Predicting the future of dermatology

Ronald G. Wheeland, M.D.Someone once said that if we don’t know the past we are destined to repeat it.  As I have reached a certain age, I find that I’m more interested in looking at and being aware of the past, so as to better try and accurately predict the future of dermatologic healthcare.  Perhaps by doing so dermatologists can be better prepared for the many unknowns that the future is sure to bring.  I have the luxury of not likely being around in 25 or 30 years to live up to any errors or mistakes I may make in this editorial, giving me the opportunity to make some pretty ridiculous predictions and leave it to the readers to look back from the future to critique these thoughts and determine how smart or wrong I’ve been.  To try and cover this topic methodically, I would like to begin with how I believe dermatology be practiced several decades from now.

The Practitioner of the Future

With the multitude of major scientific advances that have already occurred in the diagnostic and therapeutic areas in dermatology, my first (easy) prediction is that an enormous additional number of scientific advances will continue to occur in the future.  The sheer volume of this new knowledge in all areas of dermatology will add to the complexity involved in the management of patients with skin diseases.  While it is not impossible for a solo practitioner to remain optimally well informed as these advances occur and still permit the delivery of the best possible care for all of his or her patients, it will certainly become more difficult in the future. 

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Because of this, I predict that in the future, solo dermatology practitioners will cease to exist and subspecialty dermatologists will affiliate with one another to practice as a group.   Evidence that this trend has already begun can be found from a recent AAD dermatology practice survey showing a decline over the past ten years in the percentage of solo dermatologists practicing in the United States.  In 2007, 44% of dermatologists were in solo practice, but by 2014 that number had dropped to 35%.  Further, the percentage of dermatologists in dermatology specialty group practices and multispecialty group practices averaged 50-60%.  While there can be many explanations for this dramatic change to have occurred, one reason might be that providing the best possible patient care requires a level of knowledge most easily done by subspecialists affiliating with one another rather than practice alone.  Further subspecialization in dermatology will continue to deal with the scientific advances that emerge in the future.

NEXT: Research in dermatology

Research in dermatology

I believe the advances seen over the past ten years in biologic agents, monoclonal antibodies, cultured stem cells, growth factors, laser and light instruments, immunohistochemistry, chemotherapy, wound healing, cosmetic surgery, and a host of others will continue. My biggest concern is that, under the future healthcare delivery system, which is likely to be single-payer in nature, will there still be sufficient governmental and private monetary support to permit the unfettered pursuit of research.

The demand for dermatologic services

I believe the current high demand for dermatologic services will continue unabated in the future. While new university residency training programs in dermatology may develop in the future under some new healthcare delivery system, current growth has been hampered by federal budgetary shortfalls. 

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To make up for what I believe will be an overwhelming continued demand, I believe more mid-level practitioners will be trained in the future. These mid-level practitioners may practice alongside dermatologists or they may be required to locate in underserved rural or urban areas.

The Practice Setting

The complexity of treating patients as the new advances occur is not only limited to diseases and treatments; added administrative requirements that are likely to evolve as well. Already, in today’s world it is often more efficient and cost effective to divide responsibilities among a group of non-physicians, like accountants, lawyers, human resource officers and other trained individuals who can deal with the current complex insurance company, licensing bodies and governmental regulations, including the Clinical Laboratory Improvement Amendments (CLIA), the Health Insurance Portability and Accountability Act (HIPPA) as well as the use of the electronic medical record (EMR). 

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As voice recognition programs continue to improve, I predict that in the future the entire patient visit will be electronically recorded and automatically added to the EMR.  Of course, given that the entire healthcare delivery system is likely to change as frequently as the political tides, none of the current regulations may even exist in the future. (I know, I know, when did I bump my head?) On the other hand, it could be even worse with even more governmental intrusions.

NEXT: The healthcare system

The healthcare system

The options for future healthcare delivery systems are relatively few in number, especially since I believe that most current private health insurers will cease to exist in the future as an effort will be made to have all people covered under one system that is managed and paid for by the government.

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During the current presidential debates there has been discussion of “single-payer” systems similar to an expansion of our current Medicare system or a “socialized medicine” system similar to our current Veterans Health Administration system where the government pays the bills, employs the physicians and healthcare providers and also owns the facilities. 

My personal prediction is that the most likely future healthcare system will be of the single-payer type, perhaps with some affiliation with a small number of select private insurance companies.

Conclusion

No matter what happens over the next several decades, I remain optimistic about the future of the specialty of dermatology.  Certainly changes can be anticipated in the future, but I believe our specialty has worked very hard as a group to scientifically advance the care of our patients with skin disease and that must never be allowed to diminish.