Assessment of Dermatology Clinic Resources at Safety-Net Hospitals: Results from a National Survey

BACKGROUND: The extent of resources available to outpatient dermatology clinics at safety-net hospitals providing care to the underserved is not well characterized. Identification of resource gaps can direct strategies that improve dermatologic care to this population.
OBJECTIVE: To determine the state of resources at safety-net dermatology clinics. We hypothesized that staffing and specialty services at safety-net hospital dermatology clinics were suboptimal, and that these clinics have long patient wait-times and high no-show rates. METHODS: A cross-sectional survey was conducted to assess resources at outpatient dermatology clinics in safety-net hospitals affiliated with US dermatology residency programs. Surveys consisting of 42 questions were sent via e-mail to the chiefs of outpatient dermatology clinics at 50 safety-net hospitals. The survey was administered between July and October 2016. RESULTS: 31 (62%) safety-net dermatology clinics participated in the survey. The median wait time for the third next available appointment for a new and follow-up patient was 45 (interquartile range: 30-90) days and 30 (16.5-55) days, respectively. The median no-show rate was 30% (24.5-35). Clinics reported median ratios of 3 providers to 1 nurse (1.75-4), and 2 providers to 1 medical assistant (2-4). 58.1% utilized non-paid dermatology attendings. 93.5% offered dermatopathology and pediatric dermatology services, while 41.9% had on-site Mohs surgery. CONCLUSION: Patients face long wait times and no-show rates are high, with suboptimal provider to support staff ratios. Most clinics had access to dermatology subspecialty care, such as pediatric dermatology, and dermatopathology. Expanding staffing, improving patient no-show rates, and use of teledermatology could improve access to dermatologic care in safety-net hospital systems.