Dermatologists? I worry more about the Family practitioners, Ob-Gyns, and Internists...

Implications: As insurance reimbursements decline, everyone suddenly thinks they're a cosmetic surgeon.

Analysis: While the article in the New York Times accurately points out the fact that more and more dermatologists are moving away from acne and rosasea and toward Restylane and Botox, the trend isn't new and the article only addresses the surface of a growing trend toward fee for service procedures.

Remarkable as it sounds, I get approached on a regular basis by nonsurgeon collegues asking for a "good book to learn how to do liposuction" or a number of other procedures that I trained through residency to do. I feel sorry for the patients who will be guinea pigs for these wannabe cosmetic surgeons but, I understand the forces driving them in this direction. Physicians are getting squeezed from all sides.

Doctors celebrated this past week as Congress overroad legislation that would have caused a 10% drop in Medicare reimbursements -reimbursements that already are so low, many elderly patients in Florida and elsewhere can't find health care providers willing to take it. Forget about a raise in Medicare despite higher costs to run an office, pay malpractice premiums or keep qualified office staff.

Doctors are scrambling for anything that will supplement their falling incomes and cosmetic services seem an easy fix. One practitioner in my area has become the local Amway distributor, another sells vitamins to patients. The point is, when I hear about dermatologists doing cosmetic procedures it doesn't surprise me a bit. When the neurologist who uses Botox for migraines starts touching up wrinkles in addition I begin to wonder if medicine will continue to attract our best and brightest.