Practice Rounds: The Dermatology Gap
By Matt Westerfield
When cancer survivor Niki Rickles of Vicksburg called to make an appointment for a screening at the University of Mississippi Medical Center Cancer Institute’s Melanoma Clinic in May, she was originally told she couldn’t be seen until August.
“They called me back the next day and asked if I could come in that Friday instead,” Rickles said during a recent follow-up appointment to the clinic at the Jackson Medical Mall Thad Cochran Center. “I was very surprised. It’s nice to know I can find a melanoma expert so close to home.”
Her luck, however, is the exception to the rule. A shortage of dermatologists in Mississippi usually means long waits for would-be patients, who may end up going out of state for care or leaving skin problems untreated.
But a new Department of Dermatology at UMMC, complete with its own residency program, aims to meet that problem head-on by expanding services and training homegrown dermatologists.
“There appear to be just north of 40 actively practicing dermatologists in the state of Mississippi for three million people,” said Dr. Robert Brodell, professor and chief of dermatology. “So we are tremendously underserved.” Brodell said that’s partly because dermatology residency training has never been available in the state.
“It’s been frustrating for primary care doctors who know that they need help but find that they can’t get help from a dermatologist for months,” he said. “We are not going to improve this situation overnight, but we will start chipping away at the problem.”
Six years ago, the Division of Dermatology in the Department of Otolaryngology and Communicative Sciences was created to help lay the groundwork for a future department. Brodell joined the Medical Center last summer to shepherd that process and develop a residency training program.
Working in private practice for 27 years in his hometown of Warren, Ohio, Brodell had long been interested in becoming a full-time academic physician. He jumped at the chance to join the Jackson dermatology community and UMMC.
The new department received formal approval last fall and is training its first two residents.
Dr. LouAnn Woodward, associate vice chancellor for health affairs and vice dean of the School of Medicine, says dermatology is one of the most competitive specialties nationally. In fact, there are only 360 slots in the entire country.
“Only the top students match,” Woodward said, “and we have a great track record in matching our students into dermatology. So without a residency program, we’re guaranteeing that we export some of our very best students.
“In the past, we just had to tell them, ‘We’ve got nothing for you.’”
Brodell said there’s no problem having applicants interested in training in dermatology; the challenge is having adequate training for the residents.
During the three-year residency, which ensues after one year of primary care training, residents would be required to have training in pediatric dermatology, dermatopathology, surgery, and general dermatology areas, “and that can only be provided by groups of people with specialized talents,” Brodell said.
To provide that training, Brodell has recruited three new faculty members with expertise in areas such as Mohs surgery, occupational dermatology and lymphoma. They add to what he describes as an already stellar faculty.
As for reaching more patients, the nascent department is expanding its reach across campus as well. The residents will rotate through the recently opened Melanoma Clinic, a multispecialty clinic conducted one day each month at the Jackson Medical Mall, and the new “Suite K” Dermatology Clinic, which recently opened in the University Physicians Pavilion.
“It’s really important for the Department of Dermatology to have a presence on campus,” Brodell said. “For instance, there could be circumstances where patients who are admitted to the hospital have a minor dermatologic problem, one that really doesn’t require the cost of having a specialist come to the floor.
“But on the day of discharge, it would be wonderfully convenient if they could just sweep by Suite K and have their dermatologic situation taken care of on their way home.”
Additionally, the residents will rotate through the established clinics at Grant’s Ferry in Flowood and the Face and Skin Center in Ridgeland. Dr. Nancy McCowan, an expert in complex medical dermatology and cosmetic dermatology, is program director of the residency.
“We’re shooting high, and we’d like to think that with the start of July this year, we’re going to have a world-class place to learn dermatology,” Brodell said. “Give me 10 years and we’ll have world-class clinical and basic science research in dermatology.”
Melanoma clinic established at UMMC
The University of Mississippi Medical Center has established the first multidisciplinary melanoma clinic in the state of Mississippi. This allows patients to see a dermatologist (Dr. Will Black), an oncologist (Dr. Natale Sheehan), a plastic surgeon (Dr. Ricky Clay) and a head and neck surgeon (Dr. Randy Jordan) in one visit. Patients will be advised about all approaches to the care of melanoma, including the width of removal, recommendations on the use of interferon and the utility of a sentinel node biopsy, and in stage 4 melanoma, a recommendation about targeted therapy. To schedule an appointment, contact Sheehan at 601-984-5590.