Spotlight on: Jules Lipoff, MD
Dr Lipoff is an assistant professor of dermatology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, PA, where he focuses on access to care, teledermatology, and global health. He also teaches dermatology residents, medical students, primary care residents, and family medicine residents.
During his residency at Montefiore Medical Center, he established a mobile teledermatology consult service with sites in Uganda and Guatemala utilizing medical student proxies. At Penn, he has continued his research interests in global health and teledermatology, seeking improved access to care at home and abroad. In 2014, he established a dermatology clinic dedicated to HIV and immunosuppressed patients. He is project leader of a team funded by the Penn Medicine Center for Healthcare Innovation and Independence Blue Cross that is focused on expanding the use of teledermatology for outpatient consults and triage, urgent care, and inpatient dermatologic care. In addition, he is coproject director of the Penn-Guatemala dermatology outreach and resident exchange program.
Dr Lipoff volunteers monthly at local free municipal and student-lead clinics, and serves as a teledermatology volunteer consultant in Philadelphia and abroad, including for Médecins Sans Frontières.
At the American Academy of Dermatology (AAD), he is deputy chair of the Teledermatology Task Force. His dermatology review book, Dermatology Simplified: Outlines and Mnemonics, was published by Springer in 2015.
Q: What part of your work gives you the most pleasure?
A: My time is divided among patient care (both outpatient and inpatient), teaching, clinical research, volunteerism, and writing. I enjoy all of these equally, but for different reasons. I love patient care for both the ability to connect with people and the intellectual satisfaction of solving problems. One thing I savor in particular is that my patient population fully reflects the demographics of my entire city, Philadelphia, and not just one small part of it, ensuring that the most traditionally underserved patients are getting access to care. I believe that seeing Medicaid patients and even patients without insurance is a moral and ethical imperative. Through my work in free clinics and telemedicine, I am able to serve patients who experience barriers for all kinds of reasons.
Q: Are an understanding and appreciation of the humanities important in dermatology and why?
A: Yes, of course! I would argue that understanding and appreciating the humanities is important to life, no matter what the path. More and more I hear people questioning the value of a liberal arts education, with the push for clearly translatable skills in majors. But that is entirely missing the point. I was a molecular biophysics and biochemistry major, a supposedly more practical discipline, but I took as many humanities classes as I could. It is important to learn about the world, arts, and history, all to broaden our perspective, because no matter how hard we try, we all live in our own bubbles and have limited experiences of the world. Seeking out humanities and the liberal arts can shape who we are, how we approach life, and how we figure out our place in the world.
One of my big passions is creative writing. In college, I ran a humor magazine, interned at The Onion and Mad Magazine, and even took a class called “Writing Comedy,” which I loved so much that I audited the next year to take it again. Recently, I published an article in Vox about what real diseases could explain the feared fictional skin disease “greyscale” on HBO’s Game of Thrones, and I was thrilled by the enthusiastic response it received. On the side, I’ve been writing screenplays and trying my hand at medical consultation for television shows. I see value in pop culture as a means to communicate science and medicine to the general public in engaging and entertaining ways (including on Twitter @juleslipoff). Pursuing nontraditional avenues allows me a chance to explore and realize diverse ideas.
Q: Who was your hero/mentor and why?
A: I have been so lucky to have generous mentors in all stages of my education and career. My parents have always supported my interests, no matter what they were. My wife, Renee, and my 2 amazing daughters, Zadie (4), and Tess (1), brighten my days, support my goals, and put up with me in general.
In college, my writing teacher was the late playwright and comedy writer Mark O’Donnell (Saturday Night Live, the musical Hairspray). Mark was endless in his encouragement, good humor, and generosity, and I am so sad that he is gone. His friendship and advice meant so much to me. I bet the medical school letter of recommendation he wrote for me was the only one he ever wrote, and I would kill to read it.
As a faculty member, I have so many mentors, that it is hard to keep track. I am particularly indebted to Bill James, MD, and Carrie Kovarik, MD, at Penn, and Bob Dellavalle, MD, PhD, and Shelly Torgerson, MD, PhD, through AAD leadership programs. I have learned from each mentor in different ways, but the biggest lesson overall is that there is no one right way to support colleagues, which has informed how I mentor residents and students myself. The most important thing is to help people achieve their own goals, no matter how different they may be from your own. A great mentor can be a sounding board, a connector to opportunities and people, or a teacher who imparts wisdom from his or her experience. I have been constantly delighted by how many truly kind, intelligent, and wonderful people I have met since joining this field.
Q: What is the best piece of advice you have received and from whom?
A: The best piece of advice I have recently gotten was from an AAD program mentor, Dr Torgerson, program director at the Mayo Clinic. She advised me to identify my core values to help me direct my career down the path that would suit me best. I identified my 5 core values as “service,” “health,” “family,” “personal growth/creativity,” and “fun/adventure.” As a young faculty member, I am constantly offered new and exciting opportunities, and it is easy to get caught up and feel I must say yes to everything. But, I have realized with time that the most difficult skill to develop is figuring out what to say no to and how to do it in a way that builds and preserves relationships. For instance, I may get many different opportunities to do service, but I should prioritize the options that also support my other core values, eg, include my family, entertain me, or improve my health. It would be easy to take on tasks that can help my career but then hurt my other values.
I am constantly working toward making informed choices for a healthy work-life balance that will grow my career the way I want to grow it rather than do what other people might think is most prestigious or important. I think a successful and happy career and life comes from appreciating the process (the journey rather than the destination) and being open to new opportunities and many definitions of what success can be. The more flexible you are in defining success and happiness, the more likely you are to achieve that. If you define success and happiness narrowly, you may be setting yourself up for failure.
Q: What is the greatest political danger in the field of dermatology?
A: I believe that dermatology as a field has an important, critical, and often underappreciated role to play in the house of medicine. However, I also think dermatology has a tendency to isolate itself and not allocate its resources for the greatest good for the greatest number of people. Case in point: Dermatologists accept Medicaid less than any other specialty. A recent study suggested only 33% accept it, and frankly, this is unacceptable.1 If you look at it cynically, the way to make money in medicine is to fill your time with a high volume of low acuity, low-risk patients with lots of highly reimbursing procedures. There is nothing wrong with trying to make money, but our greater mission must always come first. We cannot complain as a specialty that we are not valued or respected if we do not identify and prioritize our own value to society first. For instance, we should not have cosmetic appointments be more accessible than melanoma check appointments.2 Since everyone has visible skin and the potential need for care, it should be on us, not the marketplace, to better triage and make sure our services are always reaching those who need it most, and I know we could do better in this respect. We have a collective responsibility to take care of the population, and I believe we should be judged as a society by how we take care of our poorest and most vulnerable among us. And by that standard, we are not doing well.
1. Franki, R. Medicaid acceptance at 33% for dermatologists. Dermatology News. April 27, 2017. https://www.mdedge.com/edermatologynews/article/136797/practice-management/medicaid-acceptance-33-dermatologists. Accessed October 18, 2018.
2. Resneck JS Jr, Lipton S, Pletcher MJ. Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists. J Am Acad Dermatol. 2007;57(6):985-989.
Dr Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.