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    Contrary to public belief

    We all have secretly held opinions which run counter to what has been labeled “conventional wisdom.” For a variety of reasons, we are reluctant to act on those beliefs.  That is usually a wise decision. However, as one gets older and it matters less if others think of him as eccentric, ill-informed, out of touch or just plain weird, expressing unpopular views or putting these notions into action becomes much easier.

    I am now in the later stages of my professional career and have had years to solidify my biases about much having to do with dermatology. Having absolutely nothing to lose, I am now ready to share a partial list of my most unpopular views publicly with other dermatologists.

    Dermatologists are overpaid for the services that they render

    It is not as if we are doing something illegal, but it so happens that the current system rewards us too generously for performing often unnecessary exams and procedures. An example would be a patient with a history of actinic keratosis who returns every three months for an exam. We are paid each time we perform a complete skin evaluation in this person, even if it is probably overkill to repeat this type of evaluation that frequently. If we happen to see a solitary seborrheic keratosis and one actinic keratosis, we can bill for the visit as well as the treatment of the AK. The whole process takes under 10 minutes and the fee is at least $120. Sorry, but I do not feel like I have provided $120 worth of service. A much better system would be to be paid for the time spent with a given patient rather than for the individual procedures performed. That system might end what most of us do on occasion, searching for a billable procedure during the examination.

    I freely admit that I enjoy a comfortable income level which allows me to take my extended family on nice vacations and to buy useless electronic gadgets. Somehow, it does not seem completely right to me. Soon, others with authority to make public policy will agree and our incomes will fall. I am trying to prepare psychologically and financially before the inevitable takes place. Perhaps you should make similar plans.

    NEXT: Sometimes it's better not to treat

    Levine_Norman-2.jpg
    Norman Levine, M.D.
    Norman Levine, M.D., is a private practitioner in Tucson, Ariz. He also is a member of the Dermatology Times Editorial Advisory board ...

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