Skincare in the outback: Primary clinics in Australia raise concerns

Key Points

International report - Skin cancer is the most common cancer in Australia treated by general practitioners (GPs), with more than 800,000 patients seen a year.

Due to the sharp rise in skin cancers in Australia, there has been an emergence of skin cancer clinics that are mainly staffed by GPs and other nonspecialists. As these clinics are still part of the primary care sector, patients do not require a referral for treatment.

According to one expert, there is some concern regarding the adequate training of these physicians in skin cancer medicine, and the new training programs that are beginning to appear could not have been started too soon.

"Traditionally, in Australia, the way that skin cancers have been treated is that a patient goes to a GP - the first port of call for the majority of patients - and then would be referred to a specialist if the GP did not feel able to properly manage the lesion.

"For patients to get reimbursed in our national health insurance system, the referral from a specialist has to come by a GP," says Deborah Askew, Ph.D., of the discipline of general practice, faculty of health sciences, University of Queensland, Herston, Queensland, Australia.

According to Dr. Askew, these clinics have not only emerged due to the alarming increase in frequency of nonmelanoma skin cancers, but also because of the financial gain of the doctors working in the clinic system.

Dr. Askew says there is a general assumption that the patients visiting these clinics with their skin cancer lesions would be receiving higher- quality care.

The problem is that, since these clinics have sprouted up across the country, there were no additional or specialized dedicated training programs available for GPs or primary care physicians who want to work in the skin cancer clinics, at least not until very recently.

"Only until very recently, there have been very limited opportunities to acquire any additional training in primary care skin cancer medicine," Dr. Askew says.

Training now offered

In recent times, a variety of different training programs geared to training these GPs and nonspecialists in better diagnosing and treating skin cancers have been established.

For example, the University of Queensland has now begun a part-time, year-long master's level program for GPs and nonspecialists who can return to complete post-graduate studies in primary care skin cancer medicine, as well as a variety of certificate courses to help sharpen their skills in skin cancer medicine.

"Many dermatologists have expressed concern in the quality care that skin cancer patients receive from the nonspecialists. One of the primary concerns of dermatologists and plastic surgeons is the perception of these clinics in the eyes of the public, because the public perceives these clinics as specialist care, which is clearly not the case.

"The physicians working in these clinics advertise that they specialize in skin cancer medicine, which may, at first, give a false sense of security to the unwary prospective patient seeking help," Dr. Askew tells Dermatology Times.

Only during the last couple of years have GPs and these nonspecialist physicians been able to access newly offered training programs to help them better take care of the patients they treat.

Dr. Askew says that previously, doctors working in these clinics had neither special skin cancer training nor any method of accreditation, nor were there any safety or quality standards in place to critically control such clinics.

"There is a shift in thought, and important long-needed dialogue happening between providers of primary care skin cancer and dermatologists, reflected in the dawn of the much-needed appropriate training provided to primary care physicians who see skin cancer patients," Dr. Askew says.