American Academy of Dermatology
|Henry Lim, MD|
|Brian Berman, MD, PhD|
|Suzanne Olbricht, MD|
|Ted Rosen, MD|
The American Academy of Dermatology (AAD) is one of the largest organizations of dermatologists in the world. It was founded in 1938 and represents 19,000 dermatologists in the United States, Canada, and around the world. The academy grants fellowships and associate memberships, as well as fellowships for nonresidents of the United States or Canada. Since 1979, the AAD also publishes a monthly medical journal, the Journal of the American Academy of Dermatology.
To become a Fellow of the American Academy of Dermatology (FAAD), a physician must be a resident of the United States of America or Canada and certified by the American Board of Dermatology or in dermatology by the Royal College of Physicians and Surgeons of Canada.
To become an associate member, a physician must have three years of experience in practice or as a teacher or graduate student of dermatology and must have had training that qualifies for examination by the American Board of Dermatology or the Royal College of Physicians and Surgeons of Canada.
Sulzberger Institute Committee
The Sulzberger Institute for Dermatologic Education was a grant-giving organization that funds research technology of education. Initially, the Sulzberger was a free-standing institute loosely affiliated with the AAD and governed by an independent board of trustees. Since 2005, the Sulzberger has been subsumed within the AAD, and has become the Sulzberger Institute Committee of the AAD.
Each fall, the Sulzberger awards one or two seed grants for research designed to improve the teaching of dermatology via novel technological applications. In recent years, the Committee has been particularly interested in funding research to advance continuing graduate medical education in dermatology and the teaching of dermatologic surgery. Grants are typically for one to two years, and are targeted to young investigators, including junior faculty and residents-in-training.
Dermatologists in the United States have the third highest annual incomes among physicians, at $381,000 per year. They were topped only by cardiologists at $410,000 per year and orthopedists at $443,000 per year. The dermatologist income was an 11% increase from 2015, fourth highest among all physicians. Male dermatologists’ annual incomes exceeded their female counterparts by $73,000. For their income, most (39%) male dermatologists spent an average of more than 12 minutes with each patient; more female dermatologists (48%) spent more than 12 minutes per patient.
Compensation and dermatology practices
Dermatologist income had risen to the fourth highest of all specialties by 2012, averaging over $380,000/year, even though dermatologists’ workload is among the lightest of all specialties. This is mainly due to the ability of dermatologists to manage several streams of revenue into their practices – cosmetic dermatology and skin surgery, for example. Cosmetic dermatology is 100% patient paid and is very lucrative in larger markets like New York City and Los Angeles, but only makes up 10% of dermatology revenue. It is also grounded on the strength of the economy.
Skin surgery is where most dermatologists find their income. For example, the Mohs procedure has become a staple in US dermatology practices. According to industry statistics, a hospital on average pays a Mohs procedure surgeon $586,000, more than a cardiovascular surgeon.
Mohs procedures typically cost two-thirds more than a regular excision.
To check the unfettered growth of the Mohs procedure, in 2012, the American Academy of Dermatology issued “appropriateness” guidelines on when the technique should be applied. B.M. Coldiron, MD, former president of the American Academy of Dermatology, co-authored a study on the overall use of the Mohs procedure by state. He discovered that there were dramatic fluctuations in the number of procedures conducted. One of the physicians studied had allegedly performed and was reimbursed for 2,400 surgeries in one year. He concluded that there was some questionable behavior among dermatological surgeons.
Medicare reimbursements are based on an intricate algorithm that figures the average time and skill needed for a particular procedure, adjusted by the specialties’ malpractice rates. It is far simpler to determine time and skill for individual procedures than for complex patient management processes. The rates are then negotiated by the American Medical Association’s Relative Value Scale Update committee, a group of 26 specialists who set the prices Medicare will pay. These prices are used as standards by other insurers, who use them as their own payment basis.
Medicare placed the Mohs procedure on its list of potentially misvalued procedures in 2011 and was overwhelmed by complaints from dermatologists. The AMA Update Committee then pronounced Mohs valued. The American Academy of Dermatology Association (PAC) has successfully lobbied for protection of the Mohs surgery.
Political action committee
The American Academy of Dermatology Political Action Committee (SKINPAC) donated nearly $1.3 million to both Democratic and Republican office-seekers during the 2016 election cycle. The PAC raised more than $1.4 million from 1,700 donors, who gave more than $200 each, with 49 donors, mostly dermatologists, making the maximum donation allowed by law, $5,000 each.
SKIN PAC gave:
- $325,000 to House Democrats
- $390,500 to House Republicans
- $32,500 to Senate Democrats
- $120,00 to Senate Republicans
- $182,500 to Democratic PACs
- $239,000 to Republican PACs.
Donations in the 2016 cycle were slightly down (6.6%) from the 2014 cycle. The PAC spent an additional $29,900 with the Mammen Group, a DC-based direct mail agency and $28,800 with Prevail Strategies, a political consulting and public affairs company.
Pharmaceutical industry relationship
A study in the Journal of the American Medical Association (JAMA) that researched the Centers for Medicare and Medicaid Services (CMS) database under the Physician Payments Sunshine Act, which requires reporting on the financial relationships between health care providers and pharmaceutical manufacturers, found that 8,333 of the approximately 9,600 US dermatologists accepted payments from the pharmaceutical industry.
There were a total of 208, 613 payments made in 2014, with a total of over $34 million. The top ten percent of dermatologists received more than $31.2 million, with a mean payout of more than $38,000 each. The top one percent received a mean of $93,622. Median total payment was $298 each. Fifteen pharmaceutical companies made up the bulk (81%) of the payouts, at $28.7 million.
Dermatology residents exam fraud
Dermatology residents who had taken the dermatological board certification examination would routinely write down all the questions and answers to the tests while returning home on airline flights. The documents, called “airplane notes” contained 20% to 50% of the questions on subsequent examinations and would be shared with other dermatological residents before they took the certification examination. The Mayo Clinic Proceedings called this deceptive misconduct an “established norm” in the dermatological certification process which, while morally indefensible, was very difficult to bring to an end.
The American Board of Dermatology warned dermatological residents that the practice of using the “airplane notes” was illegal, because the questions and answers on the examinations were copyrighted. Other medical specialty groups implicated in the cheating scandal include radiologists. The American Board of Radiology called the process unacceptable and noted that it would be very difficult for a physician to practice radiology without being certified. The use of “airplane notes” in dermatology exams has been confirmed by residents as being widespread in that specialty, but is not usually found in others such as orthopedic surgery or family medicine.
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