Unify the United with Unity

Such an adventure 2024 has been, especially the fall where we couldn’t catch a breath. Of course, my wife’s Dodgers finished the job while yet another Milwaukee season ends in heartbreak. My boys are now 9 and 6 and explaining how the world works gets to be quite exhausting, especially when I can’t even make heads or tails of anything. Of course, most of us know why that is…

Now that the world stage is off the circus and we can get back to a world without hourly attack ads and propaganda, let’s not forget that simple but elusive talking point of unity that everyone preaches and still gets dismantled. After all, the American Association of Dermatology’s Unity presidency ends in March, and we still have work to do.

Dermatologists, at least many of you, have stood solid ground to make derm great again. We spent the year fighting for better physician reimbursements in a world of 26% increase compared to the commensurate rises matching inflation for institutions. We have more conferences that are just derm-run without industry participation that have a strong cult following and were a blast to be part of. The chat rooms and social media presence have been a lot calmer and more productive, and the advocacy movements gain ground every year in both money and marching. Look at that—we’re actually doing something right!

On the other hand, we are still divided, and being divided, when it comes to our foundation of medical dermatology. More and more of our colleagues have given up the art of medicine based on misperceptions and misinformation about the science of medicine, which is a shame. The ratio of the potency of our treatment arsenal to the demise of our medical acumen is not healthy and is getting worse. As someone who has run out of breath preaching the safety of novel therapies and how we can’t let the pipeline dry up, I find myself petrified that we are losing medical dermatology and our identity.

The excuses for abandoning medical dermatology are obvious, yet sad, and are heading toward irreversible. Older dermatologists claim they don’t have time to fill out paperwork, sit and talk to patients about options, or answer questions about safety of new treatments, let alone read journals and go to meetings. I totally feel that in my work world … and it can feel like quicksand. By the same token, younger dermatologists often come out of training either sheltered from industry or with limited exposures to new approaches. Even worse are the concerns for the costs to the system, which, although honorable and pragmatic, are obstacles when we forget about the costs of not treating patients and getting them back their quality of life.

Is there a means for us to truly say we are unified when we are divided on what are ethical relationships with industry, what practice models are considered the devil, and what “comfortable vs not comfortable” means for those in the most competitive medical specialty? How are we supposed to unify and come together when the wolves at the door try to poach and erode our scope of practice? What brings us together when we have a fraction of us giving time and money for our advocacy while the masses complain? And even worse, how do we stand with those we train and who work alongside us broadcasting that medical dermatology patients have options and will “carry the load for dermatology patients in this country?” 

Maybe dermatologists need to step forward and dissect the sources of division and erosion of our identity and take our AAD president’s mission to heart, beginning with bringing medical dermatology back to our foundation and not just an afterthought or a nuisance, rather than ending up “Throwing It All Away” as Phil Collins once professed. Ounce of prevention, pound of cure, or tons of remorse … lots to choose from.

So let’s not lose our skills and our position in the house of medicine. Let’s get comfortable if we aren’t and stand together rather than apart when we disagree on philosophy and opinion when patients need us—not just to carry the load, but to lighten their loads as well.