ACKNOWLEDGEMENTS · Dermatology services are in high demand The demand for dermatology services will continue to rise, due to an aging U.S. population, increasing rates of skin cancer

1 PATIENTS ARE WAITING: America’s Dermatology Appointment Wait Times Crisis

ACKNOWLEDGEMENTSThis report is endorsed by the Greater Access for Patients Partnership (GAPP). GAPP includes

American Academy of PAs, AIM at Melanoma, The American Health Quality Association, Derma Care

Access Network, Dermatology Nurses’ Association, Melanoma Research Alliance, National Eczema

Association, National Alopecia Areata Foundation, Polka Dot Mama Melanoma Foundation, and the

Society of Dermatology Physician Assistants.

2

TABLE OF CONTENTS

Executive Summary

Appointment Wait Times: A Worsening Crisis

The Consequences of Waiting

Solutions to Increase Access

Key Takeaways

3

5

9

12

17

3

EXECUTIVE SUMMARY

Appointment wait times for dermatology services have increased by 46% since 2009. In many cities, such as Philadelphia (78 days on average) and Cedar Rapids, Iowa (91 days), lengthy delays for both new and returning dermatology patients have become the norm. Waiting months for care has unintended physical, emotional, economic and lifestyle impacts on patients, caregivers and health systems at large.

According to a 2018 survey, nearly all patients (91%) said their skin condition impacted their daily life, and half of those surveyed experienced sadness due to activities that they missed because of their skin condition and wait for a dermatology appointment. Wait times were also found to be a significant cause of anxiety. More than half (54%) reported anxiety while waiting for an appointment, and 58% worried that their skin condition would worsen while waiting.

The Greater Access for Patients Partnership (GAPP), a coalition of leading professional and patient organizations, aims to improve the dermatology wait times crisis and support access to quality care.

4

8 IN 10 PATIENTSwould likely see a PA or NP over a dermatologist if they

could get a quicker appointment2

Summary: Dermatology Patients are Waiting and Worried

4

4 IN 10 PATIENTSreport that they had to wait a month or

longer for a dermatology appointment2

The average wait time to receive a dermatology appointment is 32.3 days,

which is a 46% increase since 20091

Waiting for dermatology appointments takes an emotional toll on patients

Major U.S. cities with the longest wait times

51 DAYS

42 DAYS

Denver

Boston52 DAYS

78 DAYS Philadelphia

Seattle

22.1 Days2009

28.8 Days2014

32.3 Days2017

Among caregivers whose

loved ones did not visit a

dermatology provider, long

wait times were the

#1 REASON

48%

reported using over-the-counter (OTC) treatments while waiting for an

appointment, with 53% feeling the treatments were too costly

54%

say that waiting for a dermatology appointment causes anxiety

say that their skin condition regularlyinterferes with their daily life

61%

58%

worried that a skin issue would get worse while waiting for a

dermatology appointment

45%

reported having to wait so long fora dermatology appointment that it

disrupted daily life

felt self-conscious while waiting for an appointment

50%

48%



54%



61%

58%



45%




50%

2

1 2


According to a 2017 Merritt Hawkins Survey, the average wait time to receive a dermatology appointment is 32.3 days, which is a 46% increase since 2009.1

There is a strong inverse correlation between the number of dermatologists in an area and

waiting time for appointments. Over the past decade, the average wait time for a dermatology

appointment in a metropolitan area has significantly increased. Outside of major cities,

wait times can be several months, as many areas in rural America have limited access to

dermatology services.

Appointment Wait Times: A Worsening Crisis

Average wait time for a dermatology appointment1

35 DAYSAverage wait time for a dermatology appointment in a midsize city

32 DAYSAverage wait time for a dermatology appointment in a large metropolitan area

22.1 Days2009

28.8 Days2014

32.3 Days2017

6

Average wait times for a dermatology appointment in major U.S. cities1

A 2017 JAMA Dermatology study found that of the 933 three-digit zip codes across the U.S., 23.7%

had no dermatologists.3 Among the areas with at least one dermatologist, 70% had fewer than

the recommended ratio of dermatologists to provide adequate care to a community. According

to the study, communities need four dermatologists per 100,000 persons to adequately care for

the population. Even those zip codes that numerically appear to have enough density to provide

adequate care may be impacted by neighboring zip codes with inadequate density.3

In a survey by the American Academy of Dermatology (AAD), 33% of dermatologists (and 48% in rural areas) reported that the

number of dermatologists in their community is not enough to meet patient demand.4

As far back as 2001, long wait times have been a concern in the dermatology community. It is

well documented that the supply of dermatologists is both lacking and distributed unequally

across the country.5 A recent study showed that the ratio of dermatologists older than 55 years

to younger than 55 years increased 170% in metropolitan areas and 75% in non-metropolitan and

rural areas. While the increase in the national density of dermatologists is positive, there is a

disparity in terms of dermatologist density in metropolitan versus non-metropolitan areas, and

that disparity has actually widened over time, impacting patient care.6

As dermatologists tend to practice in or near large cities or academic centers, many rural

patients must travel between one to two hours to visit a dermatologist.3, 6, 7 Less than 10% of

dermatologists practice in rural areas, with 40% practicing in the 100 densest U.S. areas. This

unequal distribution may cause patients to postpone or forgo care, leading to treatment delays

and disease progression.7

35 Days

51 DaysDenver

78 DaysPhiladelphia

Los Angeles

42 DaysSeattle

Miami 11 Days

15 DaysNew York


Dermatology patients are waiting too long for care2

In 2018, the Society of Dermatology Physician Assistants (SDPA) conducted a national survey of

1,000 people who have experienced or who care for someone with a skin condition. The survey

assessed lifestyle, emotional, economic, and physical impacts of appointment wait times to treat

skin conditions.

This survey confirmed the average wait time for a dermatology appointment was 32 days, the

same average found by the 2017 Merritt Hawkins Survey.1

An average wait time of about

5 WEEKS for a follow up appointment

An average wait time of about

6 WEEKS for a follow up appointment

Among caregivers whose

loved ones did not visit a

dermatology provider, long

wait times were the

#1 REASON

OVER 70%of patients and caregivers wished

their wait time was shorter

4 IN 10 PATIENTSreport that they had to wait one month or

longer for a dermatology appointment

PATIENTS REPORTED CAREGIVERS OF PATIENTS REPORTED

An average wait time of approximately

one month for a first appointment1 MONTH

8

Dermatology services are in high demand

The demand for dermatology services will continue to rise, due to an aging U.S. population,

increasing rates of skin cancer and other skin diseases, such as psoriasis and eczema.3

The number of dermatology residency and

fellowship positions for medical school

graduates is lower than many other specialties.

Though the number has increased in recent

years, it is still not enough to meet demand.10

Almost 500 dermatologists enter the workforce

post-residency each year, with approximately

In 2018, out of more than

33,000 residency spots in the

U.S. available to graduating

medical students, 472 were in dermatology.10

325 leaving.3 The number of retiring dermatologists will continue to rise over the next decade,

with research showing that most dermatologists retire at approximately age 70.4, 11 For all

specialty categories (including dermatology), physician-retirement decisions are projected to

have the greatest impact on supply, and more than one-third of all currently active physicians

will be age 65 or older within the next decade. Statistical modeling by IHS Markit shows that the

shortage in supply of dermatologists will be increasingly unable to meet the demand of a growing

U.S. population.11

Skin conditions affect millions of Americans8, 9

Atopic dermatitis (commonly known as eczema)

50 million

30 million

Acne

16 millionRosacea

5.4 millionSkin cancer

Psoriasis 7.5 million


43 DAYS Lafayette, La.

47 DAYS Hartford, Conn.

35 DAYSAverage wait time in

a midsize city for an

appointment to examine

suspected melanoma.1

Patients are waiting more than a month to have their suspected melanoma checked

Average examination wait times1

71 DAYS Fargo, N.D.TreatmentProviding specialty care to patients with possible

melanoma within 14 days of referral is associated

with a 20% increase in survival.14

SurgeryTwenty percent of Medicare patients with melanoma

had to wait an average of 1.5 months, according to a

2015 study published in JAMA Dermatology; 8% had

to wait more than three months.17

Lengthy waiting periods to receive a dermatology appointment are more than a nuisance to patients. Increased dermatologist density is associated with decreased waiting time for appointments, lower melanoma mortality rates, and improved diagnosis of skin disease.2, 12

Consider that one in 74 Americans will develop melanoma, the deadliest skin cancer, during his

or her lifetime.13 Providing specialty care to patients with possible melanoma within 14 days of

referral is associated with a 20% increase in survival.14 However, many patients in metropolitan

areas wait on average more than double this time, and rural patients may wait several months.1

Skin cancers are not the only conditions that may require rapid treatment. The number of patients

seeking treatment for serious skin infections is also increasing. From 2005 to 2011, there

was a 17% increase in hospital admission rates due to skin infections.15 If left untreated, some

skin infections can become life threatening and some of these infections, such as MRSA and

necrotizing fasciitis, may require the urgent administration of antibiotics to avoid fatality.15, 16

The Consequences of Waiting

91 DAYS Cedar Rapids, Iowa

10

Worried, sad, avoiding activities: The emotional toll of waiting

Nearly all patients (91%) in the 2018 SDPA survey say their skin condition impacts daily life, and

half experience sadness related to activities they have avoided due to their skin condition. Wait

times were also found to cause anxiety. More than half (54%) report anxiety while waiting for an

appointment, and 58% worry that their skin condition will worsen.2

While waiting for appointments, 75% of caregivers report their loved ones avoided activities

because of their skin condition. Sixty-five percent of caregivers reported anxiety while waiting,

and 67% worried that their loved one’s condition would worsen while waiting for an appointment.2

48%



54%



61%

58%



45%




50%


Despite living in the Research Triangle of North Carolina,

an area renowned for medical scholarship, Tracy Callahan

waited four months for an appointment to examine the

small mole on her neck. Eventually, she received an

appointment with a dermatology physician assistant who

took multiple photos of Callahan’s mole and assured her

that someone would call her later that day. At age 38,

Callahan, a busy working mom of two children, received

her first melanoma diagnosis.

Today, Callahan is a four-time melanoma survivor.

After her third diagnosis, she began to write a blog that

eventually led her to found the Polka Dot Mama Melanoma

Foundation to fund research, raise awareness, and

educate the public about melanoma.

“I was one of the lucky ones,” Callahan said. “My cancer was caught early. The survival rate for melanoma is extremely high for people with earlier stage cancers, but melanoma is still the deadliest form of skin cancer. Four months is too long to wait for an examination. It’s possible for melanoma to progress rapidly over a few months, which is why Polka Dot Mama Melanoma Foundation joined GAPP to implement solutions to fight the dermatology wait times crisis.”

P A T I E N T P E R S P E C T I V E

Tracy CallahanCEO and Founder of Polka Dot Mama Melanoma Foundation, a GAPP member organization

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Solutions to Increase Access

It is estimated that less than half of dermatologists employ either a PA or NP,

leaving these highly qualified

medical professionals as an

underutilized resource.4

VS

56 DAYS19 DAYS

DERMATOLOGY PAs/NPs

DERMATOLOGISTS

Evidence-based solutions may help reduce the serious issue of patient wait times for dermatology appointments. These include greater access to dermatology physician assistants (PAs) and nurse practitioners (NPs), dermatology-specific training for primary care physicians (PCPs), and telemedicine.

PAs and NPs are proven to reduce wait times

Dermatology appointment wait times are increasing, and the supply of dermatologists does

not meet current demand.18 However, the number of dermatology PAs and NPs are growing at a

significantly greater rate than the number of dermatologists.11, 18 Statistical modeling by IHS Markit

suggests that by 2025, the supply of PAs/NPs is projected to increase substantially, and this rapid

growth could help alleviate the physician shortage.11 As further evidence of this trend, SDPA has

reported a dramatic increase from 49 members in 1994 to more than 3,400 members in 2018.19, 20

There is strong evidence that the utilization of dermatology PAs/NPs decreases wait times. In a 2017

study in Ohio, the average wait time to see a dermatologist was 56 days. In 32% of the offices that

had PAs/NPs, the average wait time to see the PA or NP was 19 days. When a PA or NP was available

for patients, they were able to be seen in one third of the time.20

Though many rural areas remain underserved, there are more dermatology PAs/NPs in less

populous regions. Including dermatology PAs/NPs in dermatology workforce calculations

elevates the average provider density to greater than four per 100,000 people, the minimum ratio

suggested for adequate care.18


Patients are open to alternatives

The 2018 SDPA survey found that patients strongly indicate they would see a PA instead of a

dermatologist if it meant getting an appointment more quickly. Openness to a PA is also high

among caregivers, with 80% of caregivers indicating their loved one would see a PA if the wait

time was shorter. Additionally, patients report being satisfied by the care they receive from a PA.2

8 IN 10would likely see a PA over a dermatologist

if they could get a quicker appointment2

78% OF PATIENTS would likely see a PA over a dermatologist if it meant they could have a shorter

in-office wait time2

81% OF PATIENTS would likely see dermatology PA if it meant they could ask more questions

about their skin issue during the appointment2

88% OF PATIENTS who have received care from a dermatologist report a positive experience,

and this level of satisfaction remains the same for patients who have seen

a dermatology PA (87%) or NPs (88%)2

PAs and NPs Provide Quality Care to Patients 21–23

There is overwhelming evidence that PAs and NPs deliver similar quality of care, services and

referrals compared to physicians. In a 2016 study in the Journal of the Dermatology Nurses’

Association, PAs/NPs played an instrumental role in evaluating and managing patients with skin

issues, including psoriasis. The study concluded that PAs/NPs are well positioned to optimize

psoriasis care by building strong, long-term relationships with their patients.21

Studies in other specialty areas support the quality of care PAs/NPs provide. A study published

by the Annals of Internal Medicine found that patients with diabetes who received primary care

services at VA facilities over a two-year period saw no significant variation in health outcomes

whether they were treated by a physician, an NP, or a PA.22 A similar study, published in The American

Journal of Medicine, showed that standards of diabetes management in PAs/NPs were similar to

the treatment provided by physicians. The study also suggests that the increased use of PAs/NPs

could be a potential solution to the issue of primary care provider shortages in the U.S.23

14

Diagnostic confidence in PCPs

PCPs are increasingly caring for patients with skin conditions. Overall, 6% to 7% of all outpatient

visits are for skin complaints, and 60% of these patients are treated by non-dermatology

professionals.24

Often the first point of contact for dermatology issues, it is important that these medical

professionals are confident in their clinical decisions. However, many PCPs have expressed a

lack of confidence in their ability to diagnose more serious skin conditions. These attitudes are

consistent with studies demonstrating that many PCPs struggle to accurately diagnose benign

and malignant skin conditions.25–27 Since the early detection of skin cancer is paramount to

survival rates, it is essential that patients can immediately receive the potentially life-saving

care they require.14

Continuing medical education courses in dermatology may help increase confidence of PCPs to

improve patient care. Several studies have shown the positive long-term impact of postgraduate

training courses with a focus on medical dermatology, particularly with regard to reducing the

rate of unnecessary biopsies and referrals by PCPs.28–30 These findings suggest that even minimal

increases in dermatology training at the medical school level or beyond may have a measurable

impact on PCPs’ abilities in dermatology.

Telemedicine may extend dermatology services to more patients

With the rise of tablets, apps and other mobile technology, it is becoming easier to treat

patients remotely.31 Telemedicine is an innovation on the rise that may enable patients to receive

care without physically visiting a dermatology office. Patients send photos of their skin to a

dermatology care provider who can then review the images and remotely instruct the patient

on the best course of action.

Specific telemedicine models are shown as increasingly effective for managing many skin

conditions. For example, an October 2018 study found that a telehealth platform provided online

treatment for psoriasis that yielded equivalent improvement as in-person care.32

Evidence also suggests that telemedicine may increasingly be an option to decrease wait

times and to give access to care in more remote areas of the U.S. A 2017 JAMA Dermatology

investigation examined 21 studies related to teledermatology and found that such services

consistently reduced wait times and yielded high patient satisfaction.33 A similar 2018 study found

that when patients scheduled a telemedicine appointment, nearly 94% of patients received a

consultation within two days and almost all patients were highly satisfied with their care.34


In her late 20s, AnnMarie MacDonald noticed that new

moles had begun to appear on her skin over a short

period of time. MacDonald knew her past use of tanning

beds put her at greater risk for skin cancer. She called for

a dermatologist appointment and ended up seeing a PA.

“I was able to get an earlier appointment,” MacDonald

said. “I called at the beginning of the week for my first

appointment and was able to be seen by a PA by the

middle of the week. Waiting to see a dermatologist was

going to take several weeks, and I felt very concerned

about these new moles.”

During a follow-up appointment, her PA noticed that

one of MacDonald’s moles had suspiciously changed

in only a few months. A biopsy confirmed the mole

was precancerous.

“I am grateful that my PA was cautious with my skin checks because of my tanning bed history,” MacDonald said. “The mole changed very quickly, but because it was still caught so early, I had a good prognosis and a great result.”

P A T I E N T P E R S P E C T I V E

AnnMarie MacDonald

PATIENTS ARE WAITING: America’s Dermatology Appointment Wait Times Crisis 15

16

P U B L I S H E D C A S E S T U D Y

Parkland Memorial Hospital, Dallas, TX In 2012, dermatology wait times for new patients were at least one year. To decrease wait times, the clinic made five strategic changes.

1 Discharged patients with stable, low-intensity skin problems to follow up with their PCPs

2 Changed scheduling templates by establishing goal numbers for new and established patients to increase consistency

3 Hired a nurse and extended work shifts of support staff so that enough staffing was always available

4 Designated a resident and a nurse to perform all biopsies

5 Hired a PA to support increasing patient volume and maintaining short wait times

From May 2012 to September 2015, these interventions

led to a significant decrease in new patient wait times

from 377 days to 48 days, and established patient wait

times from 95 days to 34 days.

“It’s critical that we can provide patients with the care they need when they need it. The dermatology clinic’s efforts have been tremendous—wait times have been reduced from a year to just several weeks. Based on the dermatology clinic’s success, we’ve expanded these initiatives to our cardiology and neurology clinics, and they have brought down their wait times too.”

Joseph Chang, MD, MBA, FACOGAssociate Chief Medical Officer for Outpatient and Ambulatory Services, Parkland Health and Hospital System

35

16

42


Health care delivery is undergoing fundamental changes at an increasingly rapid pace. These changes must include implementing evidence-based approaches to reducing appointment wait times, including those for dermatology, where the problem is particularly acute.

1 Dermatology appointment wait times are increasing, and the supply of dermatologists does not meet current demand.

2 This problem is complex. Causes include an aging patient population, rising rates of skin diseases, the geographic maldistribution of dermatologists, and the limited number of residency programs for new dermatologists.

3 Increased dermatologist density is associated with decreased wait times for appointments, lower melanoma mortality rates and improved diagnoses of skin disease.

4 New technologies, such as teledermatology, may help decrease wait times for patients in rural areas and for patients with non-urgent conditions.

5 Continuing medical education courses in dermatology may help increase the confidence of PCPs to improve patient care.

6 The number of dermatology PAs/NPs is increasing at a significantly greater rate than the number of dermatologists, yet PAs/NPs remain an underutilized resource. There is strong evidence that the greater utilization of dermatology PAs/NPs decreases wait times.

Key Takeaways

18

REFERENCES

1. Merritt Hawkins. 2017 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/. Published September 2017. Accessed March 14, 2019.

2. SDPA conducted an online survey from Aug. 31–Sept. 6, 2018 among a national sample of 1,000 Americans who have either experienced or cared for someone who has experienced a skin condition.

3. Glazer AM, Farberg AS, Winkelmann RR, Rigel DS. Analysis of Trends in Geographic Distribution and Density of US Dermatologists. JAMA Dermatol. 2017 Apr 1;153(4):322-325. doi:10.1001/jamadermatol.2016.5411.

4. Ehrlich A, Kostecki J, Olkaba H. Trends in Dermatology Practices and the Implications for the Workforce. J Am Acad Dermatol. 2017 Oct;77(4):746-752. doi:10.1016/j.jaad.2017.06.030.

5. Suneja T, Smith ED, Chen GJ, Zipperstein KJ, Fleischer, Jr AB, Feldman SR. Waiting Times to See a Dermatologist Are Perceived as Too Long by Dermatologists: Implications for the Dermatology Workforce. Arch Dermatol. 2001;137(10):1303–1307. doi:10.1001/archderm.137.10.1303.

6. 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.

7. T Vaidya, L Zubritskey, A Alikhan, A Housholder. Socioeconomic and Geographic Barriers to Dermatology Care in Urban and Rural US Populations. J Am Acad Dermatol. 2018;78(2):406-408. doi:10.1016/j.jaad.2017.07.050.

8. Derma Care Access Network. Overcoming Barriers to Dermatological Treatment. https://www.dermacareaccess.org/news/2017/9/6/overcoming-barriers-to-dermatological-treatment. Published September 2017. Accessed March 14, 2019.

9. Del Rosso JQ, Tanghetti EA, Baldwin HE, Rodriguez DA, Ferrusi IL. The Burden of Illness of Erythematotelangiectatic Rosacea and Papulopustular Rosacea: Findings from a Web-based Survey. J Clin Aesthet Dermatol. 2017;10(6):17-31. PubMed PMID:28979654.

10. National Resident Matching Program. Results and Data: 2018 Main Residency Match. National Resident Matching Program. http://www.nrmp.org/wp-content/uploads/2018/04/Main-Match-Result-and-Data-2018.pdf. Published April 2018. Accessed March 14, 2019.

11. IHS Markit. 2017 Update: The Complexities of Physician Supply and Demand: Projections from 2015 to 2030. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/a5/c3/a5c3d565-14ec-48fb-974b-99fafaeecb00/aamc_projections_update_2017.pdf. Published February 2017. Accessed March 14, 2019.

12. Aneja S, Aneja S, Bordeaux JS. Association of Increased Dermatologist Density with Lower Melanoma Mortality. Arch Dermatol. 2012 Feb;148(2):174-8. doi:10.1001/archdermatol.2011.345.

13. Rigel DS, Carucci JA. Malignant Melanoma: Prevention, Early Detection, and Treatment in the 21st Century. CA Cancer J Clin. 2000;50(4):215-236. doi:10.3322/canjclin.50.4.215.

14. Pacifico M, Pearl R, Grover R. The UK Government Two-Week Rule and Its Impact on Melanoma Prognosis: An Evidence-Based Study. Ann R Coll Surg Engl. 2007;89(6):609-615. doi:10.1308/003588407X205459.

15. Kaye KS, Patel DA, Stephens JM, Khachatryan A, Patel A, Johnson K. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact. PLoS One. 2015 Nov 24;10(11):e0143276. doi:10.1371/journal.pone.0143276. eCollection 2015. PubMed PMID:26599005.

16. Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current Concepts in the Management of Necrotizing Fasciitis. Front Surg. 2014 Sep 29;1:36. doi:10.3389/fsurg.2014.00036.

17. Lott JP, Narayan D, Soulos PR, Aminawung J, Gross CP. Delay of Surgery for Melanoma Among Medicare Beneficiaries. JAMA Dermatol. 2015;151(7):731–741. doi:10.1001/ jamadermatol.2015.119.

18. Glazer AM, Holyoak K, Cheever E, Rigel DS. Analysis of US Dermatology Physician Assistant Density. J Am Acad Dermatol. 2017 Jun;76(6):1200-1202. doi:10.1016/j.jaad.2017.02.018.

19. Who We Are. Society of Dermatology Physician Assistants. https://www.dermpa.org/page/Who_We_Are. Updated March 2019. Accessed March 14, 2019.

20. Zurfley F, Mostow EN. Association Between the Use of a Physician Extender and Dermatology Appointment Wait Times in Ohio. JAMA Dermatol. 2017;153(12):1323–1324. doi:10.1001/jamadermatol.2017.3394.

21. Aldredge LM, Young MS. Providing Guidance for Patients with Moderate-to-Severe Psoriasis Who Are Candidates for Biologic Therapy: Role of the Nurse Practitioner and Physician Assistant. J Dermatol Nurses Assoc. 2016;8(1):14-26. doi:10.1097/JDN.0000000000000185.

22. Jackson GL, Smith VA, Edelman D, et al. Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study. Ann Intern Med. 2018 Dec 18;169(12):825-835. doi:10.7326/M17-1987.

23. Yang Y, Long Q, Jackson SL, et al. Nurse Practitioners, Physician Assistants, and Physicians Are Comparable in Managing the First Five Years of Diabetes. Am J Med. 2018 Mar;131(3):276-283.e2. doi:10.1016/j.amjmed.2017.08.026.

24. Lowell BA, Froelich CW, Federman DG, Kirsner RS. Dermatology in Primary Care: Prevalence and Patient Disposition. J Am Acad Dermatol. 2001 Aug;45(2):250-255. doi:10.1067/mjd.2001.114598.

25. Ramsay DL, Fox AB. The Ability of Primary Care Physicians to Recognize the Common Dermatoses. Arch Dermatol. 1981 Oct;117(10):620-622. PubMed PMID:7283454.

26. Federman DG, Reid M, Feldman SR, Greenhoe J, Kirsner RS. The Primary Care Provider and the Care of Skin Disease: The Patient’s Perspective. Arch Dermatol. 2001 Jan;137(1):25-29. doi:10.1001/archderm.137.1.25.

27. Gerbert B, Maurer T, Berger T, et al. Primary Care Physicians as Gatekeepers in Managed Care. Primary Care Physicians’ and Dermatologists’ Skills at Secondary Prevention of Skin Cancer. Arch Dermatol.1996 Sep;132(9):1030-1038. PubMed PMID:8795541.

28. Eide MJ, Asgari MM, Fletcher SW, et al. Effects on Skills and Practice from a Web-Based Skin Cancer Course for Primary Care Providers. J Am Board Fam Med. 2013 Nov-Dec;26(6):648-57. doi:10.3122/jabfm.2013.06.130108.

29. Lam TP, Yeung CK, Lam KF. What Are the Learning Outcomes of a Short Postgraduate Training Course in Dermatology for Primary Care Doctors?. BMC Med Educ. 2011 May 16;11:20. doi:10.1186/1472-6920-11-20.

30. Cipriano SD, Dybbro E, Boscardin CK, Shinkai K, Berger TG. Online Learning in a Dermatology Clerkship: Piloting the New American Academy of Dermatology Medical Student Core Curriculum. J Am Acad Dermatol. 2013;69(2):267-72. doi:10.1016/j.jaad.2013.04.025.

31. American Academy of Dermatology Association. Teledermatology Toolkit. https://www.aad.org/practicecenter/managing-a-practice/teledermatology. Accessed March 28, 2019.

32. Armstrong AW, Chambers CJ, Maverakis E, et al. Effectiveness of Online vs In-Person Care for Adults with Psoriasis: A Randomized Clinical Trial. JAMA Netw Open. 2018;1(6):e183062. doi:10.1001/jamanetworkopen.2018.3062.

33. Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the Diagnosis and Management of Skin Cancer: A Systematic Review . JAMA Dermatol. 2017;153(3):319–327. doi:10.1001/jamadermatol.2016.4361.

34. Rajda J, Seraly MP, Fernandes J, et al. Impact of Direct to Consumer Store-and-Forward Teledermatology on Access to Care, Satisfaction, Utilization, and Costs in a Commercial Health Plan Population. Telemed J E Health. 2018 Feb;24(2):166-169. doi:10.1089/tmj.2017.0078.

35. O’Brien JC, Chong BF. Reducing Outpatient Dermatology Clinic Wait Times in a Safety Net Health System in Dallas, Texas. J Am Acad Dermatol. 2016;75(3):631-632. doi:10.1016/j.jaad.2016.04.043.


Documents

ACKNOWLEDGEMENTS · Dermatology services are in high demand The demand for dermatology services will continue to rise, due to an aging U.S. population, increasing rates of skin cancer