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Voices of MCMS:

Medical Dermatology, Joining a Large Group, and Organized Medicine

A conversation with Lindsay Ackerman, MD, FAAD, of US Dermatology Partners.

MCMS: Here we are at the practice of Dr. Lindsay Ackerman, who specializes in medical dermatology. Can you tell us more about your background and training?

Dr. Ackerman: First, thanks so much for having me. This is great. Always fun to meet new people with similar interests of bringing physicians together. My background is in complex medical dermatology. I trained as a resident in dermatology at Tulane University and then completed a fellowship at Tulane in complex medical dermatology, immune-dermatology, and clinical education. I consider myself an educator in my soul and a complex medical dermatologist by trade.

MCMS: And you traded the really good food in New Orleans for Arizona?

Dr. Ackerman: I did. This is home. I was born and raised here, left when I was 18 for school, and made my way back when I was 31 and opened up the practice in 2008.

MCMS: We want to talk about medical dermatology and from what I've seen, there are a lot of dermatologists who are also offering aesthetic services, cosmetic work. Why do you think that shift has happened and why do you focus on medical dermatology?

Dr. Ackerman: You see shifts based on desired use and disease states. We’ve seen a greater increase and ability to access cosmetic procedures. With many more people trained in cosmetic procedures and more devices and products used in cosmetics, the field has grown substantially, and dermatologists have chosen to pursue that. And there's obviously a need.

MCMS: There's a market for it.

Dr. Ackerman: Exactly. If there's a market for it, then you're going to find providers who are capable, willing, and able to do it and do it very well. My focus in medical dermatology has just come directly out of my interest in why I wanted to become a physician. I really enjoy the opportunity to use my skill sets to take care of sick people. You could call me a glutton for gratification. I find it an unbelievably cool privilege to have an opportunity to take someone who's in a state of being not well to making them so much more well and able to enjoy their life. I'm really a big tent kind of a person. I enjoy it all. I frankly think I've got the best job in the world. I really do. I enjoy every aspect of my practice from the very complex, difficult, mentally exhausting parts of trying to work through some of these interesting but complicated disease states and patients that are desperate for help to the kids that need help, feeling maybe more confidence when they're facing the world and helping them through an acne problem. But my focus has always really been on trying to help the sick get more well and I couldn't be more pleased with the opportunities I've had.

MCMS: That is awesome because there are a lot of physicians I've spoken with over the last couple of years who are not pleased with changes in healthcare and you seem very positive and uplifting, and you've got a smile on your face. You seem to be happy doing what you're doing.

Dr. Ackerman: Yeah, I'm 100% satisfied with my job. It doesn't mean every day's a perfect day. It doesn't mean every patient is satisfied. But there's always a challenge. You don't know what's behind door #2. And you walk in, and you're gifted with this opportunity to get close to somebody, to understand what they've been through, and you've got a skill set that can help them get to the other side. There is no better day-to-day. I would never wish for this, but if it all ended tomorrow, I could honestly tell you I've done everything I would have ever wanted to do with my career. I get to have relationships with people. I've got a fantastic staff, and an amazing patient base that I adore. We do research. We take care of kids and adults. It’s good.

MCMS: Your practice merged with US Dermatology Partners in 2017. Tell us more about what value you wanted from the larger group and how the transition went.

Dr. Ackerman: It's interesting. With most of these transitions, the consensus opinion by experts is that it takes about a year for the dance to really settle into place and it was probably a bit like that. Not that there was anything dramatic, just understanding one another. Like, at the beginning, we asked how do you get new gauze if you need new gauze? I used to just order from a different vendor, but it's been absolutely fantastic and it was probably, in earnest, the last thing I thought would ever happen to the practice, which speaks to how interesting it is as a business that you have to remain flexible and nimble and open-eyed and keep the entire purview and scope of markets and what's happening around you in your vision. When you're a physician, if you run a practice, it was part of my obligation to myself, my patients, to continue to have access to us, my partners, to make sure we were going to be here for the long run. It was the last thing I thought would happen, but as the market was changing around us, it became very, very clear that we were a unique practice in the sense that we were taking care of the much more complicated patient population. We were small. We had just a few physicians and we were, by virtue of that, at risk as a small practice of maybe not being able to maintain certain insurance contracts over time or being questioned about utilization. Well, we have a higher utilization of high-cost drugs in my practice because I've got sicker patients. It's just the way it goes. I was really looking for good partners who could help maybe distill some of that risk for us long term. Also, the complexity of managing an office was becoming greater, and my real desire and love is to take care of patients. I'm not excited to wake up and do background checks on new staff. Having a safety net of personnel involved that was going to help with a lot of the nuances of running the practice as we were getting bigger and bigger was going to be helpful.

MCMS: And you found that in the larger group?

Dr. Ackerman: Absolutely. I also have physician colleagues that are now within our network, which makes it easier to cross pollinate. If I need to refer somebody to somebody else for, say, a cosmetic procedure that I don't do, it’s easy. They can access the chart. They can see what's been done before. Likewise, if someone needs to refer in, it’s easy for me to access their biopsy results and lab findings and imaging. The partnership itself has been really wonderful. They're good people. I really believe if you take integrity and ethics into play and decision making, you're going to end up finding the right partners because they're going to share those two key things with you.

MCMS: I understand that you volunteer quite a bit of time you teach residents. You speak with colleagues, conduct research, and you’re involved with organized medicine. Why do you do all that?

Dr. Ackerman: I really have a tremendous passion for the broader scope of what we do in the House of Medicine. I have desires to have an impact long term in a lot of ways. When you're thinking bigger picture, it's legislation in ensuring that our patients have access to care or that we are compensated fairly for the work we do. And a lot of that I think really circles back to my soul being that of an educator. I find it imperative that we are the people educating people outside of medicine about what it is we do and how important it is. My participation in organized medicine has included representing the American Academy of Dermatology to the American Medical Association for probably the past 17 years or so. We have meetings a couple times a year and we give up four or five days of office time, twice a year to go and really hash out hundreds of resolutions on the floor of the House of Medicine at the AMA. You develop other partnerships and relationships with other specialties and physicians across the country. But moreover, really what you're doing is advocating for all the dermatologists throughout the United States for issues that are relevant to them and their practices. There's a lot of pride in that. There's a lot of pride in being able to step forward and have the know-how.

MCMS: Does that energize you? Does that fuel you?

Dr. Ackerman: Absolutely. I almost dread the weeks leading up to the meetings because there's a lot of work in reviewing all of the resolutions that will be before us, about which we have to come up with some conclusive statement whether we agree or disagree or want to modify or amend the resolutions.

MCMS: Because you take it seriously.

Dr. Ackerman: We take it very seriously. But as much as the work is exhausting, it is one of those things that you finish at the end of the meeting, and you feel much more energized. I'm so privileged. I work with incredible representatives in our Dermatology Section Council at that level to get the work done.

MCMS: What are some examples of things that happen more locally to energize physicians, whether it's organized medicine or what you get from the residents and teaching them?

Dr. Ackerman: Yeah, that's an incredibly rewarding part of my practice is having the ability to have residents see what we do, be inspired by what we do, and I'll tell you just very recently we had a resident on our rotation who started. He's an internal medicine resident. He was toward the end of his second year of a three-year program, at the point where he had to decide what he wanted to do with the rest of his life and I ask him the first day, “So, what are you planning on doing with your life and are you going to become a hospitalist? Are you gonna become a specialist?” And he said, “I'm really focused on probably applying to either immunology/allergy or rheumatology as a specialty, so I thought derm would be good to rotate through because we cross, we have a lot of cross pollination in the diseases that we treat.” I tried to bring him into every case that might cross into rheumatology or allergy, and, at the end of the rotation, I thought he'd had a great time. I thoroughly enjoyed teaching him. He had great questions, which are always energizing as a teacher. And then he contacted me a few days afterwards and said, “I've rethought my career focus and I'm really behind the eight-ball now but wondering if I could get a spot in dermatology.” You have these moments where you really think that you've done something that has made someone's future that much brighter and whether he does dermatology or not is still yet to be determined. But he certainly enjoyed his focus with us, and I think it has directed him to realizing that there was a passion that he had not otherwise understood, that he'll take into his future whatever he does, and that's really cool.

MCMS: You’ve been working in the valley for several years. Have you seen residents stick around and stay connected in the medical community?

Dr. Ackerman: That's a great question. I opened the practice about 15 years ago and an unexpected plus of volunteering as an instructor for the dermatology rotation has become that I have developed relationships with them sort of unknowingly at the time. We're working together and then they stay in town as either a primary care physician or a sub specialist. They’ve got your cell number and call when they have a patient who needs some help.

MCMS: Final question for you. Are there any messages that you'd like to share with primary care physicians about dermatology in general or the relationship that you and they should continue to build for better patient care?

Dr. Ackerman: I really appreciate this question. We so need our primary care physician workforce. They are everything to the fulcrum of patient care. I would like to think that what I do is extraordinarily important, and, in some cases, I really believe it is, but without the PCP, it's nothing. We can't be primary care physicians. I'm not skilled enough skilled to provide patients the background of what they need for their general health to make them well long term. I so value the relationships that I have with my referring providers. We are better together and rather than working in silos, if we can just communicate with one another, we're going to be amplifying what we can provide as a resource to individual patients, but also for the betterment of the public health of our community here in Maricopa County.

MCMS: Dr. Lindsay Ackerman, thank you so much.

Dr. Ackerman: Thank you. Appreciate it.

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