Petition Seeks to Oust AAD President-Elect, Citing Private Equity Conflicts

Alicia Ault

September 08, 2020

A petition on Change.org is seeking to prevent the American Academy of Dermatology's president-elect from taking office in early 2021, claiming that his ties to private equity make him too conflicted for the job.

The petition, created anonymously, appeared in early August and is seeking 1,500 signatures — calculated as the number needed to initiate a vote to recall Mark Kaufmann, MD. Dr. Kaufmann was voted president-elect of the AAD and its sister organization, the AAD Association, in April. He takes the position in 2021 and would become president in 2022.

The petition objects to the fact that Dr. Kaufmann is the chief medical officer of Advanced Dermatology and Cosmetic Surgery (ADCS), the nation's largest private equity-backed dermatology group. It claims that he took the position in July, after being elected, which it portrays as dishonest.

The petition said Dr. Kaufmann "will have concurrent fiduciary responsibilities to both the AAD and a corporation whose interests may or may not be aligned with the AAD." Even if Dr. Kaufmann chose to recuse himself from some decisions, that would be a disservice to the AAD, said the petition, which added that he "cannot serve two masters simultaneously."

Several efforts were made to reach Dr. Kaufmann for a comment, with no responses at press time. At press time, ACDS had not responded to a request for comment.

In response to questions, Bruce H. Thiers, MD, president of the AAD/A, said that the organization has no policy barring officers from holding capital in a private equity (PE)–backed corporation, but that any elected officer is subject to the organization's "fiduciary duties and obligations."

The AAD/A shared a 7-page administrative regulation on disclosure of outside interests and management of conflicts of interest. The policy notes that employment by a private equity group is considered a potential conflict of interest, but so is employment by a government agency, solo practice, academic medical center, or multiple other models. Key leaders, including the president, president-elect, and immediate past president, are required to divest themselves of any direct financial relationships with industry during their entire term.

Members who do not disclose potential conflicts each year and who fail to update their disclosure within 30 days of acquiring a new financial relationship "will lose the right to hold office, serve in the governance structure and, except in unusual circumstances approved in advance by the Board of Directors, to participate in Academy programs," according to the policy.

Petitioners Lament Conflicts, Private Equity

At press time, the petition had more than 1,100 signatures. Most who signed indicated in their comments that they believed that Dr. Kaufmann's association with private equity disqualifies him.

"I believe private equity should not have a place at the table of the governing body of the AAD," commented Cynthia Abbott, MD, an Atlanta dermatologist. In his comment, Ron Birnbaum, MD a Los Angeles–based dermatologist, wrote, "I oppose the movement to PE-based purchase and consolidation of practices," adding that he had not voted for Dr. Kaufmann in April. Dr. Kaufmann "might resolve the conflict of interest by resigning from the job of CMO of ADCS," wrote Dr. Birnbaum.

"I have great respect for Dr. Kaufmann but am very troubled by the influence of PE infiltration into dermatology," Mark Gaughan, MD, a dermatologist in Durango, Colo., wrote in the petition.

The petition seeks 1,500 signatures — which is 10% of the AAD membership. That's key because, as per AAD administrative rules, members can initiate the removal of a board member through a petition that is signed by 10% of voting members or by a two-thirds vote of entire board of directors.

Dr. Thiers said the AAD/A's "administrative regulations do not cover the removal of an elected officer prior to the start of his or her term." Thus, it's not even clear that Dr. Kaufmann could be recalled before he took office in 2021.

Dr. Kaufmann previously served on the AAD/A board of directors for 4 years and is currently deputy chair of the AAD/A's Patient Access and Payer Relations Committee. He is chair of the AAD's Workgroup on Innovation in Payment and Delivery Actinic Keratosis Alternative Payment Model Development and is a member of numerous other AAD/A committees, including: the AAD budget committee; the AAD appointment selection committee; the Resource-Based Relative Value Scale and Current Procedural Terminology committee; the work group on innovation in payment and delivery; the work group on ICD-10; and the work group on rapid response team Medicare Physician Fee Schedule.

Since March 2019, Dr. Kaufmann has also served as the chief medical officer of Florham Park, N.J.-based MoleSafe, a company that provides full-body skin cancer screening directly to patients.

In an interview, former AAD president Daniel Siegel, MD, said that he believes the petition is an unwarranted attack. "Mark is an honest upstanding individual who has, in the almost 2 decades I've known and worked with him, always put the interests of the specialty and the AAD ahead of any personal interests," said Dr. Siegel of the department of dermatology at State University of New York, Brooklyn. Dr. Siegel also disclosed that he is chief compliance officer for the Florida-based Skin and Cancer Associates, a large group of practices owned by private equity.

Dr. Kaufmann is "an objective person who has no difficulty declaring a conflict where there is one," Dr. Siegel said.

But Sailesh Konda, MD, a critic of private equity in dermatology, who signed the petition, said in an interview that he believed the "membership is rightfully concerned and responding to these new conflicts of interest with a valid petition."

"This is readily apparent with a petition signed by more than 1,000 dermatologists," added Dr. Konda of the department of dermatology at the University of Florida in Gainesville.

It might be hard to erase all potential conflicts at the AAD. Some members work for industry, some for academia, and some for government agencies – all of which come with their own biases.

But the AAD will not publicly release disclosures for members, board members, or officers. Those disclosures are compiled in an internal AAD database, but the organization leaves it up to each individual to decide what they will make public.

Second Anonymous Conflict Petition

It is not clear what will happen with the Dr. Kaufmann recall effort, but it is not the first time that a petition has taken aim at an AAD official. An October 2019 petition – also submitted by an anonymous dermatologist — sought to remove Scott M. Dinehart, MD, from the AAD board.

The petition noted Dr. Dinehart's involvement in creating the American Dermatology Board of Physician Assistants, a group that aims to offer board certification to PAs who work with dermatologists. Dr. Dinehart's "concurrent relationships with both organizations is a major conflict of interest," said the petition, which garnered some 4,200 signatures — far in excess of what is required to initiate a removal vote.

That led to a unanimous decision by the AAD/A board to present the membership with a resolution to remove Dr. Dinehart. Some 6,400 votes were cast, with 97% approving Dr. Dinehart's removal.

He is no longer a member of the AAD/A board.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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