Learning how to prescribe biologics, talking to mentors, reviewing journals, and getting involved in clinical trials are all ways to boost your expertise.
In an expert interview with Dermatology Times®, Adel Haque, MD, a board-certified dermatologist at Dermatology Partners in Philadelphia, Pennsylvania, takes a deep dive into his experiences in private practice and how other dermatologists can further diversify their skills and knowledge. Haque covers the importance of patient access to biologics, how to network with colleagues in your specialty, how he reviews important journal articles, and how clinical trial opportunities are important to consider when looking at residency programs.
Adel Haque, MD: Hi, everyone, my name is Adel Haque, I'm an MD dermatologist living currently in Philadelphia, Pennsylvania. I work currently in private practice at a practice called Dermatology Partners. I also speak for AbbVie, and speak for Amgen as well, and then have done consulting for Regeneron and Dupixent, and a couple of other companies here and there. Overall, I have a faculty position also with Jefferson Northeast Hospital, where I'm in their department of internal medicine.
Dermatology Times: What is your experience with prescribing biologics and increasing patient access?
Haque: I think biologics were a big focus of a lot of stuff in residency. When I was getting into residency, biologics weren't new, but they weren't old either. So there were a lot of new ones coming into the market as I was in residency, there were some that we were doing clinical trials for in my residency program, and the process of getting them approved and getting them through to pharmacies and everything wasn't so tight, and wasn't so easily done. So when I got out into private practice, I had a lot of experience prescribing them, but not a lot of experience seeing the patient side, where they would have trouble getting access to it, or some of my patients would come and say, "Well, I went to another dermatologist, and he said, it would take me 8 weeks until I got my medication. And another dermatologist said we'll know in 6 weeks whether we can even get you this medication." And it just seemed like a really difficult process overall. But you know, in private practice, the good thing is that you get a lot of people coming into your office every day, you get a lot of reps coming into your office, you get a lot of doctors coming into your office, you get a lot of exposure to people that you don't even know exist, like field reimbursement managers and pharmaceutical companies. And I got really lucky in that, in that Philadelphia is a really big area, it's really a big academic area as well with Penn, Jefferson, and Temple. PCOM [Philadelphia College of Osteopathic Medicine] has a dermatology program over here as well. You know, there were so many people I could kind of draw knowledge from and kind of just piece together a lot of different stuff. A couple of things that I was able to do that really seem to help my patients is our note templates. I made kind of automated note templates. So every time we saw a patient that needed a biologic, it automatically pulled in 4 or 5 things that we knew we had to ask the patient. So then when our biologic coordinator, or nurse or me or the specialty pharmacy that we work with was prescribing the biologic or doing the prior authorization, they knew exactly where to check every single box. And it was never a missed box in a note. So that was a huge piece that we did. A second thing that we did, was actually automating the pre-population of the notes. So each of these pharmaceutical companies, they have these patient access programs, they call it something different in every company that you go to, that basically, they want you to fill out this form that allows the patient if they're on a commercial coverage to get free medication for up to 2 years if their insurance denies it. Now, filling out those forms is a 4-page process where you have to fill out the patient's name and date of birth and insurance information and your practice information. But certainly EMRs, like the one that we use is called Modernizing Medicine, you can build those forms to pre-populate all of that information. So that ended up saving us about 5 to 7 minutes every time we prescribed a biologic. And then the third thing we did is we partnered with specialty pharmacies, and we gave them read-only access to our notes. So then we wouldn't have to fax over any of our notes to them, they could then automatically get our prescriptions from the e-prescription. And then they could also start our prior authorizations for us. And so that was a couple of things that we did to not only reduce the time burden, but also reduced, I think, the access burden to our patients in general.
Dermatology Times: What advice do you have for young dermatologists just starting in their field?
Haque: That's a great question. Because I think that's one of the hardest things about starting in private practice is that you don't have someone looking over your shoulder, you don't have someone helping you all the time. One tip is to try to reach out to a lot of people early on, especially people that are kind of practicing in your area and just get one or 2 tips or tricks from each one of them. And then eventually, as you add in that, you know, it'll really help a lot. Just something to think about when you're going in your practice is really think about what you want to be doing in your practice. Think about if you want to be in private practice, or academics, if you want to be with the private equity company, or non-private equity company, and make that like a big deal because that's where you're going to be working for a long time. And then when you're talking about contracts, I mean, make sure to negotiate. Just about everything is negotiable. Most young physicians, especially the ones in dermatology, I would love for them to know just like I wish that I'd known, that you're a really great commodity, you've worked really hard to get this degree and you've worked really hard to get into this field. And there's a reason you had to work so hard for it because we're in such high demand overall, that you can really structure contracts, kind of how you want to. You can really ask for what you want to, you know, to a reasonable degree, that will actually make sure that you're happy not only in your life, but also just when you're practicing because you're at work almost more than you're at home a lot of the time, and just make sure you structure to where you're going to be really happy.
Dermatology Times: Can you provide an overview of the monthly dermatology journal club you lead?
Haque: One of the most dreaded things to do in residency that every resident hates doing every month is journal club. We have 5 or 6 journals that we like to read every single month. And it's assigned to you usually by your chief, and you have to review some articles that are inside of it. Now, when I got into private practice, I realized, hey, maybe I don't want to be doing journal club, maybe I don't want to read all these, but then you realize that you quickly run out of new information. And there's no other way to get that new information. But I also realized that working with other providers and other doctors and other PAs and other nurse practitioners, life gets in the way. Not everyone has time to read 4 or 5 journals a month, a lot of these journals are really thick and really big and have a lot of great information. But I get 5 delivered to my door, just about the first week of every month. And by the end of the month, sometimes I've read 2 or 3. So what I implemented over here was kind of a journal club of our own, where we work with some of the mid-level providers and some of the other providers in the area that are also in private practice. And I basically go through and try to summarize a lot of the great articles that are there that are really relevant to our practice. So you know, there are monsters in our field that really publish great stuff that's so relevant to clinical practice, that I think it would be really remiss to our patients if we miss these kinds of things. So I think just updating doctors on that would be a good idea. So then we started doing it monthly to where I would just pick out like 4 or 5 articles between these like 5 journals and say, "I think these are the ones that are really relevant to our practice," because a lot of the ones that are really heavily researched based aren't so relevant to us, at least in private practice. So I made this journal club for private practice. And I'm excited to hopefully get that going with Dermatology Times at some point in the future, which would be great. Where maybe just monthly, we go through and say, "hey, this is something from JAAD, this is something from JAMA, this is something from Cutis. And I thought this was great for practice. Maybe you could adjust this here, adjust this there, add this into your protocol." And I think that'll be great for private practice docs who are busy with their normal lives to say what's the most relevant 5 or 6 articles last month.
Dermatology Times: How have you been involved in clinical trials?
Haque: I think when students are looking for residency programs, something really important is to ask whether your program does clinical trials are not. Now there's a lot of stuff that's weird about the pharmaceutical world. In America, obviously, we hear all the bad things that happen when you see a pharmaceutical leader ends up being busted for hundreds of millions of dollars or frauding up the system for a lot of stuff. But at the end of the day, these pharmaceutical companies are doing a lot of research, and they're cranking out all these new medications that we're going to use in our lives. So if you can, in your residency, get ahead of that. Be a part of the clinical trials that are at your university, be a part of the ones that you really think are going to help your patients down the line and that you see yourself doing. At the University of South Florida where I went to residency, there were anywhere between 6 and 15 clinical trials going on at any given time. My mentor, who I'm going to give a shout out to, Dr. Lucia Seminario-Vidal. She was just a beast at doing these clinical trials. She must have been overseeing I don't even know how many at any given time, but she was just so good at discussing eczema, psoriasis, cutaneous T cell lymphoma, vitiligo, any difficult to treat disease just because she would see the most difficult cases in these clinical trials. And she would say, "you know what, I think maybe this person is a good candidate to go in there." So if you can be really involved in that. One thing I kind of regret from residency is not being more involved in the clinical trials. And I think it's a little bit tough because you have these clinical requirements that you have to do or hospital requirements you have to do. But the ones that I was involved with, or helped recruit patients for or help add in patients for, it was monumentally rewarding. And those kinds of experiences stick with you for a long time. And eventually, if you see yourself as a person who wants to get into the pharmaceutical industry, these clinical trials and these experiences in clinical trials are really going to help you because you'll be able to speak to those medications and speak to your experiences with those medications on a much higher level than most of your colleagues and most other people that you interact with. You can even tell your patients, "This is a really scary side effect of this medication. I actually saw this over here and we treated it like this." Maybe it was a very rare case or you think it's a more probable thing than we're actually reporting or something, but you really add to your depth of knowledge with those things just based on that clinical trial experience.
[Transcript edited for clarity]