National report — Member discontent over the handling of the American Academy of Dermatology's (AAD) workforce initiative unveiled last fall is bringing about fundamental changes in the program — and perhaps in the decision-making process that governs such matters.
A petition introduced at the 63rd Annual Meeting of the AAD in February in New Orleans proposes amending AAD bylaws to prevent the organization from becoming involved in or funding any workforce initiative without first holding a membership debate and vote.
"We felt that this was our only recourse to either stop the initiative itself or stop it at some point in the future," says Orin M. Goldblum, M.D., one of the petition's co-sponsors. "After talking to a number of colleagues, I was bothered by the fact that such an important decision was made by the board of directors without allowing the members to vote."
Dr. Goldblum is a Pittsburgh-based private practitioner who also serves on the staff of the University of Pittsburgh Medical Center's South Side Hospital.
Chronology The Ad Hoc Task Force on the Dermatology Workforce Initiative began meeting last summer. Among its recommendations was to establish an AAD fund to support resident training in an attempt to offset a predicted shortfall in the number of dermatology residents (Resneck J Jr, Kimball AB. J Am Acad Dermatol. 2004 Jan;50(1):50-54).
Members' concerns about the initiative include the potential for conflicts of interest and the inability to guarantee that newly trained dermatologists will ultimately practice in areas where they're needed.
However, Dr. Goldblum says, "The underlying issue is, what is a major decision for this organization? And when should a board of directors of an organization such as the AAD consult with membership and allow them to debate and vote on such an issue?"
According to AAD Secretary-Treasurer David M. Pariser, M.D., board members never considered allowing members to vote.
"We have no precedent for doing that," he tells Dermatology Times. "The board passes a $27 million budget every year without direct member input."
Initiative retooled In response to members' concerns, the AAD retooled the Dermatology Workforce Initiative in December; it's now the Dermatology Resident Support (DRS) program.
"The board of directors decided to broaden the scope of this initiative to look at the idea of dermatologist shortages not only from the supply side, but also to look at other, larger issues such as the proper use of physician extenders and primary care physicians," Dr. Pariser says.
Board members also opted to hold off on funding any residency positions beyond the initial 10 - for which funding had already been committed - at least until they discuss the matter at the AAD's April Solutions Summit.