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 H. Brodkin, MD and the “Dermatologist of the Year Award” will be presented to Booth H. Durham, MD. Please join us at this meeting.
Sincerely yours,
Alexander Doctoroff, DO
President of DSNJ