Cold Iron Truth

Town and gown – the virtuous circle


I recall in college we used to talk a lot about the relationship between town and gown, that is, the town community and the academic community, and how they relate to each other. This remains pertinent today as we consider the dermatology academic community and practicing dermatologists. There should be a virtuous circle between dermatologists in their community and their academic medical center.

Dr. Brett M. Coldiron, a dermatologist and Mohs surgeon in Cincinnati.

Dr. Brett M. Coldiron

Academic medical centers are up to date and on the cutting edge of science and treatments – and happy to share with community dermatologists. This is where you will learn about teledermatology and how to use the latest biologics.

They provide educational opportunities such as grand rounds and visiting speakers. They allow community physicians to attend staff and resident lectures, bring their most challenging cases to grand rounds, and get feedback and suggestions, with everyone learning from the experience. They host dermatology events for all. They allow community physicians to staff resident clinics where both benefit from the interaction. The academic center provides a charity care network for the community – and usually provides the experts of last resort for difficult cases as they are often on the cutting edge of research and newest treatments.

Large multispecialty practices– and private equity groups – are not going to fill this role.

Dermatology is a highly isolated specialty and the interaction with others at the academic center may be the only physical link to the outside world of medicine. Having an academic dermatology program in your community is a serious asset that community dermatologists should appreciate and support.

However, as the gown supports the town, so should the town support the gown. There is a pervasive inaccuracy in the community that these academic dermatology departments are supported by government funds or a “state line” of support. This is incorrect. These departments support themselves with clinical work. In addition, the dean and/or the medical school takes a generous cut out of their profits, and the departments also must compete – furiously – for grants, of which the medical school immediately takes about 55% for indirect “overhead,” a frequent complaint of academic physicians.

If you practice near such an academic center and benefit from its virtuous circle, you can consider sending them some of your dermatopathology or Mohs, even if you are a large group and could handle them yourselves. You can join the local dermatologic society and bring cases to grand rounds. You can offer to teach the residents in their clinic, or in your office, and expose them to real life practice.

If you have the means, you could consider funding a lectureship or an endowed departmental chair. No matter the virtual content available online, the quality of learning one on one from another specialist cannot be beat. So make the effort to visit the gown from the town. You will be warmly welcomed and join a virtuous circle of lifelong learners.

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected]

Next Article: