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Nearly 85 million—or one in four—Americans were seen by a physician for skin disease in 2013. Skin disease, which ranges from acne to skin cancer to chronic conditions like eczema, is now more common than all cardiovascular diseases and diabetes.
Skin disease is serious: of 24 skin disease categories explored in the American Academy of Dermatology’s Burden of Skin Disease study, half were fatal. These skin diseases caused 22,953 deaths in 2013 according to the same study. And, on average, those who died of skin disease in 2013 died at an age five years younger than those who died of all causes.
Skin disease also places a significant burden on patients, families, and employers. In 2013, skin disease cost the U.S. health care system approximately $75 billion in medical, preventative, and drug costs. Lost productivity (also referred to as the opportunity cost) totaled $11 billion for patients with skin diseases and their caregivers, not including additional time with at-home care and treatments.
Given the prevalence, seriousness, and far-reaching effects of skin disease, it is estimated that approximately 20,000 clinicians are needed to treat this volume—nearly twice the number of current board-certified dermatologists in the United States.
This demand is particularly concerning due to the aging U.S. population. The 2013 research showed that nearly 50 percent of Americans over age 65 had a skin disease, with an average of 2.2 skin diseases per person. The number of individuals with skin disease is anticipated to increase as the population ages. By 2060, projections show there will be nearly 95 million Americans age 65 or older, an increase of 45.5 million from 2016. Those 65 or older will comprise nearly a quarter of Americans.
These findings have significant implications for patients and the entire health care system. This growing burden of skin disease, along with the increasingly multidisciplinary aspect of treating dermatologic conditions, and the growing emphasis on coordinated care, requires dermatologists to respond innovatively by adapting their practice models to these evolving changes.
A Multidisciplinary Approach
Newer models of patient care delivery that drive improved quality of care, efficiency of care, and access to care demand and incentivize greater collaboration. This means that dermatologists cannot go it alone; we must work closely with primary care physicians and other specialists to meet patients’ needs. Being on the front lines treating more than 3,000 skin diseases requires dermatologists to work in tandem with their peers and other clinicians to ensure timely delivery of high-quality, patient-centered care.
This collaboration is of particular importance, given co-morbidities related to skin disease. The skin serves as a ‘first alert’ for many other conditions and comorbidities. Studies show eczema and psoriasis, for instance, are associated with heart disease and diabetes. One study found adults who have had shingles have an increased risk of stroke and heart attack—at 35% and 59%, respectively—than those who have not had shingles. Undiagnosed cellulitis can progress in mere hours and lead to death. Other skin conditions can be a manifestation of underlying disease, such as cancers or autoimmune disorders.
The Push To Coordinate Care
Historically, most medical specialties—including dermatology—have practiced in independent settings. The advent of value-based payment models through incentivized quality improvement performance focusing on a coordinated, team-based approach to patient care are driving all specialties to embrace collaboration.
Like other specialists, many dermatologists are responding to value-based care by making themselves more accessible to their peers and patients.
Health care is at a critical crossroad and dermatology is adapting in response, alongside our peers in medicine. We are focused on the outcomes of millions of patients with skin diseases and associated comorbidities who rely on our expertise and training in the face of increasing challenges to accessing the health care they need.