Women’s Health Magazine highlights derm access issues

Academy responds with info on efforts to improve access to expertise

In September, Women’s Health published an article about “dermatology deserts” — the magazine’s term for areas with limited access to dermatologic care. The Academy responded to the article with a letter to the editor from Academy President Henry W. Lim, MD, FAAD. Member to Member discussed how the Academy is working to improve access issues with Karen E. Edison, MD, FAAD, chair of the Academy’s Specialty Positioning Work Group.

M2M: Were you surprised by the access issues presented in the Women’s Health Magazine article?

Karen_Edison_2017.jpegDr. Edison: As the previous chair of the Academy’s Access to Dermatologic Care Committee, it doesn’t surprise me at all that access is an issue that has bubbled to the top for Women’s Health. The Academy has long recognized that access is a major issue for our specialty.

The Academy released the Burden of Skin Disease report in 2016 that showed that one in four Americans received care for skin disease during 2013, the year studied in the report. One in two people over the age of 65 received dermatologic care in that same year.

However, two in three patients captured by the study were treated by non-dermatologists. We estimate that 20,000 dermatologists would be needed to provide all skin disease-related care, based on the 2013 claims data. This is twice the number of board-certified dermatologists in the U.S.

The burden of skin disease in the United States is great. In most areas of the country, there are not enough dermatologists.

  womens health
The online edition of Women's Health includes a video of Catherine Lewis describing why it took nine months for a melanoma diagnosis.

M2M: The article described a woman’s harrowing experience in getting a melanoma diagnosis. It took nine months before she was finally diagnosed with Stage 4 melanoma.  What is the Academy doing to address working with healthcare providers to ensure patients are getting proper dermatologic care?

Dr. Edison: We’ve long known that early access to our expertise can save lives, save patients suffering and save money. The Academy and members of the specialty are doing several things to improve that access. For example, for the last several years, the Academy has held learning collaboratives related to access at the AAD Annual Meeting. At these events, like-minded dermatologists come together and share their ideas. Some best practices that have been shared include tweaking schedules to ensure that patients with serious conditions always have access and using technology, such as teledermatology, to serve patients in remote and underserved areas.

I’m at the University of Missouri and I’ve used teledermatology for more than 20 years to serve patients in remote areas. Currently, we’re doing a lot of store-and-forward teledermatology in our VA dermatology clinics and using patient portal visits through our electronic health record system, which has been particularly useful for parents of small children.

The program I’m most excited about is Project ECHO (Extension for Community Healthcare Outcomes). Project ECHO links expert specialist teams at an academic hub with primary care clinicians in local communities. Primary care clinicians become part of a learning community, where they receive mentoring and feedback from specialists. Together, we manage patient cases so that patients get the care they need.

My team has a dermatology ECHO every Friday, during which primary care providers call in via videoconferencing from around the state. We spend 10 or 15 minutes educating them on some facet of dermatology and then spend the rest of the time discussing the art and science of managing their patient cases. They really get better at dermatology as a result of these sessions. We studied the success of the program and found that primary care clinicians greatly improved their diagnostic ability after participating in the Derm ECHO for a couple of years.

We really can increase primary care providers’ expertise in dermatology. We need to open our minds to that in our specialty as we move to a more value-based health care system and as we focus more on population health. Rather than just having our clinic full of patients, we need to be thinking about the health of our community and how we can use technology and innovative methods to extend the reach of our expertise.
SkinSerious features patient stories that raise awareness about the critical role dermatologists play in an era of team-based health care.

M2M: The Academy recently launched SkinSerious, an effort to raise awareness about the breadth of skin diseases that affect patients, improve access to dermatologic care, and highlight the role dermatologists play in team-based care. As chair of the AAD Specialty Positioning Work Group you were instrumental in developing the campaign. Can you explain how SkinSerious is raising awareness of the critical role dermatologists play in an era of team-based health care?

Dr. Edison: The Specialty Positioning Work Group’s research found that many patients and health care providers identify dermatologists with skin cancer, but markedly fewer identified dermatologists with many of the other serious skin diseases that we treat. Physicians in other specialties don’t understand the broad scope of skin diseases dermatologists treat on a daily basis.

You can get through medical school, go into primary care and never rotate through dermatology. In fact, about half of primary care physicians don’t take a rotation in dermatology. If a physician has never spent time in a dermatology clinic, he or she won’t understand the diseases that we treat and the impact they have on patients’ lives. For example, research has found that patients with psoriasis have a lower quality of life than patients with congestive heart failure.

Through SkinSerious, we are working to educate other physicians as well as policymakers about the seriousness and breadth of the diseases we treat, and about the importance of dermatology as a specialty. Additionally, we’re highlighting how often we collaborate with other health care providers to deliver high-quality care to patients. We’re also using the campaign to show how we’re working to improve access to our expertise.

M2M: How can members participate in the campaign?

Dr. Edison: I encourage members to go to the SkinSerious website, which includes a form where members can submit their stories. We need good stories related to improving access and collaborating with other physicians and the health care team to help patients with skin disease. We are also interested in more stories that reflect the serious nature of the many diseases that we treat.

These stories from dermatologists and their patients are the foundation of the SkinSerious campaign. To make our stories more impactful and reach our key audiences, it’s important that our efforts show the perspectives of patients who have benefited from the care of dermatologists and non-dermatologist physicians or other providers who have worked collaboratively with them, as well as how you are working to improve access to dermatologic care.