Dermatologists specialize in a branch of medicine focused on the diagnosis and treatment of diseases of the skin, hair, and nails. Medical dermatologists treat various common skin conditions such as acne, dermatitis, warts, Psoriasis, rosacea, eczema, skin cancer screening, skin growths/infections, nail disorders and hair loss. Fellowship-trained Mohs surgeons and dermatologic surgeons have expertise in skin cancer evaluation and treatment, destruction and excision of benign, premalignant and malignant skin lesions, nail surgery, and skin cancer evaluation and treatment using Mohs micrographic surgery and facial reconstruction.
The current demand for dermatologists far exceeds the supply. Dermatologists see females and males in relatively equal numbers and see all age groups, but the majority of dermatology visits are from patients aged 10-55 and 65+. Given the epidemic of skin cancer (over one million cases per year) and the aging population, dermatologists are in very high demand with the average wait of 6-8 weeks to see one. Nationally, the ratio of dermatologists to patients is approximately 1: 33,000, but this is much higher in the rural areas. These ratios have been similar for several decades.
Because it is very difficult to develop new dermatology training programs and considering the fact that several dermatology residencies have folded in recent years, it is nearly impossible to increase the numbers of dermatologists in any reasonable time frame. Recently some dermatologists are specializing in cosmetics, thus not treating skin cancers or providing medical dermatology. Also around 65% of dermatologists are over 54 years old and will be retiring soon, thus adding to the shortage. Because dermatology is currently one of the top three most competitive specialties in medicine, there are very few foreign medical students that can enter residency training programs such as is the case for internal medicine or family practice programs. The relatively high percentage of females entering the dermatology work-force at less than full time positions also limit how many patients can be seen. All these factors will continue to assure the necessity for good dermatologists for many years.
Healthcare reform is of mild concern to dermatologists as it could mean cuts to Medicare reimbursement, but given that it can be changed at each new Presidential administration and given the fairly recent abysmal failure of the HMO experiment, the likelihood that patients will tolerate inferior insurance coverage/care and higher insurance premiums, is low.
Mohs surgeons are also in high demand especially in the rural areas. Like many specialists, Mohs surgeons do concentrate in large urban centers, but there are several Mohs Surgeons that serve rural areas and have very busy practices. Given the epidemic of skin cancer, the higher cure rates, and the cost-effectiveness of Mohs Micrographic surgery, it will remain the gold standard for non-melanoma skin cancer treatment on the head and neck and other body sites that demand tissue preservation.
