Dermatology Workforce Research Articles

Bringing international medical graduates into the dermatology workforce: New licensing pathways to expand dermatologist supply and access

Bringing international medical graduates into the dermatology workforce: New licensing pathways to expand dermatologist supply and access

The Impact of the Recent Supreme Court Ruling on the Dermatology Recruitment Pipeline.

The 2023 ruling by the Supreme Court of the United States (SCOTUS) on the use of race-based criteria in college admissions may have implications for the selection of individuals into the dermatology workforce. This article highlights the impact of these decisions at the undergraduate, medical school, and graduate medical education levels, as well as within the field of dermatology.

Dermatology workforce projections in the United States, 2021 to 2036.

There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Re-engagement, quality of life, and burden of treatment in adults on dupilumab for severe atopic dermatitis-A mixed methods study.

Targeted biologic therapies have revolutionised the treatment of severe atopic dermatitis (AD). To assess effects of dupilumab on patient re-engagement, quality of life (QOL), and burden of treatment (BOT) in severe AD. Adults on dupilumab for AD completed questionnaires on QOL, BOT, and provided qualitative reflections, with a subset interviewed to explore experience of leaving and re-engaging with dermatology. Prior treatments, adverse events, and clinical severity scoring were evaluated. Statements and interviews were qualitatively reviewed. Of 41 patients; median age was 34years, 68% were male; and 93% (n=38) had trialled ≥1 immunomodulatory therapies before dupilumab. Median dermatology life quality index was 21 (range 9-30, SD±5.1) pre-dupilumab, and 2 (range 0-11, SD±3.4) post-dupilumab. Median eczema area and severity index was 31.4 (range 10-46.4, SD±11.8) pre-dupilumab, and 6.4 (range 0.4-13.2, SD±3.6) on dupilumab. Burden of treatment scores on dupilumab were low (median 0-3/10) across all domains. Themes identified pre-dupilumab included sleep disturbance, low self-esteem, social isolation, disempowerment, frustration with ineffective treatments, and high financial costs. Benefits included confidence reacquisition, enhanced sleep, liberation from time-consuming 'messy' topical regimes, improved relationships, and reclaimed autonomy. Side effects included red/itchy eyes (37%, n=13) and facial dermatitis (20%, n=7).Twelve patients had deeper interviews. Regarding disengagement with dermatology, themes included ineffectiveness and toxicity of older treatments, attendance futility, dermatologist fatigue, and 'fizzling out'. Regarding re-engagement with dermatology, themes included social media influence, novelty, exasperation with QOL, and life-changing improvements seen with dupilumab. The emergence of novel effective treatments for AD has significant implications for dermatology workforce and financial planning.

Pediatric consultative dermatology: A survey of the Society for Pediatric Dermatology workforce reveals shortcomings in existing practice models of pediatric dermatology consult services in the United States.

The rate of pediatric hospitalization for cutaneous pathology has been increasing in recent years, often requiring the expertise of consulting pediatric dermatologists; however, the infrastructure of inpatient pediatric dermatology consultative services remains poorly characterized. We sought to assess the structure, consult volume, physician compensation, and utilization of teledermatology in pediatric dermatology inpatient services to better understand the current care model. Our survey of 118 pediatric dermatologists revealed that 89% of respondents see between 1 and 10 new consults per week, 39% perform all inpatient consults including evening and weekends without assistance from other providers, 71% do not have protected time during the week to provide inpatient consultations, and only 10% receive financial compensation via stipend. By highlighting both the high demand for pediatric consultative dermatology as well as the significant burden placed on these providers by existing practice models, we hope to encourage a reappraisal of the current infrastructure of pediatric inpatient dermatology to increase structural and financial support for this vital service.

Characteristics of physician associates/assistants in dermatology

The dermatology workforce includes physicians, nurse practitioners (NPs), and physician associates/assistants (PAs). The number of dermatologists is growing slowly while the growth of PAs working in dermatology is rapid and accelerating. To understand their characteristics, a descriptive study of PAs practicing in dermatology utilizing the National Commission on Certification of Physician Assistants (NCCPA) workforce dataset on PA practices was undertaken. NCCPA certifies PAs who practice in the United States and queries them about their role, employment, salary, and job satisfaction. Analyses consisted of descriptive statistics, Chi-Square, and Mann–Whitney tests for comparisons between PAs practicing in dermatology versus the total of all other PA specialties. As of 2021, 4,580 certified PAs reported practicing in dermatology—a nearly twofold increase since 2013, when 2323 worked in the specialty. This cohort's median age was 39 years, and 82% were female. Almost all (91.5%) are office based, and 81% work more than 31 h per week. The median salary was $125,000 (2020 dollars). Dermatology PAs work fewer hours and see more patients than their counterparts compared to all 69 PA specialties. At the same time, dermatology PAs are more satisfied and less burnt out when compared to all PAs. The increased number of PAs selecting dermatology as their discipline can help lessen the projected physician shortage in this field.

Delegation and oversight of non-physician practitioners in dermatology.

A rising demand for dermatologic procedures has led to a recent increase in the number of non-physician operators (NPOs) in the dermatology workforce. Nurse practitioners, physician assistants, and aestheticians commonly perform procedures in both physician-based practices and medical spas with varying degrees of dermatology-specific training and physician oversight. Although the lack of regulations can negatively impact patient outcomes and adverse events, the role of NPOs in dermatology continues to grow. Among Medicare beneficiaries, nurse practitioners and physician assistants are independently billing for a growing number of dermatologic procedures, whereas the number performed by dermatologists remains relatively stable. Medical spas are an increasingly popular destination for aesthetic consumers, and the majority employ only NPOs as primary providers. Recent data suggest that compared to dermatologists, NPOs have a higher rate of adverse events. As attempts are made to standardize and improve the training requirements for dermatologic procedures, a concerted effort should be made to prioritize patient outcomes and safety.

Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study.

The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP-led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of "medical overuse" and "high-value care." Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy; however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. Australian and New Zealand Clinical Trials Registry ACTRN12616001716459; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865.

Diversity and Career Goals of Graduating Allopathic Medical Students Pursuing Careers in Dermatology

Dermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US. To examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation. This secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires. The proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology. A total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98). The findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.

34953 Specialty choice motivations among diverse graduating medical students pursuing careers in dermatology

Background: Efforts are needed to increase diversity in the dermatology workforce, but few empirical data exist on factors influencing medical student’s decision to pursue careers in dermatology. Methods: This is a cross-sectional study using data from the 2016-2019 Association of American Medical Colleges Graduation Questionnaires. We calculated mean scores and β-coefficients using linear regression analyses for the importance of factors influencing specialty choice (0 = “no influence”, 1 = “minor influence”, 2 = “moderate influence”, and 3 = “major influence”) comparing graduating medical students intending to practice dermatology (GMS-D) and those pursuing other specialties (GMS-OS), and, among GMS-D, by sex, race/ethnicity, and sexual orientation. Results: Among 57,393 participants, we found GMS-D (n = 1,336) compared with GMS-OS (n = 56,057) were more likely to report balance (mean: 2.60 vs. 2.14, respectively; β = 0.47; P < .001), family planning (2.15 vs. 1.67; β = 0.49; P < .001), salary (1.82 vs. 0.37; β = 0.40; P < .001), length of training (1.78 vs. 1.29; β = 0.50; P < .001), competition (1.47 vs. 1.18; β = 0.31; P < .001), family (1.32 vs. 0.95; β = 0.50; P < .001), and educational debt (0.96 vs. 0.73; β = 0.40; P < .001) as influencing specialty choice. Among GMS-D, females were less likely than males to report salary (1.71 vs. 2.0; β = -0.29; P < .001), length of training (1.70 vs. 1.90; β = -0.22; P < .001), competition (1.39 vs. 1.59; β = -0.25; P < .001), family (1.27 vs. 1.40; β = -0.21; P < .001), and debt (0.87 vs. 1.10; β = -0.24; P < .001) as influencing specialty choice; sexual minority were less likely than heterosexual students to report family planning (1.58 vs. 2.18; β = -0.61; P < .001) or family (0.74 vs. 1.36; β = -0.68; P < .001) as influencing specialty choice; and, factors did not differ significantly by race/ethnicity. GMS-D reported mentorship and balance as the most important factors. Conclusions: GMS-D are more likely than GMS-OS to report family, income and lifestyle factors as influencing specialty choice. Diverse backgrounds affect the importance of certain factors, although all GMS-D highly value mentorship and balance. These findings will inform efforts to build a more diverse workforce.

32947 Geographic practice preferences of diverse graduating medical students pursuing careers in dermatology

Background: Geographic disparities in the distribution of dermatologists in the United States have resulted in poorer access to dermatologic care in rural and underserved urban areas. Few data exist on current trends in the dermatology workforce pipeline.

33515 Pilot survey project on procedural skills opportunities in skin of color for dermatology physician assistants

Background: Physician assistants (PAs) are increasingly vital to the dermatology workforce to meet the demands of the U.S. population as it increases in size and diversity. Dermatology physicians undergo training in specialized treatment for skin of color (SoC) patients. This pilot study explored the educational and procedural experiences among dermatology PAs. A survey was used to identify strengths and areas of improvement in SOC procedural skill education. Methods: The link to an IRB-exempt, anonymous 16-item survey was posted to the Society of Dermatology Physician Assistants (SDPA) message forum for 3 weeks, with 1 follow-up reminder. Survey questions assessed the dermatologic education and training for SoC before, during, and after PA education via voluntary self-report. Data on PA procedural experiences, procedural confidence levels, and training satisfaction were collected. Statistical analysis was conducted using R Version 4.0.5. Results: Twenty-five PAs responded, while 19 completed the survey (completion rate: 76%). Forty-four percent (13/19) reported receiving no SoC dermatologic didactic sessions in their PA curriculum. Fifty-two percent (11/19) reported no supervised procedural training specific to SoC. Those who received training reported greater confidence in choosing and performing treatments for SoC patients (P < .05). Conclusion: Our pilot highlighted the need to shorten our questionnaire for ease of completion (acceptability) and develop alternative dissemination options (ie, email) to increase respondent participation (feasibility). Some PAs expressed apprehension about participating, and thus, clarification of study’s goals will be an important factor to improve participation for the next version.

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.1 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.

Differences in Underrepresented in Medicine Applicant Backgrounds and Outcomes in the 2020-2021 Dermatology Residency Match.

Dermatology is one of the least diverse medical specialties. Although there have been studies addressing barriers faced by underrepresented in medicine (UIM) applicants to dermatology, there is little information about how UIM applicants approach and fare in the dermatology residency match process. This study aimed to assess differences between UIM and non-UIM applicants in the dermatology match process. A survey was administered to 2020-2021 dermatology applicants (N=232) to evaluate applicant characteristics, approaches, and outcomes in the match process. Survey responses were analyzed to determine if differences between variables were statistically significant. An additional survey was administered to dermatology residency program directors to evaluate their approach to the 2020-2021 application process. Our findings are important in identifying interventions to improve equity in the dermatology application process and to improve diversity in the dermatology workforce.

320 Regional disparities in the dermatology workforce

Socioeconomic disparities are an important barrier to dermatological care in the US. While access to care has grown with telehealth and use of advance practice providers (APPs), gaps in healthcare are still being identified and addressed. Prior studies have shown racial, ethnic, and socioeconomic disparities, but there is little data examining the geographic distribution of dermatologists throughout the US. Our study uses the 2006-2019 Association of American Medical Colleges (AAMC) Data Warehouse data to investigate trends in dermatologist density by US Census Region (Northeast, Midwest, South, or West).

342 Patterns and predictors of NIAMS funding for early career researchers

Both basic and clinical research are important for advancing science and public health, and the NIH has been working to increase support for investigators performing clinical research. Our objective was to evaluate the distribution of mentored career development awards in dermatology and to compare it to other specialties funded by the National Institute for Arthritis and Musculoskeletal and Skin Disease (NIAMS). We collected data on K08 and K23 awards from NIAMS through the publicly available NIH Reporter database and classified these awards as dermatology, musculoskeletal, or rheumatology research to compare the K08 and K23 distribution across specialties. We also classified award recipients as men or women according to the gender pronouns used in publicly available institutional biographies. From January 2012 to June 2021, NIAMS granted K23 awards to 104 unique recipients and K08 awards to 108 unique recipients, resulting in an overall ratio of 1.0 for K23 to K08 recipients. This K23:K08 ratio varied by specialty: it was 0.4 for dermatology, 0.8 for musculoskeletal research, and 1.7 for rheumatology. Adjusted multivariate regression models show that the odds of K23 versus K08 awards were over three times higher in rheumatology than dermatology (OR 3.63, 95% CI 1.72-7.90). Women were almost three times more likely to receive K23 awards (OR 2.64, 95% CI 1.47-4.82), and there was evidence of effect modification in the association between specialty and award type by gender (likelihood ratio test, p-value = 0.015). When stratified by gender, the K23:K08 ratio in dermatology was 0.1 for men and 1.1 for women. The imbalance between support for early career researchers in dermatology focusing on basic versus clinical research may have important implications for the state of dermatological science and the academic workforce. Efforts to address these challenges and correct the imbalance in research funding is needed to improve equity in the dermatology workforce and improve patient outcomes.

The Resident Physician Shortage Reduction Act: An opportunity to address the rural dermatology workforce deficit

Access to dermatological care is especially challenging in rural America, with a greater density of dermatologists concentrated in urban areas.1 One strategy for expanding the dermatology workforce is increasing the number of dermatology residency training positions, including in rural settings.2 In the Consolidated Appropriations Act (CAA) of 2021, the Congress allocated Medicare funding for 1000 residency positions over 5 years, effectively ending the 25-year federal funding drought for graduate medical education.

Reply to: “Strategies for augmenting the Spanish-speaking dermatology workforce of the United States”

Reply to: “Strategies for augmenting the Spanish-speaking dermatology workforce of the United States”

Dermatology workforce over a decade in Saudi Arabia: demographics, distributions, and future challenges

BackgroundThe dermatology workforce is an important topic, as many countries are facing an undersupply of dermatologists, while some are expecting a surplus. Therefore, we conducted this study to identify the current dermatology workforce demographics in Saudi Arabia (SA) and the changes in such demographics over the last 10 years to identify future workforce-related challenges.MethodsThis study was conducted in SA, and it included all the practicing dermatologists in the country over the last decade (2010–2020). The number of practicing dermatologists, their gender, their nationality, and dermatology residency candidates and graduates were obtained from the Saudi Commission for Health Specialties (SCFHS). The geographic distribution of dermatologists was obtained from the Ministry of Health Statistical Yearbook 2018.ResultsAs of September 2020, there were 2678 practicing dermatologists in SA at a ratio of 7.82 dermatologists per 100 000 people. Of the 2678 dermatologists, only 24.8% were Saudis. The Saudi dermatologist ratio has been almost constant over 10 years, ranging from 1.3 to 1.9 per 100 000 people. Of all Saudi dermatologists, 42% were female. The number of residents who graduated from the residency program was not consistent for each year and ranged from 4 to 25. The number of dermatologists varied by region, with 9.2 in Riyadh and 3.4 in Najran per 100 000 people.ConclusionsThe results of our study revealed that a quarter of dermatologists in SA are Saudis. In addition, the number of non-Saudi dermatologists has increased in the last 10 years, while the number of Saudi dermatologists to the population has remained almost constant. There is also a geographic maldistribution of dermatologists, with urban areas having a higher number of dermatologists than rural areas. We encourage local studies that can elucidate the factors influencing the workforce, such as the dermatologist appointment waiting time, dermatologists’ working hours, and the geographic maldistribution of dermatologists in the country.

Diversifying the dermatology workforce: Physician characteristics vary by race/ethnicity

BackgroundIn the United States (US), dermatology remains one of the least diverse specialties in medicine. Increasing the diversity of the dermatology workforce is essential for reducing health disparities. ObjectiveTo describe the experiences of racially and ethnically diverse physicians in the US who successfully matched into dermatology. MethodsBoard-certified dermatologists and dermatology residents were recruited to participate in an anonymous, online survey in which self-reported demographic, socioeconomic, pre-residency, and post-residency career data were obtained. ResultsOf the 100 participants included in the study, 30% were dermatology residents and 25% belonged to a group underrepresented in medicine (UIM). Black physicians were 3.69 times more likely to select dermatology prior to medical school (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.04 – 13.0) compared to non-Black physicians. UIM dermatologists and trainees were more likely to receive a need-based scholarship in medical school (OR, 4.37; 95% CI, 1.30 – 14.7), graduate from a private medical institution (OR, 6.49; 95% CI, 1.95 – 21.6), and have at least one UIM dermatology mentor during medical school (adjusted OR, 13.1; 95% CI, 2.77 – 61.5) compared to non-UIM physicians. ConclusionsA holistic review of dermatology applicants by residency programs may reduce racial/ethnic disparities in the admission process. Our data provide further evidence in support of pre-medical outreach programs, mentorship, and institutional funding to promote diversity in dermatology.