Evaluating Industry Attractiveness of Cosmetic Dermatology: an India & Middle East perspective. (Part 1)

Porters five forces
Illustration of Porters 5 Forces. Illustrates article Porter 5 forces analysis (currently available in 11 languages). (Photo credit: Wikipedia)
Westlake Dermatology Prep Oval 003
Westlake Dermatology Prep Oval 003 (Photo credit: Associated Fabrication)

DICODerm is gathering steam. Thanks for all the contributions from +Apratim Goel, +Feroze Kaliyadan+Geraldine Jain and +Sunaina Hameed. Special thanks to +Feroze Kaliyadan for the contributions on positioning standards. Will work on it some more and get some technical expert to have a look. I was actually planning to write several posts on #DICODerm, but most of the issues I wanted to highlight have already been discussed. So I am starting yet another interesting (probably a little controversial) topic:

If you attend a dermatology conference in India or Middle East, there is a very high probability that you will be surrounded by dermatologist-CEOs (If you are not one yourself). I don’t think you will find that many CEOs in any other specialty. The dermatologist-CEOs have added a unique dimension to the cosmetic dermatology industry and have ended the era of brand monopoly. Can all these dermatologist-CEOs make it big? Unlikely, as in any other business. Can the corporate brands strike back? Depends, on their strategic capabilities.

I am not an MBA, but for the last few months I am surrounded by business minds and I am extending few lessons I have learnt from them to write this series.

My motive is rather selfish. I am just trying to learn how to apply business principles in real world situations in health care. But it may help budding dermatologist entrepreneurs to position their business better. This may also help consumers to make informed decisions too. For a start: Should you, as a consumer consider having your BOTOX® in a brand or an individual clinic? We shall try to answer questions like this in due course.

I shall use the popular Porter five forces analysis:

Illustration of Porters 5 Forces. Illustrates ...
Illustration of Porters 5 Forces. Illustrates article Porter 5 forces analysis (currently available in 11 languages). (Photo credit: Wikipedia)
  • Threat of new entrants
  • Threat of substitute products or services
  • Bargaining power of customers
  • Bargaining power of suppliers
  • Intensity of competitive rivalry

Here are my satirical views on the cosmetic dermatology industry and my white paper on research methodologies in cosmetic dermatology.

What are your views on the cosmetic dermatology market based on the above five forces?

Read the full series on Cosmetic Dermatology Industry here

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Bell Eapen

Techie Dermatologist, Information Systems Ph.D. candidate, Supporter of Open-Source Software, Machine Learning and AI geek,loves cricket, Canadian wine and beer, skeptical about the worth of Cosmetic Dermatology. [Resume]
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About Bell Eapen 244 Articles
Techie Dermatologist, Information Systems Ph.D. candidate, Supporter of Open-Source Software, Machine Learning and AI geek, loves cricket, Canadian wine and beer, skeptical about the worth of Cosmetic Dermatology. [Resume]

15 Comments

  1. Bell Firstly hats off to putting up all the unspoken truths about cosmetic dermatology into proper words.
    While I was quickly grazing through the list, I think one important point missing was “self grooming” of course the language aspect is mentioned but make up, dressing and creating a wow factor is very essential. In my experience clients are not looking to look like a name in Hollywood or bollywood these days. They want to be like you. Have a skin like yours. They actually are compelled to touch your hair and skin. So the most important thing according to me is ” start treating yourself like a celebrity and also start working towards that” no point you preach something that you don’t follow.

    Bell this is definitely the discussion closest to my heart and I can go on and on. .. However my question to everyone here is
    ” for all that we are discussing do we really have to be possessing a dermatologist degree. At least in India? ”

    Will soon post some other mind boggling points. Right now have to rush. …..

  2. Leukodermic view blog is personal and satirical, but skin deep (including the above post) is professional and pragmatic. Any resemblance is purely coincidental Interesting comment on the ethical dimension. Awaiting other’s views.

  3. Bell, a very good post & something that I can go on & on too.

    1) Anyone can set up a Cosmetology practice. However like Apratim says , is a Dermatologist degree required in India?
    I’ll stick to the questions that you have put up:-
    In my experience, the experienced ones can always profit from their loyal base of patients ( I still like to address my patients as patients & not clients) & have a significant advantage over the new entrants.One’s patients, staff & ideas will always be at risk from competitors. You never know, their tactics may be aggressive or unethical & can pull everything from under your feet. So one has to be vigilant & hone one’s skills all the time.

    2) One is either a brand by herself/ himself or is depending on brands as props. Do I need to say more? Like Shahrukh khan says”I am working for brand Shahrukh Khan”

    3)One has to be geared up for bargaining by customers.In India, where everything is 1+1, people expect the same from you too. I expect my staff to be firm but gentle.

    4) It is mainly the “Prestige” issue which is associated with branded supplies. If the results are the same, I wouldn’t think twice before switching over to something less expensive & pass on the benefit to the patient. If I have to compromise on quality, I’d rather shamelessly succumb to the bargaining (even more expensive) supplier & let him have an upper hand, at least for the moment!

    5) Embrace competition & let it feed your positive instincts related to growth,knowledge & sustainability.
    “The More The Merrier”

    THERE IS ENOUGH PLACE UNDER THE SUN FOR ALL OF US TO SHINE”.

  4. I don’t have my own practice (yet :-p) so I don’t understand a LOT about business and marketing but here are my two cents.. In medicine, success ultimately boils down to the one-on-one relation between doctor and patient. As Dr Apratim rightly pointed out, patients are enamoured by their doctors and will keep coming back to ‘the superstar docs’ even if their treatment is not working or only showing suboptimal results. Which is why, unlike other businesses, branding and franchises don’t really work in medicine. One doc can open 20 branches and hire doctors to work under him. He may even consult in each clinic for 1 hour every week to drive in business. But patients will always ask for that principle doctor, while shunning the hired assistants. As for new entrants, for anyone with the courage and the resources, if you want to be taken seriously, go independent. Like they say, “a sapling can never grow under a banyan tree”.

    Even with bargaining patients, I have come to realize that patients respect you more when you deny discounts and bargains. Its almost as if they feel that you MUST be worth every cent if you have the confidence to let a patient walk out rather than succumbing to bargaining tactics!

  5. Our discussions are becoming more and more engaging!! BTW Sunaina: I too don’t have a practice, and probably never will

    My plan is to challenge (in the upcoming posts) the notion of a holistic doctor-patient relationship in cosmetic dermatology. Since cosmetic dermatology is a business, the ‘clients’ may behave more like consumers (as Geraldine pointed out). Hence application of business principles and market forces may be vital here. Let me give you two examples (one in the past and other from the future!)

    1. In the last decade, a brand with more than 100 clinics, with a fleeting dermatologist workforce had a reasonable amount of success. How did this happen?

    2. Imagine a disruptive innovation inaccessible to you but available to your competitor. (For example: A new laser that actually achieves 100% permanent hair removal). Can you still retain your clients?

    Apratim’s question is actually an important regulatory issue in most parts of the world. I don’t even use the ‘Dr’ title here. India is the only place where you can be a consultant on day 1 of medical school. A dermatologist entrepreneur should be a dermatologist first!

  6. well , i agree with bell regarding the use of the word consultant in India , where as abroad , it is based on hierarchy (similar to Indian medical colleges) – starting from medical officer (specialist) in dermatology , to junior dermatologist , to being a senior specialist to being a junior consultant then to being a consultant , and then a senior consultant …all monitored by exams at each level and accredited by Ministry of Health.

    With due respect to Indian hard working dermatologists .,Money and Influence do count a lot in setting up a cosmetic private practice in India .One who got a better marketing skill, can still get a good business in cosmetology. i stress the word Marketing skill rather than Academic skill. You need good amount of money to invest in a cosmetology clinic , lasers ,support staff , advertisement. if you got the money, and if you have the passion , then success will follow.

    i am not biased . cosmetology may work even without marketing , but if you have good marketing tricks , success may reach you early.,

    I remember my early days , soon after passing my DNB exam , I tried to set up a simple clinic of dermatology in my hometown – Palakkad . I was really shocked to see that the very senior dermatologists in that area advised me to practice as general practitioner rather than a dermatologist , (they themselves were practicing as g.p.) . the reason being the rural population still do not need a dermatologist , they need a medical officer in a village setting rather than a dermatologist. But times have changed and good to know that now they have got 3 dermatologists practising dermatology.

  7. Thanks Vijay. It is normal for organizations getting into any business to compete, and then Political, Economic, Social and Technological forces (PEST) come into play. There’s nothing healthy about it Just as Pepsi said “There’s nothing official about it” (During the Wills World Cup)

  8. @Bell Eapen , hope the PEST will get rid of the weeds , for the medical standards to improve , there should be strict enforcement of laws and implementation of laws …………….. how easy is it to get Betnovate ointment from a local drug store in India (even without a prescription leave alone dermatologist prescription) , where as here it is only allowed with dermatologist prescription………………….sorry im going a bit off topic

    @Sunaina Hameed , i do agree we should not entertain bargaining in our profession , of course helping poor patients with sample medicines is a different matter altogether.

  9. @Vijay: Totally agree with you on regulations. In the place where I am now, it is not even allowed to use your own patient data for research, unless you have explicit consent from all your patients.

  10. Bell there is no doubt that cosmetic dermatology is a professional business and I think sooner we realise this and accept it to our advantage better it is for all of us. Else we will keep banging the empty drums. When the whole world is growing and people from all medical specialties are getting into business mode, why should derms be left out. The only problem is that till a decade ago, dermatology was not a very respected and sought after branch of medicine. But now with the advent of lasers and injectables, the face of cosmetic dermatology is changing. And this is getting an envy for some others fields. But the bad news is that since anyone in India can use the word cosmetic dermatologist, it is using its authenticity. But I have little hope that our discussions will do any help. Just a feel good thing. I have always felt myself to be someone who can really say all this with command. I hold an MD and DNB degree in dermat. Still I choose not to practice the conventional dermatology in a traditional style. Well this was not accepted well by many of my colleagues. But aesthetics was my passion and still is.

  11. Cosmetology has advanced the scope of dermatology . & i do agree with Apratim Goel , Cosmetology is indeed a professional service , and has caught up in a big way , especially in metros .
    My Previous statements were in a rural setting with people of minimum spending capacity. of course it is a contrasting experience to work in a village & in a city .

    Regarding the usage of word “Cosmetic Dermatologist”, there are no laws to govern , and if there is a law , Many will bypass the law.

    There is no doubt the most exciting advances in dermatological treatments will come from research into stem cell therapies & i am looking forward to it.

  12. Apratim: I totally agree that it is a professional business. The blog post is an attempt to actually see it as a professional business from a business perspective (rarely done) rather than a professional perspective to reconcile both and get some insights. The PEST in my previous post is actually an analytic framework! Vijay/Apratim: In my opinion any term with dermatology/dermatologist in it, has to be regulated (as in most countries) and we should all try to defend it. But we have no control/claim over ‘cosmetology’. We cannot claim that only a dermatologist can give a facial. ‘Medicated Facial’ was our attempt at poaching on a different territory.

  13. @All: Have spent a few days mulling over the question on qualification. I did my MD (3 yrs with dissertation) at KMC Manipal, but under Kathmandu University. I call myself ‘MD (Nepal)’ and I have done modestly well so far. I have a few questions. (1) Botox and Fillers: Dermatologists claim only we can do it. But botox and fillers (say, in the mid-face or temporal region) have nothing to do with skin. It is all about anatomy, anatomical landmarks, SMAS, facial planes etc and are often about nerve blocks. Our education in these matters is at MBBS level. So are’nt dentists and plastic surgeons justified in claiming that only they can perform these procedures and dermatologists have no business meddling with these? (2) Lasers: How does an MD in dermatology automatically qualify us in the safe and effective use of lasers (which are powerful and destructive devices). Even the best have very limited knowledge on laser physics and biophysics. We undergo device specific training from the manufacturer. Legally and ethically, is that enough? (3) Dermatosurgery: At the ASCICON 2013 conference, I learnt that as per the MCI regulations, one must perform 50 (for MD) or 100 (for MBBS) hair transplantations under the supervision of an expert before we can do it independently. And that goes for all procedures and surgeries, though numbers may vary. How many of us have really acquired such intensive training? Is it even feasible? Apologies in advance if lines have been crossed but I have a feeling, in 10 years time, with litigation at peak, we will all have to eventually face these questions anyway..

  14. @Sunaina: I agree with you completely and what you mentioned here are looming threats for dermatology entrepreneurs. But in my opinion, the real threat will come not from the tip of the pyramid (plastic surgeons) but from the bottom (non-dermatologist CEOs). Similarly the de-regulation will hurt more than tighter regulations (may be more in Middle East context).

    The brands created a business without knowing what dermatology is/means! Dermatologist entrepreneurs jumped into the bandwagon spotting the opportunity. Both makes good business sense, but will be affected by rules of business (The topic of this blog post).

    But “defending dermatology” is a non-business theme that will neither be safe with the brands nor with the dermatologist CEOs!

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