Prevention and protection: Dermatology and the AMA HOD

By Seemal R. Desai, MD

When we educate our patients about skin cancer, we tell them to stay out of tanning beds, wear sunscreen, seek shade, and wear protective clothing. Our talking points have a recurring theme: Prevention. The desired outcome for our advocacy efforts on behalf of the specialty are not far off from that theme. Our specialty is a small one, and one of many in the health care arena. As a result, our presence in the American Medical Association’s (AMA) House of Delegates (HOD) is focused primarily on preventing negative policy changes, rather than improving our situation.

Some of the relevant issues that the AMA HOD has taken a strong position on include:

  • Preventing cuts to Medicare physician payment and advocating for a fix to the sustainable growth rate formula.
  • Preventing a physician workforce shortage by advocating for increased funding for graduate medical education.
  • Preventing skin cancer by supporting the exemption of sunscreen from bans in schools about the possession of over-the-counter medications. This would allow students to apply sunscreen at school without restriction or a doctor’s note.
  • Preventing the repeal of the Stark exemption for in-office pathology services.

The AMA has taken a strong position on these issues because of our involvement in the HOD. We know that at the end of the day, hospitals, government entities, and private payers are looking for guidance on policies, and are turning to the AMA because the AMA is the most listened to group in the house of medicine. If we want to have any effect on the specialty as a whole, we need to be involved in the AMA HOD to ensure that our vote is counted. 

The AMA is the one group in the house of medicine where every state medical society and every specialty has a representative. The number of delegates a specialty receives is proportionate to the number of specialists who are members and designate that specialty as their primary organization. For example, the AAD has four delegates, but pathologists have dozens of delegates. Ultimately, the more delegates you have:

  • The more votes your specialty has to support/prevent resolutions that fit within your agenda.
  • The more the specialty can lobby and talk to other groups about their vote.
  • The more the specialty can change the perception of its members. For example, in the past, dermatologists have conducted free skin cancer screenings at the AMA HOD biannual meetings.

Unfortunately, dermatology will lose a vote in the AMA HOD unless more AAD members join the AMA and designate the AAD as its specialty society by Jan. 1, 2014. The AMA recently conducted its five-year review of the AAD to determine the number of representatives it should receive in the HOD, and the number of AAD members in the AMA is down by several hundred.

In this current climate of unprecedented change within the health care arena, dermatology is at risk. If we lose a delegate in the AMA HOD, we diminish our chances of defending against attempts to implement dangerous scope of practice policies, repeal of the in-office pathology Stark exemption, as well as a multitude of other potentially negative policies. 

If we don’t continue to be involved and ward off all these negative influences, there may be no dermatology in 30 years and the quality of the health care that our patients receive could be in serious jeopardy. 

After you renew your membership with the AAD, join the AMA and designate the AAD as your primary organization. If we’re not there, someone else will speak for us and we may not like what they have to say.

Dr. Desai is a member of the SkinPAC board of directors, serves on the AAD Congressional Policy Committee, and is an active member of the AAD Grassroots Advocacy Workgroup. In addition, he serves as the AAD delegate to the American Medical Association (AMA) Young Physicians Section representing the interests of young dermatologists to the AMA, and is the current president of the Dallas Dermatological Society. He is the president and medical director of Innovative Dermatology, PA, and serves as clinical assistant professor in the department of dermatology at the University of Texas Southwestern Medical Center. 

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