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- Presentation
Improving Rural Dermatology Access in New Mexico Through Triage, Telederm, and Local Capacity Building
Description
The speaker, a dermatologist from the University of New Mexico, describes the severe access challenges for rural dermatology in a geographically large and sparsely populated state where patients often travel hours for specialty care. Using maps and local data, he shows that New Mexico has far too few dermatologists, uneven geographic distribution, limited acceptance of new and Medicaid patients, and especially weak access to Mohs surgery, with no area meeting national access benchmarks. He explains that access is shaped by more than distance alone, including provider capacity, insurance barriers, travel time, and fragmented referrals. Because the UNM dermatology waitlist became unmanageable, the team looked for scalable solutions. He argues that adding more dermatologists and teledermatology alone are not sufficient, though telederm can help; instead, the most effective strategies have been centralized triage, interprofessional e-consults, a physician access line, training primary care clinicians to manage and biopsy skin conditions, dermatology education conferences, ECHO tele-mentoring, outreach screenings, and a traveling specialty clinic in Gallup. These approaches improve local capacity, preserve specialist time, and help patients receive care closer to home while reserving urban referral centers for complex cases.
View moreConclusions
- Rural dermatology access in New Mexico is severely limited and highly uneven, with no regions meeting the benchmark for adequate coverage.
- Geography alone does not explain access problems; provider capacity, patient competition, insurance status, and system barriers are equally important.
- Long travel distances and limited local specialist availability widen disparities and discourage many rural patients from obtaining care.
- The state’s dermatology workforce is far below need, and many active dermatologists practice part-time, accept few new patients, or do not take Medicaid.
- Teledermatology helps with triage and consultation but does not by itself solve rural access problems because of workflow, image quality, reimbursement, and provider-time constraints.
- Centralized triage and provider-to-provider interprofessional consults are more effective than direct-to-consumer telederm for extending specialist reach.
- Training primary care clinicians and APPs to biopsy and manage common dermatologic problems locally can meaningfully expand access.
- Educational models such as dermatology ECHO and local conferences build community capacity and improve rural dermatology care over time.
- Outreach clinics and specialty satellites, such as the Gallup clinic, can deliver care to populations that would otherwise not travel to urban centers.
- The most practical rural dermatology strategy is to triage remotely, treat locally whenever possible, and centralize only the most complex cases.
- Coughlin SS, et al. [journal citation and DOI information shown on slide].
- Hester T, et al. [journal citation and DOI information shown on slide].
- Glazer, A. M., Farberg, A. S., Winkelmann, R. R., & Rigel, D. S. (2017). Analysis of trends in geographic distribution and density of US dermatologists. JAMA Dermatology, 153(4), 322-325.#10.1001/jamadermatol.2016.5411