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Figure.
US Dermatology Provider Density by 3-Digit ZIP Code
US Dermatology Provider Density by 3-Digit ZIP Code

The number of dermatology providers practicing per 100 000 people in each 3-digit postal section code is indicated by the colors on the map. Section codes without a dermatology provider are included in white. Note that the Great Lakes are included in US section coding and do not appear on the map.

Table.  
Changes in Dermatology Provider Density for the Addition of DPAsa
Changes in Dermatology Provider Density for the Addition of DPAsa
1.
Glazer  AM, Farberg  AS, Winkelmann  RR, Rigel  DS.  Analysis of trends in geographic distribution and density of US dermatologists  [published online February 1, 2017].  JAMA Dermatol. doi:10.1001/jamadermatol.2016.5411.Google Scholar
2.
Aneja  S, Aneja  S, Bordeaux  JS.  Association of increased dermatologist density with lower melanoma mortality.  Arch Dermatol. 2012;148(2):174-178.PubMedGoogle ScholarCrossref
3.
Glazer  AM, Holyoak  K, Cheever  E,  et al.  Analysis of US Dermatology Physician Assistant Density.  J Am Acad Dermatol. 2016. In press.Google Scholar
4.
Kimball  AB, Resneck  JS  Jr.  The US dermatology workforce: a specialty remains in shortage.  J Am Acad Dermatol. 2008;59(5):741-745.PubMedGoogle ScholarCrossref
5.
Resneck  JS  Jr, Kimball  AB.  Who else is providing care in dermatology practices? Trends in the use of nonphysician clinicians.  J Am Acad Dermatol. 2008;58(2):211-216.PubMedGoogle ScholarCrossref
6.
Arnold  T.  Physician assistants in dermatology.  J Clin Aesthet Dermatol. 2008;1(2):28-31.PubMedGoogle Scholar
Research Letter
May 2017

Analysis of Trends in Geographic Distribution of US Dermatology Workforce Density

Author Affiliations
  • 1National Society for Cutaneous Medicine, New York, New York
  • 2Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York
JAMA Dermatol. 2017;153(5):472-473. doi:10.1001/jamadermatol.2016.6032

The demand for dermatologic care is rising. Dermatologist density in the Unites States has increased over the past decade and is currently estimated at 3.4 per 100 000 individuals.1 However, it is still below the suggested 4 per 100 000 population needed to adequately care for a community.1 Increased dermatologist density has been associated with lower melanoma mortality rates and improved diagnosis of skin disease.2 Therefore, dermatologist density is of critical importance and may lead to lower skin disease economic burden.

In addition to the undersupply, there is also a material geographic variance of dermatologists throughout the United States leaving some areas underserved.1 Dermatologists are now being supplemented by nonphysician clinicians which may help to correct for the dermatology provider shortage. The purpose of this study was to examine the combined geographic distribution of dermatologists and dermatology physician assistants (DPAs) to determine overall dermatology provider density and how this combination may potentially be augmenting access.

Methods

Membership data and geographic data on practicing dermatologists and DPAs were obtained from the American Academy of Dermatology (AAD) and the Society for Dermatology Physician Assistants (SDPA). The data were combined and total dermatology provider-to-population ratios were calculated using population data obtained from the US Census Bureau for 3-digit ZIP code locations (section codes). Adjacent section codes were combined where appropriate. Institutional review board approval was waived because this study did not report on data involving human subjects.

Results

The 2016 total number of dermatology providers was 13 365 (10 845 dermatologists and 2520 DPAs) yielding an overall density of 4.14 per 100 000 individuals. Of the 734 section codes containing at least 1 dermatology provider, 22 (3%) contained only DPAs. By including DPA coverage, the number of section codes containing less than 3 dermatology providers per 100 000 individuals decreased from 59.8% to 47.4% when accounting for dermatologists alone. With the combined data, the percentage of section codes containing greater than 4 providers per 100 000 increased from 27.7% to 40.2%. Overall, 35.0% of dermatology providers practiced in the 100 densest section codes compared with just 1.5% in the 100 least dense section codes. Differences between data on physicians only vs total dermatology providers are summarized in the Table.

Discussion

Including DPAs in dermatology workforce calculations increases the average US dermatology provider density to more than 4 per 100 000 individuals, which is the number that has been suggested to adequately care for a population. Dermatologists and DPAs in the United States are both nonuniformly geographically distributed.1,3 However, dermatologists tend to be more concentrated in major urban areas and academic centers vs DPAs in somewhat less populous regions. Analysis of the distribution combining both groups therefore leads to a broader, more uniform coverage and potentially extends access (Figure). Adding DPAs to the dermatology provider pool augments care away from the 100 most dense section codes suggesting that DPAs may extend care benefit to communities that were previously underserved.

Dermatologists alone have been unable to meet increasing patient demand for dermatologic services. The number of dermatology residency training positions has been relatively stagnant, suggesting that the current supply of dermatologists in training will be insufficient to fully meet growing future demand.4 This gap is being filled in part by a substantial of influx of physician assistants into the field of dermatology.5 The increasing numbers of physician assistant training programs and slots coupled with shorter required training periods for physician assistants suggest a continuation of this trend in the dermatology workforce provider mix.6 However, to better correct the geographic maldistribution and its impact on access, initiatives may need to be developed that will incentivize both dermatologists and DPAs to relocate to underserved regions.

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Article Information

Corresponding Author: Alex M. Glazer, MD, National Society for Cutaneous Medicine, 35 E 35th St, Ste 208, New York, NY 10016 (alexglazer@gmail.com).

Correction: This article was corrected on April 12, 2017, for an error in the figure key.

Published Online: March 15, 2017. doi:10.1001/jamadermatol.2016.6032

Author Contributions: Drs Glazer and Rigel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, or material support: Glazer.

Conflict of Interest Disclosures: None reported.

References
1.
Glazer  AM, Farberg  AS, Winkelmann  RR, Rigel  DS.  Analysis of trends in geographic distribution and density of US dermatologists  [published online February 1, 2017].  JAMA Dermatol. doi:10.1001/jamadermatol.2016.5411.Google Scholar
2.
Aneja  S, Aneja  S, Bordeaux  JS.  Association of increased dermatologist density with lower melanoma mortality.  Arch Dermatol. 2012;148(2):174-178.PubMedGoogle ScholarCrossref
3.
Glazer  AM, Holyoak  K, Cheever  E,  et al.  Analysis of US Dermatology Physician Assistant Density.  J Am Acad Dermatol. 2016. In press.Google Scholar
4.
Kimball  AB, Resneck  JS  Jr.  The US dermatology workforce: a specialty remains in shortage.  J Am Acad Dermatol. 2008;59(5):741-745.PubMedGoogle ScholarCrossref
5.
Resneck  JS  Jr, Kimball  AB.  Who else is providing care in dermatology practices? Trends in the use of nonphysician clinicians.  J Am Acad Dermatol. 2008;58(2):211-216.PubMedGoogle ScholarCrossref
6.
Arnold  T.  Physician assistants in dermatology.  J Clin Aesthet Dermatol. 2008;1(2):28-31.PubMedGoogle Scholar
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