“Skin May Be Deep, But Dermatologists Are Superficial…”

Findings from a recent telephone survey revealed, once again, that many patients fail to understand what dermatologists do for a living. The survey results indicate that patients believe dermatologists don't work as hard as primary doctors and yet make more money than they deserve (but still less than cardiologists). Moreover, according to the findings, only half of us are interested in dealing with skin cancer—which, in the minds of many patients, really isn't cancer at all because we don't send them to oncologists to be managed.

Despite a heightened television and Internet presence discussing skin cancer, RUC teams working tirelessly to defend our reimbursements, and office marketing campaigns directed at patient safety and education, dermatologists are looked at by patients (and arguably other specialties) as not being “serious,” since apparently all we do is pump up lips and stop the dreaded malignant rhytid. What more do we have to do to be taken seriously as specialists? How many more campaigns do the AAD, ASDS, SPD, and other dermatology societies have to launch to put this perception to rest? Or, should we just give in and be called superficial and when patients have serious or life-threatening skin problems, we let our care speak for itself?

Is closing off our knowledge of the skin the answer? I have heard from more than one angry dermatologist that we should treat education about the skin like foreign aid to countries that are betraying us. They suggest we start slowly cutting off the pipeline to treating skin disease so that we don't continue to give it all away. Satisfying as that might be, who are we really hurting by not teaching our colleagues? That won't stop the melanoma that's growing or the acne that's untreated from leaving scars in patients that don't know what we do.

Are we not taken seriously because we aren't going to the hospital anymore? Because the reality is that many of us still do, even though the number of inpatient consultations continues to shrink, but that is definitely not our fault. While the survey quoted that 63 percent of those contacted believe that primary care physicians have a more critical role than dermatologists, that doesn't have to translate into us not practicing serious medicine. Many of us also make sure we send letters to referring doctors, market the need for screenings to transplant patients, and, more often than not, try to stay connected in our practice systems or communities.

Maybe the answers are simple: Wear the lab coat, make sure the clinic feels like a doctor's office, have appointments available for patients with real problems and not just the touch-up, and emphasize that skin cancer is something to be taken seriously. Maybe, then, the depth of our specialty will resonate and we won't be just “aloe pushers,” “pimple poppers,” and “one step above the Clinique counter,” as we have been so fondly labeled.

After all, if perception starts with marketing, we can swim a little deeper and improve our images one dermatologist at a time.

Neal Bhatia, MD
Co-Chief Medical Editor