President's Message
Dear fellow Mohs surgeons,
I am sure you all enjoyed an excellent meeting in Las Vegas. We had 942 attendees, a record attendance level, and initial reviews were excellent. Congratulations and thanks go out to the Scientific Program Committee headed by Tanya Humphreys, MD.
As you know, the Mohs College is handing off fellowship accreditation and training to the ACGME in 2013, except for some overseas programs. Our annual Board meeting was productive with an early morning retreat facilitated by Suzanne Olbricht, MD, that concentrated on what role the Mohs College will play in future training of fellows.
Several of these ideas were later approved by the Board of Directors, including establishing a committee to identify fellowship programs that are centers of excellence, establishing a grievance panel for ACGME programs that do not have a sponsoring institution, a non-voting board position for the fellows in training, and establishing a committee to make standardized slide review available to our members. The Board wants to be prepared for blinded independent slide review in case it becomes mandated.
Also at our Board meeting we approved hiring Vicki Hart, RN, MPH of Hart Health Strategies as our lobbyist in Washington D.C. Next weekend Brent Moody, MD and I are meeting with Ms. Hart to explain what Mohs surgery is and to outline our message to congress and other institutions. Our message is, "There is a skin cancer epidemic and we are a cost effective part of the solution."
We also want to alert her to our concerns about the IPAP (Independent Payment Advisory Panel) and to integrate Hart Health Strategies into CapWiz and our new grass roots network, headed by Brent Moody, MD, which we are in the process of rolling out. I encourage all of you to participate, if not as a state leader then individually (visit our Cap Wiz page on the College website at: http://capwiz.com/mohscollege/home/). Recently, the College sent you a poll to determine who you know in Washington D.C. and what possible lobbying influence you may have. If you did not receive the original message with the survey, visit: http://www.surveymonkey.com/s/P5H88VQ to fill it out. Please continue to contribute to your federal representatives and host fund raisers. Difficult times are ahead and we will need every bit of influence we can muster.
Thanks go to our outgoing Board Members, Drs. Andrew Kaufman, Gregg Menaker, Marcy Neuburg, and Duane Whitaker (Immediate Past President) and warm welcome to our new Board Members Drs. Sumaira Aasi, Scott Fosko (Secretary Treasurer), Chris Harmon, and Tri Nguyen.
As you know, I sent an email to all of our members two weeks ago. To reiterate, I urge all of you to use Mohs surgery judiciously on the trunk and extremities. Last week I spoke to The American Society of Mohs Surgery about this very topic and expect to receive some cooperation. Unfortunately, we will all hang together when it comes to overutilization. I am determined to preserve Mohs surgery for our patients who suffer from problem skin cancers.
We have since discovered that the RAC audit denying Mohs surgery is due to a pathology code (8830X) being billed on the same day as Mohs surgery. Apparently, some tissue being sent out for staging was being billed by consulting pathologists on the same day as the Mohs surgery. You should check how your consulting pathologists are dating specimens you send them. You should document in the chart that you did a biopsy, or additional excision, in addition to the Mohs surgery, when you send tissue out for staging or a formalin check of the margins. I've sent a detailed email on this topic to membership on June 30. If you did not receive it, please contact the College Office to have it re-sent to you.
I encourage you all to contribute to SkinPac and to join the AMA, or to renew your membership. The politics of the AMA aside, our CPT and RUC (Relative Value Update Committee) appointments depend on the number of AMA members from our organization.
Our new patient education website of the ACMS is up and running at www.SkinCancerMohsSurgery.org, and you are encouraged to visit it. Aside from linking your own websites to the Mohs College website, you can now also link to this new website, making your and the College's websites more powerful.
Next year our Annual Meeting will be at the Fairmont Hotel in Chicago from Thursday, May 3 - Sunday, May 6, 2012. Please mark your calendars. Deborah MacFarlane, MD is heading up the Scientific Program Committee and we look forward to another excellent program.
As always, I and all of your Board members welcome your ideas and feedback.
Sincerely,
Brett M. Coldiron, MD, FACP
Annual Meeting Recap
If you were unable to attend the 2011 Annual Meeting in Las Vegas, or missed out on a few sessions, here is a recap of what you may have missed:
Nasal Reconstruction: Art & Practice
Dr. Fred Menick described reconstruction of a wide range of nasal defects. He likes to use the forehead as a donor site when repairing nasal defects. He will often allow the defects to granulate one to two weeks prior to placing skin grafts. He also discussed local flaps such as the bilobed flap and the dorsal nasal flap. However his "workhorse flap" for nasal reconstruction is the paramedian forehead flap. For more difficult nasal defects (where mucosa is needed, or substantial cartilage grafting is needed) he advocated the use of the three staged paramedian forehead flap.
Controversies in Mohs Surgery
Does EMR slow down the Mohs surgeon? Should Mohs fellowship training occur in an academic or private practice setting? Is Mohs surgery overutilized? Lively debate ensued following presentation of both sides of the questions mentioned above. After the dust settled, we learned that: EMR is here to stay (and slows us down), there are advantages to training in an academic setting and in a private practice setting, and as long as we continue to train fellows (in either setting), the use of Mohs surgery will continue to increase. Whether it is overutilized or not is for you to decide.
The Tromovitch Award Abstract Session on Thursday afternoon featured a number of fascinating young investigators' research and scholarly activities. The winner of the Tromovitch Award, Todd V. Cartee, MD, presented "Histologic Evaluation of Surgical Margins in Mohs Micrographic Surgery: Quantification of Margin Distance with Each Section of a Mohs Stage and a Survey of Standard Practices among Mohs Surgeons". To view all the accepted abstracts visit: http://www.mohscollege.org/annualmeeting/ and select 2011 Accepted Abstracts from the list.
The Diagnostic Quality Control (DQC) Exam was a big draw this year and proved to be an interesting evaluation for meeting participants. If you were unable to attend the Sunday morning review session, you may access the exam answers at: http://www.mohscollege.org/annualmeeting/ by selecting 2011 DQC Exam Answers from the top of the list.
Fred Mohs, Jr. joined the Annual Meeting on Saturday delivering his keynote address, Remembering Dr. Frederic Mohs, where he shared his first-hand account and personal memories of Dr. Mohs' life and career. If you missed any portions of his speech, you can access it online at: http://www.mohscollege.org/annualmeeting/fredmohsjr.
Photos from the 2011 Annual Meeting are online
Save the Date for 2012
ACMS Happenings
Congratulations to the newly slated ACMS Executive Committee & Board of Directors Members
Secretary/Treasurer:
Scott W. Fosko, MD (2011-2012)
Directors:
Sumaira Z. Aasi, MD (2011-2014)
Christopher B. Harmon, MD (2011-2014)
Tri H. Nguyen, MD (2011-2014)
Congratulations to the following 2011 ACMS Award Winners
Distinguished Service Award
Bruce Deitchman, MD
John K. Geisse, MD
Frederic E. Mohs Award
Randall K. Roenigk, MD
Theodore Tromovitch Award
Todd Cartee, MD
Congratulations to the Newest Fellow Members of the ACMS
Eric A. Adelman, DO
Suleman J. Bangash, DO
Anna A. Bar, MD
R. Sonia Batra, MD
Beatrice Jennifer Berkes, MD
Anand Raja Bhupathy, DO
Samuel Ephraim Book, MD
Anne Chapas, MD
Elbert Chen, MD
Judy Kay Chiang, MD
Steven D. Cronquist, MD
James R. DeBloom, II, MD
Daihung V. Do, MD
Bradley Kent Draper, MD, PhD
Jared S. Friedman, MD
Trephina Helen Galloway, DO
Hayes B. Gladstone, MD
Marc Glashofer, MD
Robert Gerard Goodrich, MD
Juliet L. Gunkel, MD
John G. Hancox, MD, FAAD
Julia Ho, MD
Tamara Housman, MD
Richard P. James, Jr., MD
Evan C. Jones, MD
Andrew L. Kaplan, MD
Malcolm Ke, MD
Christopher Kearney, MD
Amor Khachemoune, MD
Ravi S. Krishnan, MD
David R. Lane, MD
Sherry H. Maragh, MD
Diego E. Marra, MD
Stephen H. Mason, MD
Elena Maydan, MD
Jeffrey K. McKenna, MD
Isaac M. Neuhaus, MD
Sandra C. Paek, MD
Anthony J. Papadopoulos, MD
Sean Pattee, MD
Albert Peng, MD
Michelle Pipitone, MD
William Posten, MD
Liana Proffer, MD
Zheng Qian, MD
Saadia T. Raza, MD
Jennifer L. Reichel, MD
Adam M. Rotunda, MD
Frank C. Saporito, MD
Chrysalyne D. Schmults, MD
Subhadra Shah, MD
Michael Shapiro, MD
Adam T. Sheridan, MBBS, FACD
Jeffrey A. Squires, MD
Jeannine M. Stein, MD
Zeina S. Tannous, MD
Chad Thomas, MD
Payam Tristani-Firouzi, MD
Stacey Tull, MD, MPH
Joy Twersky, MD
Hobart W. Walling, MD, PhD
Anthony G. Yug, MD
Fiona O' Reilly Zwald, MD
Congratulations to the Newest Associate Members of the ACMS
Russell Akin, MD
Imran Amir, MD
Sarah Arron, MD
Maryam M. Asgari, MD
Christian L. Baum, MD
Sandra E. Bendeck, MD
Sanjay Bhambri, DO
Thomas S. Breza, Jr., MD
Mariah R. Brown, MD
Aaron M. Bruce, DO
Tracy M. Campbell, MD
Kyung H. Chang, MD, PhD
Linda C. Chang, MD
Johnathan L. Chappell, MD
Lisa Chipps, MD
Gary Si-Ching Chuang, MD
David H. Ciocon, MD
Nicholas B. Countryman, MD
Christopher V. Crosby, MD, PhD
Jennifer M. Defazio, MD
Keith L. Duffy, MD
Jason D. Givan, MD
Julie A. Gladsjo, MD, PhD
Nicholas J. Golda, MD
Sarah E. Grummer, MD
Todd H. Gunson, MBChB, FRACP, FACD
Allison M. Hanlon, MD, PhD
Keith M. Harrigill, MD
David Thomas Harvey, MD
Michael Hinckley, MD
Syed W. Hussain, MD
Sherrif F. Ibrahim, MD, PhD
Leonid Izikson, MD
Hillary Johnson-Jahangir, MD, PhD
Katherine Kerchner, MD
Misbah H. Khan, MD
Mark Krasny, MD
Philippe Lafaille, MD
Arnold Wu Che Lee, MD, PhD
Kevan G. Lewis, MD
Christine Liang, MD
William E. Love, DO
Rebecca Lu, MD
Jennifer Lucas, MD
Jessica Maddox, MD
Ian A. Maher, MD
Bradley G. Merritt, MD
Missale Mesfin, MD
Daniel Michael, MD, PhD
Rachael L. Moore, MD
Hari Nadiminti, MD
Andrew A. Nelson, MD
David M. Ozog, MD
Anetta Reszko, MD
Carina Rizzo, MD
Rana Rofagha-Sajjadian, MD
Kathleen M. Rossy, MD
Sheldon Sebastian, MD
Joseph F. Sobanko, MD
Brian Somoano, MD
Divya Srivastava, MD
John Starling, III, MD
William G. Stebbins, MD
Earl R. Stoddard, MD
Jamison E. Strahan, MD
Joshua A. Tournas, MD
Wil Tutrone, MD
Daniel I. Wasserman, MD
Christine H. Weinberger, MD
Elliot T. Weiss, MD
Naissan O. Wesley, MD
Joshua B. Wilson, MD
Yang Xia, MD
Michael J. Yablonsky, MD
Deborah Zell, MD
I'm an Associate Member of the College-Now What?
When & How to Apply for Fellow Status of the ACMS
An Associate member of the College in good standing for at least three (3) years is eligible for membership as a Fellow. However, as an Associate member, you can submit your application materials at any time, and the College will hold your application until you are eligible for Fellow membership.
To apply, submit a completed Fellow Membership Application & case log containing 300 cases completed since your fellowship training to the College administrative office at: 555 E Wells Street, Suite 1100 Milwaukee, WI 53202.
Application materials can be found at: http://www.mohscollege.org/acms/membership/joinfellow.php
The deadline for Fellow Membership Applications is August 1st (annually) for review by the Membership Committee. Application review takes place in the winter, and new Fellow members are voted in during the Membership Business Meeting at the College's Annual Meeting.
Highlights from the Literature
Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. NEJM 2011; published online on June 5, 2011.
BRAF is a member of the Raf kinase family, which produces signals from growth factor receptors on the cell surface to the nucleus. The most common mutation in BRAF is BRAF V600E, which is found in 30 to 60% of melanomas. This mutation constitutively activates the MAPK-EFK signal-transduction pathway, which enhances the proliferative and metastatic potential of tumor cells. In a phase I study, use of the selective BRAF V600E kinase inhibitor vemurafenib (PLX4032) was associated with a 69% response rate in melanoma patients whose tumors harbored the BRAF V600E mutation.
Chapman and colleagues conducted a phase 3 randomized clinical trial comparing vemurafenib to dacarbazine in 675 patients with previously untreated stage IIIC or stage IV metastatic melanoma with the BRAF V600E mutation. The patients were randomly assigned to receive either vemurafenib orally twice daily or dacarbazine IV every 3 weeks.
In the vemurafenib group, most patients had a detectable decrease in tumor size, and a median time to response of 1.45 months. 106 of 219 patients had a confirmed objective response, including 2 patients with a complete response and 104 with a partial response. In the dacarbazine group, only 12 of 220 patients met the criteria for a confirmed response (all partial responses), with a median response time of 2.7 months.
The most common adverse events in the vemurafenib group were cutaneous events, arthralgias, and fatigue. Photosensitivity reactions were seen in 12% of patients. In 18% of patients, a cutaneous squamous cell carcinoma, keratoacanthoma, or both developed. This observed cutaneous neoplasia may be due to paradoxical stimulation of MAP-kinase mediated events in wild type BRAF cells. While no other secondary neoplasia was noted in this study, careful surveillance of patients receiving this drug for other cancers is probably warranted.
Ultimately, single agent vemurafenib improved the rates of response, and progression-free and overall survival, as compared with dacarbazine in metastatic melanoma patients with the BRAF V600E mutation. Vemurafenib was associated with a 63% relative reduction in the risk of death, and a 74% relative reduction in the risk of tumor progression as compared with dacarbazine. These findings provide new hope for increased survival–and quality of life–for our patients with metastatic melanoma.
Désirée Ratner, MD
Columbia University Medical Center
Viewpoints with Glenn Goldman, MD
Dr. Glenn Goldman has been a member of the ACMS for 14 years. He is Professor and Chief of dermatology at Fletcher Allen Health Care / University of Vermont College of Medicine. He heads the fellowship program in procedural dermatology and has trained 6 fellows. He also started and was the first program director for the dermatology residency program. Dr. Goldman is a board member of the ACMS and serves on the fellowship training committee. He is a reviewer for multiple journals including Dermatologic Surgery. He served a three-year term for the American Board of Dermatology on the surgical test writing committee. He is the ACMS representative to the RUC committee of the AMA.
1. What sparked your interest in Mohs surgery?
I love geometry and surgery, and I am a visual person. I felt comfortable with dermatology and then really fell in love with tumor removal and repair during my residency with Dr. David Leffell. I realized how creative I could be during my fellowship with Dr. Len Dzubow.
2. Tell us about your current practice.
I am an academic dermatologic surgeon. I do about 700 Mohs cases per year, most of them challenging, and we do all of our own reconstructions with just a few sent to oculoplastics. I have three partners who perform a similar volume each. We also do a fair amount of general dermatologic surgery, laser, fillers etc. I will see anyone who walks in the door if I have an open appointment, so I still have the occasional psoriasis patient on MTX and a few lupus patients on Plaquenil.
3. What do you enjoy most about your practice?
I enjoy challenging Mohs cases and reconstruction. I also feel fortunate to really get to know my patients well during their procedures. I am appreciative of the fact that we are referred the most challenging patients, whom other physicians may not wish to manage. I enjoy being the Chief of dermatology because it gives me the ability to be creative in expanding our unit. When I started we had no residency, no fellowship, and just a small group. There was no Mohs surgeon in Vermont when I got here. We have grown and improved our unit a great deal. I love the education we provide in our practice. I greatly enjoy doing studies, writing papers, presenting at national meetings, and serving on the board. I am writing a large text about flaps with my mentor Len Dzubow, and while this is consuming my life it is a labor of love.
4. What do you enjoy least about your practice?
I dislike red tape imposed by government bureaucrats who do not practice medicine. I actually like our hospital administration and share their pain in complying with an ever changing complex landscape.
5. Clinically, what do you find challenging at this point?
I still find dealing with aggressive tumors to be the most challenging aspect of my job. That and managing transplant patients with many tumors is what I find the most challenging clinically at this point.
6. What challenges do you foresee the Mohs College and its members facing in the future?
Mohs surgery overutilization is a real problem and ACMS members do contribute to this. I think that many of us do a tremendous job treating skin cancer, and we need to make sure that this is recognized, but we need to take the lead in developing appropriateness criteria for Mohs surgery. Our current President, Dr. Coldiron, understands this. We also are facing a situation in which there are potentially too many individuals doing Mohs surgery. Fellowships need to be for the purpose of education, not for revenue generation. If we keep graduating 70 fellows per year and if some institutions continue to train 2 or 3 fellows per year - in addition to ASMS surgeons - there will be a workplace glut of services. I already see this occurring as younger fellow graduates are not finding ideal employment.
7. What advice would you give fellows just starting practice?
Do not focus on money and business. Focus on the art and beauty of dermatologic surgery. Be adventuresome within the appropriate confines of your practice environment. Do not be afraid to take care of challenging patients and difficult cases. However, ask for help and advice early and often. Don't shoulder the burden alone. Be very respectful of your colleagues in ENT and plastic surgery. Their friendship and cooperation will be of great value in your career. I am serious about the money. No one is going to earn what the golden earners earned, and trying and failing will just make you miserable. Accept Medicaid patients. You will get some great cases that way.
8. What do you enjoy doing outside of work (professionally)?
I love to write, and I am writing a major text of flap reconstruction with an enormous number of photos including hundreds of intraoperative photos and many HD videos.
9. What do you enjoy doing outside of work (personally)?
Everything outside: biking, fishing, hiking, boating, landscape design, building rock walls, and rock, hip hop and alternative music.
10. What would people be surprised to know about you?
The only complaint I get from patients is occasionally about my music selection, and I have to remind them that it is not for them . . .
Jeremy S. Bordeaux, MD, MPH
Practice Tips: Advice on Starting your own Practice
Starting a Mohs Practice can be a daunting task. But don't worry–the skills that got you to this point in life will serve you well in establishing a successful Mohs practice. In general, rely on your more experienced colleagues so you aren't reinventing the wheel; set expectations for your staff as high as those you have for yourself; and most importantly, treat your patients as you would want to be treated. These overarching guidelines coupled with the tips below will serve you well in establishing a successful Mohs practice.
Together with Drs. Jeffrey Ellis and Priya Zeikus, young Mohs surgeons who started their own practices soon after completing fellowship, we have developed the following tips and pointers.
- Do not re-invent the wheel. Ask your colleagues for copies of their Mohs manuals and CLIA logs.
- Learn to code very well.
- Train your entire staff well. Take the time early on to make your practice run smoothly and efficiently. Have written checklists for all tasks i.e. drawing lidocaine syringes, applying a pressure bandage, autoclaving instruments, etc.
- Take the time to meet dermatologists and primary care doctors in your area.
- Develop relationships with plastic surgeons, ENTs, oculoplastic surgeons, and surgical oncologists.
- Take excellent care of your patients. They are your best referral source.
- Treat your patients like family and you will soon have a busy office!
- Call your surgical patients to make sure all is well in the evening after surgery.
- If you want to get on insurance plans – start early! Some seem to take months – so the sooner you start, the better.
- Don't be afraid to buy used/refurbished equipment such as cryostats and microscopes. They often come with warranties comparable to those of newer models, and can save you significant money.
- Cross-train multiple staff to cut Mohs sections, since you don't want to be in a bind if your tech is out. Going through a Mohs consulting service, while expensive, can be useful for training your staff to cut tissue and getting your lab ready for CLIA inspection.
- Apply for your CLIA certificate as soon as possible, as this process can be very slow and can take at least 3 months or more to obtain.
- A well organized and user friendly website is important. This valuable resource can be a source for patients to download and complete intake forms, read and prepare for their surgery visit, and obtain wound care instructions. Your website can also be a way for doctors to refer patients directly to you (i.e. downloading referral forms directly off the website).
- Start off your practice with an EMR. CMS has incentives for physicians that e-scribe. You may want to consult with the dermpath company you plan to use, since some of these might consider making a donation towards funding the cost of your EMR.
Monika Srivastava, MD
ACMS Advocacy
Vicki Hart, RN, MPH
This past winter, the ACMS Lobbyist Selection Task Force vetted a number of advocacy specialists to hire and work on behalf of the ACMS. After their review process, the chosen candidate was Vicki Hart, RN, MPH and her company, Hart Health Strategies, located in Washington D.C.
Vicki Hart, the President and Founder of Hart Health Strategies, provides the ACMS with a breadth and depth of knowledge and experience in health care policy, politics and process. Ms. Hart has counseled policy makers, business leaders and association executives for more than twenty years. She is a Registered Nurse and has a Masters in Epidemiology and Public Health.
Prior to establishing the Firm in 2002, Vicki Hart served as a senior lobbyist and policy advisor and headed the health policy practice for the law firm of Verner Liipfert. Her expertise includes knowledge of health care reform, Medicare and Medicaid reimbursement, quality, health information technology, and other health-related issues. She has successfully built coalitions to advance health care priorities, including the establishment of the Alliance of Specialty Medicine.
Before moving to the private sector, Ms. Hart was a Presidential fellow and worked for nearly a decade as a senior health policy advisor for two Senate Majority Leaders. In this high-level position, she provided technical and strategic advice to the Senate Majority Leader, members of the United States Senate and their staff.
Ms. Hart holds B.A. (English) and B.S. (Nursing) degrees from Fairfield University and a Masters in Epidemiology and Public Health from the Yale School of Medicine.
As a company, Hart Health Strategies has been a successful advocate for its clients due to its in-depth understanding of health policy and the legislative process. Each of the individuals comprising the Hart Health Strategies team has worked in key positions on Capitol Hill and understands the legislative process. These professionals have bipartisan, bicameral legislative expertise and also have multi-talented backgrounds in health-related fields.
Ms. Hart and her team at Hart Health Strategies have recently set forth their advocacy initiatives for the ACMS. The key items that they plan to take on are:
- Education: "There is a skin cancer epidemic, and Mohs surgeons are a very cost effective part of the solution, not the problem!"
- Organization: Grassroots political action, CapWiz, survey ACMS membership for political connections. Coordinate with the AAD, Skin Pac to get the word out.
- Lobbying: Get our message out, keep tabs on IPAB. Make sure we get treated fairly.
The ultimate goal for Ms. Hart and her team is to aid in the preservation of the Mohs technique for patients who suffer from problem skin cancers.
To get in touch with Vicki Hart and Hart Health Strategies, contact the ACMS Public Policy Committee, Chaired by Dr. Brent Moody via email at info@mohscollege.org specifying the message is for the Public Policy Committee and Ms. Hart.
News from the Derm RRC
2nd Quarter 2011 News items for Program Directors
- Complete the American Board of Dermatology Summative Evaluation form
- Program requirements for Procedural Dermatology require all Program Directors to complete the Summative Evaluation for fellows at the completion of the fellowship (requirement V.A.2.c))
- The form can be found online at the ABD website:
http://www.abderm.org/ - You must log in at the ABD website, click on the "Current Residents" tab and then under the "Misc." column click on the "EDIT Eval 1" button. Once you have completed the form click "Release to Resident" at the bottom of the last screen and make a hard copy and place in the fellows hard copy file. Site Visitors will need to see these copies at the time of the site visit.
- Submit the Annual Case Log Summary for 2010-2011 Fellows to the ACGME
- Each year Program Directors are required to submit to the ACGME a summary report of the cases entered into the ACGME on-line case log system by their fellows.
- In the past the ACGME would accept a written log but it is now a quick on-line process and must be completed by August 1, 2011.
- To For instructions on how to complete go to:
http://www.acgme.org/residentdatacollection/documentation/2010-2011%20YearEndInstructions_.pdf - Fellows are encouraged to generate a "Full Detail Report" prior to the August 1, 2011 deadline and save to disk for their personal files.
- Enter 2011-2012 Fellows in the ACGME Case Log System
- Program Directors must enter their new fellows into the Case Log system before fellows can begin to enter data on the cases they are performing. To enter your fellows into the system sign on at the address below and complete the pages for entering new fellows.
https://www.acgme.org/residentdatacollection/
- Program Directors must enter their new fellows into the Case Log system before fellows can begin to enter data on the cases they are performing. To enter your fellows into the system sign on at the address below and complete the pages for entering new fellows.
- Updated ACGME On-line Case Log System Goes Live the first week of September 2011.
- After a year of working with the ACGME, a number of improvements to the case log system will become available for all 2011-2012 fellows.
- An important change in the system involves linking procedures performed with a Lesion ID. In other words if multiple lesions are treated on the same patient on a given date then each lesion will be assigned a Lesion ID and each Lesion ID will have its own data entry screen. All procedures performed on a particular lesion are then entered on the data entry screen for that particular Lesion ID. This is an improvement that should provide cleaner data entry.
- In addition case log reports will be formatted to facilitate completion of the summative reports requested by the College and the American Board of Dermatology.
- Instructions on how to use the new system will be available at the go-live but until then all fellows should continue to enter case data into the existing system. Data entered between July 1, 2011 and the implementation of the new system will migrate to the new system so that fellows will receive credit for all case entries for the 2011-2012 academic year.
- Educational program for new program coordinators
- If you are new to the ACGME accreditation process then this educational session is for your staff person in charge of coordinating the ACGME accreditation process for you.
- "The Basics of Accreditation for New Program Coordinators" was created for all program coordinators who need to become savvy managing the all aspects of accreditation from the PIF to the site visit.
- The annual session for Dermatology is scheduled for this October 10th. More details at:
http://www.acgme.org/acWebsite/meetings/me_adminWork.asp
Stan Taylor, MD
Dermatology RRC, Chair
The Occasional Reader
This Summer Become a Pleasure Seeker: Of Reading, That is
Summer has finally arrived in my high mountain valley. June brings a predictable explosion of fluttering lime aspen leaves and pink wild roses; but like the dandelions that show up after three warm days, summer also brings a blossoming of book lists. Perhaps the book publishers know us too well; that with summer's first warm breeze we concoct myths of long vacations, free time, and leisurely reading. These June lists, foisted upon us by every conceivable publication, enumerate the books writers or other famous people are taking to the "Cape" or on safari-usually the hippest recent publications. Although I admit to a certain voyeur-like pleasure when pursuing these book choices, bitter experience has taught me that following this kind of "expert" advice usually results in sleep and guilt–why can't I stay awake when turning the pages of this "must read" book?
Because I have recently finished an English graduate degree, my friends and physician colleagues presume (falsely) that I now possess book selection expertise and have taken to asking, "Do you have suggestions for my vacation reading?" While graduate school did require reading an inordinate number of books, I have grown ambivalent about offering book suggestions. (I do recognize this is a somewhat ironic stance for a book column writer!) But it turns out that while suggesting a "best" book surely relates to our "tastes," it is far more dependent on the "why" of our reading.
Like all physicians, I try to "keep up with the literature." But after over thirty-five years of practicing this discipline it would be a lie of Bernie Madoff proportions to suggest that I derive anything remotely resembling pleasure from the experience. This technical reading bears no resemblance to the unrestrained joy that reading granted me during my growing up years. Then, I was captivated by the stories and adventures of the Three Musketeers, Beau Geste, and the English sea captains, Jack Aubrey and Horatio Hornblower. Growing older I lapped up novels by Dickens, Michener, Hemingway, and even Jane Austen. I am not certain when or where I lost the joy, the ability to lose myself in a story–perhaps it was guillotined somewhere between organic chemistry and gross anatomy. I have, only in my late middle age, realized this grievous error.
Alan Jacobs recently published a wonderful and instructive book, The Pleasures of Reading in an Age of Distraction. He points out that among the many objectives for which we engage books, whim is an important and often overlooked reason to read. By whim Jacobs means for us to read books for the sheer pleasure of it. Reading shouldn't, as is too often the case in my overcommitted and multitasking world, the equivalent of eating greens, a session with your CPA, or a colonoscopy–the kind of reading C. S. Lewis referred to as "social and ethical hygiene." For physicians with limited time, reading for whim means putting down the journals, turning off the cell phone's email dinger, spurning "ought to" lists, and finding a book with an engaging story, a story told with such skill that you are carried away, reading past your bedtime, and becoming cranky when the last page arrives.
So here is my list of summer reading suggestions. These titles have stood the test of multiple readers. Most of them won't be found on any list of the hundred books you ought to read in order to appear hip or the "smartest person in the room" at the next social function. Rather, these books share one characteristic–they are extraordinarily good stories, well told. These were books I couldn't put down, often re-read, and couldn't wait to pass on to my fellow bookie friends–in short, books that gave me a great deal of pleasure simply by reading them. These books derive from a wide diversity of types; I hope at least one of them catches your whimsy and carries you away. If even one of these books forces you to forget Facebook for at least thirty minutes, I will count this column a success. (Feel free, of course, to Facebook me your opinions and choices!)
1) Jayber Crow by Wendell Berry
You may know Berry as an outspoken essayist and speaker but his greatest talents may reside in fiction. This story placed in Port William, Kentucky and told by the town barber combines an easy-going prose with a thought-provoking story. I find some of Berry's essay work pedantic; but his fiction is seductive, even addictive.
2) Spies of Warsaw by Alan Furst
Readers of this column know my love of detective and historical thrillers. Alan Furst is, in my opinion, the master of the latter category. This is a recent (2008) offering and it does not disappoint.
3) The Harry Potter series by J.K. Rowling
I realize the last Potter film is coming out shortly and a few critics feel Rowling's books are for kids. Trust me, you will–if you allow yourself–enjoy reading this series–far more pleasure in the pages than on the screen. Two years ago my wife and I spent six weeks in Hawaii while I filled in for a colleague. We didn't have a TV and knew few people in the Islands. We both read the series–start to finish. She started volume one on the plane over to Honolulu in order to stay one book ahead of me–marital discord arose when she wasn't ready to give up her book. It was a wonderful experience. Hide your reading in a Kindle if you are embarrassed about carrying a "Harry tome" in public, but read Rowling's masterful and wonderfully crafted story.
4) The Madonnas of Leningrad by Debra Dean
This novel, set in World War II during the German siege of Leningrad, combines a fascinating story of war, art, and memory. Although a first novel, this author does a masterful job of weaving the various stories together while writing with a lyrical prose.
5) Gilead by Marilynne Robinson
Although I like to recommend books "off the beaten path," meaning books you may not have heard of, this Pulitzer Prize winning novel continues to get the highest marks from those to whom I have made reading suggestions. The book explores big ideas and tells a great story with a graceful, even poetic, prose. But be forewarned, this is a book that should be read slowly, savored even.
Have a great summer and enjoy your reading for a change.
David P. Clark, MD
ACMS Classifieds
Surgeons
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs in Metro Texas |
| Position Description | We are in search for a fellowship trained Mohs surgeon to join a large group of 11 dermatologists in metro Texas. This well established group has two locations. You will be busy from day one; the group only has one Mohs surgeon! From the start you will be performing two full days of Mohs surgeries which will quickly develop into more of a full time Mohs opportunity. In the beginning there will be some general derm and cosmetics. You will receive 45% of collections with a four month guarantee! Depending on how hard you want to work you should be making in the range of 400K-500K! You will have a standard benefit package (health, CME, Dental, retirement, moving expense). The office for Mohs is 16,500 sq. ft. and the other general derm and admin office is 19K sq. ft. You will have three exam rooms that are large enough and equipped to perform procedures! You will have plenty of support staff with two medical assistants. I can email you the specific details of this great opportunity. Please contact me! Thanks. |
| Position Type | Full Time |
| Position Location | TX |
| Date Job was Posted | 06/14/2011 |
| Contact Information | Keith DeChristina ~ kcdmedical@aol.com ~ 866-523-5627 |
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs Surgeon |
| Position Description | Colt Consulting has been retained to recruit a second Mohs Surgeons by a fast growing, successful and highly respected Dermatology practice with multiple offices in desirable communities. This practice combines the most attractive aspects of private and academic practice, offering a monthly journal club which includes article reviews, clinical pathology conferences and visiting professor lectures. Additionally, the group cultivates a strong collegial environment which encourages the sharing of interesting cases. The group is affiliated with a respected academic institution and is involved in Resident and Physician Assistant training. The ideal candidates will be clinically inquisitive, motivated and able to function both independently and as part of this dynamic team of Dermatologists. The practice strives to work with its doctors to develop their individual clinical interests. The group offers the expertise and state-of-the-art equipment usually found at university health centers. Some of the services include: · Electronic Medical Records · Patient access to scheduling, billing and other services through secure, state-of-the-art interactive website · Active Mohs Surgery program in five locations · PUVA and narrow band UVB program, including total body and hand/foot machines and targeted UVB · Fully equipped aesthetic centers with seven lasers including the Sciton Profractional Laser, Botox and fillers · Digital photography studio · Full-time Dermatopathologist with national reputation (two-headed scope) |
| Position Location | NJ |
| Date Job was Posted | 06/07/2011 |
| Contact Information | Judy Colt 413-369-0030 judy@coltconsulting.com |
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs Surgeon |
| Position Description | Choate Consulting has been retained to recruit an additional Mohs surgeon for a well-established, prestigious and rapidly-growing dermatology practice in northeast Ohio (Greater Cleveland-Akron market). The successful practice was established in 1979, has six locations throughout the market, 13 practitioners, a great support staff, state-of-the-art equipment and the financial stability of a successful and dynamic 30+ year practice. It is the leading dermatology practice in one of the nation's most prestigious medical services markets. The practice offers a highly competitive salary and benefits package, excellent support staff, state-of-the-art equipment, and the stability of a dominant major market practice in a small town suburban setting. There is so much to say about this wonderful opportunity! |
| Position Type | Full Time |
| Position Location | Akron Suburbs- Cleveland Area, OH |
| Date Job was Posted | 05/31/2011 |
| Contact Information | Wendy Brown www.choateconsulting.com wendy@choateconsulting.com 203-987-2424 |
| Position Details | |
| Position Category | Surgeon |
| Position Title | BC / BE Dermatologist with Mohs Certification |
| Position Description | Immediate opening for a BC/BE Dermatologist with Mohs Certification to join a thriving successful practice. Great Opportunity, Competitive base salary, benefits |
| Position Type | Full Time |
| Position Location | South FL |
| Date Job was Posted | 05/31/2011 |
| Contact Information | David Wagener DavidW@admcorp.com 305-623-5595 |
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs Surgeon |
| Position Description | Colorado Springs Health Partners, PC (CSHP) a 100 physician, 22 specialty physician group practice with ten area locations and multiple ancillary services is seeking the following fulltime, board-certified physicians: Mohs Surgeon: Certification in related specialty. Experience preferred, but not required. |
| Position Type | Full Time |
| Position Location | Colorado Springs, CO |
| Date Job was Posted | 05/16/2011 |
| Contact Information | Please send your CV to: Dennis Schneider 2 South Cascade, Suite 140 Colorado Springs, CO 80903 |
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs Surgeon |
| Position Description | Established Mohs practice is seeking an additional Mohs surgeon. |
| Position Type | Full Time |
| Position Location | Arlington, TX |
| Date Job was Posted | 04/18/2011 |
| Contact Information | Aimee Turner, aimee@arlingtonskinsurgery.com, (817) 460-4444 |
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs Surgeon |
| Position Description | Outstanding opportunity for a Mohs surgeon in a busy 5 person general dermatology practice in the northwest suburbs of Chicago near South Barrington. Newly built Mohs lab with about 35-40 patients currently referred monthly. Opportunity to develop skin cancer clinic and referrals. |
| Position Type | Full Time |
| Position Location | Hoffman Estates, IL |
| Date Job was Posted | 04/13/2011 |
| Contact Information | ndermatology@aol.com |
| Position Details | |
| Position Category | Surgeon |
| Position Title | Mohs Surgeon, Part-Time / Locums |
| Position Description | The Dermatology Center of Indiana, PC is seeking a current MOHS Surgery Fellow or Board-Eligible or Board Certified MOHS Surgeon for its practice. The position would consist of 2-3 days per month performing 8-12 MOHS cases per day. The patients initially would be solely from our practice, but could expand to patients from other practices thus generating more cases and days on site performing MOHS Surgery. Our practice would provide all equipment and personnel for the MOHS Surgeon as well as handling all billing for the individual. This is an excellent opportunity for all MOHS Surgeons, but could be especially suited for a fellow working to expand his or her skills as well as generate extra income or for a MOHS Surgeon who wants to continue practicing but at a reduced level. |
| Position Type | Part Time |
| Position Location | Plainfield , IN |
| Date Job was Posted | 04/12/2011 |
| Contact Information | Ask for: Scott T. Guenthner, MD 317-838-9911 (Office) sguenthner@indy.rr.com (Email) |
Histotechs
| Position Details | |
| Position Category | Histotech |
| Position Title | Mohs Histotech |
| Position Description | Derm Recruiting has been retained to recruit a Mohs histotech needed for a busy, fellowship trained Mohs surgeon in Northern Virginia. Responsibilities include tissue preparation, processing, staining, slide review, quality control, and assisting in maintenance of CLIA certification. Other duties may apply. Applicant should be detail oriented, able to multitask, and a team player with the desire to be an integral part of the Mohs surgical team. |
| Position Type | Full Time |
| Position Location | Northern Virginia, VA |
| Date Job was Posted | 06/25/2011 |
| Contact Information | DermRecruiting@gmail.com All resumes are kept confidential. |
| Position Details | |
| Position Category | Histotech |
| Position Title | Mohs Histotech |
| Position Description | Mohs histotech needed for a busy, private practice, fellowship trained Mohs surgeon. Lab hours are Monday -Thursday but full time employment may be accommodated if needed. Responsibilities include tissue preparation, processing, staining, slide review, quality control, and assisting in maintenance of CLIA certification. Other duties may apply. Applicant should be detail oriented, able to multitask, and a team player with the desire to be an integral part of the Mohs unit team. HT certification or educational requirements for a high complexity lab preferred. Willing to train a HT certified individual without prior Mohs experience. |
| Position Location | Williamsburg , VA |
| Date Job was Posted | 06/22/2011 |
| Contact Information | Davia Carrier 757-259-9466 or E-mail to jobs@opderm.net |
| Position Details | |
| Position Category | Histotech |
| Position Title | Histotech for Busy Mohs Practice |
| Position Description | Experienced Histotech wanted for busy Mohs practice. Part time (3-5 hours/day avg.) Monday - Friday. Pay commensurate with experience. |
| Position Type | Part Time |
| Position Location | Thousand Oaks, CA |
| Date Job was Posted | 06/20/2011 |
| Contact Information | Wanda Zack at 805-497-1694 |
| Position Details | |
| Position Category | Histotech |
| Position Title | Mohs Histotech |
| Position Description | Mohs histotech needed PT for one or both offices in Columbia and Havre de Grace, Maryland. Candidate will perform the routine tasks associated with making stained slides from surgically excised tissue for the purpose of diagnosis by a pathologist. Will be responsible for Mohs lab CLIA as well. Willing to train the right candidate. Must be detailed oriented. |
| Position Type | Part Time |
| Position Location | Ellicott City, MD |
| Date Job was Posted | 06/20/2011 |
| Contact Information | Please send resume to dermasc@verizon.net |
| Position Details | |
| Position Category | Histotech |
| Position Description | Performs all basic responsibilities on instruments and completes daily testing and troubleshooting for busy Mohs Surgeon. · Completes and documents quality control testing and preventive maintenance according to CLIA standards. · Performs all competencies and proficiency testing to maintain CLIA standards. · Orders laboratory supplies. · Maintains a clean, organized and safe working environment. · Performs other clinic specific responsibilities as requested or assigned. |
| Position Type | Full Time |
| Position Location | Wauwatosa, WI |
| Date Job was Posted | 06/14/2011 |
| Contact Information | Brian Meuler (414) 298-7108 or BMeuler@columbia-stmarys.org |
| Position Details | |
| Position Category | Histotech |
| Position Title | Mohs Histotech |
| Position Description | Work in beautiful Colorado Springs, Colorado! Provide histotech support to a fellowship trained Mohs Surgeon. Responsibilities include; processing of Mohs frozen sections and general laboratory duties. |
| Position Type | Part Time |
| Position Location | Colorado Springs, CO |
| Date Job was Posted | 06/03/2011 |
| Contact Information | Judi Spurgeon 719 471-1763x120 jspurgeon@csderm.com |
| Position Details | |
| Position Category | Histotech |
| Position Title | Mohs Histotechnologist |
| Position Description | College Park Family Care Center is a busy, growing multi-specialty practice located in the heart of Johnson County, KS. This position can be part or full-time. Clinic Hours are Monday-Thursday 7a-4p. College Park provides a competitive benefits package with a family friendly work environment. Only electronic applications will be accepted. College Park Family Care Center is an Equal Opportunity Employer. |
| Position Type | Full Time |
| Position Location | Overland Park, KS |
| Date Job was Posted | 05/23/2011 |
| Contact Information | For additional information, or to apply, visit our website: www.collegeparkfamilycare.com, or email cknapp@cpfcc.net |
| Position Details | |
| Position Category | Histotech |
| Position Title | Mohs Histotech |
| Position Description | Provides histotechnology support to a fellowship trained Mohs surgeon. This includes accurately preparing and processing histologic specimens for microscopic evaluation and review by the Mohs Surgeon, maintaining appropriate quality controls, and ensuring the lab is in accordance to all standards set forth by OSHA, CLIA and other regulatory agencies. |
| Position Type | Full Time |
| Position Location | Ogden, UT |
| Date Job was Posted | 04/22/2011 |
| Contact Information | Quincy Robinson 801-475-3422 |
American College of Mohs Surgery
555 East Wells Street • Suite 1100
Milwaukee, WI 53202
Phone: (414) 347-1103 Fax: (414) 276-2146
Email: info@mohscollege.org
You have received this message because you have had previous contact with the American College of Mohs Surgery. If you do not wish to be included in our mailing list, please forward this message to info@mohscollege.org. © 2011 American College of Mohs Surgery. No part of this publication may be reproduced without the prior written permission of the ACMS.