As members of the Medical Dermatology Society, a group formed 4 years ago to address educational and professional survival issues related to the care of our sicker patients with medical dermatologic problems,1 we would like to respond to the editorial written by Lynch2 about the future of medical dermatology. We agree that medical cosmetology is attractive to physicians in our field, while the care of our sicker patients with medical dermatologic problems is being relinquished to nondermatologists, but it is important to state why. Even in many academic centers, there is no longer any mechanism to fund the expertise and time required for physicians to care for sicker patients with serious dermatologic problems. With declining reimbursements, it is difficult to support the time required to manage complex patients, let alone maintain or acquire the knowledge base required for care of such patients. Patients with serious dermatologic problems are traveling farther to access the few surviving experts, and if the system does not change, there will be no one to replace us.
Werth VP, Sontheimer RD, Piette WW, Lee LA. The Proper Future for Medical Dermatology. Arch Dermatol. 1998;134(9):1159-1160. doi: