The State of Dermatology: An ever-evolving field of medicine.

By Kenneth R. Warrick, MD, FAAD | Dermatology and Laser Center of Charleston

As one of the senior dermatologists in South Carolina, I have witnessed how the field of dermatology has changed over the past third of a century.  Among the major trends are:

• Broadening of the array of treatment modalities such as newer classes of pharmaceuticals and cosmeceuticals, and newer physical modalities as well.Improved electronic means of rapid access to and “crunching” of medical data to enable more evidence-based assessment of our diagnostic techniques and treatments;
• The shift from male to female predominance among new graduate dermatologists;
• The shift towards more cosmetic procedural practice patterns;
•  Freezes on number of dermatology residency slots;
•  Earlier retirement of those dodging reimbursement changes and the switch from paper to electronic medical records, all of which result in markedly fewer traditional medical/surgical dermatologists per capita; and
• Medical school curricula are devoting fewer and fewer hours to teaching dermatology—the subspecialty with the largest number of separately identifiable diseases—further widening the knowledge gap between specialties.

While all of the above factors have had strong impacts on the field, the cost to bring a new drug to market, from test tube to pharmacy, has also skyrocketed.  With ever-increasing economic pressure from governmental and private insurers, decisions of pharmaceutical manufacturers must be closely tied to profitability.  Prohibition of discounts have made many medications unobtainable by patients covered under Medicare, Medicaid, Tricare, and even government employee health insurances.

In some instances the newer classes of pharmaceuticals have been associated with newly described adverse reactions.  Protocols have been developed for dealing with such reactions to enable the continuing use of non-substitutable anti-cancer drugs.

We are seeing an alarming increase in skin cancer cases with reports being published regularly about this climb.  This and the increased cost of pharmaceuticals have stretched both patients’ and insurors’ healthcare expenditure budgets to the max, while dermatologists are working to find the middle ground in providing affordable treatment solutions.