House divided: Some derms worry procedural certificate will cut out Mohs surgeons

December 1, 2008

National report - Certification for procedural dermatology, now under consideration by the American Board of Medical Specialties (ABMS), could result in preferential treatment by insurance companies for Mohs surgeons who have earned such certificates, some dermatologists worry.

Key Points

But backers of the move say it would be unlikely - and also illegal - for Medicare or insurers to freeze out surgeons who don't acquire the credential.

And as debate continues within the specialty, some Mohs surgeons say they don't support the push for procedural certification.

The present controversy stems from a decision by the Accreditation Council for Graduate Medical Education (ACGME) to begin accrediting one-year procedural dermatology fellowship programs in 2003, sources say.

Cutaneous reconstructive surgery and various cosmetic dermatologic procedures are also taught, says Randall K. Roenigk, M.D., Robert H. Kieckhefer Professor and chairman of dermatology, Mayo Clinic, Rochester, Minn.

Dr. Roenigk is also president of the American Board of Dermatology (ABD), which submitted a plan to the ABMS in April to make procedural dermatology a board-certified subspecialty.

Currently, 34 fellowship programs - most affiliated with the American College of Mohs Surgery (ACMS) - have achieved ACGME accreditation. The goal for procedural dermatology fellowship programs is ABMS certification, according to Dr. Roenigk, who has spearheaded this drive.

Some opposed

Dr. Menkes is among surgeons who don't support the dermatology field's increasing subspecialization (see Guest Commentary).

Since dermatopathology certification became available in the mid-1970s, for example, he says increasingly fewer U.S. dermatologists read their own pathology slides - although anyone with ABD certification is qualified to do so.

"It boils down to the simplest question," he says. "Should people be doing Mohs surgery who did not do a one-year fellowship in the procedure?"

The answer depends upon whom one asks, he says - and it highlights a strong division in the field over available Mohs training.

"There's a lot of Mohs surgery being done in this country by people who are not members of the ACMS, but who learned the procedure in various ways," Dr. Menkes says. He says he's never seen a study that demonstrates worse outcomes - either clinical or cosmetic - for surgeons who aren't ACMS members.