Abstract
This cross-sectional analysis of responses to a telephone algorithm finds that dermatology appointment wait times have doubled over the past decade and appointment wait time may have an influence on dermatology office management.
A 2015 report released by the Association of American Medical Colleges projects a shortage of up to 90 000 physicians by 2025. The total demand for physicians is expected to increase 17% from 2013 to 2025 because of an aging and expanding population and the implementation of the Affordable Care Act. The field of dermatology is not immune from this perceived physician shortage. A 2014 US survey reports that the average appointment wait time for a skin cancer screening examination with a dermatologist was 28.8 days. This appointment wait time was increased from 22.1 days in 2009.
Recent attempts have been made to decrease the shortage of practicing dermatologists. Dermatology residency positions in the National Resident Matching Program have increased more than 20% since 2012. Physician extenders have also been used in dermatology offices to reduce the time burden on dermatologists. The term physician extender is generally defined as a physician assistant, nurse practitioner, or physician not board-certified in dermatology. The Society of Dermatology Physician Assistants has grown from 49 members in 1994 to more than 2700 members in 2014. However, the association between the use of physician extender and current wait times to see a dermatologist is not well established. We sought to examine the mean appointment wait time to see a dermatologist in Ohio and to characterize whether the availability of a physician extender affected scheduling.
Methods
We conducted this cross-sectional study using a list obtained from the American Academy of Dermatology and the American Osteopathic College of Dermatology websites of 337 board-certified dermatologists practicing medicine in Ohio. One of us (F.Z.) placed telephone calls to each office and posed as a new patient with concerns about the cancer risk of a changing skin mole. The telephone algorithm (Figure) used questions to determine the wait time for the next available appointment specifically with a dermatologist and whether physician extenders were used in the office. Physicians not accepting new patients or practicing only cosmetic or surgical dermatology were excluded from the study. The institutional review board at the Northeast Ohio Medical University in Rootstown granted a memorandum of exemption. An unpaired t test was used, and a 2-sided P < .10 defined statistical significance.
Figure. Telephone Script Algorithm to Schedule Appointment With a Dermatologist.
Results
The study population included 269 practicing medical dermatologists in Ohio. Of these, 236 (87.7%) were a doctor of medicine and 33 (12.3%) were a doctor of osteopathy; 183 (68%) offices were staffed by a dermatologist only and 86 (32%) offices also used a physician extender. The mean wait time to see the dermatologist was 56 days, with a median wait time of 41 days (Table). An earlier appointment was offered with a physician extender in 86 offices (32%). The mean wait time to see a physician extender was 19 days (range, 0-41 days).
Table. Office Characteristics and Appointment Wait Time Data for Dermatologists and Physician Extenders Obtained by Patient Telephone Communicationa.
| Characteristic | Data (N = 269) |
|---|---|
| Office Characteristics | |
| Type of physician, No. (%) | 269 |
| Doctor of medicine | 236 (87.7) |
| Doctor of osteopathy | 33 (12.3) |
| Office staff, No. (%) | |
| Dermatologist only, No. (%) | 183 (68.0) |
| Doctor of medicine | 168 (91.8) |
| Doctor of osteopathy | 15 (8.2) |
| Dermatologist and physician extender, No. (%) | 86 (32.0) |
| Doctor of medicine | 68 (79.1) |
| Doctor of osteopathy | 18 (20.9) |
| Offers same-day appointments, No. (%) | 27 (10.0) |
| Has same-day appointment availability, No. (%) | 6 (2.2) |
| Website availability, No. (%) | 219 (81.4) |
| Appointment Wait Times | |
| To be seen by dermatologist, d | |
| Mean (range) | 56 (0-344) |
| Doctor of medicine | 56 |
| Doctor of osteopathy | 56 |
| Median | 41 |
| Doctor of medicine | 42 |
| Doctor of osteopathy | 24 |
| To be seen by physician extender, d | |
| Mean (range) | 19 (0-41) |
| Median | 10 |
| To be seen by dermatologist in office using physician extender, d | |
| Mean (range) | 48 (8-196) |
| Median | 41 |
| To be seen by dermatologist in office without physician extender, d | |
| Mean (range) | 60 (0-344) |
| Median | 44 |
| Cost of Evaluation, $ (n = 259)b | |
| Offices with set charge, $ (n = 155) | |
| Mean (range) | 172 (52-635) |
| Median | 105 |
| Offices with range of charges, $ (n = 104) | |
| Range | 52-300 |
| Low value, $ | |
| Mean (range) | 74 (52-150) |
| Median | 60 |
| High value, $ | |
| Mean (range) | 159 (80-300) |
| Median | 150 |
The term physician extender is generally defined as a physician assistant, nurse practitioner, or physician not board-certified in dermatology.
Cost data were obtained from 259 offices; 10 offices were unable to provide cost estimate.
Offices unable to offer an appointment with a physician extender had a mean wait time of 60 days (range, 0-344 days) to see the dermatologist. Offices that offered an appointment with a physician extender had a mean wait time of 48 days (range, 8-196 days) to see the dermatologist. This difference did not reach statistical significance (P = .10).
Discussion
Our study concludes that wait times in Ohio have almost doubled compared with results from a 2009 study, which showed wait times to be a mean of 33 days for a similar dermatologic problem. These data suggest that the current supply of dermatologists in Ohio is not sufficient for the increasing demand for dermatologic services. The difference in wait times for offices that use physician extenders compared with offices without physician extenders (48 vs 60 days) was not statistically significant. However, the additional days of wait time could be sufficient to discourage patients from keeping their appointments or to encourage them to seek a physician less experienced to diagnose skin cancer than a board-certified dermatologist.
Despite this increase in appointment wait times, we do not believe that these results confirm a current shortage of dermatologists. As a multitiered community of trained and certified medical professionals in the field of dermatology, we need to determine an acceptable wait time range for patients with a concern for skin cancer, to evaluate and determine whether we are meeting that measure, and to promptly make adjustments in the dermatology physician workforce (which may include physician extenders who work in dermatology offices), if needed. More research needs to be done on the subject of dermatology physician extender training, their patient outcomes, and the effect on wait times for patients seen in a dermatology office.
References
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