Tri-State Analysis of the Distribution of Southeastern Dermatologists and Dermatology Residency Graduates Among Rural and Urban Areas

Problems with access to healthcare are not unique to rural areas, but they are especially prevalent in reference to dermatology. Many factors influence a dermatologist’s decision whether to practice in rural vs urban areas, and it is far more common to choose the latter. It has been shown that medical school graduates from public medical schools or rural tracks are more likely to practice in rural areas.¹ Additionally, it is becoming increasingly common for dermatologists to join group practices; therefore, running a solo, rural practice presents its own challenges.²

To adequately provide dermatologic care for a community, it is estimated that four dermatologists per 100,000 individuals are needed.³ The current US average is about 3.⁴ dermatologists per 100,000 individuals, and urban areas have 40 times the concentration of dermatologists per 100,000 citizens that rural areas do.⁴

The objective of this study was to analyze the distribution of dermatologists throughout Arkansas, Louisiana, and Mississippi; the factors that influence this distribution; and the distribution of University of Arkansas for Medical Sciences (UAMS), Louisiana State University Health Sciences Center (LSUHSC), and University of Mississippi Medical Center (UMMC) dermatology graduates.

Methods

The 2021-2022 Area Health Resource File was used to gather data regarding distribution of dermatologists throughout Arkansas,⁵ Louisiana,⁶ and Mississippi.⁷ A list of dermatology graduates from UAMS and LSUHS between 2006-2023 and UMMC between 2016-2023 (the program was founded in 2013) was collected. Graduates’ hometowns and current practice locations were determined from referencing alumni rosters received from respective residency programs and biographies on current practice websites. These data sets were used to calculate the percentage of graduates who returned home, are rural natives, are rural natives practicing in rural areas, and who currently practice in rural areas. Rural cities were defined as having a population of less than 50,000, and rural parishes/counties were determined using census data.^8,9

Results

Concentration of dermatologists in urban parishes/counties is evident in a mapped distribution across all three states. All three states display inadequate coverage in rural parishes/counties (Figure 1).

Figure 1. Mapped distribution of dermatologists among counties/parishes by rate of dermatologists per 100,000. A map of Arkansas, Louisiana, and Mississippi showing the rates per parish/county with darker color indicating a higher rate.

Louisiana has an adequate number of dermatologists in approximately 16% of its parishes; Arkansas and Mississippi have adequate numbers in closer to 7% of their counties. In urban parishes/counties, Louisiana still holds double the coverage that Arkansas/Mississippi do (33.3% compared to approximately 17%). All three states had inadequate coverage in rural areas with only 0-2 parishes/counties displaying adequate coverage (Table 1).

Table 1. Parishes/counties with adequate dermatologic coverage. The number of parishes/counties that meet 4 dermatologists per 100,000 individuals was calculated as a percentage of all parishes/counties in the state, rural parishes/counties, and urban parishes/counties.

Of the three residency programs, LSUSHSC has the largest number of graduates returning home to practice (57.4%). UAMS/UMMC lead in rural-native resident recruitment (28.6% and 27.8% respectively). UMMC has the largest number of graduates (40%) currently practicing in rural areas. UMMC also has the largest number of rural native residents returning to rural areas to practice (100%) (Table 2).

Table 2. Distribution of dermatology residency alumni. Distribution of dermatology residency alumni from UAMS & LSUHSC between 2006-2023 and from UMMC between 2016-2023.

Discussion

These data sets show that the majority of areas in all three states have an unmet need for dermatologists, with a majority of dermatologists concentrated in urban parishes/counties. Additionally, Louisiana has around double what is considered adequate coverage as a whole state and in urban areas compared to both Arkansas and Mississippi. It is difficult to fully attribute this pattern of distribution to any number of factors; however, the current training structure of dermatology residency programs and cultural/economic factors likely play a role. Louisiana currently has two dermatology residencies, whereas Arkansas and Mississippi currently have one. While not all graduates from Louisiana stay in the state, producing roughly double the dermatologists likely plays a role in providing more state-wide coverage. Additionally, Louisiana is more populous with a greater number of metropolitan areas compared to Arkansas and Mississippi.⁹

Alumni practice choice amongst the three southeastern programs showed variation. Graduates of LSUHSC had the highest distribution of graduates returning to their hometowns to practice. UAMS and UMMC recruited about double the rural natives as residents compared to LSUHSC. Lastly, UMMC not only displayed the largest number of graduates practicing in rural areas, but also showed the highest retention of rural natives to rural areas.

The rural-favoring statistics to UMMC likely can be attributed to the program having a specific rural training track dedicated to recruiting and placing rural natives in rural practice settings. Overall, UAMS and UMMC having higher recruitment of rural residents may speak to larger numbers of rural areas in Arkansas and Mississippi compared to Louisiana.

Conclusions

Most of the dermatologists in these southeastern states practice in urban areas. Among Arkansas, Louisiana, and Mississippi, there is similar coverage in rural areas; however, Louisiana shows roughly double in urban areas. Of these states’ dermatology residency programs, UMMC demonstrated the largest recruitment of rural residents and placement of residents in rural areas. In all, these results speak to the value of specific rural residency tracks in placing dermatologists in rural areas.

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2. Ehrlich A, Kostecki J, Olkaba H. Trends in dermatology practices and the implications for the workforce. J Am Acad Dermatol. 2017;77(4):746-752. doi: 10.1016/j.jaad.2017.06.030
3. Glazer AM, Farberg AS, Winkelmann RR, Rigel DS. Analysis of trends in geographic distribution and density of US dermatologists. JAMA Dermatol. 2017;153(4):322-325. doi: 10.1001/jamadermatol.2016.5411.
4. 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.
5. Dermatology Workforce Data - Arkansas.” Area Health Resources Files, data.hrsa.gov/topics/health-workforce/ahrf. Accessed 17 Dec. 2023.
6. Dermatology Workforce Data - Louisiana.” Area Health Resources Files, data.hrsa.gov/topics/health-workforce/ahrf. Accessed 4 Oct. 2023.
7. Dermatology Workforce Data - Mississippi.” Area Health Resources Files, data.hrsa.gov/topics/health-workforce/ahrf. Accessed 17 Dec. 2023.
8. Defining Rural Population | HRSA. www.hrsa.gov. Published March 2022. https://www.hrsa.gov/rural-health/about-us/what-is-rural
9. Bureau UC. 2020 State-based Metropolitan and Micropolitan Statistical Areas Maps. Census.gov. https://www.census.gov/geographies/reference-maps/2020/demo/state-maps.html. Accessed 17 Dec. 2023.

Disclosures: The authors reported no relevant financial disclosures.

Ty Theriot, BS

• Louisiana State University Health Sciences Center (LSUHSC), New Orleans, LA, Department of Dermatology

Alexandra Streifel, MD

• Louisiana State University Health Sciences Center (LSUHSC), New Orleans, LA, Department of Dermatology

Adam Byrd, MD

• University of Mississippi Medical Center (UMMC), Jackson, MS, Department of Dermatology

Vinayak Nahar, MD, PhD, MS

• University of Mississippi Medical Center (UMMC), Jackson, MS, Department of Dermatology

Megan S Evans, MD

• University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, Department of Dermatology

Christopher Haas, MD

• Louisiana State University Health Sciences Center (LSUHSC), New Orleans, LA, Department of Dermatology