Diversifying the specialty can result in high quality access to dermatologic care

Diversifying the specialty can result in high-quality access to dermatologic care
Dr. Callendar Headshot

Providing access to dermatologic care continues to present challenges in dermatology with demand for services outstripping supply in many locations nationwide. As such, access was selected by the AAD Board of Directors as one of five strategic goals in the AAD 2019 strategic plan. Board member Valerie D. Callender, MD, suggests that if we’re going to expand access to care to patients who need it most, we must first start by diversifying the specialty. In a Q&A with Dermatology World Weekly, Dr. Callender explained how she approaches training medical students to prioritize patient access, her take on opportunities for future underrepresented minority (URM) physicians, and telemedicine’s ability to improve patient care.

DWW: When asked about the future of the specialty, one of the themes that emerged from Academy members was AAD’s “need to diversify” and the importance for the “workforce to look more like the people we serve.” What does this comment mean to you? 

Dr. Callender: It is well documented that underrepresented minority (URM) physicians tend to care for patients of their own race and ethnic background. Going a step further, though, research, studies, and surveys show that minority physicians are more likely to work in underserved communities, ultimately improving patient care for minority, poor, and uninsured patients. 

While dermatologists are the specialists and experts in treating 3,000 skin, hair, and nail diseases, we know that there is a shortage of physicians in our specialty. Diversifying our specialty won’t only address the shortage, but diversity brings broad cultural awareness, which improves relatability and patient care.

DWW: Tell us how the strategic goal — Access to Dermatologic Care — helps Academy leaders foster diversity in the specialty.

Dr. Callender: Diversity in our specialty is very important, especially since research shows that minority physicians are more likely to work in medically underserved areas (MUA) and health professional shortage areas (HPSAs). Patients in rural areas, MUAs, and HPSAs have a very difficult time accessing dermatologic care. Usually, the closest dermatologist is located miles or hours away. 

Diversity in the workforce starts prior to residency by engaging college and medical students. I think the Academy is moving in the right direction on that front. Several initiatives and programs like the AAD Diversity Mentorship program, where I served as task force member and chair, facilitates an introduction to dermatology, provides mentorship opportunities, and exposes medical students to valuable experiences in research and clinical medicine. The AAD teamed up with Nth Dimensions, an organization dedicated to increasing diversity in medicine, to host a well-attended bioskills workshop at Morehouse and Howard Universities, historically Black colleges. The AAD Annual Meeting features the Access to Care Learning Collaborative workshop where dermatologists share idea-focused alternatives to traditional care that increase access to care. This year, panelists led discussions on approaches to increase access to care by collaborating with other specialties or physicians and using teledermatology and AccessDerm to reach rural and other underserved populations. 

DWW: How can maximizing the responsible use of telemedicine and other methods help the AAD and its members increase dermatology services to underserved populations?

Dr. Callender: The underserved population deserves access to the best dermatologic care. We as board-certified dermatologists should be the ones to deliver that care or supervise mid-level providers in delivering that care. Telemedicine can assist us in delivering that care to areas where there are few-to-no dermatologists.

If we can improve the penetration of dermatologic care into these areas by using modern technologic tools such as telemedicine, we would be performing a great service for the country. The AAD’s AccessDerm teledermatology program, designed to deliver dermatologic expertise to underserved populations, is a step in the right direction. 

AccessDerm does two very vital things. It engages AAD members and residents with training in providing safe and secure telemedicine consultations to underserved communities in their state. It also provides a telemedicine platform free-of-charge to eligible sites providing health care services to underserved populations in the United States. There are plenty of ways to get involved with this initiative, too. I encourage my colleagues to volunteer with this telemedicine platform and stand in the gap for underserved communities who need care, but just don’t have the access.

DWW: According to the Academy’s Burden of Skin Disease Report, data from claims and providers suggest that just one in three patients treated for skin disease was seen by a dermatologist in 2013. What kinds of opportunities are there to explore and expand the board-certified dermatology workforce to meet demand?

Dr. Callender: In order to expand the dermatology workforce, we need to increase the number of residency positions in dermatology. We need to actively change the narrative about what dermatologists appear to be and what dermatologists actually do. One of the ways to reach our medical colleagues, I would say, is visually. Seeing images of the more than 3,000 skin, hair, and nail diseases that dermatologists treat delivers a powerful message to our medical colleagues. The visual images (before treatment and after treatment) of actual diseases demonstrate that the specialty does life-changing and life-saving work that would be rewarding to any resident and future physician. 

DWW: How do AAD efforts like the SkinSerious campaign and public education initiatives increase consumer understanding of the importance of care delivered by board-certified dermatologists and their teams?

Dr. Callender: More and more we are viewed as “beauty doctors.” These campaigns demonstrate that board-certified dermatologists treat a wide spectrum of skin diseases, including blistering disorders, lupus, psoriasis, atopic dermatitis, keloids, etc. The campaigns also, in large part, tell the patient story. Dermatologic-related diseases are painful, at times relentless, draining on families, etc. Our patients are looking to us — skin, hair, and nail doctors — to provide relief, the ability to take back control of their lives, and quality care. 

DWW: In September, the Academy is hosting the Diversity Champion Workshop to bring together dermatology faculty to discuss diversity outreach programs and initiatives. Why is it important to have open forums where dermatologists can strategize about effective ways to increase dermatologic services for underserved populations? 

Dr. Callender: This workshop will bring together academic dermatologists with various backgrounds and viewpoints to discuss strategy on how to improve on the acceptance rate of URM applicants to dermatology residency programs. Open forums like this allow for exchanging ideas and strategies in order to unify our specialty to achieve a common goal: Diversity in dermatology.

DWW: How can dermatologists provide patients with access to excellent dermatology care at the right time and place?

Dr. Callender: Excellent dermatologic care starts with excellent training, continuing education, and commitment.

Health care should be available to everyone in order to eliminate health disparities. Unfortunately, inequities in access to health care rid vulnerable populations of what should be a basic right. One small act of kindness can go a long way, though. I applaud my colleagues who are mobilizing their communities by volunteering their time at free skin cancer screenings, health fairs, and clinics. I challenge more of us to get involved. Apart from taking care of patients, the real reward comes when we provide access to care and use our rare skills and expertise to make an impact on the most vulnerable communities. 

Learn more about the AAD 2019 Strategic Plan.