From the desk of the EMD: Will allergists become extinct?

June 3, 2019

I have had a great career in allergy. It would not surprise me if just about every board-certified allergist in their sixties and seventies would agree that it has been a very rewarding field, both in terms of helping patients and financially. But what about the newly-minted allergists just starting their profession, or allergists in the middle of their careers – will they be able to say the same thing when they near retirement?

As Executive Medical Director of the College, one of the most common emails I get from members has to do with the increased remote practice of allergy in their geographic area by persons not properly trained or board certified in allergy. They want to know what the College can do about their situation. When I tell them that there is little that can legally be done to prohibit such practices, I know they are concerned and ask, “Why did I do an allergy/immunology fellowship and continue to do MOC if any MD, NP, PA, or nurse can do what I am doing?” Fortunately, there is much that can be done to promote the expertise of allergists and encourage patients to seek advice from physicians who have been properly trained, had completed allergy fellowships and obtained board certification in allergy.

We are seeing more bills reach Congress and state legislatures that threaten physicians’ scope of practice. HR 2009 has recently been introduced in the U.S. House. This bill is the Removing Barriers to Allergy Diagnostic Testing Act of 2019. It is “to amend titles XVIII and XIX of the Social Security Act to provide equal coverage of in vitro specific IgE tests and percutaneous tests for allergies under the Medicare and Medicaid programs, and for other purposes.” On first look, this doesn’t sound like a big deal. The bill states “In vitro specific IgE tests and percutaneous tests must be equally accessible for clinicians and patients to improve health outcomes, reduce system costs, and reduce current health care disparities caused by the lack of equal coverage.” As allergists, we know that a positive skin test or blood test for allergies only means sensitization. It may not mean true allergy. The results must be interpreted in light of history to determine if they are clinically relevant. If it passes, this bill may increase use of in vitro tests by non-allergists, which may mislabel more and more patients with inhalant and food allergies. ACAAI’s Advocacy Council is working with other professional and lay organizations to stop this bill from becoming law.

Direct-to-consumer allergy testing is increasing. While watching CNN recently, I saw a commercial for measuring IgG sensitivity to 96 different foods for $159. Their YouTube video has been viewed over 124,000 times. While we are not aware of any credible scientific data validating this test, it is indicative of an ever-increasing trend toward self-management of allergies. It is estimated that the allergy diagnostics market will continue to grow and be worth $3.8 billion by 2024.

Are allergists doomed to extinction like the dodo bird? No, I don’t believe so, if we act now. One approach is to get the word out on what you do best as a board-certified allergist and to promote your practice through the media. We can’t rest on our laurels (and immunotherapy for allergic rhinitis). Others, without our expertise and training, seek to encroach on our specialty. We need to underscore our expertise, especially to grow our specialty in areas that other health care providers aren’t trained in or aren’t interested in touching.

Here are some ideas:

  • Marketing yourself as the food allergy specialist and setting up food allergy centers now is one approach.
  • Being more involved in drug allergy by working with hospitals in your area to evaluate and desensitize their patients.
  • Becoming the go-to physicians for severe asthma, severe atopic dermatitis, and chronic rhinosinusitis.
  • Embracing telemedicine to expand your practice.
  • Marketing your practice on social media and having a user-friendly website.
  • Delivering quality care and service. It is estimated that if one patient is satisfied, their opinion reaches four new patients, but if one patient is dissatisfied, it reaches 10 other potential new patients. 
  • Use the College’s Marketing and Patient Materials Toolkit. Download the resources, customize with your practice information and distribute them to your patients, community and the media.

You may have some ideas that I have not mentioned. Send them to me to promote to College membership. The College will fight for the community allergist and take every step possible to protect our specialty.

Michael Blaiss, MD, FACAAI, Executive Medical Director