Rationale, impact of AAD Workforce Initiative 'questionable'

The data suggesting there is a need for more dermatologists are weak and open to different interpretations, says Jean-Claude Bystryn, M.D.

"The available data are not strong enough to warrant a major, expensive program to correct a problem that may not exist," he says referring to the AAD Workforce Initiative.

Discussing the findings from the 2004 survey conducted by Merritt, Hawkins, and Associates that showed the wait time for a dermatology appointment averaged three to four weeks, Dr. Bystryn pointed out that methodological flaws leave that study's findings open to varying interpretations. For example, in Dr. Bystryn's opinion the question asked - Is Medicaid accepted and what is the wait time for a routine mole exam? - was the wrong question.

"You can't judge wait time based on a low priority visit paid by insurance that most physicians don't accept," he says.

Interestingly as well, 43 percent of respondents in that survey indicated they accepted Medicaid fees.

"To me a long wait time for a discount service may not reflect wait time for service paid in full. Furthermore, one could also argue that willingness to discount services may reflect a need to attract patients and thus a surplus of physicians in the community," he adds.

Looking at the results a different way reveals that the shortest waiting time averaged 3.3 days among the 15 participating cities and same-day visits were available in some metropolitan areas.

"It seems access to dermatological care is not that difficult, but only requires a few phone calls," Dr. Bystryn says.

Dr. Bystryn also suggested that even if there is a dermatologist shortage, the Workforce Initiative will have a miniscule impact on correcting that problem. Moreover, there are data to show its goals have already been achieved.

"The plan to train 10 new dermatologists each year will increase the supply by only 0.1 percent in three years, while over the past six years the total number of dermatology residency positions increased 17 percent and the number of first positions increased 21 percent," Dr. Bystryn reports.