Changing Dermatologic Procedural Patterns in the Medicare Population: A National Trend Analysis

Abstract

BACKGROUND Dermatologists are trained in diagnostic and therapeutic procedures for cutaneous lesions, yet comparative trends for basic dermatologic procedures across dermatology providers are lacking at the national level. OBJECTIVE To trend common dermatologic procedures among general dermatologists, Mohs surgeons, primary care providers or primary care physicians (PCPs), and nonphysician clinicians (NPCs). METHODS Longitudinal analysis of 2016 to 2021 Medicare Public Use Files. RESULTS Aggregate dermatologic procedural volume decreased 3.0%. Procedural volume declined among general dermatologists (−11.7%), Mohs surgeons (−16.7%), and PCPs (−41.7%) but increased among NPCs (+57.5%). The proportion of procedures by general dermatologists decreased substantially for premalignant destructions (−6.2%), skin biopsies and shave removals (−4.7%), and malignant excisions (−4.1%) and more notably in counties that were nonmetro (−7.1%), low in income (−6.1%), and with <4.0 dermatologists per 100,000 population (−7.0%). CONCLUSION Aggregate procedural volume decreased across the study period with general dermatologists, Mohs surgeons, and PCPs performing a progressively smaller proportion. The increase in procedures by NPCs may help to address demand but underscores the value of formalized procedural training. The procedural decline by general dermatologists in rural and low-income counties and those with baseline dermatologist shortages may exacerbate existing unmet need. Primary limitation included lack of commercial data.