NEW YORK – Can cosmetic dermatologists work with other specialists to create a multidisciplinary care clinic?
A pilot survey says it might just work – and that both physicians and patients could benefit from the arrangement, Dr. Steven R. Feldman and his colleagues reported in a poster presented at the American Academy of Dermatology’s Summer Academy Meeting.
Dr. Steven R. Feldman
The researchers wanted to find out if academic physicians at Wake Forest University Baptist Medical Center, Winston-Salem, N.C., would be interested in participating in a clinic that would include dermatologists, plastic surgeons, and specialists in otolaryngology and ophthalmology. Dr. Feldman, professor of dermatology at Wake Forest, and his colleagues surveyed six faculty members – two plastic surgeons, an otolaryngologist (ENT), an ophthalmologist, a general dermatologist, and a dermatologic surgeon – to assess their interest, and to find out what they foresaw as possible pitfalls in such collaboration. Five of the respondents reported performing cosmetic procedures.
The survey included 7 multiple-choice opinion statements and 15 open-ended questions, which allowed the participants to freely express their thoughts.
On average, the respondents agreed that patients would benefit from such a clinic, that they would be willing to work at one, and that their involvement would be a wise investment.
They reported that they did feel market competition could be a problem and that the professional relationship among providers in such a clinic could be contentious.
Opinions on who should perform which procedure were stronger. The group strongly agreed that "Certain procedures should only be performed by board-certified members of [each] subspecialty." But there was strong disagreement that only specialists who develop certain procedures should be licensed to perform them, suggesting that teaching could be a vital part of a collaborative clinic.
Overall, the ENT and general dermatologist were most in favor of such a project. The dermatologic and plastic surgeons were least in favor. The overall score for supporting the idea was positive.
Respondents were more cautious on the idea of a successful collaboration. Again, the ENT and dermatologic surgeon had the most positive view on this, while the ophthalmologist and plastic surgeons were less enthusiastic. The overall collaboration score was neutral. Dr. Feldman and his associates said the combination of the two scores among all respondents was neutral.
Responses to open-ended questions were diverse, the investigators noted. The ENT said it would be important for major institutions to offer such a program, while the dermatologic surgeon stressed the teaching possibilities. The plastic surgeons expressed concern about clear definition of roles.
The ENT saw a potential pitfall: ego, fear of competition, jealousy, sharing of expenses, resources, and referrals. One plastic surgeon said a major problem would be "increasing competition for a defined group of patients. No other specialty is bringing anything to the table other than more patients than we already have."
The general dermatologist was more positive about the idea, citing the ability to increase patient care possibilities with high-reward cosmetic procedures, the opportunity for teaching residents, and the center’s ability to provide the ethical delivery of advice to patients interested in purchasing a cosmetic service.
In voicing other concerns about such a program, one plastic surgeon was skeptical. "Plastic surgery can do anything that other specialists can provide. [They are] self reliant." Working with physicians who don’t work at the same level or achieve the same results would be an issue, the surgeon noted. And since reputations would be linked, physicians would need to watch for "subpar standards."
Overall, the investigators concluded, "Academic physicians are interested in participating in a multidisciplinary cosmetic center. This survey, although small, helps to reveal potential pitfalls of such a center, which is an important step toward constructing a practice model that minimizes conflict between specialists and maximizes cooperation and collaboration, [and] ultimately optimizes patient care and outcomes."
None of the authors noted any financial conflicts.