Dermatologist shortage fuels mounting wait for office visits

National report - Why does it take so long for patients to get dermatology appointments?

"There's clearly a shortage of dermatologists in the United States," says Alexa Boer Kimball, M.D., M.P.H., director, clinical trials, and assistant professor, dermatology, Stanford University Medical Center. She also chairs the American Academy of Dermatology's Workforce Task Force. "There are a number of reasons for that shortage," she says. "But what we're seeing, clearly, is that the wait times to get in to see dermatologists are longer than we would typically think are within the realm of good patient care."

"I don't think anybody has a specific goal," Dr. Kimball says. "But most patients, it turns out, would really like to be seen within two weeks."

Average wait: 24 days

According to a recent survey of physician appointment wait times by Merritt, Hawkins & Associates, that's not happening in most markets. The company reached a total of 269 randomly selected dermatologists in 15 major cities and requested a routine skin exam to detect possible carcinomas and melanomas. Responses revealed an average wait time of 24.3 days, with results in specific cities ranging from nine days in New York to 50 days in Boston.

Barbara Gilchrest, M.D., chief of dermatology at Boston Medical Center and professor and chair of dermatology at Boston University School of Medicine, says, "One of the issues is that we are a medical center with academic programs. I spend most of my time doing research and administration, and a relatively small portion of time doing clinical care. And that's true for many of the dermatologists in the Boston area. So not everybody who counts as 'one dermatologist' is seeing patients all week. They may see patients one to three sessions a week instead of eight or nine."

That said, no dermatologist likely would deny an appointment within 24 hours to a patient whose condition truly was urgent, she says.

"It's not that people think they're dying of melanoma but cannot be seen in a practice," says Dr. Gilchrest.

Rather, criteria for short-notice scheduling vary somewhat from practice to practice. And they often require interpretation.

At Boston Medical Center, calls from referring physicians' offices or well-informed patients with concerns about malignant processes (i.e., changing moles) often take priority. So do calls from patients suffering severe discomfort.

Conversely, Dr. Gilchrest says, "We do get some crazy calls. Some patients have an excellent sense of what is urgent, and others don't. I had somebody who wanted to see me on an urgent basis a couple weeks ago. We weren't sure what the person was describing, so we had him come in. What he had was a tan."

A judgment call Other cases are less comical.