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    'Chronic' shortage of dermatologists leaves some areas underserved


    EDITOR'S NOTE: It's a continuing problem: Patient requests exceed the time slots available at dermatologists' offices across the country. Some of the numbers are slowly changing, but wait times remain lengthy, and solutions are complicated, say doctors who have studied the metrics.

    Dr. Brodell
    National report — Robert Brodell, M.D., has been searching for an associate for three years — to no avail. The northeast Ohio dermatologist says he works about 50 hours a week, but still has more patients than he can comfortably handle. People with non-emergencies typically wait six to eight weeks for an appointment.

    Despite his efforts to attractively pitch Warren — a city of about 210,000 that's fairly close to both Cleveland and Pittsburgh — it's hard to persuade young dermatologists to sign on in the area, Dr. Brodell says.

    "I know that there's a guy across town from me who would have retired three years ago, if somebody could have come and taken over his practice," he says.

    Dr. Brodell's experience isn't unique. Dermatologists around the country are having trouble keeping up with demand, and it doesn't appear that's going to change anytime soon. It's a patchy problem: Some areas have too few practitioners; some have better numbers. Still, patient wait times remain frustratingly long virtually everywhere.

    And for younger doctors, it's a buyer's market. The job offers remain abundant, says Kathleen Beckum, M.D., who finished her dermatology training at the University of Alabama at Birmingham in June 2011.

    "There were both private practice and academic opportunities locally and across the country when I was completing residency," she says. "It was not unusual to get daily emails, postcards and sometimes phone calls from recruiting companies. Actually, even after I have started my practice, I am still approached by recruiters for dermatology positions across the country."

    Longstanding problem

    Dr. Kimball
    Today's dermatology workforce is in stable chronic undersupply, according to Alexa Boer Kimball, M.D., M.P.H., associate professor, Harvard Medical School, Boston, and author of several papers on the workforce topic.

    That's despite the fact that dermatology is a highly sought-after specialty among medical students and a field that, in 2009, offered an average starting salary of $325,000, according to the Medical Group Management Association. The reasons for the shortage are complex, experts say, and include restrictions on the number of available residency slots as well as new doctors' geographic preferences after residency.

    "Simply, there is substantial demand that we can't meet. There are substantial geographic variations in supply and demand," Dr. Kimball says. The shortages are most apparent in medical and pediatric dermatology, she says. In general, most dermatologists believe there is enough cosmetic and surgical capacity.

    Dr. Resneck
    Jack Resneck Jr., M.D., associate professor of dermatology and health policy at University of California, San Francisco, says evidence points to a persistent shortage of dermatologists in most areas of the United States.

    "Even in some of the most popular places to practice, where the ratio of dermatologists to population is highest, wait-times for patient appointments remain long, and the number of dermatologists seeking associates far exceeds the number of residency graduates," says Dr. Resneck, who has published extensively on the topic.

    He notes, however, that there are a limited number of geographic areas where a smaller number of dermatologists seems adequate.

    "This probably is due to a higher demand for dermatologic services in some areas. In particular, patient demand for surgical dermatology and cosmetic dermatology seems to vary the most," he says.

    Dr. Resneck says the shortage has been relatively stable over the past decade.

    "There has been a slight decline in appointment wait times, but the change has been surprisingly small, given both the influx of thousands of non-physician clinicians into dermatology and the recent recession," he says.


    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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