The healthcare industry is poised for unprecedented change. This is irrespective of whether Obamacare survives either constitutional scrutiny or the next election. Healthcare costs are simply too high and rising at breakneck pace. This situation cannot continue.
And it is not only a matter of rising healthcare costs. The supply of physician providers is shrinking at a time when the need for these providers – especially in light of the baby boom generation entering old age – is increasing. Reimbursements to physicians for patient care are decreasing, intrusion into physician decision-making by insurers and governmental agencies is increasing, failure to act on tort reform ensures the continuation of inefficient defensive medicine, and mandated paperwork is becoming increasingly burdensome. There is a perfect storm brewing.
The Doctors Company is the single largest malpractice provider in the United States. They insure over 71,000 physicians. If you search “plastic surgery Charleston” chances are that almost every surgeon who is listed on the first page or two is insured by the Doctors Company. A recent survey of their insured members shows that 60% of doctors feel that Obamacare will adversely affect patient care, more than 50% believe that Obamacare will compromise the doctor-patient relationship, 43% stated that they will retire early (within the next five years), and, finally, 90% (90%!!) are unwilling to recommend healthcare as a profession.
So the healthcare system will need to undergo significant change or it simply will not be there for our children—or our parents! What will take its place will be a severely constrained, inefficient, and perverse system of healthcare delivery. Almost everyone agrees with this statement. However the proposed solutions are widely divergent. Some would prefer a single-payer system much like that in Canada or Britain. But, a careful analysis of such systems shows significant shortcomings. New technologies are slow to be provided and costs are controlled only by rationing. Some prefer the system pretty much as structured but with significantly increased governmental oversight and control. But when has government supervision ever provided excellent service and controlled costs? And we are already seeing that increased governmental intrusion is driving providers from the profession.
I would agree with those who prefer a market-based solution to some of these problems. Search “plastic surgery Charleston“. Call the first five, or 10, or 15 practices that come up. Ask them what they charge for a breast augmentation, or a facelift, or Botox injections. You will find all the fees quoted within a very tight range. I would wager that there would be less than $100-200 difference between any of the quotes. And not only that, but these fees have changed little in the past five or 10 years. Numerous surveys have documented this fact and I know it from experience. I have been in practice in Charleston for 25 years and have seen my fees increase very little over that time.
This is because of one thing. Competition. Aesthetic plastic surgery is not covered by insurance. There is no third-party between the provider and the purchaser. The patient is free to shop around. The providers (plastic surgeons in Charleston in this case) know this full well. Therefore they must keep their fees reasonably in line with everyone else’s in order to be competitive and stay in business. And believe me, there is no shortage of plastic surgeons in Charleston. Just search ”plastic surgery Charleston” if you are unsure. This is basic economics, but unfortunately it does not apply to medicine in general because the straightforward relationship between provider and purchaser has been subverted by the presence of a third party (insurers, the government, etc.).
Do you think that the cost of a gallbladder removal would continue to escalate year after year if the patient was free to shop around amongst all the general surgeons in Charleston who were free to set their fees? Of course not. Costs would stay in a reasonable range because of competition. And just like with “plastic surgery Charleston”, there would not be a shortage of general surgeons.
Yes the government may have a role in ensuring care for the neediest among us (although if doctors and hospitals were free to provide charity as they see fit, I’m not sure that role would be necessary). And yes private insurance plays a role in providing protection from a catastrophic medical event. However for the routine parts of medical care—physical exams, cuts and bruises, infections, typical surgical procedures, etc.—I would submit that a system that allows patients to bargain with medical providers to determine costs would be most effective at controlling those costs. Such a system would reward physicians with appropriate reimbursement and also free them to provide the kind of care they have been trained to deliver in a system that provides the satisfaction they desire and therefore keeps them in the game and encourages others to enter the profession.
Win—win, it seems to me.
ABOUT DR. TERRANOVA: Dr. Terranova is a Board-certified plastic surgeon practicing in the Charleston, SC area. He has over 25 years of experience performing breast enhancement, body contouring including liposuction, and facial rejuvenation. For more information, please visit http://www.drterranova.com.
I am a plastic surgeon in Charleston, SC. Although in this Internet/website age, I am “plastic surgeon, Charleston SC“. I have been in practice long enough to have seen the Internet come of age and be a great influence on my patients. Some good; some bad.
Many of the patients who choose to visit with me for consultation have done their homework. They have been to many Internet sites and have gathered a lot of information. Some factual. Much myth and propaganda. One of my primary responsibilities, therefore, is to help separate fact from fiction.
A particular example is liposuction. I am reminded of that recently because there was a much-needed study recently reported in the current Journal of Plastic and Reconstructive Surgery comparing results of traditional, tumescent liposuction with newer technology. Tumescent liposuction has been, for many years now, the gold standard of liposuction technology. There have been a number of newer technologies developed over the past two decades which claim to improve results. These developments range from ultra-sound assisted, to laser-assisted, to power-assisted technologies. The familiar trade names are SmartLipo, SlimLipo, VASER Lipo, and TickleLipo. Claims range from less bruising and swelling, to less postoperative pain and downtime, to less surgeon fatigue, to better skin retraction and therefore better aesthetic results. However there is no solid evidence in the peer-reviewed literature that any of these claims are true. In fact, the few prospective trials that do exist comparing different techniques in the same patient, have shown no clinical difference in results between techniques. The most recent study (which I referred to above) compared tumescent liposuction with VASER technology and showed that neither patients nor surgeons could tell the difference between technologies. Why then are these newer technologies promoted so heavily? Here’s how the system works.
Liposuction is the most commonly performed aesthetic plastic surgery procedure in the US. Every plastic surgeon, Charleston SC performs liposuction. Many non-plastic surgeons also perform liposuction. Well over a half million liposuction procedures are performed in the US each year generating hundreds of millions of dollars. Everyone wants a piece.
So Company X develops a new technology. We’ll call it SexyLipo. The company heavily promotes the new technology with a big advertising campaign including appearances on the daytime talk shows, particularly the doctor shows. Soon each and every plastic surgeon, Charleston SC receives an e-mail that the representative for Company X will be in town to demonstrate SexyLipo. The rep says it is better than the tumescent technique. Tumescent is so yesterday! Where is the data one asks? Data? Well Dr. Famous out in LA uses it and he says it is the best thing since sliced bread. Yes, the technology costs well over $100,000, but those costs can be passed on to the patients. And yes, the complication rate may be slightly higher. But if you don’t do this, Dr. Famous-in-Waiting down the street will do it and he will get all the patients that Company X is working so very hard to convince that SexyLipo is the new, best, and only way to get liposuction.
I’m overstating? About a year ago at a national aesthetic plastic surgery meeting, the attendees were polled as to their usage of newer liposuction technologies. Of those who answered that they did use these newer technologies, 70% (that’s right, more than 2/3) stated that they did so as a marketing tool. A leg up on the competition!
So as a potential patient, you must be educated. Do your homework. Understand that FDA approval of any technology only means it is safe and effective. Not better. More expensive, more complex, but not necessarily clinically, aesthetically better. There is an old saying in woodworking and it applies to each and every plastic surgeon, Charleston SC. It’s not the tool, but the person wielding the tool that determines the result.
ABOUT DR. TERRANOVA: Dr. Terranova is a Board-certified plastic surgeon practicing in the Charleston, SC area. He has over 25 years of experience performing breast enhancement, body contouring including liposuction, and facial rejuvenation. For more information, please visit http://www.drterranova.com.
There are a great many plastic surgeons in Charleston. With this many, how does one choose? How does a prospective aesthetic surgery patient know who is qualified and who is not? Who is experienced and who is not? Who is good and who is not? Who is the right fit for them and who is not? I was reminded of this recently, when reading the sad story of a cosmetic surgery gone very wrong. The patient suffered uncorrectable deformities at the hands of a totally unqualified practitioner in New York City. Her lament was that there was no way she could have known of the dangers before-hand. There was and is a way. But there is a lot of homework to be done.
All of the plastic surgeons in Charleston have websites. Start there. The website will tell you a lot. Is this surgeon certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgery? This is a must to ensure proper training. Is the surgeon a member of the American Society of Aesthetic Surgeons? This will tell you that the surgeon has a large experience with aesthetic surgery.
On many of the websites of plastic surgeons in Charleston, you can meet the physician and staff. This is particularly true if the site contains videos. Video can allow you to meet the surgeon even before you set foot in the office. You can get a quick tour of the facility. Does this surgeon have an accredited in-office operating suite? Plastic surgeons in Charleston who have their own in-office accredited operating suite can offer the same level of patient safety as hospital operating facilities or free-standing ambulatory surgery centers, but with much lower costs and greater privacy.
Ask around. You may have friends or relatives who have been to one of the plastic surgeons in Charleston. Would they recommend that surgeon? Finally, ask medical personnel you may know. Nurses and doctors in the community know who among plastic surgeons in Charleston is good and who is not. Here at the Center for Plastic Surgery, Dr. Terranova and staff are proud of the fact that many area medical professionals have entrusted themselves, family and friends to our care.
Finally visit the plastic surgeon and his or her facility. Do you like the staff? Do they treat you like a friend or like a customer? Do you like and trust the surgeon? Does this surgeon share your vision for the expected result? Does he or she inspire confidence? Could you be in it for the long run with these people?
Yes, there are many plastic surgeons in Charleston. But if you do your homework and choose carefully, you will find the one who is just right for you.
ABOUT DR. TERRANOVA: Dr. Terranova is a Board-certified plastic surgeon practicing in the Charleston, SC area. He has over 25 years of experience performing breast enhancement, body contouring including liposuction, and facial rejuvenation. For more information, please visit http://www.drterranova.com.
Charleston plastic surgeons are an interesting lot. We are all different personalities, have different levels of experience and technical skill, and have different degrees of ambition. Some are male and some are female. But in one thing all Charleston plastic surgeons are the same. We all firmly believe that what we do is important and valuable. Not only reconstructive plastic surgery for which the value is indisputable but aesthetic plastic surgery as well years back, I was asked to consult with a patient who was extremely unhappy with her breasts. She had experienced some psychological instability in her past and had seen a psychiatrist on and off. During the conversation about whether or not surgery was appropriate for her, she became somewhat frustrated as she could tell that I was concerned enough about her past psychiatric history to perhaps say no. Most Charleston plastic surgeons have seen such a challenging patient at one time or another. In any event, she finally looked me full in the eye and stated flatly, “look, you’re nothing but a psychiatrist with a scalpel anyway”.
I was initially stunned and somewhat amused. But the more I thought about it over the next few days, the more I realized that she had hit the nail squarely on the head. We see people who are unhappy because of a deformed, or, simply an inadequate, body part. We fix or change the body part. The patient is most often then much happier. I, and all my Charleston plastic surgery colleagues, perform psychiatry with a scalpel!
I was thinking about this a lot lately when I came across a column in the LA Times by a gentleman named Alexander Edmonds who is an assistant professor of anthropology at the University of Amsterdam. As some of you may have read, and certainly all Charleston Plastic Surgeons have learned, the French manufacturer of silicone implants (PIP) is involved in a scandal because some of their implants were manufactured using industrial grade, rather than medical grade, silicone. Mr. Edmunds uses this as a starting point to wonder whether we should consider a ban on breast augmentation (he actually speaks broadly about a ban on all cosmetic surgery, but he specifically only addresses breast augmentation).
Right now, I realize that some readers, and many of my colleagues among Charleston plastic surgeons, are screaming about individual rights, and government telling us how we can spend our money, and “slippery slopes”, etc. (and I would be in agreement here). However, this is an interesting point of discussion by Mr. Edmunds, and I would not dismiss it out of hand. Although, I would submit, that he is incorrect on many levels.
He claims that breast augmentation procedures are “well known” for causing many medical and physical problems. All my colleague plastic surgeons in Charleston know that, of course, this is not true, as the overwhelming majority of breast augmentation patients are extremely happy with the results and have no problems at all. The claims of disease caused by the older style silicone implants in the mid-eighties have proven to be totally without merit. He argues that as specific standards of beauty become normalized, people will ignore any risks in order to achieve this ideal of beauty. And it is the role of “government” to protect people from themselves in this instance. Many, of course, would argue that adults no longer need to be taught how to cross the street. Or be prevented from crossing the street.
If there is a role for “government” here, it is not to protect potential plastic surgery patients from themselves, but to protect these individuals from untrained and unscrupulous providers. Although the failure of PIP to adhere to proper standards is obviously reprehensible, there is no clear indication in the literature that any medical harm has come from this. What is clear in the literature is that great harm has come to many patients at the hands of providers who are not properly trained in plastic and aesthetic surgery techniques. Charleston plastic surgeons, for example, are certified by the American Board of Plastic Surgery to have been fully and expertly trained in these techniques and must perform surgery only in facilities fully accredited by national agencies. The proper focus of government in this arena is certainly not to inhibit patients from pursuing their individual goals but to ensure that they can reach those goals safely.
So we come back to the plastic surgeon as psychiatrist. Every individual has a right to be happy with themselves and with their life. If that means having larger and fuller breasts as opposed to not being afraid of heights, or not being overly neurotic, who is an anthropology professor from Amsterdam to tell them they are wrong? As long as breast augmentation, or liposuction, or facial rejuvenation, or whatever cosmetic procedure you may wish to consider, can be done safely, what is wrong with that?
ABOUT DR. TERRANOVA: Dr. Terranova is a Board-certified plastic surgeon practicing in the Charleston, SC area. He has over 25 years of experience performing breast enhancement, body contouring including liposuction, and facial rejuvenation. For more information, please visit http://www.drterranova.com.