By Dirk Elston, MD, December 2, 2013
How are we dermatologists perceived by our medical colleagues — and by the public in general? The question has loomed large this year, and our Ad Hoc Task Force on Perceptions of Dermatology has been both assessing the results of a survey of our medical colleagues, as described in October’s cover story (see www.aad.org/dw/monthly/2013/october/a-matter-of-perception), and looking at ways to enhance our image.
How we are viewed by our fellow physicians takes on even greater significance as the nation grapples with health care reform and how to pay for physician services. If we are not perceived as critical partners in reducing the burden of disease, we risk being marginalized. The task force has identified several tactics that can improve the way we are viewed by both the medical community and the broader public. They fall into six categories: educating medical students, working with primary care, inpatient/hospital consultations, volunteerism, leadership, and a proactive communications strategy.
Many of these categories interrelate. For instance, a long-term project to make activity in the local medical community part of the residency experience and encourage residents to continue being active once they are in practice involves leadership training. Our Leadership Institute offers a variety of courses at the Annual Meeting to help dermatologists at all stages of their careers be more effective in their practices, in the house of medicine, and in their communities. These courses are clearly marked in the Advance Program Book you received in the mail last month.
As the various provisions of the Affordable Care Act are implemented, one area where the law’s impact is clearly being felt is in efforts by Medicare and many private payers to achieve better care coordination between primary care providers and specialists. These efforts require each of us to look carefully at our current referral relationships and how we can optimize them.
With an increasingly wide range of providers delivering dermatologic care, how do we ensure that patients get to the right provider at the right time? We are working on referral guidelines that can help dermatologists achieve this. Can we do more to ensure that patients who need our care are able to see us quickly once they’re referred? The Academy has been developing strategies for ensuring timely access to expert care by a dermatologist (see the sidebar to the October cover story on perception).
How do we ensure that dermatologists maintain their leadership role in the health care team? This requires active involvement as new paradigms for health care delivery are being developed. How do we ensure that our referring physicians get the information they need from us after we’ve seen a patient they referred? Each referral letter or chart note we return to our referral sources gives our image a boost and helps make the overall health care system more efficient. Integration of dermatology into multispecialty teams and participation in hospital and group practice committees helps to ensure the future of our specialty as reimbursement models begin to focus on global payments for episodes of care. Not all of us need to join multispecialty groups, but those who practice in those environments have unique opportunities to demonstrate our value to our colleagues. Each of us can contribute in different ways, as every opportunity to interact with another physician is an opportunity to demonstrate the value of our specialty.
Technology is making it possible to handle some referrals in ways some of us couldn’t imagine during residency. Teledermatology has tremendous potential to enhance our ability to provide care to underserved populations in rural and urban areas. It can also help address one of the major concerns raised by our medical colleagues — the difficulty of obtaining inpatient dermatology consultation. Teledermatology may offer a solution that provides the needed expertise without creating multiple-hour disruptions in our schedules to see a single patient. In August, the Board of Directors approved a pilot project to demonstrate the value of teledermatology in improving the ability of dermatologists to provide inpatient consultations.
There are many ways to help promote a positive image of our specialty. Volunteerism, as I discussed in my October column, is a great way to enrich yourself while serving others — and it makes you and the specialty look good as well. The AAD recently recruited a new senior director of integrated communications who will focus on optimizing our communications strategy to convey the unique value of specialty care to the public, our peers, purchasers, payers and policy makers. The Academy works to make sure the media covers the full scope of our field and highlights the good that we do; you can help by showing off the full scope of your talents, your engagement in the community, and your volunteer efforts.
We provide vital services to patients and the health care system, but unless those making decisions know about what we contribute, our future is at risk. We can each play a part to ensure that our skills and the role we play in reducing the burden of disease is properly understood and valued.