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Wrinkles Treated More Quickly Than Skin Cancer

By Brian Carty, MD, MSPH

March 11, 2008

A study in the December 2007 Journal of the American Academy of Dermatology showed that the average waiting time to see a dermatologist was 38 days for a changing mole (a lesion which is suspicious for skin cancer), but only 16 days for Botox treatment of wrinkles. In the study, sham patients called over 800 US dermatologists' offices to request appointments for one of these two problems.

Obviously, waiting time should be shorter for a potentially more serious condition. Although the study did not examine the reasons for the difference in waiting times, it seems likely that the difference is due to the way physicians are paid. Fees for wrinkle treatments are not covered by insurance plans or Medicare, are paid out of pocket by the patient, and are set by supply and demand. Fees for evaluation of a possible skin cancer are usually set by government programs or by insurance companies. The fee for the Botox injection may be several hundred dollars, but for the mole examination the dermatologist will have to wait for $50 or $75 from Medicare or an insurance company.

It would be wonderful if dermatologists acted without regard to how they are paid or how much they are paid, but the laws of human nature and economics are not going to be repealed. We ignore them at our peril. Price controls always fail and always produce the same results: decreased quality, shortages, and black markets.