LAUSR

C linical registries are good and important potential sources for enhancing our knowledge of diseases, therapy outcomes, and the effect of diseases on our patients. Physicians who volunteer to enroll their patients in these registries must be willing to spend the time obtaining patient consent, filling out questionnaires, and obtaining photographs for documentation. Participation in such a registry does not bring academic kudos or authorship in most cases. It has been my experience that most dermatologists who participate are doing so because they want to contribute to our base of knowledge. I have spent my life in academics and am therefore used to volunteering for work without compensation. My husband, on the other hand, has run a private practice for more than 35 years, and I know first-hand that private practice is equivalent to running a small business (or larger business depending on the size of the group). Time is money, and the incorporation of extra work will likely reduce the number of patients seen in a day resulting in lower compensation for the practice. Meanwhile, the overhead is not reduced but actually increased as staff is likely to be participating in some of the data collection. Therefore, the bad news is that without some stipend to cover this volume loss and staff overhead, clinical registries will not be viable or robust. However, it is my opinion and experience that dermatologists do not work the system (the ugly). For example, as noted as a potential concern by Jariawala and Lipoff, I have never observed a dermatologist retain their patients on potentially toxic medications to preserve their enrollment in a clinical registry. In an interview study in the United Kingdom, the authors investigated the role of payment on