AAD program initiative debated

Dear Editor: The American Academy of Dermatology (AAD) recently announced that the AAD Dermatology Workforce Initiative, a program designed to increase the number of U.S. dermatologists, was approved by the AAD Board of Directors. In brief, this multimillion-dollar initiative, which will be financed by AAD reserve funds, industry contributions and private donations, is aiming to expand the dermatology workforce by increasing residency positions by up to 10 percent. This bold and unprecedented initiative was passed by the AAD Board of Directors without a full membership debate or vote. Although a membership survey indicated there might be a shortage of dermatologists, by not allowing a member debate and vote, the AAD Board has indiscriminately discounted the opinions and wishes of the AAD's rank-and-file membership, a group that will be partly funding the initiative, and one that will be profoundly affected by the initiative's outcome.

There are two interrelated issues here. First is the Board's decision not to allow a member debate and a vote. Second, there is the initiative itself. Both issues are equally important and must be addressed simultaneously. For a better understanding of what has transpired, it is instructive to examine the timeline of the Workforce Initiative. In July 2002, the American Academy of Dermatology Association (AADA) announced the establishment of an Ad Hoc Task Force to Oversee Workforce Issues. Recommendations from a report on Physician Workforce Shortage Initiatives, presented to the Board of Directors of the AADA, were published in October 2002. AAD members were informed that the Workforce Task Force would develop action plans and programs as well as serving as a conduit between the Board of Directors and other groups on all workforce issues.

On June 7, 2004, the Ad Hoc Task Force on the Dermatology Workforce Initiative held its first meeting. An article about the meeting was published in August 2004 and stated:

Furthermore, it was stated at the end of the article that:

"All Academy members are invited to send their comments about the dermatology workforce issue to Sandra Peters, senior manager, Workforce, Insurance, and Practice Issues, via e-mail at:"speters@aad.org

In September 2004, AAD members were then told that:

"The Boards of Directors of the American Academy of Dermatology (AAD) and the AAD Association (AADA) met on July 31, 2004, during Academy '04 in New York City... The AAD and AADA Boards... approved the May 19, 2004, Summation Report of the AHTF on Dermatology Workforce Initiatives, including its recommendation to establish an Academy fund to support resident training."

In other words, AAD members were informed in August 2004 that they could send comments to an AAD staffer, but the Summation Report had already been approved on July 31, 2004, which members did not find out until September 2004. Following this, on October 18, 2004, some AAD members were surprised to learn via email that the Dermatology Workforce Initiative's Guiding Principles were approved at the Board of Directors meeting on July 31, 2004, and that the Board would officially vote on the plan on October 23, 2004.

On October 20, 2004, after numerous objections to the proposed initiative were raised and discussed on the Dermchat listserv, I felt there was an ethical obligation to write to each member of the Board, informing them that there were serious objections to the proposal and that it warranted a debate and vote by the entire AAD membership. Some of the objections raised were that 1) members had insignificant opportunities to learn about, debate and vote on the issue; 2) it is highly unlikely that the initiative will succeed in attracting dermatologists to practice in underserved areas; 3) there are significant concerns that industry contributors may have conflicts of interest in such an initiative; and, 4) AAD members are partly funding the initiative through their dues. Although the Workforce Task Force has attempted to overcome and minimize some of these objections, problems remain.