QUALITY OF CARE - ISSUE OR OVERSIGHT IN HEALTH CASE REFORM

Background: Health care reform is not dead but merely on hiatus. The v ehicle for the reform is managed care, in particular health maintenanc e organizations (HMOs). HMOs employ primary care physicians as gatekee pers to act as regulators and points of entry into the health care sys tem. It is through these gatekeepers that most dermatologic care is re ndered. Objective: Our purpose was to assess (1) the level of dermatol ogy training of family practice physicians compared with dermatologist s and (2) the impact on the delivery of quality dermatology services. Methods: A national study of university residency programs was underta ken. Twenty color Kodachromes of typical cutaneous diseases were analy zed by the two physician groups. A questionnaire was used to evaluate the average formal dermatology training received, the number of primar y dermatology patients examined by family practitioners, the correct r esponse rates to the questions, and the dermatologic procedures perfor med by family practitioners. A total of 723 family practice physicians and 443 dermatologists responded. Results: Our results indicate that, in comparison to dermatologists, primary care physicians significantl y are deficient in their ability to recognize common and serious derma toses. Conclusion: This study provides data emphasizing the need for r eevaluation of the dermatology curriculum in medical schools and famil y practice residencies. Most important, it suggests that direct access to dermatologists provides better quality of care to members of HMOs and hence indirectly is most cost effective for the provision of derma tology services.