Dr Clare Tait

Neither an ongoing global pandemic nor an AHPRA review of cosmetic surgery sparked by the public disgrace of a former ACD Fellow is deterring College president Dr Clare Tait from getting on with the job in 2022.

The WA dermatologist said COVID-19 had certainly had a huge impact on the College, its fellows and trainees.

“The challenge has been that inevitably with the restrictions of working and movement, not just within our College and workforce but across government and multiple other areas, there are …some things we have had to put on hold very deliberately and haven’t been able to pursue.”

“But I think we are now moving to a stage where we are trying to get right back on track with our Strategic Plan and that’s exciting.”

The College welcomes Dr Haley Bennett as its new CEO from 1st February, as the departing CEO Tim Wills retires.

“We’re very confident she’ll do a wonderful job for the College,” Dr Tait told the limbic.

Amongst the ACD priorities in 2022 are an ongoing focus on corporate social responsibility.

“We’re hoping to lead by example in this area – addressing issues such as environmental responsibility, ethics and a responsible business strategy.”

Of course COVID-19 has also impacted College members more directly.

“There have been some very particular challenges around our trainees and making sure they continue to get adequate training with the great disruption and dislocation of their clinical work, particularly in Victoria and NSW,” she said.

“Fellows have had huge challenges in terms of managing their private practices with sometimes very little guidance from state health departments and when there is guidance, as we know, things change.”

“So we are having to learn to be very nimble and react to new advice quickly to keep a service going for our patients. It’s that very fine balance between managing patients safely in a COVID environment but also enabling them to receive services.”

“How we do that obviously varies state to state and what is happening locally but that will be an ongoing challenge for 2022 without a doubt.”

Dr Tait said she believes the pandemic has also brought the College community closer together.

“We established a COVID-19 Taskforce which is led by one of our excellent fellows in Victoria, Bruce Tate. He and his committee have managed to provide really good solid advice to our fellow and trainees on how best to manage things although inevitably that advice keeps on changing.”

‘The other positive thing to come out of COVID is the acceptance by the government of telemedicine. For years and years and years we have been advocating for telehealth MBS item numbers and support for telehealth, particularly for rural and remote areas who are most significantly disadvantaged by a maldistribution of dermatology services.”

“It has just been wonderful to have Medicare-assisted item numbers for both video and telephone consults. Inevitably there are things we can’t manage with telehealth but an awful lot we can.”

Technology

Dr Tait said COVID-19 has certainly highlighted the benefits of technology-assisted practice and has accelerated its uptake.

“Certainly with app based technology we are finding that patients are much more comfortable with using smart phones to access advice. I think our big challenge in the dermatology world is to actually embrace that …and to make sure this technology-assisted practice can be the best it can be for our patients.”

She said patients, particularly younger patients, were accessing pill prescriptions and advice about all sorts of issues online without ever seeing a dermatologist.

“Some of us would say that is not ideal, but for dermatologists, we need to be part of this movement in order to ensure patients do have access to expert opinion and expert advice through this technology.”

“How we do this and to what extent is one of the big challenges – always accepting that the gold standard is face to face – but because we are such a small specialty and there is a significant maldistribution of us across the country, we do want to make sure patients can access at least some form of expert care even if it is online rather than in person.”

“Anything that helps our practice is good. It doesn’t mean the whole service will be delivered remotely but it can be an entry point for people to then get advice.”

Dr Tait said she was impressed by some presentations at the International Congress of Dermatology 2021 including from a Japanese team using specialised type AI, rather than just algorithms to predict the severity of drug eruptions.

“Their technology was better at predicting severe outcomes of drug eruptions evolving to potentially serious conditions of SJS/TENS. Their system was better than the clinician.”

She said while technological advances in dermatology had probably focused on imaging of skin cancers to date, the future may also include inflammatory skin conditions being helped with this specialised type of AI.

“We really need to be part of this space to make sure that the advice and guidance patients are getting, if they are using these types of web-based approaches, is as good as it can be.”

Treatment advances

Dr Tait said there were a large number of new agents in phase 2 and phase 3 trials.

“As a general dermatologist, the thing I have found most exciting recently has been the ability to treat our psoriasis patients with the biologic therapies and really achieve the sort of result we aspired to but often didn’t achieve.”

Similarly, PBS approval of agents like dupilumab for atopic dermatitis and adalimumab for hidradenitis suppurativa had been completely life changing for some people.

“We have had good therapies for atopic dermatitis but we have always had a significant number of patients that we struggle to control well using conventional immunosuppressive therapies. And some patients choose to not go down that path so they live with quite significant disease.”

She said other agents such as IL-17 inhibitors and JAK inhibitors were now on the horizon for HS.

“I guess the other condition which I see which causes such terrible psychological and practical problems for patients is alopecia areata – where we have always had a menu of treatments to try but some patients have remained very resistant.”

“Most of us now have patients who have been treated with some of the JAK inhibitors and have had wonderful results – complete regrowth of hair and that again is completely life-changing.”

Equity of access to services

However not all patients benefit equally from access to dermatological services.

Dr Tait is a visiting dermatologist to the Kimberley region of WA and has last year published an audit of skin conditions seen in Aboriginal and non-Aboriginal patients.

“We’ve done that as a starting point to try and work out what kind of training the local doctors or Aboriginal health workers need and how to most effectively direct our resources into that area.”

“One of our big challenges in College is the significant workforce shortage that every year is getting more challenging. We need another 90 dermatologists by 2050 and at our current rate of increase in training, we haven’t got any possibility of achieving that at the moment. This affects regional, rural and remote areas most acutely.”

“It’s one of our big policy and advocacy areas – working at a number of approaches that will include things like telehealth as part of the solution, different models of outreach, in the regional areas trying to get more support for the few dermatologists based out there, and trying to get some training for the registrars out there.”

“And then going back a step further and trying to attract individuals more likely to end up working in regional, rural and remote areas into our training program and how we can provide them with an experience that is positive and makes them want to continue to do that incredibly valuable work.”

Dr Tait said the College’s dedicated training position for Indigenous doctors had graduated three dermatologists to date.

She said those graduates were already providing important dermatology services to communities who had previously not been well serviced as well as being wonderful role models for young Indigenous people from school and medical school students to junior doctors.

However, not everyone is an appropriate role model for the profession.

“We welcome AHPRA’s current inquiry into cosmetic surgery and want to be part of that. We have a number of very expert cosmetic dermatologists who can really add enormous value to that sort of Inquiry and in setting standards and making sure that patients can access really good quality care.”

“College is committed to the highest standard of practice whether it’s inflammatory disease, skin malignancy or cosmetic medicine, and that is something that can be more difficult for College to achieve in a very unregulated environment.

“What I have learned from patients and also from my colleagues who are involved in cosmetic work is there is a real demand from patients to have cosmetic work and that demand is not going to go away.”

“In an ideal world there would be enough of us to go around and be able to do everything for our patients but we know there isn’t. We are really committed to the treatment of diseased skin but it is important that we have a level of expertise in College that addresses the cosmetic issues as well.”