Dermatologists need to work to change physician perceptions of the specialty

0814-Perceptions

Elizabeth Martin, MD, (left) and Mary Maloney, MD, discuss the perceptions of dermatologists among other physicians.

Dermatology has a perception problem. Some physicians recognize that dermatologists are the experts in diagnosing and treating skin cancers and other dermatologic conditions. Other physicians also see dermatologists as difficult to access, reluctant to see patients in hospitals, and more interested in lucrative cosmetic procedures than in less well-paid medical work.

“For the vast majority of dermatologists, those perceptions are a myth,” said Elizabeth Martin, MD, president of Pure Dermatology & Aesthetics in Birmingham, Alabama. “But those misperceptions commonly exist. We need to be concerned because as health care models are changing, we are moving toward a team approach. In some models, primary care physicians are the gatekeepers. We must ensure that dermatology and dermatologists are seen as important and relevant parts of the patient’s overall health.”

Dr. Martin was the featured speaker at “What Your Fellow Physicians Think of You and Why it Matters” (F021) on Aug. 9. It does not matter that physician perceptions of dermatologists as being difficult to access, unwilling to participate, and focused on cosmetic procedures are inaccurate because the perceptions are there. And for many people, perception becomes reality.

“You have to remember that perception, true or not, can spread faster than reality,” she said. “Perceptions can be very stubborn and difficult to change. Whether those perceptions are true or not is almost irrelevant.”

Mary Maloney, MD

Mary Maloney, MD

The session grew out of Academy research as well as personal experience, said Mary Maloney, MD, the session director and director of dermatologic surgery at the University of Massachusetts Medical School and chief of dermatology at University of Massachusetts Memorial Health Care in Worchester, Massachusetts. Many physicians recognize that dermatologists play a key role in the diagnosis and treatment of significant dermatologic conditions. But a few negative encounters can shift a clinician’s perception of the entire specialty.

“If dermatologists choose not to engage with the house of medicine at this crucial time of change to health care, that only perpetuates the idea that we’re not team players,” Dr. Maloney said. “Remember the aphorism that all politics are local? All reputations are local, too. It is important that each of us reach out to other physicians and other specialties and work with them to improve health care.”

Elizabeth Martin, MD

Elizabeth Martin, MD

Changing a reputation is slow work, but it can be accomplished. The key is to address misperceptions in thoughtful and methodical ways, Dr. Martin said.

In terms of access, dermatologists should make sure their practice scheduling procedures provide flexibility to immediately see patients with acute problems. Make sure the schedule can accept referral patients in a timely manner, not two months from now.

When other physicians make a referral, get a report back to that referring physician immediately, not next week.

“It is important to work with the patient who was referred, but it is just as important to work with the referring physician,” Dr. Martin said. “Keeping that other physician informed is also part of patient care.”

Most dermatologists have office-based practices and little to no contact with local hospitals, Dr. Maloney added. The office focus makes it easy to forget that the hospital is a cornerstone of care for most specialties and most physicians. That same office focus can be a factor in other physicians’ perceptions of dermatologists as standoffish and reluctant to contribute to the larger health care community.

“Recognize that perception and take direct steps to change it,” Dr. Maloney said. “Do hospital rounds and consults. Volunteer for hospital committees. If there are multiple dermatologists in your community, agree on who will play what role in changing those perceptions. If one dermatologist lectures to primary care physicians, another can work with ob/gyns; everyone can become more active with hospital care. Create a place for dermatology and dermatologists in your community. Make it a priority to change those misconceptions and introduce some reality about who we are and what we have to offer.”

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