Falling reimbursement is no longer a background administrative complaint in dermatology — it is actively restructuring how the specialty operates. That is the central message of a new AJMC interview with Jane Grant-Kels, MD, FAAD, a past president of the American Academy of Dermatology and longtime voice on practice-economics issues facing dermatologists.

Grant-Kels frames the problem in direct terms: payers continue to chip away at what dermatologists are paid for both medical and surgical services, and the cumulative effect of that erosion now shapes decisions that clinicians once made on clinical grounds alone. The title of the piece states her thesis plainly — reimbursement erosion is reshaping dermatology.

For a specialty that straddles medicine, surgery, and aesthetics, the payment squeeze lands unevenly. Dermatologists manage chronic inflammatory disease, perform skin-cancer surgery and screenings, and increasingly compete with non-physician providers and direct-to-consumer platforms for visits. Each of those revenue streams responds differently to reimbursement pressure. Medical dermatology visits — the management of psoriasis, atopic dermatitis, acne, and skin-cancer surveillance — depend heavily on payer rates, because the encounter-based evaluation-and-management codes that carry most of that work have seen their real value decline year after year through failure to keep pace with practice-cost inflation.

Grant-Kels's commentary arrives at a moment when dermatology practices are weighing consolidation, private-equity affiliation, and shifts toward cash-pay aesthetics as hedges against declining insurer payment. Her observation that erosion is "reshaping" the specialty suggests the consequences go beyond tightening margins: they alter access, practice composition, and possibly which patients get seen and how quickly.

The interview sits within a broader payer-policy conversation AJMC has been tracking across specialties — how insurer utilization management, site-of-service payment differentials, and downward code-value drift change physician behavior in ways regulators did not explicitly intend. Dermatology's experience is a useful case study because the specialty combines high-volume, low-acuity visits with high-stakes procedural work such as melanoma diagnosis and excision, where delays carry clinical consequences.

Practice leaders reading Grant-Kels's account will recognize the operational levers at stake: coding accuracy, payer-mix management, prior-authorization burden, and the decision of whether to participate in payer networks at rates that may not cover the cost of delivering complex medical dermatology. When reimbursement for a skin examination or a surgical excision falls below the cost of providing it, practices rationally respond — by shortening visit times, redirecting effort toward non-covered services, or exiting contracts entirely. Each response carries an access implication for patients with medically necessary dermatologic disease.

The American Academy of Dermatology, which Grant-Kels has led as president, has repeatedly pressed regulators and payers on the gap between dermatology's documented value in skin-cancer early detection and chronic-disease management and the payment rates the specialty actually receives. Her continued public commentary signals that the academy's economics agenda remains active rather than resolved.

For dermatologists in both academic and private settings, the practical takeaway is that practice economics now demand the same attention as clinical protocols. Reimbursement trajectory, payer contracting, and service-mix strategy will determine which practice models remain viable over the next decade — and, by extension, where patients with psoriasis, eczema, and skin cancer can find timely specialist care. How payers and regulators respond to warnings like Grant-Kels's will shape the specialty's structure for years to come.