Dermatology's identity crisis

August 27, 2018

In spite of significant public relations efforts, patients are still confused about the role of dermatologists. Dr. Wheeland explores why in this column.

A few weeks ago. I was invited by my 8-year-old grandson to speak to his class on “Professions Day” about being a dermatologist.

I naturally accepted and after giving what I thought was a particularly interesting talk - complete with color slides of various skin diseases and even lasers that I use to treat patients - one of my grandson’s classmates asked the all-important question: “Are you a real doctor?”

When I told him that I was indeed a “real” doctor, he asked why I didn’t sound like his doctor - a pediatrician. I’m relatively sure that his comment wasn’t a true reflection of the quality of my presentation, since it wasn’t the first time I’d been asked this question, albeit often by adults and not an 8-year-old child. I’ve been told this same kind of story over the years by many colleagues.

When I was president of the American Academy of Dermatology (AAD), I learned first-hand of the tremendous public relations and advocacy campaigns they performed to educate the public about the skills, abilities and training that dermatologists receive, the type of care we provide our patients, the innovations we develop, and the research we perform in all aspects of dermatologic care - infections, eczema, photobiology, pathology, wound healing, oncology, immunology, cosmetics, alopecia, aging, lasers and light applications and many more.

In spite of these significant public relations efforts, why is there still patient confusion concerning our “identity?” One of the biggest reasons, I believe, is perhaps the relatively small size of our specialty. The most recent government statistics show that of the nearly 700,000 practicing physicians in the United States, only approximately 8,500 or 1.2% were dermatologists. This small size decreases the visibility of our specialty and may also impact our availability which may be part of the reason that some HMO’s use generalists to provide skincare to their patients and refer only those patients with the most complex or difficult skin problems to dermatologists.

Physician competition with other specialties is intense and may also contribute to an inaccurate understanding about our specialty. It’s certainly hard to argue with the ability and training of some specialties like plastic surgery, otorhinolaryngology and oculoplastic surgery to provide some limited skin care, but they are not dermatologists.

Non-Physician competition with other providers may confuse patients about who is qualified to perform certain procedures. When I recently read through the weekly supplement to our local newspaper I found a number of large colorful ads for various aesthetic procedures like Botox, Kybella, injectable fillers, microneedling, permanent cosmetics (tattooing), laser hair removal and chemical peels. All of these procedures were being offered by registered nurses, nurse practitioners and physician assistants, often independent of physician supervision and sometimes even in nationally recognized spas. There is no mention in any of these ads of the professional training or physician supervision of these individuals, only endorsements by some physician or a designation as a “Master Level Injector” by some unidentified group or company.

In view of these facts, is there any wonder why patients may be confused about who is qualified by training, certification and licensure to provide dermatologic care?

How can we help to educate people about the specialty of dermatology and correct this misinformation about our “identity” to ensure the safe and effective skincare for our patients?

The academy has done a superb job of informing the public about the specialty of dermatology and dermatologists, but it isn’t enough. Education, as is typically the case, is very important and there is no better place to begin that process than locally.

To implement change, we must try to further educate our patient population. This can be done in a number of ways. I’ve personally found that volunteering to speak to any one of a number of local service groups, like Rotary or Kiwanis, at one of their weekly luncheons on a dermatology topic is very effective. Trust me, they are always looking for speakers and would always welcome an offer of a speaker.

It's also relatively easy to start a small educational program at an elementary school near your practice by volunteering to speak on sun safety and importance of sun protection. The teachers will love your involvement helping to keep young children stimulated to learn. You can obtain teaching materials from the academy to provide interested teachers with exciting electronic or printed learning materials that can be easily upgraded as children learn. As the children advance, these programs can be easily changed to remain pertinent, exciting and interesting.

Several of our local physicians have begun a unique way to interact with people by organizing “Walks with the Doc.” These are short walks usually along a river bank or in a park where the walkers can simply ask questions of the physician about a relevant topic.

The walkers get some exercise, learn about the specific attributes of the physician and get some important and accurate information about some health care issue.

I've also heard of "Yoga Night" " where a physician rents the use of a yoga facility for a minimal foe with an instructor teaching simple yoga moves. During the cool down, the dermatologist can either give a short lecture on a topic of relevance or simply answers questions. Both of these types of activities can serve to help familiarize people about the dermatology specialty and skin care.

Obviously, any complications that may result from treatments by non-physicians, unsupervised practitioners that that are subsequently seen in the dermatologist's office, should be reported to the state medical board.

Further, if there is interest in pursuing legislative changes to improve patient safety, it would also be appropriate to contact your state representative and describe the types of complications you may have seen that resulted from treatments provided by these types of individuals.

I believe that this plan has the potential to be successful in increasing the awareness of what kinds of services dermatologists provide to help solve our identity crisis, but also improve thee quality of skincare people receive.

However, this will work only if it receives the attention and support it deserved from dermatologists who desire to make a change.