Access as equity: Addressing the distribution of the pediatric dermatology workforce

Abstract

Equitable distribution of the physician workforce is critical to ensuring the health of the world's population. Significant imbalances in this distribution can compromise access to care and have lasting implications on health outcomes. 1 Advancements in healthcare delivery and expanded health coverage have accelerated the race to health equity over the past three decades; however, the pace of progress remains uneven, both between and within countries.National health averages conceal the fact that some gains have proven fragile, and several of our most vulnerable communities are being overlooked. 2 While overall shortages in the pediatric dermatologist workforce have been well-documented, recent evidence indicates a geographic maldistribution of providers, which can further exacerbate health disparities for children. 3 Wide geographic gaps in access to pediatric care constitute a critical public health issue and impede upon a child's right to access care. In this review, we examine the issue of geographic maldistribution of pediatric dermatologists through the lens of health equity: describing the problem, exploring the enablers of and barriers to change, and offering potential solutions. | BACKG ROU N DRecent estimates by the Association of American Medical Colleges (AAMC) project a nationwide physician shortage of up to 139 000 physicians by 2033 across both primary care and subspecialties. 4 As the demand for physicians continues to exceed supply, we risk eroding hard-earned advances in health outcomes. Undersupply of dermatologic services in the United States is well-established. 5 Among dermatologic subspecialties, the pediatric dermatologist shortage is especially daunting. Although the past decade has brought a 62% increase to the size of the pediatric dermatology workforce, there is an urgent need for more widespread progress. 3 Currently, there are approximately 73 million children (under age 18) in the United States (US), with an estimated 317 board-certified pediatric dermatologists constituting an average of 4.3 pediatric dermatologists per 1 000 000 children. 3,6 A 2004 survey of dermatology chairs and residency directors found challenges in filling vacant pediatric dermatologist faculty positions, and 70% of respondents reported a perceived shortage of pediatric dermatologists despite high need for services. 7,8 Furthermore, in an independent survey of pediatric generalists, pediatric dermatology was ranked severely understaffed,

Where Have All the Pediatric Ophthalmologists Gone?—Pediatric Eye Care Scarcity and the Challenge of Creating Equitable Health Care Access

“…Several studies have shown that physicians typically practice in regions where physician supply is already high, leaving underserved areas vulnerable to difficulties in access. 4 The Walsh et al study confirms that pediatric ophthalmologists also concentrate in populated areas. However, while the authors suggest a notion of incentivizing the redistribution of the existing pool of pediatric ophthalmologists to more underserved areas, the more significant problem appears to be the astonishing scarcity of total pediatric ophthalmologists.…”

“…Next, it is a seller’s market, where pediatric ophthalmologists ultimately have a high degree of flexibility in selecting the location of their practice given the small number of eye care professionals. Several studies have shown that physicians typically practice in regions where physician supply is already high, leaving underserved areas vulnerable to difficulties in access . The Walsh et al study confirms that pediatric ophthalmologists also concentrate in populated areas.…”

Access to pediatric dermatology

“…There are 4.3 pediatric dermatologists per 1 000 000 children nationally [10 ▪ ]; this ratio is ten times lower than adult dermatologists [11]. There is a markedly uneven distribution of pediatric dermatologists between urban and rural counties [8 ▪ –10 ▪ ,12,13]. According to a 2020 study, 98% of all pediatric dermatologists practice in a metropolitan county, none practice in rural counties [10 ▪ ], and seven states are without a pediatric dermatologist [8 ▪ ].…”

“…Early exposure and familiarity with target communities are strongly associated with physician recruitment and retention [9 ▪ ]. Patients of minority races and gender identities have less access to dermatologic care; diversifying the dermatology workforce and educational curriculum is critical to address this.…”

“…As of 2021, seven states remained without a pediatric dermatologist [8 ▪ ]. Despite a 62% increase in the size of the pediatric dermatology workforce over the past decade, demand continues to outpace physician availability [8 ▪ ,9 ▪ ].…”