Dermatology workforce projections in the United States, 2021 to 2036.

BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Systemic Photoprotection in Skin Cancer Prevention: Knowledge among Dermatologists.

BACKGROUND: Systemic photoprotection (i.e., administration of substances such as nicotinamide, carotenoids, and vitamin D) may be important to reduce photocarcinogenesis or to support long-term protection against UV irradiation. Clinical trials showed that oral nicotinamide is effective in reducing the onset of new nonmelanoma skin cancers (NMSCs), while other oral photoprotectors failed to achieve the reduction of new melanoma or NMSC formation in humans. The aim of this study was to summarize the current state of knowledge of systemic photoprotection and to evaluate the knowledge and attitude of dermatologists regarding these treatments. METHODS: The survey was conducted on a sample of dermatologists recruited according to a snowball sampling procedure. The questionnaire consisted of a first part asking for characteristics of the participant and a second part with 12 specific questions on their knowledge about systemic photoprotection, particularly their knowledge of astaxanthin, ß-carotene, nicotinamide, and vitamin D3. RESULTS: One hundred eight dermatologists answered the survey. Most of them (85.2%) stated that oral photoprotectors have a role in the prevention of skin cancer, and responses mainly mentioned nicotinamide. More than half of them (54.6%) had prescribed all the considered oral photoprotectors, but the majority of them had prescribed nicotinamide, mainly for 2 to 3 months during summer, almost invariably (n = 106) associated with topical photoprotectors. Most dermatologists (>80%) were aware of scientific publications demonstrating an effect of systemic photoprotectors on NMSC. CONCLUSIONS: Most Italian dermatologists have positive views on oral photoprotection in skin cancer and are aware of the demonstrated potential of nicotinamide in the prevention of NMSCs.

Teledermatology: current indications and considerations for future use.

Telemedicine is one of the most consequential technologies in modern healthcare. In certain situations, it allows for the delivery of care with high quality and minimal difficulty. This is particularly true in dermatology, in which many dermatological conditions can be treated remotely. The burden on dermatology patients has been greatly reduced for certain pathologies due to telemedicine. Health care providers also achieve improved job satisfaction following the convenience of meeting their patients. This paper details select dermatological conditions, and subsequently divides them into those treatable by telemedicine appointments, and those requiring face to face appointments.

Maintaining our edge and training the next generation of dermatologists.

As dermatologists, we are unique in our ability to diagnose and treat diseases that present in the skin. This includes special expertise in the core disciplines of medical dermatology, pediatric dermatology, dermatologic surgery, and dermatopathology. Just as individual dermatologists strive to remain on the forefront of advances in our field, dermatology residency programs have an obligation to ensure that residents demonstrate competence in all facets of our field, and in the United States the American Board of Dermatology is moving toward a modular examination format to help assure the public that their dermatologist is truly an expert in all aspects of diagnosis and treatment of skin disease. This contribution focuses on key advances in our field, how our societies help us to remain on the cutting edge of science, and how dermatology training has kept pace.

Changing trends in dermatology practice during COVID-19 pandemic: A single tertiary center experience.

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre-pandemic period (March-May 2019) and (b) the Pandemic period (March-May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (P values were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (P values were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (P values were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P = .51). However, the use of biologic agents significantly decreased during the pandemic period (P = .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.

Evaluation of the effects of COVID-19 pandemic on hair diseases through a web-based questionnaire.

AIM: Current quarantine conditions are a difficult process for individuals and can worsen the psychological state. Increased psychosocial stress can affect the course of many common "stress-sensitive" skin conditions. This study examined the possible effects of coronavirus disease 2019 (COVID-19) on hair and scalp diseases such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD) in individuals who had to stay at home for a long time and the patients' methods of dealing with these diseases. METHODS: The study was conducted using an online questionnaire. All the individuals were asked questions about pre- and post-pandemic TE, AA, and SD. Participants with complaints were asked what they did for treatment. RESULTS: During the pandemic, TE was seen in 27.9% of the participants, AA on the scalp was seen in 2.8%, AA on the face was seen in 2.5%, and SD was seen in 19.9%. Applying to a dermatologist for complaints during the pandemic was lower than before pandemic. TE was higher in women before and during the pandemic. CONCLUSION: It was found that the rates of referring to a dermatologist for the complaints before the pandemic varied between 15% and 28% and that these rates decreased significantly during the pandemic (2.5%-12.5%).

Trends in Medicare Utilization by Dermatologists, 2012-2015.

Importance: Medicare represents the second largest component of national health expenditures, and dermatologists receive a disproportionate percentage of Medicare payments. Analyzing trends in Medicare utilization by dermatologists informs optimal Medicare usage for both patients and physicians. Objective: To characterize Medicare charges and payments over time by dermatologists. Design, Setting, and Participants: This study was a retrospective analysis of publicly available Medicare utilization and payment data for all dermatologists, regardless of practice setting, who provided services to Medicare beneficiaries between January 1, 2012, and December 31, 2015. Main Outcomes and Measures: Dollar amount of charges submitted to Medicare and amount paid by Medicare to dermatologists. Results: The number of dermatologists utilizing Medicare increased from 10 623 in 2012 to 11 279 in 2015 (6.2% increase), with a corresponding increase in total submitted charges ($312 340 vs $346 432; P < .001) but no change in the amount paid by Medicare ($137 742 vs $134 206; P = .47), number of services per clinician (2762 vs 2780; P = .98), or number of unique beneficiaries (541 vs 554; P = .80). There was also an increase in all drug service metrics from 2012 to 2015, including number of services per clinician (18 vs 27; P < .001), number of unique beneficiaries (12 vs 15; P < .001), dollar amount of submitted charges ($153 vs $466; P < .001), and amount paid by Medicare ($35 vs $89; P < .001). Conclusions and Relevance: Utilization of Medicare by dermatologists increased from 2012 to 2015 with no corresponding increase in the number of services per clinician or number of beneficiaries. In addition, the role of drug services in dermatologist Medicare utilization appears to be increasing. Understanding these trends may be useful when considering how to optimize payments to maintain patient access to dermatologists in the Medicare population.

Trends and Scope of Dermatology Procedures Billed by Advanced Practice Professionals From 2012 Through 2015.

Importance: Advanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time. Objective: To examine the trends in scope and volume of dermatology procedures billed by APPs over time. Design, Setting, and Participants: A longitudinal study was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. The data encompass nearly all outpatient procedures paid by Medicare Part B in the United States and include the type of clinician under which procedures were billed. Main Outcomes and Measures: For each type of dermatology procedure, the total number performed by APPs and the total number performed by dermatologists each year. Results: The total number (and percentage) of all dermatologic procedures performed by APPs increased from 2.69 million of 30.7 million (8.8%) in 2012 to 4.54 million of 33.9 million (13.4%) in 2015. The most common procedures performed by APPs in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788 834), and destructions of malignant neoplasms (48 982). The numbers of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs also increased each year from 2012 through 2015. Conclusions and Relevance: The number and scope of dermatologic procedures performed by APPs appear to be increasing over time. These procedures can be difficult and invasive. This study suggests that further studies are needed to determine what association these procedures have with patient outcomes and the potential need for more formal training.

Currently Constrained, Dermatologists Are Ready for New Acne Therapies.

Acne is the most common skin condition in the United States, affecting 50 million Americans annually. The disease's severity can range from mild to severe, with approximately 20% of people with acne experiencing moderate to severe disease.

Clinical Insights About Onychomycosis and Its Treatment: A Consensus.

BACKGROUND: Recently, experience and knowledge have been gained using effective topical treatment for onychomycosis, a difficult-to-treat infection. METHODS: This project aims to help understand and improve patient-focused quality of care for fungal nail infections. A panel of dermatologists who treat onychomycosis convened on several occasions to review and discuss recent learnings in the treatment of onychomycosis. The panel developed and conducted a survey on diagnosis, treatment and prevention, discussed the results, and provided recommendations. RESULTS: The survey was sent out digitally to the Canadian Dermatology community. Ninety-two dermatologists completed the questionnaires, which were included in the analysis. The survey respondents and panel members agreed that the diagnosis of toe onychomycosis should be confirmed with a positive microscopic examination for fungus or a positive mycological culture when oral therapy and/or topical treatment is prescribed, except when it is not clinically feasible, in which case topical therapy could be started based on clinical presentation. The panel and survey respondents also agreed that treatment is to be based on percentage of nail involvement: less than 20%=topical efinaconazole; 20%-60%=topical efinaconazole±oral terbinafine (for greater than 3 nails); greater than 60%=oral terbinafine±topical therapy. CONCLUSIONS: The current treatment paradigm for onychomycosis may have shifted from mainly oral antifungals to topical treatment, improving patient-focused quality of care.

J Drugs Dermatol. 2018;17(3):253-262.