Variation in Family Physician Dermatology Care by Dermatologist Availability

Access to procedural dermatologic care is threatened by limited access to dermatologists. Our objective was to determine whether the availability of dermatologists is associated with family physicians (FPs) providing office-based skin procedures.

We used the 2022-2023 Virginia All Payer Claims Database (VA APCD), merged with American Board of Family Medicine (ABFM) administrative data, and the Area Health Resource File. We limited the sample to continuity care FPs with at least 60 claims. We determined FPs' performance of five skin procedures from claims. We classified dermatologist supply as high, low, or none based on county-level, population-adjusted thresholds. We used logistic regression to determine adjusted associations of FPs performing skin procedures.

Our sample was 1,723 ABFM-certified FPs with 75.1% performing at least one office-based dermatologic procedure. Compared to FPs in counties with high dermatologist density, those in low-density counties were 6.7% (95% confidence interval = 4.4% to 9.0%) more likely to perform any dermatologic procedure, and those in counties with no dermatologists were 11.9% (95% confidence interval = 8.4% to 15.4%) more likely (both P<0.001). This pattern was consistent across all dermatologic procedures.

FPs perform more office-based skin procedures in areas with limited dermatologist availability, playing an important role in providing access to services. However, some areas lack both, suggesting access gaps. These findings can influence workforce and training policies aimed at improving dermatologic care access in underserved regions and tailoring FP training to equip them to fill such gaps in care.