The University of Nebraska Board of Regents approved a request on May 25 by the University of Nebraska Medical Center to establish a Department of Dermatology in the UNMC College of Medicine.
Dermatology is the branch of medicine and surgery dealing with the expert care and treatment of diseases of the skin, hair and nails.
"The creation of a dermatology department is a major first step in addressing the shortage of dermatologists in Nebraska," said UNMC Chancellor Jeffrey P. Gold, M.D.
Currently, Nebraska has about one dermatologist for every 52,000 people – the poorest 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.
"Addition of a department of dermatology also will contribute to the breadth of educational, research and clinical expertise in the prevention and treatment of skin diseases offered through UNMC and Nebraska Medicine," Dr. Gold said.
Because of the amount of time spent outdoors, Dr. Gold said 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 a rare type of skin cancer known as melanoma, he said.
Dermatology services are in high demand, said Dele Davies, M.D., vice chancellor for academic affairs at UNMC. "This is being driven by the rising occurrence of skin cancer, the aging of the population and increasing demand for cosmetic procedures," he said.
More than $2.9 billion is spent annually on skin cancer, Dr. Davies said, making it the 16th most costly Medicare diagnosis.
Bradley Britigan, M.D., dean of the UNMC College of Medicine, said creation of the department will begin with recruitment of a department chair followed by a small number of faculty with focused subspecialty interests within dermatology.
He said it is hoped that community dermatologists in Omaha and other parts of Nebraska also will be interested in contributing to the academic missions of the department as volunteer or part-time faculty.
The department also will quickly move toward the establishment of a dermatology residency training program and eventually subspecialty fellowships that will enhance the availability of trained dermatologists for the region, Dr. Britigan said.
Given the high demand for their services around the nation, recruiting dermatologists to Nebraska who are completing training in other parts of the country is always a challenge, he said.
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.
"For many years, dermatology residency positions have been among the most competitive to obtain in the U.S.," Dr. Britigan said.
Previously, dermatology had only 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 to grow and develop clinically as well in education and research.
In looking at peer institutions, Dr. Davies said eight of nine schools have dermatology departments and only one had a division. One institution, Colorado Health Science Center, had 23 physicians and six Ph.D. researchers in its dermatology department.
If the Fred & Pamela Buffett Cancer Center is to be a world-renowned cancer center, Dr. Gold said 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.
The creation of a Department of Dermatology also is critical to better meeting the needs of patients at UNMC’s major clinical partners – Nebraska Medicine, Children’s Hospital & Medical Center and the VA-Nebraska/Western Iowa, said Harris Frankel, M.D., chief medical officer for Nebraska Medicine.
He said 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 reduces wait time for patients while allowing dermatologists to place a higher priority on more serious conditions.
Many of the patients cared for in these health systems develop dermatologic problems during the course of their inpatient care for other diseases, Dr. Frankel said. This is particularly true of patients being treated for cancer, undergoing transplantation or in other ways immunosuppressed. Timely and rapid availability of specialized dermatologic expertise is important to their care, he said.
This marks the second new department created by the UNMC College of Medicine in the past year. In June 2015, the Board of Regents approved creation of the Department of Physical Medicine and Rehabilitation. PM&R physicians treat patients suffering from stroke, musculoskeletal injuries and pain syndromes and help rehabilitate patients with severe impairments.
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