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Director’s Commentary: Greatest Challenges in Next 5 Years

What are the greatest challenges dermatology residents will face in the next five years? Adrianna Gonzalez Lopez, MD, asks Adam Friedman, MD, for his opinion on the field in this video.

Dr Gonzalez Lopez is a first-year dermatology resident with the department of dermatology at George Washington School of Medicine in Washington, DC.

Dr Qureshi is a first-year dermatology resident with the department of dermatology at George Washington School of Medicine in Washington, DC.

Dr Friedman is the director of the residency program at George Washington School of Medicine in Washington, DC.


Dr Adrianna Gonzalez Lopez: Dr Friedman, I have a question for you. [laughs] We know that our new graduates are facing many challenges once they graduate in the midst of the pandemic. We know some of them are having issues with job placement and finding opportunities due to the pandemic.

That aside, what do you envision are the greatest challenges that newly graduating dermatologists will have to face in the next five years?

Dr Adam Friedman: Oh, boy. That’s a tough question. I realize you’re asking to push aside the pandemic, but it’s very hard to do that because, what is the face of medicine going to be in five years? Where are you going to be with the pandemic, and how is that going to influence our practice?

I think trying to cut that out in the fun that comes with trying to get your bearings, whether it be a day or five years out of your training program, I think one of our greatest challenges is going to be ensuring we get our patients the medication and the care that we want them to have, and we’re already seeing this.

I think the hurdles being put before us, prior authorization, step therapies, copay accumulator programs, these are just a litany of various roadblocks and car wrecks on the road to getting our patients better, and I worry that this will only get worse.

In parallel, as these challenges and administrative work burdens us further, will reimbursement keep going down? I feel like we get emails from the AADA almost every day about cuts to Medicare, which means that everyone is going to jump on that train and cut reimbursements for a lot of the things we do, and undermine the value of the things we do.

I think that mixed bag of more administrative pressures and getting paid less equals disaster, so I think that’s a struggle. In that setting, will there be those who take advantage of that high administrative burden, that stress, the concern for making ends meet?

We’ve seen some of that in terms of VC-backed practices and the cannibalization of small solo practices into larger conglomerates. There are certainly pros to that model, but there are certainly cons.

I think we need to have some policing of that to make sure that the quality of care is not compromised, but also our colleagues are not being taken advantage of and being worked to death, and they have a nice and a healthy work-life balance, and they get satisfaction from their work.

For those who want to go into academics, which certainly can avoid some of those things, obviously there are growing pressures. Thinking of the pandemic, which has hit every institution, every university, every hospital tremendously, will there be resources to help develop junior faculty into fully-formed, well-established, well-experienced senior faculty who will shape what our specialty looks like?

Along those lines, certainly right now, there’s such an emphasis on improving diversity, inclusion, and equity in dermatology. I worry that this will just be the flavor of the month.

It cannot be. It absolutely cannot be, but in order to improve those things, that also requires resources, and funding, and time dedicated to it. I worry that, with limited resources, will it not be able to be maintained?

I hope that’s not the case, but I think those will be some challenges. I know I sound really pessimistic, and I’m not. These are worse case scenarios. I do not think any of these things will be the reality in five years. I think things will be wonderful, but these are things to consider and plan ahead for to make sure these don’t become realities.

Dr Lopez: Those are all valid points. Thank you, Dr Friedman.

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