The gap between dermatologists in urban and rural areas is widening across the United States, according to a new study of county-level data from 1995 to 2013 in JAMA Dermatology.

Specifically, dermatologist density increased by 21 percent from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013, and the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas, the study showed.

The ratio of dermatologists older than 55 years to younger than 55 years increased 75 percent in nonmetropolitan and rural areas (from 0.32 to 0.56) and 170 percent in metropolitan areas (from 0.34 to 0.93). Dermatologists tended to be located in well-resourced, urban communities, the study found.

Our findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time,” write researchers led by Jennifer A. Stein, M.D., Ph.D., a dermatologist at the New York University School of Medicine in New York City.

In an accompanying editorial, Boston dermatologists Martina L. Porter, MD and Alexa B. Kimball, MD, MPH, offer some predictions and potential solutions to this problem, including taking steps to engage residents in rural areas and doubling down on technology. “ Residency selection, exposure to rural medicine, and targeted financial incentives, such as loan repayment, can all be leveraged to bring about change,” they write. “In parallel, because there appears to be increasing willingness to fund telemedicine, doubling down on training rural physicians and advanced practice practitioners in some areas of dermatology and engaging technology to support them seem prudent and responsible.” These efforts may not modify the overall dermatology workforce imbalance, but they will improve access to dermatologists, they write.