News and Trends: News and Trends - News of the Match What’s Hot, What’s Not This past month, when 14,000 new doctors learned where they’d landed residencies, it was evident that the most popular specialties were those that enabled doctors to have more balanced lives and fewer controls placed on them by managed care. What’s Hot Some of this year’s big winners include the following: • Physical medicine and rehabilitation. This specialty jumped by a whopping 33%. • Anesthesiology. This specialty also had great gains, with the number of applicants increasing by 25%. • Diagnostic radiology. This year, applications grew by 8% for this area. • Internal medicine preliminary track. This track was also a favorite, jumping in popularity by 10%. Which brings us to dermatology, a specialty that has no problems filling positions. Although no hard data exists to quantify exactly how many applications the more than 60 U.S. programs get, the word is that schools are overrun with applications. “Anecdotally speaking,” says Alexa Boer Kimball, M.D., M.P.H., chair of the Workforce Taskforce for the American Academy of Dermatology, “most medical programs receive 300 to 400 applications for about 3 available spots on average.”        Seniors are obviously aware that the competition is fierce. “Looking at the polls on the dermatology students’ Web site [http://pub50.ezboard.com/bdermatology] is interesting,” explains Dr. Kimball, “86% of respondents indicate they had applied to more than 20 programs.” Why the popularity in dermatology? No surprise really. Lynn McKinley-Grant, M.D., who’s a member of the AAD’s Workforce Taskforce, cites several reasons. For one, “The students have huge debt from medical school — about $250,000 on average — so they’re trying to go into specialties where they can make some money.” She adds, “I also think dermatology is a specialty that’s academically challenging and diverse — it covers medical and surgical aspects of practice.” Lifestyle issues are important as well, adds Dr. McKinley-Grant, who is also associate professor of dermatology at George Washington University. “Many dermatologists can go home by 5 p.m., and they work fewer hours compared with other doctors. Also, patients don’t need emergent care as often.” But despite the great demand for the few coveted dermatology positions, Dr. McKinley-Grant notes a need for more dermatologists in the workforce. “We need more medical dermatologists,” she says. What’s Not On the flip side of dermatology’s popularity, other residencies realized a decrease in applicants. Primary care continued to attract fewer residents this year, but the drop in applicants wasn’t as severe as it was between 2000 and 2001 when 17% fewer seniors matched to family practice residencies. This year, applications dipped by 7%. But primary care isn’t the only area experiencing a decline. Other trends included the following: • Positions in pediatrics fell by about 9% — from 80% to 71% this year. • The general surgery fill rate fell 4% — from 79% to 75%. This continues a consistent decline in this area. In 1999, 83% of these positions were filled. Overall, the number of applicants has fallen by 30% over the past 9 years Hairy Situation Using Hair to Detect Illegal Drugs You treat some patients’ excess hair and help others to grow more. Now, you could even use hair to discover the presence of some illegal drugs. The FDA has approved clearance for a test that detects Ecstasy and methamphetamine use through hair testing. This radioimmunoassay test identifies the presence of d-methamphetamine, d, 1-methamphetamine and Ecstasy uses. Developed by Psychemedics, the test is “. . . particularly suitable for workplace, criminal justice and medical applications,” according to company president and CEO Ray Kuback. He says, “it is critical that our new assay be available to businesses, agencies and institutions interested in stopping the use of illegal substances.” With the recent rise in Ecstasy use, hair samples are an efficient way to detect drugs in the system. Exczema Eczema Cases Up, Awareness Down Survey Finds Mothers Have a Low-Awareness of Eczema Although eczema affects almost 15 million Americans — mostly children — the American Academy of Dermatology (AAD) recently released survey results revealing that mothers have a low awareness about the chronic, life-altering skin condition. According to the AAD, prevalence of the condition, characterized by dry, scaling, red and itchy skin rashes, has tripled in the last 30 years. Many dermatologists agree that this condition can lead sufferers to feeling self-conscious, sad, alone and frustrated. The AAD, which conducted a survey through Original Research Corp. International of 321 women currently living with a child between the ages of one and 16, found: • 55% of respondents said eczema was not a serious condition or were “unsure” of its seriousness. • 58% of respondents said they believed that the 10% or less of school-age children suffer from eczema, although about 20% of school-age children are living with eczema. • 16% of respondents believed that eczema has a devastating impact on a patient’s psychological well being. The results are being used by the AAD to help shape its public education campaign, “Outside & In: Healthy Living with Eczema.” The goal of this campaign is to build awareness about the serious impact eczema has on the quality of life of sufferers, caregivers and their families. Fast Facts HIPAA’s Privacy Requirements New Proposal May Give Doctors Major Break This month, talks are underway to revamp a major provision of the privacy regulations — one of the cornerstone regulations of the Health Insurance Portability and Accountability Act (HIPAA). As the regulations now stand, beginning on April 14, 2003, you would need to get written consent from all of your patients before using or disclosing medical information for treatment, in order to receive payment for claims and more. Naturally, this would have huge ramifications on the way you now interact with patients by building extra time into already time-constrained patient interactions. Other healthcare entities are affected, as well. For example, pharmacists would no longer be able to fill prescriptions phoned in by doctors that are for pick up by a patient’s relative or friend. Secretary of Health and Human Resources Tommy G. Thompson proposed that the consent requirements be removed because they could delay patient care. Even if the proposal gets passed, protective measures are still in place regarding patient privacy. You would still need to inform patients of their rights and about disclosure policies. You’d also need to ask them to sign a form acknowledging that you informed them of this information. However, you could still provide care if you hadn’t received the patient’s written acknowledgement. In addition, the proposal would still ensure the following: • Patients could inspect and copy their medical records, and they could suggest corrections. • Parents could have access to their children’s medical records, including access to information such as treatment for drug or alcohol abuse, abortion and information about mental health. The proposal has been published in the Federal Register and is under review this month. A ruling is expected soon after the 30-day review period is up. Onychomycosis Therapy New Survey Documents Patient Satisfaction Results Onychomycosis can be a chronic condition for our patients — and until recently, effectively treating it has always been a struggle. Two years ago, the first topical treatment for onychomycosis was approved by the FDA. Penlac Ciclopirox antifungal nail lacquer, which was launched in March 2000, remains the only topical treatment for this condition. To date, more than 2 million Penlac prescriptions have been dispensed, and currently, Penlac represents one out of every three prescriptions dispensed for onychomycosis. These data seem to directly contradict many dark predictions regarding the medication’s success, given its package insert efficacy rates in the single- and low double-digit percentiles. So why has Penlac become so successful? To quantify the anecdotal trend of high patient satisfaction regarding treatment with this drug, a recent survey was conducted. Selya Associates, an independent research company, interviewed 1,750 Penlac patients who revealed the following: • 87% found Penlac easy to use • 65% reported improvement in their nails after using Penlac • a majority said the possible health risks associated with oral antifungals discouraged their use for treating nail fungus. These data may alert you to new and varied ways of regarding onychomycosis. Many of our patients think of their onychomycosis as a chronic and repetitive problem that necessitates safe and effective chronic treatment. Many patients with considerable first-hand experience with the problem (recurrence and relapse with oral therapy) realize that a “permanent cure” may not be a realistic treatment endpoint — perhaps clinicians may embrace different realistic treatment endpoints for onychomycosis as well. Like many chronic dermatoses for which safe, effective, long-term therapy is a desired therapeutic goal, onychomycosis now has such a therapy with Penlac nail lacquer. Patient satisfaction is an important, if not the most important, marker for successful clinical practice. Often, patient satisfaction is directly and markedly influenced by the medications we prescribe. This, in turn, influences ultimate compliance and therapeutic efficacy. Evaluate your prescription choices carefully — both for their safety and efficacy, as well as for their ability to please your patients and enhance their compliance, ensuring ultimate therapeutic success. —S. Manjula Jegasothy, M.D. web review Hormone Replacement Therapy Use May Prevent Leg Ulcers in Older Women Researchers may have discovered a preventive therapy in treating pressure ulcers and venous leg ulcers in women older than 65 years. In a case-cohort study of 44,195 women, those receiving hormone replacement therapy (HRT) were less likely to develop leg ulcers than those women not on HRT. The report published in the February 23 issue of The Lancet, noted the women on HRT were 30% to 40% less likely to develop leg ulcers. A 32% reduction in pressure ulcers occurred in women using HRT and they were 35% less likely to acquire venous leg ulcers. According to lead researcher, David J. Margolis at the University of Pennsylvania, previous research that suggested estrogen use prompted an increase in wound healing led to the study on the effects of HRT. Says Dr. Margolis, “HRT may help prevent dermal breakdown or help the dermis repair itself.” The study indicated further trials needed to be conducted based on the recent findings. In Brief... Skin Cancer Foundation Elects New Officers ... At the AAD’s annual meeting in New Orleans, the Skin Cancer Foundation announced its newly elected VPs. The new vice presidents are David J. Goldberg, MD, JD; Allan C. Halpern, MD; and C. William Hanke, MD. National Rosacea Society Accepting Grant Applications ... Researchers are encouraged to submit their application forms for research grants to the National Rosacea Society. The submission deadline is July 15, 2002. Send applications to NRS, 800 South Northwest Highway, Suite 200, Barrington, Illinois, 60010, call at 847-382-8971, fax at 847-382-5567 or email at rosacea@aol.com. Long-Term Psoriasis Treatment ... Results presented at the recent AAD annual meeting indicate the disease-modifying drug, infliximab, safe and effective for treating patients with moderate-to-severe psoriasis. In an open-label extension trial, more than half of the 29 patients receiving infliximab showed a high level of efficacy and durable response without retreatment. The drug, also known as Remicade, supports findings published in the June 9th edition of The Lancet. Connetics’ Luxiq and Olux Show Success ... Two topical, foam-formulated treatments for corticoid steroid-responsive scalp dermatoses, Luxiq and Olux, have shown encouraging results in recent studies. In a recent Phase IV study on Olux, 67% of 279 patients indicated complete or almost complete clearance of dermatoses. A sNDA has been filed with the FDA as a result of this study. In a related study, patients treated with Luxiq for scalp dermatoses noted an improved quality of life over other patients treated with other topical treatments. Anneberg Circle Grows To 102 Members ... The Dermatology Foundation announced its numbers have grown to 102 members, known as the Anneberg One Hundred. Twenty-one new members from the specialty and lay public have joined the group in pursuit of expanding research-funding opportunities in surgical and medical dermatology. The Dermatology Foundation honored David A. Whiting, M.D., at the 2001 Clark W. Finnerud Award during the foundation’s annual meeting at the AAD. Also honored was Nancy Burton Esterly, M.D., who received the Lifetime Career Educator Award. James O. Ertle, M.D., was awarded the 2001 Practitioner of the Year Award. Potential Psoriasis Drug Reported Weak in Trials ... In recent phase II trials, the experimental topical compound, ISIS 2302 (alicaforsen), demonstrated a weak response rate after 8 weeks of study. Manufactured by Isis Pharmaceuticals, the compound initially showed a significant response in 12 of 30 psoriasis patients, but response rates fell after 8 weeks. The response rate in lesion thickness among patients initially showed a significant response but again fell after 8 weeks. Isis is considering combining ISIS 2302 with other steroid creams to treat inflammatory skin diseases such as atopic dermatitis. Latex Allergies Drop ... Medical workers in Germany are suffering from fewer latex allergies. Since latex allergies peaked in 1998 among German medical workers, allergic reactions have dropped more than 60% within the past 2 years, according to the Professional Association for Health Services and Welfare Work (BGW). In recently published BGW statistics, the drop in medical workers’ complaints fell due to the popular use of anti-allergenic and non-powdered gloves. Latex allergies rose in the 1990s and caused skin irritation, rashes and associated respiratory difficulties. BGW says about 90% of workers order the “non-powdered” variety of protective gloves. Skin & Aging - ISSN: 1096-0120 - Volume 10 - Issue 4 - April 2002 - Pages: 6 - 14