To the Editor: ZocDoc is an online appointment scheduling platform that hosts thousands of independent practices and hospitals.1 Wait times for online dermatology appointments have been reported; to our knowledge, the impact of COVID-19 on appointment availability and wait times has not been studied.2 Our objective was to characterize dermatology appointment wait times on ZocDoc based on dermatologist density during the COVID-19 pandemic.
In April 2020, searches for “dermatologist” were conducted on ZocDoc in chronological order of the most to least dermatologist-dense areas in the United States as of 2016.3 Overlapping providers between cities and duplicate providers were excluded. Data analyzed included provider characteristics, days until the next available appointment, and video appointment availability. Descriptive statistics were generated, and Pearson correlation coefficients and t tests were calculated. All data analyses were performed by using the Excel Data Analysis Toolpak (Microsoft Corporation, Redmond, WA).
A total of 615 providers were obtained for 20 searches on ZocDoc; 67% were dermatologists (Table I ). Mean appointment wait times for the most and least dermatologist-dense locations were 3.9 and 6.8 days, respectively. There was no significant correlation between provider density and wait times and no significant difference in overall mean wait times for dermatologists (5.7 days) versus nondermatologists (5.4 days). When stratified by specialty, overall mean wait times ranged from 2 to 6 days, excluding primary care (17.3 days).
Table I.
ZocDoc appointment search results for “dermatologist” in the most and least dermatologist-dense locations
| Characteristics | Density rank |
|||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 703 | 704 | 705 | 706 | 707 | 708 | 709 | 710 | 711 | 712 | |
| Location | Upper East Side, NY | Palo Alto, CA | Santa Monica, CA | Boston, MA | Middlesex County, MA | Lower Manhattan, NY | Hanover, NH | Bethesda and Rockville, MD | Annapolis, MD | Portland, ME | Swainsboro, GA | Amarillo, TX | Flint, MI | South Bend, IN | Dayton, OH | Mojave, CA | Beaumont, TX | Yakima, WA | Lexington, KY | Jamaica, NY |
| Providers, n | 116 | 107 | 63 | 54 | 4 | 18 | 2 | 54 | 2 | 0 | 32 | 30 | 18 | 20 | 4 | 12 | 39 | 24 | 0 | 16 |
| Specialty, n (%) | ||||||||||||||||||||
| Dermatology | 113 (97.4) | 75 (70.1) | 47 (74.6) | 32 (59.3) | 1 (25.0) | 16 (88.9) | 2 (100.0) | 35 (64.8) | 2 (100.0) | 17 (53.1) | 4 (13.3) | 11 (61.1) | 5 (25.0) | 4 (100.0) | 8 (66.7) | 14 (35.9) | 11 (45.8) | 16 (100.0) | ||
| Family medicine | 18 (16.8) | 5 (7.9) | 12 (22.2) | 1 (25.0) | 9 (16.7) | 1 (3.1) | 10 (33.3) | 4 (22.2) | 6 (30.0) | 1 (8.3) | 12 (30.8) | 2 (8.3) | ||||||||
| Internal medicine | 5 (4.7) | 4 (6.3) | 6 (11.1) | 1 (25.0) | 7 (13.0) | 1 (3.1) | 1 (3.3) | 1 (5.6) | 2 (10.0) | 1 (8.3) | 5 (12.8) | |||||||||
| Physician assistant | 3 (2.6) | 1 (1.9) | 2 (11.1) | 12 (37.5) | 8 (26.7) | 1 (5.0) | 2 (5.1) | 4 (16.7) | ||||||||||||
| Nurse practitioner | 1 (0.9) | 1 (1.6) | 3 (5.6) | 1 (25.0) | 7 (23.3) | 1 (8.3) | 3 (7.7) | 2 (8.3) | ||||||||||||
| Primary care | 2 (1.9) | 2 (3.2) | 1 (3.1) | 2 (11.1) | 5 (25.0) | 2 (5.1) | ||||||||||||||
| Other | ||||||||||||||||||||
| Addiction | 1 (0.9) | |||||||||||||||||||
| Cardiology | 1 (1.9) | |||||||||||||||||||
| Allergist | 1 (1.9) | |||||||||||||||||||
| Naturopathic doctor | 1 (8.3) | 5 (20.8) | ||||||||||||||||||
| Plastic surgery | 2 (1.9) | 3 (4.8) | ||||||||||||||||||
| Sports medicine | 2 (1.9) | 1 (5.0) | 1 (2.6) | |||||||||||||||||
| Pediatrics | 1 (0.9) | 1 (1.6) | 1 (1.9) | |||||||||||||||||
| Sex, n (%) | ||||||||||||||||||||
| Female | 50 (43.1) | 57 (53.3) | 24 (38.1) | 31 (57.4) | 3 (75.0) | 12 (66.7) | 0 (0.0) | 33 (61.1) | 1 (50.0) | 27 (84.4) | 22 (73.3) | 5 (27.8) | 6 (30.0) | 2 (50.0) | 6 (50.0) | 21 (53.8) | 19 (79.2) | 4 (25.0) | ||
| Male | 66 (56.9) | 50 (46.7) | 39 (61.9) | 23 (42.6) | 1 (25.0) | 6 (33.3) | 2 (100.0) | 21 (38.9) | 1 (50.0) | 5 (15.6) | 8 (26.7) | 13 (72.2) | 14 (70.0) | 2 (50.0) | 6 (50.0) | 18 (46.2) | 5 (20.8) | 12 (75.0) | ||
| Total number of languages represented | 25 | 28 | 14 | 22 | 4 | 5 | 1 | 12 | 1 | 23 | 8 | 12 | 11 | 4 | 7 | 21 | 14 | 10 | ||
| Total number of zip codes represented | 33 | 54 | 35 | 25 | 2 | 12 | 0 | 33 | 2 | 3 | 9 | 3 | 2 | 0 | 1 | 10 | 6 | 5 | ||
| Number of available days in May 2020 | 11.8 | 15.4 | 14.4 | 9.6 | 4.0 | 7.5 | 2.0 | 13.0 | 6.5 | 7.8 | 16.1 | 13.8 | 16.2 | 2.0 | 14.6 | 17.1 | 13.1 | 9.7 | ||
| Clinic distance, miles | 1.7 | 15.8 | 12.1 | 11.2 | 69.5 | 2.3 | 9.8 | 59.0 | 44.0 | 67.9 | 61.0 | 60.6 | 71.1 | 5.3 | ||||||
| Appointment interval, minutes | 17.9 | 18.0 | 21.6 | 21.3 | 15.0 | 25.7 | 15.0 | 30.1 | 10.0 | 23.3 | 26.7 | 27.3 | 65.0 | 37.5 | 30.0 | 23.5 | 34.3 | 28.4 | ||
| Type of appointment offered | ||||||||||||||||||||
| In person | 38 (32.8) | 21 (19.6) | 38 (60.3) | 19 (35.2) | 0 (0.0) | 5 (27.8) | 0 (0.0) | 23 (42.6) | 2 (100.0) | 0 (0.0) | 0 (0.0) | 8 (44.4) | 13 (65.0) | 4 (100.0) | 4 (33.3) | 2 (5.1) | 0 (0.0) | 10 (62.5) | ||
| Video | 52 (44.8) | 12 (11.2) | 6 (9.5) | 13 (24.1) | 1 (25.0) | 6 (33.3) | 2 (100.0) | 5 (9.3) | 0 (0.0) | 11 (34.4) | 3 (10.0) | 1 (5.6) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 9 (23.1) | 4 (16.7) | 1 (6.3) | ||
| Both | 24 (20.7) | 63 (58.9) | 13 (20.6) | 2 (3.7) | 0 (0.0) | 6 (33.3) | 0 (0.0) | 20 (37.0) | 0 (0.0) | 20 (62.5) | 27 (90.0) | 6 (33.3) | 2 (10.0) | 0 (0.0) | 1 (8.3) | 26 (66.7) | 20 (83.3) | 5 (31.3) | ||
| Not provided | 2 (1.7) | 11 (10.3) | 6 (9.5) | 20 (37.0) | 3 (75.0) | 1 (5.6) | 0 (0.0) | 6 (11.1) | 0 (0.0) | 1 (3.1) | 0 (0.0) | 3 (16.7) | 5 (25.0) | 0 (0.0) | 7 (58.3) | 2 (5.1) | 0 (0.0) | 0 (0.0) | ||
| Mean wait time, d | ||||||||||||||||||||
| In person | 9.8 | 8.5 | 4.9 | 17.3 | 22.8 | 5.0 | 7.5 | 19.6 | 33.7 | 35.0 | 7.5 | 0.0 | 9.0 | |||||||
| Video | 0.9 | 0.4 | 1.3 | 3.3 | 4.0 | 1.6 | 0.0 | 2.7 | 6.5 | 0.3 | 1.0 | 1.0 | 1.3 | 6.0 | ||||||
| Both | 1.5 | 2.5 | 2.9 | 22.5 | 2.8 | 7.7 | 4.3 | 2.4 | 1.5 | 0.0 | 0.0 | 0.7 | 1.8 | 2.6 | ||||||
| Any video | 1.1 | 2.1 | 2.4 | 6.2 | 4.0 | 2.3 | 0.0 | 6.7 | 5.0 | 2.2 | 1.4 | 0.0 | 0.0 | 0.8 | 1.7 | 3.2 | ||||
All providers in Bethesda/Rockville, MD; Swainsboro, GA; Amarillo, TX; and Yakima, WA offered video appointments (Supplemental Fig 1; available via Mendeley at https://doi.org/10.17632/k9v34n2fpr.1). Fewer than one third of providers in South Bend, IN, and Mojave, CA, offered televisits. There was no significant difference in the proportion of dermatologists versus nondermatologists offering video appointments. The overall mean wait times for providers offering in-person versus video or in-person appointments were 11.7 and 2.4 days, respectively (Fig 1 ).
Fig 1.
The mean wait time for scheduling video versus in-person appointments by geographic location in April 2020. “In person” includes providers who offer in-person appointments only. “Video” includes any providers who offer video appointments. Cities with fewer than 5 providers (including Middlesex County, MA; Hanover, NH; Annapolis, MD; Dayton, OH; and Lexington, KY) listed were excluded from the figure. No providers in Swainsboro, GA; Amarillo, TX; Beaumont, TX; or Yakima, WA, offered only in-person appointments. Cities are ranked in order of highest to lowest dermatologist density from left to right.
The COVID-19 pandemic has resulted in increased use of telemedicine to deliver patient care.4 ZocDoc providers in the most low and high dermatologist-dense cities had ample video appointments available. Video wait times (2.4 days) were shorter than average in-person wait times on ZocDoc (11.7 days). This difference in wait times is consistent with findings from a single institution study performed in 2018, showing that mean wait times for virtual dermatology consultations (14.3 days) were significantly shorter than those for in-person referrals (34.7 days).5 In a ZocDoc search for “dermatologist” for in-person appointments in April 2019, 26% of providers were nondermatologists compared to 33% in April 2020.2 Therefore, in this past year, there has been an increase in nondermatologist physicians and midlevel providers offering dermatologic care.
This study is subject to several limitations. Because it was performed during a unique time period, future telemedicine use and reimbursement cannot be extrapolated. Only ZocDoc was analyzed, which may not fully represent the availability of online dermatology appointments. Additionally, there may have been less demand for dermatologists earlier in the pandemic, which may have affected wait times.
The availability of virtual dermatology appointments during a global pandemic has helped provide timely patient care across the United States. Patient outcomes with teledermatology versus in-person visits and the impact of dermatologic care by nondermatologists merit further study.
Footnotes
Funding sources: None.
Conflicts of interest: None disclosed.
IRB approval status: Not applicable.
Reprints not available from the authors.
References
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