What Happens When There’s a Dermatology Shortage?

There’s a national dermatologist deficit. According to the Academy of Dermatology, we need around 9,000 more dermatologists in order to provide adequate diagnoses and treatment across the country.

Melinda Wenner Moyer examined the dermatologist shortage for Women’s Health, and found that in many rural areas the closest dermatologist is almost 100 miles away. In many states, the wait lists go on for weeks. In a midsize city, the average wait time for a skin exam for a possible melanoma detection is 35 days, and in large cities the wait is 32 days. These wait times pose a great risk, as skin cancer advances typically 14 days after the patient first notices the lesion. In Cedar Rapids, Iowa, patients waited on average 91 days before they could see a dermatologist for possible melanoma; in Boston, the wait period is 51 days; and in Philadelphia, it’s 78 days.

Medicare patients suffer the most under these excruciating wait times. A JAMA Dermatology study found that eight percent had to wait over three months before their melanoma could be removed. The country-wide average for Medicare subscribers is 1.5 months.

However, the shortage has nothing to do with a lack of interest in dermatology. The average dermatologist’s salary is $318,000, and the quality of life is reportedly higher than other specialties. However, it’s a challenging field to break into, especially because there are not sufficient training resources. In 2016, there were only 420 dermatology residencies out of the total 31,000 residency spots. This dismal figure is partially due to the fact that teaching hospitals rely on Medicare funds, which have been compromised in recent decades. It also doesn’t help that dermatology residents don’t generate much financial benefit for hospitals. Moreso, their services are expensive for insurance providers, and some companies choose to restrict the number of associated dermatologists. For example, Mohs surgeons are commonly removed from insurance networks. “One insurance company went into a major city and said, ‘We’ll delist the 50 most expensive doctors,’” said former American Academy of Dermatology president Brett Coldiron, MD. “And the thing is, the delisted doctors generally perform more procedures. So they’ll delist the Mohs surgeons, or [those who see] the toughest psoriasis patients and prescribe expensive drugs.”

Read more about the societal and health consequences of the dermatologist shortage in Women’s Health.