INPATIENT DERMATOLOGY

STEVEN R. FELDMAN, MD, PhD

ALAN B. FLEISCHER, JR, MD

Guest Editors

These are the times that t y men’s souls. THOMAS PAINE

The delivery of high quality dermatologic care is being affected by a broad array of changes. There are a plethora of new treatments, both medical and surgical, providing physicians more opportunity than ever to treat the many manifestations of cutaneous disease. There are new and rapidly changing payor systems, systems that at least in some cases make it more difficult for patients to access even basic dermatologic care. There are new regulations, mostly misguided attempts to improve delivery of care, that, at best, have little effect on care or, at worst, create havoc in the delivery of care. Finally, there are changing demands from patients, who at times seem to expect the best medical science can deliver but at no personal expense. This issue was developed not to address advances in the treatment of one particular disease but to address the factors affecting the delivery of dermatologic care. These factors may have a greater impact on patient outcomes than any other single aspect of skin disease treatment. The goal of this issue is to provide a blueprint for action to improve delivery of dermatologic care. This blueprint outlines the magnitude of the skin disease problem, describes systems for delivery of dermatologic care, and the evidence for the role of dermatologists in the delivery of this care. Impediments to the delivery of dermatologic care and resources to assist physicians delivering dermatologic care are discussed. We have chosen to address the issue of physician manpower requirements in dermatology because of our recognition of the central role of dermatologists in the delivery of dermatologic care. Not all factors contributing to the delivery of dermatologic care can be covered in an issue such as this. Important areas that are not covered include the delivery of cosmetic dermatology services, the role of the American Academy of Dermatology and of the Dermatology Foundation on furthering delivery of dermatologic care, delivery of “excellence” as defined by principles of excellence in business, and ethical issues in the delivery of care. We recognize that research in health care delivery is necessary but not sufficient to solve the problems facing physicians delivering dermatologic care. There must be action by physicians and patients to address these problems. In the final articles, we offer a description of actions that dermatologists should, and perhaps must, take to address challenges in the delivery of dermatologic care to patients with skin disease. Go to it! STEVEN R. FELDMAN, MD, PHD JR, MD ALANB. FLEISCHER, Guest Editors Westwood-Squibb Center for Dermatology Research Department of Dermatology Wake Forest University School of Medicine Medical Center Boulevard Winston-Salem, NC 27157-1071