Changes in dermatology practice characteristics in the United States from 2012 to 2017

Abstract

Background Dermatology practice has recently seen multiple changes. A better understanding of trends pertaining to dermatology practice setups is necessary. Objective To analyze the recent changes in dermatology practice in terms of geography, practice size, and gender distribution as well as to analyze the availability of dermatologists based on zip codes’ income levels. Methods This was a cross-sectional study. We extracted data on the sex and billing addresses of dermatologists from Medicare provider utilization and payment data for 2012 and 2017. We used 2017 tax returns data to calculate the poverty level for each zip code. Results Between 2012 and 2017, the number of solo practitioners decreased, while that of dermatologists working in large groups increased. The southern region experienced the largest changes. The male-to-female ratio decreased. Dermatology practices mainly comprised mixed genders, with a higher proportion of all-male groups versus that of all-female groups, but this difference decreased over time. In the northeastern and western regions, more than one third of dermatologists were located in the wealthiest zip codes. Limitations The Medicare data may not be exhaustively representative of the dermatology workforce, and the zip codes of 489 dermatologists’ billing addresses were missing in the tax return dataset. Conclusions These findings provide an understanding of the recent changes pertaining to dermatology practice setups and of the substantial health care disparities based on geographic distribution.

Medicare Opt-Out Trends Among Dermatologists May Reflect Systemic Health Policy: Cross-sectional Analysis

“…Overall, 196 (1.8%) dermatologists out of 11,003 total practicing dermatologists in the United States [ 3 ] opted out of Medicare. The majority of opt-outs were seen in New York, Texas, and California; although some of these opt-out providers are located in cities with populations lower than 10,000, all are in localities comprising statistical metropolitan areas, suggesting that there is likely still reasonable access to alternate avenues of care for Medicare beneficiaries in these areas.…”

“…Given that provider enrollment for participation in the Medicare program, or “opting in,” is a relatively uncomplicated process consisting of a 1-time application, other persistent systemic issues may have relevance to the mid-2010s shift. Rising practice operational expenses [ 1 ], complex compliance or regulatory requirements, and uncertainties from delayed payments [ 3 , 4 ], along with resource-constraining policies such as prior authorizations, can make it challenging for providers to effectively deliver patient-centric care [ 5 ]. The mid-2010s surge may be explained by heightened consolidation, as 15% of clinic acquisitions among private equity groups from 2014 to 2016 were dermatology clinics [ 3 ].…”

“…Due to the Medicare program’s role in providing broad access to care, it is important to explore characteristics associated with provider Medicare opt-out and trends over time to assess potential impacts on aspects of care delivery. Although literature on opting out is limited and the practice is infrequent [ 2 , 3 ], trends among provider opt-out may be revelatory of systemic issues such as complex Medicare reimbursement [ 1 ], bureaucratic intricacies, and prolonged accounts receivable periods, which can strain practitioners [ 4 ]. Therefore, assessing national metrics such as Medicare opt-out may also provide insights into health policy and systemic changes that shape Medicare provider participation.…”

Changing spectrum of hair and scalp disorders over the last decade in a tertiary medical centre

“…There is a scarcity of data on the prevalence of HSRD visits in the outpatient dermatological care setting. Studies assessing temporal trends in dermatological visits infrequently included HSRDs 24,29–37 . Research focusing on HSRDs included relatively short‐time intervals, focused on a single disease entity, studied a specific demographic group or derived from primary or secondary care settings 11,14–19,38–41 .…”

“…Studies assessing temporal trends in dermatological visits infrequently included HSRDs. 24,[29][30][31][32][33][34][35][36][37] Research focusing on HSRDs included relatively short-time intervals, focused on a single disease entity, studied a specific demographic group or derived from primary or secondary care settings. 11,[14][15][16][17][18][19][38][39][40][41] It stands to reason that the prevalence of HSRDs varies by the type of patient population and care settings that are evaluated.…”