Advocacy: When, Where, and How for Dermatologists

Health care providers can sometimes develop a level of empathetic separation between the person and the work. In between jam-packed schedules, payer conversations, practice management meetings, electronic health record updates, and more, dermatologists may find themselves going through the motions without much thought beyond what comes next in the day-to-day. Bruce Brod, MD, MHCI, FAAD, believes dermatologists should reinvigorate their love of the specialty by advocating for dermatology and its patients.

“I’m really happy to talk about advocacy, why it matters to the dermatologist, the issues that are important to us at the state and federal level, and what each and every one of us can do to advocate in some way for our specialty to ensure that we can practice, that we can provide the best care for our patients. That’s really what it’s all about, that’s why we do this,” he said in an interview with Lawrence Green, MD, clinical professor of dermatology at George Washington University School of Medicine in Washington, DC. Dr Brod is a clinical professor of dermatology at the University of Pennsylvania in Philadelphia. He is also actively involved in with the American Academy of Dermatology (AAD) Association (AADA), representing the specialty within government affairs and health policy at various levels.

“We want to make sure we have the ability to practice in a setting that gives patients as many choices as possible in a safe, reasonable, efficient environment that provides the best value for patients. We’re the experts. We’re the dermatologists. We know what’s best for our patients, and it’s important for policymakers to hear our voice.”

For Dr Brod, advocacy is an important part of the job for a dermatologist, because it comes down to providing care and improving patient outcomes. He is often meeting with members of Congress and representing the interests of dermatology in state and federal government.

“Legislators tend to focus a lot on the cost of care, but they really don’t understand what we do as dermatologists,” said Dr Brod. “It’s important for them to understand how the decisions they make could impact patients, could impact even jobs in their district, and could impact them and their families. One of our biggest roles as advocates is to serve as educators. One of the first things I do when I talk to a legislator is I try to open up a conversation with them so that they understand what a dermatologist does, that we take care of serious skin diseases, both medical and surgical, and what we do is critically important for patients.”

Dr Brod started his advocacy efforts at the state level. After noticing that Pennsylvania, had no laws limiting minors from accessing tanning salons, Dr Brod advocated that indoor tanning needs to be restricted for people younger than 18 years. He met with various stakeholders and provided insights into the drafting of a bill. Following Dr Brod’s efforts, the Pennsylvania state government passed and enacted the Indoor Tanning Regulation Act in 2014, effectively banning anyone younger than 16 years from using a tanning booth, requiring people aged 17 years to have written authorization from their parent or guardian to use an indoor tanning booth, and creating regulations on the indoor tanning industry facilities within the state.¹ Since then, Dr Brod has pushed his advocacy to a national level.

“Dermatology is uniquely impacted, perhaps more than any other specialty, because we’re living in an age now where we have amazing ability to treat debilitating diseases,” said Dr Brod. The specialty has several layers to which advocacy efforts can be directed.

First, dermatologists can advocate for the specialty through the interests of the American Medical Association (AMA). The AMA is actively involved in multiple ongoing matters in federal and state governments, including commitments to public health, access to care, administrative burdens, and payment reform.²

Within the confines of the specialty, the AAD is another place to start. With resources such as the AADA and Academy position statements,³ dermatologists should feel empowered to advocate for issues most important to them. Similar professional organizations at lower levels, such as city, regional, or state societies, can also be a valuable resource, particularly for matters that are more local to a dermatologist’s practice. The AADA work outlines several advocacy priorities for dermatologists to target, including federal-level issues such as:

• Reducing the regulatory burden for access to compounded medications and improving Medicare physician payment policy
• Ensuring patient access to dermatologic care through both private and public payers
• Preserving private practice amid health care market consolidation and maintaining appropriate scope of practice
• Helping patients receive and afford appropriate medications and therapies as well as enhancing skin cancer prevention measures (eg, sunscreen access, indoor tanning)
• Reforming the Medicare Access & CHIP Reauthorization Act (MACRA)⁴

Dermatologists are encouraged by the AADA to bring many of those themes and issues to their local legislatures, along with issues such as defining the need to supervise nonphysician clinicians, ameliorating communication between pharmacists and the health care team regarding biosimilar substitutions, removing taxation on cosmetic procedures and physician services, and increasing access to office-based localized surgery, among others.⁵

Patient-focused advocacy groups are another resource, particularly for causes or diseases of interest to the provider. These organizations typically have various commitment levels, such as medical or scientific boards and professional membership.

Dermatologists may also need to advocate with nongovernmental sources, such as payers or employers. Such was the case for Lisa Swanson, MD, of Ada West Dermatology in Boise, ID. During her presentation on pediatric dermatology at the Society of Dermatology Physician Assistants Annual Summer Dermatology Conference 2021,⁶ Dr Swanson described her experience with the prior authorization requirements of her state. “In Idaho, we have two insurance companies that require a trial of systemic immunosuppressants before they approve a biologic for atopic dermatitis or psoriasis,” said Dr Swanson in her presentation. Prior authorization can be difficult to deal with even in normal times, and Dr Swanson said the idea that patients need to go through step therapy before receiving appropriate care during a pandemic was detrimental to their outcomes. So, instead of waiting for change, she repeatedly contacted the four medical directors of a particular insurance carrier in Idaho to explain why the failure of an immunosuppressant step was inappropriate. After a few emails, Dr Swanson received a positive response from the carrier noting that her persistence and advocacy resulted in an updated policy not requiring failure of a systemic immunosuppressant before approval of a biologic agent for children aged 18 years or younger with atopic dermatitis or psoriasis.

Reaching out to an appropriate organization of interest is a great start for dermatologists looking to add a new level of fulfillment to their practice. The AADA also offers a Legislative Conference, taking place this year virtually on September 23 to 28, 2021, to focus on the legislative, regulatory, and political issues affecting the specialty.⁷ The conference is a unique opportunity to connect with others, including members of Congress, and boost the voice of dermatologists on matters impacting practice.

“There’s so many different ways [to get involved,” said Dr Brod. “A great way to start is at the state level, the county level. Get involved with your county medical society. Be the voice of dermatology there, that can lead to getting involved in your state medical society.

We should all get involved. We have dermatologists now who are in state legislatures; we have a dermatologist in Congress now. Dermatologists can also get involved in insurance panels as well to be advisors for formulary boards and things like that so that they understand the importance of what we do so that we have that voice there…Advocacy isn’t just for the advocates that you know. It’s for all of us.”