“Best in Show”

The bio on any aesthetic physician’s (or now extender’s) social media page or website is likely to include words like “best,” “award winning,” “world famous,” and “internationally renowned.” I often read these and think, “I’ve never heard of them.” Although I’m not the definitive arbiter of aesthetic talent, after almost 3 decades practicing, lecturing, and consulting in this industry around the globe, I am aware of the stars—established and emerging. So, I ask, are there really that many stars I don’t know, has the definition of stardom changed, and have the awards become meaningless?

The number of graduates of core aesthetic specialty training programs is small. According to the 2019-2020 Accreditation Council for Graduate Medical Education (ACMGE) statistics, feeder specialty residency program graduates included: Dermatology, 514; Plastic Surgery, 213; Ophthalmology, 501; Otolaryngology, 331. Only a small percentage of each focus their practice on aesthetics, let alone follow residency with sub-specialized aesthetic fellowships. Even adding non-core physicians and extenders practicing aesthetics, the number is small. Can everyone be the best?

When I started practice as an Ivy League-trained, board certified, surgical fellowship-trained, published dermatologist in 1995, I was loath to call myself the best. Call it respect for my elders or imposter syndrome, but it took a decade of clinical practice, podium lectures, symposium directorships, trainer experience, publications, advisory boards, academy committee memberships, and becoming a media resource to start calling myself well-known and respected. I didn’t add the words “global,” “world,” and “international” until I’d lectured and consulted outside the USA.

There are still thought leaders and key opinion leaders who follow that slow traditional route to leadership. However, an increasing number ascend from social media. Social media savvy medical students, trainees, or new graduates can quickly gain hundreds of thousands of followers. That grabs the attention of industry and even academic meetings. Being well known on the world wide web is a form of global fame. But does being the best virtually translate into clinical excellence? I’ve heard of young physicians earning more annually from social media sponsorships than the average physician does seeing patients. Those dollars are helpful to pay medical school debt, buy a house, and invest in your practice without the stress of bank loans. But does all that personal effort or money spent on production leave time to see patients and become a true expert?

As physicians, we know not all awards represent achievement. Within our specialty academies and congresses, there are distinctions of merit based on innovating and elevating the field. For me, one of my proudest career achievements was my nomination and election to the American Dermatological Association (My father’s response: “Heidi, that’s a big f’ing deal”). For others, it is election to high office, a certificate of merit, or an award by a department or academy are special. Being named a top doctor by your peers on lists by Castle Connolly (although votes may be kindly requested by colleagues or firmly pressured by department chairs) or magazines like the new annual Newsweek lists are also meaningful. However, unbeknownst to the public, the numerous paid labels are not. They aren’t bad, but they are marketing, not a sign of greatness in our field.

I admit I am a dinosaur—I spent 2 decades splitting my time between a university and private practice and on work travel. I’ve since left the university, stopped taking new patients, and limited my meetings. I look at that as my reward for my achievements: clinical skill, patients who trust me ,and respect from my global peers. I share my heideas™️ on social media for fun. At times, I wonder if I am stubborn and stupid to ignore the potential revenue from social media but it isn’t my passion. What concerns me more is what will happen to our fields as our youngest colleagues embrace the virtual over reality.