Future of dermatology will bring greater demand, more physician extenders
EDITOR'S NOTE: What's the outlook for the specialty of dermatology over the coming years? In this issue, we look at physicians' concerns about the major trends that will impact the field, including healthcare reform. We also examine changes in credentialing for Mohs surgeons (see "Mohs surgeons wrestle with increasing skin cancer rates, scrutiny by insurers").
National report — The key concerns that dog dermatology today — healthcare reform, workforce woes and the impact of cosmetic dermatology — aren't going to disappear soon, sources say. Nevertheless, they say, the specialty will survive, although probably with more nonphysician clinicians delivering dermatologic care.
Healthcare reform ranks high among many dermatologists' worries for the immediate future.
Dr. James says the American Academy of Dermatology Association (AADA) will continue to work in collaboration with others in the medical community to influence the scope and speed of planned reforms.
Another major and related concern is the need for a long-term fix for Medicare's sustainable growth rate (SGR) formula, Dr. James says. At press time, the AADA expressed hope for legislators to find a long-term solution before the current Band-Aid expires Nov. 30, opening the door to a 23 percent cut in reimbursements.
Influx of patients
Healthcare reform will add an estimated 30 million patients to an already strained system, Dr. Pariser says. That will exacerbate what is already a shortage of dermatologic care, he says.
"Not only will it be harder to get appointments, but care will be delivered more by nonphysician clinicians (NPCs) than directly by physicians, particularly in dermatology," Dr. Pariser says. Nondermatologist physicians also may pick up some of the slack, he predicts.
"We can argue about what the quality of care will be, but that's going to be a fact of life," he says.
Extending the workforce
Consumers continue to express a robust desire for aesthetic treatments, he says, while dermatologists have done "an amazing job of educating people about the value of skin exams and skin cancer prevention. Those two trends have filled our offices in ways that I'm not sure we anticipated."
The burgeoning demand has led to long wait times for patient appointments.
AAD practice profile surveys indicate that in 2009, established patients waited 33.9 days, on average, to see their dermatologists (versus 33.2 days in 2007), while new patients waited 17.9 days (versus 19.5 days in 2007).
Meanwhile, the number of dermatology residency slots is expanding only slowly, Dr. Kvedar says, which means "The mismatch continues to grow."
U.S. institutions offered 360 dermatology residency slots in 2010, versus 338 in 2009 and 306 in 2006, according to data from the 2010 National Resident Matching Program.
To date, "I haven't seen any appetite in organized dermatology to do something bold like double the number of trainees," Dr. Kvedar says.
MORE ARTICLES IN THIS ISSUE
Drugmaker Allergan recently agreed to pay $600 million to resolve federal charges that the company improperly marketed Botox (onabotulinumtoxinA) for off-label use. On Call wondered whether dermatologists think that this increased effort in enforcing off-label marketing rules is a good pursuit for the government. Would derms rather they never be allowed to hear about potentially beneficial off-label uses from drug reps?
Melanocytic nevi always have the potential to change in size, shape and color regardless of when they first appear in the skin, or the age of the patient. A recent study shows that though some nevi demonstrate dynamic change throughout a pregnancy, there does not appear to be an increased risk of malignant transformation of these nevi, nor is there an association between changing nevi and melanoma.
Rising melanoma rates among patients of color in portions of the country indicate that dermatologists must tailor specific sun-safety messages for these populations, experts say.
Lenore S. Kakita, M.D., learned about perseverence, acceptance, determination and strength during an unlikely time. She was a United States-born Japanese toddler when the fear of "Yellow Peril" gripped the country during World War II. She spent five of the first six years of her life in U.S. relocation camps. Her father, Hajime Uyeyama, M.D., a family practitioner born in Berkeley, Calif., was forced to close his Oakland practice, and he and his family were interned at camps in California, then in Colorado.
Dr. Buttox travels to Europe to learn about a new botulinum toxin that is popular there. He understands he can't use the product in his office without FDA approval, but his marketing department gets him to discuss the product with the national press. Does the FDA have jurisdiction over Dr. Buttox in this instance, and if so, to what extent?