Kaiser’s ‘roving’ dermatologists alleviate physician shortage


Kaiser Permanent’s Diablo service area has found an innovative solution to its shortage of dermatologists: the roving physician.

The program involves arming a dermatologist at each Kaiser site in the service area with a cellular telephone to respond to the call of primary care doctors with patients that display suspect moles or non-obvious skin rashes.

The roving dermatologists can provide same-day assessments and biopsies of skin lesions, saving patients the month-long wait it can otherwise take to get an appointment with a dermatologist.

“I get on the phone and within five minutes they show up in my exam room,� said Dr. Thomas Connolly, a Kaiser internist and associate physician in chief with the Diablo region, which includes clinics in Pleasanton, Walnut Creek, Livermore, Martinez and Antioch. “Very frequently, the time between hitting primary care physician and biopsy is a matter of hours instead of a month or months.�

Kaiser’s approach in the Diablo area is a hit with primary care doctors like Connolly, who says this program is helping alleviate what has been a long-standing problem at Kaiser. The roving doctor concept, which started in Pleasanton and is now being employed throughout the service region, is also a money saver for patients.

“Patients say, ‘I don’t have to spend money on gas or another co-pay,’ � said Dr. Kathleen Ting, chief of surgery for the Diablo region. “Especially for elderly patients, it’s a big deal to go to the doctor and have a family member take off work.�

The Kaiser system’s shortage of dermatologists, however, is symptomatic of a national problem that could become more serious as baby boomers, those born between 1946 and 1964, age and the demand for services increases.

“We are seeing two separate issues,� said Dr. Jack Resneck, a dermatologist with the UCSF School of Medicine. “One is that with the aging of the baby boomers, there are more skin cancers because the population is aging, and older patients are more likely to develop skin cancers.

“The other issue is that the actual prevalence of skin cancers – both melanoma and non-melanoma skin cancers – has been increasing steadily over the last few decades.�

The reasons for the shortage are manifold, ranging from lack of training programs, which has resulted in just 300 new dermatologists a year nationally for the last three decades, to the fact that dermatology tends to attract a lot of part-time physicians with family responsibilities.

Also, the scope of practices has grown, with more dermatologists performing skin cancer surgeries as well as cosmetic dermatology.

The average dermatologist spends 10 percent of the work day treating cosmetic conditions, although a sub-set of dermatologists spend 29 percent in that area, according to a 2007 report by Resneck and Dr. Alexa Boer Kimball of Massachusetts General Hospital, which was published in the Journal of the American Academy of Dermatology.

Kaiser Permanente didn’t provide details about the number of dermatologists it has in Northern California, despite multiple requests for the information.

Doctors, however, admit the system has long been plagued by a shortage of skin specialists.

The average wait for a dermatologist appointment in the United States is 33 to 36 days, according to the report by Resneck and Kimball, although that varies widely from region to region.

Some non-Kaiser doctors said the shortage of dermatologists is in rural areas and that the Walnut Creek area doesn’t have a shortage.

“My hunch is that in the East Bay, there are enough dermatologists to satisfy the needs of the population,� said Dr. Jerome Potozkin, who has offices in Walnut Creek and Danville and is the president of the California Society of Dermatology and Dermatologic Surgery. “I think that the issue with Kaiser would be more Kaiser-specific.�

Potozkin said he chose to practice on his own because he valued being able to make choices about his own practice.

The Oakland health organization previously experimented with a program that involved nurses taking digital images of patients’ skin for review by a physician at a later time. It has since moved away from that effort, Ting said, because “patients want a dermatologist to look at their skin.�

Lately, the system has had more luck with recruiting dermatologists, although it still finds that assigning a roving dermatologist every day helps deal more efficiently with routine patient concerns.

“There are about half a thousand dermatological diseases, but about eight of these diseases make up about 80 percent of the consultations,� Ting said.

Kaiser doctors do perform cosmetic services, but Kaiser spokesman Jim Caroompas estimates that those services accounted for only about 5 percent of dermatology patients, and 3 percent of those were handled by nurses and physician assistants.

“We are doing cosmetics inside Kaiser, but it is easier to get an appointment for a changing mole than a cosmetic procedure,� Ting added.

mhogarth@bizjournals.com |925-598-1432

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