34341 Patterns and determinants of adult dermatologic care in the United States: An evaluation of the National Ambulatory Medical Care Survey

Background: Both dermatologists and other providers play an important role in shaping the care of patients with dermatologic conditions. We aim to describe the prevalence of skin diseases encountered by both dermatologists and nondermatologists in a contemporary cohort and to examine determinants shaping patterns of care in the United States using a nationally representative database. Methods: The National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of nonfederal outpatient-based physicians, was used to identify adult patients with dermatologic diagnoses from 2009 to 2015. Clinical and demographic information were evaluated, and visit diagnoses were stratified based on provider type (dermatologists vs. other providers). Multivariable logistic regression analysis was used to evaluate for determinants of visit evaluation by dermatologists compared with providers from other specialties. Results: Of 13,412 adult patients with dermatologic diagnoses identified in the NAMCS, 9362 (69.8%) were seen by dermatologists, and 4050 (30.2%) were seen by other providers. On multivariable logistic regression, patients seen by dermatologists were older, were more likely to be Caucasian as opposed to African American, have residence in a metropolitan area compared with a rural area, have private insurance compared with Medicaid, have no chronic health conditions, and have longer wait times to be seen for an appointment. Conclusions: Our study identifies factors shaping patterns of adult dermatologic care in the United States and highlights health disparities in race and insurance status as African Americans and patients on Medicaid were less likely to be evaluated by dermatologists.