Today's dermatologist workforce

National Report - Dermatologists and their patients nationwide are feeling the crunch. Patients are waiting longer to get appointments, and many dermatologists are searching for months - even years - to find practice associates.

No documentation These are signs of a dermatologist shortage. But, until recently, there was little data to document a workforce shortfall.

Dr. Butler, who is director of the Scott and White Northside Dermatology Clinic at Texas A&M, found answers to his workforce concerns with the release of two national dermatologist workforce surveys by the American Academy of Dermatology (AAD): The 2002 Dermatology Practice Profile Survey and 1996 Dermatology Practice Profile Survey. He compared those findings to a 2004 survey of the Texas Dermatological Society.

Measuring a shortage Measuring a shortage is not an easy task, according to Dr. Butler.

There is no direct measurement of the shortage. So, the AAD surveys measured national data by looking at several factors, including the waiting time for new patient appointments; the ability of a new practice to find or add associates; the increased use of physician extenders, such as physician assistants and nurse practitioners; and, to some extent, the refusal to accept Medicare and Medicaid and other insurances, and simply going on a cash-only basis, according to Dr. Butler.

A long time coming A lot has happened, historically, to put pressure on the national dermatology workforce.

From 1965 to 1983, federal legislation resulted in a significant increase in the number of dermatology residency positions, from 150 to 300, according to Dr. Butler. But by the late 1980s, many people felt that there was an oversupply of dermatologists; so, the government responded by pulling in the reins. By 1994, the Council on Graduate Medical Education recommended increasing the number of primary care residencies from 30 percent to 50 percent. The government then decided not to fund any additional residency training positions in dermatology in 1996. Government funding for residency training has been fixed to 300 positions since that year.

"Essentially, the shortage is a function of supply versus demand," Dr. Butler says. "On the supply side, there is a reduced supply because the number of graduating residents has not increased in 20 years in dermatology. It is remarkable, really - we are graduating the same number this year as we did in 1984."

The AAD surveys also found that there is an increased percentage of women in dermatology. However, women work 10 percent to 20 percent less hours than men in the specialty; so, their mere presence reduces the people-power, in a global sense.

Women are becoming the majority in dermatology. In 1990, the number of female dermatologists in the country was 18 percent and, in 2003, it was 33 percent. Sixty percent of the people graduating as residents from dermatology training in the year 2004 are women.

Overall, dermatologists are working fewer hours; there is a national tendency toward early retirement; and there is significant geographic misdistribution of dermatologists.

"Dermatologists want to go to the big cities and not the rural areas as much," Dr. Butler says.

While these factors are putting pressure on the supply side, there are elements increasing demand for the specialty. These include, according to Dr. Butler, not only the aging population and skin cancer epidemic, but also a broadened scope of practice for dermatologists who are offering lots of services that they did not offer in the past, including surgical and cosmetic procedures.