Traditional fields of European dermatology that are now at risk of being lost to other specialties include venereology, dermato-oncology, type 1 allergy, and dermatopathology. Phlebology has already been largely taken over by vascular surgeons. On the other hand, European dermatology will see expansion of genodermatology, aesthetic dermatology, and dermatologic surgery, he added.
Dermatologic Role Changing in Japan
In Japan, as elsewhere throughout the world, the traditional dermatologic role as caregiver for severely ill patients is being taken over by other specialties.
"Traditional dermatologists are an endangered species," said Dr. Masayuki Amagai, professor of dermatology at Keio University, Tokyo. For example, Japanese dermatologists traditionally have cared for melanoma patients with terminal disease as well as for those who have early-stage disease. Now, however, more patients with advanced melanoma are being seen in integrated oncology centers.
Following the same model, it is likely that the near future will bring a new sort of integrated immunologic disease center for patients with Crohn’s disease, rheumatoid arthritis, psoriasis, and other conditions that share common inflammatory mechanisms. Dermatologists who hunger to take on the most interesting and challenging cases will want to become a part of such centers, where they will work alongside rheumatologists and gastroenterologists, Dr. Amagai said.
The good news in the United States, according to Dr. Katz, is that the recent skin biology discoveries will eventually translate into major clinical advances. And dermatology continues to attract the best and brightest medical school graduates, he said. In 2004-2007, 5.8% of U.S. dermatology residency positions were held by MD/PhDs, a rate nearly threefold greater than the average for other residency programs.
His wish list for the dermatology specialty includes a better-organized research agenda, including research programs in the cosmetic and procedural aspects of the specialty. He would also like to see the development of a clinical research consortium in dermatology, similar to the way pediatric research is conducted. "Dermatology departments are just too small to not work together," said Dr. Katz.
More effort should be placed on educating dermatologists about health services research, comparative effectiveness studies, and clinical outcomes research.
"These are areas we're not very good at. We need to be part of that whole scenario because reimbursement is going to be based on these types of studies," he said.
The speakers declared having no financial conflicts.