Remember the "Seinfeld" episode in which Kramer presents himself as a Juilliard-trained dermatologist in order to get a photo of George's new boss with his shirt off? Most fans of the show have seen this funny episode at least once, and maybe several times thanks to syndication. The dermatology specialty is roasted pretty thoroughly in this particular installment of the series, capped off by Jerry exclaiming to his dermatologist date, "You call yourself a lifesaver. I call you pimple popper M.D.!" While these jokes make for hilarious television, they certainly do'?t present an accurate depiction of the dermatology profession. This article takes a look at the real-life experiences of dermatologists, as well as what it's like to sell to this group of specialists.

A serious specialty

According to the Evanston, IL-based American Board of Medical Specialties, the umbrella organization for the 24 approved medical specialties in the United States, roughly 10,000 board-certified dermatologists are practicing in the United States today. Although most of us think solely of skin when we think of dermatology, these specialty physicians have been trained to evaluate and treat disorders of the skin, hair, nails and adjacent mucous membranes. Most dermatologists treat both adults and children, while some choose to subspecialize in pediatric dermatology, which focuses on evaluating and treating the various dermatological diseases that occur predominantly in infants, children and adolescents. Physicians who seek to become board-certified in dermatology must first complete four years of residency training, three years of which consist of full-time training in an accredited dermatology residency training program. Additionally, at least 75% of the resident's time throughout each year must be devoted to the direct care of patients. According to the American Academy of Dermatology, based in Schaumburg, IL, specialty training for dermatologists includes experience with the following:

* The diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin.
* The management of contact dermatitis and other inflammatory skin disorders.
* The recognition of the skin manifestations of systemic and infectious diseases.
* Dermatopathology, or the study of the microscopic appearance of diseased skin tissue.
* Surgical techniques used in dermatology.

Dermatologists also have expertise in the management of cosmetic disorders of the skin, such as hair loss and scars, and the skin changes associated with aging. Problems they treat include everything from wrinkles and warts to acne and skin cancer. Skin diseases are relatively common, accounting for about 15% of all illnesses. In fact, industry experts agree that there are not enough dermatologists practicing today to meet patient demand.

For many instances of skin disease, physicians can neither identify a cause nor provide a permanent cure. This is true for many cases of psoriasis and eczema, two of the most common skin conditions. When a cure is not possible, dermatologists focus on minimizing symptoms and improving the patient's comfort and quality of life through a variety of therapeutic approaches, including topical and systemic medications, surgery, and the destruction of unwanted growths by freezing, burning, lasers and radiation.

Dermatologists also diagnose and treat a number of far more serious skin conditions. Skin cancer, one of the more common forms of cancer, is a life-threatening disease that dermatologists diagnose and treat. Basal cell carcinoma, a skin tumor that usually occurs on the face or neck, is the most frequently occurring form of skin cancer, with an annual incidence of about 150 cases per 100,000 people. Unless it's caught and properly treated, the growth can spread to invade surrounding tissues. Treatment of malignant skin tumors involves surgical excision of the tumor or destruction of the tumor by radiation therapy, which usually provides a complete cure. New tumors can develop in people who fail to take the recommended preventive measures, most notably avoiding exposure to sunlight. Another type of malignant skin tumor dermatologists manage is Kaposi's sarcoma, a prominent feature of AIDS. For mild cases, low-dose radiation therapy is usually effective, but anticancer drugs may be necessary to slow the spread of the tumors in more severe cases.

Selling to dermatologists

In pharmaceutical selling, as in any other profession, quality-of-life factors can serve to make the job more enjoyable on a day-to-day basis. After interviewing several dermatology reps and riding along during sales calls with dermatologists, we've found that selling to dermatologists provides many favorable experiences that may not typically come along with selling to primary care or other specialties that boast large numbers of physicians. Here are a few of the most compelling advantages of selling to dermatologists:

Access to target physicians. Call lists from the home office are a great tool to help you direct your time and effort in the field. What's not so great, however, is when a large portion of the doctors on your target list turn out to be "no see" docs. Stopping at these offices month after month to satisfy your call requirements can be boring, frustrating and unproductive. While there are certainly dermatologists who choose not to see sales representatives, the majority of physicians in this specialty welcome the opportunity to speak with sales representatives on a regular basis -- allowing, of course, for the chance emergency or overbooked afternoon that can come up in any specialty. An opportunity to discuss the benefits of his product is really all any salesperson wants. In most dermatology offices, you can see the doctor, promote your product and have a reasonable expectation of gaining some business.

Dermatology offices are not overrun with reps. Primary care physicians will always attract more attention from the pharmaceutical industry, simply because they treat large numbers of patients and a wide range of disease states. As a result, more and more pharmaceutical representatives are vying for the attention and prescriptions of these doctors, to the point where primary care reps often find themselves in waiting rooms filled with more reps than patients. Because of the small number of dermatologists across the country, most offices are busy with patients; however, they are not as busy with pharmaceutical representatives. Dermatology is known as one of the more rep-friendly specialties, and most pharmaceutical companies dedicated to dermatology have come to recognize that a sales force size of 50 to 100 representatives is sufficient to adequately cover the specialty.

Your results are your own.Because the typical pharmaceutical sales force calling on dermatologists is significantly smaller than what would be necessary to cover all of primary care, there is little chance that the sales force will be organized in a team or "pod" structure. The results produced -- or not produced -- in your territory are a direct reflection on you and your efforts. There are no teammates to fall back on or to hold accountable for not fulfilling their duties. This situation may be especially appealing to reps with an entrepreneurial spirit, as it allows for maximum ownership and decision-making authority within one's own territory.

Everyone knows you, and you know them, too. The small number of companies dedicated to research and development in dermatology, coupled with the small size of their sales forces, provides dermatology reps with a larger share of voice in the market and a higher percentage of one-on-one time with their customers. This environment breeds a sense of togetherness and familiarity that is uncommon in the primary care area. Similarly, the company culture tends to be close-knit. Since dermatology companies and dermatology divisions of larger organizations are usually small, it is not uncommon for the president of the company or division to know each sales rep, where he's from and what his interests are. While this type of company culture may not be ideal for everyone, many sales reps appreciate a work environment where phone calls are taken and projects are assigned quickly because the decision makers have a personal connection to all parties involved.

Now back to that "Seinfeld" episode ...

Toward the end of the show, Jerry (at George's urging, of course) decides to take the dermatologist on a "revenge date." Instead of an opportunity to get back at his date for exaggerating the importance of her profession, the evening becomes an eye-opening experience for Jerry. In the middle of the date, one of the doctor's patients walks up to the table to thank her for saving his life. As it turns out, the patient is a skin cancer survivor, thanks to her diagnosis and treatment. Just as Jerry came to realize the seriousness of dermatology, we hope this article has provided you with an appreciation of the training, expertise and experience of dermatologists, and provided some insight into what it might be like to sell to this serious specialty with a human touch.