Feldman cautioned that the estimate of savings is probably too low because it does not take into account the cost of medications a non-dermatologist might have prescribed before referring the patient.
"For skin problems the medication costs are often three times the cost of the office visit, so the total cost before the referral is much higher than our conservative estimate," he said.
The results are based on data about office visits to doctors as recorded in the National Ambulatory Medical Care surveys for 1990 through 1994.
A separate study found that dermatologists take less time to diagnose skin problems even when seeing a patient for the first time, compared to a primary care doctor who has known the patient for years.
"You might think that it would be more efficient to go to your family doctor," Feldman said. "They already know you, they know your background, they should be more efficient in taking care of your skin problems. But it turns out that the greater expertise of dermatologists allows them to make a definitive diagnosis rapidly and accurately, with a minimum of testing."
This study -- also based on the surveys of office visits in 1990 through 1994 -- found that dermatologists required 12 percent less time than other doctors to make a diagnosis with patients 18 or younger, and 20 percent less time with patients over 18. This was the case even when dermatologists were seeing a patient for the first time.
Given that "time is money," Feldman said, there is only one logical conclusion to be drawn from these studies: "If you're trying to run a managed care system and utilize your physician resources efficiently, you should send patients directly to a dermatologist.
"In the first study we showed that referral is likely, so the initial visit is a waste of money, and in this we show that you use fewer physician resources by going straight to the dermatologist."
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Contact: Robert Conn, Mark Wright or Jim Steele
rconn@wfubmc.edu
336-716-4587
Wake Forest University Baptist Medical Center
19-Mar-1999