Diagnosis of skin disease by nondermatologists

To determine how often primary care physicians diagnose and treat skin disease and to compare their experience with that of dermatologists.

Retrospective review of National Ambulatory Medical Care Survey data.

We reviewed data from the 1990-1994 National Ambulatory Medical Care Survey on outpatient visits to physicians for both dermatologic and nondermatologic disorders.

Dermatitis is the most common dermatologic problem diagnosed by internists, family physicians, and pediatricians and is the 35th, 17th, and 15th most common diagnosis made by these providers, respectively. Dermatologists had 728 and 352 office visits per year for acne and contact dermatitis, respectively, whereas internists averaged 3 and 9 visits, family physicians averaged 8 and 27 visits, and pediatricians averaged 8 and 37 visits. Overall, dermatologists spent 930 outpatient hours per year with patients with dermatologic conditions, compared with 21, 53, and 56 hours per year for internists, family physicians, and pediatricians.

Although most visits for skin disease are managed by primary care physicians, these physicians treat few cases of individual skin conditions. The different levels of experience between dermatologists and nondermatologists may affect the quality of dermatologic care and may explain in part the greater expertise dermatologists have in diagnosing and treating skin disease. This should be considered in decisions about the delivery of dermatologic healthcare services and in planning educational programs designed to improve dermatologic care.