Biomedical subjects
Publications and source records attributed to Jack S Resneck.
Uninsured patients and those receiving Medicaid make up a smaller fraction of dermatology practices (5%) than would be predicted by their prevalence in the population (27%). We illustrate the ways in which insurance acceptance patterns and practice composition vary by the age, gender, practice type, and geographic location of the dermatologist.
BACKGROUND: Previous studies have shown long wait-times for general dermatology patients seeking routine appointments. No evidence has been gathered on wait-times for patients with urgent problems or on the impact of physician extenders on access to dermatologic care. OBJECTIVE AND METHODS: To evaluate access for patients with an urgent problem, we performed scripted patient telephone calls to 851 dermatologists to assess wait-times for both patients with Medicare and those paying out-of-pocket complaining of a changing mole. RESULTS: Mean wait-times were similarly long for patients paying out-of-pocket (38.2 days) and those on Medicare (38.9 days; P = .85). Acceptance rates and wait-times varied greatly by geographic area (range of mean wait-times, 19.7-73.4 days). Many dermatologists (23.3%) employed a physician extender, and the wait-times for these extenders (27.9 days) were significantly shorter than those for the physicians supervising them (45.8 days; P < .001). LIMITATIONS: The metropolitan areas sampled represented about one tenth of practicing dermatologists in the United States, and no remote or highly rural communities were included. CONCLUSIONS: Patients with a changing pigmented lesion, a possible indicator of malignancy, face wait-times just as long as those previously published for patients with routine complaints. Medicare patients did not experience any greater barriers to access. Although the use of physician extenders remains controversial, these practitioners were able to schedule patients more quickly than their supervising physicians.
OBJECTIVE: To analyze professional liability premiums in dermatology and factors associated with premium variation. DESIGN: This study examines data from a survey of dermatologists conducted in 2004. RESULTS: Survey respondents (n = 1095) reported mean medical liability premiums of $10,898 in 2004 (95% confidence interval, $10,295-$11,501). Premiums increased by 24.4% in 2003 and 16.7% in 2004. There was substantial variation by state, and mean premiums were higher in American Medical Association (AMA)-declared "crisis states" than in those states listed as "currently OK" ($11,669 vs $9527; P = .03). Premium growth from 2002 through 2004 was higher in AMA crisis states and in states without $250 000 caps in place for noneconomic damages. Even when excluding payment for cosmetic riders, premium levels were higher for dermatologists spending more than 10% of their time in cosmetic practice ($13,816 vs $10,185; P<.001) or more than 30% of their time in noncosmetic surgery ($12,551 vs $10,453; P = .01). CONCLUSIONS: While premiums paid by dermatologists for professional liability insurance in 2004 were well below those experienced by higher-risk specialties, geographic factors and state tort law variation seem to be affecting dermatology premiums in much the same way they affect the field of medicine as a whole.
BACKGROUND: There is a perception among many academic dermatologists that departments of dermatology face severe challenges with recruitment and retention of faculty. In an era when evidence points to a shortage of dermatologists and residency graduates have plentiful private practice offers in almost every geographic area, some fear that academic programs will face even steeper challenges attracting and keeping enough dermatologists on staff. METHODS: To compare the practice patterns of academic dermatologists with those of the dermatology workforce in other settings, data from the American Academy of Dermatology 2002 Practice Profile Survey were analyzed (1425 respondents, 35% response rate). RESULTS: The mean age of academic dermatologists (45.6 years) was younger than that of those in other practice settings (51.9 years solo practice, 49.0 years multispecialty group), and older age cohorts were significantly less likely to be working in academics (P < .001). Academic physicians were much more likely than those in solo practice or dermatology-only groups (62.2% vs 18.3%-39.4%) to report that their institution or practice was seeking new dermatologists. The average waiting time for new patient appointments varied from a low of 31.1 days in solo practices to a high of 55.9 days in academic practices. Academic dermatologists saw 32% to 41% fewer patients per week, but spent much more time (24.1 vs 5.5-8.6 h/wk) participating in research, hospital consults, medical writing, administrative activities, and teaching than dermatologists in any other setting. LIMITATIONS: Academic dermatologists reflected a relatively small proportion of survey respondents, and may not be representative of the nation's dermatology faculty (although the percentage of academics in the survey was similar to that in the overall workforce). Possible response biases could also have affected the survey results. CONCLUSIONS: The survey results identify a number of differences between the practice patterns of academic dermatologists and their colleagues in other settings, and suggest that academic departments of dermatology may be facing unique workforce challenges.
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CONTEXT: A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive. OBJECTIVE: To determine the etiology of PPE occurring in HIV-infected individuals. DESIGN, SETTING, AND PATIENTS: Cross-sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist. MAIN OUTCOME MEASURES: Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity. RESULTS: Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/microL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/microL; P = .02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/microL; P = .07) than those without histological evidence of arthropod bites. CONCLUSIONS: Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients.
OBJECTIVE: To examine the effect of age and other demographic factors on dermatologists' practice characteristics. DESIGN: Anonymous practice profile survey. PARTICIPANTS: Dermatologist members of the American Academy of Dermatology Association. MAIN OUTCOME MEASURES: Analyzed survey questions included information about legal practice entity, geographic area served, weekly patient care hours, patients seen per hour, and scope of patient care activities. RESULTS: Of 4090 surveys sent, 1425 (35%) were returned. As the age of the cohorts increased, the percentage practicing in solo practices increased (range, 21%-39%), as did the percentage serving urban areas (range, 31%-46%). Measures of physician productivity increased in the older age cohorts; however, age was not a significant factor after controlling for other variables. More patient-hours per week were associated with male sex (P < .001), solo practices (P < .001), and non-urban-based practices (P = .04), whereas a greater number of patients per hour was associated with non-rural-based practices (P = .02) and male sex (P = .03). As the cohorts progressed in age, more time was spent practicing medical dermatology. The number of hours spent practicing cosmetic dermatology peaked in the 41- to 50-year-old cohort (P = .03). CONCLUSIONS: Practice patterns differ significantly among dermatologists of different ages. As the current cohorts age and new dermatologists emerge from training, changes in scope of practice and generational differences in productivity are likely to cause a contraction in the effective supply of dermatologists, which has important implications for dermatology workforce planning.
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