Jump to content
Acne.org
Search In
Find results that contain...
Find results in...
Andi

What to do? Change derms? *UPDATE*

Recommended Posts

Alrighty, I've talked about this before on the board, I have Kaiser insurance which is an HMO. So my primary dermatologist is through them, and she agreed to accutane. The thing is that I guess since they are an HMO they have some sort of waiting list for accutane. My approximate timing of starting my course would probably be around January of Feb.

In the last few weeks I had some cysts that I wanted to get cortisone shots for, the dermatology dept. at Kaiser is so busy that they don't even do same day appointments and so I found another derm here in my town that would do the shots for me, only.

Well I've gone to them a few times, and everytime I dealt with the physician's assistant, which is fine..she was good and I had confidence in her for the cort. shots.

Last night I went in and the actual dermatologist whose practice it is came in and met me and wanted to take a look at my skin I guess. She asked what I was doing, I told her all about the Kaiser thing and how they're my primary and I'm starting accutane with them in a couple of months, obviously because it's my insurance and they will cover it.

She said that I shouldn't have to wait that long, and that she thinks I can still be covered for accutane through my insurance, but go through her. She was going to check on it and get back to me, so I can start accutane as soon as possible. She seems like a very nice woman, and I'm sure that she's a great dermatogist.

I'm just thinking of a bunch of different "what ifs" now. What if she just wants to do this because they get some sort of a commission off of prescribing accutane? Also, my derm at Kaiser seemed like a no-nonsense, get you in/get you out kind of derm. But I do think that she's a good derm and when I expressed to her that I wanted to do a low dosage to help prevent a bad IB, she said that's bull and she was going to start me on a higher dosage, the highest she could with me to wipe it out strong, and so that I wouldn't be on the drug for a long time. She also thinks that derms only do the low dose thing so that you have to go to them longer and they get paid more. (I dunno what to think about that)

This other dermatologist who's not through my insurance said that I was pretty tiny (I'm 5'1 and weigh about 97 lbs.) says that she'll have to start me on whatever dosage is good for my weight.

I'm just annoyed now that I might have to make this decision as to who to go with, and which one's the better derm who knows what they're talking about :wall:

Please help... :(

Share this post


Link to post
Share on other sites

the IB thing isn't 'bull' but you do not have to do a lower dose to start if you don't want to.

they should do your dose based on your weight and severity.

I'd say go with whichever derm can get you on accutane faster! and no, they don't get 'commission' per say, but they get the fees for your visits, etc.

Share this post


Link to post
Share on other sites

Jessy! You always reply! :cool:

Yeah I think I would want to start it as soon as possible, especially since it's close to winter and I think that's better as far as me staying out of the sun.

the IB thing isn't 'bull' but you do not have to do a lower dose to start if you don't want to.

Share this post


Link to post
Share on other sites

If your insurance will cover it, go with the one who you feel comfortable with and trust. If you trust both, go with the one who can get you started first.

As for commissions: as finallymejess said, there's no commissions involved, just the business. All doctors want to attract more patients to keep busier and make a better living. That's not unusual for any professional. That's the only motivation involved. The private practice doc. has more of this motivatio than the Kaiser (or any HMO) doc. probably. This has nothing to do with their skill and expertise, just the type of business model they're working in.

IB: I think the statistics say it can go either way regardless of the dose you're on. I've started on the 0.5 mg/kg dosage all three of my courses. This is a "low normal" dosage and I still had a significant IB, not horrible and life shattering, but a drag for a week or two. Then it was gone and I moved on and had good success with the treatment For you, a similar dosage would be 20 mg/day. I wouldn't get too hung up on this factor. I would discuss the concerns and options for starting dosage with the doctor - absolutely. But if the doctor seems experienced and trustworthy, I'd go with his/her advice. They almost always have more experience in this regard than those of us posting on this board.

That said, I can't see any possible harm in starting at 10 mg/day and progressing upwards to whatever daily dosage your doc. thinks you should be on. Assuming you're shooting for the cumulative dosage goal of 120-150 mg/kg, this ramped-up strategy would only delay your course a few weeks. It might make the difference of one additional office visit and maybe another set of labs.

Share this post


Link to post
Share on other sites

Thank you for the advice everyone. GUESS what I just found out? I was trying to do some research on both derms online, and I couldn't find my dermatologist's name on the Kaiser website. I called the derm dept. and asked the woman why she wasn't listed on the site as a dermatologist, and she told me that she's a nurse practitioner :| I'm thinking this whole time that she was an actual dermatologist. This worries me. I'm not saying that she doesn't know what she's doing, but why was I never seen by an actual DERMATOLOGIST and is a nurse practitioner able to even prescribe accutane? Maybe she just saw me for the initial appointment and when it came closer to starting my course I would be seen and monitored by an actual derm, but she didn't even say anything about this at my appointment. And not to mention that this was my FIRST appointment with them and it took all of about maybe 4 minutes.

Now I did research on the other independent derm that wants to take me on as a patient and she went to Columbia University and Harvard Medical School. She's really starting to outweigh this nurse practitioner. :|

Share this post


Link to post
Share on other sites
Now I did research on the other independent derm that wants to take me on as a patient and she went to Columbia University and Harvard Medical School. She's really starting to outweigh this nurse practitioner.

Yeh, i'd go with the qualified derm. I think your instincts are good.

Share this post


Link to post
Share on other sites

Thank you for the advice everyone. GUESS what I just found out? I was trying to do some research on both derms online, and I couldn't find my dermatologist's name on the Kaiser website. I called the derm dept. and asked the woman why she wasn't listed on the site as a dermatologist, and she told me that she's a nurse practitioner :| I'm thinking this whole time that she was an actual dermatologist. This worries me. I'm not saying that she doesn't know what she's doing, but why was I never seen by an actual DERMATOLOGIST and is a nurse practitioner able to even prescribe accutane? Maybe she just saw me for the initial appointment and when it came closer to starting my course I would be seen and monitored by an actual derm, but she didn't even say anything about this at my appointment. And not to mention that this was my FIRST appointment with them and it took all of about maybe 4 minutes.

Now I did research on the other independent derm that wants to take me on as a patient and she went to Columbia University and Harvard Medical School. She's really starting to outweigh this nurse practitioner. :|

Columbia and Harvard are excellent schools. However, you can get excellent care for acne from any qualified and sensitive physician or qualified midlevel provider (nurse practitioner or physician assistant). I see a physician assistant for all of my primary care and he follows me for stuff that is much more difficult to treat than acne. I would not hesitate to see a midlevel provider for any simple heatlh matter. And frankly, acne - even treated by accutane and cortisone injections - is not a complicated affair. The treatment options are straight forward. There are very simple parameters for treatment and very simple follow up required (e.g. blood work and visual progress of the skin). A dermatologist I saw many years ago took on a good PA and many of my appointments were with the PA. I felt very comfortable with this and was confident that the things he was doing were exactly as would have been done by the MD.

That said, it should have been clear that the person who you saw was an NP, not an MD.

I'd bet that most highly qualified dermatologists would agree with me that although acne is one of their most common conditions that they see, the depth and breadth of knowledge required to treat it is not huge and most, if not all, would feel comfortable delegating this treatment to a good NP or PA.

Regardless, my original advice stands: if your insurance covers both, go with the one you trust. If you trust both, go with the one that can see you first. If you honestly feel more comfortable with a physician, there is absolutely nothing wrong with that - and you should choose the physician instead of the NP.

Share this post


Link to post
Share on other sites

Yeah, I think you are right Zoilo. I guess I really shouldn't doubt that the NP is any less able to help and do the job than the physician. I guess I was just irked that no one told me that she was a nurse and I wasn't completely satisfied with my first visit with her. If I could explain it you- well, you already know of my panic and paranoia (lol), I have a lot of questions. When she met me I think she knew right away that I might be a "pain in the ass" female that's paranoid about everything and she wanted to stop me before I got started.

Like when I said I wanted to do a low dosage because I didn't want an inital breakout she kind of just stopped me in the middle of me talking and practically told me to shut it, lol...then said that she didn't want to do a low dosage at all. She wasn't being mean, even though it sounds like it, but I guess just kind of acting like she's dealt with a person like me many many times and by now she's just over and done with and knows what she's talking about, so just stop kind of thing, you know?

And like I said it was real in and out and I just felt like I didn't have a chance to really sit with her and express my concerns or fears, and have them answered.

Well I guess I'll just have to wait to hear from the other derm to see if she's able to treat me and have it covered by my insurance. She said somethng about still being able to get my lab work done at Kaiser, and that Pfizer has some kind of program or something that would allow me to still be covered, I dunno I'll have to ask her again in detail. Is Pfizer the maker of the brand name Accutane?

Share this post


Link to post
Share on other sites

No, it's Roche, unless Pfizer makes one of the generics. But Roche stopped their patient assist program for Accutane awhile back.

And i wouldn't feel comfortably with a N.P. for Accutane. I wouldn't even want a basic M.D. I want a dermatologist with lots of experience with Accutane.

Share this post


Link to post
Share on other sites

Yeah, I think you are right Zoilo. I guess I really shouldn't doubt that the NP is any less able to help and do the job than the physician. I guess I was just irked that no one told me that she was a nurse and I wasn't completely satisfied with my first visit with her. If I could explain it you- well, you already know of my panic and paranoia (lol), I have a lot of questions. When she met me I think she knew right away that I might be a "pain in the ass" female that's paranoid about everything and she wanted to stop me before I got started.

Like when I said I wanted to do a low dosage because I didn't want an inital breakout she kind of just stopped me in the middle of me talking and practically told me to shut it, lol...then said that she didn't want to do a low dosage at all. She wasn't being mean, even though it sounds like it, but I guess just kind of acting like she's dealt with a person like me many many times and by now she's just over and done with and knows what she's talking about, so just stop kind of thing, you know?

And like I said it was real in and out and I just felt like I didn't have a chance to really sit with her and express my concerns or fears, and have them answered.

Well I guess I'll just have to wait to hear from the other derm to see if she's able to treat me and have it covered by my insurance. She said somethng about still being able to get my lab work done at Kaiser, and that Pfizer has some kind of program or something that would allow me to still be covered, I dunno I'll have to ask her again in detail. Is Pfizer the maker of the brand name Accutane?

hope i don't step on any toes with this but....there is a world of difference between a MD physician and a PA. Go to a dermatologist.

Share this post


Link to post
Share on other sites
No, it's Roche, unless Pfizer makes one of the generics. But Roche stopped their patient assist program for Accutane awhile back.

Oh okay...Well then there's ANOTHER one, would it be best to go with brand name or generic? :lol: It just never ends. I know what will be said too, because some people will say that it's the same, and some will swear that the brand name accutane works better.

Well I don't even know if this other derm will be able to help me yet...I'm going to call her today and see if she found anything out.

Thanks everyone for your input! :angel:

Share this post


Link to post
Share on other sites

Go with whichever is cheaper.

Would that really matter though if it was being covered by insurance? What if Roche Accutane is like Coca Cola and has the secret ingredient that nobody knows about!?!?!?!! :lol:

Share this post


Link to post
Share on other sites

Yeah, I think you are right Zoilo. I guess I really shouldn't doubt that the NP is any less able to help and do the job than the physician. I guess I was just irked that no one told me that she was a nurse and I wasn't completely satisfied with my first visit with her. If I could explain it you- well, you already know of my panic and paranoia (lol), I have a lot of questions. When she met me I think she knew right away that I might be a "pain in the ass" female that's paranoid about everything and she wanted to stop me before I got started.

Like when I said I wanted to do a low dosage because I didn't want an inital breakout she kind of just stopped me in the middle of me talking and practically told me to shut it, lol...then said that she didn't want to do a low dosage at all. She wasn't being mean, even though it sounds like it, but I guess just kind of acting like she's dealt with a person like me many many times and by now she's just over and done with and knows what she's talking about, so just stop kind of thing, you know?

And like I said it was real in and out and I just felt like I didn't have a chance to really sit with her and express my concerns or fears, and have them answered.

Well I guess I'll just have to wait to hear from the other derm to see if she's able to treat me and have it covered by my insurance. She said somethng about still being able to get my lab work done at Kaiser, and that Pfizer has some kind of program or something that would allow me to still be covered, I dunno I'll have to ask her again in detail. Is Pfizer the maker of the brand name Accutane?

The way you were handled by the NP - that you weren't aware she wasn't an MD and also the way she was so dismissive about your concerns would be good enough reason for me to try to see the other provider. Again, I personally feeel that a good NP is fine for accutane treatment, but you just weren't treated well. This is ironic because studies have been done on patient satisfaction, and NPs and PAs often score higher on average. Patients are often more satisfied with the care they get from them, largely because they spend more time and appear to be better communicators and listeners.

I strongly believe that a well-informed patient should be a full partner in treatment decisions, and she wasn't letting you do that. However, if she is the only option for you and your insurance, don't let this stop you. Get treated by her. At that point you could either just follow her prescription (which as I said earlier, frankly it probably doesn't matter all that much). OR, you could be a little sneaky and start at a lower dosage on your own. Just adjust your dosage. Hey, good luck to you.

Share this post


Link to post
Share on other sites

Thanks Zoilo...yeah I'm just going to have to wait and see who I have to go with I guess. Either way I'm not THAT worried about it because I'm going to get accutane no matter what and that's all that really matters.

Share this post


Link to post
Share on other sites

Oh, please let me know how it goes with the blood tests at Kaiser, if you go with the independent doctor. I'm a Kaiser patient seeing an independent doctor myself. I guess I could just call Kaiser and find out what the cost would be. I also wonder about filling my prescription at Kaiser pharmacies...

Share this post


Link to post
Share on other sites
Would that really matter though if it was being covered by insurance?

You usually have to pay a higher copay for the brand name which may or may not matter to you. Some insurance is the reimbursal type where they reimburse you for 80% or something like that - you'd want to go with the least out of pocket cost while you wait for the reimbursal check. Some insurance requires you to take the generic if it's available unless your doctor writes a letter saying it's medically necessary.

What if Roche Accutane is like Coca Cola and has the secret ingredient that nobody knows about!?!?!?!!

Oh, they'd like you to think that, but it isn't true of course.

Share this post


Link to post
Share on other sites

hope i don't step on any toes with this but....there is a world of difference between a MD physician and a PA. Go to a dermatologist.

I disagree. There is no question that a physician (MD or DO) is much, much more educated than a physician assistant (PA) or Nurse Practitioner (NP). However, it is very common for physicians to work with NPs and PAs in their practice and delegate routine care to them. It is common for NPs and PAs to specialize in certain areas and become fully qualified to treat specific conditions - as qualified as the physicians they work with.

Acne, regardless of what any of us think, is a very easy condition to treat, even in its worst case. An experienced NP or PA who works in practice supervised by a dermatologist can be perfectly qualified to treat it. You would in fact, not get better care from the physician. The options and follow up just aren't that complicated.

Contrasted to this are other skin conditions that are much harder to diagnose and treat, as well as skin cancers.

Share this post


Link to post
Share on other sites

You would in fact, not get better care from the physician.

That is NOT a fact, it is your opinion.

You're right of course. Sorry.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Personalized Advice Quiz - All of Acne.org in just a few minutes


×