Suzanne M. Olbricht, MD

I admit it. I am a professional association junkie. I belong to more than 20 professional societies that serve dermatologists in my home state and in my region, nationally and internationally, as well as 2 other societies encompassing the entire house of medicine. I have worked on the boards of 6 of them and I have been on committees or developed educational programs for 15 of them. Dermatologists tend to be joiners and I enjoy being with my colleagues. However, in terms of my daily job of taking care of patients with skin disease, what are the real benefits of joining these professional associations?

Common advice on the Internet is for professionals to join relevant associations. Anderson¹ on college.monster.com recommends that undergraduates seek membership in professional organizations for job opportunities, mentoring, professional development, networking, and scholarships. Some associations offer exclusive resources and group buying power. Others are prestigious and membership is a capstone achievement. There is strength in numbers, making advocacy a mission of many professional associations.

The AAD is the largest, most diverse, and most multifaceted of the dermatology associations to which I belong. For the last 6 years I have been privileged to serve as one of the secretary-treasurers, and I have seen the time and effort spent by many of my fellow dermatologists for the good of dermatology. The AAD has 19,265 members, of which the largest subgroup is the category of active fellows (10,858); 90% of dermatologists certified by the American Board of Dermatology belong to the AAD and 96% of members renewed last year (Cindy Kuhn, personal communication, February 2016). In 2016, the AAD surveyed the satisfaction of members by administering an online questionnaire inviting responses from a randomly selected 5975 members (excluding internationals, retirees, or those older than 72 years). The respondents ranked the major activities of the AAD according to their importance. Most important were professional development and educational programs (70% said very important) and up-to-date information on dermatology (70%). Also ranked highly were advancing advocacy agenda (57%), increasing public awareness (54%), and increasing visibility in the house of medicine (55%). Of less importance were products and services to support practice (29%), networking within the profession (25%), reference directory of members (24%), member discounts (22%), opportunity to gain leadership experience (10%), and career and employment opportunities (14%). In general, the members were either very satisfied or satisfied with the activities corresponding with the ranked importance. Overall satisfaction with the AAD was 88%. When divided demographically, young women in academics and group practice were somewhat more satisfied with AAD services and benefits than men older than 60 years in solo practice, though even in the latter group more than 83% were either very satisfied or satisfied. More than 67% of the members supported the initiatives taken for enhanced online education and information resources; data collection and registry platforms; development of new models of payment; and education, training, and online resources for the dermatology care team. Members of the AAD also can attend the meetings (7992 members at the 73rd Annual Meeting in 2015; 1639 at the 2015 Summer Academy Meeting) and read the Journal of the American Academy of Dermatology and Dermatology World. In 2015, 10,061 AAD members participated in CME activities (Cindy Kuhn, personal communication, February 2016). In addition, members work within the committee and task force structure; in the last few years, the Organization Structure Committee and the officers have worked hard to place almost everyone who applied for an assignment on a committee.

Do dermatologists reflect the association world? We are incredibly engaged and the AAD’s penetrance into the community and high renewal rate are unique. In 2014, John Wiley & Sons, Inc,² surveyed 1.2 million research professionals across 75 disciplines to learn how research professionals view scholarly societies and associations. Similar to AAD members, these professionals indicated that they joined their societies to take advantage of peer-reviewed journals, learning opportunities, and publications on techniques and trends. There was little variation across age, geographic location, and member status. The primary reason members renewed was because they felt connected to the community and appreciated the mentorship and networking that was available.²

The future of dermatology and specialty societies is dependent on young dermatologists who are currently in residencies or in their first jobs. They need the professional development, educational opportunities, networking and mentoring, and other benefits of joining specialty societies. Although skilled at acquiring networks through social media, the best growth and leverage of their professional networks occur within professional associations. Because of my experience meeting other dermatologists in the association world, I can find expert physicians for my patients who have unique problems or who have moved out of my location. Colleagues who have met me in person also seek me out to take care of their patients. Much learning occurs online; however, the value of attending educational sessions can be found in the ability to ask questions in real time and in the face-to-face connection with the experts as well as other members with similar interests. I recently attended a session on interesting hospital consultations and we had an active discussion about drug eruptions with many questions from the audience. The next day I was called to my hospital to see a patient and I went with confidence that I could use my new knowledge to ensure a good outcome. Most importantly, in this era of rapid unprecedented technological advances, the data and the information it produces are transforming our culture. When members with similar interests, skill sets, and goals come together in an effective professional association, they have the strength in numbers to drive change in a way that facilitates growth and development in the specialty. In 2016 this may be the single best reason to join a professional society. We can insure patients with skin disease receive excellent dermatological care by working with other dermatologists in our state and national societies to keep our knowledge and skills current, push for new concepts and treatments, and advocate for our patients and our practices.

The most important reason I joined dermatology associations is the stimulation from learning new concepts and skills in the presence of others who are also passionate about dermatology. Finding jobs to do within these groups was a natural progression of my membership and my career and has insulated me against the lurking danger of professional burnout. I recommend the same prescription for you: Join local, regional, and national dermatology associations; attend meetings; and find interesting work furthering the specialty with other passionate dermatologists.

I admit it. I am a professional association junkie. I belong to more than 20 professional societies that serve dermatologists in my home state and in my region, nationally and internationally, as well as 2 other societies encompassing the entire house of medicine. I have worked on the boards of 6 of them and I have been on committees or developed educational programs for 15 of them. Dermatologists tend to be joiners and I enjoy being with my colleagues. However, in terms of my daily job of taking care of patients with skin disease, what are the real benefits of joining these professional associations?

Common advice on the Internet is for professionals to join relevant associations. Anderson¹ on college.monster.com recommends that undergraduates seek membership in professional organizations for job opportunities, mentoring, professional development, networking, and scholarships. Some associations offer exclusive resources and group buying power. Others are prestigious and membership is a capstone achievement. There is strength in numbers, making advocacy a mission of many professional associations.

The AAD is the largest, most diverse, and most multifaceted of the dermatology associations to which I belong. For the last 6 years I have been privileged to serve as one of the secretary-treasurers, and I have seen the time and effort spent by many of my fellow dermatologists for the good of dermatology. The AAD has 19,265 members, of which the largest subgroup is the category of active fellows (10,858); 90% of dermatologists certified by the American Board of Dermatology belong to the AAD and 96% of members renewed last year (Cindy Kuhn, personal communication, February 2016). In 2016, the AAD surveyed the satisfaction of members by administering an online questionnaire inviting responses from a randomly selected 5975 members (excluding internationals, retirees, or those older than 72 years). The respondents ranked the major activities of the AAD according to their importance. Most important were professional development and educational programs (70% said very important) and up-to-date information on dermatology (70%). Also ranked highly were advancing advocacy agenda (57%), increasing public awareness (54%), and increasing visibility in the house of medicine (55%). Of less importance were products and services to support practice (29%), networking within the profession (25%), reference directory of members (24%), member discounts (22%), opportunity to gain leadership experience (10%), and career and employment opportunities (14%). In general, the members were either very satisfied or satisfied with the activities corresponding with the ranked importance. Overall satisfaction with the AAD was 88%. When divided demographically, young women in academics and group practice were somewhat more satisfied with AAD services and benefits than men older than 60 years in solo practice, though even in the latter group more than 83% were either very satisfied or satisfied. More than 67% of the members supported the initiatives taken for enhanced online education and information resources; data collection and registry platforms; development of new models of payment; and education, training, and online resources for the dermatology care team. Members of the AAD also can attend the meetings (7992 members at the 73rd Annual Meeting in 2015; 1639 at the 2015 Summer Academy Meeting) and read the Journal of the American Academy of Dermatology and Dermatology World. In 2015, 10,061 AAD members participated in CME activities (Cindy Kuhn, personal communication, February 2016). In addition, members work within the committee and task force structure; in the last few years, the Organization Structure Committee and the officers have worked hard to place almost everyone who applied for an assignment on a committee.

Do dermatologists reflect the association world? We are incredibly engaged and the AAD’s penetrance into the community and high renewal rate are unique. In 2014, John Wiley & Sons, Inc,² surveyed 1.2 million research professionals across 75 disciplines to learn how research professionals view scholarly societies and associations. Similar to AAD members, these professionals indicated that they joined their societies to take advantage of peer-reviewed journals, learning opportunities, and publications on techniques and trends. There was little variation across age, geographic location, and member status. The primary reason members renewed was because they felt connected to the community and appreciated the mentorship and networking that was available.²

The future of dermatology and specialty societies is dependent on young dermatologists who are currently in residencies or in their first jobs. They need the professional development, educational opportunities, networking and mentoring, and other benefits of joining specialty societies. Although skilled at acquiring networks through social media, the best growth and leverage of their professional networks occur within professional associations. Because of my experience meeting other dermatologists in the association world, I can find expert physicians for my patients who have unique problems or who have moved out of my location. Colleagues who have met me in person also seek me out to take care of their patients. Much learning occurs online; however, the value of attending educational sessions can be found in the ability to ask questions in real time and in the face-to-face connection with the experts as well as other members with similar interests. I recently attended a session on interesting hospital consultations and we had an active discussion about drug eruptions with many questions from the audience. The next day I was called to my hospital to see a patient and I went with confidence that I could use my new knowledge to ensure a good outcome. Most importantly, in this era of rapid unprecedented technological advances, the data and the information it produces are transforming our culture. When members with similar interests, skill sets, and goals come together in an effective professional association, they have the strength in numbers to drive change in a way that facilitates growth and development in the specialty. In 2016 this may be the single best reason to join a professional society. We can insure patients with skin disease receive excellent dermatological care by working with other dermatologists in our state and national societies to keep our knowledge and skills current, push for new concepts and treatments, and advocate for our patients and our practices.

The most important reason I joined dermatology associations is the stimulation from learning new concepts and skills in the presence of others who are also passionate about dermatology. Finding jobs to do within these groups was a natural progression of my membership and my career and has insulated me against the lurking danger of professional burnout. I recommend the same prescription for you: Join local, regional, and national dermatology associations; attend meetings; and find interesting work furthering the specialty with other passionate dermatologists.

I admit it. I am a professional association junkie. I belong to more than 20 professional societies that serve dermatologists in my home state and in my region, nationally and internationally, as well as 2 other societies encompassing the entire house of medicine. I have worked on the boards of 6 of them and I have been on committees or developed educational programs for 15 of them. Dermatologists tend to be joiners and I enjoy being with my colleagues. However, in terms of my daily job of taking care of patients with skin disease, what are the real benefits of joining these professional associations?

Common advice on the Internet is for professionals to join relevant associations. Anderson¹ on college.monster.com recommends that undergraduates seek membership in professional organizations for job opportunities, mentoring, professional development, networking, and scholarships. Some associations offer exclusive resources and group buying power. Others are prestigious and membership is a capstone achievement. There is strength in numbers, making advocacy a mission of many professional associations.

The AAD is the largest, most diverse, and most multifaceted of the dermatology associations to which I belong. For the last 6 years I have been privileged to serve as one of the secretary-treasurers, and I have seen the time and effort spent by many of my fellow dermatologists for the good of dermatology. The AAD has 19,265 members, of which the largest subgroup is the category of active fellows (10,858); 90% of dermatologists certified by the American Board of Dermatology belong to the AAD and 96% of members renewed last year (Cindy Kuhn, personal communication, February 2016). In 2016, the AAD surveyed the satisfaction of members by administering an online questionnaire inviting responses from a randomly selected 5975 members (excluding internationals, retirees, or those older than 72 years). The respondents ranked the major activities of the AAD according to their importance. Most important were professional development and educational programs (70% said very important) and up-to-date information on dermatology (70%). Also ranked highly were advancing advocacy agenda (57%), increasing public awareness (54%), and increasing visibility in the house of medicine (55%). Of less importance were products and services to support practice (29%), networking within the profession (25%), reference directory of members (24%), member discounts (22%), opportunity to gain leadership experience (10%), and career and employment opportunities (14%). In general, the members were either very satisfied or satisfied with the activities corresponding with the ranked importance. Overall satisfaction with the AAD was 88%. When divided demographically, young women in academics and group practice were somewhat more satisfied with AAD services and benefits than men older than 60 years in solo practice, though even in the latter group more than 83% were either very satisfied or satisfied. More than 67% of the members supported the initiatives taken for enhanced online education and information resources; data collection and registry platforms; development of new models of payment; and education, training, and online resources for the dermatology care team. Members of the AAD also can attend the meetings (7992 members at the 73rd Annual Meeting in 2015; 1639 at the 2015 Summer Academy Meeting) and read the Journal of the American Academy of Dermatology and Dermatology World. In 2015, 10,061 AAD members participated in CME activities (Cindy Kuhn, personal communication, February 2016). In addition, members work within the committee and task force structure; in the last few years, the Organization Structure Committee and the officers have worked hard to place almost everyone who applied for an assignment on a committee.

Do dermatologists reflect the association world? We are incredibly engaged and the AAD’s penetrance into the community and high renewal rate are unique. In 2014, John Wiley & Sons, Inc,² surveyed 1.2 million research professionals across 75 disciplines to learn how research professionals view scholarly societies and associations. Similar to AAD members, these professionals indicated that they joined their societies to take advantage of peer-reviewed journals, learning opportunities, and publications on techniques and trends. There was little variation across age, geographic location, and member status. The primary reason members renewed was because they felt connected to the community and appreciated the mentorship and networking that was available.²

The future of dermatology and specialty societies is dependent on young dermatologists who are currently in residencies or in their first jobs. They need the professional development, educational opportunities, networking and mentoring, and other benefits of joining specialty societies. Although skilled at acquiring networks through social media, the best growth and leverage of their professional networks occur within professional associations. Because of my experience meeting other dermatologists in the association world, I can find expert physicians for my patients who have unique problems or who have moved out of my location. Colleagues who have met me in person also seek me out to take care of their patients. Much learning occurs online; however, the value of attending educational sessions can be found in the ability to ask questions in real time and in the face-to-face connection with the experts as well as other members with similar interests. I recently attended a session on interesting hospital consultations and we had an active discussion about drug eruptions with many questions from the audience. The next day I was called to my hospital to see a patient and I went with confidence that I could use my new knowledge to ensure a good outcome. Most importantly, in this era of rapid unprecedented technological advances, the data and the information it produces are transforming our culture. When members with similar interests, skill sets, and goals come together in an effective professional association, they have the strength in numbers to drive change in a way that facilitates growth and development in the specialty. In 2016 this may be the single best reason to join a professional society. We can insure patients with skin disease receive excellent dermatological care by working with other dermatologists in our state and national societies to keep our knowledge and skills current, push for new concepts and treatments, and advocate for our patients and our practices.

The most important reason I joined dermatology associations is the stimulation from learning new concepts and skills in the presence of others who are also passionate about dermatology. Finding jobs to do within these groups was a natural progression of my membership and my career and has insulated me against the lurking danger of professional burnout. I recommend the same prescription for you: Join local, regional, and national dermatology associations; attend meetings; and find interesting work furthering the specialty with other passionate dermatologists.

Raise your hand if you join me in becoming increasingly annoyed at the following instruction: “Don’t work harder (or longer), work smarter.” Despite this admonition, I am working more intensively and spending more hours working than ever before. My friends in a variety of occupations and my colleagues at my institution are too. It is not just a mirage; from 1970 to 2000, average workers in the United States added nearly 200 hours of work per year to their schedules.¹ That’s a whole extra month! And this is not just logging more hours at work. These hours also are more hectic with fewer breaks and many more demands. Unfortunately, more hours at work does not necessarily translate into getting more work done. There is good evidence to show that once our working day stretches beyond 8 hours, our cognitive performance and our productivity decline.^2,3

I am feeling the squeeze, and I know you are too. Is it possible to be more productive in less time? In the reading I did to answer this question I found 4 major themes: (1) single task, (2) plan downtime, (3) schedule priorities, and (4) manage procrastination.

As a full-time clinician and a single mother with 4 children, a dog, 2 cats, and a house, I admire those who can multitask; however, experts now conclude that multitasking is not productive. People doing 2 tasks at once took up to 30% longer and made twice as many errors as those who completed the same tasks in sequence.⁴ Frequent interruptions had the same effect. A study found it took employees 15 minutes to fully regain their train of thought after they were interrupted by an email, even if they did not reply to the email.⁵ Instant messages produced a lag of 10 minutes. In addition, habitual multitaskers take longer to switch between tasks, probably because of losing the ability to focus.⁶ Those of us who think we are great multitaskers are the worst at it.⁷ The ping of the new email or text is exciting and can become addictive. To counteract the interruptions, batch up related tasks (eg, electronic medical records in-box, emails, telephone calls) and remove distractions. Smartphones can be programmed to announce loudly and specifically when our 12-year-old child texts but not announce other texts and calls that can be retrieved later. Slip a small notebook in your pocket or use your smartphone to record free-floating ideas to come back to at another time.

As soon as we wake up in the morning, we start making decisions. Some of the simple moment-to-moment choices have been automated; most of us rarely have to decide to brush our teeth or make coffee. Then a day of constant decision-making starts, which means finding options, evaluating the pros and cons, comparing the possible sequelae, and then determining a course of action. The more decisions we ask our brain to make, the less able we are to concentrate and make nuanced assessments, and the more our decisions exhibit less insight and forward thinking.^8,9 However, rest periods improve task performance. As seen in brain imaging studies, rest allows the brain to continue processing and set up new connections.¹⁰ To prevent decision fatigue, plan downtime even if it is for just a few minutes of deep breathing or stretching against the wall every 90 minutes or less. An ideal time is between batches of tasks. Longer reflection time after a meeting is key before the next activity, solidifying the events of the meeting.

I know that on the occasions when I get up in the morning and focus on what is most important to do that day, I generally get it done, as well as other items on my to-do list. If I made prioritizing and planning a deliberate daily habit, it would allow for much greater productivity. It often is recommended that a list be made of all the activities and tasks to be done that day or week and then to compare it to a list of primary goals. Pay attention to the important items and not just the urgent ones. Urgent items can fill up the day but some of them may have little relationship to our primary goals. Those that are urgent but not important can be delegated, deferred, or even purged. Rank the important tasks and schedule the highest priority in defined blocks. This kind of deliberate prioritizing requires repeated monitoring and revisiting of goals and tasks but ensures that what is most important gets done.

Most physicians are perfectionists, which can be a good thing. I want my doctor to be a perfectionist when he/she is examining me or writing me a prescription. But perfectionism also has a high price. It makes delegation of a task difficult because of the perception that the other person might not do the task as well as you can. It also can cause us to put off doing a task because we do not have enough time now to do it well enough. Later we feel stressed because it is still undone, and then we panic and become overwhelmed at the thought of tackling this task, which now has an even bigger emotional load. Being productive means learning to manage procrastination. Brian Tracy has 21 great ways to stop procrastination in his book Eat That Frog,¹¹ but you really only need 3 of his rules: (1) If you have to eat a frog, eat it first thing in the morning. (2) If you have to eat 2 frogs, eat the bigger one first. (3) If the frog is too big to eat, cut it into bite-size pieces.

Will it ever be possible for me to do the same amount of work in less time and feel good about it? I am not sure. However, I have become convinced that I can end each day satisfied with the tasks I was able to accomplish if I develop the habits of single tasking, planning downtime, scheduling priorities, and managing procrastination. I hope these tools will also help you find the same satisfaction.

Raise your hand if you join me in becoming increasingly annoyed at the following instruction: “Don’t work harder (or longer), work smarter.” Despite this admonition, I am working more intensively and spending more hours working than ever before. My friends in a variety of occupations and my colleagues at my institution are too. It is not just a mirage; from 1970 to 2000, average workers in the United States added nearly 200 hours of work per year to their schedules.¹ That’s a whole extra month! And this is not just logging more hours at work. These hours also are more hectic with fewer breaks and many more demands. Unfortunately, more hours at work does not necessarily translate into getting more work done. There is good evidence to show that once our working day stretches beyond 8 hours, our cognitive performance and our productivity decline.^2,3

I am feeling the squeeze, and I know you are too. Is it possible to be more productive in less time? In the reading I did to answer this question I found 4 major themes: (1) single task, (2) plan downtime, (3) schedule priorities, and (4) manage procrastination.

As a full-time clinician and a single mother with 4 children, a dog, 2 cats, and a house, I admire those who can multitask; however, experts now conclude that multitasking is not productive. People doing 2 tasks at once took up to 30% longer and made twice as many errors as those who completed the same tasks in sequence.⁴ Frequent interruptions had the same effect. A study found it took employees 15 minutes to fully regain their train of thought after they were interrupted by an email, even if they did not reply to the email.⁵ Instant messages produced a lag of 10 minutes. In addition, habitual multitaskers take longer to switch between tasks, probably because of losing the ability to focus.⁶ Those of us who think we are great multitaskers are the worst at it.⁷ The ping of the new email or text is exciting and can become addictive. To counteract the interruptions, batch up related tasks (eg, electronic medical records in-box, emails, telephone calls) and remove distractions. Smartphones can be programmed to announce loudly and specifically when our 12-year-old child texts but not announce other texts and calls that can be retrieved later. Slip a small notebook in your pocket or use your smartphone to record free-floating ideas to come back to at another time.

As soon as we wake up in the morning, we start making decisions. Some of the simple moment-to-moment choices have been automated; most of us rarely have to decide to brush our teeth or make coffee. Then a day of constant decision-making starts, which means finding options, evaluating the pros and cons, comparing the possible sequelae, and then determining a course of action. The more decisions we ask our brain to make, the less able we are to concentrate and make nuanced assessments, and the more our decisions exhibit less insight and forward thinking.^8,9 However, rest periods improve task performance. As seen in brain imaging studies, rest allows the brain to continue processing and set up new connections.¹⁰ To prevent decision fatigue, plan downtime even if it is for just a few minutes of deep breathing or stretching against the wall every 90 minutes or less. An ideal time is between batches of tasks. Longer reflection time after a meeting is key before the next activity, solidifying the events of the meeting.

I know that on the occasions when I get up in the morning and focus on what is most important to do that day, I generally get it done, as well as other items on my to-do list. If I made prioritizing and planning a deliberate daily habit, it would allow for much greater productivity. It often is recommended that a list be made of all the activities and tasks to be done that day or week and then to compare it to a list of primary goals. Pay attention to the important items and not just the urgent ones. Urgent items can fill up the day but some of them may have little relationship to our primary goals. Those that are urgent but not important can be delegated, deferred, or even purged. Rank the important tasks and schedule the highest priority in defined blocks. This kind of deliberate prioritizing requires repeated monitoring and revisiting of goals and tasks but ensures that what is most important gets done.

Most physicians are perfectionists, which can be a good thing. I want my doctor to be a perfectionist when he/she is examining me or writing me a prescription. But perfectionism also has a high price. It makes delegation of a task difficult because of the perception that the other person might not do the task as well as you can. It also can cause us to put off doing a task because we do not have enough time now to do it well enough. Later we feel stressed because it is still undone, and then we panic and become overwhelmed at the thought of tackling this task, which now has an even bigger emotional load. Being productive means learning to manage procrastination. Brian Tracy has 21 great ways to stop procrastination in his book Eat That Frog,¹¹ but you really only need 3 of his rules: (1) If you have to eat a frog, eat it first thing in the morning. (2) If you have to eat 2 frogs, eat the bigger one first. (3) If the frog is too big to eat, cut it into bite-size pieces.

Will it ever be possible for me to do the same amount of work in less time and feel good about it? I am not sure. However, I have become convinced that I can end each day satisfied with the tasks I was able to accomplish if I develop the habits of single tasking, planning downtime, scheduling priorities, and managing procrastination. I hope these tools will also help you find the same satisfaction.

Raise your hand if you join me in becoming increasingly annoyed at the following instruction: “Don’t work harder (or longer), work smarter.” Despite this admonition, I am working more intensively and spending more hours working than ever before. My friends in a variety of occupations and my colleagues at my institution are too. It is not just a mirage; from 1970 to 2000, average workers in the United States added nearly 200 hours of work per year to their schedules.¹ That’s a whole extra month! And this is not just logging more hours at work. These hours also are more hectic with fewer breaks and many more demands. Unfortunately, more hours at work does not necessarily translate into getting more work done. There is good evidence to show that once our working day stretches beyond 8 hours, our cognitive performance and our productivity decline.^2,3

I am feeling the squeeze, and I know you are too. Is it possible to be more productive in less time? In the reading I did to answer this question I found 4 major themes: (1) single task, (2) plan downtime, (3) schedule priorities, and (4) manage procrastination.

As a full-time clinician and a single mother with 4 children, a dog, 2 cats, and a house, I admire those who can multitask; however, experts now conclude that multitasking is not productive. People doing 2 tasks at once took up to 30% longer and made twice as many errors as those who completed the same tasks in sequence.⁴ Frequent interruptions had the same effect. A study found it took employees 15 minutes to fully regain their train of thought after they were interrupted by an email, even if they did not reply to the email.⁵ Instant messages produced a lag of 10 minutes. In addition, habitual multitaskers take longer to switch between tasks, probably because of losing the ability to focus.⁶ Those of us who think we are great multitaskers are the worst at it.⁷ The ping of the new email or text is exciting and can become addictive. To counteract the interruptions, batch up related tasks (eg, electronic medical records in-box, emails, telephone calls) and remove distractions. Smartphones can be programmed to announce loudly and specifically when our 12-year-old child texts but not announce other texts and calls that can be retrieved later. Slip a small notebook in your pocket or use your smartphone to record free-floating ideas to come back to at another time.

As soon as we wake up in the morning, we start making decisions. Some of the simple moment-to-moment choices have been automated; most of us rarely have to decide to brush our teeth or make coffee. Then a day of constant decision-making starts, which means finding options, evaluating the pros and cons, comparing the possible sequelae, and then determining a course of action. The more decisions we ask our brain to make, the less able we are to concentrate and make nuanced assessments, and the more our decisions exhibit less insight and forward thinking.^8,9 However, rest periods improve task performance. As seen in brain imaging studies, rest allows the brain to continue processing and set up new connections.¹⁰ To prevent decision fatigue, plan downtime even if it is for just a few minutes of deep breathing or stretching against the wall every 90 minutes or less. An ideal time is between batches of tasks. Longer reflection time after a meeting is key before the next activity, solidifying the events of the meeting.

I know that on the occasions when I get up in the morning and focus on what is most important to do that day, I generally get it done, as well as other items on my to-do list. If I made prioritizing and planning a deliberate daily habit, it would allow for much greater productivity. It often is recommended that a list be made of all the activities and tasks to be done that day or week and then to compare it to a list of primary goals. Pay attention to the important items and not just the urgent ones. Urgent items can fill up the day but some of them may have little relationship to our primary goals. Those that are urgent but not important can be delegated, deferred, or even purged. Rank the important tasks and schedule the highest priority in defined blocks. This kind of deliberate prioritizing requires repeated monitoring and revisiting of goals and tasks but ensures that what is most important gets done.

Most physicians are perfectionists, which can be a good thing. I want my doctor to be a perfectionist when he/she is examining me or writing me a prescription. But perfectionism also has a high price. It makes delegation of a task difficult because of the perception that the other person might not do the task as well as you can. It also can cause us to put off doing a task because we do not have enough time now to do it well enough. Later we feel stressed because it is still undone, and then we panic and become overwhelmed at the thought of tackling this task, which now has an even bigger emotional load. Being productive means learning to manage procrastination. Brian Tracy has 21 great ways to stop procrastination in his book Eat That Frog,¹¹ but you really only need 3 of his rules: (1) If you have to eat a frog, eat it first thing in the morning. (2) If you have to eat 2 frogs, eat the bigger one first. (3) If the frog is too big to eat, cut it into bite-size pieces.

Will it ever be possible for me to do the same amount of work in less time and feel good about it? I am not sure. However, I have become convinced that I can end each day satisfied with the tasks I was able to accomplish if I develop the habits of single tasking, planning downtime, scheduling priorities, and managing procrastination. I hope these tools will also help you find the same satisfaction.

Fifth grade is a wonderful school year and fifth graders are interesting, enthusiastic, and busy people, but conflicts can arise amidst their many activities. We discovered that our fifth grader could not finish his homework, play on 3 sports teams, take bass lessons (and practice), join the city chorus, play outside with his friends, walk his dog, spend quality time with his parents, and do his chores—much less eat and sleep. Choices needed to be made. Unfortunately, in our community dropping out of the premier soccer club probably limits future possibilities in the sport; nevertheless, it would entail 6 to 8 hours of game and practice time per week (plus travel), as well as multiple 3-day tournaments. Therefore our son dropped soccer, as we decided the best strategy for our fifth grader to develop and mature was to do his personal best at his schoolwork while also exploring a greater variety of less intensive extracurricular experiences.

Most dermatologists appropriately adopt a different strategy during medical school and dermatology training. An intensive, single-minded focus gets us through hours in the anatomy laboratory, the first difficult clinical rotations, sleepless nights, grand rounds quizzing, and board examinations. Completion of our training does not, however, signal that development and maturation are complete; rather, we must then choose among a new set of options, such as the basic questions of whether to practice in an academic setting or group or solo practice and whether to emphasize a subspecialty. These choices involve some mutually exclusive options and exist in a milieu of adult (ie, nonacademic) dilemmas concerning family life, community and spiritual life, avocations, exercise regimens, housing and material goods, and other routine aspects of life. The professional options that are available may be limited by the lack of community opportunities, geographic need, or job availability in a preferred location or institution.

So how do dermatologists manage to start their careers, then develop and maintain them? A best practice is to be both introspective as well as aware of our external environments. Good questions to ask ourselves periodically (having different answers at different stages is highly recommended!) include: What are my core values and what do I want to accomplish? Pay attention to your gut. When do you lose track of time and what makes you want to scream in frustration? Regularly take an inventory of your strengths and find opportunities to acquire the competencies that can take you to the next level. What skill do I need to finesse and how do I finesse it? Do an external scan and understand limiting factors such as geographic saturation in your desired practice type or the lack of appropriate collaborators in your preferred area of interest. Search out people who are doing what you’d like to do and then identify their paths and what you can use from their experiences to help with your career development.

Once you have identified a few professional goals to pursue, utilize all the resources you can find. You might find helpful seminars at an academic institution or at conferences. Do you want to become the regional expert in sarcoidosis? Check out what has been written and find other experts in the subject and where they are speaking. Many organizations have practice management or leadership development courses and seminars. There also are books for everything—those that I have found most useful include Douglas Stone’s Difficult Conversations: How to Discuss What Matters Most¹ and William L. Fisher and Roger Ury’s classic, Getting to Yes: Negotiating Agreement Without Giving In.² Have to give a talk? There is a PowerPoint 2016 for Dummies.³ The same series also includes a book on the Microsoft^® Excel spreadsheet. Also check out my all-time favorite—Brian Tracy’s Eat That Frog! 21 Ways to Stop Procrastinating and Get More Done in Less Time.⁴

It is important to experiment with different professional experiences and have an open mind when a new activity presents itself. Look for opportunities for new side ventures or interesting projects that will not take up much time so you can continue to do your best at your daily work. When I was a senior resident, a dermatologist from Maine asked me if I would help him find a dermatologist who would work regularly at a rural clinic in the northern part of the state. My answer was, why not me? For 8 years I worked in that clinic once to twice per month, seeing as many patients as I could for 8 to 12 hours a day on Friday, Saturday, and Sunday, and then returning to Boston, Massachusetts, for my normal work week. I even took my 2 youngest children (who were born during that time) with me and found a family there who took excellent care of them while I worked. It ended up being one of the most important experiences, both intellectually and emotionally, of my professional career. I learned how to diagnose difficult and complex dermatology problems by myself in an environment with few resources (the closest dermatologist was 150 miles away), how to use primary care providers to manage patients remotely, how to set up a clinic and manage staff (I hired other part-time staff to help me), and how to lead an effort that I felt passionate about. I sometimes even took on residents, which helped me finesse my teaching and supervision style.

Unlike the achievement of becoming a board-certified dermatologist, a dermatology career does not develop in a straight line, and rarely at a steady pace. It seems to me that a shift from a single-minded focus during residency to the fifth-grade strategy of doing our personal best at the main tasks of everyday work as well as participating in a variety of other experiences successfully develops a career that encompasses excellence, enthusiasm, and the fulfillment of personal needs along with those of our practice or institution. When we do our personal best on the day-to-day matters, people will be beating down the doors to offer other valuable experiences. To paraphrase an old truism, if you want something done well, find a busy person who does other things well. Some of the experiences presented to us may question our basic assumptions and redirect our careers; others will fizzle out, but not before they garner self-confidence or even indirectly lead to something more substantial in our careers. Sometimes all that an experience teaches us is that we do not want to continue down that path.

Career development is a dynamic process. Strive for excellence in everything that you do, keep your eyes open for broadening experiences, and maintain your fifth-grade enthusiasm! I am not sure what I will be doing in 5 years, but I hope it will be fresh, varied, and exciting. Do dermatology careers develop through a focused plan or serendipity? At my mature age, with a well-developed career, my answer is mostly serendipity.

Fifth grade is a wonderful school year and fifth graders are interesting, enthusiastic, and busy people, but conflicts can arise amidst their many activities. We discovered that our fifth grader could not finish his homework, play on 3 sports teams, take bass lessons (and practice), join the city chorus, play outside with his friends, walk his dog, spend quality time with his parents, and do his chores—much less eat and sleep. Choices needed to be made. Unfortunately, in our community dropping out of the premier soccer club probably limits future possibilities in the sport; nevertheless, it would entail 6 to 8 hours of game and practice time per week (plus travel), as well as multiple 3-day tournaments. Therefore our son dropped soccer, as we decided the best strategy for our fifth grader to develop and mature was to do his personal best at his schoolwork while also exploring a greater variety of less intensive extracurricular experiences.

Most dermatologists appropriately adopt a different strategy during medical school and dermatology training. An intensive, single-minded focus gets us through hours in the anatomy laboratory, the first difficult clinical rotations, sleepless nights, grand rounds quizzing, and board examinations. Completion of our training does not, however, signal that development and maturation are complete; rather, we must then choose among a new set of options, such as the basic questions of whether to practice in an academic setting or group or solo practice and whether to emphasize a subspecialty. These choices involve some mutually exclusive options and exist in a milieu of adult (ie, nonacademic) dilemmas concerning family life, community and spiritual life, avocations, exercise regimens, housing and material goods, and other routine aspects of life. The professional options that are available may be limited by the lack of community opportunities, geographic need, or job availability in a preferred location or institution.

So how do dermatologists manage to start their careers, then develop and maintain them? A best practice is to be both introspective as well as aware of our external environments. Good questions to ask ourselves periodically (having different answers at different stages is highly recommended!) include: What are my core values and what do I want to accomplish? Pay attention to your gut. When do you lose track of time and what makes you want to scream in frustration? Regularly take an inventory of your strengths and find opportunities to acquire the competencies that can take you to the next level. What skill do I need to finesse and how do I finesse it? Do an external scan and understand limiting factors such as geographic saturation in your desired practice type or the lack of appropriate collaborators in your preferred area of interest. Search out people who are doing what you’d like to do and then identify their paths and what you can use from their experiences to help with your career development.

Once you have identified a few professional goals to pursue, utilize all the resources you can find. You might find helpful seminars at an academic institution or at conferences. Do you want to become the regional expert in sarcoidosis? Check out what has been written and find other experts in the subject and where they are speaking. Many organizations have practice management or leadership development courses and seminars. There also are books for everything—those that I have found most useful include Douglas Stone’s Difficult Conversations: How to Discuss What Matters Most¹ and William L. Fisher and Roger Ury’s classic, Getting to Yes: Negotiating Agreement Without Giving In.² Have to give a talk? There is a PowerPoint 2016 for Dummies.³ The same series also includes a book on the Microsoft^® Excel spreadsheet. Also check out my all-time favorite—Brian Tracy’s Eat That Frog! 21 Ways to Stop Procrastinating and Get More Done in Less Time.⁴

It is important to experiment with different professional experiences and have an open mind when a new activity presents itself. Look for opportunities for new side ventures or interesting projects that will not take up much time so you can continue to do your best at your daily work. When I was a senior resident, a dermatologist from Maine asked me if I would help him find a dermatologist who would work regularly at a rural clinic in the northern part of the state. My answer was, why not me? For 8 years I worked in that clinic once to twice per month, seeing as many patients as I could for 8 to 12 hours a day on Friday, Saturday, and Sunday, and then returning to Boston, Massachusetts, for my normal work week. I even took my 2 youngest children (who were born during that time) with me and found a family there who took excellent care of them while I worked. It ended up being one of the most important experiences, both intellectually and emotionally, of my professional career. I learned how to diagnose difficult and complex dermatology problems by myself in an environment with few resources (the closest dermatologist was 150 miles away), how to use primary care providers to manage patients remotely, how to set up a clinic and manage staff (I hired other part-time staff to help me), and how to lead an effort that I felt passionate about. I sometimes even took on residents, which helped me finesse my teaching and supervision style.

Unlike the achievement of becoming a board-certified dermatologist, a dermatology career does not develop in a straight line, and rarely at a steady pace. It seems to me that a shift from a single-minded focus during residency to the fifth-grade strategy of doing our personal best at the main tasks of everyday work as well as participating in a variety of other experiences successfully develops a career that encompasses excellence, enthusiasm, and the fulfillment of personal needs along with those of our practice or institution. When we do our personal best on the day-to-day matters, people will be beating down the doors to offer other valuable experiences. To paraphrase an old truism, if you want something done well, find a busy person who does other things well. Some of the experiences presented to us may question our basic assumptions and redirect our careers; others will fizzle out, but not before they garner self-confidence or even indirectly lead to something more substantial in our careers. Sometimes all that an experience teaches us is that we do not want to continue down that path.

Career development is a dynamic process. Strive for excellence in everything that you do, keep your eyes open for broadening experiences, and maintain your fifth-grade enthusiasm! I am not sure what I will be doing in 5 years, but I hope it will be fresh, varied, and exciting. Do dermatology careers develop through a focused plan or serendipity? At my mature age, with a well-developed career, my answer is mostly serendipity.

Fifth grade is a wonderful school year and fifth graders are interesting, enthusiastic, and busy people, but conflicts can arise amidst their many activities. We discovered that our fifth grader could not finish his homework, play on 3 sports teams, take bass lessons (and practice), join the city chorus, play outside with his friends, walk his dog, spend quality time with his parents, and do his chores—much less eat and sleep. Choices needed to be made. Unfortunately, in our community dropping out of the premier soccer club probably limits future possibilities in the sport; nevertheless, it would entail 6 to 8 hours of game and practice time per week (plus travel), as well as multiple 3-day tournaments. Therefore our son dropped soccer, as we decided the best strategy for our fifth grader to develop and mature was to do his personal best at his schoolwork while also exploring a greater variety of less intensive extracurricular experiences.

Most dermatologists appropriately adopt a different strategy during medical school and dermatology training. An intensive, single-minded focus gets us through hours in the anatomy laboratory, the first difficult clinical rotations, sleepless nights, grand rounds quizzing, and board examinations. Completion of our training does not, however, signal that development and maturation are complete; rather, we must then choose among a new set of options, such as the basic questions of whether to practice in an academic setting or group or solo practice and whether to emphasize a subspecialty. These choices involve some mutually exclusive options and exist in a milieu of adult (ie, nonacademic) dilemmas concerning family life, community and spiritual life, avocations, exercise regimens, housing and material goods, and other routine aspects of life. The professional options that are available may be limited by the lack of community opportunities, geographic need, or job availability in a preferred location or institution.

So how do dermatologists manage to start their careers, then develop and maintain them? A best practice is to be both introspective as well as aware of our external environments. Good questions to ask ourselves periodically (having different answers at different stages is highly recommended!) include: What are my core values and what do I want to accomplish? Pay attention to your gut. When do you lose track of time and what makes you want to scream in frustration? Regularly take an inventory of your strengths and find opportunities to acquire the competencies that can take you to the next level. What skill do I need to finesse and how do I finesse it? Do an external scan and understand limiting factors such as geographic saturation in your desired practice type or the lack of appropriate collaborators in your preferred area of interest. Search out people who are doing what you’d like to do and then identify their paths and what you can use from their experiences to help with your career development.

Once you have identified a few professional goals to pursue, utilize all the resources you can find. You might find helpful seminars at an academic institution or at conferences. Do you want to become the regional expert in sarcoidosis? Check out what has been written and find other experts in the subject and where they are speaking. Many organizations have practice management or leadership development courses and seminars. There also are books for everything—those that I have found most useful include Douglas Stone’s Difficult Conversations: How to Discuss What Matters Most¹ and William L. Fisher and Roger Ury’s classic, Getting to Yes: Negotiating Agreement Without Giving In.² Have to give a talk? There is a PowerPoint 2016 for Dummies.³ The same series also includes a book on the Microsoft^® Excel spreadsheet. Also check out my all-time favorite—Brian Tracy’s Eat That Frog! 21 Ways to Stop Procrastinating and Get More Done in Less Time.⁴

It is important to experiment with different professional experiences and have an open mind when a new activity presents itself. Look for opportunities for new side ventures or interesting projects that will not take up much time so you can continue to do your best at your daily work. When I was a senior resident, a dermatologist from Maine asked me if I would help him find a dermatologist who would work regularly at a rural clinic in the northern part of the state. My answer was, why not me? For 8 years I worked in that clinic once to twice per month, seeing as many patients as I could for 8 to 12 hours a day on Friday, Saturday, and Sunday, and then returning to Boston, Massachusetts, for my normal work week. I even took my 2 youngest children (who were born during that time) with me and found a family there who took excellent care of them while I worked. It ended up being one of the most important experiences, both intellectually and emotionally, of my professional career. I learned how to diagnose difficult and complex dermatology problems by myself in an environment with few resources (the closest dermatologist was 150 miles away), how to use primary care providers to manage patients remotely, how to set up a clinic and manage staff (I hired other part-time staff to help me), and how to lead an effort that I felt passionate about. I sometimes even took on residents, which helped me finesse my teaching and supervision style.

Unlike the achievement of becoming a board-certified dermatologist, a dermatology career does not develop in a straight line, and rarely at a steady pace. It seems to me that a shift from a single-minded focus during residency to the fifth-grade strategy of doing our personal best at the main tasks of everyday work as well as participating in a variety of other experiences successfully develops a career that encompasses excellence, enthusiasm, and the fulfillment of personal needs along with those of our practice or institution. When we do our personal best on the day-to-day matters, people will be beating down the doors to offer other valuable experiences. To paraphrase an old truism, if you want something done well, find a busy person who does other things well. Some of the experiences presented to us may question our basic assumptions and redirect our careers; others will fizzle out, but not before they garner self-confidence or even indirectly lead to something more substantial in our careers. Sometimes all that an experience teaches us is that we do not want to continue down that path.

Career development is a dynamic process. Strive for excellence in everything that you do, keep your eyes open for broadening experiences, and maintain your fifth-grade enthusiasm! I am not sure what I will be doing in 5 years, but I hope it will be fresh, varied, and exciting. Do dermatology careers develop through a focused plan or serendipity? At my mature age, with a well-developed career, my answer is mostly serendipity.

The patient was in his 70s—a professor, not quite retired, who was quiet but engaged. The basal cell carcinoma on his temple was finally clear after 4 stages of Mohs micrographic surgery. The resident and I discussed an A-to-T flap for reconstruction as we reviewed his last slides at the microscope. While I finished another repair, the resident went into the procedure room to explain the proposed repair. He was still with the patient when I finished but finally came out saying the patient understood what we wanted to do, so I entered the room, ready to put on my gloves.

Something about the way the patient looked at me made me stop. I went over to him, put my hand on his arm, and said, “I know you’ve heard about the repair. It will look really good when we are done and you are healed. Are you ready?” He continued looking at me and nodded. Because I was not sure why he was looking at me, I kept looking at him eye-to-eye and talked about the procedure. I started my usual explanation of why we have to move tissue to close the defect, and out of the corner of my eye I could see his foot moving while he peered back at me. I went back to explaining about the tumor and the Mohs procedure and what had created the defect, and his foot stopped moving. Then I started talking about the repair again, reassuring him that we would avoid his eye, leaving his vision intact, and that we could place most of the scar in his hairline. His foot started moving again. He kept looking at me and I kept looking back at him with my hand on his arm.

By this time I knew there was something about the repair that made the patient uncomfortable, but I did not know what. I said something about the bandage and asked whether that would bother him during his classes or in meetings. He said no, and his foot stopped momentarily. Then I said that while we wanted to do this repair, I could give him other treatment options. I started to talk about Mother Nature (second intention healing). His look got less intense and his foot stopped moving, so I discussed the end result of this healing process, the time it would take to heal, and the required wound care. Then the patient took a big breath, smiled, and said, “Mother Nature always does a good job for me.”

Empathy is a tool that can be used in the patient-physician relationship to arrive at a mutually acceptable plan of action. Empathy is defined in the dictionary as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either in the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.”¹ However, I prefer the more simple explanation that empathy is engaged curiosity about another’s emotional perspective.² It is not sympathy, which is sharing another person’s emotions with mutual susceptibility, and it is not compassion, which is the emotion that drives us to help someone in need. Instead, empathy is a form of knowledge, albeit reflexive and personal, as if the physician were momentarily in the place of the patient. An empathetic physician also retains a sense of self so that he/she can be purposeful and objective in examining the information gained in that moment. Empathy is openness to oneself (Why do I have an odd feeling about the way the patient is looking at me?) as well as openness to the patient (Why is his foot moving?).

Not only a form of knowledge but also a skill that can be practiced and mastered, empathy consists of observation, listening, introspection, and deliberation repeated in cycles as needed to come to a conclusion. It is a cognitive process that acknowledges competing interests in a respectful nonjudgmental way. Its manifestation is that of the provider being fully present but without the emotional complications of concern or pity.

Why should we, as physicians, bother with adding the skill of empathy to our clinical armamentarium? First, although the physiology of empathy is not well understood, it has physiologic effects in the physician-patient relationship. Skin conductance studies of 20 well-established patient-therapist dyads documented a significant positive correlation between skin conductance concordance and patient reports of perceived therapist empathy (P=.03).³ Secondly, it has been found that physician empathy, as determined by the ability to understand a patient’s needs, encouraged patient cooperation, pain relief, and healing in studies of metastatic cancer⁴ and trauma surgery patients⁵; the physician-patient relationship was protected even if patient’s needs were unmet. Third, empathy can speed up the process of developing a mutually agreed upon treatment plan. My discussion with the patient presented here lasted less than 5 minutes, and the resident, who had spoken to the same patient for 30 minutes, expressed amazement that I “knew” the patient did not want to undergo the proposed procedure. The use of empathy definitely fits within the profile of professional ethics, as it attends to the basic principle of respecting the autonomy of the patient. It certainly promotes teamwork and an integrative approach to patient care.⁶ Empathy also allows us to take good care of patients who have a long list of physical traits and characteristics that are known to elicit negative responses from physicians, such as an unkempt appearance or substance abuse.⁷ Empathy may even have a therapeutic context of its own. Behavioral scientists hypothesize that empathy allows emotions to be managed in a socially positive way that conserves metabolically costly resources and facilitates adaptation to environmental changes.⁸ Importantly for physicians, having empathy can protect against the symptoms and consequences of burnout.⁹

Modern society needs empathy to understand the events and consequences that occur in our lives and the choices we must make. Witness the popularity of Atul Gawande’s latest book, Being Mortal: Medicine and What Matters in the End.¹⁰ The book is intensely personal and thought provoking, and the end-of-life issues Gawande discusses are true to the challenges faced by patients and their caretakers. We may be the caretakers now, but we will all be the patient at some point in our lives. I suggest reading (or rereading) the book and considering whether some of the troubling stories Gawande tells might have been improved if empathy had been present.

If you are having trouble getting in touch with your empathy, the Cleveland Clinic created a powerful video about empathy and patient care that might be helpful (https://www.youtube.com /watch?v=cDDWvj_q-o8).

Be present today, be open to yourself, and be  open to the others around you. Let me know if it makes a difference.

The patient was in his 70s—a professor, not quite retired, who was quiet but engaged. The basal cell carcinoma on his temple was finally clear after 4 stages of Mohs micrographic surgery. The resident and I discussed an A-to-T flap for reconstruction as we reviewed his last slides at the microscope. While I finished another repair, the resident went into the procedure room to explain the proposed repair. He was still with the patient when I finished but finally came out saying the patient understood what we wanted to do, so I entered the room, ready to put on my gloves.

Something about the way the patient looked at me made me stop. I went over to him, put my hand on his arm, and said, “I know you’ve heard about the repair. It will look really good when we are done and you are healed. Are you ready?” He continued looking at me and nodded. Because I was not sure why he was looking at me, I kept looking at him eye-to-eye and talked about the procedure. I started my usual explanation of why we have to move tissue to close the defect, and out of the corner of my eye I could see his foot moving while he peered back at me. I went back to explaining about the tumor and the Mohs procedure and what had created the defect, and his foot stopped moving. Then I started talking about the repair again, reassuring him that we would avoid his eye, leaving his vision intact, and that we could place most of the scar in his hairline. His foot started moving again. He kept looking at me and I kept looking back at him with my hand on his arm.

By this time I knew there was something about the repair that made the patient uncomfortable, but I did not know what. I said something about the bandage and asked whether that would bother him during his classes or in meetings. He said no, and his foot stopped momentarily. Then I said that while we wanted to do this repair, I could give him other treatment options. I started to talk about Mother Nature (second intention healing). His look got less intense and his foot stopped moving, so I discussed the end result of this healing process, the time it would take to heal, and the required wound care. Then the patient took a big breath, smiled, and said, “Mother Nature always does a good job for me.”

Empathy is a tool that can be used in the patient-physician relationship to arrive at a mutually acceptable plan of action. Empathy is defined in the dictionary as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either in the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.”¹ However, I prefer the more simple explanation that empathy is engaged curiosity about another’s emotional perspective.² It is not sympathy, which is sharing another person’s emotions with mutual susceptibility, and it is not compassion, which is the emotion that drives us to help someone in need. Instead, empathy is a form of knowledge, albeit reflexive and personal, as if the physician were momentarily in the place of the patient. An empathetic physician also retains a sense of self so that he/she can be purposeful and objective in examining the information gained in that moment. Empathy is openness to oneself (Why do I have an odd feeling about the way the patient is looking at me?) as well as openness to the patient (Why is his foot moving?).

Not only a form of knowledge but also a skill that can be practiced and mastered, empathy consists of observation, listening, introspection, and deliberation repeated in cycles as needed to come to a conclusion. It is a cognitive process that acknowledges competing interests in a respectful nonjudgmental way. Its manifestation is that of the provider being fully present but without the emotional complications of concern or pity.

Why should we, as physicians, bother with adding the skill of empathy to our clinical armamentarium? First, although the physiology of empathy is not well understood, it has physiologic effects in the physician-patient relationship. Skin conductance studies of 20 well-established patient-therapist dyads documented a significant positive correlation between skin conductance concordance and patient reports of perceived therapist empathy (P=.03).³ Secondly, it has been found that physician empathy, as determined by the ability to understand a patient’s needs, encouraged patient cooperation, pain relief, and healing in studies of metastatic cancer⁴ and trauma surgery patients⁵; the physician-patient relationship was protected even if patient’s needs were unmet. Third, empathy can speed up the process of developing a mutually agreed upon treatment plan. My discussion with the patient presented here lasted less than 5 minutes, and the resident, who had spoken to the same patient for 30 minutes, expressed amazement that I “knew” the patient did not want to undergo the proposed procedure. The use of empathy definitely fits within the profile of professional ethics, as it attends to the basic principle of respecting the autonomy of the patient. It certainly promotes teamwork and an integrative approach to patient care.⁶ Empathy also allows us to take good care of patients who have a long list of physical traits and characteristics that are known to elicit negative responses from physicians, such as an unkempt appearance or substance abuse.⁷ Empathy may even have a therapeutic context of its own. Behavioral scientists hypothesize that empathy allows emotions to be managed in a socially positive way that conserves metabolically costly resources and facilitates adaptation to environmental changes.⁸ Importantly for physicians, having empathy can protect against the symptoms and consequences of burnout.⁹

Modern society needs empathy to understand the events and consequences that occur in our lives and the choices we must make. Witness the popularity of Atul Gawande’s latest book, Being Mortal: Medicine and What Matters in the End.¹⁰ The book is intensely personal and thought provoking, and the end-of-life issues Gawande discusses are true to the challenges faced by patients and their caretakers. We may be the caretakers now, but we will all be the patient at some point in our lives. I suggest reading (or rereading) the book and considering whether some of the troubling stories Gawande tells might have been improved if empathy had been present.

If you are having trouble getting in touch with your empathy, the Cleveland Clinic created a powerful video about empathy and patient care that might be helpful (https://www.youtube.com /watch?v=cDDWvj_q-o8).

Be present today, be open to yourself, and be  open to the others around you. Let me know if it makes a difference.

The patient was in his 70s—a professor, not quite retired, who was quiet but engaged. The basal cell carcinoma on his temple was finally clear after 4 stages of Mohs micrographic surgery. The resident and I discussed an A-to-T flap for reconstruction as we reviewed his last slides at the microscope. While I finished another repair, the resident went into the procedure room to explain the proposed repair. He was still with the patient when I finished but finally came out saying the patient understood what we wanted to do, so I entered the room, ready to put on my gloves.

Something about the way the patient looked at me made me stop. I went over to him, put my hand on his arm, and said, “I know you’ve heard about the repair. It will look really good when we are done and you are healed. Are you ready?” He continued looking at me and nodded. Because I was not sure why he was looking at me, I kept looking at him eye-to-eye and talked about the procedure. I started my usual explanation of why we have to move tissue to close the defect, and out of the corner of my eye I could see his foot moving while he peered back at me. I went back to explaining about the tumor and the Mohs procedure and what had created the defect, and his foot stopped moving. Then I started talking about the repair again, reassuring him that we would avoid his eye, leaving his vision intact, and that we could place most of the scar in his hairline. His foot started moving again. He kept looking at me and I kept looking back at him with my hand on his arm.

By this time I knew there was something about the repair that made the patient uncomfortable, but I did not know what. I said something about the bandage and asked whether that would bother him during his classes or in meetings. He said no, and his foot stopped momentarily. Then I said that while we wanted to do this repair, I could give him other treatment options. I started to talk about Mother Nature (second intention healing). His look got less intense and his foot stopped moving, so I discussed the end result of this healing process, the time it would take to heal, and the required wound care. Then the patient took a big breath, smiled, and said, “Mother Nature always does a good job for me.”

Empathy is a tool that can be used in the patient-physician relationship to arrive at a mutually acceptable plan of action. Empathy is defined in the dictionary as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either in the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.”¹ However, I prefer the more simple explanation that empathy is engaged curiosity about another’s emotional perspective.² It is not sympathy, which is sharing another person’s emotions with mutual susceptibility, and it is not compassion, which is the emotion that drives us to help someone in need. Instead, empathy is a form of knowledge, albeit reflexive and personal, as if the physician were momentarily in the place of the patient. An empathetic physician also retains a sense of self so that he/she can be purposeful and objective in examining the information gained in that moment. Empathy is openness to oneself (Why do I have an odd feeling about the way the patient is looking at me?) as well as openness to the patient (Why is his foot moving?).

Not only a form of knowledge but also a skill that can be practiced and mastered, empathy consists of observation, listening, introspection, and deliberation repeated in cycles as needed to come to a conclusion. It is a cognitive process that acknowledges competing interests in a respectful nonjudgmental way. Its manifestation is that of the provider being fully present but without the emotional complications of concern or pity.

Why should we, as physicians, bother with adding the skill of empathy to our clinical armamentarium? First, although the physiology of empathy is not well understood, it has physiologic effects in the physician-patient relationship. Skin conductance studies of 20 well-established patient-therapist dyads documented a significant positive correlation between skin conductance concordance and patient reports of perceived therapist empathy (P=.03).³ Secondly, it has been found that physician empathy, as determined by the ability to understand a patient’s needs, encouraged patient cooperation, pain relief, and healing in studies of metastatic cancer⁴ and trauma surgery patients⁵; the physician-patient relationship was protected even if patient’s needs were unmet. Third, empathy can speed up the process of developing a mutually agreed upon treatment plan. My discussion with the patient presented here lasted less than 5 minutes, and the resident, who had spoken to the same patient for 30 minutes, expressed amazement that I “knew” the patient did not want to undergo the proposed procedure. The use of empathy definitely fits within the profile of professional ethics, as it attends to the basic principle of respecting the autonomy of the patient. It certainly promotes teamwork and an integrative approach to patient care.⁶ Empathy also allows us to take good care of patients who have a long list of physical traits and characteristics that are known to elicit negative responses from physicians, such as an unkempt appearance or substance abuse.⁷ Empathy may even have a therapeutic context of its own. Behavioral scientists hypothesize that empathy allows emotions to be managed in a socially positive way that conserves metabolically costly resources and facilitates adaptation to environmental changes.⁸ Importantly for physicians, having empathy can protect against the symptoms and consequences of burnout.⁹

Modern society needs empathy to understand the events and consequences that occur in our lives and the choices we must make. Witness the popularity of Atul Gawande’s latest book, Being Mortal: Medicine and What Matters in the End.¹⁰ The book is intensely personal and thought provoking, and the end-of-life issues Gawande discusses are true to the challenges faced by patients and their caretakers. We may be the caretakers now, but we will all be the patient at some point in our lives. I suggest reading (or rereading) the book and considering whether some of the troubling stories Gawande tells might have been improved if empathy had been present.

If you are having trouble getting in touch with your empathy, the Cleveland Clinic created a powerful video about empathy and patient care that might be helpful (https://www.youtube.com /watch?v=cDDWvj_q-o8).

Be present today, be open to yourself, and be  open to the others around you. Let me know if it makes a difference.

My life is not the same as it was 15 years ago; my children are grown, my parents are elderly, and what I do in my leisure time reflects both new friends and maturing old friends. Some of these changes I embrace; others I simply accept. Some changes I intensely dislike but still know I have to accept them. Family changes can be difficult for all of us to manage. But changes in our profession? Now that gets to our core. These changes are unwanted and we do not have the time or energy for them. We have patients waiting! We have worked hard to develop a practice style that fits our patients’ needs and that feels authentic to our personal experiences and skill set. I completed 7 years of postgraduate training and still spend a lot of time pursuing continuing medical education opportunities, but now my prescription pad has become a suggestion pad and my overhead has swollen. Sure, I am happy to have new bench-to-bedside approaches to understanding diseases and cutting-edge treatments, but role changes? Employer expectation changes? Changes in insurance benefits for my patients? Regulatory invasion? Alternative payment models? The tsunami of changes we heard about several years ago is now crashing up on the shore.

Take a minute and write down 3 changes in your practice over the last few years that you dislike the most and then turn over the paper. We will come back to them in a minute.

In the midst of all these changes or perhaps as a consequence, there has been an epidemic of physician burnout characterized by emotional fatigue; depersonalization as evidenced by a negative, callous, and cynical attitude toward patients and their concerns; and a decreased sense of personal accomplishment. Burnout symptoms are more common in physicians than in the general population and penetrate as high as 46% of physicians in general practice, but it is relatively low in dermatology, affecting approximately 24% of our colleagues.¹ Just working in a practice with high expectations surrounding the use of an electronic medical record creates burnout and the intent to leave the practice.² Consequences of burnout are major and can include³ decreased quality of care, increased clinical errors, frequent job changes, migration to other occupations,⁴ early retirement, and even suicide.⁵ Change can sometimes feel like too much to endure.

People manage change with a number of strategies. One group of strategies is labeled disengagement: wishful thinking, problem avoidance, self-criticism, and social avoidance.⁶ Some of us just do not implement any meaningful use measures; we wish they would just go away and, after all, the penalties are not pinching us yet. More alarmingly, rates of physician substance abuse are rising,^7,8 a response to stress that allows for at least temporary problem avoidance and creates social isolation. Disengagement strategies do not promote coping, our ability to reduce or control stress.

Another group of choices include engagement strategies: problem solving, social support, expression of emotion, and cognitive restructuring.⁶ These strategies develop resilience, which is the capacity to respond to stress in a healthy way so that goals are achieved at minimal psychological and physical costs. Resilience creates positive resource spirals, and resilient individuals bounce back with increased strength.⁹

Let’s do some cognitive restructuring: First, we accept that change happens. Even facts change. Psoriasis was once said to be a disease of the keratinocytes, but now we consider it a disease of the immune system gone awry. It was dogma 30 years ago that excision of melanoma required 5-cm margins of normal skin, but the standard of care today includes much narrower margins. Once we accept that change happens, we learn to expect it as the natural course of events, and then we can look for the parts of change that we can enjoy. Learning something new about psoriasis and melanoma can be stimulating. Learning something new about the science of population health, patient management rubrics, quality measure development, and practice business models can be energizing too. Spend time and effort working on embracing changes that both interest you and are relevant to your practice. Do you hate the idea of having to incorporate quality measures in your practice? The fact that regulatory policy requires quality measures is not going to change, but we can gain some control by reading quality measure literature, working within our practice settings to develop quality improvement projects that are relevant and effective, and contributing to the discussion of quality measures in dermatology either in print or through committee work. Accepting change as well as working with our colleagues to promote relevant and positive change are examples of engagement strategies that help develop resilience.

Studies have shown that job satisfaction is highest among physicians who practice with defined professional and personal boundaries and pursue continued professional development, particularly by attending continuing medical education programs.¹⁰ Learning something new can be an antidote for boredom and depression. Being with other dermatologists, a wonderful group of interesting and passionate people, also can provide social support and allows us to express frustration regarding stresses in the workplace. I almost always return from dermatology meetings energized and stimulated.

Another factor related to job satisfaction is a focus on the positive aspects of one’s work. Dermatology is a fascinating study of a group of diseases that we can actually see and touch and biopsy. Some diseases are benign, while others may be fatal. They can occur in patients young and old, sick and healthy. Effective treatments exist that can change the course of these diseases, and new therapies continue to evolve. The art of diagnosis and patient care appeals to me as much as the science. A Canadian study found that appreciating the value of a relationship with the patient correlated with job satisfaction among physicians.¹¹ As dermatologists, we have this opportunity every day with each patient that we see.

Dermatologists indeed are very privileged. Take out another piece of paper and write down 3 aspects of our profession that you are thankful for. You can include things you are grateful for in other parts of your life too because physicians with strong relationships and activities outside of work report fewer episodes of emotional exhaustion.¹²

Now flip over the paper with the recent changes you do not like. They do not seem so bad anymore, do they?

My life is not the same as it was 15 years ago; my children are grown, my parents are elderly, and what I do in my leisure time reflects both new friends and maturing old friends. Some of these changes I embrace; others I simply accept. Some changes I intensely dislike but still know I have to accept them. Family changes can be difficult for all of us to manage. But changes in our profession? Now that gets to our core. These changes are unwanted and we do not have the time or energy for them. We have patients waiting! We have worked hard to develop a practice style that fits our patients’ needs and that feels authentic to our personal experiences and skill set. I completed 7 years of postgraduate training and still spend a lot of time pursuing continuing medical education opportunities, but now my prescription pad has become a suggestion pad and my overhead has swollen. Sure, I am happy to have new bench-to-bedside approaches to understanding diseases and cutting-edge treatments, but role changes? Employer expectation changes? Changes in insurance benefits for my patients? Regulatory invasion? Alternative payment models? The tsunami of changes we heard about several years ago is now crashing up on the shore.

Take a minute and write down 3 changes in your practice over the last few years that you dislike the most and then turn over the paper. We will come back to them in a minute.

In the midst of all these changes or perhaps as a consequence, there has been an epidemic of physician burnout characterized by emotional fatigue; depersonalization as evidenced by a negative, callous, and cynical attitude toward patients and their concerns; and a decreased sense of personal accomplishment. Burnout symptoms are more common in physicians than in the general population and penetrate as high as 46% of physicians in general practice, but it is relatively low in dermatology, affecting approximately 24% of our colleagues.¹ Just working in a practice with high expectations surrounding the use of an electronic medical record creates burnout and the intent to leave the practice.² Consequences of burnout are major and can include³ decreased quality of care, increased clinical errors, frequent job changes, migration to other occupations,⁴ early retirement, and even suicide.⁵ Change can sometimes feel like too much to endure.

People manage change with a number of strategies. One group of strategies is labeled disengagement: wishful thinking, problem avoidance, self-criticism, and social avoidance.⁶ Some of us just do not implement any meaningful use measures; we wish they would just go away and, after all, the penalties are not pinching us yet. More alarmingly, rates of physician substance abuse are rising,^7,8 a response to stress that allows for at least temporary problem avoidance and creates social isolation. Disengagement strategies do not promote coping, our ability to reduce or control stress.

Another group of choices include engagement strategies: problem solving, social support, expression of emotion, and cognitive restructuring.⁶ These strategies develop resilience, which is the capacity to respond to stress in a healthy way so that goals are achieved at minimal psychological and physical costs. Resilience creates positive resource spirals, and resilient individuals bounce back with increased strength.⁹

Let’s do some cognitive restructuring: First, we accept that change happens. Even facts change. Psoriasis was once said to be a disease of the keratinocytes, but now we consider it a disease of the immune system gone awry. It was dogma 30 years ago that excision of melanoma required 5-cm margins of normal skin, but the standard of care today includes much narrower margins. Once we accept that change happens, we learn to expect it as the natural course of events, and then we can look for the parts of change that we can enjoy. Learning something new about psoriasis and melanoma can be stimulating. Learning something new about the science of population health, patient management rubrics, quality measure development, and practice business models can be energizing too. Spend time and effort working on embracing changes that both interest you and are relevant to your practice. Do you hate the idea of having to incorporate quality measures in your practice? The fact that regulatory policy requires quality measures is not going to change, but we can gain some control by reading quality measure literature, working within our practice settings to develop quality improvement projects that are relevant and effective, and contributing to the discussion of quality measures in dermatology either in print or through committee work. Accepting change as well as working with our colleagues to promote relevant and positive change are examples of engagement strategies that help develop resilience.

Studies have shown that job satisfaction is highest among physicians who practice with defined professional and personal boundaries and pursue continued professional development, particularly by attending continuing medical education programs.¹⁰ Learning something new can be an antidote for boredom and depression. Being with other dermatologists, a wonderful group of interesting and passionate people, also can provide social support and allows us to express frustration regarding stresses in the workplace. I almost always return from dermatology meetings energized and stimulated.

Another factor related to job satisfaction is a focus on the positive aspects of one’s work. Dermatology is a fascinating study of a group of diseases that we can actually see and touch and biopsy. Some diseases are benign, while others may be fatal. They can occur in patients young and old, sick and healthy. Effective treatments exist that can change the course of these diseases, and new therapies continue to evolve. The art of diagnosis and patient care appeals to me as much as the science. A Canadian study found that appreciating the value of a relationship with the patient correlated with job satisfaction among physicians.¹¹ As dermatologists, we have this opportunity every day with each patient that we see.

Dermatologists indeed are very privileged. Take out another piece of paper and write down 3 aspects of our profession that you are thankful for. You can include things you are grateful for in other parts of your life too because physicians with strong relationships and activities outside of work report fewer episodes of emotional exhaustion.¹²

Now flip over the paper with the recent changes you do not like. They do not seem so bad anymore, do they?

My life is not the same as it was 15 years ago; my children are grown, my parents are elderly, and what I do in my leisure time reflects both new friends and maturing old friends. Some of these changes I embrace; others I simply accept. Some changes I intensely dislike but still know I have to accept them. Family changes can be difficult for all of us to manage. But changes in our profession? Now that gets to our core. These changes are unwanted and we do not have the time or energy for them. We have patients waiting! We have worked hard to develop a practice style that fits our patients’ needs and that feels authentic to our personal experiences and skill set. I completed 7 years of postgraduate training and still spend a lot of time pursuing continuing medical education opportunities, but now my prescription pad has become a suggestion pad and my overhead has swollen. Sure, I am happy to have new bench-to-bedside approaches to understanding diseases and cutting-edge treatments, but role changes? Employer expectation changes? Changes in insurance benefits for my patients? Regulatory invasion? Alternative payment models? The tsunami of changes we heard about several years ago is now crashing up on the shore.

Take a minute and write down 3 changes in your practice over the last few years that you dislike the most and then turn over the paper. We will come back to them in a minute.

In the midst of all these changes or perhaps as a consequence, there has been an epidemic of physician burnout characterized by emotional fatigue; depersonalization as evidenced by a negative, callous, and cynical attitude toward patients and their concerns; and a decreased sense of personal accomplishment. Burnout symptoms are more common in physicians than in the general population and penetrate as high as 46% of physicians in general practice, but it is relatively low in dermatology, affecting approximately 24% of our colleagues.¹ Just working in a practice with high expectations surrounding the use of an electronic medical record creates burnout and the intent to leave the practice.² Consequences of burnout are major and can include³ decreased quality of care, increased clinical errors, frequent job changes, migration to other occupations,⁴ early retirement, and even suicide.⁵ Change can sometimes feel like too much to endure.

People manage change with a number of strategies. One group of strategies is labeled disengagement: wishful thinking, problem avoidance, self-criticism, and social avoidance.⁶ Some of us just do not implement any meaningful use measures; we wish they would just go away and, after all, the penalties are not pinching us yet. More alarmingly, rates of physician substance abuse are rising,^7,8 a response to stress that allows for at least temporary problem avoidance and creates social isolation. Disengagement strategies do not promote coping, our ability to reduce or control stress.

Another group of choices include engagement strategies: problem solving, social support, expression of emotion, and cognitive restructuring.⁶ These strategies develop resilience, which is the capacity to respond to stress in a healthy way so that goals are achieved at minimal psychological and physical costs. Resilience creates positive resource spirals, and resilient individuals bounce back with increased strength.⁹

Let’s do some cognitive restructuring: First, we accept that change happens. Even facts change. Psoriasis was once said to be a disease of the keratinocytes, but now we consider it a disease of the immune system gone awry. It was dogma 30 years ago that excision of melanoma required 5-cm margins of normal skin, but the standard of care today includes much narrower margins. Once we accept that change happens, we learn to expect it as the natural course of events, and then we can look for the parts of change that we can enjoy. Learning something new about psoriasis and melanoma can be stimulating. Learning something new about the science of population health, patient management rubrics, quality measure development, and practice business models can be energizing too. Spend time and effort working on embracing changes that both interest you and are relevant to your practice. Do you hate the idea of having to incorporate quality measures in your practice? The fact that regulatory policy requires quality measures is not going to change, but we can gain some control by reading quality measure literature, working within our practice settings to develop quality improvement projects that are relevant and effective, and contributing to the discussion of quality measures in dermatology either in print or through committee work. Accepting change as well as working with our colleagues to promote relevant and positive change are examples of engagement strategies that help develop resilience.

Studies have shown that job satisfaction is highest among physicians who practice with defined professional and personal boundaries and pursue continued professional development, particularly by attending continuing medical education programs.¹⁰ Learning something new can be an antidote for boredom and depression. Being with other dermatologists, a wonderful group of interesting and passionate people, also can provide social support and allows us to express frustration regarding stresses in the workplace. I almost always return from dermatology meetings energized and stimulated.

Another factor related to job satisfaction is a focus on the positive aspects of one’s work. Dermatology is a fascinating study of a group of diseases that we can actually see and touch and biopsy. Some diseases are benign, while others may be fatal. They can occur in patients young and old, sick and healthy. Effective treatments exist that can change the course of these diseases, and new therapies continue to evolve. The art of diagnosis and patient care appeals to me as much as the science. A Canadian study found that appreciating the value of a relationship with the patient correlated with job satisfaction among physicians.¹¹ As dermatologists, we have this opportunity every day with each patient that we see.

Dermatologists indeed are very privileged. Take out another piece of paper and write down 3 aspects of our profession that you are thankful for. You can include things you are grateful for in other parts of your life too because physicians with strong relationships and activities outside of work report fewer episodes of emotional exhaustion.¹²

Now flip over the paper with the recent changes you do not like. They do not seem so bad anymore, do they?

Can dermatologists influence the political process? This age-old question raises its head when things are happening that we do not like or that we believe could be done better. Even though dermatologists have skills and expertise that allow us to be effective in our medical practice, most of us feel incompetent when it comes to dealing with the government. The political process is not the primary focus of our time and energy, not a topic in continuing medical education, and definitely not a place of comfort. At my medical school commencement ceremony, Leon Jaworski, a special prosecutor during Watergate, gave an address in which he scolded the medical community for not being more involved in the political process, insisting that society would benefit from our participation. This message was a lightning bolt out of the blue for me. It was the first time in all my medical school years that any respected senior figure had broached the concept that a physician’s role includes engagement in the workings of government. Jaworski was insistent, and he was right.

Influencing the political process (ie, advocating effectively) requires skills and expertise that can be acquired with attention to 3 primary principles: interfacing with legislators, establishing credibility, and joining forces within professional societies.

How to Interface With Legislators

Interfacing with legislators is exactly that: interFACEing. Based on 4 online surveys of congressional staff members (2010-2013) by the Congressional Management Foundation, the most influential way to communicate with a senator or representative is an in-person visit.¹ Successful politicians regard keeping in touch with their constituents to be the most critical factor in their effectiveness.

Getting face time with a legislator can be difficult. In the short-term, the most successful strategy is for the request to come from a constituent who is affiliated with an association or corporation that represents the interests of many constituents. In the long-term, personal visits, letters (e-mail is preferred for security reasons), and telephone calls are most important when they come from constituents who are well known, highly regarded, and have gone out of their way to be helpful to the legislator’s office, which means we need to pay attention to building a relationship with our legislators. For example, I had a long-standing, one-sided correspondence with former representative Barney Frank (Democrat, Massachusetts), writing him regularly on issues that concerned me. I once chided him for not showing up for a vote I thought was important and in return I received a 3-page handwritten letter from him concerning his absence. YES! He knew my name, he knew what was important to me, and he had enough regard for my opinion to answer me personally.

Building a relationship with a staffer can be as important or sometimes even more important than with the legislators themselves. Staffers have direct access to legislators and understand the best way to facilitate moving your information and concerns forward. Meet with them, keep their contact information on hand, and direct your questions and comments to them. Staffers know how you can be helpful to their office, whether it is by supplying information, providing feedback on a position or comment, or hosting a neighborhood coffee gathering in your home so the legislator can meet other constituents. Attending events in your district or offering a simple fundraiser in your home for local and state legislators is an excellent way to be involved with candidates in a way that promotes a future relationship. When the Stark exemption was being discussed in relation to anatomic pathology at an in-office laboratory, I offered a tour of my Mohs unit to a staffer so she could see how integral and important it is for surgeons to perform histology examinations to ensure proper patient care. She did not take me up on the offer, but she subsequently called me with a question concerning a similar issue.

It is not optimal to develop relationships solely with legislators from the political party with which you identify. Dermatologists’ professional interests of concern will likely require bipartisan support for resolution.

Establish Your Credibility

Do some homework on your key issues; find the facts that support your position and also be sure to understand the opposition’s concerns. Be able to present your viewpoint in a focused and concise way with a clear sense of what you are asking the legislator to do.

Keep in mind that you want to develop a long-term, trusted relationship. It is important to be respectful and leave general political feelings out of the meeting. Schedule a meeting with the intention of presenting only 2 or 3 concrete requests. During the visit, it helps to set the context for the conversation if you reference a particular bill. Staffers often ask questions about the bill if it is not one they are currently following, which allows you to become a dependable source of good information. You can engage with staffers or legislators by asking them directly and politely for their views and position on the issue. It often is effective to leave them with a 1- to 2-page summary for review and to follow up later with a formal thank you for their time.

Participate in Professional Societies

Join professional societies to acquire the information you need, refine and consolidate messaging, and represent a larger constituency. Most of the societies that dermatologists belong to, including the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, and the American College of Mohs Surgery, have identified legislative priorities and promote coordinated visits to Congress. The American Academy of Dermatology Association organizes its annual Legislative Conference in Washington, DC, each fall, which includes an in-depth program of speakers, discussions, and information concerning priority issues. Messages are refined and appointments are made for visits with legislators and/or their staffers. Your small group will include experienced colleagues so that you develop your skills with their mentorship. Many state societies also train their members to be effective at advocacy at the State House. Finally and most importantly, a sizeable war chest (yes, your dollars are needed too) for SkinPAC, the American Academy of Dermatology Association Political Action Committee, creates notice and respect for dermatology’s commitment to the issues of importance to the profession.

Dermatologists Have Impacted Legislation

Interaction by individual dermatologists with legislators has had a direct impact on health care issues. A Medicare Advantage Participant Bill of Rights recently was introduced and has garnered bipartisan support in the Senate due to meetings between dermatologists and key members of Congress and the Obama administration about concerns with narrow physician networks. There is a robust bipartisan Congressional Skin Cancer Caucus that representatives have joined because of discussions with their constituent dermatologists. The strong testimonies of 2 dermatologists in Maryland has picked up 3 more yes votes for passing a bill that prohibits use of tanning devices in minors younger than 18 years in that state. California dermatologists also put enough pressure on their state senators to defeat the elimination of the in-office exception to self-referral for anatomic pathology services.

Final Thoughts

Dermatologists do have a voice. We do have influence. We must “sit at the table.”² Build a relationship with your legislators. Develop your message and become a trusted voice. Join forces with other dermatologists. “Let’s grab the front seat together.”²

Can dermatologists influence the political process? This age-old question raises its head when things are happening that we do not like or that we believe could be done better. Even though dermatologists have skills and expertise that allow us to be effective in our medical practice, most of us feel incompetent when it comes to dealing with the government. The political process is not the primary focus of our time and energy, not a topic in continuing medical education, and definitely not a place of comfort. At my medical school commencement ceremony, Leon Jaworski, a special prosecutor during Watergate, gave an address in which he scolded the medical community for not being more involved in the political process, insisting that society would benefit from our participation. This message was a lightning bolt out of the blue for me. It was the first time in all my medical school years that any respected senior figure had broached the concept that a physician’s role includes engagement in the workings of government. Jaworski was insistent, and he was right.

Influencing the political process (ie, advocating effectively) requires skills and expertise that can be acquired with attention to 3 primary principles: interfacing with legislators, establishing credibility, and joining forces within professional societies.

How to Interface With Legislators

Interfacing with legislators is exactly that: interFACEing. Based on 4 online surveys of congressional staff members (2010-2013) by the Congressional Management Foundation, the most influential way to communicate with a senator or representative is an in-person visit.¹ Successful politicians regard keeping in touch with their constituents to be the most critical factor in their effectiveness.

Getting face time with a legislator can be difficult. In the short-term, the most successful strategy is for the request to come from a constituent who is affiliated with an association or corporation that represents the interests of many constituents. In the long-term, personal visits, letters (e-mail is preferred for security reasons), and telephone calls are most important when they come from constituents who are well known, highly regarded, and have gone out of their way to be helpful to the legislator’s office, which means we need to pay attention to building a relationship with our legislators. For example, I had a long-standing, one-sided correspondence with former representative Barney Frank (Democrat, Massachusetts), writing him regularly on issues that concerned me. I once chided him for not showing up for a vote I thought was important and in return I received a 3-page handwritten letter from him concerning his absence. YES! He knew my name, he knew what was important to me, and he had enough regard for my opinion to answer me personally.

Building a relationship with a staffer can be as important or sometimes even more important than with the legislators themselves. Staffers have direct access to legislators and understand the best way to facilitate moving your information and concerns forward. Meet with them, keep their contact information on hand, and direct your questions and comments to them. Staffers know how you can be helpful to their office, whether it is by supplying information, providing feedback on a position or comment, or hosting a neighborhood coffee gathering in your home so the legislator can meet other constituents. Attending events in your district or offering a simple fundraiser in your home for local and state legislators is an excellent way to be involved with candidates in a way that promotes a future relationship. When the Stark exemption was being discussed in relation to anatomic pathology at an in-office laboratory, I offered a tour of my Mohs unit to a staffer so she could see how integral and important it is for surgeons to perform histology examinations to ensure proper patient care. She did not take me up on the offer, but she subsequently called me with a question concerning a similar issue.

It is not optimal to develop relationships solely with legislators from the political party with which you identify. Dermatologists’ professional interests of concern will likely require bipartisan support for resolution.

Establish Your Credibility

Do some homework on your key issues; find the facts that support your position and also be sure to understand the opposition’s concerns. Be able to present your viewpoint in a focused and concise way with a clear sense of what you are asking the legislator to do.

Keep in mind that you want to develop a long-term, trusted relationship. It is important to be respectful and leave general political feelings out of the meeting. Schedule a meeting with the intention of presenting only 2 or 3 concrete requests. During the visit, it helps to set the context for the conversation if you reference a particular bill. Staffers often ask questions about the bill if it is not one they are currently following, which allows you to become a dependable source of good information. You can engage with staffers or legislators by asking them directly and politely for their views and position on the issue. It often is effective to leave them with a 1- to 2-page summary for review and to follow up later with a formal thank you for their time.

Participate in Professional Societies

Join professional societies to acquire the information you need, refine and consolidate messaging, and represent a larger constituency. Most of the societies that dermatologists belong to, including the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, and the American College of Mohs Surgery, have identified legislative priorities and promote coordinated visits to Congress. The American Academy of Dermatology Association organizes its annual Legislative Conference in Washington, DC, each fall, which includes an in-depth program of speakers, discussions, and information concerning priority issues. Messages are refined and appointments are made for visits with legislators and/or their staffers. Your small group will include experienced colleagues so that you develop your skills with their mentorship. Many state societies also train their members to be effective at advocacy at the State House. Finally and most importantly, a sizeable war chest (yes, your dollars are needed too) for SkinPAC, the American Academy of Dermatology Association Political Action Committee, creates notice and respect for dermatology’s commitment to the issues of importance to the profession.

Dermatologists Have Impacted Legislation

Interaction by individual dermatologists with legislators has had a direct impact on health care issues. A Medicare Advantage Participant Bill of Rights recently was introduced and has garnered bipartisan support in the Senate due to meetings between dermatologists and key members of Congress and the Obama administration about concerns with narrow physician networks. There is a robust bipartisan Congressional Skin Cancer Caucus that representatives have joined because of discussions with their constituent dermatologists. The strong testimonies of 2 dermatologists in Maryland has picked up 3 more yes votes for passing a bill that prohibits use of tanning devices in minors younger than 18 years in that state. California dermatologists also put enough pressure on their state senators to defeat the elimination of the in-office exception to self-referral for anatomic pathology services.

Final Thoughts

Dermatologists do have a voice. We do have influence. We must “sit at the table.”² Build a relationship with your legislators. Develop your message and become a trusted voice. Join forces with other dermatologists. “Let’s grab the front seat together.”²

Can dermatologists influence the political process? This age-old question raises its head when things are happening that we do not like or that we believe could be done better. Even though dermatologists have skills and expertise that allow us to be effective in our medical practice, most of us feel incompetent when it comes to dealing with the government. The political process is not the primary focus of our time and energy, not a topic in continuing medical education, and definitely not a place of comfort. At my medical school commencement ceremony, Leon Jaworski, a special prosecutor during Watergate, gave an address in which he scolded the medical community for not being more involved in the political process, insisting that society would benefit from our participation. This message was a lightning bolt out of the blue for me. It was the first time in all my medical school years that any respected senior figure had broached the concept that a physician’s role includes engagement in the workings of government. Jaworski was insistent, and he was right.

Influencing the political process (ie, advocating effectively) requires skills and expertise that can be acquired with attention to 3 primary principles: interfacing with legislators, establishing credibility, and joining forces within professional societies.

How to Interface With Legislators

Interfacing with legislators is exactly that: interFACEing. Based on 4 online surveys of congressional staff members (2010-2013) by the Congressional Management Foundation, the most influential way to communicate with a senator or representative is an in-person visit.¹ Successful politicians regard keeping in touch with their constituents to be the most critical factor in their effectiveness.

Getting face time with a legislator can be difficult. In the short-term, the most successful strategy is for the request to come from a constituent who is affiliated with an association or corporation that represents the interests of many constituents. In the long-term, personal visits, letters (e-mail is preferred for security reasons), and telephone calls are most important when they come from constituents who are well known, highly regarded, and have gone out of their way to be helpful to the legislator’s office, which means we need to pay attention to building a relationship with our legislators. For example, I had a long-standing, one-sided correspondence with former representative Barney Frank (Democrat, Massachusetts), writing him regularly on issues that concerned me. I once chided him for not showing up for a vote I thought was important and in return I received a 3-page handwritten letter from him concerning his absence. YES! He knew my name, he knew what was important to me, and he had enough regard for my opinion to answer me personally.

Building a relationship with a staffer can be as important or sometimes even more important than with the legislators themselves. Staffers have direct access to legislators and understand the best way to facilitate moving your information and concerns forward. Meet with them, keep their contact information on hand, and direct your questions and comments to them. Staffers know how you can be helpful to their office, whether it is by supplying information, providing feedback on a position or comment, or hosting a neighborhood coffee gathering in your home so the legislator can meet other constituents. Attending events in your district or offering a simple fundraiser in your home for local and state legislators is an excellent way to be involved with candidates in a way that promotes a future relationship. When the Stark exemption was being discussed in relation to anatomic pathology at an in-office laboratory, I offered a tour of my Mohs unit to a staffer so she could see how integral and important it is for surgeons to perform histology examinations to ensure proper patient care. She did not take me up on the offer, but she subsequently called me with a question concerning a similar issue.

It is not optimal to develop relationships solely with legislators from the political party with which you identify. Dermatologists’ professional interests of concern will likely require bipartisan support for resolution.

Establish Your Credibility

Do some homework on your key issues; find the facts that support your position and also be sure to understand the opposition’s concerns. Be able to present your viewpoint in a focused and concise way with a clear sense of what you are asking the legislator to do.

Keep in mind that you want to develop a long-term, trusted relationship. It is important to be respectful and leave general political feelings out of the meeting. Schedule a meeting with the intention of presenting only 2 or 3 concrete requests. During the visit, it helps to set the context for the conversation if you reference a particular bill. Staffers often ask questions about the bill if it is not one they are currently following, which allows you to become a dependable source of good information. You can engage with staffers or legislators by asking them directly and politely for their views and position on the issue. It often is effective to leave them with a 1- to 2-page summary for review and to follow up later with a formal thank you for their time.

Participate in Professional Societies

Join professional societies to acquire the information you need, refine and consolidate messaging, and represent a larger constituency. Most of the societies that dermatologists belong to, including the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, and the American College of Mohs Surgery, have identified legislative priorities and promote coordinated visits to Congress. The American Academy of Dermatology Association organizes its annual Legislative Conference in Washington, DC, each fall, which includes an in-depth program of speakers, discussions, and information concerning priority issues. Messages are refined and appointments are made for visits with legislators and/or their staffers. Your small group will include experienced colleagues so that you develop your skills with their mentorship. Many state societies also train their members to be effective at advocacy at the State House. Finally and most importantly, a sizeable war chest (yes, your dollars are needed too) for SkinPAC, the American Academy of Dermatology Association Political Action Committee, creates notice and respect for dermatology’s commitment to the issues of importance to the profession.

Dermatologists Have Impacted Legislation

Interaction by individual dermatologists with legislators has had a direct impact on health care issues. A Medicare Advantage Participant Bill of Rights recently was introduced and has garnered bipartisan support in the Senate due to meetings between dermatologists and key members of Congress and the Obama administration about concerns with narrow physician networks. There is a robust bipartisan Congressional Skin Cancer Caucus that representatives have joined because of discussions with their constituent dermatologists. The strong testimonies of 2 dermatologists in Maryland has picked up 3 more yes votes for passing a bill that prohibits use of tanning devices in minors younger than 18 years in that state. California dermatologists also put enough pressure on their state senators to defeat the elimination of the in-office exception to self-referral for anatomic pathology services.

Final Thoughts

Dermatologists do have a voice. We do have influence. We must “sit at the table.”² Build a relationship with your legislators. Develop your message and become a trusted voice. Join forces with other dermatologists. “Let’s grab the front seat together.”²