Strength in unity

From the President

Dirk Elston

Dr. Elston served as the Academy's president from March 5, 2013 until March 25, 2014.

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When I took office as your president I knew it could be a tough year with lots of changes facing our specialty. I also knew I would be working with a great team. As it turns out, I was right on both counts. Never before has our specialty faced such fundamental changes in how health care is delivered. The rapidly changing landscape of regulation, reimbursement, and limited provider networks is complex and difficult to navigate, but the AAD will always be there to provide tools and guidance to help each of us to continue to practice and thrive in a changing environment. 

With the help of a broadly representative group of leaders from our state and local societies, we established a set of key priorities fundamental to the future of our specialty. They included establishing how dermatologists fit into new payment and care delivery models, developing plans to obtain the data we need to demonstrate the value dermatologists bring to patient care and the health care system, enhancing the image of our specialty, and optimizing our support of state and local dermatology societies as they confront a growing range of issues. Our state societies are our specialty’s front line, and the AAD has established an ad hoc task force under the leadership of Mary Maloney to improve coordination on issues as they arise locally. A bad payer policy that dermatologists confront in one state will rarely remain regional. Each regional challenge is one that can potentially affect us in many states. Most state societies have limited resources to fight these battles, and the AAD is there to provide expertise and staff support to mount coordinated efforts on issues that can affect us all. 

A productive health policy strategic retreat, held late last spring, brought together thought leaders to discuss critical areas that needed to be addressed to ensure future success for the specialty. We also did some hard work on the perception of the specialty. An ad hoc task force is working on a variety of recommendations to help improve the way we are perceived by our medical colleagues, especially in primary care as our nation rolls out new health care delivery systems based on the patient-centered medical home model. The Government Accountability Office’s report on dermatopathology showed us just how tough the environment is for us right now. The study suggested that on average, dermatologists who in-source dermatopathology demonstrate a sharp increase in the number of biopsies per patient — several groups seized on the findings to call for closing the Stark Law exceptions that allow dermatologists to use the full scope of our training to read slides for our patients. What is at stake is no less than our scope of practice, as our right to read slides is key to the practice of Mohs surgery as well as dermatopathology. [pagebreak]

Over the past year, we have responded successfully to each of these challenges, and I know that as I hand the reins to Dr. Coldiron, the Academy will continue to move forward on these issues and new ones that will arise. 

In the face of these challenges, we need to remember what is good. We are privileged to practice a specialty that can provide its patients with dramatic improvements in their health and quality of life. We give back in so many ways. As a group, we turned Niagara Falls orange on Melanoma Monday to raise skin cancer awareness and made possible the continued success of Camp Discovery. Every time one of us works to squeeze in a patient who cannot pay at the end of a long day, to see a hospital consult, or to volunteer in the community we enhance the image of our specialty and reinforce why we chose to go into the most noble of professions. 

To face the challenges ahead, we must stick together. Dermatology is a small specialty, representing less than 2 percent of physicians, but we have always been successful in projecting a voice much larger than our numbers. Unity is key to our success. There are many ways to fail as we move forward. My year as president has convinced me that there is only one way to succeed: we must work together with a unified vision of ourselves as dermatologists and the Academy as our unified voice. Our future is in good hands with Brett at the helm and a dedicated team at his side. It has been an honor to serve as your president and I leave knowing that our leadership team is strong and the future is bright.