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Original Investigation
November 2018

Comparison of Dermatologist Density Between Urban and Rural Counties in the United States

Author Affiliations
  • 1The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
  • 2Yale University School of Medicine, New Haven, Connecticut
JAMA Dermatol. 2018;154(11):1265-1271. doi:10.1001/jamadermatol.2018.3022
Key Points

Questions  What are the longitudinal dermatologist density trends, and are there urban and rural disparities?

Findings  In this study county-level data from the Area Health Resources File, from 1995 to 2013, dermatologist density increased the most in rural followed by nonmetropolitan and metropolitan counties; however, the gap between metropolitan and other areas also widened. Dermatologists were heterogeneously distributed and consistently located in well-resourced communities.

Meaning  The findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time; correcting workforce disparities is important for patient care.

Abstract

Importance  As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce.

Objective  To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme.

Design, Setting, and Participants  This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists.

Main Outcomes and Measures  Active US dermatologist and physician density.

Results  In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas. The ratio of dermatologists older than 55 years to younger than 55 years increased 75% in nonmetropolitan and rural areas (from 0.32 to 0.56) and 170% in metropolitan areas (from 0.34 to 0.93). Dermatologists tended to be located in well-resourced, urban communities.

Conclusions and Relevance  Our findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time. Correcting the workforce disparity is important for patient care.

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