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.

This cross-sectional study collected data from archived versions of the Centers for Medicare & Medicaid Services Physician Compare Database (2014-2020) for physicians reporting their primary specialty as dermatology.² We 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

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.

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 characteristics. 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.

We identified 12 320 dermatologists and 4283 medical practices from 2014 to 2020, with a total of 19 541 unique dermatologist or practice positions. An average annual proportion (range) of 15.4% (12.4% [2019] to 18.1% [2018]) of dermatologists separated from their positions each year. Overall, a total of 51.3% of positions in 2014 were separated by 2020. The District of Columbia (73.8%), Rhode Island (67.3%), and Missouri (61.3%) had the highest cumulative practice separation, while Vermont (30.8%) and Maine (32.1%) had the lowest (P < .001; Figure). The multivariable logistic regression model revealed that practices located in the Northeast (adjusted odds ratio [aOR], 1.19; 95% CI, 1.06-1.33) or West (aOR, 1.14; 95% CI, 1.02-1.28), those with medium (10-99; aOR, 1.17; 95% CI, 1.05-1.32) or large group size (≥100; aOR, 1.13; 95% CI, 1.02-1.27), and those in academic settings (aOR, 1.23; 95% CI, 1.07-1.40) had increased odds of practice separation (Table). Lastly, dermatologists at the beginning (1-9 years since training; aOR, 1.91; 95% CI, 1.67-2.20) and later in their careers (≥25 years since training; aOR, 1.38; 95% CI, 1.26-1.51) had increased odds of practice separation.

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.^1,6

Accepted for Publication: February 14, 2021.

Published Online: February 9, 2022. doi:10.1001/jamadermatol.2021.5862

Corresponding Author: Thomas B. Cwalina, MBA, Department of Dermatology, University Hospitals Cleveland Medical Center; Lakeside 3500, 11100 Euclid Ave, Cleveland, OH 44106 (thomas.cwalina@case.edu).

Author Contributions: Mr Cwalina had full access to all the data in the study and takes 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: Cwalina, Mazmudar.

Drafting of the manuscript: Cwalina, Mazmudar.

Critical revision of the manuscript for important intellectual content: Cwalina, Bordeaux, Scott.

Statistical analysis: Cwalina.

Administrative, technical, or material support: Scott.

Supervision: Mazmudar, Bordeaux, Scott.

Conflict of Interest Disclosures: None reported.