By Bruce Brod, MD
Imagine a world in which electrologists, dentists, and naturopaths are allowed to perform dermatologic procedures without proper training or oversight. It’s a thought that gives one pause, but it also illustrates why defending our scope of practice in dermatology is such an important issue.
Dermatology care team
The Academy looks at the practice of medicine from a team-based approach. It’s not the goal of the Academy to prevent any other health care provider from addressing problems with the skin. However, we emphasize that for people with dermatological conditions, board-certified dermatologists are the most qualified to be the leaders of the care team.
I and other Academy members have given very careful thought to defending our scope of practice, and we have developed positions that take a reasoned stance. We want to reinforce that dermatologists are the optimal caregivers for conditions of the skin, hair, and nails due to our extensive education and training. This is especially important as other groups seek to provide dermatologic services to the public.
In addition to a growing focus on the dermatology care team and promoting dermatologists as the leaders of the care team, the Academy is allocating more resources where most scope of practice battles occur: At the state level.
For example, in my home state of Pennsylvania, the State Board of Dentistry wrote a draft policy proposing that it is within the scope of dentistry for dentists to perform cosmetic procedures, including administering Botox™ and fillers. The Academy worked with the Pennsylvania Academy of Dermatology and Dermatologic Surgery to help orchestrate a letter-writing campaign to state our opposition to this policy, which would infringe on our scope of practice.
The AADA also has been instrumental in working with representatives from the American Medical Association (AMA) to counter scope of practice infringement issues like this one. In the end, the Pennsylvania State Board of Dentistry’s proposed policy was altered to include a clause that recommends dentists to have additional training to perform cosmetic procedures. It was a small concession, but a gain nonetheless. We were able to express our concerns about this policy on many levels, including to the public and lawmakers.
This is just one case of many across the country where the AADA has devoted its resources to scope of practice issues for the benefit of the specialty. In another instance in Louisiana, optometrists wanted to extend their scope of practice to perform cosmetic laser procedures around the eyes, which the AADA and the Louisiana Dermatological Society opposed. The bill was ultimately defeated.
In Colorado, naturopaths are fighting to expand their scope of practice and are working to gain credibility and licensure. They are pushing for the ability to perform certain procedures without having attended medical school. It’s a grave concern. For dermatologists who perform aesthetic dermatology, not a week that goes by that they don’t see complications from these types of procedures that are performed by untrained and unlicensed providers. These are the types of issues we want to engage in to not only represent the specialty of dermatology, but to protect patients and make sure they are receiving proper treatment and diagnosis.
To that end, the AAD’s Ad Hoc Task Force on State Society Relationships, which was formed in 2013, is devoting time and resources to carefully evaluating how to continue to foster the relationships between the AAD and state societies.
The AAD provided new resources for state societies in 2013, including developing a state society resources section on AAD.org and launching the quarterly State Society Insider e-newsletter that is sent to leaders of state societies. The Academy also provides grants to state societies through its State Advocacy Grant Program to help address scope of practice issues in their states so they have the funding to hire a lobbyist to take on these issues if needed. Look for the Academy to provide increasing support for state societies as these relationships continue to develop.
When people ask me why I participate in groups like the AADA’s State Policy Committee, I like to quote Pericles, who said, “Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you.” At this critical juncture, I encourage every dermatologist to get involved to ensure that the best-qualified people are taking care of patients.
Getting involved in your state society is not difficult, and most will welcome the help. You also can reach out to your state legislators, who are generally more accessible than those at the federal level.
When meeting with our elected representatives, it’s also important that we speak with one voice. Familiarize yourself with the policies and priorities of the AAD, and reach out to the Academy’s state affairs staff for more information. There’s a real opportunity to get to know your representatives so they know what dermatology is about and can provide assistance if needed. There are so many misperceptions about our specialty that we can undo just by getting to know them.
For example, I arranged for my state representative in Pennsylvania, who is also running for a state senatorial seat, to spend a half a day in our practice next month. I will let him know about the serious problems and challenges we face. This type of face-to-face interaction is easy to achieve; you don’t need to be involved in advocacy for years to develop relationships with your representatives.
This year, resolve to get more involved with your state dermatology society for the benefit of the entire specialty. Every interaction, no matter how small, can help make a difference.
Dr. Brod is a board-certified dermatologist in private practice in Lancaster, Pa. He is clinical professor of dermatology at the University of Pennsylvania Perelman School of Medicine, as well as chair of the AADA State Policy Committee, adviser to the AAD State Society Development Task Force, a member of the AADA GAHPP Council, and a member of the AAD Ad Hoc Task Force on State Society Relationships.
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