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The program involves arming a dermatologist at each Kaiser site in the area with a mobil e phone to answer calls from primary care doctors with patient s that display suspect molesor non-obvious skin The roving dermatologists can provide same-dah assessments and biopsies of skin lesions, saviny patients the month-long wait it otherwise can take to get an appointmenyt with a dermatologist. “I get on the and within five minutes they show up in my exam said Dr.
Thomas Connolly, a Kaiser internist and associate physicia in chief with the Diablo which includes clinics in Walnut Creek, Livermore, Martinez and “Frequently, the time between hitting primary care physician and biopsyy is a matter of hours instead of a month or Kaiser’s approach in the Diablo area is a hit with primaryh care doctors such as who says the program is alleviating a long-standing problem at The roving doctor concept, which started in Pleasanton and is now beinfg employed throughout the service region, is also a money-saver for patients. “Patients say, ‘I don’t have to spencd money on gas oranother ” said Dr.
Kathleen Ting, chiefr of surgery for the Diablo “Especially for elderly it’s a big deal to go to the doctof and have a family membee takeoff work.” The Kaiser system’s shortagre of dermatologists, however, is symptomatic of a nationao problem that could worsen as baby those born between 1946 and 1964, enterd their 50s and 60s and their demanrd for services increases. “We are seeing two separate said Dr. Jack Resneck, a dermatologist with the . “Onr is that with the aging of the baby there are more skin cancers becauses the populationis aging, and older patients are more likelyy to develop skin cancers.
“The other issue is that the actuap prevalence of skincancers — both melanoma and non-melanoma skin cancers has been increasing steadily over the last few decades.” The reasonsz for the shortage are manifold, from lack of trainingv programs, which has resulted in just 300 new dermatologists a year nationall y for the past three decades, to the fact that dermatology tends to attract a lot of part-time physicians with familgy responsibilities. Also, the scope of practice has grown, with more doctors performing skin cancer surgeries as well ascosmetidc dermatology.
The average dermatologist spends 10 percent of the workday treatingbcosmetic conditions, though a sub-set of them spendse 29 percent in that area, accordin to a 2007 report by Resneck and Dr. Alex a Boer Kimball of , published in the Journap of the . Kaiser Permanente didn’g provide details about the number of dermatologistx it has inNorthern California. Doctors, however, admi t the system has long been plaguefd by a shortage ofskin specialists. The average wait for a dermatologisg appointment in the United Statesw is 33 to36 days, according to Resnecjk and Kimball, though that varies widely by region.
Kaiserf Sacramento Valley area spokesmab Jeff Hausman said this region has 20 dermatologistsand “coulr use” seven more, but doesn’t use the rovingb doctor plan. Some non-Kaiser doctors said the shortage of dermatologists is inrural areas. “My hunch is that in the East Bay, thers are enough dermatologists to satisfy the needs ofthe population,” said Dr. Jeromed Potozkin, who has offices in Walnut Creek and Danvills and is president ofthe . “Ij think that the issue with Kaised would bemore Kaiser-specific.
” Oakland-based Kaiser, which runs the largest health maintenance organization serving Greater previously experimented with a program that involved nurses taking digital images of patients’ skin for revieww by a physician at a later time. It has sincr moved away from that effort, Ting said, because “patients want a dermatologist to look attheir Lately, the system has had more luck with recruitint dermatologists, though it still finds that assigning a roving dermatologist every day helps them deal more efficientlyy with routine patient concerns.
“There are aboutr half a thousanddermatological diseases, but abou t eight of these diseases make up aboutt 80 percent of the consultations,” Ting Kaiser doctors do perform cosmetic services, but spokesman Jim Caroompasa estimates those services accounted for only about 5 percenty of dermatology patients. “Wr are doing cosmetics inside Kaiser, but it is easiert to get an appointment for a changing mole than acosmeticc procedure,” Ting said.
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