SALT LAKE CITY — A national magazine recently pronounced Utah a "dermatology desert" that has only 22 skin doctors to serve a state of 3 million people — a questionable claim since there are more than 22 dermatologists at the University of Utah hospital alone.
The Utah Medical Association counts 135 practicing dermatologists, 78 who are members of the group and 57 who are not, said Mark Fotheringham, vice president of communications and membership.
Why does this matter to you and your family?
It matters because the number of dermatologists — and whether any of them practice close to where you live — affects how quickly you can get an appointment. And should you happen to have melanoma, a fast-growing and deadly type of cancer, the sooner you are treated, the greater your chance of surviving.
"There’s a national dearth of M.D.s in general, but the derm problem is particularly alarming: The U.S. has about 55,000 practicing pediatricians, 40,000 gynecologists, 38,000 psychiatrists—and a mere 10,845 dermatologists," Melinda Wenner Moyer wrote.
The problem is particularly worrisome, the Women's Health article said, because rates of melanoma, the deadliest form of skin cancer are rising. The chance of being diagnosed with invasive melanoma over a lifetime is 1 in 54, up from 1 in 58 in 2009. The American Academy of Dermatology says the nation needs 22,000 skin doctors to treat everyone with skin issues "in an appropriate amount of time."
The report correctly notes that Utah has the nation's highest rate of melanoma, more than twice the national average. But it erred in saying that Utah has only 22 dermatologists to treat a population of 3 million.
"Our department at the University of Utah has 30," Dr. Douglas Grossman, a professor of dermatology and an investigator in Huntsman Cancer Institute's Melanoma Program, told the Deseret News.
The website of the American Academy of Dermatologists lists 44 members in Utah, better than 22 but still likely not sufficient, given the increasing number of people who seek the services of a dermatologist for laser treatments, Botox and other cosmetic procedures, as well as Utah's persistently high skin cancer rates.
Women's Health reported that to adequately treat everyone in Utah, the state needs 120 dermatologists, which, according to the Utah Medical Association, it has.
In response to a query about its Utah numbers, a magazine representative told the Deseret News that its numbers came from the academy's website, which updates its numbers in real time, and the numbers may have grown since the article was reported. Also, in their count, Women's Health editors excluded dermatologists who are in research-only positions and don't see patients.
Where the doctors are
In one 2010 study published in JAMA Dermatology, researchers analyzed the density of dermatologists within ZIP codes and found the most clustered in affluent, urban centers such as New York City, Boston and Palo Alto, California.
The three areas with the fewest number of dermatologists were Jamaica, New York; Fresno, California; and Dayton, Ohio. (Utah was not among the bottom 10.)
Other research has sought to determine if melanoma deaths are related to a lack of dermatologists.
In a study released earlier this year, analysts at Merritt Hawkins found that people in 13 of the 15 largest metropolitan areas waited two weeks or more before they could see a dermatologist. The wait was longest in Philadelphia (78 days), Boston (52 days) and Denver (51 days).
Data for Utah cities were not included, but Women's Health reported that the average wait time in a mid-sized city nationwide is 35 days.
The generally accepted rule of thumb is that for every 100,000 people, a minimum of four dermatologists are needed to meet the population's needs. The current number in the U.S. is 3.4 As in many specialties, dermatologists are unevenly distributed "with most practicing in major urban areas or large academic centers," according to Dr. Alex M. Glazer, a clinical research fellow at the National Society for Cutaneous Medicine.
But writing in JAMA Dermatology, Glazer noted that dermatology physician assistants can help meet the need, and the journal noted that there are six in Ogden, Utah, making Ogden 18th among the cities with the most dermatology PAs in the nation.
Additionally, the American Academy of Dermatology has said that telemedicine, when practiced by a board-certified dermatologist, improves access to care. And increasingly, primary-care doctors are getting specialized training in skin care, Women's Health reported.
What you can do
In a letter to Women's Health magazine, academy president Dr. Henry W. Lim said that dermatologists who belong to his organization report that they spend a small amount time on cosmetic procedures, but that the demand for dermatologists exceeds demand.
"We encourage readers to be their own health advocates by checking their skin for suspicious growths and changing moles, and to clearly convey their concerns when making an appointment — most dermatologists will see patients with urgent problems promptly," Lim wrote.
Visitors to the academy website can download a printable map on which you can record moles and any changes to them over time. The academy also offers a yearly email reminder to do a skin check, as well as occasional free screenings. (There are none currently scheduled in Utah, but you can check for screenings in other states, or sign up to be notified when one occurs within 50 miles of your location.)
Skin cancer specialists say that people should check their skin monthly for any changes to existing moles or new growth, even in places like the bottom of your feet or your scalp. Use a mirror or ask your spouse to check your back, which is the most common place for melanoma.
And if you do find something suspicious and want to be seen right away, Women's Health recommends the exact words to say when you call the doctor's office: “I have a mole that’s changing/bleeding, and I’m afraid that it’s melanoma.”
"This makes a big difference in how quickly you are seen," the magazine's report said.