Distribution and Characteristics of the Inpatient Dermatology Workforce in the US Between 2013 and 2019
abstract
This abstract is available on the publisher's site.
Access this abstract nowWhile time spent practicing inpatient dermatology has decreased since the 1990s, less is known about the current state of inpatient dermatology. We describe the distribution and frequency of inpatient dermatology encounters servicing the United States Medicare population between 2013 and 2019. Cross-sectional analysis of publicly available inpatient Medicare Part B claims data from 2013 to 2019 was conducted. Main outcomes and measures were characteristics and trends of dermatologists performing inpatient encounters. Categorical variables were compared using χ2 analysis. Trends were analyzed for linearity using Pearson correlation coefficient. 782 physicians met inclusion criteria for inclusion. Dermatologists were more often male (56.5%), possessing allopathic Medical Doctorate (MD) (86.3%), and in metropolitan settings (98.2%). However, proportion of female inpatient dermatologists increased significantly (37.9% to 46.2%). Across rural and metropolitan practices, number of inpatient physicians (2013: 356; 2019: 281) and number of medical centers in which dermatology encounters occurred (2013: 239; 2019: 157) decreased, more significantly in non-residency-associated institutions. Spatial analysis revealed wide regions lacking dermatologists meeting defined criteria. Limitations included the need for ten Medicare inpatient encounters for inclusion, counties without reported data. In conclusion, the number of dermatologists performing > 10 inpatient encounters per year is decreasing, and large variations exist in the number of U.S. inpatient dermatology visits.
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The United States dermatology inpatient workforce between 2013 and 2019: a Medicare analysis reveals contraction of the workforce and vast access deserts-a cross-sectional analysis
Arch Dermatol Res 2024 Mar 14;316(4)103, JA Hydol-Smith, MA Gallardo, A Korman, L Madigan, S Shearer, C Nelson, K Fisher, K Hoffman, A Dominguez, BH KaffenbergerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
We found this article to be incredible.....98% of dermatology inpatient hospital consultations occurred in urban settings!! There are 65 hospitals in Mississippi, but only 1 academic medical center with a hospital consultation service. The data presented show a disturbing map that suggests that this situation is even worse in many areas of the United States. How can we possibly take care of hospitalized patients? We would suggest an "all of the above" approach....let's do everything that anyone can do to help this situation....all dermatologists should be involved!
Devise methods to see hospitalized patients who need dermatologic care by dividing the coverage among local dermatologists perhaps rotating each week.
Use dermatology and even telepathology for hospitalized patients....a resident or nurse can easily let us see these patients from almost anywhere on our phones.
Devise a rapid access clinic at your office to see patients on the day they are discharged from the hospital.
Devise a system for truly emergent hospital consultations to be seen by having the primary care physician call the dermatologist directly.
Transfer patients with widespread blistering diseases etc to regional medical centers who have a service to provide appropriate care.
Of course, we understand that liability and privacy issues need to be addressed, but there's the old adage about not letting the perfect get in the way of the good.
Let's find a way to have as many dermatologists as possible help a little....and the impact will be very important to the patients who need us in the inpatient setting.
In a follow-up to my previous editorial1 on the article "Teledermatology availability post–COVID-19: A cross-sectional secret-shopper study" published in the Archives of Dermatological Research highlighting the decreasing outpatient teledermatology in Ohio, comes even more distressing news for our specialty concerning the lack of inpatient dermatology consultations in the US. Most of these consultations are done in academic settings, and non-residency–associated hospitals are out of luck. Our physician colleagues and patients need our expertise in the more than 6000 hospitals in the US! How can we fix the problem? — By developing inpatient teledermatology consultation services between the dermatologist and the hospital through shared electronic medical records. It has been shown to be time-efficient, shorten hospital stays, and provide appropriate triage for outpatient follow-up.2 My institution developed an inpatient asynchronous teledermatology consultation service for both our academic and sister hospitals. Our inpatient teledermatologists changed the diagnosis from the community hospital primary team the majority of the time for cellulitis (89.3%), Stevens–Johnson syndrome/toxic epidermal necrolysis (97.0%), leg ulcers (86.4%), erythroderma (78.8%), vasculitis (89.0%), herpes zoster (82.0%) and immunobullous disease (84.9%).2 These percentages are much greater than the literature-published percentages by dermatology hospitalists at academic centers.2 Our specialty is not meeting the burden of skin disease in both outpatient and inpatient settings. We need to train more dermatologists, specifically in medical/general dermatology, to become proficient in the use teledermatology during training. Our specialty needs to become more receptive to the future of electronic healthcare to ensure our specialty remains the expert for skin disease.
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