Dermatologists Dispensible?

The Importance of Board-Certified Dermatologists and Supervised APPs in Healthcare Systems

Since 2008, I have provided in-hospital and extensive healthcare system dermatology consultations because of my strong belief in the value of the knowledge and care board-certified dermatologists have to offer the healthcare community and our community at large.

Dermatologic care is a crucial component of comprehensive healthcare, with skin diseases being among the most prevalent health problems globally. Dermatologic conditions, both physically and psychologically impactful as well as life-threatening, necessitate specialized knowledge for effective management. The inclusion of board-certified dermatologists and adequately supervised Advanced Practice Providers (APPs) within healthcare systems is vital for several reasons:

1. Prevalence of Skin Diseases: Skin diseases affect millions worldwide, indicating a high demand for specialized dermatologic services. Studies estimate that over one billion people are affected by skin conditions, highlighting their status as a significant health issue.1

2. Psychological Impact: Skin diseases have a significant psychological burden on individuals, affecting their quality of life, emotional well-being, and self-esteem.2 Dermatologists play a key role in mitigating these effects.

3. Specialized Knowledge for Effective Management: Dermatologists possess the expertise to diagnose and manage skin disorders. This specialized knowledge is essential for effective treatment and prevention of complications, as emphasized by research in JAMA Dermatology.3

4. Skin Cancer Awareness: With the rising incidence of melanoma, dermatologists are critical for the early detection and management of skin cancer, reducing the likelihood of advanced and potentially fatal outcomes.4

5. Financial Savings: Dermatologists significantly reduce healthcare costs by detecting and managing skin diseases, especially skin cancer. Their expertise helps avoid advanced-stage treatments, which are more extensive and costly. By efficiently managing chronic conditions and reducing emergency department visits, dermatologists also prevent the escalation of skin issues into more severe and expensive stages, ultimately leading to substantial long-term cost savings.

6. Cost Savings in Hospital Settings: The involvement of dermatologists in hospital settings leads to cost-effectiveness by reducing lengths of hospital stays, avoiding surgical complications, optimizing resources, and lowering readmission rates.6

7. Need for In-Hospital Dermatology care: Board-certified dermatologists are essential for managing complex and critical hospital cases, addressing dermatological emergencies, controlling infectious diseases, collaborating with multidisciplinary teams, and ensuring timely diagnosis and intervention.7

8. Critical Role of Dermatologists in Diagnostic Accuracy: The specialized knowledge of dermatologists is paramount in accurately diagnosing skin conditions, a task often challenging and prone to misdiagnosis. Misdiagnoses can result in unsuitable treatments, escalated healthcare costs, and extended patient distress. Dermatologists' expertise is crucial for correctly treating common dermatological issues and early detecting severe conditions like melanoma, significantly improving treatment outcomes. A study in the International Journal of Dermatology underscores that board-certified dermatologists frequently provide more precise diagnoses than primary care providers, markedly enhancing the quality of patient care, especially in hospital settings.8 This precision in diagnosis is instrumental in ensuring patients receive appropriate and effective treatment, thereby minimizing complications and promoting better health outcomes.

9. Educational Role: Dermatologists also serve an educational role for patients and other healthcare providers. They provide valuable insights into skin care, prevention of skin diseases, and public health education, which are crucial for preventing skin diseases and promoting overall health.

Board-certified dermatologists and supervised APPs are indispensable in healthcare systems. Their expertise ensures holistic care by considering these conditions' physical and psychological impacts. Their role in hospitals is particularly critical, offering specialized knowledge that enhances patient outcomes and contributes to cost-effective healthcare delivery. They must be included and adequately supported to perform the role they have dedicated themselves to.

REFERENCES:

1. Hay, R.J., Johns, N.E., Williams, H.C., Bolliger, I.W., Dellavalle, R.P., Margolis, D.J., ... & Naghavi, M. (2014). The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions. Journal of the American Academy of Dermatology, 70(5), 788-798. doi: 10.1016/j.jaad.2013.12.018. This comprehensive study provides an analysis of the global prevalence and impact of various skin conditions, establishing the widespread nature of dermatological health issues.

2. Basra, M.K.A., Fenech, R., Gatt, R.M., Salek, M.S., & Finlay, A.Y. (2009). The Dermatology Life Quality Index 1994-2007: A Comprehensive Review of Validation Data and Clinical Results. Journal of the European Academy of Dermatology and Venereology, 23(4), 385-392. doi: 10.1111/j.1468-3083.2009.03157.x. This review assesses the psychological impact of skin diseases on quality of life, emphasizing the significant emotional and social effects of dermatological conditions.

3. Kovarik, C.L., Tejasvi, T., Pizarro, M., Lipoff, J.B., & Imaeda, S. (2015). The Global Burden of Skin Disease: Role of Dermatology in Patient Care and Public Health. JAMA Dermatology, 151(5), 478-479. doi: 10.1001/jamadermatol.2014.5372. This article discusses the crucial role of dermatologists in the management and care of skin diseases, highlighting the need for their specialized skills in healthcare systems.

4. American Cancer Society. (2022). Key Statistics for Melanoma Skin Cancer. This resource provides data on the incidence and prevalence of melanoma, underscoring the growing concern and the importance of early detection in skin cancer management.

5. Aneja, S., Aneja, S., & Bordeaux, J.S. (2014). Early Detection of Melanoma: An Overview of Current and Future Diagnostic Tools. Journal of the American Academy of Dermatology, 71(4), 717-726. doi: 10.1016/j.jaad.2014.03.041. This study demonstrates the financial benefits of early melanoma detection in terms of healthcare costs.

6. Rasmussen, B.S., Waymack, J.R., & Maender, J.L. (2016). The Value of Dermatologic Consultation for Hospitalized Patients: A Prospective Study of Dermatology Inpatient Consultations. JAMA Dermatology, 152(3), 325-330. doi: 10.1001/jamadermatol.2015.5455. This research explores the cost-effectiveness and value of dermatologic consultations in a hospital setting.

7. Piliang, M.P., & Kolodney, M.S. (2011). Hospitalist Dermatology: A Prospective Study on the Consultative Dermatologic Care of Hospitalized Patients. Journal of the American Academy of Dermatology, 65(4), 801-807. doi: 10.1016/j.jaad.2010.08.026. This study discusses the role of dermatologists in reducing hospital stay lengths and the importance of their involvement in inpatient care.

8. Int J Dermatol. (2016). Dermatology Consultations Significantly Contribute Quality to Care of Hospitalized Patients: A Prospective Study of Dermatology Inpatient Consults at a Tertiary Care Center. 55(10):e547-51. doi: 10.1111/ijd.13327. This study highlights the improved diagnostic accuracy and quality of care contribution by dermatologists in a hospital setting.