When Your Dermatologist Becomes a Salesperson

Posted: February 11, 2026

(February 10, 2026) By: Rebecca Gao, The Local

Getting a mole checked can takes months, but Botox appointments are readily available. Why dermatologists say their practice is the canary in the coal mine for privatized care.

Agnes Ryoo had been trying to get her moles checked out for months. The 32-year-old Toronto resident is Korean-Canadian, fair-skinned, and has a smattering of moles all over her body and face. “That combination, plus me being anxious, [means] I’m always afraid of what my moles could become,” Ryoo says. When her family doctor referred her to a dermatologist, she spent a lot of time online looking for clinics that would see her quickly. Just four weeks later in August 2025, Ryoo saw a dermatologist.

She’d hoped the doctor would measure her moles and log them for future monitoring.  “That’s all I wanted. And I think that’s the bare minimum of what a derm should be doing—log the symptoms and make note of it for the patient’s future care,” she says. But the dermatologist didn’t seem concerned, Ryoo says, and didn’t investigate the moles that were worrying her, including one particular mole that Ryoo was concerned about. “The doctor was so dismissive,” she recalls.

And then came the sell: the dermatologist told Ryoo that while her mole wasn’t medically concerning, she’d be happy to perform a cosmetic procedure to remove it—and any other moles she wanted—that day for $300 each. Ryoo was shocked. “It was just so obvious she was trying to make a sale,” Ryoo says. “It just felt really disappointing and annoying that a medical conversation was being turned into a sales talk.”

Ryoo is far from the only one who has gone to the dermatologist and experienced the blurring of lines between for-profit cosmetic treatments and medically necessary care.  In Canada, the average wait time to see a dermatologist is five months. Ontarians that do go see a dermatologist for a medical issue are sometimes sold a procedure that isn’t covered by OHIP. At the same time, dermatologists are filling their schedules with cosmetic treatments—Botox, lasers, dermaplaning, removal of non-cancerous moles—making it even harder for people to get an appointment for life-saving dermatological care. It’s a trend that critics warn is creating a two-tier system for dermatological care, and may foreshadow what’s to come in Ontario’s health care system more broadly.

When it comes to health care privatization, dermatologists are “the canary in the coal mine because we have such an easy route to privatization,” says Dr. Mark Kirchhof, the president of the Canadian Dermatology Association. “I don’t know many dermatology practices now that don’t have a storefront in the office that’s trying to sell you products or don’t offer some sort of cosmetic procedures that are private pay.”

Kirchhof, who is also the head of dermatology at the University of Ottawa and at the Ottawa Hospital, says that one of the major reasons that dermatologists are doing more private pay treatments is the dismal pay that the public system offers them. In 2016, dermatologists were paid $72.15 for a consultation and $21.90 for partial assessments and follow-up e-assessments. Today, a decade later, those rates have not budged.

While OHIP compensation has stagnated, costs for running clinics have skyrocketed.

“Doctors are not immune to inflationary pressures. We still have to pay for offices, we have to pay our staff, we have to pay for materials to run practices,” Kirchhof says. “This has created an economic disconnect and because of that, dermatology—much like other practices in medicine—have increasingly sought out alternative areas to fund their practice.”

Natalie Mehra, the executive director of public health care advocacy group Ontario Health Coalition, says that the situation with dermatologists is an example of creeping privatization in our health care system. Today, physicians in Ontario routinely charge for services that aren’t explicitly covered under OHIP like doctor’s notes, ear washes, and driver’s medical forms.

“In recent years, this has run away,” Mehra says, adding that doctors now charge for something as routine as a skin tag removal. But, back in the day, in many specialties “doctors made enough money and they just covered [these services].”

But if the pressure to find alternative funding paths is felt across all of health care, few areas have more opportunity than dermatologists. “For dermatologists, it’s easy because we are trained and have experience in cosmetic treatments,” says Kirchhof.

With our culture’s obsession with skin care and looking youthful, as well as the popularity of aesthetic treatments like filler, Botox, and lasers, there’s endless demand for their services. While OHIP pays doctors $53.20 to $143.55 for the excision of pre-malignant lesions and $124.10 for removing malignant melanomas, if you want to remove a mole you simply don’t like the look of, dermatologists can charge whatever they want. There’s a wide range of prices out there—and price varies depending on size and removal process—with some clinics in Toronto charging about $300 per mole on the lowest end and others starting at $600 a mole. Cosmetic mole removal can get up into the thousands.

According to data from The Aesthetic Society, a California-based group of medical professionals who perform cosmetic procedures in Canada and the U.S., more than 5.4 million injectable procedures were performed in these two countries in 2021.

What complicates matters is that in dermatology, Kirchhof says, the line between cosmetic and medically necessary procedures is blurry. Kirchhof points to rosacea, an inflammatory condition that impacts the face and chest and results in redness, flushing, and visible blood vessels. While treatment for inflammatory symptoms—things like bumpiness, pimples, and pustules—is covered by OHIP, the redness that characterizes rosacea is best treated with lasers, which is not covered. “This might be perceived as an upsell, but really it is what’s medically necessary,” Kirchhof says.

For patients looking for medically necessary care, the wait to see a dermatologist and get treated can be months long—even as lucrative cosmetic procedures like Botox, lasers, and fillers are readily available from a practicing dermatologist. In 2016, researchers from the University of Toronto conducted one of the first population-wide studies of wait times for dermatologists in Ontario. They discovered that while cosmetic appointments had an average wait time of about three weeks, urgent medical appointments had a nine week wait and non-urgent medical appointments saw a 12.7 week wait (that average is higher in rural areas).

Those long wait times can lead to patient dissatisfaction, a reluctance to go to the doctor, and worse outcomes. Andrew Turner says that after waiting months to see a doctor about a mark on his arm in 2009, and then being dismissed immediately, he didn’t want to go back to the dermatologist, even as the mark grew and changed. “I just was not willing to go back and be ignored,” he says.

It wasn’t until over a decade later, in 2021, that Turner saw a dermatologist in Halifax for an unrelated neck mole. The doctor decided to biopsy his arm and diagnosed Turner with stage two amelanotic melanoma, a rare and aggressive skin cancer. According to Turner’s doctor, if they’d waited another year, the melanoma would’ve reached stage four and been fatal. Six months and four surgeries later, Turner was cancer-free.

Things have gotten even worse in the decade since the 2016 study. In March 2025, a new study looked at whether Ontario’s dermatologists accepted referrals for alopecia, or hair loss, consultations, which are covered by OHIP. The study found that nearly half of the dermatologists surveyed did not accept these referrals. The authors of the study hypothesized that the complex nature of an alopecia assessment and the long care path meant that dermatologists are disincentivized to take on these cases.

“Given the wait lists and given how much selling of medically unnecessary stuff there is to patients, there needs to be more accountability around public wait lists,” Mehra says. “Why are patients who are in medical need waiting a long time while somebody whose education is highly subsidized by the public is selling medical junk to people who just don’t want to look older?”

So what needs to be done to make dermatological care more accessible for those who need it, without upselling them?

Creating public medical dermatology clinics may be a start, Mehra explains. Since practices are privately-owned, having the government run clinics that mandate a majority of their patients be medical could create more availability for patients who need medical treatment and ensure they won’t have to wait in a queue with those seeking cosmetic treatments.

Advocating for team-based care can also help increase capacity for dermatologists—and it’s already being done in cosmetic settings. Kirchhof explains that in cosmetic clinics, dermatologists have nurses and nurse practitioners who provide treatment alongside them and do the work of following-up after appointments. If that same model of care could be extended to medical practice, “one dermatologist is not just limited by what they can see but they can extend their knowledge and abilities to a larger group of patients,” he says.

And of course, addressing Canada’s doctor shortage will also help lower wait times and increase the number of hands working on medical cases. Right now, there are about two dermatologists for every 100,000 Canadians, lagging behind other countries like the U.S. where there are 3.4 dermatologists for every 100,000 people. Kirchhof says that the Canadian Dermatology Association is lobbying for more dermatologist residency spots to open up—the number of training spots available has been stable for years, despite Canada’s population growth. Incentivizing trained dermatologists to practice and stay in rural areas is also a big concern for his association, since wait times in these parts of the country tend to be exponentially longer than in urban centers. Another solution is to allow more foreign-trained dermatologists into the country, which Kirchhof says the regulatory boards have been pushing for as of late.

Making it easier and cheaper to own a practice is another step forward. Kirchhof says government-backed rent control for medical offices, or a government-owned facility where doctors can buy equipment like sutures at a fixed price, would be able to lower the financial strain on dermatology practices. Increasing OHIP pay and expanding what OHIP covers is also part of incentivizing dermatologists to do more medical procedures. In fact, Kirchhof says more dermatologists performed more medical procedures after Ontario recently introduced a new OHIP billing code that increases the pay to doctors for more complicated procedures or diagnoses.

But in our current health care system, where someone with skin health concerns enters a clinic as both a patient and a customer, the financial incentives for doctors are just not aligned with what’s best for the public. “At the end of the day, these individuals are running a business and they’re trying to increase cash flow,” Kirchhof says. “Patients obviously have the right to say no, but it’s absolutely a business and people are trying to make money.”

For patients like Agnes Ryoo, trying to get care within that system means either trudging along until the issue is impossible to ignore—like Turner—or finding some alternative way to be treated. Ryoo says she’s now considering medical tourism to address her moles and other dermatological concerns. She’s planning her next trip to South Korea in about a year, where she’ll try to fit in an appointment with a dermatologist. While she acknowledges the drawbacks, like the fact that she won’t be able to transfer patient files to Canada or that dermatologists abroad may still try to sell her unnecessary products and procedures, there’s little to no wait. “You can just walk into any clinic and you can be seen,” she says. Ryoo will have to pay out of pocket, of course. But for patients in today’s health system—where being a customer may mean quicker and better care than being a patient—that’s no longer a surprise.

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