🔍 Key Finding

Between 2012-2017, there was a significant shift from solo practices to larger group practices, particularly in the southern US, along with an increasing proportion of female dermatologists and concentration of practices in higher-income areas.

🔬 Methodology

• Cross-sectional study analyzing Medicare provider data (2012 and 2017)

• Extracted dermatologists' sex and billing addresses

• Categorized practices by size (solo, small 2-5, medium 6-10, large >10)

• Used R for statistical analysis

• Analyzed geographic distribution, practice size and gender trends

• Evaluated distribution based on zip codes' income levels using 2017 tax data

• Total sample: 10,374 (2012) and 11,003 (2017) dermatologists

📊 Evidence

• Number of dermatologists increased by 6% while number of practices only increased by 3%

• Solo practitioners decreased by 1% while those in large groups (>10 providers) increased by 12%

• Male-to-female ratio decreased from 1.3 in 2012 (57% men) to 1.1 in 2017 (52% men)

• 48% of dermatologists nationwide work in the 2 lowest poverty level quintiles, while only 18% work in the highest poverty level quintile

💡 Clinical Impact

The trend toward consolidation into larger practices may affect:

• Patient access to care, particularly in lower-income areas

• Practice management and reimbursement dynamics

• Work-life balance considerations for providers

• Gender diversity in the workforce

🤔 Limitations

• Data limited to Medicare providers only

• Single billing address per provider, not capturing multiple practice locations

• 489 dermatologists' zip codes missing from tax return dataset

• Limited data on physician age and practice ownership status