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Dr Wirtzer's thoughtful letter supports my belief stated in the essay that the current controversy in the United States surrounding teaching dermatology to nondermatologists centers about the access problem. Further, I stated that any national health plan that would limit direct access by patients to specialist's care presented serious problems that our profession is working hard to respond to and to rectify.
I am quite aware, as are all practicing dermatologists, that dermatology is one of several specialties that traditionally receives a minority of patients through direct physician referrals. In a free market, most patients with skin complaints make the decision about when and whom to consult. I am also aware that primary care physicians in general, and for quite understandable reasons, have difficulty in recognizing common dermatologic problems.
In a managed care system, I would prefer having primary care physicians who were able to recognize a skin condition in the
Johnson MT. Should Dermatologists Teach Nondermatologists?-Reply. Arch Dermatol. 1995;131(3):356–357. doi:10.1001/archderm.1995.01690150121029
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