President-Elect calls on members to come together

0305-Coldiron

Brett Coldiron, MD

Brett Coldiron, MD, found great satisfaction when he began his medical career as a general internist, but it wasn’t enough. “As an internist, I ordered tests, organized their medicines, and felt satisfaction when their breathing improved or their glucose normalized. I made friends with my patients and was dismayed when they declined and sometimes died. It broke my heart. I rotated on dermatology, where most of my patients got well. It is so gratifying to be able to cure someone,” said Dr. Coldiron, a dermatologist in private practice in Cincinnati. “I finished my training and passed my boards, but dermatology was where I decided to practice.”

Dr. Coldiron’s dedication to patients is among the many passions he brings to his role as president-elect of the Academy.

“As long as we stay focused on what is best for our patients, we will persevere and we will come out through this maelstrom of change,” he said. “There are some definite hurdles, but we have a unique skill set and we are valuable. As long as we stay united and support one another, I think we will do okay. We are a very small specialty, and we can’t afford any division in our ranks.”

Dr. Coldiron pointed to five areas that he sees as threatening for dermatologists — areas that require action.

Tight networks

“We are experiencing the phenomenon where insurance companies are no longer enrolling a large number of specialists, including dermatologists, in their networks, which is a major impediment to patient access,” Dr. Coldiron said.

He added that while insurance companies may claim they have large numbers of dermatologists in their networks, a closer look at their rosters reveals they are about 70 percent inaccurate.

“An AADA analysis of dermatology rosters of United Healthcare Medicare Advantage Plans in Boca Raton, Fla., Hartford, Conn., Providence, R.I., and Cincinnati, found that 70 percent of the advertised dermatologic capacity in the plans’ directories was made up of people who were either dead, retired, had moved, were no longer seeing new patients, worked part-time, or focused exclusively on dermatopathology or Mohs surgery,” he said, adding that patients will not realize the impact until they get sick and cannot access a doctor.

Dr. Coldiron said the AADA’s position strongly asserts that insurance companies should maintain accurate and adequate physician providers in their networks. “Very sick patients who need to see their dermatologists regularly may have to change insurance plans in order to continue to see the dermatologist. This is disingenuous and a way for plans to deselect their sickest patients,” he said.

Large group versus small group practice

Dr. Coldiron expressed concern that the overall impetus of the health care reform bill is to create larger groups. “We are a specialty with a majority of our members in one- to two-person practices. I am afraid the larger groups being formed will ration patient access to dermatologists. We need to develop tools for smaller groups to integrate if they want to,” he said.

Data

Data registries are needed to show that dermatology is effective and cost-efficient. “This seems obvious to us, but payers and the government are demanding hard data,” Dr. Coldiron said, adding that data registries are very expensive to set up and maintain.

Engagement

Dr. Coldiron emphasized that dermatologists need to become more active politically, should support their specialty’s activities, and consider personal donations to their local representatives. He also expressed the importance of joining the AMA so that dermatologists can continue to have representation in the house of medicine and at key committees, including the CPT and the RUC.

“I know everyone gets sick of the pleading for money, but our specialty is under attack and this won’t just blow over,” Dr. Coldiron said. “You have to become engaged. If you don’t, we are going to lose patient access to our specialty.”

Specialty positioning

Dr. Coldiron said a publicity campaign is needed “to burnish the image of our specialty. This will also be very expensive and an investment we should consider. This type of activity is not currently in our budget but could be funded by a special assessment dues increase.”

Membership needs to take a stand for the good of their patients, he said.

“As physicians, we must advocate for patients. At the top of our advocacy agenda is to make sure that patients are allowed to see dermatologists — we are the specialists in skin care,” Dr. Coldiron said. “When patients aren’t allowed to do that, they suffer. What we do is valuable. Our patients come first.”

The specialty will be greatly diminished if those in the field do not pull together, he said.

“The Academy will continue to do its part as the parent organization for all of dermatology,” Dr. Coldiron said, but also emphasized that the effort must be collective. “We are going to need to pull together or we are going to be greatly diminished as a specialty.”

Despite the ongoing challenges, however, Dr. Coldiron remains resolute in his optimism.

“Skin disease is difficult to treat. We have critical, specialized knowledge about the best treatment modalities. You have to have the right kind of mind. You have to have the right eye. You have to have a certain skill set to be a good dermatologist,” he said. “I am optimistic because we are needed. Things will swing back our way. Patients want to see us. I think we have a unique value equation for American medicine.”

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