Closing the Gap: Why Rural Dermatology Access Must Be a Priority

A farmer in my community waited nearly 8 months to be seen for a suspicious mole. By the time he finally reached a dermatology clinic—over 2 hours away—it was melanoma. He had survived droughts and recessions, but geography nearly cost him his life. As a dermatology nurse practitioner (NP) serving a rural population, I see stories like his all too often.

The Hidden Crisis

Dermatology workforce distribution remains heavily concentrated in cities. More than 60% of US counties have no dermatologist at all, and rural patients are far more likely to face delays in skin cancer diagnosis and treatment compared with their urban counterparts.¹ These are not minor inconveniences—they are life-threatening disparities.

The Rural Reality

Prior to my practice opening 2 years ago in a rural community, patients would routinely drive 50 to 150 miles for a biopsy or follow-up visit. Many cancel because the cost of fuel or time away from work outweighs their ability to seek care. Others put off appointments altogether, hoping their condition will improve. Primary care colleagues do their best, but with limited dermatology-specific training, serious conditions are sometimes missed or caught too late.

The result is predictable: later-stage melanoma, advanced hidradenitis suppurativa, uncontrolled psoriasis, and preventable infections. These outcomes are not about patient choice—they’re about geography.

Evidence-Based Solutions Already Exist

We don’t need to reinvent the wheel—but we do need to be realistic. Teledermatology has value in triaging rashes, monitoring chronic inflammatory conditions if stable, and reducing wait times. However, it is not a substitute for comprehensive in-person care. Skin cancer screening, dermoscopy, and biopsies cannot be performed virtually. Relying solely on telemedicine risks widening the gap if we treat it as a cure-all rather than a one tool in a broader strategy.

Dermatology NPs and physician assistants (PAs) already deliver high-quality care, and in many rural communities, we are the only access point. Removing restrictive practice laws and ensuring reimbursement parity would immediately expand access.

Workforce incentives also matter. Loan repayment programs and rural training tracks have successfully improved primary care availability. Expanding those models to include dermatology is both feasible and urgent.

What Needs to Change

To close the rural dermatology gap, we must:

• Expand teledermatology infrastructure for possible conditions and reimbursement
• Advance practice authority and reimbursement equity for NPs and PAs
• Build sustainable pipelines by incentivizing dermatology training in rural regions
• Collect and publish more data on rural dermatology outcomes so disparities can’t remain invisible

Why It Matters

Skin is our most visible organ, yet access to dermatology remains invisibly unequal. As a dermatology NP caring for rural patients, I know that geography should never determine whether a melanoma is caught early or whether a child’s eczema spirals into infection.

If we fail to act, we will keep trading early cures for late-stage crises. If we succeed, we will affirm that dermatology is not a privilege of geography—it is a matter of health equity.

Amanda Caldwell, MSN, FNP-C, is a dermatology NP at US Dermatology Partners, who is passionate about serving rural communities. She is also the president-elect of the Society of Dermatology Nurse Practitioners (SNDP).

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Reference

1.Feng H, Berk-Krauss J, Feng PW, Stein JA. Comparison of Dermatologist Density Between Urban and Rural Counties in the United States. JAMA Dermatol. 2018;154(11):1265-1271. doi:10.1001/jamadermatol.2018.3022