Trends in dermatology practices and the implications for the workforce.

BACKGROUND: The American Academy of Dermatology (AAD) practice profile surveys have been conducted for more than a decade to gauge trends in our workforce supply and demand. OBJECTIVE: To update the trends and current workforce issues for the field of dermatology. METHODS: The AAD Practice Profile Survey is sent by both e-mail and postal mail to a random sample of practicing dermatologists who are AAD members. RESULTS: Shifts are noted in the primary practice setting; fewer dermatologists are in solo practice and more are in group practices than in previous years. Teledermatology use trended upward from 7% to 11% between 2012 and 2014. The implementation of electronic health records increased from 51% in 2011 to 70% in 2014. LIMITATIONS: There is potential for response bias and inaccurate self-reporting. Survey responses collected may not be representative of all geographic areas. CONCLUSION: The demand for dermatology services remains strong. Shifts in the practice setting may be related to increases in overhead costs that are partially associated with the implementation of technology-based medical records. Integration of electronic health records and utilization of telemedicine are increasing.

Medical error in dermatology practice: development of a classification system to drive priority setting in patient safety efforts.

BACKGROUND: To date, no study to our knowledge has examined the nature and scope of medical error in dermatology practice. OBJECTIVE: We sought to collect and categorize physician-reported errors in dermatology practice. METHODS: A survey regarding most recent and most serious errors was developed and distributed to dermatologists attending US meetings. A total of 150 responses were received outlining 152 most recent errors and 130 most serious errors. Survey responses, along with classification systems for other specialties, were used to develop a classification system for medical error in dermatology. RESULTS: The respondents' demographics reflected the specialty: 63% were male, 60% were older than 50 years, and 60% were in solo or group private practice. Of the most recent errors reported, 85% happened once a year or less, and 86% did not result in harm to patients. The most common categories of both most recent and most serious errors were related to assessment (41% and 31%, respectively) and interventions (44% and 52%, respectively). Assessment errors were primarily related to investigations, and commonly involved the biopsy pathway. Intervention errors in the most recent and most serious errors were split between those related to medication (54% and 27%) and those related to procedures (46% and 73%). Of note, 5 and 21 wrong-site surgeries were reported in the most recent and most serious errors groups, respectively. LIMITATIONS: Our findings are subject to respondent and recall bias and our classification system, although an important first step, is likely incomplete. CONCLUSION: Our findings highlight several key areas of patient care in need of safety initiatives, namely the biopsy pathway, medication management, and prevention of wrong-site surgery.

An analysis of dermatologist migration patterns after residency training.

OBJECTIVE: To evaluate the migration patterns of dermatologists from residency training to eventual clinical practice to assess whether certain programs or regions were more likely to populate their own areas with graduates. DESIGN: Analysis of existing data from the American Academy of Dermatology's membership database. SETTING: The United States and Puerto Rico. PARTICIPANTS: Graduates of US dermatology residency programs completing training before 2005 and actively practicing in 2009. Data from 7067 practicing dermatologists were analyzed. MAIN OUTCOME MEASURES: Distance from training to practice site and state locations of training and practice sites. RESULTS: Almost half (43%) of dermatologists practice within 100 miles of their residency training site, although substantial variation was observed in distance (mean, 538 miles; median, 189 miles). More than 70% of graduates from all but 1 New York City program remain within a 100-mile radius, and several California and Florida programs were most likely to retain trainees in state. The Midwest was a net exporter of residents to the West and South. CONCLUSIONS: The relationships between residency and eventual practice locations are complex, but certain regions and training programs have distinct graduate migration patterns. To the extent that further expansions in residency positions are undertaken with local supply and demand of dermatology services in mind, these patterns are among many factors that should be considered.