The diminishing role of the dermatologist in the office-based care of cutaneous diseases.

The number of physicians who provide ambulatory care for patients with skin diseases is rapidly increasing. Current and proposed changes in health care financing may limit direct access to dermatologists. We provide recent data on volume of visits for cutaneous diagnoses, including the types of medical practitioners who provided these ambulatory services, and compare these data with earlier surveys that span 15 years. In 1989, dermatologists saw 41% of the 51.6 million persons with cutaneous diagnoses. The number of visits per dermatologist declined significantly from 1974 to 1989 (p < 0.05). Visits to dermatologists were significantly more likely to be reimbursed by Blue Cross/Blue Shield or self-pay than visits to other physicians for skin problems. From 1974 to 1989, the demand for dermatologic services from dermatologists has not increased as rapidly as the supply of dermatologists. Our data also suggest that restrictions on direct access to dermatologists or changes in reimbursement may substantially decrease the demand for services provided by dermatologists.