Embracing Change: Father-Son Dermatologists Reflect on Their Decades of Experience

Although many children follow their parents’ paths to medical school, the specialty of dermatology seems to have distinctive family appeal. Practical Dermatology® reached out to several dermatologists with family connections for their perspective and reflections on the field.

This segment features Kenneth Beer MD, a dermatologist and dermatopathologist in private practice with Florida office locations in West Palm Beach and Jupiter, and his son, Jacob I. Beer, MD, a second-year dermatology resident at the University of Miami.

Practical Dermatology: What inspired you to pursue a career in dermatology?

Kenneth Beer, MD: I was taking a month of dermatology at the University of Pennsylvania during medical school, and dermatology was the first rotation where everyone loved what they did. I also saw that there was such variety in the field; everything from surgery to pathology to pediatric dermatology, as well as cosmetic/aesthetic dermatology. There was also so much to do there¾from surgery to pathology and pediatric dermatology as well as cosmetics. The diversity was wonderful and drew me in.

PD: What do you think are some of the greatest changes in approaches to training and practice in dermatology since the time you began your career, and when your son entered the field?

KB: I think that molecular biology has evolved so much, to the point that tumors that we did not understand are now easily categorized. I think that many of the significant changes are structural, such as the now widespread use of medical records. They are ubiquitous, but personally I find electronic medical records to be a sterile experience; they do not fully capture the patient’s visit nor the alternatives for treatment. Also, I cannot stand the use of digital histopathology.

However, on the positive side, the use of digital images has made getting outside opinions easier and allows one to easily track the evolution of a rash or lesion. Of course, the positive aspects of electronic medical records are their constant availability. Overall, I think this is a generational shift, and that in time, EMRs will improve. I think that artificial intelligence (AI) is already having a positive impact, and in dermatology, I expect that it will improve in efficiency and accuracy as well.

PD: What are some other structural/organizational changes you have seen in clinical practice between your entry into the field and your son’s?

KB: I think the greatest structural change in dermatology has been the rise of corporate dermatology. Most people in the specialty are now employed by corporations. While this is a great change in terms of quality of life, I think that we lose some aspects of individual care. The use of physician extenders also has changed and brought concerns that the specialty may be diluted. However, another huge change has been the wide acceptance of cosmetic dermatology. When I started in clinical practice, it was sort of an orphan field. Now it is a significant aspect of the specialty.

PD: What aspects of dermatology training and practice have stayed the same between your entrance into the specialty and your son’s experience?

KB: The focus on patient care has never changed. The fact remains that dermatology is the most highly sought-after residency; and that this specialty attracts people who are generally friendly and helpful. Also, clinicians’ commitment to advancing the science of dermatology has not changed over the decades since I entered the field. The strong intellectual curiosity of those who choose dermatology, and our commitment to caring for a variety of patients also remains the same.

PD: Did you advise your son on any pearls and pitfalls of practicing dermatology once he made his decision to enter the field?

KB: I didn’t have specific conversations with him, but he has grown up seeing many of the pearls and pitfalls, so I believe that he was well informed.

PD: What do you enjoy most about having your son follow in your career footsteps?

KB: I truly enjoy being able to talk with my son about the intricacies of what we do in dermatology. I also have the great fortune to supervise his clinic monthly now that he is a resident, so I can see him evolve in the field and compare notes with him. To me, this is the best part of having him enter the specialty.

Jacob I. Beer, MD, not only followed his father into dermatology but did so via the same medical school (the University of Pennsylvania Perelman School of Medicine) and he recalls what has changed and stayed the same.

PD: As a child, and as a teenager, what did you think about your father’s job? Did that impact your decision to choose a medical career?

Jacob Beer, MD: As a child, I knew that my father injected Botox and treated acne as well as ran his own practice, but otherwise I didn’t have much of an idea about the specifics of his job. As a teenager, I started to learn about the variety of procedures he performed and conditions that he treated in the office. My own experience with acne also opened my eyes to the impact that he made on a daily basis. By shadowing him, I was also able to watch the positive effects that he had on his patients’ lives. This combined with my budding interest in science and medicine as a teenager pushed me to pursue a career in medicine.

PD: Did you know on entering medical school that you wanted to pursue dermatology?

JB: In college, I helped with research in several dermatology basic science labs and enjoyed working on those projects, but I wanted to keep an open mind. Upon entering medical school, I was interested in plastic surgery with an emphasis on facial reconstruction and wanted to pursue a procedurally focused specialty. However, as I learned more about dermatology, I became enamored by the variety of pathologies, the breadth of procedures, and opportunities to work on innovation in the field.

PD: What are some differences about your dermatology training/medical school experience compared to your father’s experience?

JB: Since we attended the same medical school, it was interesting to compare our experiences and see what had and had not changed over 30 years. We both did anatomy dissections in the same lab. Many of our lectures were in the same lecture hall. However, one notable difference in our medical school experiences was the focus on innovation in medicine. While my father is very innovation-focused, there weren’t many avenues for him to pursue this in medical school. Conversely, I was able to engage in PennHealthX and serve as the Vice President of Ventures, looking at early-stage medical companies and serving as an analyst for Advancing Innovation in Dermatology.

For both medical school and dermatology training, another big difference between my father’s and my experiences has been the increase in therapeutics. While many autoimmune conditions in dermatology had previously been treated with only a few immunosuppressive medications at the time of his training, there are now dozens of biologics with different pathways, mechanisms, and indications.

PD: How have these evolutions in training informed how you practice?

JB: I think that these evolutions have forced me to think creatively and have an expansive toolset in treating patients. I also think that using these medications in my training made me more comfortable with prescribing them for patients. My father keeps up with the current literature and is well-versed in all of the biologics/JAK-inhibitors, but he may be less inclined to use some of them in an off-label prescription.

Targeted therapeutics/biologics are perhaps the biggest advances in how I learned the basics, as well as how to manage patients clinically. These treatments have expanded the management of common conditions ranging from psoriasis to hidradenitis suppurativa to atopic dermatitis. Watching the development of these treatments throughout my training also has piqued my interest in pursuing clinical trials to study them further and may shift my practice to one more centered on clinical trials and research as well as procedures.

PD: What are some of the benefits (expected and unexpected) about having a parent in dermatology?

JB: Going into dermatology, I knew that being able to discuss topics with him would be a huge benefit; we discuss everything from how he would perform a surgical closure to his thoughts on the latest studies in the major journals. It is also incredibly helpful to hear his thoughts on emerging trends in the field, such as AI in dermatology, the role of advanced practice providers, and teledermatology.

I was not prepared for how much fun it would be to discuss patients with my father and really see him in action! About once a month, he serves as a volunteer attending at the Jackson Memorial Dermatology Clinic in Miami and I really enjoy asking him about diagnoses and treatments during those clinics. It is a very special experience to walk out of a patient room, present a difficult patient to him, hear his thoughts, then go back into the patient room and say “I’m back with the other Dr. Beer.”