2) Derm is sometimes not the best ones to remove skin cancer. In fact, derm sometimes refers to ENT for skin cancer removal of the face, especially when it comes back SCC, deep BCC, etc since neck dissection/parotidectomy may be needed. In turn, ENT often refers to derm for skin cancer as well, esp if diffusely spread out.

Instead of viewing it as a turf war, consider it to be a service provided for patients and who would be the best to address a given problem. We are all colleagues and can benefit more from working with each other.

Best post i have seen in a while.... if you are uncomfortable with then you need to do what's best for the patient.

 

[deleted87716]

a series of planar warts all over my hands

i had the same exact case (12 plantars on my fingers!!)

Um, guys? The term "plantar wart" refers specifically to warts on the sole of the foot (from the Latin planta pedis), not on the hands.

Normally, I'd let that slide...but this is a derm forum, after all.

Warts on the hands are typically described as being digital, palmar, or periungual, depending on their location.

 

[IzzyMD09]

thanks for the correction, it was a hasty post
and for the other yes its true specialists dont always know what is best, but i would think that after 7 or 13 times of trying the same thing, they would get a consult or at least modify there approach to treatment and cure

I also agree with the turf war thing, its part of the game

heres how i see it
1. a specialist in a certain field will have more experience with various treatment modalities concerning the specific disease/condition an FP isnt given the time to focus on one condition
2. thusly he/she (the specialist) will be the first to recognize and develop new methods to treat said conditions over an FP
3. if treatment is great then it becomes mainstream and yes FP's will be responsible for administering the treatment, but before it becomes mainstream, its up to the specialists to perfect and refine the new treatment so as to avoid as many complications or reactions as possible

Specialists are the innovators, they are given a problem and have to solve it so that the generalists can take advantage and treat a greater population of patients, thats what FP's do, thats what FP's want to do, let them do it, it is up to specialists to keep creating strategies and protocol that will ultimately ease the burden of disease for our patients

doesnt seem to me that the system creates turf-war mongering, maybe it serves as a way to keep us on our toes to be those innovators, make medicine happen , you know

just a thought, but what do i know Im just an MSII

izzy

 

[Faebinder]

Um, guys? The term "plantar wart" refers specifically to warts on the sole of the foot (from the Latin planta pedis), not on the hands.

Normally, I'd let that slide...but this is a derm forum, after all.

Warts on the hands are typically described as being digital, palmar, or periungual, depending on their location.

I know they are plantar cause the first one was on my foot... and then spread to my fingers later... I assumed Izzy knew the meaning of plantar.

 

[IzzyMD09]

plantar = foot
palmar = hand

great and good
can anyone attend to my other post, the one about which is better a case report ( which is taking forever because my doc is a perfectionist and doesnt have the time to discuss which areas need correction in my draft becasue doctor #2 is M.I.A) vs. a literature review

thanks, appreciated

happy new year everyone

izzy

 

[eddieberetta]

palmar = hand

use volar -- more confusing.

 

[(nicedream)]

Aldara works great on all warts. I'm only a 3rd year so I just bite my cheek whenever I see an attending use nitro (seems to never work in my experience, and hurts obviously).

 

[MOHS_01]

Aldara works great on all warts. I'm only a 3rd year so I just bite my cheek whenever I see an attending use nitro (seems to never work in my experience, and hurts obviously).

Sorry, but this is just incorrect.

Aldara is a great drug, but it will not reliably work for warts on acral skin. Simply too large a molecule to diffuse through thick skin. Even 3m reps won't attempt to push that indication.

If you are a third year resident, I suggest you work real hard this year before taking boards...they are expensive to take twice.

If you are a third year student, keep biting the cheek and listen to those that you are trying to impress. If not, you will most definitely be limiting your dermatology training to an elective month during the third year of your FP residency.

Not to knock FP -- they have one of the hardest jobs out there. Turf wars suck, but they are part of life today for many fields. Sometimes it is b/c "the grass is always greener on the other side" mentality....sometimes it really is.

Just follow a simple rule: Am I the best person for the job? If not, will there be any real consequences to my action? If there could be, refer on to the person who you feel is best. It will work out the best for you and the patient in the end.

The ENT post above is correct -- and some of the worst surgery that I have ever seen was performed by a general dermatologist (absolutely unbelieveably bad...ughhh). If I encounter a SCC that invades through the parotid capsule, I will attempt to clear the tumor if I can do so without injury to a major facial nerve trunk. If I cannot, I refer on. If I can, I refer on. The patient may benefit from nodal dissection -- this is the realm of the head/neck guys, and their input is both needed and appreciated. More often than not, if I feel that I have good margins, adjuvant XRT is rec with no further surgery, but that is not my call to make.

Do right by your patient and things will work out alright in the end. It simply is not worth the little bit of extra money that you collect to ruin your good name in the public or the medical community's eyes.

 

[deuist]

Just follow a simple rule: Am I the best person for the job? If not, will there be any real consequences to my action? If there could be, refer on to the person who you feel is best. It will work out the best for you and the patient in the end.

Therein lies the problem. There is always someone "better" than an FP for any ailment you can name: HTN, infections, depression, and the list goes on. Patients realize this and hence the decline in the family physician. Current FP are tired of seeing 30 patients a day just to pay the mortgage, forcing them to take on cosmetic roles to generate more income.

 

[deleted87716]

There is always someone "better" than an FP for any ailment you can name: HTN, infections, depression, and the list goes on. Patients realize this and hence the decline in the family physician.

BZZZZT. Thanks for playing. We have some lovely parting gifts for you.

What you're undoubtedly referring to is the relative decline in interest shown by today's medical students, which is largely financially-motivated. This has nothing to do with what patients want, what's appropriate medically, or what's best for our healthcare system.