Profession being hijacked by 'bunch of hucksters'

What a relief. There are some in our profession who assure us medical dermatology is alive and well.

Maybe they need to take a closer look at the real world of private practice and the emergence of the "cosmetic" dermatologist. This isn't even medicine, let alone medical dermatology. It's a huckster's market made up of physician salespeople hawking their services to those who want to look younger, thinner, less hairy or maybe just want a fat upper lip.

Dr. X says in his ad, "Come to my skin institute so I can inject you with a bacterial toxin that will make you look younger." Of course, it will also give you the equivalent look of (having had) a facial lobotomy when you smile. The premise is that aging is a medical disease that needs to be treated by an expert. Dermatologists will not rest until every single old lady is made to look just a little less old. All right, so this isn't really medicine. But, we are performing an important service and people really do want these things. Someone has to do it. Why not the "cosmetic" dermatologist?

There is a place for dermatologists who want to accept what someone else thinks their time treating patients is worth. It's called Canada. The "cosmetic" dermatologist would say, "If you want to practice medical dermatology, go to Canada. In America, we use physician extenders for that stuff."

The real experts are busy blasting brown spots off of aged hands. What a waste.

Recently, in some throw-away publication, the president of the American Academy of Dermatology was bragging about the quality of those applying for dermatology residencies. I guess these young scholars already understand the medical importance of making old people look younger. Maybe, if we want to preserve dermatology as a valid medical specialty, we should consider a new Catch 22. Medical students applying for dermatology residencies should be automatically eliminated from consideration. Since these are the best and brightest from the top medical schools, there is no question that their motivation is just making more money in fewer hours. We have an opportunity to save these people from themselves, and force them into some useful service. Instead, our residency directors should be recruiting people who are applying for medical and pediatric programs and have no interest in "cosmetic" dermatology. These people might be willing to make a commitment to patient care and rescue us from our self-destructive trivial pursuit. Our specialty has been hijacked by a bunch of hucksters. Those of us who care, need to take it back.

- Ronald A. Katz, M.D.
clinical professor of dermatology
and pediatrics
George Washington University
School of Medicine