Are primary care physicians replacing dermatologists?

[erasable]

I'm reading a residency guide to decide which specialty I'd like to go into. I leaned towards optho in ugrad. But my dad's friend is a dermatologist, and he is one of the happiest, most content physicians I know. I do have a concern which was brought up by the book:
"With the increase in managed car, many patients who once would have been referred to Dermatologists are now being treated by primary care practitioners, decreasing the need for Dermatologists."

Question:
How legitimate is this statement?
What can I do about it if I become a dermatologist?

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[sdnetrocks]

I'm reading a residency guide to decide which specialty I'd like to go into. I leaned towards optho in ugrad. But my dad's friend is a dermatologist, and he is one of the happiest, most content physicians I know. I do have a concern which was brought up by the book:
"With the increase in managed car, many patients who once would have been referred to Dermatologists are now being treated by primary care practitioners, decreasing the need for Dermatologists."

Question:
How legitimate is this statement?
What can I do about it if I become a dermatologist?

Well, I guess you could manage your dermatology patients' primary care problems...

 

[cdql]

How legitimate is this statement?

I would say legitimate. Why bother with the hassle of scheduling an appointment with one of the few derms in town (and then waiting 6 months before going to see him/her) when you can go in and see your primary care doc for the same treatment?

Then again, once that same primary care doc botches your botox/misdiagnoses your rash/burns you in an attempt to remove a wart/etc.../etc..., you'll be back to the dermatologist!

All in all, dermatologists are trained differently than primary care docs. If you have good training and have good skills in dermatology, there will always be a market for you.

 

[PathOne]

Unfortunately, it is a very common misconception, that you NEED to be board certified in a specific specialty in order to treat patients within that field. The truth is, that once you have a full and unrestricted medical license, you can (in theory) treat anybody for anything. So a Dermatologist can perform heart surgery, and a surgeon can treat Derm patients. And yes, in theory, a FP physician can treat ANY Derm issue that s/he is comfortable with.

Of course, reality is different, mainly governed by hospitals extending privileges, insurers providing mal prac insurance, and healthcare organizations. Also, common sense makes it somewhat unlikely that you should treat patients for something you weren't trained to do.

But to get back to the OP: Yes, needs for different physicians changes over time. However, it's very difficult to predict how use will shift. Yes, an increasing number of FP physicians have taken on some Derm procedures. However, this has not lead to any problems whatsoever for Derms. Also, Dermatologists have started performing certain procedures which was previously mainly care for by others, notably certain plastic surgery procedures.

The main question is, how the compensation structure will evolve in the future. Currently, compensation is generally structured in a way that probably on average makes Dermatologists the highest paid physicians measured in pay per working hour. That, of course, can change. Will it change? That's simply impossible to say at this point.

So choose the field that interests you the most. With the current US demographics there's unlikely to be any drop in demand for medical services, regardless of your chosen specialty.

 

[deleted87716]

Then again, once that same primary care doc botches your botox/misdiagnoses your rash/burns you in an attempt to remove a wart/etc.../etc..., you'll be back to the dermatologist!

Oh, please...spare me.

I have an excellent relationship with my local dermatologists. Believe me, they don't want me sending them run-of-the mill acne, eczema, seb derm, psoriasis, tinea, rosacea, etc. any more than any other specialist would want to waste their time seeing trivial conditions that are easily treated by primary care physicians. It's also not fair to the patients to make them wait 3+ months for an appointment with a dermatologist who's going to spend less time with them and charge them a higher co-payment for the same treatment. I respect my specialty colleagues enough to not waste their time with silly referrals. When I send them a patient, they know it's a good one (read: somebody who's been properly worked up and actually needs to see a specialist).

As for the O.P.'s original question, nobody in primary care can replace a dermatologist, nor would anyone in their right mind think that. There will always be a job for the specialist, just as there will always be a job for the generalist. Patient care is a team effort. Getting territorial just makes you bitter, not better.

Trust me...there's enough skin disease out there to keep us all busy.

 

[cdql]

?

I think we made the same argument?

The training is different enough so that primary care physicians will continue to have patients as will dermatologists. There's enough jobs to go around for everyone.

 

[tuscanito]

I wonder why our authorithies have so little brain? i mean if there are people waiting 3 moths for a dermatologist, why not train, put, pay more derms? i really can't understand this stupid market thing but i guess our medical society need common sense!!!

 

[ny skindoc]

I'm reading a residency guide to decide which specialty I'd like to go into. I leaned towards optho in ugrad. But my dad's friend is a dermatologist, and he is one of the happiest, most content physicians I know. I do have a concern which was brought up by the book:
"With the increase in managed car, many patients who once would have been referred to Dermatologists are now being treated by primary care practitioners, decreasing the need for Dermatologists."

Question:
How legitimate is this statement?
What can I do about it if I become a dermatologist?

Most primary care docs see skin problems as part of their routine practice, and for peds and FPs its very common.They are generally able to treat basic stuff.
However their skill level varies tremendously.Anyone who has recalcitrant or more complicated skin issues will invariably want to see a dermatologist if possible.And most primary docs are only too happy to send them.
The reality is that the number of derms in practice and in training is so low that there is a severe shortage dermatologists in many parts of the country.
The American Academy of Dermatologists has actually been attempting to increase the number of residents in training programs,but its all government funded and there is little federal interest in spending more on residency positions in general especially derm.So I would not worry about getting patients if you become a dermatologist..as you will be busier than you can handle in most places.

 

[PathOne]

Actually, it's not only the gov't that's reluctant to fund Derm Residency spots. A lot of hospitals really aren't that keen on Derms either. Think two scenarios:
1) Pt. A needs surgery. Not fancy liver-transplant stuff, but still surgery. S/he would need a whole host of hospital services, probably including rads, anesthes., surgeons, obviously, perhaps path, nurses galore, a hospital bed, etc, etc... Lots of billable items.
2) Pt. B is concerned about a dark mole on her left elbow. The Dermie would look at it. Take a biopsy. Send it to a Dermpath (probably external), and probably elect to remove it, perhaps under local anesthes. Not a whole lot of need for support services, nurses, real estate or "machines that go beep".

While Dermatology may be lucrative from the physician point of view, it's not really so from a hospital point of view. It just doesn't generate that much revenue per patient. So it's hard to see why hospitals should be really keen on expanding their Derm departments.
So while it's certainly true that demand currently, and for the forseeable future, outstrips supply, a fair bet would be that Derm would continue to be a rather small band.

And, again, the whole FP vs. Derm is really a non-issue. FP's refer patients to Derms, and will continue to do so. As stated above, FPs can, and will, treat the obvious, but will equally obviously refer to a specialist if it's even slightly complicated. A few probably wouldn't, but that's really people who have other issues regarding their ability to know what they can and can't treat.