Dermatology faces a potentially serious problem regarding patient access to adequate care. The following five suggestions are practical opportunities to improve the ever-growing backlog of patients in need of dermatologic care.
Throughout our short careers, our research and clinical interests have focused on improving access to dermatology, especially where there are disparities in care. Once we began practicing, these research interests were separately confronted with the reality that access to dermatology care was not improving.1,2 While there are few studies demonstrating possible solutions to the access issue, many of those solutions are potentially impractical and daunting to implement.3 For example, while teledermatology has been touted as a solution to access, the capital expenditure, limited reimbursement, and medical liability are formidable barriers to implementation.
Moreover, the most obvious change is perhaps the most contentious of all. If one wants to see more patients, one likely needs to add more physicians or advanced practice providers (APPs).2,4 A problem faced by dermatology is the workforce shortage due to fixed residency slots, limited graduation medical education funding, and decreased density of dermatologists in rural and suburban areas. This has contributed to the increased use of APPs in dermatology.4 There has been a lot of debate as to whether APPs have alleviated the shortage since they are predominantly located in urban areas, and many of them are increasingly performing cosmetic and surgical procedures, rather than medical dermatology.5-8 What most people can agree on is that we need more well-trained clinicians to see our patients. Whether it is dermatologists who are committed to medical and surgical dermatology or APPs who are appropriately trained and supervised, we need qualified professionals to ease the backlog of patients to be seen.
Therefore, we wondered what individual practitioners could do (or were already doing) in their practice to improve patient access. We identified these five suggestions that may apply to the practicing dermatologist.
Minimally Increasing Clinic Hours
If you are not able to bring new clinicians on board, it may be possible to slightly increase hours worked to improve patients’ access to dermatology. A lesser known reason for the workforce shortage is the effective decline in physician working hours for medical and surgical dermatology. As more dermatologists choose part-time schedules or devote more of their working hours to cosmetic dermatology, the workforce supply to perform medical and surgical dermatology will decrease.6 If one provider in the practice worked for one more hour per week, they could help at least three additional patients per week, which would lead to well over 100 patients per year. This number is sizeable, and for each patient, this is meaningful. Working more does not have to be a big change to our already busy lives. It is possible to build it into an earlier morning start time that can seamlessly blend in with our week.
Meet a Rural or Suburban Primary Care Group
We often gripe about how we would love to see the “sick” and “marginalized” patients, but those patients just do not show up at our doorstep. One reason might be that those patients do not know that we exist or that we are the experts for certain conditions. We all have had moments when we speak about our day at work to friends and family, and they comment, “Oh, do dermatologists also take care of [condition]?”–you can fill in the blank. Yes, we treat nail disease, hair disorders, autoimmune diseases, and skin cancers, in addition to wrinkles and photoaging. As much as we would like to think that our physician colleagues know about our clinical repertoire, many do not know about what to do or where to find us. Thus, we can go to them.9
Doing a quick online search can get you the top three primary care groups in a rural or suburban location near you. Once you have this information, you can send these practices a simple letter introducing your practice and your clinical expertise. Although many of the patients from these practices may not have compatible insurance, you just might be surprised at who shows up at your doorstep.10
Dedicated Urgent Appointment Slots
When one of the authors started at her new practice, her availability made her the “go-to” person for urgent appointments. She initially underestimated the number of patients who would want to make appointments to see a dermatologist within a week, and she has since been surprised. Each day, she has around five patients who have a new concerning lesion or a very uncomfortable eruption who want to be seen. At the end of those appointments, these patients have so much gratitude from being seen. This made us wonder about whether there is a sustainable way of seeing urgent patients. Going forward, that author will have one appointment a day that can only be filled no further than one week before with an urgent appointment.11 Full skin checks or other nonurgent appointments can be seen at the next available visit, but if there truly is no urgent patient to be seen, that slot can be given on the day before.