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

Dermatologists may seem to be in short supply or just difficult to see because of the increased demand for specialty care, particularly in the arenas of skin cancer and skin rejuvenation.  There is certainly an epidemic of both skin cancer and ageing in the United States.  This phenomenon is more prevalent in the sun-belt states where healthy adults enjoy their retirement with daily outdoor recreation.

Cosmetic procedures such as injections of Botox for wrinkles and facial fillers like Restylane and Juvederm, laser resurfacing, laser removal of enlarged blood vessels, brown sun spots, and tattoos are all very popular and in high demand.  Naturally, the time  spent learning and practicing these techniques to get good results subtracts from the Dermatologist’s time to see acne, warts, or rashes.

What can Dermatologists do to help make appointments available without reducing the amount of time spent with the patient?

We can see patients with certain problems less frequently.  For example, full body skin screening exams may be done once annually for low risk patients instead of twice per year.  Acne follow up exams may be performed every 3-6 months instead of monthly (unless the patients are taking Accutane).  Patients with psoriasis may rechecked every 12 weeks instead of every 6 weeks.

Priority appointments should be reserved for certain conditions or complaints, for example, a rapidly changing black mole, an abrupt flare up of acne or psoriasis, or painful blisters on the trunk (shingles).  Most Dermatologists already add patients at the end of the morning and afternoon sessions, extending the work day while accommodating patients when the schedule is full.

How can Patients help?

  1. Keep scheduled appointments or cancel a few days in advance (not one hour before!) so that another patient can take your time slot.
  2. Avoid no-showing.  It wastes the doctor’s and staff’s time and takes the slot away from someone on the waiting list.
  3. Arrive on time, or better yet, come early, and you may be seen early.

Finally, there is something that we can all do to improve access to dermatological care.  Hire, train, and accept physician assistants and nurse practitioners as extenders of the Dermatologist.  These professionals can evaluate rashes and growths, perform skin biopsies and other diagnostic tests, and prescribe most medicines for patients who need to be seen more urgently, usually within a week of the call.  The Dermatologist will review the case with the mid-level provider at the time of the initial visit or see the patient at their follow up visit.  There are currently over 1500 dermatological physician extenders in practice, thus it appears that the concept is being received favorably by all concerned.

More About Dermatology and Society:
Why Does It Take So Long to Get an Appointment With a Dermatologist? (Part I)
Importance of the Second Opinion: Editorial with Illustrative Cases

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