Like just about everyone else across the country, dermatologists are naturally concerned about the status of the US and global economies. As discussed in this month's "Business Advisor" column by Bruce Maller (p. 9), now is the time for open and honest communication with staff and associates. It's an opportunity to thoughtfully assess your practice and to plan meaningul short- and long-term changes. As Joel Schlessinger, MD notes in his "Ask an Expert" department (p. 61), he has already shifted his marketing strategy to emphasize lower-cost cosmetic procedures, though he notes there is still demand for more invasive, higher-priced interventions.

Perspective is an important tool for any professional during tough economic times. It's essential to recognize that economic "trends" are just that, and that circumstances vary from region to region. It's also important to remember that adaptability is essential, but reactionism rarely pays off in the long-term. Sometimes perspective comes from recognizing that others—such as general practitioners—are in a worse predicament. A recent survey by The Physicians' Foundation (physiciansfoundation.org) revealed that nearly half of responding physicians plan to reduce the number of patients they see or stop practicing entirely within the next three years. Although specialists participated in the survey, about three-quarters of responses were from GPs; 52.4 percent of respondents were age 51 or older. More than one-third of physicians said Medicare reimbursement rates are lower than the costs of providing care, and only 17 percent rated their practice as financially "healthy and profitable." Just six perenct of respondents said the professional morale of their colleagues is "positive." Sixty percent of respondents said they would not recommend medicine as a career to young people.

Dermatologists face many of the same challenges that GPs do, including falling reimbursement rates and mounting paperwork requirements. But dermatologists overall seem to lack the level of despair evident among non-specialists. The specialty has become adept at identifying new opportunities and growing medical practices.

We face a new year knowing that challenges lay ahead. But opportunities—though potentially limited—will continues to emerge. Dermatologists must confront economic troubles head-on with thoughtful planning and perhaps some creativity. On behalf of our entire staff, I wish you continued professional success and satisfaction in 2009 and thank you for choosing Practical Dermatology as a source for reliable clinical and practice management advice.