Predictions on the Future of Dermatology

Joel M. Gelfand, MD, MSCE, and Joseph R. Merola, MD, MMSc, explored trends in dermatology practice organization and the impact of drug development, research priorities, and emerging technology on clinical practice, during their session, “The Future of Dermatology,” on the first day of the 2023 Interdisciplinary Autoimmune Summit.

Dr Gelfand noted that dermatologists are increasingly working in large practice settings owned by private equity, and physician assistants are taking on a larger role within these practices. Future trends include dermatologists leading large care teams that are responsible for thousands of patients, spending time with patients whose cases only a board-certified dermatologist can treat, and being outnumbered by advanced care practitioners. “One of the major drivers is the progress we make in medicine means there is going to be an increasing demand for our services, and we are not training enough clinicians. There has to be something to fill in the gap and that is where advanced practice people come into play,” Dr Gelfand said.

Drug development is exploding, with at least 16 Janus kinase inhibitors in development, and there are now dozens of treatment options and permutations for treating psoriasis. Dr Gelfand predicts that there will be an exponential increase in new treatment options; however, many of them may be of low value. He also foresees that marketing and market access will have a larger impact on which treatments patients receive.

“The research priorities of today will impact practice tomorrow,” Dr Gelfand remarked. He posits that more real-world randomized controlled trials will be conducted to determine best use for treatments, with coordinated and holistic care becoming the standard. He also thinks that artificial intelligence will disrupt clinical practice, leading to treatment of pathways not diseases.

Dr Merola forecasts that dermatologists will work more collaboratively via patient education, comanagement and referral, and other methods to support a holistic care approach, with increasing acknowledgement and discussion of comorbidities in inflammatory dermatologic conditions. Using psoriatic disease as an example, he discussed building a team for patient care. Dermatologists are asked to treat psoriasis, screen for comorbidities, refer, and do some amount of patient education. Rheumatologists provide psoriatic arthritis treatment and similarly they must think about how the skin matters and take into consideration other comorbidities. “In my system, I can put a referral in to rheum, but how do our community colleagues implement this?” Dr Merola asked. Dr Gelfand added, “To some extend we end up being siloed and we have our hands full trying to manage the disease that is in our purview. I think this is one of the things from a systems point of view that needs to be considered.”

In an ideal world, patients love the idea of seeing multiple clinicians at the same time, Dr Merola stated. Combined dermatology-rheumatology clinics can improve care, research, and patient satisfaction. “The problem we always come up with is, ‘Is it practical?’” he challenged. “Part of the solution from a systems point of view might be can people on the front lines rapidly access centers of excellence collaboratively?” Dr Gelfand commented. Dr Merola pointed out the importance of considering ways to intervene earlier in the disease process and capitalizing on opportunities for prevention.

“We are excited about digital health,” Dr Merola indicated, “We helped develop, with a merger of 2 nonprofit organizations and some industry supporters, an app called Psorcast that uses passive and active biometrics to predict the development of psoriatic arthritis over time. Patients can use this at home on their smartphone and maybe eventually a wearable. It is pretty incredible that you can have a phone in your pocket that can tell if your gait is a little off, maybe if you are walking funny. Is this your development of psoriatic arthritis? There is lots of hope for the future,” he concluded.   

Reference

Gelfand JM, Merola JR. The future of dermatology. Presented at: Interdisciplinary Autoimmune Summit; April 26–28, 2023; Virtual.