Dermatology specialty faces challenges

September 1, 2004

New York - If dermatologists aren't careful, they could see their specialty erode in the coming years.

Margaret E. Parsons, M.D., took that message to the American Academy of Dermatology's (AAD) Academy '04 meeting here.

The private practitioner from Sacramento, Calif., says the specialty faces a number of threats.

Family practitioners are treating more dermatologic problems, Dr. Parsons notes. And she sees other inroads.

"A medical group here in Sacramento assigned one person to be a mole checker, and they designated one of their internal medicine doctors as the dermatology 'expert.' Patients would go to that physician, and if he couldn't handle the problem, then he would refer them to us," she says.

Seeking other options Some Kaiser Permanente operations are also looking at ways around the need for more dermatologists, she says.

"They have a program where they are training an internal medicine physician for several months to be a dermatology care provider within the dermatology clinic in the San Francisco Bay area and in Southern California," she says.

"The physicians train for about eight months in the dermatology clinic and start seeing patients on their own in about four months. It's like a little, short residency, but I can tell you - it takes three years to be a good dermatologist. A little knowledge can be a dangerous thing."

Dr. Parsons says the AAD is putting together workforce numbers - and they show a major swing from a decade ago.

"When I was a resident, the comment was often made that there were too many dermatologists; we didn't need more. They were worried about competition. Then, a few years ago, you started to hear that people couldn't find an associate. When they looked at the numbers, they found there were not enough dermatologists to go around."

Dermatologists are retiring early, often because they are simply tired of the paperwork hassle and of fighting the system, says Dr. Parsons.

While female dermatologists have received some blame for taking residency spaces, and yet, working less than men, Dr. Parsons says the actual numbers show that women work - on average - just four hours less a week than men, and they work for more years.

She says younger dermatologists - both male and female - are working less than they used to.

"Younger men don't want to be as burned out as their mentors were, who got fed up and are retiring early. They are more careful about how they spend their time," she says. "They are taking time out to be a soccer coach, to be with their family. They are trying not to burn out as early."

As a result, Dr. Parsons says, more dermatologists must be trained, but to do that, dermatology residency slots must be funded.

"Part of the problem is that dermatology is a clinic-based specialty and the ACGME (Accreditation Council for Graduate Medical Education) dollars that fund residencies are a hospital-based funding mechanism," she says.

"In1997, caps were placed on those dollars, and currently, they are looking at redistribution. But even if we've got more patients and can get more funding, the ACGME funding is based on hospital, not clinic, dollars."