PracticalDermatology

Post-pandemic dermatology is curiously similar to pre-pandemic dermatology, yet also dramatically changed. We revel as things have gone “back to normal.” We can finally practice without masks or shields and see patients in person. We celebrate returning to meetings and interactions with colleagues and industry. Nevertheless, the challenges of the pandemic brought forth rapid changes in medicine and dermatology was not left unscathed. It seems that 2023 will be another year of both challenges and opportunities for dermatology.

One of the greatest challenges to board-certified dermatologists is the erosion of our status as the dermatology experts. The pandemic has seemed to usher in a trend in medical and cosmetic training with elevation of mid-level providers as experts and injectors. Industry meetings and training sessions that for many years were attended by a majority of physicians now have seen a dwindling of core physicians to a small minority. We are seeing a shockingly rapid transformation of the cosmetic expert injector or lead panel speaker from board-certified dermatologist with years of clinical experience, trainings, clinical trial experience and research, to anyone whom the sponsor company deems as an “expert.” This was recently highlighted in a social media post on “National Woman Physicians Day” in which industry ignored our distinction, education, and sacrifices we have made as physicians, to instead elevate others lacking our education, expertise, or credentials.

Scope of practice will continue to be a major challenge for our field. Across dermatology, there are mid-levels practicing independently who are not properly trained or supervised. We can have different practice models in dermatology and can support various types, but the board-certified dermatologists must be the leaders of the practice and be supported in providing the highest quality patient care. Failure of this required leadership has diminished the quality of care and public perception in a way that damages our specialty. This should serve as a wakeup call for all dermatologists: we need to join together as we never have before and support our fellow physicians, societies, and educational institutions so that advocacy for a physician-led model is maintained.

We have an opportunity to come together as a specialty and support initiatives that train residents and young physicians. We should not accept from industry that they have no access to the dermatology residents and therefore cannot support injectables training for them. Academic and cosmetic dermatologists need to collaborate to make this possible. We have a challenging relationship to re-define with an industry that on one hand makes our meetings possible, supports our research, and forges science ahead and on the other hand quotes market demand and short-term growth potential as a reason to undermine our entire medical hierarchy and risk damaging our future and the future of many generations of physicians to come. We must recognize that their fiscal goals do not always align with a healthy future for cosmetic and medical dermatologists. The future of our specialty should be our compass. We must elevate our own young physicians and residents, support our independent thought leaders, and not let industry decide who will become the next generation of dermatology experts and “KOLs.”

Another challenge for dermatology is the rapid decline in independent dermatology practices. Financial demands of private practice have shifted many board-certified dermatologists to private equity-backed practices. Escalating cost of lasers and laser maintenance, Medicare reimbursement reduction, and inflation have made private practice even more difficult to navigate. We should not allow our voice to be diminished even if our independence has. We as a specialty need more unified education and support for independent practices. There are challenges with management, billing, HIPPA, OSHA, compliance, and legal issues just to name a few. We need to demand equal pricing of injectables for small physician practices. There are great efforts happening for our specialty and all of medicine at the national level for reimbursement, and we are all appreciative. However, there is little help for navigating your local contracts, and very little traction for improvement in rates if you are a small-physician practice. Supporting the American Academy of Dermatology (AAD) and American Society of Dermatologic Surgery (ASDS) and other societies in their support of dermatologist as business owners is crucial.

Another major challenge will be the prevention of burnout for our generation of dermatologists. We have, for many years, scored on surveys as one of the “happiest” specialties and seeing our descent down this list is jarring. With telemedicine, store-and-forward technology, text, email, and web portals, we have lost the buffer of work vs personal time. Patients want access and quick turnaround times for addressing their issues. With eroded boundaries, we need to practice self-care and be aware that we must thoughtfully set limits and prioritize our personal needs in a way that supports and facilitates our professional lives.

Our biggest opportunity in dermatology is that we are one of the most intelligent, highly functioning, overachieving groups in all of medicine. If we join together to look at our future and foresee possible adversities, we can navigate together to maintain our place in the house of medicine. We have a chance to lead the charge in closing gaps in diversity in our field and in our patient care across diverse ethnic and gender backgrounds. We can spearhead future research in the science of aging and cancer genomics. We may live in the era of medicine that eliminates cancer and we need to lead skin cancer treatments and advances. Improvements in artificial intelligence can help us with early detection and we need to guide that technology and align it with our examinations. We as physicians are scientists, lifelong learners, and experts in our field. It is imperative that we remain at the forefront of dermatology.

Another opportunity is to increase our voice. There are many dermatologists who are uninvolved or critical of our societies. There are certainly areas for improvement that need to be addressed. However, in the landscape of the future of medicine and dermatology, there is no way we can survive unless we unite as board-certified dermatologists. This means getting involved, donating, attending meetings in person, and supporting our physician societies. The AAD, the ASDS, The American Medical Association, The Dermatology Foundation, The Women’s Dermatological Society, The Skin of Color Society, many other national physician societies, and especially all our local and state physician societies need our support.

Advocacy, scope of practice, reimbursement, physician burnout, and many other issues will continue to be trials for physicians. United we, as board-certified dermatologists, can face the challenges that the future brings us, and seize the many opportunities that lie ahead.