Family MDs take second job in 'spa medicine' to pay bills

By Michelle Lang

Dr. Sandra Goranson used to joke that as a family physician in inflation-fuelled Calgary, she should take on a second job to cover her climbing office expenses.

Recently, Goranson took the leap and joined the growing number of family physicians in the city who have started a cosmetic medicine business — offering services such as Botox injections — to make ends meet in their regular practice.

“For me, if I wanted to stay doing family practice, I needed another job,” she said.

“I really believe in (family medicine) and I’m trying to make it work, even though it’s financially very difficult.”

Doctors’ offices, like all city businesses, are facing growing expenses. Unlike most other companies, however, physicians can’t raise their prices for medically necessary procedures covered through the public health system.

So, many local doctors are offering cosmetic procedures — treatments for which they can privately bill patients — to supplement their income, according to the Calgary and Area Physicians Association.

“Lots of doctors are doing things like Botox,” said Dr. Linda Slocombe, president of the association. “I know of several who quit their practice and are just doing spa medicine.”

The comments follow an internal Calgary Health Region study that shows the city’s doctor shortage could grow worse in the coming years as physicians close their offices in the face of rising rents.

The report concluded operating a family practice in Calgary is not sustainable, noting many physicians are facing significant rent hikes as their office leases come up for renewal. Nearly half the physicians in the study who are facing lease negotiations plan to close their local family practice.

For some doctors, the solution to their income woes has been offering cosmetic procedures such as injectable “fillers” for lip augmentation and Botox, the botulinum toxin famous for smoothing wrinkles by paralyzing facial muscles.

Physicians learn how to perform the treatments at clinics like CosMedics.

Officials with CosMedics, based in Edmonton, say they train doctors from around North America and have noticed more Calgary physicians “moonlighting to make ends meet.”

Cosmetic treatments, of course, are often more lucrative than traditional family practice. Alberta doctors bill the government $28 to $30 for a standard 15-minute office visit. Physicians typically charge $300 to $600 for a 20-minute Botox treatment.

“Is that significantly more than what a physician makes when they comprehensively analyze a diabetic with high blood pressure? It certainly is,” says Dr. Darryl LaBuick, president of the Alberta Medical Association.

“I’ll leave it up to the public to decide what’s more valuable.”

Indeed, some observers say the trend of physicians opening cosmetic medicine businesses comes at a steep price for the health system, particularly given the shortage of doctors in Calgary. The more time doctors spend offering the treatments, the less time they have for regular patients.

The University of Calgary’s Dr. Tom Noseworthy said it’s time for Alberta to change the business model for family doctors. He said the government and regional health authorities should consider buying office space and renting it to doctors at reasonable rates — a solution other experts have suggested.

“We’re not doing a good job of looking after their interests,” said Noseworthy, who heads the university’s department of community health sciences.

“Family physicians have a bad deal. So why would we be surprised when along comes a lucrative alternative that lures them away?”

For Goranson, the decision to begin a cosmetic medicine business came after skyrocketing lease costs forced her to leave her old office, where she worked for 14 years with another physician.

She moved her practice into a local health clinic, with a chiropractor and naturopath, but her expenses have continued to grow.

Offering cosmetic procedures has helped somewhat, although she is still building the business and concedes she could do more to market her services.

But Goranson doesn’t want to take away too much time from her long-time patients.

“Anytime we end up taking on something else . . . it takes your energy away from the thing we’re best at, which is primary care,” she said.

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