Dr. Records has a large dermatology practice in the Sunbelt. He is known as an expert skin cancer doctor and does thousands of body exams every year.

"In July 2008, we were elated to learn that Congress had reversed the 10.6 percent cut in the Medicare conversion factor scheduled for the second half of that year. Even better, Congress added a 1.1 percent increase — in lieu of the mandated 15.1 percent cut — for 2009 in the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). "

The outline of plans to reform healthcare that may be developed under the Obama presidency is beginning to take shape, and while there no doubt will be positive developments for dermatologists, there are also some areas that could cause concern.

Not long ago, a dermatologist from the southwestern United States who works in a busy six-physician practice received a check in the mail from the Center for Medicare and Medicaid Services (CMS). It was his share of more than $36 million in bonus payments made by CMS for satisfactorily reporting quality information under the 2007 Physician Quality Reporting Initiative (PQRI).

Dr. Head, a prominent dermatologist, has five years of experience using botulinum toxin injections for the treatment of migraine headaches. He knows that botulinum toxin injections are approved for the treatment of hyperhidrosis and hyperkinetic glabellar lines, but he also is very comfortable treating a variety of wrinkles and headaches with these injections.

Dr. Job is a hard-working dermatologist practicing in a city hard hit by the downturn in the economy. Overhead is up, and revenues are down. He is left with no choice but to start terminating some employees.

Early in September, a group of dermatologists descended on Capitol Hill, where they met with members of Congress to discuss their concerns and priorities and sought to increase awareness among lawmakers of the importance of dermatology to their constituents.

National standards for ranking physicians may be on the horizon, but many dermatologists doubt that they can be implemented fairly and accurately. Insurance companies have proposed ranking physicians in tiers that could be used to determine levels of reimbursement or the amount of co-pays for patients to see the physician of their choosing.

Although the 5.4 percent Medicare pay cut for 2009 that had been slated by the Centers for Medicare & Medicaid Services (CMS) has been averted, the challenge to reform the system that determines physician payments will be dumped in the lap of the new 111th Congress that takes office in January.