From the Journals

Dermatologists continue to prefer urban areas


Key clinical point: Geographic disparity for dermatologists in the United States has increased over time.

Major finding: The density of dermatologists increased by 21% from 1995 to 2013, but gaps persist between urban and rural areas.

Study details: A review of county-level data for 1995-2013 from the Area Health Resources File.

Disclosures: The researchers had no financial conflicts to disclose.

Source: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

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Undertraining and underused technology prolong workforce gaps

A stagnation of dermatology training programs in the 1980s and 1990s led to a limited supply of dermatologists, most of whom chose to work in urban areas, and this geographic distribution gap has persisted and worsened, Martina L. Porter, MD, and Alexa B. Kimball, MD, wrote in an editorial. The trend of more dermatologists opting for academic, group, or multispecialty practices instead of solo practices has continued, which adds to the maldistribution of dermatologists by geography, they said. “This demographic pattern poses an additional threat because almost half of rural dermatology practices were solo practices as of 2014,” they noted.

In addition, women make up approximately half of the current and future dermatology workforce, and they have historically been less likely to move to rural areas, even when offered forgiveness on student loans. Even so, the authors encouraged the use of exposure to rural medicine to establish a connection to an area, along with financial incentives and loan repayment.

“In parallel, because there appears to be increasing willingness to fund telemedicine, doubling down on training rural physicians and APPs in some areas of dermatology and engaging technology to support them seems prudent and responsible,” they wrote. “We may not be able to modify the overall dermatology workforce imbalance, but ensuring timely access to our expertise for those patients who need us most can still be achieved if prioritized correctly” (JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.2925).

Dr. Porter and Dr. Kimball are affiliated with Harvard Medical School in Boston. They had no financial conflicts to disclose.



More dermatologists in the United States practice in urban areas than in nonurban or rural areas, and this trend is likely to continue, according to data from a longitudinal study published online Sept. 5 in JAMA Dermatology.

Data from previous studies suggest that the demand for dermatologists continues to outpace the supply, thus dermatologists have their choice of locations and prefer urban areas because of greater professional opportunities, desire to live near family, and lack of financial incentives to relocate to underserved areas, wrote Hao Feng, MD, of the department of dermatology, New York University, and his colleagues.

To evaluate the latest longitudinal trends in dermatology and factors affecting geographic distribution, the researchers used the Area Health Resources File from 1995 to 2013 to examine the geographic densities of dermatologists and other physicians, as well as the age distribution of dermatologists. The counties were classified as rural, nonmetropolitan, and metropolitan.

Although the percentage changes in dermatologist density at the county level showed a greater increase during the study period in rural counties (30%) and nonmetropolitan counties (25%), compared with metropolitan counties (18%), the differences in actual density of dermatologists per 100,000 people were highest in urban areas.

Overall, dermatologist density in metropolitan areas increased from 3.47 to 4.11 per 100,000 people between 1995 and 2013. Dermatologist density in nonmetropolitan areas during this time increased from 0.84 in 1995 to 1.05 per 100,000 people in 2013, and from 0.065 to 0.085 per 100,000 people in rural areas during that time.

The researchers also evaluated dermatologist trends by age, and found that the number of dermatologists younger than 55 years increased by 21% in metropolitan areas and by 7% in nonmetropolitan and rural areas combined between 1995 and 2013.

The study findings were strengthened by the long time period, but limited by factors including inability to differentiate among full-time and part-time dermatologists, and among medical or cosmetic dermatologists and dermatologic surgeons, the researchers said. However, the results suggest that geographic disparities for dermatologists in the United States continue to increase, and strategies to correct it are important to maintain patient care, they wrote. “Careful workforce planning will be needed to consider alternative health care delivery models, dermatologist recruitment strategies, and the role of nonphysician practitioners and telemedicine, especially in nonmetropolitan or rural areas,” they noted.

The researchers had no financial conflicts to disclose.

SOURCE: Feng H et al. JAMA Dermatol. 2018 Sep 5. doi: 10.1001/jamadermatol.2018.3022.

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