Fighting for patient access

By Allison Evans, Assistant Managing Editor, February 1, 2026

There is no elephant in the room. Medicare physician payment and scope of practice are perennial problems that can have a direct impact on the practice of dermatology, and dermatologists have been and are continuing to speak loudly about these issues.

“I first became involved in advocacy as a medical student,” said Sandra Marchese Johnson, MD, FAAD, chair of the Academy’s Grassroots Advocacy Task Force. “Dr. Bob Brodell was my dermatology advisor and mentor (and now friend), and he was very involved in advocacy, particularly with the American Cancer Society. When I was first shadowing him, he invited me to participate in the American Cancer Society’s Relay for Life. I ended up walking for an entire 24 hours and became hooked.”

Rachel L. Kyllo, MD, FAAD, FACMS, recipient of the Academy’s 2025 Advocate of the Year Award, was also inspired to get involved from her fellowship director. “Dr. Murad Alam is an incredible example of a selfless, dedicated physician advocate. His involvement with advocacy work during my fellowship inspired me to get more involved.”

After graduation, Dr. Kyllo started a private practice with her husband, who is a general dermatologist. “Starting and running our practice really solidified my interest in physician advocacy because I saw firsthand how the deck is stacked against independent practices.”

The persistent decline in the Medicare physician fee schedule and burdensome, ineffective regulations like MIPS are forcing practices to close and stealing the joy from the practice of medicine, she emphasized. “My advocacy work is driven by a desire to protect the future of independent practice and ensure that patients continue to have access to high-quality, physician-led care.”

Medicare physician payment reform

The AADA has tirelessly been advocating for Medicare payment reform — its sole congressional priority since 2024. While the 2026 Medicare Physician Fee Schedule included a 3.32% increase in payment rates for 2026, this is still not enough to keep up with increasing costs and inflation, and other policies included in the rule will reduce physician payment in future years. The AADA remains fully committed to securing meaningful Medicare physician payment reform that will meet the needs of the dermatology community and will continue to call on Congress to enact legislation that provides an inflation-based update and fixes the structural flaws in the Medicare payment system.

Why does grassroots advocacy matter?

Congress needs to hear directly from physicians about the impact of Medicare cuts on their practices, and grassroots advocacy is the way to do it, said Hannah Calvert, the AADA’s senior specialist of advocacy engagement. “Grassroots advocacy gives AADA members a direct line to their members of Congress, whether via emails or personal relationships developed through in-person meetings.”

Some members have done a great job of developing relationships with their legislators, said Liz Demorest, the AADA’s associate director of political engagement. “We have dermatologists who are on their legislator’s health advisory committees to give direct input on congressional policy. Often these dermatologists can meet with or even text their member of Congress, and the member of Congress will sign on to a bill we’re supporting the next day.”

“Grassroots advocacy gives AADA members a direct line to their members of Congress, whether via emails or personal relationships developed through in-person meetings.”

State advocacy engagement

For Dr. Marchese Johnson, grassroots advocacy has become a family pastime. “My brother-in-law, his wife, my husband, and I are all physicians, and we regularly discuss health care and health care delivery issues, including prior authorization. My brother-in-law helped pass the ‘Gold Card Bill’ (Act 575), which helped ease the burden of prior authorizations in Arkansas.”

The bill, passed in 2023, exempts Arkansas physicians from most other prior authorization requirements, provided they have maintained at least a 90% approval rate for prior authorization requests over the last 12 months. The legislation rewards sound medical judgment, allowing physicians to deliver care more effectively and avoid treatment delays.

Dr. Kyllo, a member of the Academy’s Advisory Board and of the SkinPAC Board of Advisors, attends her state medical society’s legislative event every year. “Being involved at the state level is very important. Missouri has been able to successfully thwart scope of practice expansion efforts from NPs, PAs, pharmacists, and optometrists for the past few years. Much of that success has been due to personal relationships between physicians and their legislators, and the fact that we have two physicians serving in the state legislature — one of whom is a dermatologist (State House Rep. George Hruza, MD, FAAD)!”

Additionally, in February 2025, the Indiana Senate Health and Provider Services Committee considered a bill that would have allowed pharmacists to diagnose and treat skin conditions.

“Forty AADA members contacted their state senators to advocate against this legislation in response to our grassroots advocacy alert, and it ultimately did not pass,” Calvert said.

Setting yourself up for success

“Our members’ grassroots advocacy efforts are a critical component of the AADA’s overall advocacy strategy,” said Demorest. “They amplify and reinforce the work of our experienced federal and state advocacy staff as well as our political action committee, SkinPAC.”

“Everyone has skin. Everyone knows about the importance of skin — even politicians and their teams,” Dr. Marchese Johnson added.

For dermatologists looking to appeal to legislators, be sure to include how the issue affects patients. It is so important to have clearly defined, attainable goals that a lot of people can support and rally behind, said Dr. Marchese Johnson. “Get to know all the players involved with those issues — your supporters and your non-supporters — and be ready to tell a good story for why your cause is important.”

Additionally, “knowing people in power who understand the issues is very helpful as well as having data to support your cause,” she added. “Be visible! Attend community events; get involved locally and nationally; know your local representatives and their teams.”

Dr. Marchese Johnson drew upon the concept of the emotional bank account introduced by Stephen R. Covey in The Seven Habits of Highly Effective People. “As Stephen Covey says, you need more emotional deposits than withdraws. I try to deposit at least several times before asking anything from anyone — especially a politician who is used to having people ask for favors all the time.” To help make some of those deposits and build trust, Dr. Marchese Johnson regularly attends events and donates to the campaigns of her congressional delegation.

“If you're able to take time away from your practice, attending the AADA’s Legislative Conference or a state advocacy day is a great way to get a taste for advocacy work and start developing relationships with your legislators,” Dr. Kyllo said. “Having personal relationships with your legislators is one of the best ways to make a difference and influence policymaking.”

While Dr. Marchese Johnson has had her share of advocacy success stories, she emphasized that being successful takes time — much like raising a child. “You spend years shepherding an infant, toddler, then kid through life, and the magic comes in the many years of dedication and devotion of raising that child to become a successful adult.”

Advocacy is similar. “Deciding to reform Medicare and learning how to do it is exciting, but it takes a village and, unfortunately, is taking many years and much effort to make real change,” she added.

Take action

Dr. Marchese Johnson recommends finding a friend or mentor because, “it’s more fun to advocate with a friend. The Academy will gladly find you a mentor.”

If you are a joiner, volunteer to be on an Academy council, committee, or task force. There are several that focus on advocacy, including congressional policy, grassroots advocacy, SkinPAC, coding & reimbursement, practice management, patient access, and more.

Members who want to get involved in grassroots advocacy can sign up for the AADA’s Advocacy Key Contacts program, noted Calvert. AADA Advocacy Key Contacts are grassroots advocates who develop and maintain personal relationships with their elected officials to tell the story of how health care policies impact patients and physicians every day. Advocacy key contacts receive resources and support from AADA staff. As of 2025, 62 AAD members are signed up to be Key Contacts.

From there, members can set up in-district meetings with their legislators, attend the AADA’s Legislative Conference in Washington, D.C., host a practice visit with their members of Congress or their district staff, and more, Calvert continued. In 2025, five Academy members met with their members of Congress through a practice visit or in-district meeting.

An easy first step to get involved is to visit the AADA’s Advocacy Action Center, said Calvert. Members can send a pre-written message to their members of Congress or use instructions and talking points to call their offices urging them to reform Medicare physician payment. In 2025, nearly 2,500 dermatologists called and emailed their representatives and senators urging them to stop the cuts to Medicare physician payments and prioritize long-term reform.

While long-term Medicare payment reform is the AADA’s sole federal congressional priority, there was also an action alert last year to urge Congress to streamline the sunscreen ingredient review process (the SAFE Sunscreen Standards Act), which passed thanks to the AADA’s advocacy efforts in 2025.

“Everyone should be able to find two minutes to contact Congress using the AADA action alerts,” Dr. Marchese Johnson said.

Picking up the phone or sending a personalized email to your legislator is even more impactful, Dr. Kyllo said. “Having a personal relationship with your legislator increases the impact of those phone calls and emails. Building those relationships over time by attending campaign events or making campaign contributions to your legislators is a great way to maximize your influence.”

Reach out to AADA staff for help with talking points or organizing meetings or practice visits with legislators locally at grassroots@aad.org.

“Contribute to SkinPAC, a bipartisan political action committee that provides political contributions to federal legislators who demonstrate understanding of and interest in the views and goals of dermatology and our advocacy agenda,” Dr. Marchese Johnson suggested.

AADA staff are here to provide tools to help members make an initial connection with their members of Congress, so that they can continue building a relationship, Calvert said. “We offer a tipsheet on hosting a practice visit or attending an in-district meeting with legislators and can share current talking points on priority legislation as well as background information on the member of Congress to help ensure visits and meetings are successful.”

“The best advocates for dermatology and the issues we care about are dermatologists,” Dr. Kyllo said. “No one is going to do this work for us. If we don’t consistently show up and speak up about our issues, other people who do not understand our specialty will shape the policies that determine how we practice and whether our patients can access the care that they need.”

The political purpose of American Academy of Dermatology Association Political Action Committee (“SkinPAC”) is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for federal elective office, and other federal political committees, who demonstrate understanding and interest in the views and goals of the American Academy of Dermatology Association.

Contributions to SkinPAC are not deductible for federal income tax purposes. Contributions to SkinPAC must be made from your own personal funds and may not be reimbursed. SkinPAC cannot accept contributions from corporate accounts. Any recommended contribution amount is merely a suggestion. All AADA members have the right to contribute more or less, or refuse to contribute without reprisal. Federal law prohibits us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.

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