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Presentation

Rural Dermatology Access, Disparities, and Solutions

Description

The speaker, a rural dermatologist from South Dakota and founder of the Rural Access to Dermatology Society, describes the severe shortage and maldistribution of dermatologists in rural America, where many counties—especially those with Black, Hispanic, and American Indian majorities—have no dermatologists at all. She explains that rural patients often travel long distances, face compounding geographic and insurance barriers, and experience worse outcomes, including higher skin cancer mortality and more severe inflammatory skin disease. The talk highlights that subspecialties such as Mohs surgery and pediatric dermatology are even more concentrated in metro areas, with rural counties largely unserved, and criticizes training, certification, and reimbursement systems that may worsen inequities. She argues that solutions must include rural residency tracks, rural rotations, mentorship, scholarships, better Medicaid participation, fair reimbursement, teledermatology, Project ECHO, and sustainable partnerships with local communities. Emphasizing that rural America is culturally diverse and not a monolith, she calls for trust-building, consistent presence, and advocacy to expand access, close gaps, and train more dermatologists where they are most needed.

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Conclusions

Dermatology care is severely maldistributed in the United States, with rural communities bearing the greatest access gaps and longest travel burdens.
Rural and minority communities experience compounded health inequities because geographic barriers layer onto existing socioeconomic and insurance barriers.
Training location matters: physicians, including dermatologists, are more likely to practice where they train, so rural residency tracks could be one of the most effective long-term solutions.
Teledermatology, Project ECHO, free clinics, and satellite clinics can help, but they do not close the access gap as effectively as placing and training dermatologists in rural communities.
The current workforce is especially skewed for subspecialties like Mohs surgery and pediatric dermatology, where rural access is extremely limited or nearly absent.
Expanding access requires sustainable, longitudinal partnerships, fair reimbursement, mentorship, and culturally respectful community engagement rather than one-time outreach.
Recruiting rural-background students and supporting them through holistic admissions, scholarships, and mentorship may improve the future rural dermatology workforce.
The presentation concludes that improving rural dermatology is both a systems problem and a values problem, requiring specialty-wide advocacy and a commitment to serve underserved communities.

Feng H, Berk-Krauss J, Feng PW, Stein JA. Comparison of Dermatologist Density Between Urban and Rural Counties in the United States. JAMA Dermatol. 2018;154(11):1265-1271. doi:10.1001/jamadermatol.2018.3022.#10.1001/jamadermatol.2018.3022
Feng H., et al. JAMA Dermatology. 2018.
Vaidya T., et al. J Am Acad Dermatol. 2018.
Tomtschik et. al, JAAD, 2022.
Feng et. al, Derm Surg, 2019.
Tessier-Kay M, Beltrami E, Sinha S, Feng H. Characteristics of board-certified pediatric dermatologists accepting Medicaid. Pediatr Dermatol. 2024 Sep-Oct;41(5):841-844.