Dermatologist
Kim Carney / MSNBC.com
By
msnbc.com contributor
updated 3/26/2007 8:38:29 AM ET 2007-03-26T12:38:29

Barbara Ross had just moved to Seattle when a rather irritating visitor came to call: eczema.

“I’ve had flare-ups before,” says the 58-year-old account executive. But this time the scaly patches on her chest were cracking and bleeding. “It was incredibly painful and very, very itchy. A co-worker recommended a dermatologist so I called for an appointment. And they told me it would be four months before I could get in.”

Liz Blank got much the same answer when she tried to get a “weird spot” on her arm checked out.

“I work in construction and spend a lot of time outside, and I noticed this odd-looking spot,” says the 37-year-old from Richmond, Va. “It was shiny and irregular around the edges, all the things they tell you to watch for. So I called a dermatologist to see if they could get me in quickly and they told me it would be an eight-month wait.”

Long wait times have become customary for dermatology practices over the last few years, but now even patients with urgent problems complain they are being told to take a number and stand in line.

So a pair of California researchers decided to put these complaints to the test. Posing as patients concerned about a “changing mole” (aka skin cancer central), they called 851 dermatologists across the country to make appointments and reported the results in a 2006 study in the Journal of the American Academy of Dermatology.

The average wait time given them was 38 days, with doctors’ offices in some cities taking much longer: 47 days in Syracuse, N.Y., 48 days in Phoenix and a whopping 73 days in Boston.

What's with the wait?
So why the long delays, especially with regard to the scary stuff? Is there a dermatologist shortage? Some raging acne epidemic? Or are youth-crazed baby boomers scooping up all the time slots for extraneous cosmetic work?

“Dermatologists are seeing an increase in demand for everything,” says Dr. Jack Resneck, assistant professor of dermatology at University of California, San Francisco, and co-author of the 2006 study. “There are a lot of new treatments available for diseases like psoriasis and eczema, so those patients are coming in more. There’s also been an explosion in the amount of skin cancer in the past couple of decades. Patients have become more educated about the warning signs, so a lot more people are coming in for skin checks.”

Unfortunately, Resneck says this increase in patient load hasn’t been met by an increase in doctors, partly because of a federal cap on the number of medical residents who can be trained each year. “A lot of specialties are facing physician shortages,” he says. “Dermatology is one of the ones at the extreme.”

“We’ve been consistently training 300 dermatologists a year for the last 30 years or so, even though the population has grown dramatically and the field has broadened dramatically,” he says.

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One area where the field has experienced the most visible growth is cosmetic procedures.

“These days, it seems like the plastic surgeons and the dermatologists are elbowing each other for patients,” says Catherine Berlin, 48, of Buffalo, N.Y., a regular dermatology patient who says in the last decade her wait times, even for cosmetic procedures such as Botox injections, have gone from three days to three months. At the same time she’s been getting sales pitches from the assistants for the latest cosmetic fixes and even the doctor’s own line of beauty treatments. “Now when I’m on hold, they run spiels about Thermage [a skin-tightening procedure],” she says.

It’s easy to understand the allure of cosmetics for dermatologists.

“Typically, people will spend between $300 and $1,000 for a Botox treatment,” says Resneck, all of which is paid for by the patient (given it’s for cosmetic reasons), usually at the time of service. By comparison, a skin checkup might net a dermatologist an eventual insurance payment of anywhere from $30 to $100.

Quick and pretty
Beauty treatments can also be handled quickly.

“Cosmetic procedures are less likely to require significant amounts of time,” says Dr. Joel Schlessinger, president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. “Botox injections can take 15 to 30 minutes versus a skin cancer procedure, which may take several hours.”

Does that mean cosmetic patients are getting in the dermatologist’s door right away while those with medical needs are left to stew about their scary moles and painful rashes?

“I think in general most people who wish to come in for cosmetic procedures are put into a fast-track program,” says Schlessinger, who runs a dermatology and general cosmetic surgery clinic in Omaha, Neb., and is the founder of Lovelyskin.com, a skin-care and products Web site. “They can get in on short notice, rather than, say, a new acne patient which might take longer. In my practice, if you call up, you’re put in the same pecking order as a medical patient. But in some practices, it is easier to get in as a cosmetic patient than a medical patient. They reserve certain slots and the medical slots just fill up quicker.”

While there are doctors who spend 100 percent of their time on one side of the spectrum or another (including some high-profile cosmetic-only practitioners), 75 percent of the 1,100 doctors in the American Society of Cosmetic Dermatology and Aesthetic Surgery practice both medical and cosmetic dermatology, according to Schlessinger.

But attributing increasing wait times entirely to short-and-monetarily-sweet cosmetic procedures is a “common misconception,” says Dr. Alexa Kimball,an assistant professor of dermatology at Harvard Medical School who’s studied dermatology workforce issues for years. Even if cosmetic procedures vanished tomorrow, you’d likely still have to wait to get into your dermatologist. Which may be the shape of things to come, she warns.

“Dermatology is the canary in the coal mine,” she says. “We’re struggling mightily both in dermatology and in medicine overall as to how we’re going to handle a shortage of physicians in the future. My own mom called last week and said she was having trouble finding a primary care physician. ‘Oh my god,’ she said. ‘You’re right. No one is accepting new patients.’”

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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