Aesthetic Surgery Practice: Another Nigersaurus?

Abstract

The dinosaur Nigersaurus wandered the earth 110 million years ago. Its shovel-shaped mouth, which contained 50 rows of teeth, was uniquely adapted for the purpose of eating massive quantities of grass as it ambled along, head constantly to the ground, perhaps consuming as much as a football field worth of “munchies” in a day. Unfortunately, as the climate changed, the specific grasses to which it had become uniquely adapted were replaced by different vegetation. Nigersaurus did not adapt along with its environment and thereby became extinct. Although this story may not seem relevant at first, I propose that this is a situation—one of failure to adapt and subsequent extinction—in which the independent plastic surgeon (or independent groups of plastic surgeons) whose practice exclusively or primarily comprises aesthetic surgery may soon find himself or herself. The downturn in the economy, along with certain medical insurance issues, has accelerated a dynamic that has been evolving for several years in the medical community. “Strength in numbers” has become the byword. Multispecialty medical groups have rapidly expanded across the United States, in many cases forcing the independent practitioner to join them. For example, a urologist who has served a community well might be informed by a multispecialty group that unless he joins their practice, they will bring in their own urologist and his referral base will disappear. Although practitioners in this dilemma may initially resist, many eventually succumb to the pressure. In an editorial published in the Archives of Family Medicine (May 31, 2010), Kevin Grumbach, MD, called the small independent practice an “endangered species.”1 It is true that large medical groups offer certain economic advantages. For example, the larger groups can negotiate more favorable …