Petroleum products. Precious metals. Plastic surgery?
Technically speaking, only two of the above can be considered commodities but sometimes it can be hard to tell which two. Between industry developments, competitive pressures and changing consumer behavior, it’s not surprising that longtime aesthetic providers are feeling that a profession built on personal expertise and one-on-one relationships is getting increasingly commoditized.
“Historically speaking, a patient went in and had a lengthy consult with a plastic surgeon,” says Robert Singer, M.D., FACS, of La Jolla, Calif. “Now they go to some commercial office with salespeople who are looking to close sales. Too often the salespeople try to fit the patient to the procedure rather than finding the right procedure for the patient.”
For Singer, the trend is exacerbated by a host of other influences including practice drift, the prevalence of unfiltered information on the Internet and TV programs that shortchange (and endanger) patients by trivializing what’s involved.
“People now equate getting a procedure with buying a t-shirt,” says Singer. “But it’s not a commodity like a t-shirt. There are all sorts of aspects that are involved including the artistry of the provider.”
Multiplying med spas
If you want to see evidence of the commoditization of cosmetic surgery, you probably don’t have to go very far, especially if the subject is fillers, chemical peels and other non-invasive procedures. Chances are there’s a med spa or office-park clinic offering these and other services not far from your practice.
In fact, according to a November 2012 study by Marketdata Enterprises Inc., there are now 2,100 med spas in the U.S., generating $1.9 billion a year in revenue. Those figures are expected to rise to 3,400 facilities generating $3.6 billion by 2016.
Such competition has only fostered more commoditization.
“Everybody and their brother is trying to get into the med spa business,” says William Portuese, M.D., of Seattle. “Botox and other fillers — that stuff is totally commoditized.”
At the same time, he says, consumers have come to expect deals and discounts almost as a birthright: “Patients go for the next Groupon or wherever they can get it the cheapest.”
Together, the two trends create a self-fulfilling cycle of increased commoditization. “If you’re getting $7/unit for Botox and you’re paying $6, you get margin compression. Next thing you know, you’re on a gerbil wheel.”
The problem of practice drift
Meanwhile, commoditization is also making inroads on the surgical side of things. Between the recession, reimbursement issues and the rise of standardized, multi-office providers, many doctors are feeling squeezed on several fronts.
“We’re seeing a lot of practice drift,” says Singer. “Because of insurance, declining reimbursement and increasing overhead, there are physicians who are looking to add to their bottom line by performing procedures for which they have minimal, if any, training. They may be Board Certified but Board Certified in what?”
“There’s just more and more competition,” agrees Jeffrey Epstein, M.D., FACS, of Miami and New York. “You have ophthalmologists doing facelifts and oral surgeons doing rhinoplasty. I’m not saying a dermatologist can’t do a good facelift; I’m just saying the market’s becoming more saturated.”
Both Singer and Epstein also point to the prevalence of large plastic surgery service companies with multiple offices, which, in pursuit of standardization may also be fostering further commoditization. “They make it seem like a facelift is a facelift is a facelift,” says Epstein.
So what’s a plastic surgeon who wants to differentiate himself or herself from the herd to do? Not surprisingly, patient education is paramount. “We put a ton of information on everything we do on our website,” says Portuese. “Consumers are much more educated than they used to be; they recognize that not all doctors provide the same level of service.”
For Singer, that education continues once a potential patient reaches out to a particular provider: “Part of what good, ethical surgeons do is screen patients as to whether a procedure is appropriate. It should be an education process, not just a sales pitch.”
As for the larger issue of commoditization, he adds: “Plastic surgery is not paint by numbers. There needs to be an evaluation of appropriate options, the artistry involved and what happens if there’s a problem. These are the things doctors can do to educate the public.”