Shaping Dermatology's Future by Increasing Access, Data, and Advocacy

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Dermatologists at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida, explored key areas poised to shape the future of dermatology, including access, data aggregation, and advocacy.

Thy N. Huynh, MD, FAAD, Bruce A. Brod, MHCI, MD, FAAD, and Melissa Piliang, MD, FAAD, discussed expanding access to pediatric dermatology, dermatology data aggregation, and advocacy for Medicare physician payment reform, respectively. | Image Credit: ibreakstock - stock.adobe.com

Addressing Shortage, Access Challenges in Pediatric Dermatology

Thy N. Huynh, MD, FAAD, of the University of Mississippi Medical Center kicked off the session, “The Future of Dermatology: What Changes are Coming and How Can We Prepare?,” by stressing the importance of growing the pediatric dermatology field. She explained that pediatric dermatology is the smallest specialty, with only about 300 board-certified pediatric dermatologists nationwide.

Huynh highlighted the significant access problem as many of these specialists are concentrated in Massachusetts and Illinois. In contrast, 7 states have none, namely Delaware, Louisiana, Maine, Montana, Nevada, North Dakota, and South Dakota. Even patients in states with a pediatric dermatologist are not guaranteed to be seen promptly. Huynh noted that her appointment wait time is 4 to 6 months; among her colleagues, it is sometimes up to a year.

She stressed that high demand does not equate to high patient show rates, with her no-show rates ranging from 25% to 45%. Huynh explained that these rates are higher among Medicaid-insured patients who live in lower socioeconomic areas.

In response to the access and no-show issues, she suggested that pediatric dermatologists save 2 spots, particularly early morning and early evening appointments, for up to 2 weeks in advance to accommodate acute cases, such as acne management and atopic dermatitis treatment. Implementing this strategy can increase patient show rates by 30% to 40%. Because most pediatric cases are time-sensitive, she said rapid access is “crucial.”

Despite the small numbers, Huynh concluded by expressing optimism for the future of pediatric dermatology.

“The world of pediatric dermatology is very small,” Huynh said. “It is around 300 pediatric dermatologists and is actually slowing down because the world leaders are mostly retiring. There are about 12 that graduate every year, but I think the future in pediatric dermatology in the hands of this small group will be amazing.”

Harnessing Data for Advocacy

Next, Bruce A. Brod, MHCI, MD, FAAD, of Penn Medicine, discussed the various benefits of AAD’s DataDerm, the largest clinical dermatology data registry in the world—particularly the ability to use it to create a strong narrative to support advocacy efforts. Launched in 2016, DataDerm aggregates data extracted directly from the electronic health records of dermatologists worldwide. It currently contains data from over 1700 practices, 6000 clinicians, 16 million unique patients, and 68 million patient visits.

DataDerm was initially created to assist in Merit-Based Incentive Payment System reporting. Bord explained that it has since evolved into a more comprehensive data collection tool capable of aiding research, advocacy, and beyond.

For example, DataDerm was used to help push back against Aetna’s limited photodermatology service coverage. Bord explained that Aetna's coverage of photodermatology services excluded vitiligo and other non-psoriatic conditions. However, he noted that DataDerm data was analyzed to demonstrate the utilization of photodermatology codes for a range of diagnoses beyond psoriasis. Because of DataDerm, Bord highlighted that AAD has specific data to support these ongoing conversations with Aetna.

Looking ahead, he explained that DataDerm is migrating to a new in-house platform for better dashboard customization and reporting. Bord concluded by encouraging more dermatology practices to participate in DataDerm for its research and advocacy benefits.

“We’re going to need data to support our advocacy,” he said. “I think it’s really helpful in the whack-a-mole world of insurance companies to have data to push back.”

Advocacy for Medicare Payment Reform

Advocacy was further discussed by Cleveland Clinic's Melissa Piliang, MD, FAAD, the chair of AAD’s Council on Government Affairs and Health Policy. She focused more on federal advocacy, highlighting that AAD’s priority in 2024 was Medicare physician payment reform. Piliang predicted that this will again be the focus this year, but the final decision will be made at the AAD board meeting on Monday.

She explained that the Medicare Physician Fee Schedule has remained virtually unchanged since 2001, even as practice expenses and the Medicare Economic Index (MEI) have risen 47% and 73%, respectively. Meanwhile, inflation-adjusted physician reimbursements have declined by more than 30%, with medical inflation projected at 3.6% and the current conversion factor showing a 2.5% decrease. Although dermatologists and other physicians have found ways to cut costs and keep their practices open, Piliang said that “this is not sustainable forever.”

“We’re down to the bone, there’s nothing else we can cut away in our cost, so it really needs to be addressed,” she said.

AAD’s proposed changes include annual inflationary updates to the MEI, adjustments to budget neutrality rules, and the implementation of retrospective budget reviews.

Piliang listed several actions AAD has taken to advocate for these changes, including AAD president Seemal R. Desai, MD, FAAD, testifying to the House of Representatives Ways and Means health subcommittee in May. He voiced dermatologists' concerns, helping representatives understand the issue's impact on dermatologists, their patients, and access to care.

She also highlighted AAD’s annual 3-day legislative conference in Washington, DC, where dermatologists are trained to effectively engage with their elected representatives. These skills are then used on Capitol Hill to advocate for Medicare physician payment reform.

Piliang concluded by encouraging audience members to get involved in grassroots advocacy, emphasizing the power of strength in numbers. She urged those interested to send letters to their congressional representatives to ask for a permanent solution.

“If they get a note from every dermatologist in their community, in their district, if they get a letter from every physician in their district, then they start to say, ‘Oh, we have got to do something about this,'" Piliang said. "'This is really upsetting people.'”