Are Dermatologists Disproportionately Spread Across the Country?

Despite the nationwide dermatologist shortage, over the last couple of decades, the number of dermatologists has increased across cities and rural areas, according to a study recently published in JAMA Dermatology.

For the study, researchers looked at physician data from 1995 to 2013 from the Area Health Resources File (AHRF). Over those 18 years, they found a 21 percent increase of dermatologists across all community sizes: metropolitan, nonmetropolitan, and rural. The researchers determined that the number of dermatologists per 100,000 people had increased from 3.47 to 4.11 (an 18.4 percent increase) in metropolitan areas, .84 to 1.05 (a 25.1 percent increase) in nonmetropolitan areas, and from .065 to .085 in rural areas — a 30.3 percent increase. Although the number of dermatologists in less populated areas has grown significantly over the last two decades, the vast majority of dermatologists are drawn to urban settings because of social and family resources and professional opportunities. Cities are hubs for medical spa and cosmetic dermatology practices, which can be lucrative career options for dermatologists.

The surge in dermatologists outpaced the growth of other specialties, including otolaryngology, urology, plastic surgery, general practitioners, and “total physicians.” The researchers attribute the increased number of dermatologists to the expanding availability of residency and graduate medical education positions. Although there are still not enough dermatologists in rural areas, the 30 percent increase was higher than the development of other specialists locating to small towns.

The researchers also found that younger dermatologists are more likely to practice in “well-resourced, urban communities.” There are twice as many dermatologists over the age of 55 practicing in nonurban areas than in cities, and there are fewer of their younger counterparts in rural areas.

“Correcting this workforce disparity, which is likely to worsen, is important to minimize disruptions in patient care,” write the researchers. “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.”