The UNMC College of Medicine takes great pride in having strong academic, research and clinical programs in the major medical specialties and subspecialties. But, there is one area that we continue to lack – dermatology.
I’m happy to report that we are about to do something about this.
On May 25, the University of Nebraska Board of Regents approved our request to establish a Department of Dermatology in the UNMC College of Medicine.
As some of you probably know, dermatology has only previously existed at UNMC as a section of the Department of Internal Medicine. During the mid-1990s into the early 2000s, the section was only able to recruit and retain a single faculty member, and this person ultimately left as the structure did not allow the autonomy necessary for the discipline to grow and develop clinically and academically. In contrast, over the past decade a strong program in dermatopathology has emerged that supports practices regionally and nationally.
Last summer a committee was established, chaired by Dr. Carl Smith, to assess the need and feasibility of the establishment of a dermatology program at UNMC. To do so they sought input from the community dermatologists, regional health systems, and other potential stakeholders. This included studying peer institutions.
The result of this work was a definitive agreement on the need for the presence of dermatology at UNMC. We also found that all of our peer institutions had such programs and at nearly all of them dermatology was its own department. Eight of the nine schools we studied had dermatology departments with an average of nine physicians and one Ph.D. on staff. One of the schools – Colorado Health Science Center – had 23 physicians and six Ph.D. researchers on its dermatology faculty.
We plan to proceed along a carefully defined plan to create this new department. Our first order of business will be to hire a department chair. Once a chair is identified, we will begin the process of recruiting a core group of faculty. The exact number and areas of clinical and research focus will require close collaboration, strategic planning, and support from our major clinical partners Nebraska Medicine, Children’s Hospital and Medical Center and the VA.
We also expect to work closely with community-based dermatologists within the metropolitan Omaha area, as well as regionally, to enhance the educational and research missions of the department and in turn provide clinical resources as needed to those practitioners.
If the blueprint sounds familiar, it is. It’s almost exactly the same approach we have taken over the past year to create the Department of Physical Medicine and Rehabilitation (PM&R), a specialty that treats people suffering from stroke, musculoskeletal injuries and pain syndromes and helps rehabilitate patients with severe impairments.
As with PM&R, we hope to move relatively quickly to establish a residency program in dermatology. Of the many types of specialty residency programs available, dermatology residencies rank among the most competitive in the U.S.
Each year, a number of our own students who are interested in becoming dermatologists must leave the state in order to complete their residency training. Once they have left Nebraska, it is not that easy to get them to return to help meet the needs of our citizens with disorders of the skin.
Dermatology training consists of an initial medical, transitional, or surgical intern year followed by a three-year dermatology residency. Following this training, one-or two- year post-residency fellowships are available in immunodermatology, phototherapy, laser medicine, Mohs micrographic surgery, cosmetic surgery or dermatopathology.
Why pursue starting a dermatology department at this time? The reasons are plentiful:
- It would be an important step in addressing the shortage of dermatologists in Nebraska. Currently, Nebraska has about one dermatologist for every 52,000 people – the highest ratio of any state in the Midwest region. The American Professors of Dermatology recommends a goal of having one dermatologist for every 20,000 to 30,000 people.
- It would contribute to the breadth of cancer expertise and services offered through the Fred & Pamela Buffett Cancer Center, which is slated to open in the spring of 2017.
- If the Fred & Pamela Buffett Cancer Center is to be a world-renowned cancer center, it will need to provide the expertise required for state-of-the-art care of melanoma and other skin cancers. This includes expertise in Moh’s surgery, which is not currently available within Nebraska Medicine.
- Because of the amount of time spent outdoors, farmers are at a higher risk of developing skin cancer. One recent study found that workers who apply certain pesticides to farm fields are twice as likely to contract melanoma.
- Dermatology services are in high demand. This is being driven by the rising occurrence of skin cancer, the aging of the population and the increasing demand for cosmetic procedures. More than $2.9 billion is spent annually on skin cancer, making it the 16th most costly Medicare diagnosis.
- The rural nature of Nebraska makes tele-dermatology a good fit for the state. Photos/videos/data communication of many skin conditions can be evaluated off-site by dermatologists. This would reduce wait time for patients while allowing dermatologists to place a higher priority on more serious conditions.
- Not only would it help Nebraska Medicine meet current shortcomings in the care of its patients, it also would benefit our clinical partners, Children’s Hospital & Medical Center and the VA-Nebraska/Western Iowa, which have similar deficits in dermatology.
There are more hurdles that need to be cleared (e.g. approval of the Nebraska Coordinating Commission for Postsecondary Education), but we are optimistic that this will occur. For now, we are delighted the Board of Regents agrees that a Department of Dermatology is needed at UNMC.
I will keep you posted as new developments take place, but for now, I just wanted to share this exciting news with you.