ORGANIZING STATE DERMATOLOGIC SOCIETIES

DELIVERY OF DERMATOLOGIC HEALTH CARE

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ORGANIZING STATE DERMATOLOGIC SOCIETIES Clifford Warren Lober, MD

When one thinks of dermatology responding to legislative and regulatory situations, the American Academy of Dermatology (AAD) immediately comes to mind. Although the AAD is clearly the preeminent organization in this specialty, there are situations in which the AAD can succeed far more efficiently with the cooperation of a state dermatologic society. Every year, regulations that affect dermatologists’ practices are promulgated by state legislatures (e.g., direct access legislation), boards of medicine (e.g., office surgery rules), and departments of insurance. Despite the importance of state dermatologic societies, there is virtually nothing in print concerning the establishment and nurturing of these groups. At present, the level to which dermatologists have organized.varies strikingly among the states as reflected in the directory of local, state, and regional dermatologic societies published annually by the AAD.3 Several states have long-established state dermatologic societies that sponsor well-attended annual meetings, provide major member benefits, and have achieved meaningful legislative and regulatory successes. This is not the case uniformly, however. Many dermatologists practice in states where there are no established state dermatologic societies. They are

fundamentally unable to confront state legislative or regulatory challenges with a united front. At best, they attempt to organize loosely and sporadically in response to intermittent challenges. This article presents several constructive ideas for forming or strengthening state dermatologic societies.

ESTABLISHING A STATE SOCIETY

To form a state society, it is first imperative that the need is clearly recognized. Dermatology colleagues need to be reminded that state regulatory and legislative authorities promulgate rules, such as office surgery regulations, that directly affect their practices. Mention may be made of states such as Georgia, Florida, and South Carolina, which have achieved direct access for dermatology primarily as a result of their state organizations. When the activities and gains of other medical specialty organizations within the state are cited, the need for dermatologists in a state to organize is again crystallized. When forming a society, it is important to choose at least one key individual in each major city to be the nidus of all efforts. These individuals personally know and can directly contact dermatologists in their cities to stir

From the Department of Medicine, Division of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida ~~

DERMATOLOGIC CLINICS VOLUME 18 * NUMBER 2 * APRIL 2000

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and maintain interest in forming a state society. If regional or metropolitan dermatologic societies exist, they should be contacted to obtain their support and to locate dynamic individuals. Furthermore, when forming or electing the governing board of the organization, it is important that all regions of the state be represented. The primary reason for establishing a state dermatologic society is to promote and protect the interest of dermatologic patients and the practice of dermatology. It is critical that committees on managed care and legislation be established. Similar to the governing board, each of these committees should be composed of individuals from each major city or region of the state. At least once a year, the full membership should be solicited to determine if any member wishes to serve on one or more committees. During the annual meeting, it is usually desirable to have each committee briefly report to the full membership. Key individuals should be appointed to be liaisons to organizations such as the state board of medicine or department of insurance. These persons are responsible for monitoring that entity and informing the officers of situations to which the society may wish to respond. Several of the organizations, such as the board of medicine, may have fax or mailing lists that inform those interested of pending meetings or issues under consideration.

EXPANDING BENEFITS AND SERVICES

As the society matures, a periodic newsletter may be sent to the membership. This communication informs members of the current issues in the state and highlights what the state dermatologic society is doing about them. In several states, the chairpersons of the major committees are routinely asked to submit reports for inclusion in the newsletter. The society may also wish to use broadcast fax, e-mail, or other means of communicating with the members. As the state society addresses socioeconomic issues, it becomes increasingly im-

portant to have constructive relationships with the state medical society and with other state specialty societies. These relationships are useful not only for suppressing internecine turf battles, but also serve to facilitate addressing common issues with a united front. Although the state medical society and other specialty societies are not in agreement on every issue, a decision may be made to work cooperatively on issues on which there is agreement and to avoid confrontation on issues on which significant agreement is not reached. The relationship of the state dermatologic society to the AAD can be as close or distant as the members of the state society desire. Because approximately 98% of all dermatologists are members of the AAD, virtually all members of the state society are also members of the AAD. Through Dermatology World and other communication vehicles, the AAD routinely informs members of items of significant events in each ~ t a t eThe . ~ AAD also employs a full-time resource person whose primary focus is state and regional issues. The AAD has sponsored training workshops and published numerous support materials on grassroots action.' The Advocacy Handbook, published by the AAD in 1996, is a particularly rich and comprehensive source of information.*It addresses organizing society members, assessing political situations, planning campaigns, dealing with the legislative process, working with lobbyists, and building coalitions. In most cases, individual state societies involve the AAD on an issue-by-issue basis. Determining which member services the state specialty society should offer its members may at first appear perplexing. The state medical society, the AAD, and a plethora of other organizations each offers a variety of member benefits. Nevertheless, the state dermatologic society is in a unique position to offer benefits specifically crafted to address special circumstances that exist in the state and affect dermatologists. One state, for example, requires that physicians demonstrate their continued competency in performing certain laboratory tests, such as potassium hydroxide examinations. At the annual meeting of that state dermatologic society, a brief

ORGANIZING STATE DERMATOLOGIC SOCIETIES

examination that fulfills the requirements of that state is offered. Members may wish to purchase benefits and services from the state dermatologic society solely as a means of supporting it. If a member is currently purchasing magazine subscriptions for his or her waiting room, for example, why not do so through the state dermatology society and increase its revenues without direct cost to the member? Hiring professional management provides for growth and expansion of the society. In addition to freeing the officers from a barrage of administrative duties, the engagement of a professional manager facilitates the expansion of the organization as that individual or management service suggests and assists in the implementation of programs desired by the members. The decision to obtain professional management for the organization depends on several factors. If the organization is just starting out or is small with limited resources, it may seem that paying for professional management is out of the question. Dermatology Services, Inc., a wholly owned subsidiary of the AAD, offers professional management services at reasonable fees. State medical associations may do the same. ANNUAL MEETINGS Although there is significant value in holding annual meetings .for the members, many state dermatologic organizations do not do so. In addition to fostering collegiality, these meetings give the society a chance to meet member needs for information and education. It is important that the meeting be centered around the perceived needs of the members. During the 1980s and early 1990s, for example, surgical courses were in demand among dermatologists. During the last few years, as a result of inroads by managed care and significant changes in Medicare, socioeconomic sessions have been of central interest. The meetings of the state society should ideally be held either in a centrally located city to facilitate easy attendance or at a resort. If it is deemed desirable to have members bring their families, a weekend meeting at a

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resort site is preferable. Typically, successful meetings begin with a welcoming reception on a Friday evening, have a half-day or fullday meeting on Saturday, and conclude with a half-day meeting on Sunday to allow the members time to travel home Sunday afternoon. Should additional time be needed to present socioeconomic or scientific program material, the meeting can be expanded to begin on Thursday evening. Many members, however, may hesitate to attend a meeting on weekdays because doing so requires them to close their offices. The socioeconomic program may center on a key issue or set of issues that confront dermatologists in the state. In Florida, for example, for several years a socioeconomic symposium has been held on Saturday morning. By addressing issues such as changes in Medicare regulations, coding, and other reimbursement issues on Saturday mornings, the interests of the membership have been addressed and high attendance maintained. The placement of this symposium on Saturday morning has also permitted those who cannot (or will not) take additional time away from their offices to attend this portion of the meeting. Almost without exception, the departments of dermatology at the universities in the state can be approached and usually participate in the scientific portions of the program. It may also be desirable to send a notice to the full membership inviting them to present information at the meetings. Bringing in an outof-state speaker can add to the meeting. With minimal effort, the time allotted for the program fills rapidly.

CONCLUSION The AAD is uniquely positioned to address regulations and legislation promulgated at the national level. The day-to-day practice of dermatology, however, is increasingly affected by a barrage of fiats issued by state boards of medicine, legislatures, and departments of insurance. If dermatology as a specialty is to respond optimally to these challenges, it is mandatory that state derma-

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tologic societies be established and function efficiently in each state.

2. American Academy of Dermatology: Advocacy Handbook, Shared Advice from State Dermatologic Societies. Schaumbure. IL. AAD. 1996 3. American Academy of Dermatology: State, Local and Regional Dermatologic Societies, 1998-1999. Schaumburg, IL, AAD, 1998 4. American Academy of Dermatology: Dermatology World. Schaumburg, IL, AAD, 1999 " I

References 1. American Academy of Dermatology: Grassroots Action Handbook. Schaumburg, IL, AAD, 1994

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