A determined call to arms

"We need to be at the table when decisions are made and have our voices heard. Think about how you want our specialty to look five, 10 or 20 years from now, and realize 'what will be, is up to me.' The needs are great, but the possibilities are greater, and we must continue to fight and never give up if we want dermatology to go where we want it to go and ensure its success in the future," says Dr. Cockerell, president of the AAD and clinical professor of dermatology and dermatopathology, University of Texas Southwestern Medical Center, Dallas.

Some harsh realities

"While it seems like there are a lot of people at this meeting, dermatology is just a dust speck compared to internal medicine, family practitioners and other specialties, and that places us at risk of being outvoted or not being included at all when decisions are made," Dr. Cockerell says.

Become proactive instead of reactive

In issuing his call to arms to ensure the preservation of the specialty, Dr. Cockerell compares the status quo to trying to put toothpaste back in the tube. Looking to the future, he urges dermatologists to take actions that will position them to be on hand before the "toothpaste" gets out.

"No one is interested in the best interests of dermatology but us, and once the ball gets rolling, we are going to be recipients of more bad news if we are not at the table. To do that, we need to leverage our small numbers and high intelligence," he says.

Developing a strong, adequately funded SkinPAC with power to lobby will be one important component, along with establishing close alliances with patient advocates who can put a human face on problems when testimony is needed in front of congressional committees, Food and Drug Administration (FDA) advisory boards or other decision-making groups. However, increasing dermatologist representation in government, medical board and medical society leadership positions is highly critical as well.

Currently, there are only 50 dermatologists among the thousands of medical personnel employed in government regulatory agencies, only four holding state legislative offices, a handful serving in municipal government positions, and none in Congress. In addition, only eight dermatologists occupy positions on state medical boards nationwide, only a few dermatologists are deans of medical schools or on a boards of directors for relevant industries, and there are none in the top leadership of the American Medical Association.

"With so few dermatologists in positions of influence, coupled with our small size, we have a small voice and our specialty is at risk," Dr. Cockerell contends.

"Now is the time is to address that problem, but it will require dermatologists who are committed to the specialty."