Beautiful bottom line for plastic surgeons

By Tracie Darnell, Jaclyn Keenan and Brigid Sweeney
Medill News Service


While the income of most physicians is shrinking under insurance pressures, one medical specialty — largely free from reimbursement hassles — is enjoying a gusher of riches.

Plastic surgery, once perceived as the frivolous domain of society matrons and Hollywood divas, has become serious business. According to the American Society of Plastic Surgeons in Arlington Heights, Americans spent more than $9.4 billion on cosmetic procedures in 2005, up $1 billion from 2004.

With 148 plastic surgeons in the metro area, Chicago ranks behind only New York and Los Angeles in the number of practicing plastic surgeons.

“The number of people seeking procedures has tripled in the past five years,� said Michael Horn, a plastic surgeon in Chicago’s Gold Coast neighborhood. “What’s really catapulted is the number of injectables we administer.�

The term “injectables� refers to non-surgical, minimally-invasive cosmetic procedures, including Botox injections to temporarily eliminate brow furrows and Restylane shots to artificially plump lips.

These relatively new procedures boast minimal recovery times as well as significantly lower price tags than surgery.

According to Horn, Botox injections take about 10 to 15 minutes and can be administered during lunch.

“You can be back to work an hour later and it’s not totally noticeable,� he said.

Moreover, a Botox treatment costs about $360, while a standard facelift — major surgery that requires general anesthesia — costs $4,500.

Beyond these factors, plastic surgeons say business also has increased due to the recent onslaught of cosmetic surgery-focused television shows, such as ABC’s “Extreme Makeover� and Fox’s “The Swan.� While physicians voiced concern that these programs portray surgery in an extreme light, they also noted that their patients are more informed as a result of the mainstream media focus.

“Patients say, ‘Oh, I watch the show every week; I love it; I know exactly what you’re going to do,’æ� Horn said. “They already know the name of the procedures and what’s involved.�

The number of patients visiting plastic surgeons quintupled from fewer than 413,000 in 1992 to more than 2 million in 2002, according to a new book by The New York Times reporter Alex Kuczynski.

Because elective plastic surgery is generally not covered by insurance, well-heeled patients pay up front and doctors do not have to haggle with insurance companies to receive payment.

According to the Association of American Medical Colleges, plastic surgeons’ annual salaries range from $185,250 to $453,000, one of the highest averages of any medical specialty — and cosmetic surgeons practicing in large cities can make significantly more. (Plastic surgeons spend eight years training in residencies, while general surgeons spend five years and general practitioners spend three.)

The lush incomes of plastic surgeons contrasts with other physicians’ take-home pay, which has fallen in the face of skyrocketing medical malpractice insurance premiums and continually decreasing reimbursements from insurance companies.

A study published last summer by the Washington, D.C.-based Center for Studying Health System Change found primary care physicians’ real incomes had fallen by as much as 10.2 percent between 1995 and 2003, to $121,262 in inflation-adjusted dollars.

Dr. Peter Eupierre, the president of the Illinois State Medical Society, expects the average physician’s income will continue to decline. He noted that anecdotal evidence suggests an imminent “brain drain� in lower-paying fields.

According to the National Resident Matching Program, 1,123 medical students chose a residency in family medicine last year, down more than half from a peak of 2,340 in 1997.

At the same time, local medical schools have seen increasing competition for plastic surgery residencies.

“We are very selective,� said John Cook, a Gold Coast plastic surgeon who also reviews plastic surgery fellowship applications at Rush University Medical Center. “It’s great for the field — the best and the brightest will be the future of the industry.�
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