Non-M.D. dermatologists: Providers meet service demands - in some regions

Key Points

San Antonio - Analyses of multisource data on geographic distribution of dermatology providers reveal some positive trends, but also show persistent shortfalls in the ability to meet patient care needs in many regions of the country, according to Alexa Boer Kimball, M.D., M.P.H., who spoke at the annual meeting of the American Academy of Dermatology (AAD).

In a poster presentation, Dr. Kimball reports the findings of a study designed to examine if non-M.D. clinicians - including D.O. dermatologists and physician extenders - are helping to fill existing gaps in the dermatology work force.

The results show the D.O. dermatologists were generally continuing to aggregate in the states where they received resident training. The numbers of physician extenders were rising in states with rapidly rising aging populations or a high prevalence of patients with photodamage (e.g., Florida, Arizona), but also in some areas where an M.D. dermatologist work force shortage is more severe.

"In the setting of a persistent work force shortage and geographic maldistribution of M.D. dermatologists, we thought it important to assess how dermatology services are being provided by D.O.s, physician assistants (P.A.s), and nurse practitioners (NPs)," says Dr. Kimball, associate professor of dermatology, Harvard Medical School, Boston.

"Overall, the news appears to be good, because we are seeing that non-M.D. providers are filling some of the gaps. However, the numbers of these clinicians are still too few to have any major impact on the overall geographic maldistribution in terms of improving patient access to dermatology care," Dr. Kimball tells Dermatology Times.

Data for the analyses were derived from the 2004 U.S. census and membership surveys of the AAD, America Osteopathic Association, American Academy of Physician Assistants, the Dermatology P.A. Association and the American Academy of Nurse Practitioners.

Density for the various providers was calculated per state and reported as the number of providers per 100,000 population.

The results showed the M.D. dermatologists continued to aggregate in large metropolitan regions along the coasts and, particularly, in the densely populated Northeast states, where the M.D. dermatologist densities ranged from 3.4 to 4.9 per 100,000 population.

States with the lowest densities of M.D. dermatologists were represented mostly by several states in the Midwest and Great Plains regions, where there were, in some cases, fewer than two M.D. dermatologists per 100,000 population.

The states with the highest density of D.O. dermatologists tended to be those where there are the highest number of D.O. dermatology residency positions - Michigan, Florida, Ohio, Pennsylvania, Arizona, California, Missouri, Texas and Nevada.

Density data on the physician extenders showed they were most well-represented in states with greater rural areas, and where the density of M.D. dermatologists also tended to be low, including Nevada, Idaho, Nebraska, Iowa and West Virginia.

The data were also analyzed to determine the density of the various providers in states with the highest proportion of older residents (ages 65 and above).

The top five states in this category had high densities of M.D. dermatologists and dermatology P.A.s and also were among the leading states with respect to the ratio of P.A.s to M.D. dermatologists.

"These data suggest that states with rising aging populations have an expanding demand for physician and physician extender dermatology services," Dr. Kimball says.

"Since the biggest absolute recent increases in the dermatology work force have been in the P.A. work force, it's logical that states with recent increases in demand would be meeting the demand with P.A. employment," she says.