Ethics of using advanced practice providers to expand dermatologic access in rural and underserved areas

As patient demand continues to outpace the supply of dermatologists, advanced practice providers are increasingly delivering dermatologic care. Outside metropolitan areas, advanced practice providers outnumber dermatologists. This raises an ethical question of balancing expanding access with equitable quality of care. We examine this through the ethical principles of distributive justice, beneficence, nonmaleficence, and autonomy. Key data are discussed, including workforce distribution, collaborative care models, and quality of care. To realize the full potential of advanced practice provider utilization, there must be improved incentives to practice in rural and underserved areas, mandated supervision of advanced practice provider colleagues, and informed patient consent about the scope of practice. Without these safeguards, efforts to expand access may inadvertently compromise the quality of care and deepen existing inequities.