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J Am Acad Dermatol. 2007 Dec;57(6):985-9. Epub 2007 Aug 27.

Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists.

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Department of Dermatology and Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, California 94143-0316, USA.



Wait times for both routine and urgent dermatology appointments typically exceed 3 to 4 weeks. Many factors affecting physician workforce adequacy and patient access have been explored, but little is known about the impact of increasing numbers of doctors offering cosmetic services.


We sought to evaluate access to dermatologists for patients requesting cosmetic services.


Scripted patient telephone calls were made to 898 dermatologists in 12 metropolitan areas to assess wait times for an appointment to receive cosmetic botulinum toxin injections. The areas chosen were surveyed completely, and respondents represented about one tenth of practicing dermatologists in the United States. The methodology was identical to that used in a previous study of wait times for evaluation of a changing mole (a possible indicator of malignancy).


Half of dermatologist respondents (455, 50.7%) offered appointments for botulinum toxin injections, and the median wait time was 8 days. Acceptance rates and wait times varied greatly by geographic area (range of median wait times 6.0-32.5 days), with dermatologists in Miami, Fla, and Orange County, California, most likely to provide a botulinum toxin appointment with a short wait time. Many dermatologists (241, 27%) employed physician extenders, and 39% of these extenders also offered appointments for botulinum toxin injections (median wait time 6 days). In comparison with a previous study showing median wait times of 26 days for evaluation of a changing mole in these communities, wait times for cosmetic injections were significantly shorter (P < .001).


The metropolitan areas surveyed contain no highly rural areas and do not represent a random sample of all US dermatology practice sites. The cosmetic and medical studies were not conducted concurrently, but were carried out in the same metropolitan areas.


Patients seeking a cosmetic botulinum toxin injection have more rapid access to dermatologists than has been previously reported for patients seeking urgent consultation for a changing mole. This study cannot differentiate between many possible explanations for the observed differences in wait times. Because physicians in many other specialties with physician shortages are also offering cosmetic services, further studies are needed to assess the broader policy implications of these findings.

[Indexed for MEDLINE]

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