In the 15 years since dermatology access was last investigated on a national scale, the practice landscape has changed with the rise of private equity (PE) investment and increased use of nonphysician clinicians (NPCs).OBJECTIVE To determine appointment success and wait times for patients with various insurance types at clinics with and without PE ownership. DESIGN, SETTING, AND PARTICIPANTSIn this study, PE-owned US clinics were randomly selected and matched with 2 geographically proximate clinics without PE ownership. Researchers called each clinic 3 times over a 5-day period to assess appointment/clinician availability for a fictitious patient with a new and changing mole. The 3 calls differed by insurance type specified, which were Blue Cross Blue Shield (BCBS) preferred provider organization, Medicare, or Medicaid. MAIN OUTCOMES AND MEASURESAppointment success and wait times among insurance types and between PE-owned clinics and control clinics. Secondary outcomes were the provision of accurate referrals to other clinics when appointments were denied and clinician and next-day appointment availability.RESULTS A total of 1833 calls were made to 204 PE-owned and 407 control clinics without PE ownership across 28 states. Overall appointment success rates for BCBS, Medicare, and Medicaid were 96%, 94%, and 17%, respectively. Acceptance of BCBS (98.5%; 95% CI, 96%-99%; P = .03) and Medicare (97.5%; 95% CI, 94%-99%; P = .02) were slightly higher at PE-owned clinics (compared with 94.6% [95% CI, 92%-96%] and 92.8% [95% CI, 90%-95%], respectively, at control clinics). Wait times (median days, interquartile range [IQR]) were similar for patients with BCBS (7 days; IQR, 2-22 days) and Medicare (7 days; IQR, 2-25 days; P > .99), whereas Medicaid patients waited significantly longer (13 days; IQR, 4-33 days; P = .002). Clinic ownership did not significantly affect wait times. Private equity-owned clinics were more likely than controls to offer a new patient appointment with an NPC (80% vs 63%; P = .001) and to not have an opening with a dermatologist (16% vs 6%; P < .001). Next-day appointment availability was greater at PE-owned clinics than controls (30% vs 21%; P = .001).CONCLUSIONS AND RELEVANCE Patients with Medicaid had significantly lower success in obtaining appointments and significantly longer wait times regardless of clinic ownership. Although the use of dermatologists and NPCs was similar regardless of clinic ownership, PE-owned clinics were more likely than controls to offer new patient appointments with NPCs.

Overview of TikTok's most viewed dermatologic content and assessment of its reliabilityTo the Editor: Around 80% of people seek medical information online, and #45% report that social media influences their decisions to seek medical care. 1,2 With [2 billion total downloads, TikTok is the world's fastest growing social media platform. This popular app allows users to create and share short videos on numerous topics, including health care. Previous studies have analyzed the dermatologic content posted on Instagram, Twitter, and YouTube. 3 This study is the first to characterize the content, sources, and reliability of the most popular dermatology videos on TikTok.Based on the National Ambulatory Medical Care Survey, we generated a list of the top 20 most commonly diagnosed dermatologic conditions. 4 On September 18, 2020, these diagnoses were queried as hashtags on TikTok, and the 8 diagnoses with the most videos were evaluated (Table I). The top 25 videos per diagnosis were identified based on engagement, a TikTok metric based on views, likes, comments, and shares. Videos unrelated to dermatology, paid advertisements, and non-English videos were excluded. Two investigators classified the remaining videos into $1 categories based on content. Interrater reliability was calculated using Cohen . Educational videos were subcategorized and compared with American Academy of Dermatology (AAD) guidelines to determine reliability. 5 Four board-certified dermatologists reviewed content assessment. The identities of content creators were confirmed through biographic information on TikTok or other linked social media platforms; board-certified dermatologists were confirmed through the AAD. Identity confirmation required $2 sources of congruent biographic information. Statistical analysis was performed using the z score test for 2 population proportions. P \.05 was considered statistically significant.Of the 200 videos identified, 171 were included. These videos amassed [521 million views. Videos were most often related to patient experiences/ testimonies, followed by education, clinical demonstrations/live procedures, and product reviews/nonpaid advertisements (Table I). Cohen yielded 0.988, showing excellent interrater reliability on content categorization. Content creators were most commonly patients (48.0%), board-certified dermatologists (25.8%), and estheticians (4.8%) (Table I). Board-certified dermatologists were the main source of educational videos (41.3%), adhering to AAD guidelines 96.8% of the time (Table II).Percentages are based on 171 total videos. *Videos were classified into $1 categories. y Defined as information about prevention, cause, diagnosis, and treatment of skin disease. z Defined as advice on skin appearance, and use/application of beauty and skin care products.x Makeup artists, barbers, relatives of patients, and unidentified posters.