Scaling Virtual Inpatient Dermatology Consults: Workflow, Challenges, Outcomes, and Compensation

The speaker described Wake Forest’s experience building and scaling a virtual inpatient dermatology consult service starting in 2022, noting that teledermatology was supported by prior studies and accelerated by COVID-19. The service now covers 11 hospitals, including several rural facilities, with plans to expand further. Success depends on strong institutional and hospital leadership buy-in, standardized workflows, reliable photography, and a dedicated nonclinical coordinator who manages orders, scheduling, nursing coordination, and equipment setup. Consults are typically brief, often around 11 minutes, and can be more efficient than in-person rounds because the dermatologist can pre-review charts, labs, and images. The speaker discussed common challenges such as credentialing across multiple hospitals, limited service hours, curbside requests, post-discharge follow-up across distances, nursing availability, technical glitches, and biopsy logistics. Outcomes have been favorable: most patients stay at their originating hospital, diagnoses and treatments are frequently changed, and about half present with a skin problem as the primary admission issue. Roughly a quarter require biopsy, and wound care recommendations are common at smaller hospitals. For compensation, the group moved from fee-for-service to a coverage model tied to clinic RVU value, which was easier to negotiate and helped support staffing. Overall, the speaker emphasized that virtual inpatient dermatology is rewarding, efficient, and valuable for keeping patients close to home while delivering subspecialty care.