It’s time for teamwork in dermatology


RRegardless of specialty, no physician can truly provide patients with the care they deserve if they practice in isolation. In recent years, the health care system has acknowledged this reality by embracing greater collaboration and team-based care. With an aging population increasing the prevalence of chronic disease and life-threatening conditions, the timing couldn’t be better.

For the field of dermatology, the American Academy of Dermatology’s recent Burden of Skin Disease report is a sobering reminder of the challenges ahead. The report found that in 2013 more than 84.5 million Americans — one in four — saw a physician for skin disease; nearly 50 percent of those over age 65 sought treatment, and have an average of 2.2 skin conditions. Skin disease is now more common than cardiovascular disease, diabetes, or end-stage renal disease.

These findings have significant impact on patients and the health care system. Half of the skin disease categories studied are associated with mortality, with skin cancer alone accounting for 60 percent of skin disease-related deaths. In 2013, the direct costs of skin disease totaled $75 billion, and patients and caregivers suffered $11 billion in lost productivity due to their skin disease.

Roughly 20,000 clinicians are needed to treat that volume of skin disease — twice the number of board-certified dermatologists in the United States. We are taking a hard look at ourselves to determine how we can transform dermatology to meet today’s health care environment and patient needs.

What’s most clear is that we cannot go it alone. We need to work closely with physicians trained in other specialties to help meet the needs of patients with skin disease. Dermatologists must increasingly focus where their training is most needed.

This will be easier said than done. Many people do not realize that the scope of dermatology is far more than “skin deep.” Skin health is inextricably linked to everything from cardiovascular disease and neurological health, to mental health and sleep medicine — which is why greater collaboration with primary care physicians and other specialists is so critical to caring for our patients.

We won’t accomplish this overnight, but we’ve made important strides — through programs that teach primary care colleagues about common dermatologic diseases, by opening joint clinics with appropriate specialties, and by increasing hospital consults. Dermatologists are piloting and spreading practice management techniques to increase availability to patients while maintaining a high standard of quality and safety. We’re increasingly working in teams to improve the diagnosis and treatment of rare and serious conditions. We’re exploring how to strengthen and diversify the makeup and location of dermatologists.

As dermatologists, we know that the health of our patients’ skin is intrinsically connected to every other aspect of their physical and mental health. Ultimately, if we want to truly provide the best care we can for our patients, we must forge stronger partnerships with our colleagues throughout the house of medicine.

Henry W. Lim is president, American Academy of Dermatology

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