A Conversation With Kesha Buster, MD

Dr Buster is founder and director of VibrantSkin Dermatology and Laser in Tulsa, OK. She graduated from the University of Iowa College of Medicine in Iowa City, later completing a combined dermatology residency and clinical research fellowship at the University of Alabama at Birmingham (UAB). While at UAB, she established the Skin of Color Clinic. Dr Buster’s contributions to dermatology include clinical research and publications on skin of color (SOC) and dermatologic health disparities as well as serving as an invited speaker both nationally and internationally.

As a pioneer in the direct care movement, Dr Buster launched VibrantSkin Dermatology and Laser to provide dermatologic care regardless of insurance status. She also continues to advise colleagues on direct care, health disparities, and SOC. Dr Buster is an active member of numerous organizations, including the American Academy of Dermatology (AAD) and the Oklahoma State Dermatology and Dermatologic Surgery Society (OSDS), currently serving as a member on the AAD Public Web Content Workgroup and as  an OSDS board member.

Q. What part of your work gives you the most pleasure?
A. I truly enjoy bringing healing and health to patients while simultaneously developing meaningful relationships with them. Though some conditions clearly are acute and do not require long-term management, so much of what we do as dermatologists allows us to invest in getting to know our patients and be a positive influence in their lives. It was fun, for example, to “run into” several patients while at the water park with my family over the summer and casually encourage good sun protection habits where they could see me practice what I preach! Or, more recently, sobering to ask a high school senior I’m treating for acne how he’s doing after cancellation of his senior trip. I find these conversations almost as important in patient care as the ones confirming they are adhering to the treatment plan. Through them, we are able to build strong doctor-patient relationships that establish trust and show we care.

Q. Which patient had the most effect on your work and why?
A. That’s a tough question because so many have taught me through valuable experiences, but I would probably say this goes to a patient who I was blessed to see very early in my career. In the first visit, I found numerous lesions suspicious for malignancy, mostly nonmelanoma skin cancers. However, I had no idea what the lesion was that ended up being invasive melanoma; I just had a bad feeling about it. That was my first memorable “trust your gut” reaction in practice. Over the years, I have continued to learn through taking care of her and have seen how important it is for us, as dermatologists, to be advocates for our patients and to trust our and their instincts. I believe I’m a better dermatologist due to caring for her.

Q. What is the best piece of advice you have received and from whom?
A. Let go of regret. This is sometimes difficult for me but important, as regret can hold you back from future success. Instead, take each perceived failure and use that energy to transform the “failure” into a learning experience. Both my mother and husband have given me this advice—and still do when I need the reminder!

Q. Which medical figure in history would you want to have a drink with and why?
A. I would love to meet Daniel Hale Williams, MD, who was a Black American surgeon. It would be fascinating to hear his account of performing the first successful open-heart surgery on record (in 1893) as well as his other admirable achievements. Dr Hale countered then-current medical opinion when he carried out surgery to repair the pericardium of a young man who had been stabbed. In addition, Dr. Hale established the first interracial hospital in the United States, opened the first nursing program for Blacks, and was the only Black charter member of the American College of Surgeons.

Q. What is the greatest political danger in the field of dermatology?
A. The reigns of medicine currently are not in the hands of physicians. A pervasive disconnect has snuck into our profession, the proverbial elephant in the room. And that elephant has two heads: third party payers and excessive administrators. The constant battle of physicians working to do the best for their patients and get paid appropriately for such has become the norm. The ever-increasing mountains of meaningless paperwork, including prior authorizations for readily available and inexpensive medications, also is a massive assault on the doctor-patient relationship. Rules and regulations established by an exponentially growing number of nonphysicians far removed from clinical practice is also contributory. The trials physicians face on a daily basis contribute to burn out that used to be foreign in the field of dermatology, but sadly seems to be increasingly common today.

Having a cash practice allows me to combat these burdens and get back to the traditional doctor-patient relationship (Note that the great majority of my practice is direct pay. I have one contract with a local self-insured business and see their employees and family members through that contract.) Medical insurance and/or health sharing ministries are important, but I believe we have lost sight of the proper place for insurance. Like car insurance, medical insurance should be for large, expensive, and catastrophic events, not typical day-to-day care. Could you imagine using your car insurance to pay for oil changes, tires, and minor repairs? The result would be insanely high car insurance costs, lack of price transparency, overutilization of services, and subsequent insurance control of the care of your vehicle. This is exactly what has transpired in medicine, and I believe moving towards reversing this trend is essential to the health of medicine in the U.S. 

Direct care medicine is a growing trend that allows physicians to spend quality time with patients, helps eliminate needless paperwork, and also allows for transparent and reasonably priced care. In states that allow it, prescriptions can be directly dispensed by physicians to patients bringing them increased value via convenience and low-cost medications. This can be true for labs as well. For example, typical isotretinoin labs at my office cost patients less than $35.

Since the 1970s, the proportion of administrators to physicians has exploded, and along with this has come a greater than 2000% increase in health care spending in the US.¹ These health care expenditures have consistently outpaced growth of the economy for decades.² Simply stated, there are too many cooks in the kitchen.

But the tides are changing. More dermatologists and other physicians are leaving third party and government contracts behind and contracting directly with their patients. Taking back medicine and providing high-quality, affordable care to our patients is an achievable goal. We just need to think outside of the box.

References

1. Borders M. The chart that could undo the US healthcare system. FEE Stories. April 29, 2015. Accessed September 28, 2021. https://fee.org/articles/the-chart-that-could-undo-the-us-healthcare-system/

2. Health care costs: a primer. Kaiser Family Foundation. Published May 1, 2012. Accessed September 28, 2021. https://www.kff.org/report-section/health-care-costs-a-primer-2012-report/