Time-efficiency of nondermatologists compared with dermatologists in the care of skin disease

Abstract

Background: It has been suggested that using an established primary care doctor potentially could be a more efficient use of physician time than a new visit to a dermatologist for patients seeking care for skin diseases. Objective: We test the hypothesis that seeing an established primary care doctor for a skin problem is a more efficient use of physician-time resources than a new visit to a dermatologist. Methods: The duration (in minutes) of outpatient visits for dermatologic conditions was obtained from the National Ambulatory Medical Care Survey from 1990 to 1994. To control for the complexity of visits, the analysis was limited to the 62% of these visits in which a single dermatologic condition was the only condition being treated. Results: For all outpatient dermatologic visits combined, dermatologist visits for patients 18 years old or younger were 1.5 minutes (12%) shorter than nondermatologist visits, and dermatologist visits for patients older than 18 years were 3.1 minutes (20%) shorter than nondermatologist visits. Compared with nondermatologists, dermatologists have a shorter average visit duration for new, first-time patient encounters and for encounters with established patients. A significant difference in outpatient visit duration does not exist when comparing new, first-time visits for dermatologists to established visits for nondermatologists ( P = .3). Conclusion: A visit to an established primary care provider for treatment of a skin problem is not a more efficient use of physician resources than a new or return visit to a dermatologist. (J Am Acad Dermatol 1999;40:194-9.)