Analysis of Wait Times for Online Dermatology Appointments in Most and Least Dermatologist-Dense Cities

May 2020 | Volume 19 | Issue 5 | Editorials | 562 | Copyright © May 2020


Published online April 3, 2020

Laura Xiang , Shari R. Lipner

aCase Western Reserve University School of Medicine, Cleveland, OH bDepartment of Dermatology, Weill Cornell Medicine, New York, NY

There was no association between dermatologist density and wait times (r=0.1; P=0.01). As dermatologist density decreased, the mean clinic distance increased (r=-0.60; P<.00001) and as mean clinic distance increased, percentage of in-network Medicaid providers and language diversity decreased (r=-0.61and r=-0.79, respectively; P<.00001). Additionally, a positive correlation was found between dermatologist density and percentage of MD degree providers (r=0.60; P<.00001).

DISCUSSION
Wait times for dermatologists were much shorter on ZocDoc compared to the national mean wait time of 33 days in 2007.1 These findings are consistent with a previous study reporting shorter wait times for primary care appointments on ZocDoc compared to phone call scheduling.4 From our search for “dermatologist”, one-fourth of providers were not dermatologists, and these providers had shorter wait times. This, may in turn, result in many patients receiving their dermatologic care from non-dermatologists, leading to inappropriate biopsies, missed diagnoses, and treatment failures. Additionally, some clinics were over 70 miles away, which may reflect a shortage of online provider representation or low dermatologist density. These factors may have contributed to the weak correlation between wait times and dermatologist density. Alternatively, dermatologist density may not be a good indicator of wait times for locations where neighboring areas are denser, such as Jamaica, NY.

Limitations of this study include ZocDoc’s changing price structure from subscription to flat fees in select states.5 For example, in New York, the fee is $35 per new patient for general dermatologists and $80 for procedural dermatologists. Several providers became inactive after data collection, thus highlighting a possible shift away from ZocDoc in some states.

In sum, ZocDoc scheduling allows for shorter wait times for dermatologic care, however this may lead to patients receiving diagnosis and treatment from providers who are not formally trained in dermatology with negative consequences.

DISCLOSURES
The authors have no conflicts of interest to declare.
References

1. Kimball AB, Resneck JS. The US dermatology workforce: A specialty remains in shortage. J Am Acad Dermatol. 2008;59(5):741-745. doi:10.1016/j. jaad.2008.06.037
2. Glazer AM, Farberg AS, Winkelmann RR, Rigel DS. Analysis of Trends in Geographic Distribution and Density of US Dermatologists. JAMA Dermatology. 2017;153(4):322. doi:10.1001/jamadermatol.2016.5411
3. How Search Works | Zocdoc. https://www.zocdoc.com/about/how-searchworks/. Accessed July 18, 2019.
4. Kurtzman GW, Keshav MA, Satish NP, Patel MS. Scheduling primary care appointments online: Differences in availability based on health insurance. Healthcare. 2018;6(3):186-190. doi:10.1016/j.hjdsi.2017.07.002
5. Farr C. Doctor booking app Zocdoc will start charging a new patient fee despite objections from some providers.https://www.cnbc.com/2019/01/29/ zocdoc-moves-ahead-with-its-new-business-model-change.html. Published January 29, 2019.

AUTHOR CORRESPONDENCE

Shari R. Lipner MD PhD shl9032@med.cornell.edu