Urban areas attract more dermatologists than rural ones, according to Yale researchers.

Using data spanning the period from 1995 to 2013, the team found that overall, the number of dermatologists per 100,000 people has increased. However, that increase has been more pronounced in urban areas, leaving vast swaths of the country underserved by such physicians, said Hao Feng MED ’14, lead author of the study. The work was published in JAMA Dermatology on Sept. 5.

“In our study, we show that the vast majority of counties in the United States don’t have a single dermatologist,” Feng said.

The physician shortage issue is well-known in the medical community and a significant issue in specialties that are in high demand, such as dermatology, said Juliana Berk-Krauss MED ’17, co-author of the paper. It can potentially take months to see a dermatologist in some areas of the country, she added.

For patients who cannot wait that long, that means traveling long distances for care. Others will simply choose not to see a dermatologist at all, Berk-Krauss continued.

There are numerous reasons, both personal and professional, physicians tend to gravitate toward urban locations, Feng said. Younger, educated working professionals often flock to cities because of the potential for job growth and lifestyle flexibility, he said.

Other factors are specific to physicians, however. For example, Feng said, dermatologists often prefer to work in larger groups and organizations to reduce the administrative demands of the job; these institutions are generally more common in urban areas. Furthermore, urban clientele tend to have a higher demand for cosmetic dermatology, an attractive field for practitioners. Overall, dermatologists are more likely to settle in resource-rich areas, Feng said.

While the paper does not directly address the backgrounds of dermatologists, the authors believe that the disparity in where dermatologists settle could have some relation to the regions they are from, Berk-Krauss said. There is evidence that where practitioners choose to practice is related to where they grew up — which previous studies have shown is skewed toward metropolitan areas, Feng said. Physicians are often married to other working professionals, who may have big-city career concerns of their own, he continued.

“Even though there is an increase in the national density of dermatologists, there is a disparity in terms of dermatologist density in urban versus nonurban areas, and that disparity has actually widened over time,” Feng said.

There is also strong potential for that disparity to get even worse, as practitioners in rural and nonmetropolitan areas are aging at a faster rate than their urban, metropolitan counterparts, Feng said. This suggests that younger practitioners are less likely to set up shop in rural locations than previous generations.

The authors said there are steps institutions can take to address the dermatologist disparity. Given the correlation between place of origin and practice, medical schools could decrease the size of the dermatology desert by actively recruiting more students from rural backgrounds, Berk-Krauss said.

“This article is part of a larger dialogue about physician workforce disparity in this country. Because this is not just a dermatology issue, it’s a specialist issue, a primary care issue,” Berk-Krauss said. “As a community we need to be more critical and more creative about how we ensure that resource-poor areas have access to the care they need.”

Maya Chandra | maya.chandra@yale.edu