Easier to Get Appointment for Botox Than Precancerous Moles

A study in The Journal of the American Academy of Dermatology finds that patients seeking to have a potentially cancerous mole evaluated by a dermatologist are waiting longer than patients seeking Botox injections for the removal of wrinkles.

The researchers report that dermatologists in more than 10 cities offered a typical waiting time of 26 days for a patient requesting an evaluation of a changing mole, compared to only 8 days for a patient seeking Botox for wrinkles.

The lead author, Dr. Jack. S. Resneck, Jr., says, “We need to look further and figure out what is leading to shorter wait times for cosmetic patients.” This study did not examine the causes.

One explanation, as offered by the The New York Times, could be that the demand for medical dermatologists outstrips the supply. Several dermatologists in the article said that financial incentives plus obstacles in receiving payment from insurance companies could also be playing a role in varying wait times.

The study, in which a researcher posing as a patient called every board-certified dermatologist in the 12 cities, including Miami, Cleveland and Lansing, Mich., did not examine the possible causes for the varying times.

Dr. David M. Pariser, president-elect of the American Academy of Dermatology, said it seemed clear that cosmetic patients in the studied cities had faster access to dermatologists than did medical patients.

“It doesn’t make me proud to say it, but it is true,” Dr. Pariser, a dermatologist in Norfolk, Va., said.

Dr. Alexa B. Kimball, an associate professor of dermatology at the Harvard Medical School, said a simple explanation might be that the demand for medical dermatologists outstrips the supply.

At a time of increased awareness about skin diseases like melanoma and psoriasis, more people seek medical appointments with dermatologists, Dr. Kimball said. Meanwhile, a wider array of doctors like plastic surgeons and even some internists offer Botox shots, she said.

“The study shows that the Botox needs of the United States are being met,” said Dr. Kimball, who has conducted studies showing that dermatologists nationwide spent an average of three to four hours a week on cosmetic treatments. “If dermatologists stopped providing cosmetic care, it would not necessarily have an impact on medical dermatology patients.”

Other dermatologists said financial incentives to perform cosmetic treatments coupled with bureaucratic obstacles in obtaining insurance reimbursement for medical treatments might also have a role in the varying wait times.

Dr. Michael J. Franzblau, a dermatologist in San Francisco, said doctors typically charged $400 to $600 for a Botox antiwrinkle treatment, for which patients pay upfront because insurance does not cover it.

Meanwhile, doctors have to wait for health insurance to reimburse them for mole examinations, for which they receive an average of $50 to $75, Dr. Franzblau said.

Dr. Resneck, the lead author of the study, said dermatologists should better monitor how their patients are scheduled.