in keeping with its mission of  physicians , leaders and mentors ,  the women s dermatologic society brought together key physicians and industry leaders to identify the challenges , brainstorm solutions , and envision the future of the dermatology specialty . the women s dermatologic society is the third largest dermatologic society in the u.s . , and is composed of members from 32 countries . membership is 90% female , 10% male , and encompasses the diversity of dermatology with academic , private practice , practice , and industry membership . the five - year outlook : insurance reimbursement and formulary covered prescriptions continue to decline . office - based dermatologic disorders are not viewed as life - threatening or often as important as other medical issues , which further threatens adequate reimbursement . in contrast , hospital - based inpatient dermatology services , such as leg ulcer care , are highly utilized and adequately reimbursed ( turhune , 2012 ) . as a result , a two - tier system of self - pay and insurance reimbursement has developed . for example , acne , the most common skin disorder in the u.s . , is not covered by insurance in many states ( drummond , 2013 ) . given their uncertainty about insurance reimbursement , patients are often forced to pay for treatment as an outof - pocket expense . similar to dentistry , success will be mandated by balancing the cash pay vs. insurance - reimbursed segments within the medical practice . nationally , the demand for dermatological services is increasing and the specialty is experiencing workforce challenges , with physician extenders increasingly becoming the primary providers for dermatology services ( american medical association ) . access to dermatologists and trainees : current pharma guidelines have limited the access of pharmaceutical representatives to physicians , including residents and fellows , outside of cme meetings . the provision of prescription samples to patients is restricted and industry - sponsored events at training institutions are prohibited . the sunshine act , which mandates reporting of all financial interaction with the pharma industry , has further decreased dermatologists interaction with the industry representatives , both in educational and advisory capacities . mentoring , networking and grassroots initiatives , such as those sponsored by wds regional networking groups , can bridge the learning gaps for trainees and young physicians , while ensuring appropriate trainee - industry relations . doing things differently : a consensus meeting with our industry partners provided important perspective and input into strategic planning for dermatology . to facilitate that input , three needs were identified . 1 ) provide continuing education for dermatologists about the requirements and ramifications of the sunshine act . 2 ) educate the public about the value of physician - industry collaboration and dialogue . 3 ) prevent  swapouts  of generic medication for a brand - name medication . concern was expressed about the frequency of pharmacy  swapouts  when a brand - name medication is desired based on unique properties but a generic  equivalent  is substituted without the knowledge or understanding of the patient or notification of the prescribing dermatologist . prevention of these  swapouts  is an opportunity for physicians , industry representatives , and patients to develop educational materials clarifying the importance of physician prescription compliance by pharmacy and insurance companies . furthermore , the american college of clinical pharmacy issued the following guideline for pharmacists to abide by : pharmacists should not solicit or accept gifts from industry that might influence or appear to influence objectivity , independence , or fairness in clinical and professional judgment ) . new practice environment : increased and optimal utilization of social media and technology will be critical in communicating with patients and colleagues in this new practice environment . a key organizational message of the women s dermatologic society is providing service to women and families worldwide . this message , as well as the goal to address career challenges , is gender - neutral and should engage both male and female dermatologists and trainees . partnering with industry colleagues in providing unique educational opportunities for our membership is in the best interest of all stakeholders . unmet needs : a recent wds member survey focused on unmet needs for the dermatologist . the top two needs were 1 ) survival and growth of the dermatologist in the new health care environment , 2 ) positioning the dermatologist as the skin care specialist and experts in skin , hair , nail and mucous membrane disorders . the proposed solutions included : 1 ) an expansion of wds networking events to include subjects such as government regulations and 2 ) exploring and utilizing available social media for a public and physician communications campaign to emphasize the importance of the specialized training and abilities of dermatologists . the key factor for success is the recognition of the benefits of collaborative efforts between the dermatologist / physician , industry ( pharma ) and the public . the changing practice environment is challenging , but offers us an opportunity to be proactive and innovative .
the u.s . medical environment continues to evolve with issues from privacy to emr , insurance regulations , physician access and healthcare reform , and macra ( medicare access and chip reauthorization act ) on the discussion table . 
 not since the advent of medicare and medicaid in the mid 1960 s , have we seen such widespread changes in the medical healthcare environment ( centers for medicare and medicaid services ) . 
 physicians , industry , patients and consumers are affected by the changes . 
 these four groups have historically worked as separate entities , but are now key stakeholders in the future of dermatology . as stakeholders collaborating in building a future together , the dermatologists / physicians will help to ensure and preserve the quality of patient care and best patient outcomes . in the executive forum , leaders from the women s dermatologic society and industry , explored five important areas : 1 ) a five - year outlook of dermatology and medicine ; 2 ) access of industry to dermatologists and trainees ; 3 ) the new practice environment ; 4 ) doing things differently ; and 5 ) unmet specialty needs . 
 the collaborative group explored solutions for our specialty and the patients we serve .