The diversification and gradual subspecialization of dermatologic activity have led to the proliferation of conferences dealing with increasingly specific fields of knowledge. This has taken place in parallel with the increase in professionals in each autonomous region of Spain, with increased exchange in more proximate settings. Indeed, there may be a genuine bubble of conferences and congresses, fed by a feeling (real or imagined) of the need for ongoing training or improvement. As well as the classic periodic institutional meetings promoted by the different national and international dermato-venereological associations, recent decades have seen a proliferation of a large number of meetings of different types, which are also fed by the resources supplied by the pharmaceutical and cosmetic industry (such as exclusive sponsorship or temporary exhibition stands of outreach and commercial interest). At certain times of year, the concentration (even overlapping) of conferences is such that, if you attend a decent number of them, the personal and family cost, the fatigue and the financial loss (if attending means missing out on private work) can far exceed the benefits of attending these meetings.

This is, undoubtedly, the first question asked by any conference organizer or potential attendee. Probably, the most sensible and reasonable solution would be for each attendee to pay the proportional part of the expense generated: every congress and conference has transport costs, fees, infrastructure and rental, technical support, personnel expenses, hotel and catering expenses, etc., which have a positive effect on the local economy, gross domestic product, and economic growth. But this common sense and apparent benefit has gradually become distorted to the point where, in many meetings, most of the economic weight falls on the pharmaceutical or cosmetic industry, which somehow expects to recover and compensate for this cost by increasing its income. Furthermore, the high prices of some of these meetings may be partly justified by the gradual complication in terms of technical means and partly because they are a major source of income for the groups or people who promote them. And because “he (or she) who calls the piper pays the tune”, we see greater decision-making power on the part of the industry in our meetings, in which they often end up influencing the schedules, speakers, and topics for debate.

When Juan de Azúa inaugurated the initial sessions of AEDV, the content was strictly scientific and formal. Today, however, most dermatology conferences throughout the world have a trade-fair aspect, with presentation of new equipment and products. The pharmaceutical and cosmetic industry is a group of private corporations with a legitimate profit motive. This trade-fair aspect may be of interest and even justify the travel and time dedicated, but is may come to be a clear distraction from the educational role of these meetings. We should therefore think about the proportionality of these exhibitions and, while not prohibiting this informative and outreach work regarding the products, prevent it from eclipsing the true mission of the meeting, which is to provide independent scientific information. It is not a matter of blaming the industry but of assertively demanding responsibility from the organizers of scientific and professional events (and leaders of scientific societies) so that they do not distort the principles that justify this type of meeting.

The aforementioned weight of the industry and our natural desire for novelty (hence the success of this format in a large part of our meetings) may notably distort or tilt the balance and proportionality of the content of our meetings. Thus, it is common for diseases or techniques that account for a small proportion of consultations or time dedicated in routine practice to be overrepresented in meetings. Following the Pareto rule (and without intending to make a precise, systematic, or sweeping statement), it may be the case that 20% of dermatology in routine clinical practice occupies up to 80% of the time of some conferences, which leads to significant areas of our speciality without economic champions and fallow in educational terms.

Another recurring phenomenon of the traditional system of conferences and congresses (linked to subspecialization) is that it is common to find the same speakers in the same settings talking about the same things. It is true, however, that, when an author works, dedicates time and effort to, and delves deeply into a specific topic, it is likely that few other (if any) will be able to approach and write about that topic as well. But we should not ignore the need to increase the diversity of speakers at conferences, with the goal of avoiding repetition and monotony in cases where this is not inevitable, by inviting new voices that are not imposed by outside agents.

The former distribution of power among the chairs of the speciality in Spain and the major dermatology departments in public tertiary hospitals has, until recent decades, constituted an enriching environment of knowledge and development yet, at the same time, a closed, deterministic system.4 This has been partially overcome in Spanish dermatology today, which is more dynamic, more diverse, and richer than ever.

Time is one of the most valuable resources and, unfortunately, very poorly managed, to the point were we sometimes try to fill up our lives and education with content that, in truth, we do not need. The big conferences that last between 3 and 5 days are seeing an increasing reduction in real attendance because it is increasingly difficult to avail of that much free, family, or professional time. We understand that some may prefer a single annual event over several days (instead of several short events) but reality tells us that a large proportion of dermatologists attend only 1 or 2 days of these congresses because it is simply not practicable or desirable to attend more.

We believe that the answer to this question is no. Although we intuitively tend to link success to attendance and to the intrinsic quality of a conference, it is common for excessively large and diverse meetings with a huge range of content to lead to a certain amount of saturation and dispersion. This option paralysis occurs due to the simple inability to decide between so many possibilities, with an excessive range of options that are often difficult to comprehend.

There is no doubt that any conference, on any topic, brings resources and wealth to the place where it is held, with a major economic impact. So much so that many cities develop specific conference or convention tourism plans as a programmed strategy with the support of local government and business, with greater or lesser success. But beyond this, how much redundant, superfluous, ephemeral material (papers, leaflets, etc.) and largely avoidable fuel and energy consumption, and plastic and other waste is generated by our meetings? Are we aware of this? Do we respect our environment? One of the first indicators is the ecological footprint caused by holding a traditional conference, with the release of greenhouse gases into the atmosphere, caused by transporting attendees and speakers, as well as the intensive use of resources to hold the conference. An editorial by the British Medical Journal in 2008 highlighted the fact that international congresses may contribute to global warming and should be considered a luxury that our planet cannot afford.5Fig. 1

Figure 1.

Image of the meeting on Critical Reading of Articles, held on the island of San Simón, on the Vigo Ria, on September 4, 2019.

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After this analysis, we ask ourselves, what opportunities are provided by being aware of these weaknesses and dealing with them using old methods and new technologies? What trends are on the way? Where is the future of our conferences headed? Will we maintain the current formats of macro-conferences, meetings, and trade fairs? Will the current trend continue and even increase, even though we are beginning to be aware of its negative effects and weaknesses? We believe that the answer to this last question is affirmative for the present: the current model appears to be robust and few question it (reasons which, in dermatology and in medicine in general, will help it to remain vigorous for many years to come). But at the same time, initiatives are appearing that may begin to signal a change of trend or, at least, a readjustment of the system. We examine some of these initiatives in Table 1, with specific examples, together with a brief outline of what we think the alternatives should be to traditional congresses and conferences. Fig. 2

Figure 2.

Logo of the Dermachat informal instant-messaging group, which includes almost 500 dermatologists, with the logo of the “1st Virtual Dermachat Congress”, which has held on Saturday, September 14, 2019.

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Despite these little giant steps and the proposed initiatives and alternatives, in-person conferences will continue to exist. And we are glad that this is the case because, alongside the dermatologic science and its contents, there is the other equally or more important part: the face-to-face interaction of dermatologists, the greetings, the hugs, the smiles and the real life. And in the end, direct interaction between people is and will continue to be the most professionally and emotionally enriching way for human beings.