Practice Characteristics of Self-Identified Black Dermatologists in the United States

Abstract

There is a documented shortage of Black dermatologists in the United States, with little known about their practice characteristics. We analyzed the practice patterns (e.g., location, group setting, beneficiary characteristics, local geographic characteristics) of 221 self-identified Black dermatologists in the Black Dermatologist Directory through analysis of publicly available Medicare datasets. Compared to non-Black dermatologists, Black dermatologists were more likely to be female (80.1% vs. 51.1%), practice in the South (49.8% vs. 34.9%), work in solo practices (35.8% vs. 19.8%) or academic centers (18.1% vs. 15.5%), and practice in counties with a higher proportion of non-Hispanic Black individuals (21.0% vs. 13.2%). Black dermatologists treated a higher proportion of non-Hispanic Black Medicare beneficiaries (21.7% vs. 2.7%) and dual Medicare-Medicaid beneficiaries (15.0% vs. 9.7%). Major limitations include reliance on public data which may incompletely capture all practicing Black dermatologists. Overall, the findings support the important role of Black dermatologists in treating minority and Medicaid beneficiaries; increased representation of Black dermatologists may ultimately allow for improved patient access and promote awareness and knowledge of specific dermatologic needs of Black patients among the broader dermatology community.

There is a well-documented shortage of Black physicians in medicine and specifically dermatology. Currently, only three percent of dermatologists identify as Black, far less than the population proportion of Black individuals (13%).1 Physician-patient race concordance may help to improve patient satisfaction and engagement.⁶ Given that little is known about the practice characteristics of Black dermatologists in the United States, we conducted an analysis of self-identified Black dermatologists to elucidate their geographic locations and the patient populations they treat.

METHODS

We performed a cross-sectional review of Black dermatologists in the Black Dermatologist Directory, an online resource that lists self-identified Black dermatologists in the United States and seeks to address the unique dermatologic issues of Black patients.1 Individual practice characteristics of Black dermatologists listed in the directory were determined by using the Physician Compare National File, and these practice characteristics were compared to those of all other dermatologists in the dataset.2 For a minority of recent Black dermatology graduates, we supplemented our review with targeted searches of physician websites. We further resourced the Medicare Public Use File to obtain clinic beneficiary data and census data to obtain county sociodemographic information.3

RESULTS

We analyzed a total of 221 self-identified Black dermatologists, comprising 1.8 percent of all dermatologists in the National File. Compared to other dermatologists, Black dermatologists were more likely to be female (80.1% vs. 51.1%, p<0.0001), practice in the South (49.8% vs. 34.9%, p<0.0001), and work in solo practices (35.8% vs. 19.8%, p<0.0001) or academic centers (18.1% vs. 15.5%, p<0.0001). They were more likely to practice in counties with a higher proportion of non-Hispanic Black population (21.0% vs. 13.2%, p<0.0001) and non-Hispanic Black beneficiaries accounted for a higher proportion of their Medicare patients (21.7% vs. 2.7%, p<0.0001). Black dermatologists practiced in medically underserved areas to a similar degree as other dermatologists (20.4% vs. 21.9%, p=0.6587) (Table 1).4

TABLE 1.

Characteristics and local population demographic features of self-identified Black dermatologists and other dermatologists in the United States

FEATURE/ CHARACTERISTIC	SELF-IDENTIFIED BLACK DERMATOLOGISTS (N=221)	OTHER DERMATOLOGISTS (N=11,951)	P-VALUE
INDIVIDUAL AND PRACTICE CHARACTERISTCS
Gender
Male	44 (19.9)	5,846 (48.9)	<0.0001
Female	177 (80.1)	6,105 (51.1)
Mean Years of Independent Practice (SD)	14.9 (11.0)	18.6 (13.2)	<0.0001
Geographic Region (%)
Northeast	50 (22.6)	2,596 (21.9)	<0.0001
Midwest	37 (16.7)	2,198 (18.5)
South	110 (49.8)	4,144 (34.9)
West	24 (10.9)	2,935 (24.7)
Practice Setting (%)
Solo Private Dermatology Practice	79 (35.8)	2,363 (19.8)	<0.0001
Small Private Dermatology Practice	64 (29.0)	5,495 (46.0)
Multi-Specialty Group or Non-Academic Hospital	38 (17.2)	2,242 (18.8)
Academic Hospital Group	40 (18.1)	1,851 (15.5)
CLINIC BENEFICIARY CHARACTERISTICS
Mean Beneficiary Age (SD)	72.2 (2.7)	74.2 (2.9)	<0.0001
Mean Proportion of Non-Hispanic Black or African American Beneficiaries (SD)	21.7 (24.9)	2.7 (6.2)	<0.0001
Mean Proportion of Dual Medicare-Medicaid Beneficiaries (SD)	15.0 (15.0)	9.7 (12.0)	<0.0001
LOCAL GEOGRAPHIC CHARACTERISTICS
County Rurality (%)
Metro	217 (98.2)	11,239 (94.1)	0.0100
Non-Metro and Rural	4 (1.8)	709 (5.9)
Dermatologist Density in County (%)
<4.0 per 100,000 Population	74 (33.5)	3,338 (28.1)	0.0800
≥4.0 per 100,000 Population	147 (66.5)	8,530 (71.9)
County Median Income (%)
< National Median	93 (42.3)	5,424 (45.7)	0.308
≥ National Median	127 (57.7)	6,437 (54.3)
County Demographic Proportion (SD)
Non-Hispanic White	47.9 (17.6)	58.0 (20.1)	<0.0001
Non-Hispanic Black or African American	21.0 (14.4)	13.2 (12.2)	<0.0001
Non-Hispanic Asian	8.2 (5.8)	7.2 (7.3)	0.0146
Other or Combined (≥2) Races	2.6 (1.5)	3.0 (3.2)	0.0012
Hispanic	20.2 (15.2)	18.6 (15.2)	0.1208
Practice in Medically Underserved Area (%)†
Yes	45 (20.4)	581 (21.9)	0.6587
No	176 (79.6)	2074 (78.1)

Dermatologist features are primarily obtained from the 2021 Physician Compare National Downloadable File. Clinic beneficiary data are obtained from the most recent (2019) Medicare Public Use File and are not available for ~10% of dermatologists. U.S. Census data were referenced to identify local county-specific demographic features. P values are determined from Pearson’s chi-squared test (categorical data) or unpaired t-tests (continuous data);

^†Medically underserved areas (MUA) are geographic areas with a lack of access to primary care services. Because these areas may be defined at the level of the county, county subdivision, or census tract area, they were manually verified for each Black physician’s practice address using the Health Resources & Services Administration lookup tool. For comparison purposes, the aggregate proportion of recent dermatology graduates currently practicing in a MUA is provided based on recent data from the Association of American Medical Colleges; SD=Standard Deviation.

DISCUSSION

The explanation for the greater proportion of Black dermatologists in solo practice is unclear. It is possible that solo settings allow greater autonomy for these physicians to address the unique dermatologic issues of their patient populations. The notable role of Black dermatologists in academic institutions is encouraging, and their role in teaching, mentoring, and leadership may help to increase underrepresented minority trainees in dermatology.

The data indicate that Black dermatologists care for a significant proportion of non-Hispanic Black and dual Medicaid-Medicare beneficiaries. Multiple factors may be contributing to this, including location of Black dermatologists in counties with a high proportion of Black individuals and possible personal aims to care for underserved patients. Additionally, Black patients may actively seek care from Black dermatologists. Adherence to dermatologic therapy may be 11 percent higher among race concordant patient-provider dyads,5 reinforcing the importance of supporting recruitment of Black dermatologists to promote patient access and engagement. Interestingly, Black dermatologists were not more likely to practice in medically underserved areas, which are often rural and lack access to primary care. This underscores the need for simultaneous efforts to recruit dermatologists from rural or underserved backgrounds and those with specific interests to practice in medically underserved areas.

This study relies primarily on public data and may incompletely capture of all practicing Black dermatologists. Some of the dermatologists in the comparison group may identify as Black yet not appear in the Black Dermatologist Directory. Still, this study helps to better discern the current practice characteristics of Black dermatologists. Increased representation of Black dermatologists may ultimately allow for improved patient access and promote awareness and knowledge of specific dermatologic needs of Black patients among the broader dermatology community.