Kerdel, with the assistance of Kirsner, has created a superb, internationally recognized dermatologic inpatient unit. Their patient census is high enough for them to maintain their general medical skills, and as a result, are able to provide excellent care for severely ill patients with complex dermatologic problems. I applaud their effort and support their suggestion that similar centers should be developed on a regional basis. This may not be easy to accomplish, especially in areas with heavily managed care. For instance, authorization for hospitalization of patients with severe skin disease but no complicating factors often is not possible. This fact has led to a marked reduction of the dermatologic inpatient census at almost all academic health care centers. Moreover, managed care providers do everything possible to keep their patients from being hospitalized "out of plan." Unless a regional center has contracts with essentially all health plans in its area, patients simply cannot access the unit.
Lynch PJ. Declining Interest in Medical Dermatology—Reply. Arch Dermatol. 1998;134(9):1161-1162. doi: