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Dermatology: Supply and Demand

Dermatologists specialize in a branch of medicine that focuses on the diagnosis and treatment of diseases of the skin, hair and nails. Medical dermatologists treat several common skin conditions such as acne, dermatitis, warts, psoriasis, rosacea, eczema, skin cancer detection, skin growths/infections, nail disorders, and hair loss. Mohs surgeons and dermatologic surgeons trained by the fellowship are experienced in the evaluation and treatment of skin cancer, the destruction and excision of benign, premalignant and malignant skin lesions, nail surgery and the evaluation and the treatment of skin cancer using micrographic surgery and Mohs facial reconstruction.

The current demand for dermatologists far exceeds the supply. Dermatologists see women and men in relatively equal numbers and see all age groups, but the majority of dermatology visits are from patients aged 10 to 55 and over 65. Given the skin cancer epidemic (over a million cases per year) and the aging population, dermatologists are in very high demand with an average wait of 6-8 weeks to see one . Nationally, the ratio of dermatologists to patients is approximately 1:33,000, but is much higher in rural areas. These proportions have been similar for several decades.

Because it is very difficult to develop new dermatology training programs and given the fact that several dermatology residencies have folded in recent years, it is nearly impossible to increase the number of dermatologists in a reasonable amount of time. Recently, some dermatologists have specialized in cosmetics, so they do not treat skin cancers or offer medical dermatology. Also about 65% of dermatologists are over 54 and will be retiring soon, adding to the shortage. Because dermatology is currently one of the three most competitive specialties in medicine, there are very few foreign medical students who can enter residency training programs, such as internal medicine or family practice programs. The relatively high percentage of women entering the dermatology workforce in less than full-time positions also limits the number of patients who can be seen. All these factors will continue to ensure the need for good dermatologists for many years to come.

Health care reform is a mild concern for dermatologists, as it could mean cuts in Medicare reimbursement, but given that it can be changed with each new presidential administration and given the fairly recent abysmal failure of the HMO experiment, the likelihood that the patients tolerate lower insurance coverage. /care and higher insurance premiums, is low.

Mohs surgeons are also in high demand, especially in rural areas. Like many specialists, Mohs surgeons are concentrated in large urban centers, but there are several Mohs surgeons who serve rural areas and have very busy practices. Given the skin cancer epidemic, higher cure rates, and cost-effectiveness of Mohs micrographic surgery, it will remain the gold standard for the treatment of non-melanoma skin cancer in the head and neck and elsewhere of the body that require tissue preservation.

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