With much regret, I have to inform you that on August 11, 2010 the New Jersey Board of Medical Examiners rejected our petition for rulemaking. The Board’s position was that plenary license to practice medicine in the state of New Jersey entitles physicians to practice any specialty they choose. And as physician assistants’ duties are encompassed under the supervising physician’s scope of practice, the NJBME felt that PAs are adequately trained and supervised to provide dermatological services. The NJBME further rejected our proposal to define who is a dermatologist and who is able to advertise himself/herself as such. They perceived no compelling reason to single out dermatology for additional regulations as compared to other specialties.

The Board of the Dermatological Society of New Jersey does not share the NJBME’s position. The concept of a plenary license and a doctor who is a “jack of all trades” is generally useful and appropriate for the state licensure. Yet, there are certain specialties for which this concept proves detrimental. I can think of two such specialties: dermatology and, perhaps, plastic surgery.  While any plenary physician has the right to practice cardiac surgery, most physicians enter the field of cardiac surgery after completing a formal residency. The same is true not only for most highly skilled surgical specialties (brain surgery, urology, vascular surgery, orthopedics, and so on), but also for various other specialties which do not require a fine technical expertise with the scalpel (cardiology, rheumatology, pediatrics, etc.). Simple common sense stops physicians who are not adequately trained in a specialty residency from opening an office and calling themselves a specialist in a particular field. Physicians know that it is only a matter of time when an adverse outcome will cause a legal case destroying their career.

Enter dermatology. Our specialty is becoming a victim of the perfect storm. First, there is a perceived ease of diagnosing and treating skin diseases (“If it’s dry – wet it, if it’s wet - dry it”, “I have seen skin diseases in my primary practice – I can treat them just like the other guy”). Obviously, a physician who received no dermatology residency training has no idea that familiar common skin conditions are only the tip of the iceberg of what has been taught in the dermatology residency. Such a physician also lacks the skills (as many studies have shown) to diagnose skin cancer on par with a specialist in dermatology. The second part of the perfect storm is perceived high earnings in dermatology. That part makes physicians from lower-paid specialties abandon common sense and risk malpractice litigation while practicing a specialty in which they have no adequate training. Even worse is the fact that such physicians supervise physician extenders in the practice of dermatology.

Faced with similar problems as New Jersey, the Florida legislature had the foresight to see the problem and correct it. They adopted laws which ensured the protection of patients in their state. Our petition was based on Florida laws, but was rejected. We feel that there is a crisis in the specialty of dermatology in the state of New Jersey: putting our patients at risk. Such a crisis must be solved with additional regulation, despite the fact that such regulation may be applicable to only one specialty.

I am proud of our members who have written multiple letters to the NJBME and collected hundreds of patients’ signatures to support our petition. I want to thank everyone who participated in our efforts. Our conscience is clear. We have identified the quality problem affecting dermatologic care and brought it to the attention of the NJBME. Our fight is not over. Under the leadership of our incoming President, Dr. Sandra Vause and Vice President Dr. David Wrone the Dermatological Society will continue to look for ways to protect our patients.

On a different note, I would like to remind everyone about our upcoming meeting in Philadelphia on September 24-26.  Our meeting “piggy backs” the Pennsylvania Academy of Dermatology meeting. DSNJ members are invited to join the PAD meeting for a 3-day full CME program at a beautiful venue, the Westin Philadelphia. DSNJ will have its own business meeting on Sunday, September 26. During the meeting we will have the first ever presentation of two awards to two of our distinguished members. The “Lifetime Achievement Award” this year will be presented to Roger M. Brodkin, MD and the “Dermatologist of the Year Award” will be presented to Booth Durham, MD. Please join us at this meeting.

Sincerely yours,

Alexander Doctoroff, DO

President of DSNJ

Published 05 September 2010 - 0 comments (View/Post Comments)   

On July 14, 2010 Booth Durham, Rod Kaufmann, David Wrone, and myself testified in front of the New Jersey Board of Medical Examiners in support of our Petition for Rulemaking. Below are the main points we discussed.

• The Dermatological Society has heard numerous complaints about various physicians holding themselves out as dermatologists, when in fact they received no dermatology-specific training. 
• In addition, several New Jersey dermatology practices allow physicians not formally trained in dermatology to train and supervise physician assistants and other extenders engaged in the practice of dermatology.
• Physician assistants, estheticians, general practice doctors and internists do not necessarily have the expertise and additional years of training for treating the biggest organ of the body — the skin. 

• Board-certified and Board-eligible dermatologists are uniquely qualified because they undergo extensive training to evaluate and manage patients with benign and malignant disorders and cancers of the skin, contact dermatitis and other allergic and nonallergic skin disorders, and are experienced in the recognition of the skin manifestations of systemic and infectious diseases. 
• Allowing non-dermatologists to practice the specialty and further, to supervise physician assistants engaged in the practice of dermatology, not only provides a lower quality of dermatologic care, but increases the risk of misdiagnoses and harm to patients.         

We also provided some rebuttal points to the issues raised at the public hearing at the NJ BME’s May 12, 2010 meeting:

• In his statement to the Board on May 12, 2010, Dr. Geffner stated that the patients in the state are not receiving sufficient dermatological services.  First, he did not provide any studies or facts to substantiate his position.  At best, he provided only anecdotal information.  As the Dermatological Society, we are unaware of complaints about the inability of patients to see qualified Dermatologists.  A recent article in the JAAD (June 2009) has studied the wait time for dermatologic appointments in Boston.
• http://www.eblue.org/article/S0190-9622%2809%2900085-1/abstract

The Boston area is in many ways similar to New Jersey, being a large North-Eastern metropolitan area.  Patients making one call to each dermatologic practice on average obtained an appointment in 18 days.  Patients calling two practices were offered an appointment on average in 7 days. Patients calling 3 practices were also offered an appointment in 1 week.

This experience is similar to what is happening in New Jersey.  Some areas in the center of the country do experience shortage of dermatologists.  In our area the supply and demand appear to be matched. 

• The opposition of Christopher Hanifin, PA centers on the fact that he believes that PAs are over-regulated in New Jersey.  While we certainly do not wish to burden any professionals with additional unnecessary regulations, we do not feel that our proposal is unreasonable.  If a regulation is needed to protect the patients of New Jersey, then the regulation should be enacted.
• An additional point raised at the May 12, 2010 meeting was that we did not obtain evidence about the harm caused by improperly supervised PAs and non-dermatology trained practitioners advertising themselves as dermatologists. The evidence like this is difficult to obtain. The time for melanoma recurrence, or the time for melanoma or other missed skin cancers to kill the patient can take many years. It is the consensus opinion among our members that patients can be harmed if we continue to allow improperly supervised PAs and non-dermatology trained practitioners to mislead patients into thinking they are dermatological specialists; this is especially true when it comes to serious cancers; patients should not be misled into thinking the practitioner they are seeing is fully qualified to treat these diseases.
• Because of these concerns, the state of Florida recently adopted similar, even somewhat more stringent regulations to protect their patients. Our patients deserve similar protection.
• At the May 12, 2010 meeting, Matthew McQuillan, PA raised the issue on whether other specialties will be impacted by our petition.  We have emphasized to the BME that the purpose of our petition is limited to regulating physicians and physician-extenders who hold themselves out as specialty trained in dermatology when they lack such qualifications.  It is not our intent to unreasonably regulate other health care professionals who are not holding themselves out as specialists in dermatology.

On behalf of the Dermatological Society, we strongly urged the Board to adopt our proposed regulations.  The Society also offered its assistance and expertise to the Board in its consideration of our petition. 

The Board also heard from several physician assistants opposing the petition. The main talking point of these speakers was that they are not happy with any additional regulation of their profession. They felt that existing laws preventing false advertising are sufficient to fix the existing problems. They also stated that changes in one specialty (dermatology) may create a slippery slope of regulation of other specialties.

We feel that these arguments are without merit. Clearly, the existing laws are not being enforced. Additionally, if a regulation is needed to protect the patients of New Jersey, then the regulation should be enacted. There is a clear danger to patients from the status quo. We feel that the legal loopholes need to be closed to protect the patients in New Jersey.

Our fight for quality dermatological patient care is at a crucial juncture. To improve our chances of success we need the support of those whom we are trying to protect: our patients.  Please post the  documents in your waiting rooms for patient signatures. We need to collect as many signatures as possible.  As soon as the signatures are collected, please fax to them to NJBME (609) 826-7117 and to the Dermatological Society at (856) 546-5601 .  Remember, our opponents are being very aggressive in collecting signatures.  We should be too.

I have found that an explanatory flyer is very helpful in describing our goals. Patients are becoming very angry at the present situation. They are extremely willing to support our petition.

Please put your practice name on the page with collected signatures.

Thanks for your support for our cause,

Alexander Doctoroff, DO

President DSNJ

Published 25 July 2010 - 0 comments (View/Post Comments)   

The Dermatological Society of New Jersey was created in 1935 as an educational and social organization. It has a long-standing history of academic excellence in providing outstanding didactic lectures to dermatologists in the state. We have four regional chapters (Northern, North-Central, South-Central, and Southern) serving dermatologists all over the state. Over the past year we set a goal to create a modern, “full-service” medical society. The Executive Board of our Society has established the first state-wide meeting for our members. In addition to educating our members, we initiated campaign to educate general public about dangers of excessive sun exposure and methods of sun protection. We also became involved in creating regulations ensuring the best dermatologic care for patients in our state. Additionally, we have been working on bringing valuable benefits for our members. The most significant of our activities for the past year are included below.

The 1^st Annual Meeting of the New Jersey Dermatological Society was held at the Hilton Hotel and Casino in Atlantic City. The meeting was a resounding success. We had a 6-hour Cultural Competency CME course, educational lectures, as well as a discussion session about the structure and goals of our Society. The dates for our 2^nd Annual Meeting have been set for 2010. The DSNJ Annual Meeting in 2010 will be held jointly with the Pennsylvania Academy of Dermatology in Philadelphia, PA.  As our meeting format is still in nascent stages, we are trying different venues to determine which is most conducive to our purpose. Ultimately we will arrive at what suits us best.

We started the campaign of educating the public on sun protection and skin cancer prevention. Right before the summer, we sent our “Top ten sun safety tips” for publication in various media outlets. Two of them (Healthywomen.org  and Warren Reporter) picked up our story.

 I was interviewed for 101.5 radio station providing listeners with advice on sunscreen use. We also created the following public service announcement aired on multiple radio stations during the month of May

Did you know that more than 90% of skin cancer is caused by sun exposure? May is National Skin Cancer Awareness Month. The American Cancer Society estimates that 1.5 million cases of skin cancer will be diagnosed this year. Skin cancer is preventable and treatable if caught early. Protect yourself from harmful ultra-violet rays by using sun block, wearing long-sleeved shirts and pants whenever possible and checking your skin often for signs of damage. For more information visit www.aocd.org or www.aad.org and talk to your dermatologist. 

Our Society has been at the forefront of ensuring quality dermatological care for patients in this state. Over the past decade, the number of non-dermatology physicians who practice dermatology without doing a formal dermatology residency has skyrocketed. Dermatology residency is a 3-year training program after the first year of internship. The training includes learning of skin cancer detection and management, examination of skin specimens under the microscope, skin surgery, adult and pediatric dermatology, cosmetic procedures, and so on.  No one can dispute that such training is necessary to become a dermatologist. Self-study and weekend courses do not produce dermatologists. Yet, it is not against the law in New Jersey for, say, a family practitioner or internist, or even a physician with one year of training after medical school, to open their practice and specialize in dermatology without doing the training in our specialty.  Multiple studies have shown that residency-trained dermatologists are superior to primary care physicians in the detection of melanoma, which is the deadliest skin cancer.

We feel that patients who go to see a specialist in dermatology have the right to know that their doctor is, indeed, a dermatologist. We also feel that physician who presents himself or herself as a dermatologist without doing residency training in dermatology is misleading the public. Dermatological Society of New Jersey intends to make sure that non-dermatology physicians cannot call themselves dermatologists in their advertisements to the public and in their representation to insurers. 

 Even more outrageous situation exists for physician extenders (physician assistants and nurse practitioners). The laws in our state allow any physician to train and supervise (or collaborate with – in case of the nurse practitioners) physician extenders. It means that a non-dermatology physician who is himself or herself is not formally trained in dermatology would be in charge of care rendered by a physician extender in dermatology. We are of the opinion that only Board Certified or eligible dermatologists should be allowed to supervise mid-level providers engaged in the practice of dermatology. This situation is not unique to New Jersey. Florida has recently passed laws which limit the supervision of dermatology physician extenders solely to dermatologists. We need to change the regulations to prevent severe compromise in the delivery of dermatological care and to ensure quality physician extender supervision in this state.

Our formal letter to the New Jersey Board of Medical Examiners letter stated: “It is incomprehensible that non-dermatology physicians serve a role of dermatology consultants. Lacking residency training in dermatology certainly prevents them from properly managing patients with complex skin problems. It is even more outrageous that such physicians are allowed to “train” and supervise physician extenders in dermatology.”

To bring our member-dermatologists valuable discounts, DSNJ has formed a legal structure called purchasing alliance with MDAdvantage medical malpractice insurance company.  The purpose of this structure is to allow our members to receive discounts of up to 25% on their malpractice insurance (depending on claim history) with MdAdvantage. MDAvantage insures 3,500 New Jersey medical professionals and has already formed similar purchasing alliances with other specialists in our state. The discounted rates will be offered to those dermatologists already insured by MDAdvantage and to those who use a broker. The rates will only be available to active members of the DSNJ.

Our website (www.njderm.org) has been redesigned and now includes a lot of new functional features. We are currently working on eliminating “bugs” and populating the site with our Society members’ information. We would like to position the website as a prime source of information about quality dermatologists in the state. All dermatologists who are members of the Society will be able to have their profiles listed on the website

I am very excited to begin my second year as the President of the Dermatological Society of New Jersey. I hope that our members are proud to be a part of our growing and developing Society.  I have included in this update the information on only some projects which our Society leadership is working to bring to fruition. More exciting changes are coming.

Alexander Doctoroff, DO, FAOCD

President of the Dermatological Society of New Jersey

Published 06 February 2010 - 0 comments (View/Post Comments)