Understanding downstream service profitability generated by dermatology faculty in an academic medical center: a key driver to promotion of access-to-care.

Hiring new dermatology faculty at academic medical centers (AMCs) can be a difficult process. Academic dermatology departments, however, must have the financial freedom to nimbly respond to the needs of their community. To determine the downstream revenue and profitability produced by dermatology faculty, a retrospective review of charges and expenses downstream of professional services was performed to assess dermatology faculty and nurse practitioners from January 2019 to December 2020 at a single AMC in the southern United States. The downstream revenue per dermatology faculty was calculated using institutional data based on the number of services performed and the exact compensation per service. When this was not possible, the Medicare Allowable Charge was used to estimate the compensation for the service provided. Revenue was included from internal referrals to dermatopathology, Mohs surgery and repairs, chemistry and microbiology labs, radiology, and phototherapy. Profitability was calculated using institutional cost data to estimate the expense of each additional unit of services performed. The most valuable source of downstream income was dermatopathology services, which generated $85,395/provider in 2019 and $102,746/provider in 2020. Mohs surgery was also a significant source of downstream revenue contributing $92,715 in 2019 and $96,599 in 2020. Repairs after Mohs surgery internal referrals generated $30,036 in 2019 and $36,507 in 2020. The total contributions of chemistry and microbiology labs, radiology, and phototherapy were considerable but less impactful overall. The total downstream revenue calculated from these services for 2019 was $228,304/provider and $255,549 in 2020. The total downstream profitability for these services was calculated to be $112,597/provider in 2019 and $92,344/provider in 2020. In conclusion, faculty of academic dermatology departments produces a great deal more revenue and profitability for AMCs than the sum of their professional charges.

Factors Associated with Likelihood to Undergo Cosmetic Surgical Procedures Among Young Adults in the United States: A Narrative Review.

Introduction/Goals: Over the past decade, cosmetic surgical procedures have become increasingly popular. This trend has been driven by procedural innovations as well as access to Internet and social media. Consequently, patients have been seeking cosmetic surgical procedures at younger ages. In this narrative review, studies assessing attitudes towards cosmetic surgical procedures among college-aged young adults were evaluated. Methods: A search identified 20 studies published from 2002 to 2021 that focused on cosmetic surgical procedures among young adults. Each study used survey-based data to determine attitudes, acceptance, interests, perceptions, and beliefs about cosmetic surgical procedures among college-aged students in the United States. Results: The proportion of college-aged participants who had undergone cosmetic surgical procedures ranged from 1.3% to 6.4% with surveys reporting that between 21 and 43% were interested in procedures in the future. In general, young women were more likely to express interest in cosmetic surgical procedures than young men. Studies consistently demonstrated an inverse relationship between body satisfaction and use of aesthetic procedures among this patient population. Other factors associated with acceptance and approval of cosmetic surgical procedures included importance of appearance to self-worth, concern with social standing and attractiveness, investment in appearance, media influence on body image, and positive attitudes towards celebrities. Exposure to cosmetic surgery advertising was correlated with increased approval of cosmetic surgical procedures, especially the perception that advertising influences "others" more than survey respondents themselves. Conclusion: Interest in cosmetic surgical procedures continues to grow among young adults in the United States. In the future, this cohort is likely to become an increasingly important demographic to target for education, advertising, and research regarding cosmetic surgical procedures.

The iso-oncotopic response: immunotherapy-associated bullous pemphigoid in tumour footprints.

This case report describes a unique distribution of bullous pemphigoid induced by cemiplimab therapy. The patient preferentially developed bullae in the scar "footprints" of previous non-melanoma skin cancers, yet traumatic scars were spared. We propose to describe this distribution as an 'iso-oncotopic response'.

Attitudes and perceived barriers toward store-and-forward teledermatology among primary care providers of the rural Mississippi.

Telehealth expands the capacity to care for patients in rural and underserved settings. Store-and-forward teledermatology is a simple and effective approach which enables remote dermatological diagnosis and treatment. Implementing store-and-forward technology in rural Mississippi has the potential to expand access to dermatology services at locations, where an in-person dermatologist is not available including: emergency rooms, urgent care centers, and primary care practices. A survey study was conducted to assess perceived obstacles and attitudes about store-and-forward teledermatology among primary care providers in Mississippi's rural areas. Most providers are very interested in the telehealth program and the opportunities it provides them to best treat their patients. Key barriers to engagement in teledermatology were (1) primary non-adherence: this is rooted in misconception about teledermatology, the investment in time required to master the technology and establish digital links between primary care provider and consultant; and, (2) secondary non-adherence: this is related to the time required to submit a teledermatology consult which disrupts busy offices. Emphasizing the benefits of teledermatology to primary care physicians and simplification of the teledermatology consult submission process may increase the use of teledermatology in rural Mississippi and serve as a model for other academic teledermatology programs throughout the United States.