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Delay in treatment is a loss of opportunity for the patient.

Delay in treatment is a loss of opportunity for the patient.

Dermatologists stumble a little more each year in the context of shortages. This major, strained for a long time, will be “on edge.” It’s not the first alert, but this time around, dermatologists, scientific societies, and patient associations have sounded even louder on the forum Recently published in “Le Monde”. Some patients can no longer access care. The point is with Professor Marie Bellotte Barry, chief of dermatology at Purdue University Hospital.

It now takes 126 days to get an appointment with a dermatologist? Isn’t this a long time to ensure good patient care?

Indeed, the delay in taking responsibility for the diagnosis of cancer…

Dermatologists stumble a little more each year in the context of shortages. This major, strained for a long time, will be “on edge.” It’s not the first alert, but this time around, dermatologists, scientific societies, and patient associations have sounded even louder on the forum Recently published in “Le Monde”. Some patients can no longer access care. The point is with Professor Marie Bellotte Barry, chief of dermatology at Purdue University Hospital.

It now takes 126 days to get an appointment with a dermatologist? Isn’t this a long time to ensure good patient care?

Indeed, the delay in caring for cancer diagnosed at an advanced stage is a missed opportunity for the patient. A study also demonstrated that the thickness of melanomas can be measured according to dermatologists’ density. Where there were fewer, the melanomas were thicker because they were seen at a late stage. And that’s consistent with what we’re seeing today in counseling, more and more advanced-stage cancers. Also, delay in care is detrimental to chronic skin diseases and has a physical and psychological impact on the patient.

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In the best-case scenario, the density of dermatologists will not plateau before 2041, ten years after other specialties. How did we get here?

For many years, the number of medical students trained in dermatology was extremely inadequate. This specialty is not highlighted enough. For more than fifteen years we have seen the shortage occur… There is an urgent need to train more dermatologists.

Marie Bellot-Barre, Head of the Department of Dermatology at Bordeaux University Hospital, Member of the French Society of Dermatology.

MB-B.

In your opinion, how many trainees should be trained in this specialty each year?

It would be necessary to train between 130 and 150 students in dermatology in France fairly quickly, against the present hundred. We’ve been asking for this for a long time…

Why did these calls for training remain in vain?

There is definitely a misunderstanding of the importance of dermatology. Hence the importance of allowing patient associations to be heard. The infuriating thing is that dermatology is a specialty that has made impressive progress over the past 10 years, both in oncology and in the treatment of inflammatory diseases. Today, patients do not have access to care, even though we have very effective treatments to offer them.

“It is not uncommon for patients to travel more than 200 kilometers to come to visit Bordeaux Hospital”

Is this shortage of dermatologists a concern in New Aquitaine?

Yes, the situation is worrying in the region. Seven of its twelve departments have fewer than five dermatologists per 100,000 residents. La Creuse has none. If there is no facility in Lot-et-Garonne within ten years, there will be zero. There really are no dermatologists in Villeneuve-sur Lot anymore, which is tragic for the patients. The situation is also very fragile in Charente.

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It is not uncommon for patients to travel more than 200 kilometers to come to visit Bordeaux Hospital. They don’t necessarily come looking for specific expertise, and sometimes it’s simply because they can’t find dermatologists in their department.

Does your hospital department have the capacity to accommodate all of these treatments?

At Purdue University Hospital, the dermatology department is very large, so we successfully handle this influx of patients, while ensuring our mission, which is to manage the most serious or complex diseases. It’s more complicated for smaller hospitals.

Do GPs – already much needed – have a role to play?

They should not replace dermatologists, but they can assess what looks benign or malignant to them, whether or not there is an emergency. to French Society of DermatologyWe have developed treatment algorithms that can help them. MDs can treat mild psoriasis, simple dermatosis, or acne. Once they detect something potentially more serious, we should plan a course of care and request an appointment wisely.

Does this mean that dermatological consultations nowadays are not always justified?

In any case, private dermatologists say they are being invaded by patients who make appointments on their own for an examination that isn’t always warranted. The annual medical examination should be directed at patients who have risk factors. This is also part of the education of the population: you need to know how to watch yourself, but if you have dark skin and moles and fight a duel, you don’t have to consult every year …

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Aside from the increase in trained dermatologists, what are other ways to improve access to care?

In medical deserts, retired dermatologists can offer mobile consultations. To be voluntary, incentives are needed: reduced fees, administrative simplification. In collaboration with regional health agencies, we can also set up one-off checks. And there is clearly the use of telemedicine: it must be facilitated, but it also requires the availability of dermatologists.

Many liberal dermatologists are now turning to cosmetic care, which is very lucrative. Is this not a betrayal of the Hippocratic Oath in this context of scarcity?

I don’t think we should dismiss this trend because dermatologists are the best trained to do this type of treatment. Then, of course, we must avoid that some do only cosmetic medicine. I’m not an ostrich, I know there are, but it’s not the majority. Above all, this phenomenon must not hide the real problem: the lack of dermatologists in relation to demand.