A n adequate and appropriately trained physician workforce is necessary to meet the nation's current and future health care demands. As the US population continues to increase and age, there is an unmet need for dermatologic care. 1 The increasing incidence of skin cancer, high prevalence of complex inflammatory skin disorders, advanced therapeutics, and widening market for surgical and noninvasive procedures have also contributed to an increased demand for dermatologists that is expected to continue to increase. 1-7 The undersupply of dermatologists has been described during the past 2 decades, 5,8-10 and previous work has identified the maldistribution of physicians and dermatologists. 11-14 Rural areas face significant physician workforce shortages, with rural residents experiencing long wait times and traveling long distances to receive care. 5 This pattern is especially important given previous studies 15-17 that found that dermatologist density is associated with patient outcomes for diseases, such as melanoma and Merkel cell carcinoma. To develop strategies and effective policies to offset a shortage, we must better understand the characteristics and patterns observed in the dermatologist workforce. We hypothesize that despite an expanding dermatologist workforce, there is a widening gap between dermatologists in urban and rural settings given the greater professional opportunities in urban areas, desire for proximity to family and support, and insufficient financial incentives to practice in resource-poor areas. 13,18-22 The goal of this study was to build on existing work by evaluating the up-to-date longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists, using a classification scheme that measures the degree of urbanization in each US county. Methods Demographic and physician data from 1995 to 2013 were obtained from the Area Health Resources File (AHRF). 23 The New IMPORTANCE As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce. OBJECTIVE To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme. DESIGN, SETTING, AND PARTICIPANTS This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists. MAIN OUTCOMES AND MEASURES Active US dermatologist and physician density. RESULTS In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; 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 ratio of dermatologists older than 55 years to you...

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BACKGROUND Prescription opioid use often precedes opioid misuse, abuse, and addiction. OBJECTIVE To characterize the national opioid prescription practices of Mohs surgeons, with general dermatologists serving as a comparison group. METHODS A retrospective cross-sectional study using Medicare prescription data to analyze opioid prescription characteristics. RESULTS In 2014, 2,190 Mohs surgeons prescribed a total of 86,526 opioids, whereas 10,347 non-Mohs dermatologists prescribed 45,033 opioids. Among Mohs surgeons, 51.8% prescribed more than 10 opioids, whereas 93.3% of non-Mohs dermatologists prescribed 0 to 10. The estimated opioid prescription rates for Mohs surgeons and non-Mohs dermatologists were 5.9% and 0.7%, respectively. Among those prescribing at least 10 opioid claims, the mean number of opioids supplied and mean opioid prescription rate was 72.4 and 13.5, respectively, for Mohs surgeons versus 32.5 and 5.1 , respectively, for non-Mohs dermatologists. The mean days' supply of opioids was 3.9 for Mohs surgeons versus 7.9 for non-Mohs dermatologists. There was a minimal-to-moderate association between the number of procedures performed and the number of opioids prescribed. Men and Mohs surgeons located in southern states tend to prescribe a greater number of opioids. CONCLUSION Mohs surgeons prescribed short courses of opioids and less than both the national average and providers that care for patients in pain.

Purpose: To assess opioid prescribing patterns among American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members. Methods: An observational, retrospective, cohort study of ASOPRS members’ prescribing patterns in the 2013–2016 Medicare Part D Prescriber database. These prescribers were stratified by years in practice, sex, and geography. The ASOPRS member cohort was compared with all ophthalmologists, as a group, and other surgeons. Results: The authors identified 617 surgeons in the 2017 ASOPRS directory. Members wrote an average of 45 opioid prescriptions/year. Almost half (45%) wrote <10 prescriptions. Those with >10 prescriptions averaged 78 annually. A minority wrote >100 prescriptions per year (14.8%). Overall, opioids comprised 16.5% of all prescriptions written by ASOPRS members. Despite seeing a similar number of beneficiaries (p = 0.20), male members prescribed a greater number (p < 0.05) and a higher rate (p < 0.05) of opioids than female members. Older members had a lower opioid prescription rate (p < 0.0001). Many heavy opioid prescribers practiced in states with high opioid overdose deaths. Conclusions: American Society of Ophthalmic Plastic and Reconstructive Surgery members prescribe moderate amounts of opioids at a rate (16.5%) higher than all of ophthalmology (4%), 1 above the national mean (6.8%), but lower than other surgical services (36.5%). 2 Male gender, younger age, and practice in states with high opioid-related deaths were correlated to number of prescriptions. Prescribing patterns may naturally relate to the type of surgical intervention and population. Further research is warranted to understand opioid prescriptions and their role in the opioid epidemic.

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