Dermatology may face public health crisis by 2020

Dermatology may face public health crisis by 2020

Lack of resources and specialist positions could jeopardise public dermatology services by 2020 according to Health Workforce New Zealand’s latest service forecast.

This project was undertaken by a group of dermatologists who were asked to produce a vision for Dermatology services in 2020.

The New Zealand Dermatological Society Incorporated (NZDSI) is urging the Ministry of Health and district health boards (DHBs) to develop a cohesive plan to ensure a sustainable public sector dermatology service and workforce as recommended in the forecast.

Chairperson of the Dermatology Workforce Service Forecast group and member of the NZDSI, Dr Darion Rowan, says there is great concern that many Kiwis will be unable to access the medical care they need should a dermatology service not be available in public hospitals.
Dermatology involves the study, research, diagnosis and treatment of disorders, diseases, cancers, cosmetic, aging and physiological conditions of the skin, fat, hair and nails, including oral and genital membranes.

Dr Rowan says it is clear that the current public dermatology service in New Zealand is very under-resourced not only in terms of the workforce, but also in the range of services and treatment options available, resulting in unmet need.

“The service must expand to address the current deficit, long waiting lists and predicted increased demand, as well as providing equity of access to dermatologic services across the country,” she says.

The Dermatology Workforce Service Forecast report cited New Zealand’s increasing and aging population as a trigger for a likely doubling of dermatology health service demand by 2020.

There are very few dermatologists working in public hospitals in New Zealand in comparison to other countries (and also in private practice). According to the report there are 16 full time equivalent public dermatologists for the 4.5 million population of New Zealand. This is due to the lack of funding allocation for public positions and in some cases, unattractive working conditions.

Currently all DHBs in New Zealand provide some form of dermatology services, but this work is often completed by visiting specialists, locums or through private contracts and in many centres this is a minimal service.

“Access to publically funded dermatology services is currently very limited in New Zealand and varies greatly across DHBs and regions,” Dr Rowan says.

“We acknowledge that private dermatology services are available in most centres and play a role in reducing the pressure on the public system, but these services can only be accessed by those who are insured or can afford to pay the cost of these services.”

Dermatology is predominantly outpatient based and therefore relatively inexpensive on a per-capita basis compared to other hospital specialties.

However dermatology inpatients are often seriously ill and require prolonged hospital stays with multiple assessments. Many other medical and surgical inpatients develop dermatological complications that require prompt treatment by a dermatologist.

“Many DHBs will have difficulty accessing dermatologist care for seriously ill inpatients if dermatology as a service is not supported by the public health system,” Dr Rowan says.

Despite this, the growing demand for both outpatient and inpatient care has not been properly factored into current dermatologist job placements, highlighting the urgent need for more dermatologists consulting in the public sector.

“The Ministry of Health cannot expect overworked GPs and other clinicians to take on these complex specialty cases without the ongoing support, training and expertise of qualified dermatologists. It is not good practice and could put patients at risk due to incorrect diagnosis and treatment.

“There are also very few nurses working specifically in dermatology, with limited or no opportunities for training and further qualifications. There needs to be stronger dermatology training and academic capacity to enhance the service in New Zealand.

“We need to greatly increase the number of public hospital dermatologists so that dermatologists, the experts, are not only providing high quality patient care but also leading public debate on the study, research and diagnosis of skin disorders and diseases.” Dr Rowan says.

According to DermNet New Zealand, a dermatology health services website, one in six (15%) of all visits to the family doctor (GP) involves a skin problem.

To achieve the vision of establishing a sustainable, public sector dermatology service and workforce by 2020, the Group proposed a number of recommendations including:

· every DHB in New Zealand to have a dermatologist-led team, requiring an increase to 30 dermatologists working in the public sector; (from the current 16 full time equivalent dermatologists)

· comprehensive dermatology training provided with public consultant posts available at the completion of training;

· dermatology services to be equitably accessible across New Zealand, with all DHBs to run a full dermatology service with improved access to paediatric dermatology;

· establish a Centre for Dermatology Expertise led by one or more professors and/or senior lecturers in dermatology;

· increase public awareness of the key role dermatologists play, particularly in the management of skin cancer;

· ensure better information gathering and data collection relating to dermatology workforce data, non-melanoma skin cancers, inpatient and outpatient data and audits on skin conditions and neoplasms.

The Dermatology Workforce Service Forecast committee began working in July 2013 and completed the forecast in November 2013, however the report was not published by Health Workforce New Zealand until last month (16 March 2015).
To review the report, go to: www.health.govt.nz/our-work/health-workforce/workforce-service-forecasts/dermatology-workforce-service-forecast

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