What is the carbon footprint of the typical outpatient dermatology practice?
Clinical Applications
By Kathryn Schwarzenberger, MD, FAAD, April 1, 2025
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Misha Rosenbach, MD, FAAD, and Genevieve Silva, BS, about their JAMA Dermatology paper, ‘Carbon Footprint Analysis of an Outpatient Dermatology Practice at an Academic Medical Center.’
DermWorld: Your study assessed the quantity of annual greenhouse gas emissions from an outpatient dermatology practice and compared relative sources of emissions. What prompted you to study this subject?
DermWorld: For those who haven’t read your paper, how did you go about quantifying greenhouse gas emissions and how did you determine the sources of emissions?
DermWorld: What were your findings?
Dr. Rosenbach and Silva: We found that more than half of the greenhouse gas emissions from clinic operations over the course of a year were from Scope 3 (e.g., resource consumption, waste, and travel), which is a finding shared with most other carbon footprint analyses across health care systems and settings. Purchased energy — steam, electricity, and chilled water — also contributed a sizeable amount to emissions from the clinic.
These findings highlighted some low-hanging fruit that our health system is currently addressing. Penn has recently transitioned to primarily sourcing renewable energy at the clinic site, which will reduce Scope 2 emissions. We also have several pilot projects underway targeting sources of Scope 3 emissions. For example, one project aims to educate staff and reduce overutilization of regulated medical waste (“red bag waste”) bins, which leads to more emissions-intensive and costly waste processing.
The main finding, honestly, for readers, is — this is complicated, but there are real changes to be made at the department or clinic level that can reduce environmental impact. Of course, optimizing system-level energy purchasing and building infrastructure is critical, but there are many other pieces to the puzzle. A very nice accompanying editorial to our piece also encouraged the health care sector to partner with sustainability experts and take a broad lens that includes non-greenhouse gas environmental impacts (e.g., via life cycle assessment) to best understand the complex impacts of what we do, and use, in the practice of medicine.
DermWorld: What specific strategies or interventions would you recommend that target the largest contributors of Scope 3 emissions?
Dr. Rosenbach and Silva: The supply chain is a significant Scope 3 emissions contributor, which comes down to health care procurement decisions when purchasing goods and services. Tools (e.g., CHARME, MEPA, Practice Greenhealth) and frameworks exist to guide departments looking to practice environmentally preferred purchasing (buying from environmentally responsible vendors). This also raises an opportunity for advocacy, with clinicians, specialty groups, and group purchasing organizations demanding less wasteful packaging, shipping, and manufacturing practices, along with more sustainable regulations dictating use of those resources.
Looking downstream, it’s also important to practice responsible waste stewardship, especially as it pertains to proper waste stream segregation that avoids overusing regulated medical waste bins. Diminishing reliance on single-use disposable items can also reduce total waste volume. To target waste from staff and patient commuting, departments can consider ways to support lower-impact modes of transit (vs. gas-burning single-passenger vehicles), optimize telehealth utilization, and prioritize local conference attendance.
DermWorld: How can the findings and recommendations from this study be scaled to inform emissions-reduction strategies across other dermatology practices or outpatient settings?
Dr. Rosenbach and Silva: There have been several recent publications around “low-hanging fruit” and “10 things dermatologists can do right now,” which highlight actionable items for dermatology clinics. Plus, the AAD has partnered with MyGreenDoctor as a member benefit, which provides various “shovel-ready” projects that dermatologists can adopt for their practices. These resources help to identify some of the easier targets for practices (e.g., shift to renewable sources of energy, reduce unnecessary waste), but we have a lot more work to do.
Scaling the interventions listed in the above section, such as promoting adoption of greener procurement practices and decarbonizing supplier practices, could involve collective advocacy efforts. For example, a biologic that requires shipping in Styrofoam packaging with dry ice likely has a larger climate impact than a pill delivered in the mail — are there opportunities to encourage pharmaceutical companies to innovate around lower-footprint shipping? Reducing resource utilization may require dedicated attention to clinical operations to identify areas of inefficient supply use in protocolized steps (e.g., procedure setup) that could be streamlined and then standardized.
DermWorld: What role could health care policies or regulations play in reducing Scope 3 emissions?
Dr. Rosenbach and Silva: Well, when you buy food in the store, it’s labeled, so you can understand what you’re doing. If you’re trying to eat healthier, maybe you avoid something with high saturated fat, or if you’d like to avoid highly processed food, you review the ingredient list. In the practice of medicine, we don’t have ready access to the information we need to make environmentally conscious decisions about a lot of our practice and prescribing.
When deciding about what to prescribe, we usually consider the safety and efficacy of the treatment, plus its ease-of-use, tolerability, monitoring requirements, side effects, and cost. No one is arguing that we should put consideration of environmental impact above those factors, but there are likely opportunities to maximize environmental sustainability without making any sacrifices around clinical efficacy or safety. To make such decisions, we need public, accessible data about the environmental impact of what we use.
There are also a lot of regulations within health care that are — rightfully so — designed to minimize risks of infection or contamination. However, some of these policies are impractical and lead to resource waste without demonstrably preventing harm. For example, health system regulations require that vials of lidocaine be single-patient use, leading to countless mostly full vials of medication discarded per day. This represents an opportunity for physicians to advocate for policy shifts that are more aligned with reasonable resource consumption.
Misha Rosenbach, MD, FAAD, is an associate professor of dermatology and internal medicine at the Perelman School of Medicine at the University of Pennsylvania.
Genevieve Silva, BS, is a first-year medical student at the Perelman School of Medicine.
The authors do not have any relevant financial and/or commercial conflicts of interest.
Their paper appeared in JAMA Dermatology, and was selected as an Editor’s Choice article.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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