Regional disparities in the dermatology workforce: A longitudinal analysis of American Medical Association workforce data

To the Editor: Health care disparities pervade dermatologic care in the United States. For example, melanoma and nonmelanoma skin cancer outcomes are poorer among ethnic minorities, low-income individuals, those with less education, the elderly, and the uninsured.1Buster K.J. Stevens E.I. Elmets C.A. Dermatologic health disparities.Dermatol Clin. 2012; 30 (viii): 53-59https://doi.org/10.1016/j.det.2011.08.002Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar Advance practice providers and primary care providers (PCPs) often work alongside dermatologists to fill gaps in care. However, there remains an unmet need for dermatologists in underserved areas. For example, prior studies have highlighted higher dermatologist density in urban areas when compared to rural areas.2Glazer A.M. Farberg A.S. Winkelmann R.R. Rigel D.S. Analysis of trends in geographic distribution and density of US dermatologists.JAMA Dermatol. 2017; 153: 322-325https://doi.org/10.1001/jamadermatol.2016.5411Crossref PubMed Scopus (65) Google Scholar,3Glazer A.M. Rigel D.S. Analysis of trends in geographic distribution of US dermatology workforce density.JAMA Dermatol. 2017; 153: 472-473https://doi.org/10.1001/jamadermatol.2016.6032Crossref PubMed Scopus (47) Google Scholar We aimed to further study the geographic distribution of US dermatologists by state and Census region. We used 2006-2021 American Medical Association data to investigate trends in the dermatologist workforce by US Census Region (Northeast, Midwest, South, West).4AAMC Data Warehouse, AMA Data. August 2021. Accessed September 9, 2022. https://www.aamc.org/data-reportsGoogle Scholar We recorded mean annual dermatologist density (dermatologists/100,000 people) and mean PCP-to-dermatologist ratios for each year, stratifying by region. Regional data were analyzed using analysis of variance testing. Additionally, we compared 2021 workforce data to the number of dermatology residency programs in each state using a univariate linear regression. Residency program data was obtained from the FRIEDA American Medical Association database. Mean dermatologist density (dermatologists/100,000 people) was highest during the pooled study period in the Northeast (4.65), followed by the West (3.89), South (3.26), and Midwest (3.03) (P < .0001). These rankings remained consistent throughout the study period (Fig 1). During this time, annualized growth in dermatologist density was 1.2% in the Northeast, 0.8% in the West, 1.1% in the South, and 1.3% in the Midwest. The mean PCP-to-dermatologist ratios (PCPs/dermatologist) were highest in the Midwest (30.6), followed by the South (25.0), Northeast (23.5), and West (23.4) (P < .0001). The Midwest consistently maintained the highest PCP/dermatologist ratio throughout the study period (Fig 2). The number of dermatology residency programs per state was highly correlated with its number of dermatologists (r2 = 0.82, P < .0001), even when controlling for state population (r2 = 0.45, P < .0001). State comparisons are shown in Supplemental material (available via Mendeley at https://data.mendeley.com/datasets/367z8ffpxn/1).Fig 2PCP/Dermatologist Ratios by US Census Region (2006-2021). Shown are PCP to dermatologist for the United States from 2006 to 2021, with further stratification by US Census region. Compound annual growth rates for each region are listed in the figure legend. ∗P < .001; refers to one-way ANOVA comparing pooled PCP/dermatologist ratio over the study period versus region. ANOVA, Analysis of variance; PCP, primary care provider.View Large Image Figure ViewerDownload Hi-res image Download (PPT) A dermatologist density of 4/100,000 population members has been suggested as adequate to serve the needs of a community.2Glazer A.M. Farberg A.S. Winkelmann R.R. Rigel D.S. Analysis of trends in geographic distribution and density of US dermatologists.JAMA Dermatol. 2017; 153: 322-325https://doi.org/10.1001/jamadermatol.2016.5411Crossref PubMed Scopus (65) Google Scholar,3Glazer A.M. Rigel D.S. Analysis of trends in geographic distribution of US dermatology workforce density.JAMA Dermatol. 2017; 153: 472-473https://doi.org/10.1001/jamadermatol.2016.6032Crossref PubMed Scopus (47) Google Scholar According to 2021 data, this threshold has only been met in the Northeast and West. Accordingly, dermatologist supply is projected to outpace demand in the Northeast and West by 2025. Meanwhile, analysts predict that 23.6% of demand for dermatologists in the Midwest and 2.7% of demand for dermatologists in the South will remain unmet by 2025.5U.S. Department of Health and Human ServicesHealth Resources and Services AdministrationNational Center for Health Workforce AnalysisSupply and Demand Projections for Internal Medicine Subspecialties: 2013-2025. Health Resources and Services Administration, 2016Google Scholar Our study further supports a need for more dermatologists in the Midwest. Additionally, PCPs in the Midwest may have limited dermatologist referral networks compared to other regions. Increased dermatology education targeted toward PCPs in dermatologist-sparse areas may help alleviate some disparities. Despite growth in all regions, dermatologist density in the West, South, and Midwest still lags behind that of the Northeast. Factors such as rurality and availability of academic centers may help explain dermatologic care disparities both across and within regions. Further studies are needed to better understand factors that influence dermatologists' regional practice preferences. This information could help guide strategies to attract dermatologists to underserved areas. None disclosed.