Botox Appointments Faster Than for Moles, Study Finds

Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, a study published online yesterday by The Journal of the American Academy of Dermatology said.

Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared with a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.

"The difference in wait times between medical dermatology and cosmetic dermatology patients is clearly real," said Dr. Jack S. Resneck Jr., the lead author of the study and an assistant professor of dermatology at the medical school of the University of California, San Francisco. "We need to look further and figure out what is leading to shorter wait times for cosmetic patients."

In Boston, the median Botox wait was 13 days, versus 68 days for a mole examination. In Seattle, the median Botox wait was seven and a half days, compared with 35 days for a changing mole.

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 0 to 0 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 to , Dr. Franzblau said.

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