Reform's ramifications: Will Congress' current emphasis on primary care help, or hurt, specialists?

December 1, 2009

In healthcare reform discussions, there is an emphasis on primary care. We wondered what dermatologists think of this, and whether this could diminish specialty practices and/or impact patient care.

Key Points

On Call wondered what derms think of this emphasis on primary care, and whether it could diminish specialty practices and/or impact patient care.

1990s replay

"If they try to handle things they aren't trained to do, patients tend to get really frustrated that their condition is not improving the way they would like it to improve, so they're off to the specialist anyway. Since many patients went through this process before, as long as insurance companies allow patients to see specialists without referral, I don't think we will be affected one bit," Dr. Pierre says.

Dr. Pierre, who has been in practice for eight years, adds that there could actually be some benefits for dermatologists and patients.

"If someone has a little rash a primary care doctor can take care of, that could benefit dermatology. There is such a long wait in some parts of the country just to get in to see a dermatologist, that could decompress some of that volume, so we would have openings for patients who actually need a specialist for more serious issues. But, then again, I don't think it will hold, because we're just revisiting something we've already done," Dr. Pierre says.

A time factor

James Pica, M.D., has been practicing in Greensburg, Pa., for 21 years. "Based on what I hear from those living in Canada, primary care providers get swamped with all kinds of routine office visits, such as colds and other minor conditions, so that they just have no time to deal with dermatologic problems, too. I wouldn't expect the emphasis on primary care to have much impact on dermatology.

"And, we haven't really heard anything about how reform would affect anything other than primary care. They haven't talked about what services would be covered, and what wouldn't be, under any government-sponsored plan. That could have more of an effect, I think, than primary care physicians holding on to our patients. Many conditions we treat are more quality-of-life issues - such as Botox for hyperhydrosis - rather than endangering a person's health, so whether those will be eligible for coverage still needs to be determined," Dr. Pica says.