Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Mohs surgery is vilified, physicians again fail to respond effectively

Joyce Ho, MD
Conditions
January 29, 2014
257 Shares
Share
Tweet
Share

An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.

The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a $25,000 medical bill for Mohs surgery to demonstrate the prevalence of unnecessary and costly procedures.

It isn’t all bad — one big pro of this article written by internist Dr. Elisabeth Rosenthal is opening the line of communication between physician and patient regarding transparency of cost and necessity of certain procedures. That’s a great thing, and for doctors out there who are taking advantage of the system, perhaps this article can make them change their ways. That being said, I think the article was at times unfair and depicted a distorted view of dermatology and other subspecialty fields. There are a few important points to address here in response to the article, and a few things I would have liked to see as a response from the physician community.

First, the article simultaneously vilified and minimized the role of Mohs surgery in treating skin cancer. The Mohs technique, invented in 1938 by general surgeon Dr. Mohs while he was still a medical student at University of Wisconsin-Madison, is a process where thin layers of cancerous tissue are sliced off and immediately studied under the microscope. The surgery stops when the tissues are completely free of cancer at all borders. This process helps to ensure that the cancer is absolutely removed while taking the minimal amount of skin necessary to do so.

Mohs has been proven in certain cancers such as recurrent basal cell carcinoma to be  more effective than excision, and there is no doubt that it has saved countless lives while preserving tissue for reconstruction. The AAD put out guidelines in 2012 to classify which lesions require Mohs surgery to remove — certain types of tumors in certain types of patient populations, tumors that are very deep, in sensitive areas on the face or ear, or ones that are very large.

The article instead characterizes Mohs instead as a “go to procedure,” a sort of money making machine. It does not go into the details that many Mohs procedures take several hours to complete, as you go through and take stage after stage of tissue. It does not go into the fact that this procedure can be lifesaving. Most of all, this article implies that Mohs is unnecessary, which can have hugely dangerous implications for patients out there with early stage skin cancer.

Not all patients are like Ms. Little either. The patient in the article had a small basal cell carcinoma which was excised via Mohs surgery, and then she was sent to an oculoplastic surgeon for the repair. Her bill was over $25,000 because she was treated by a Mohs surgeon, an oculoplastic surgeon, and an anesthesiologist. She was billed $1,833 for the Mohs, $14,407 for the plastic surgeon, $1000 for the anesthesia, and $8774 in hospital costs. She later got the costs down to $1400 for the Mohs procedure, $1,375 for the plastic surgeon, $765 for the anesthesia, and $1050 in hospital costs.

Take a second and think about these numbers. The plastic surgeon cost was able to be reduced by 90% … ? Why exactly is this article targeting the Mohs surgeon again?  Aside from that fact, there are many patients who receive Mohs who do not have to get a repair from a plastic surgeon with an anesthesiologist. In fact, the norm is for Mohs surgeons to do the repair themselves. They are trained in it, and that is their job — they only refer out if they cannot handle the repair alone. I can’t speak for Ms. Little’s Mohs surgeon (and apparently, he can’t either, as he did not comment in the article), but most Mohs surgery clinics are a one-stop shop for excision and repair.

The article also lumps all payments together as if what you’re billed for is what the doctor pockets. That cannot be further from the truth. The article cites examples of a $915.46 bill for a mole removal in Oregon or a $500 wart freezing treatment at NYU Medical Center. I spoke to two dermatologists from Stanford who laughed and said they would never see payments like that in their practices at an academic center. That money goes into paying for nurses, hospital administrators, dermatologists, medical assistants, medical record handling, and much more.

What needs fixing in this system isn’t the physician salaries, but rather, more transparency of cost. If patients can get a more truthful breakdown of costs, they would realize that the physician is not the greedy money-hungry one in this scenario.  It takes a lot more to run a medical center than meets the eye.

To be honest, I have been disappointed in the response from the physician community thus far. Dr. Dirk Elston, president of the American Academy of Dermatology, wrote a letter to the editor that appeared in the Times.

Dr. Fosko of the American College of Mohs Surgery also wrote a letter to the editor on the same page.  The responses are well written and full of information, and are great for other physicians to read.

However, I don’t think it is the best way to reach the public. If I’ve learned anything at NBC, it is that you have to tell a patient story.

Find a patient, one who has had his life saved and his world changed by Mohs surgery. It can’t be hard to find one; there are stories like this around the country. Interview him. Interview his family and his physician. Interview many Mohs surgeons. Put statistics in the piece but they can’t be the focus; numbers are fleeting but a patient story makes an impression.  And really show the world how much good Mohs surgery can do. I know it, dermatologists and other physicians know it, but now it’s up to us to convince the rest of the world that it is a worthwhile and lifesaving procedure.

Joyce Ho is a medical student who blogs at Tea with MD.  She can be reached on Twitter @TeawithMD.

Prev

When patients are late: Should doctors charge extra?

January 29, 2014 Kevin 55
…
Next

Refusing the flu shot: Respecting the patient's right to choose

January 29, 2014 Kevin 15
…

Tagged as: Dermatology, Mainstream media

Post navigation

< Previous Post
When patients are late: Should doctors charge extra?
Next Post >
Refusing the flu shot: Respecting the patient's right to choose

More by Joyce Ho, MD

  • 5 tips to maintain work-life balance as a medical intern

    Joyce Ho, MD
  • a desk with keyboard and ipad with the kevinmd logo

    When patients attack: How safe are health care workers?

    Joyce Ho, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Is there a place for religion in the exam room?

    Joyce Ho, MD

More in Conditions

  • Epigenetics and our inheritance to future generations

    Vishruth Nagam
  • COVID-19 unleashed an ongoing crisis of delirium in hospitals

    Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD
  • Emergency care nightmare: the urgent need for experienced nurses

    Rachel Basham, RN, CCRN
  • Debating the role of psychiatric assessments in medical decisions

    Christian Youssef & Francisco M. Torres, MD
  • 5 things to know about weight from a bariatric surgeon

    Maria Iliakova, MD
  • Physician autonomy and patient interactions in corporate health care

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions
    • Practicing medicine with conviction

      Arthur Lazarus, MD, MBA | Physician
    • The power of memory in shaping human identity

      Emily F. Peters and Sandeep Jauhar, MD, PhD | Physician
    • How Tratak yoga reshaped my USMLE Step 2 prep

      Dr. Nikita Mehdiratta | Education
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 15 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • FDA Relents, Approves Novel Antidepressant After Many Rejections
  • OSHA Comes in for Both Praise and Harsh Criticism at House Hearing
  • New Insight Into Hyperglycemia Risk With PI3K Inhibitor for Breast Cancer
  • Oktoberfest Doctor: Not the Wurst Job You Could Have
  • Blue Shield of California Has Fix for MA Enrollees Worried About Co-Pays

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions
    • Practicing medicine with conviction

      Arthur Lazarus, MD, MBA | Physician
    • The power of memory in shaping human identity

      Emily F. Peters and Sandeep Jauhar, MD, PhD | Physician
    • How Tratak yoga reshaped my USMLE Step 2 prep

      Dr. Nikita Mehdiratta | Education
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Mohs surgery is vilified, physicians again fail to respond effectively
15 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...