Tracking today's trends

Knowing what these trends are - and being aware of various attitudes toward them - is an important component in shaping, revising or affirming one's own practice philosophy.

Dermatology Times asked several dermatologists to contribute their views on current trends that are having an impact: the shortage of dermatologists; reimbursement dilemmas; the increase in cosmetic procedures and the demand for new treatments and drugs; technological advances; and the growing number of skin cancer cases as young adults' "tanning booth" mentality continues to prevail.

All of these doctors agree that there is a shortage of dermatologists in the United States - but there was no shortage of varying opinions on the issue.

"This has occurred because of the limited number of dermatology residency positions available in the U.S. and the liberal policy of most managed care companies in allowing patients to see dermatologists - albeit with increasingly poorer reimbursement," he says.

Alan B. Fleischer Jr., M.D., professor and chairman of dermatology at the Wake Forest University School of Medicine, Winston-Salem, N.C., says a "geographic maldistribution" also exists.

"Many dermatologists choose to practice in larger cities, making smaller towns relatively deprived of dermatology services," he says. "Medicare is unlikely to increase the number of training positions for which it pays, so in the near term the number of dermatologists is unlikely to increase substantially."

But more training slots may not be the answer to correcting the imbalance.

"If you just train more physicians, the balance will probably not be affected," according to Christopher Zachary, M.D., professor and chair of the department of dermatology at the University of California, Irvine, School of Medicine.

"There must be other inducements to persuade physicians to practice where they are needed."

Financial, technical considerations

"This is the direct result of power among insurance companies and the inability of physicians to stand up to them," he says. "It is also one of the many reasons that dermatologists have increasingly added non-insurance-reimbursable techniques to their practices."

Dr. Fleischer agrees.

"In most Western countries there is one payor - the government," he says. "In the U.S., there are huge numbers of payors. As long as we have thousands of insurance plans with which to contend, reimbursement is likely to be challenging to understand."

Dermatologists also face the challenge of keeping up with technological advances. Most embrace technology and the advantages it brings to their practices.

"Technology is good as long as it is well-tested and the marketing does not outdo patient efficiency," says Neil Sadick, M.D., clinical professor of dermatology at Weill Medical College of Cornell University.

"Of course, dealing with these changes means continuing to attend meetings and keeping up with the literature."