Why Does It Take So Long to Get an Appointment With a Dermatologist? (Part I)

photo of Rivershase Dermatology/Camisa Psoriasis Center staffBefore I begin to answer this question, let us review the definition of a Dermatologist. A Dermatologist is a licensed physician, MD or DO in the U.S. who has completed at least 3 years of post-graduate residency training in Dermatology. A Dermatologist specializes on the diagnosis and treatment of diseases of the skin, hair, and nails. Treatment includes medicines and surgical procedures.

Some Dermatologists take additional post-residency training or fellowships to gain special skills and expertise in Immunology, Pediatric Dermatology, Dermatopathology, and Skin Cancer Surgery, for example. A Board Certified Dermatologist is one who has completed the accredited training program and passed a rigorous two-day written and visual examination.

It has been estimated that 3-4 Dermatologists are needed to care for a population of 100,000, and we currently have 3.2. Therefore, any perceived shortage or excess of Dermatologists is based on where you live, the local population, and the number of Dermatologists who serve the area. If you live in a big city with a medical school and a teaching hospital, there is most likely an abundance of Dermatologists. If you reside in a rural or semirural area, it is likely to be underserved by Dermatologists, and you may have to travel long distances to see one.

There are other factors to consider. Doctors are people with families, and they prefer to live in desirable locations. They also do not like to move frequently and often choose to settle near their training programs. Even though cities like New York, Boston, Los Angeles, and San Francisco boast a high density of Dermatologists, it may still be difficult to get an appointment in less than four weeks.

The number of newly minted Dermatologists has risen from about 300 per year to over 400 per year in the last 30 years, keeping pace with the growth of the U.S. population. However, the composition of the workforce has changed in various ways. The majority of new Dermatologists are women. Female doctors generally spend more time with patients and as a result see fewer patients per day. Older Dermatologists, mostly men, frustrated by government regulation of their businesses and the difficulty collecting fees from the myriad of commercial insurance contracts and Medicare “advantage” plans, are either cutting back work-hours or simply retiring early.

Dermatologists are not a homogeneous group. The interest levels, skill sets, and subspecialties of Dermatologists are quite variable. For example, some Dermatologists only wish to treat skin cancer. Perfect if you are calling about a new growth on your shoulder, but not good if you have an itchy rash. Some dermatologists will treat your psoriasis with creams or injections but do not offer ultraviolet light therapies. Some see only adults, others see only children. The point is that specialization, whether by training or by preference, limits the opportunities for General Dermatology appointments.

More About Dermatology and Society:
Why Does It Take So Long to Get an Appointment With a Dermatologist? (Part II)
When Should a Primary Care Doc Refer to a Dermatologist?

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