I appreciated the insightful editorial of Dec. 1: 鈥淲ait-time issue more than fees.鈥� The editorial was absolutely right in its assessment on the issues raised.
Yes, the wait-times to see a dermatologist are way too long across the province. They average four months, as of my survey of all dermatologists this past January. The longest was in Langley, at two-and-a-half years.
And, yes, the reason is not enough dermatologists. The reason for this is threefold: not enough resident trainees at the University of B.C., inability to retain dermatologists as seen by half of the dermatology resident graduates leaving B.C. in the past 10 years (including a Kamloops doctor flying to Newfoundland to practise two weeks of every month, then flying home to visit his family), and inability to recruit dermatologists to B.C. due to the lowest fees in Canada.
Victoria has tried to recruit dermatologists for several years without success. A recent promising recruitment of a dermatologist to practise Mohs surgery, a specialized treatment for high-risk or recurrent skin cancers, seemed to be coming to a successful completion until onerous building requirements by the College of Physicians and Surgeons of B.C. helped scare him away. So Island patients continue to have to go to 91原创 for this treatment.
Kelowna has also been unsuccessful in recruitment. This, along with retirement at the end of this year of the only dermatologist in Prince George, puts dermatology training of students from the UBC medical-school program into jeopardy.
Arguably, the two best cities in Canada to live are unable to recruit dermatologists. In total, there are 24聽permanent positions posted on Health Match B.C. for dermatologists, the most of any specialty. And only three resident dermatologists graduate each year.
Where I disagree with the editorial is this statement: 鈥淒ermatologists believe it all comes down to money.鈥�
A huge part of this problem is UBC failing to train enough dermatology residents. On Oct. 24, before dermatology was in the press, I sent a letter to the dean of the UBC Medical School, the president of the B.C. Medical Association and the minister of health suggesting a roundtable meeting with dermatology patient representatives from the 91原创 Skin Patient Alliance to come up with tangible solutions to improve access to dermatologic care in B.C.
This was out of frustration from trying to meet with the Ministry of Health, meeting with the successive presidents of the BCMA and the BCMA board over many years and having met with the associate dean of postgraduate medical education and the dean of the UBC medical school. These all bore no fruit. In addition, I have received no reply to my October letter.
One other issue I disagree with is the editorial鈥檚 discussion of dermatologists鈥� billings. It is misleading to compared gross billings between specialties.
Dermatology has the second-highest overhead ratio of all specialty groups (excluding lab and X-ray) of 45 per cent. Consequently, the real comparator is net income.
Dermatology is in the lowest quartile of net incomes of all specialty groups in B.C. This includes all sources of professional income, including private income.
As far as cosmetic dermatology, this is just one other reason to have robust medicare fees for dermatologists. For once a dermatologist turns to cosmetic practice, he or she rarely returns to fee-for-service medical dermatology.
That being said, we are lucky that so many dermatologists practise entirely or to a large extent in the public system in B.C.
Dr. Evert Tuyp is president of the B.C. Medical Association Section of Dermatology.
