Dermatologist Workforce Mobility: Recent Trends and Characteristics.

Author Affiliations: Department of Dermatology, University of California, San Francisco School of Medicine (Zakaria, Abuabara, Fox, Amerson, Chang); School of Public Health, University of California, Berkeley (Abuabara); Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California (Szumowski, Amerson, Chang); Division of HIV, ID, and Global Medicine, Department of Medicine, University of California, San Francisco (Szumowski); University of California, Davis School of Medicine, Davis (Kim-Lim).


Dermatologist Workforce Mobility: Recent Trends and Characteristics
Job hopping and other forms of medical practice separation increase operational costs to health care systems and affect patient experiences owing to discontinuity of care and access gaps. 1 We sought to determine how frequently dermatologists separate from their practices and to identify physician and practice characteristics associated with practice separation.Because the study used only publicly available administrative datasets, it was exempted from review and approval by the Institutional Review Board of University Hospitals Cleveland Medical Center and informed consent was waived.

Figure. US Geographic Distribution of the
Practice separation was defined as a dermatologist belonging to a medical position that was removed from the data set in the subsequent year.We determined the rate of practice separation for each year and cumulatively as the total proportion of 2014 practices separated by 2020, by both physician and practice char-acteristics.Lastly, a multivariable logistic regression model was conducted to determine physician and practice characteristics that were associated with cumulative separation by 2020.All calculations were conducted from August 1, 2021, to December 1, 2021, using R statistical software, version 4.0.2(R Foundation for Statistical Computing); tests were 2-tailed; and significance was defined as P < .05.
Discussion | The findings of this cross-sectional study demonstrate that a total of 51.3% of dermatologist positions were separated from 2014 to 2020, with practice separation more commonly occurring in medium-and large-sized practice groups and among early-and late-career dermatologists.Practice separation was also more common in certain geographic areas, ie, the Northeast and West regions.Interestingly, in contrast to radiology practices, those with academic ties were associated with increased odds of separation. 4 It is also worth noting that we did not find a significant difference in practice separation by sex, dermatologic subspecialty, and urban or rural setting.
The study limitations were an inability to determine the reason for practice separation, inclusion of only dermatologists participating in Medicare and included in the Physician Compare Database, incomplete verification for years since training and practice type, and practice buyouts or mergers leading to potential overestimation of true separation.Potential reasons for voluntary separation suggested by prior research 4,5 include higher pay, improved administrative support, burnout, and poor work relationships.While increased practice separation among early-career dermatologists may be inherent for all new dermatologists, monitoring is warranted because a younger generation of dermatologists, comprising more of the overall workforce, may increase dermatologist workforce mobility in the future. 1,6omas B. Cwalina, MBA Rishabh S. Mazmudar, BS Jeremy S. Bordeaux, MD, MPH Jeffrey F. Scott, MD a Defined as the time between the current year and medical school graduation minus 5 years (4-year residency plus 1-year fellowship).b Obtained from the National Provider Plan and Provider Enumeration System data set using the NPI (national provider identifier number).c Categorized as academic if practice name included the following text strings: univ, faculty, college, and/or school; all practices with >500 members were manually checked for accuracy.

OBSERVATION Treatment of Progressive Nodular Histiocytosis With Baricitinib
Progressive nodular histiocytosis (PNHC) is an extremely rare non-Langerhans cell histiocytosis characterized by hundreds of yellow-brown papules and nodules without spontaneous resolution. 1,2To our knowledge, few cases of PNHC have been reported, and treatment is often unsuccessful.Surgical resection and electrodesiccation are often used to treat disfiguring and dysfunctional bulky masses, but the lesions tend to re-

Total Percentage of Separations From Dermatologist Positions in 2014 to 2020
2We excluded dermatologists who were likely to be in training, ie, within 5 years of medical school graduation; in a solo practice; practicing outside of the 50 US states and the District of Columbia; and with fewer than 1000 relative value units billed in the separate Medicare Provider Utilization and Payment Data file.3