Characterization of the active Medicare dermatology workforce

To the Editor: Dermatology faces an impending shortage of practicing physicians as the US population ages and patient demand rises.1Sargen M.R. Shi L. Hooker R.S. Shen S.C. The dermatology workforce supply model: 2015-2030.Dermatol Online J. 2017; 23: 1Google Scholar,2Porter M.L. Kimball A.B. Predictions, surprises, and the future of the dermatology workforce.JAMA Dermatol. 2018; 154: 1253-1255Google Scholar The low density of dermatologists and increased distance from them have been associated with worse clinical outcomes.3Stitzenberg K.B. Thomas N.E. Dalton K. et al.Distance to diagnosing provider as a measure of access for patients with melanoma.Arch Dermatol. 2007; 143: 991-998Google Scholar In light of these critical issues, we examined the active dermatologist workforce compared with other specialties and identified trends among recent cohorts of dermatologists. We identified the demographic and practice characteristics of all the Medicare practicing physicians as of July 2020 in the publicly available Centers for Medicare and Medicaid Services databases4Datasets Centers for Medicare & Medicaid Services.https://data.medicare.gov/data/physician-compareDate accessed: August 14, 2020Google Scholar (Supplemental material available via Mendeley at https://data.mendeley.com/datasets/mvwv4ygdj7/2). We restricted the cohort to physicians with medical school graduation years through 2014 to select the physicians who had completed their residency training. The Pearson chi-square test was used to compare the categorical variables. The work was approved by the institutional review board of Mass General Brigham. We identified 12,120 practicing dermatologists (Table I). Compared with other specialties, the dermatologists were more likely to be women (50.0% vs 32.0%) and sole proprietors (19.6% vs 13.6%) and were less likely to practice in rural settings (8.8% vs 14.7%) or be affiliated with academic hospitals (26.1% vs 51.4%; all P < .001). The dermatologists in the most recently graduated cohort were less likely to be sole proprietors (0.9% vs 37.2%) and were significantly more likely to be women (62.4% vs 16.5%) and be affiliated with an academic hospital (33.2% vs 21.1%) compared with those who graduated from medical school prior to 1980 (all P < .001) (Table II). There was no difference in the percentage of rural-practicing dermatologists across all cohorts (P = .41).Table IComparison of the demographics of active US Medicare dermatologists with other specialty physiciansCategoryDermatologistsOther specialtiesP valueActive physicians (% of all Medicare physicians)12,120 (1.9%)610,808 (98.1%)Graduation year (median)19991998Female50.0%32.4%<.001Sole proprietor19.7%13.6%<.001Rural practice8.8%14.7%<.001Academic hospital affiliation26.1%51.4%<.001 Open table in a new tab Table IICharacteristics of US Medicare dermatologists by medical school graduation yearCategoryGraduation CohortP value≥20102000-20091990-19991980-1989<1980Active dermatologists (% of all active dermatologists)2375 (19.6%)3509 (29.0%)2583 (21.3%)2106 (17.4%)1547 (12.8%)Female62.4%60.4%51.3%41.4%16.5%<.001Sole proprietor0.9%17.0%22.3%29.2%37.2%<.001Rural practice8.1%9.4%9.0%8.6%8.2%.41Academic hospital affiliation33.2%28.6%21.5%23.2%21.1%<.001 Open table in a new tab Understanding the current dermatology workforce is vital to tackling the projected shortage of dermatologists and issues in access to care. In this analysis of all current Medicare physicians, we found that the Medicare dermatologists were more likely to be women, sole proprietors, non-rural practitioners, and not affiliated with academic hospitals compared with other specialties. Additionally, we found that recent dermatology graduates were more likely to be women and practiced in an academic setting, and they were less likely to be sole practitioners compared with the preceding cohorts. Less than 10% of the dermatologists across all the graduation cohorts practiced in the rural settings. The application of the data to dermatologist workforce planning is becoming increasingly important.5Ehrlich A. Kostecki J. Olkaba H. Trends in dermatology practices and the implications for the workforce.J Am Acad Dermatol. 2017; 77: 746-752Google Scholar A survey of the American Academy of Dermatology members showed a decrease in sole proprietorship, an increase in group practice, and a shift toward academic practice among the younger dermatologists.5Ehrlich A. Kostecki J. Olkaba H. Trends in dermatology practices and the implications for the workforce.J Am Acad Dermatol. 2017; 77: 746-752Google Scholar Our findings from this database of all practicing Medicare dermatologists confirm these trends, indicating that recent dermatology graduates practice differently than the cohorts closer to retirement. Importantly, these results are less subject to survey response bias. Shifts toward group and academic dermatologic practices may change how dermatology is delivered across geographies and health systems. Thus, a regular review of publicly available data for demographic and practice trends may aid professional dermatology societies and residency program directors to incentivize practice patterns that ensure equitable and timely access to care. Given the positive association between access to dermatologic care and patient outcomes, the leaders within our field can benefit from this information as they shape the future dermatology workforce. None disclosed.