The distribution of dermatologists in the United States varies substantially based on geographic location. In a survey of dermatologists by the American Academy of Dermatology (AAD) Association, 38% (and 51% in rural areas) reported believing that the supply of dermatologists in their community was less than required.1 In 2009 we last reported on the density of dermatologists in the United States, which revealed a material geographic maldistribution with some areas being underserved.2 The purpose of this study was to provide updated information on US dermatologist density to identify areas of the country that continue to be underserved while examining for changes in maldistribution.
Data on the number of practicing American dermatologists including fellows, osteopathic fellows, and associates were obtained from the AAD membership database. The AAD database included deidentified geographic information consisting of zip codes, cities, and states. Dermatologist-to-population ratios were calculated using the AAD data and population data obtained from the US Census Bureau for 3-digit zip code locations (section codes). Adjacent section codes were combined when appropriate. Compound annual growth rates (CAGR) for dermatologists and density were determined to assess the annual percentage growth over the 7-year period since the prior study.2 Institutional review board approval was not applicable because this study did not report on data involving human participants.
The 2016 AAD database contained 10 845 practicing American dermatologists compared with 9598 in 2009, a 1.76% CAGR. There are now almost 3.4 dermatologists per 100 000 persons, increased from 3.2 in 2009. Of the 712 section codes containing at least 1 dermatologist, 515 (72.3%) had fewer than 4 dermatologists per 100 000 persons. The 10 highest and lowest dermatologist density locations found in 2016 are compared with 2009 in the Table. The average density of dermatologists in the 10 highest section codes was 23.3 per 100 000, a decrease from 25 in 2009 (−1% CAGR). Overall, 38.6% of dermatologists in the AAD database practice in the 100 densest section codes compared with just 1.8% in the 100 least dense section codes.
Dermatologists are unevenly geographically distributed, with most practicing in dermatologist-dense areas, typically in or near big cities or large academic centers (Figure). There appears to have been only a minimal shift in the dermatologic workforce distribution. This analysis is consistent with literature demonstrating an undersupply of dermatologic services in the US.3 Despite increases in overall density, over 70% of section codes with at least 1 practicing dermatologist have less than 4 per 100 000 (the estimated number needed to adequately care for a population), with nearly 60% having less than 3 per 100 000.
The demand for dermatologic services is increasing with an aging population and rising rates of skin cancer and other skin diseases. A higher density of dermatologists in a given geographic area has been associated with more effective diagnosis and improved patient outcomes including a lower melanoma mortality rate.4,5 This provides an additional impetus to correct the current undersupply and maldistribution. Initiatives may need to be developed to incentivize dermatologists to practice in underserved areas.
There are almost 500 dermatologists that enter the workforce postresidency each year with approximately 325 leaving, leading to a net CAGR of 1.76%. The US population is increasing annually at 0.8%, suggesting that this shortage may be slowly improving but will still be present for many years. Part of this gap may be supplemented by the substantial influx of nonphysician dermatology mid-level clinicians. Nonetheless, the supply of new dermatologists is limited by the number of residency training slots available. Without increasing those positions, many regions will most likely experience a continued supply shortage of formally trained dermatologists over the upcoming years.
Corresponding Author: Alex M. Glazer, MD, Clinical Research Fellow, National Society for Cutaneous Medicine, 35 E 35th St, Ste 208, New York, NY 10016 (alexglazer@gmail.com).
Accepted for Publication: November 15, 2016.
Published Online: February 1, 2017. doi:10.1001/jamadermatol.2016.5411
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: Glazer, Farberg, Rigel.
Acquisition, analysis, or interpretation of data: Glazer, Winkelmann, Rigel.
Drafting of the manuscript: Glazer, Rigel.
Critical revision of the manuscript for important intellectual content: Glazer, Farberg, Winkelmann.
Statistical analysis: Glazer, Rigel.
Administrative, technical, or material support: Glazer, Farberg, Rigel.
Supervision: Farberg, Winkelmann.
Conflict of Interest Disclosures: None reported.
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