INTRODUCTION
A shortage of United States (US) dermatologists exists. In 2023, US dermatologist density was 3.7 per 100,000, below the suggested 4 per 100,000.1 Geographic nonuniformity of dermatology clinicians amplifies this problem.2 Nonphysician-clinicians have supplemented dermatologists to mitigate geographic disparities.3 With addition of dermatology physician assistants (DPAs), 2016 density of US dermatologyclinicians was 4.14 per 100,000.1 The growing disparity of dermatology-clinician density between urban and rural regions can negatively impact access to care.2 The purpose of this study was to assess changes in density and geographic distribution of US dermatology clinicians vs 2016 data1 and how these trends may impact access to care.
MATERIALS AND METHODS
A cross-sectional analysis was performed to determine the number of currently practicing US dermatologists, DPAs, and dermatology nurse practitioners (DNPs) by US postal sectioncodes (first 3 digits of ZIP codes) in 2023. Membership data were obtained from the American Academy of Dermatology (AAD), Society of Dermatology Physician Assistants (SDPA), and Society of Dermatology Nurse Practitioners (SDNP). DPAs and DNPs were defined as physician assistants (PAs) and nurse practitioners (NPs), respectively, who identify as primarily providing dermatologic care. US Census Bureau population data were used to calculate dermatology clinician density. Data from 2023 were compared with a 2017 study using the same methodology.2 Gini coefficient, a measure of population nonuniformity used in clinician distribution studies,4 was calculated to measure the degree of geographic density inequality of US dermatology clinicians.
RESULTS
There were 16,156 (12,120 dermatologists, 3,709 DPAs, and 327 DNPs) US dermatology clinicians in 2023. Overall density was 4.87 per 100,000. There was an 18.4% increase in dermatology clinicians and a 15.5% increase in overall density since 2016. Number of section-codes with greater than or equal to 4 per 100,000 dermatology clinicians increased by 55.5%, while those with <4 per 100,000 decreased by 31.4%. Section-codes having greater than or equal to 1 dermatology-clinician rose by 5.9%. Dermatology clinicians in the 100 most-populated section-codes increased by 37.4%. Gini coefficient was 0.50. Table 1 summarizes trends in the dermatology clinician workforce; Figure 1 depicts the 2023 density.
DISCUSSION
There has been an increase in dermatology-clinician density since 2016. As the suggested density is 4 per 100,000,1,2 our results show that DPA and DNP workforce augmentation helps achieve this target. There are now more section-codes achieving this density and fewer section-codes without a dermatology clinician vs 2016, suggesting an overall increase in coverage for dermatologic care. However, the Gini coefficient (0.50) indicates that a high geographic nonuniformity remains.
Dermatology clinician density has increased more substantially in urban areas.2 Furthermore, the absolute density of dermatologists has decreased in rural regions.1 Given the positive correlation between dermatologist density and patient outcomes, this trend raises concerns about access to care. Thus, patients requiring dermatologic services may need to wait longer or turn to clinicians who may not have specialized training in dermatology. Adding DPAs and DNPs to the rural workforce could mitigate the impact of this finding.
Dermatology clinician density has increased more substantially in urban areas.2 Furthermore, the absolute density of dermatologists has decreased in rural regions.1 Given the positive correlation between dermatologist density and patient outcomes, this trend raises concerns about access to care. Thus, patients requiring dermatologic services may need to wait longer or turn to clinicians who may not have specialized training in dermatology. Adding DPAs and DNPs to the rural workforce could mitigate the impact of this finding.
