Dermatologist Advocacy Key to Shaping Policy, Safeguarding Patient Care

This content was developed independently and is not endorsed by the American Academy of Dermatology.

Without stronger physician engagement in advocacy, shifts in health care threaten how dermatology care is delivered and who can access it, experts warned during a Saturday morning session at the 2026 American Academy of Dermatology (AAD) Annual Meeting.¹

Dermatologist Advocacy Needed Amid Growing Pressures

Klint Peebles, MD, FAAD, a dermatologist with the Mid-Atlantic Permanente Medical Group, opened the session, “Advocacy in Dermatology with the Experts: Intersections to Safeguard the Specialty,” by framing advocacy as essential to protecting dermatology amid growing policy, economic, and societal pressures.

He explained that policy determines who can access care, how and where it is delivered, and how it is reimbursed and regulated. Because of this, Peebles described advocacy as “clinical care outside the exam room” and a critical mechanism for physicians to shape policy in patients’ favor and protect the patient-physician relationship.

As highlighted throughout the session, he noted that 3 key policy domains shape dermatology: regulation, technology, and economics. Peebles added that climate is a “cross-cutting force” impacting all 3, affecting disease patterns, practice capacity, and public health, with significant health equity implications.

Patients often trust their physicians more than institutions, such as the American Medical Association (AMA) or federal agencies. Prior research has also shown that strong patient-physician relationships are associated with improved patient adherence, satisfaction, and clinical outcomes. Given this, Peebles underscored physicians’ unique role in helping rebuild patient trust in policy, science, and the health care system.

However, he also highlighted growing pressures that threaten this relationship. These include technological disruptions, such as the increasing use of artificial intelligence (AI) in care delivery; systemic challenges, including insurance and policy barriers; and sociocultural factors, such as mistrust in medicine and the spread of misinformation and disinformation.

Given the current landscape, Peebles encouraged dermatologists to engage in advocacy to help shape the future of medicine and mitigate these challenges before they further erode patient trust.

“Our future in dermatology is not going to be written just in journals; it's going to be written in the legislatures, and that's where it's being written now anyway,” he concluded. “The sooner we realize that and engage with that process, the better off our specialty is going to be.”

Overwhelming Administrative, Systemic Challenges Strain Practices

Jack S. Resneck, MD, FAAD, chair and the Bruce U. Wintroub Endowed Professor of Dermatology at the University of California, San Francisco, and former AMA president, built on several of Peebles’s points during his presentation, “Dermatology and Advocacy in the House of Medicine.”

Like Peebles, Resneck emphasized the urgency of collective advocacy, noting that physicians face a growing set of burdens, including electronic health record (EHR) inbox overload, documentation requirements, prior authorization, inadequate staffing, and regulatory hurdles. These challenges are compounded by newer pressures that threaten practice sustainability, such as instability in research funding, federal system dysfunction, and increasing misinformation and distrust of science and physicians.

Since President Donald Trump took office in January 2025, his administration has made several demands of the National Institutes of Health (NIH), including terminating grants on topics that do not align with its priorities, such as those related to COVID-19 and diversity, equity, and inclusion efforts.² As a result, hundreds of NIH-funded clinical trials have lost support, with approximately 1 in 30 of all trials disrupted nationwide.

Despite this, Resneck noted that the NIH has maintained relatively stable overall annual spending, in part by distributing multiyear grant funding up front to some recipients, which reduced the number of new grants awarded in a given year.¹ He added that paylines have dropped sharply, down to approximately 4% in some areas, making funding increasingly difficult to secure.

Consequently, many early-career investigators are leaving research or pursuing opportunities abroad in countries with stronger investment in science. Resneck emphasized that this trend threatens the biomedical innovation pipeline responsible for many transformative therapies. He also highlighted the growing impact of misinformation and disinformation, which is consuming more time during patient visits as physicians debunk social media myths and antivaccine narratives.

Dermatology is not exempt, Resneck noted, with viral claims like “sunscreen causes cancer, not the sun” routinely circulating. He added that media coverage and high-profile figures can sometimes misrepresent dermatology, undermining trust and discouraging patients from seeking appropriate care.

To ensure dermatologists’ perspectives are represented, Resneck encouraged greater engagement in relevant medical societies, including the AMA, and dermatology societies, like the AAD. For those unable to commit to national leadership, he urged them to engage in state and county medical societies and stressed the importance of involvement in hospital medical staffs and local civic roles.

Overall, Resneck especially recommended engagement at the patient and community levels to address misconceptions directly and serve as trusted voices in local media, public forums, and advocacy efforts.

“I'm not naive about the grim threats to our work, and I'm not exactly sure what leadership looks like in a perfect world, but I still feel in my heart that we're incredibly privileged to do what we do, despite all the noise going on in the background,” Resneck said. “…Sometimes I feel like because of that privilege, we have a deep responsibility to our patients and to the health of the nation, largely, as keepers of that very important tradition.”

Medicare Payment Cuts, Structural Flaws Threaten Dermatology Practices

Complementing Resneck’s presentation, Marta J. Van Beek, MD, MPH, FAAD, clinical professor of dermatology and director, Division of Dermatologic Surgery at the University of Iowa, highlighted another force threatening practice sustainability: ongoing Medicare payment erosion.

She began with an overview of Medicare Part B physician payment, outlining its 3 key players: current procedural terminology (CPT), the Relative Value Scale Update Committee (RUC), and CMS. CPT defines and names medical services, RUC estimates the relative physician work and practice expenses associated with each code, and CMS converts relative value units (RVUs) into dollars using the conversion factor. Contrary to popular belief, she emphasized that CMS sets dollar prices, not physicians.

Van Beek then pointed to 2 major structural challenges, starting with the lack of a meaningful inflationary update. Over about 25 years, practice costs have risen by more than 60%, but the Medicare conversion factor has remained flat or declined. As a result, each RVU is effectively worth less over time, even as expenses increase. She noted that this dynamic squeezes margins across all practice settings, placing particular strain on small, solo, and rural practices and driving consolidation into larger health systems and corporate entities.

The second issue is budget neutrality. Van Beek described Medicare physician spending as a fixed pool of funds, meaning that when new services are added or utilization increases for certain codes, CMS must offset those costs by reducing the conversion factor. Consequently, all physicians receive payment cuts, even when spending growth occurs in entirely different specialties, contributing to the steady erosion of reimbursement.

She also addressed the ongoing shift from fee-for-service (FFS) to value-based care. Although FFS is often criticized for rewarding volume over value, Van Beek noted that value-based frameworks introduce their own challenges. Value is typically defined as quality divided by cost, but quality remains difficult to define and measure.

Alternative payment models (APMs), including capitation, bundled payments, and accountable care organizations, are designed to incentivize outcomes and efficiency. However, she explained that these models are complex and, if poorly designed, may penalize physicians who care for sicker or more medically complex patients.

Dermatology faces particular challenges in this landscape. Van Beek highlighted that the specialty lacks robust, standardized severity measures that can be easily pulled from the EHR. In addition, risk adjustment can distort perceived value. She explained that a dermatologist managing milder disease with topical therapies may appear more cost-efficient, while those treating severe conditions with biologics may appear disproportionately expensive despite delivering substantial patient benefit.

In response, Van Beek outlined 3 key reform priorities for Medicare physician payment, including an inflationary update via the Medicare Economic Index (MEI). She explained that tying the conversion factor to MEI can help physician payment keep pace, at least partially, with practice costs.

She also advocated for revisiting budget neutrality requirements to avoid automatic, across-the-board payment cuts tied to new services or volume shifts. Lastly, Van Beek emphasized the need to rebuild quality and APM design to incorporate better risk adjustment and ensure that models do not punish physicians for caring for patients who are sicker, poorer, or more complex.

“It's really important for us to show up to make sure that we are not disregarded as a specialty,” she concluded. “…We know that when we intervene with the right diagnosis at the right time, our patients can get better faster than if they’re misdiagnosed and get the wrong treatment….I really encourage you to advocate on behalf of our specialty, because we have the greatest privilege in the world of having that relationship with our patients and being able to interact with them every day.”

References

1. Peebles K, Hines AC, Lester JC, et al. Advocacy in dermatology with the experts: intersections to safeguard the specialty. Presented at: 2026 AAD Annual Meeting; March 27-31, 2026; Denver, CO.
2. McCormick B. NIH grant terminations disrupt 1 in 30 clinical trials, impacting over 74,000 participants. AJMC. November 17, 2025. Accessed March 29, 2026. https://www.ajmc.com/view/nih-grant-terminations-disrupt-1-in-30-clinical-trials-impacting-over-74-000-participants