Minding the GAPP in Access to Dermatologic Care

Patients are waiting. America has an access crisis for dermatologic care and many other specialties. But why should we care? After all, most of the things we deal with in dermatology are not life threatening.

The reality is that the impact of wait times for dermatology appointments is much more than skin deep. The emotional and physical impact of wait times puts patient wellbeing at risk. A 2018 survey commissioned by the Society of Dermatology Physician Assistants (SDPA) uncovered new findings from patients suffering from skin conditions and their caregivers, finding that nearly all sufferers (91 percent) say that their skin condition impacts their daily life. More than half report anxiety while waiting for an appointment, and 58 percent worry that their skin condition will worsen while waiting for an appointment.

Something must be done to improve the situation. The costs of waiting can be measured in terms of both dollars and impact on quality of life. While awaiting a dermatology appointment, patients may seek out a primary care provder, potentially resulting in a trial-and-error approach to treatment. This in turn may lead to ineffective prescriptions, unnecessary laboratory testing, and costly repeat visits. A biopsy or laboratory workup of a process that an experienced dermatology professional could have diagnosed clinically increases cost and risk. Worse still, an overly shallow biopsy of a significant melanoma makes precise staging difficult and results in additional workup before treatment can begin.

If the patient cannot see a primary care provider, he or she is likely to self-treat with a variety of available over-the-counter options. This sometimes causes the condition to worsen and can be costly to patients. The SDPA survey showed that nearly half (52 percent) of patients turned to OTC medications or home remedies to treat their skin conditions while waiting for a dermatology appointment.

The emotional costs of waiting may be even more significant than the economic costs. Anxiously awaiting a melanoma diagnosis is stressful enough, even when patients are able to see their dermatologist. Patient symptoms can have a huge impact on quality of life. Nightly sleep, work productivity, attention in school, academic performance and interpersonal relationships can all be negatively affected. Findings from the SDPA survey show that more than 60 percent of patients said their skin condition interferes with day-to-day life and causes worry. The sooner a patient can see a dermatology professional to receive a correct diagnosis, appropriate education and treatment, the better.

The Greater Access for Patients Partnership (GAPP) is a coalition of dermatology and healthcare advocacy groups that aims to end needless dermatology wait times in America. The primary goal of GAPP is to promote solutions to the wait times problem and engage dermatology patients and medical professionals in collaborative support for timely access to high-quality dermatological care.

Until we can employ more appropriately trained and experienced professionals, the equitable distribution of available individuals remains a critical factor. All stakeholders must work together in practice and legislation to bring the number of dermatology professionals in underserved and rural areas to adequate levels. Education is key to this process. Education of primary care providers ensures the efficient and timely referral of patients who need specialty care while identifying patients who don’t need a specialist. Patient education encourages those needing dermatologic care to seek treatment early, reducing worry and ineffective care that impacts quality of life so significantly.

SDPA and GAPP are working towards improving the lives of dermatology patients. We encourage all who have the same goals to join us. Look for more information to come.